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The Northern Ireland Planned Healthcare Scheme (NIPHS) allows you to claim back some of the cost of certain healthcare in Northern Ireland.
You can only use the NIPHS to access private healthcare in Northern Ireland. You cannot use it for public healthcare.
You must pay for any healthcare that you get in Northern Ireland.
But you can apply to the HSE for repayment of some of the costs of the healthcare under the NIPHS.
The NIPHS is similar to the Cross Border Directive (CBD). You can use the CBD if you want to get healthcare in another EU or EEA member state.
Using private health services in Northern Ireland
How to use health services in Northern Ireland under the NIPHS:
- Check that you qualify for public healthcare in Ireland.
- Have a letter of referral for healthcare from a public health professional in Ireland.
- Arrange a consultation with a private healthcare provider in Northern Ireland - this is called an outpatient appointment.
- Travel to Northern Ireland for healthcare.
- Pay for any healthcare you get in Northern Ireland.
- Complete the NIPHS pro forma invoice with your healthcare provider in Northern Ireland.
- Apply for repayment towards the cost of the healthcare you received.
Qualifying for the NIPHS
To get healthcare in Northern Ireland and claim a repayment under the NIPHS you must:
- be ordinarily resident in Ireland - living in Ireland for at least 1 year
- be entitled to public healthcare in Ireland
- travel to Northern Ireland for your healthcare
- have a referral for healthcare from a GP or public hospital consultant in Ireland
- provide a copy of a letter of referral or a letter from a hospital to say you're on a public waiting list in Ireland
- apply for repayment towards the cost of your healthcare in Northern Ireland after you have paid for it
If you are unsure if you qualify for the NIPHS, contact the NIPHS office.
Private health insurance and referrals
You can only use a referral from a GP or a consultant you see as a public patient under the NIPHS.
Having private health insurance does not exclude you from the NIPHS. But you cannot use your private health insurance to get your referral.
Telemedicine and the NIPHS
Telemedicine is when you get a diagnosis, treatment or consultation using telecommunications technology such as by Skype or video call.
If you are having inpatient care, you must have your outpatient appointment in person.
If you use telemedicine instead of an in-person appointment, you cannot get a reimbursement for any of your healthcare costs.
Outpatient and day-case healthcare
You can use telemedicine for outpatient consultations for day-case healthcare.
To claim reimbursement for a telemedicine consultation, you must send proof of the consultation from your medical record.
The reimbursement rate for telemedicine consultations is €194.
The consultation must happen on a date before you are admitted for treatment.
Costs covered by the NIPHS
You can only claim for the cost of your healthcare under the NIPHS.
You cannot claim:
- travel costs
- the cost of any prescription medicines you need - but if you have a valid prescription, you should be able to use it in Ireland
The Drugs Payment Scheme (DPS) helps with the cost of prescribed medicines and some appliances. There is no means test for a DPS card.