Cross Border Directive

The Cross Border Directive (CBD) allows you to get healthcare in another EU or EEA member state. You can access this healthcare in the same way you'd get public healthcare in Ireland. The healthcare must be planned, you need a valid referral, and you must qualify for the healthcare you want as a public patient in Ireland. Once you go abroad, you must pay for any healthcare that you get. But under the CBD you can then apply to the HSE for reimbursement towards the cost of the healthcare. You can not claim reimbursement for: the cost of any medicine you'll need afterwards or any travel costs. You can access healthcare abroad using the Cross Border Directive (CBD) in much the same way that you would access public healthcare in Ireland.

How you usually get public healthcare in Ireland

The typical steps you would take when getting healthcare or treatment in a public hospital in Ireland are:

1. Visit your GP to discuss your condition.

2. Your GP refers you to a hospital consultant.

3. You are put on a hospital waiting list to see the consultant.

4. You get called for a consultation with the consultant - this is called an outpatient appointment.

5. The consultant will decide to either to put you on a waiting list for treatment, or discharge you back to your GP - this means they don’t believe you need further hospital treatment.

6. If you are on a waiting list for treatment, you will be called for hospital treatment - this is called inpatient treatment.

7. You will then have a follow up appointment with the consultant.

8. You will then be discharged back to your GP.

At any stage in the steps outlined above, you can decide to leave the Irish system and get healthcare abroad under the CBD.

To get healthcare abroad and be refunded under the Cross Border Directive (CBD) you must:

Be ordinarily resident in Ireland (Ordinarily resident means that you've been living in Ireland for at least one year or can prove your intention to remain in Ireland for at least one year). Be entitled to public healthcare in Ireland Not be in receipt of any state benefit from another EU or EEA member state Travel abroad for the healthcare Have a referral for public healthcare from a GP or hospital consultant in Ireland Provide a copy of a letter of referral or a letter from a hospital to say you're on a waiting list in Ireland Apply for repayment towards the cost of your healthcare abroad, after you have paid for it Only a GP or a consultant you are attending as a public patient can refer you for CBD healthcare. Having private health insurance does not exclude you from CBD. But you cannot use your private health insurance to access your referral for healthcare abroad. You can use a referral for public healthcare in Ireland to access healthcare abroad under the CBD. You don’t need to be referred specifically to a healthcare provider abroad. If your referral is to a public hospital in Ireland you can also use that referral to go abroad. But your healthcare abroad must be the same medical specialty you've been referred to in Ireland. This referral usually comes from a GP or hospital consultant. You'll see your GP first and discuss your condition. They will then decide if you need a referral to a hospital consultant or if they can manage your condition. Once you go abroad, you must pay for any healthcare that you get. But under the CBD you can then apply to the HSE to claim repayment towards the cost of the healthcare once you meet certain conditions. If you meet these conditions and your application is successful, you will be reimbursed whichever is the lesser: the cost of your healthcare abroad, or what the healthcare would have cost in Ireland

Types of healthcare available

There is no list of specific healthcare you can get abroad under Cross Border Directive (CBD) scheme. Generally, if the healthcare is available publicly in Ireland, you can be referred for the same healthcare abroad. Your GP or consultant can tell you if the healthcare you want to get abroad is publicly available in Ireland and if you qualify for it.

Healthcare available under CBD

Examples of healthcare available under the CBD scheme: day, inpatient and outpatient care in acute hospital services, including psychiatric services, community-based outpatient care, dental and orthodontic services (with some exceptions, such as dental screening services in schools), speech and language services, occupational therapy services (with some exceptions, such as assessment for aids at home), psychology services, physiotherapy services, disability services, ophthalmic (eyes, cataracts) services, orthopaedic (hip replacements) services, mental health services, methadone programme.

Healthcare not available under CBD

Examples of healthcare you can’t get under the CBD include: organ transplants, any long-term care that helps people do everyday tasks such as nursing home care, vaccination against infectious diseases, clinical trials, drug therapies that aren't currently provided publicly in Ireland.

Full information outlining the Cross Border Directive (CBD) can be found on the following HSE website: https://www2.hse.ie/services/cross-border-directive/about-the-cross-border-directive.html