Cross border directive

The Cross Border Directive (CBD) is a scheme to get planned healthcare in another European Union (EU) or European Economic Area (EEA) member state. This statement includes Lithuania.

To apply for the CBD scheme in Ireland you must:

• qualify for the healthcare you want as a public patient in Ireland
• have a valid referral letter
• follow the CBD process

You must pay for any healthcare that you get abroad. But under the scheme you can apply to the HSE for reimbursement towards the cost of the healthcare.

Schemes to get healthcare abroad

The CBD only applies to healthcare that is publicly available in Ireland.

The CBD scheme is different to other schemes to access healthcare outside of Ireland, such as:

• Treatment Abroad Scheme – applies to treatments that are not available in Ireland
• European Health Insurance Card (EHIC) – only applies to necessary or emergency healthcare while abroad

If the treatment you need is publicly available in Ireland, you can access it through the:

• Northern Ireland Planned Healthcare Scheme (NIPHS) – if you plan to have your treatment with a private healthcare provider in Northern Ireland
• Cross Border Directive Scheme – if you plan to have your treatment in an EU or EEA member state

You can access this healthcare in the same way you’d get public healthcare in Ireland.

Public healthcare process 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.

Qualifying for the CBD scheme

To be eligible for the Cross Border Directive (CBD) scheme you must:

• be ordinarily resident in Ireland – living in Ireland and can prove you intend to live in Ireland for at least 1 year
• be entitled to public healthcare in Ireland

Check that your referral is valid

You can use your public referral letter or waiting list letter to get healthcare abroad.

Your letter must include:

• the name and address of a hospital consultant
• your name, address and date of birth
• your current health and any other relevant information
• the healthcare you need
• the GP or consultant’s signature – it cannot be signed by their nurse or secretary
• the date of the referral letter – the letter must be issued before your first appointment abroad

You do not have to use the consultant and hospital named in the referral letter. But your healthcare abroad must be the same medical specialty on your referral letter.

Contact the Cross Border Directive office in Ireland if you are unsure if you qualify for the CBD scheme. The office is known as the National Contact Point.

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 you qualify.

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 services, such as cataract surgery 
• orthopaedic services, such as hip replacements
• mental health services
• methadone programme
• addiction care

Healthcare not available under CBD

Examples of healthcare you cannot 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 are not currently provided publicly in Ireland

Orthodontic treatment

Orthodontic treatment can be used to help straighten your teeth. It’s usually done by fitting braces. A full course of treatment usually takes 18 months to 2 years. After the braces are removed, most people must wear a retainer.

Orthodontic treatment is available under the Cross Border Directive (CBD). But you have to be eligible for the same public treatment in Ireland.

Usually, only children under the age of 16 are eligible. You can access the orthodontic service through screening appointments in primary school.

To be eligible:

1. Your local HSE dental clinic must refer your child for an orthodontic assessment.
2. The HSE orthodontic service must assess your child and approve their treatment.

Your HSE orthodontic service can give you a letter to show that your child is eligible for treatment. You must send this letter with your application.

How much you can claim for orthodontic treatment

You cannot apply for a reimbursement until you reach the retainer stage of treatment.

You can claim a reimbursement for orthodontic treatment abroad up to a maximum of €2,200.

For example, if the treatment abroad costs €5,000, you can claim €2,200. If it costs €1,000, you can claim €1,000.

The maximum amounts repayable for each stage are:

• assessment for eligibility for orthodontic treatment: €100
• orthodontic treatment: €1,800
• treatment completion – at end of retainer phase: €300

You must get the orthodontic treatment in another EU or EEA member state. This is the same as any healthcare under the CBD.

Before you travel abroad for planned healthcare:

• check if you are eligible for the Cross Border Directive (CBD) scheme
• check that your referral is valid
• consider applying for prior notification
• check what medical records you need to bring with you
• make sure you have travel insurance and a valid EHIC card
• check what documents you need to ask the hospital abroad for
• make sure you can pay the hospital abroad directly

If you do not follow the correct process, you will have to pay the full costs of your treatment.

Arranging your outpatient consultation abroad

When you have a referral letter, you must contact a healthcare provider abroad. This is to make an appointment with them. It is called an outpatient consultation.

You must have the consultation on a date before the healthcare provider admits you for treatment.

This gives you time to decide if you:

• are comfortable with the consultant and the hospital abroad
• want to proceed with healthcare at a date in the future
• have any questions before you go ahead

In a situation where a patient’s treatment is required as a matter of urgency, they are entitled to access that care under the provisions of their European Health Insurance Card (EHIC).

Travel, telemedicine and the CBD

Telemedicine is when you get a diagnosis, treatment or consultation using communication technology. For example, by Zoom, Skype or video call.

Inpatient healthcare

If you are having inpatient care, you must have your outpatient appointment in person on a date prior to being admitted.

If you use telemedicine instead of an in-person appointment, you cannot get a reimbursement for any of your healthcare costs.

Day-case healthcare

You can use telemedicine for outpatient consultations for day-case healthcare.

HSE guidelines on video and audio consultations – April 2020 (PDF, 597KB, 12 pages)

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 €178.

Medical records you may need

When you go abroad you should bring:

• your medical records
• information on any medicines you’re taking
• any relevant test results

To find out what information you need to bring you can ask:

• your GP or consultant in Ireland
• the doctor who will treat you abroad

Ask your GP or hospital in Ireland for a copy of the records you need to bring.

Planning your payment to the hospital abroad

You must pay the hospital abroad for your healthcare and keep proof of the payment.

Before you make a payment, check that you can pay the hospital abroad directly.

You cannot claim reimbursement if:

• someone else makes the payment on your behalf – for example, a relative or friend
• you make the payment to a medical tourism company instead of the hospital abroad

Prior notification from the Cross Border Directive (CBD) office in Ireland can tell you if you:

• have followed the correct process to access healthcare abroad under the CBD
• will be eligible to claim reimbursement towards the cost of your healthcare

Prior notification is optional.

You do not need prior notification if you are having day-case treatment abroad. Day-case is treatment that does not involve an overnight stay in hospital.

But if you are travelling abroad for inpatient care, we advise you to get prior notification. Inpatient care is treatment that involves an overnight stay in hospital.

Benefits of prior notification

Before you travel abroad, you’ll have:

• confirmation that you’re eligible to claim a reimbursement towards the cost of your healthcare
• an indication of how much of the cost of your healthcare you can claim back based on the diagnosis-related group (DRG) code your consultant uses

It also gives you time to decide if you:

• can afford to pay for the healthcare upfront or can get funding for it
• are comfortable with the consultant and the hospital abroad
• are willing to pay for any shortfall between the cost of the healthcare abroad and how much you can claim back – you are responsible for paying any shortfall

Getting prior notification

To get prior notification, you must send us:

• your valid referral letter
• a completed prior notification form (PDF, 922 KB, 18 pages)
• proof that you travelled abroad to have your first appointment with the consultant in person
• invoice, receipt and proof of payment for your first appointment such as a bank or credit card statement or bank transfer

We usually take about 20 working days to review and decide on your prior notification.

Completing the prior notification form

You and your consultant abroad must complete and sign the prior notification form.

You complete section A.

Your consultant completes section B. They must enter the correct DRG code for the inpatient treatment you will get.

The consultant can get the correct DRG code from the Admitted patient price list summary (inpatient) (PDF, 418 KB, 13 pages). This document is for people who have had their treatment on or after 1 July 2022.

If you had your treatment or procedure from 1 August 2020 to 30 June 2022, use the 2020 Admitted patient price list summary (inpatient) (PDF, 415 KB, 27 pages).

Send the completed form and the supporting documents to:

HSE Cross Border Directive,
National Contact Point,
St. Canice’s Hospital Complex,
Dublin Road,
Kilkenny

HSE Cross Border Directive,
National Contact Point,
St. Canice’s Hospital Complex,
Dublin Road,
Kilkenny

General enquiries: 056 778 4546 or 056 772 0551

If you have difficulty reaching us by phone, you can contact us through email crossborderdirective@hse.ie

Questions about prior notification

All queries about prior notification: 056 778 4547

If you’ve already applied for a reimbursement

Surnames beginning with A to C: 056 778 4012
Surnames beginning with D to H: 056 772 0560
Surnames beginning with I to Mc: 056 778 4924
Surnames beginning with M to R: 056 778 4923
Surnames beginning with S to Z: 056 772 0557

If you have difficulty reaching us by phone, you can contact us through email.

Email: crossborderdirective@hse.ie

Contact points for Cross Border Directive offices in other EU/EEA member states