How much you can claim

The maximum repayments for the Northern Ireland Planned Healthcare Scheme (NIPHS) are based on the healthcare costs in Ireland.

If you qualify for the NIPHS, repayments are based on whichever is the lesser amount:

  • the cost of your healthcare in Northern Ireland
  • what the healthcare would have cost in Ireland

You cannot claim repayment for:

  • travel costs or accommodation
  • any prescription medicine costs

If you get prior authorisation, you’ll know around how much you can claim back before getting inpatient healthcare in Northern Ireland.

Maximum repayments under NIPHS

You must pay for any healthcare that you get with a private provider in Northern Ireland.

The maximum amount you can be repaid depends on the type of healthcare you get. But if the healthcare costs less in Northern Ireland, you can only claim for what you paid.

Outpatient claims

Outpatient care is healthcare that involves a short appointment and you do not have an overnight hospital stay.

The maximum repayment for an outpatient consultation in a private hospital in Northern Ireland is €178.

If your consultation took place before 1 March 2021, the maximum repayment is €130.

Day-case claims

Day-case care is healthcare that does not involve an overnight hospital stay.

The maximum repayments for day-case care are based on healthcare costs in Ireland.

You can download a list of costs and DRG codes for day-case healthcare in Ireland.

If you had your treatment on or after 1 July 2022, use:

If you had your treatment before 30 June 2022, use:

Inpatient claims

Inpatient care is healthcare that involves an overnight stay in hospital.

The maximum repayments for inpatient care are based on healthcare costs in Ireland.

You can download a list of costs and DRG codes for inpatient healthcare in Ireland.

If you had your treatment on or after 1 July 2022, use:

If you had your treatment before 30 June 2022, use:

If you've had inpatient care in Northern Ireland, the HSE will also deduct €80 per night from the amount you can be repaid. This is up to a maximum of €800.

You do not have to pay the €80 per night if either of the following applies:

  • You have a medical card.
  • You have already paid €800 for overnight stays in hospitals abroad or in Ireland in the last 12 months.

Page last reviewed: 25 January 2022
Next review due: 25 January 2025