Apply for repayment

You can reclaim the cost of healthcare under the Cross Border Directive (CBD) up to the maximum amount of its cost in Ireland if you’re eligible for the scheme.

Read about how to qualify for the CBD scheme

You must pay for the healthcare yourself and then apply to claim it back.

If you are having healthcare that involves an overnight stay in hospital, we advise you to apply for prior authorisation before you go abroad.

You can claim repayment for whichever is the lesser:

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

If the healthcare costs less abroad than it would have in Ireland you can only claim for what you paid.

The maximum you can be repaid for an outpatient consultation in a hospital abroad is €130.

Outpatient care is healthcare that doesn’t involve an overnight hospital stay.

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

The HSE has a list of day-case healthcare costs in Ireland. This document is called the Admitted Patient Price List Summary (day case).

You can use this document to find out the maximum amount you can reclaim. This document is for people who have had their treatment on or after 1 August 2020.

If you had your treatment or procedure before 31 July 2020 - use the 2019 Admitted Patient Price List Summary (day case)

You can use this document to find out the maximum amount you can reclaim.

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

The HSE has a list of inpatient healthcare costs in Ireland. This document is called the Admitted Patient Price List Summary (Inpatient).

You can use this document to find out the maximum amount you can reclaim. This document is for people who have had their treatment on or after 1 August 2020.

If you had your treatment or procedure before 31 July 2020 - use the 2019 Admitted Patient Price List Summary (Inpatient)

If you've had inpatient care abroad, the HSE will deduct €80 per night, to a maximum of €800, from the amount you can be repaid.

You will not have to pay the €80 per night if either of the following apply:

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

The cost in Ireland is €10,000 with an €80 per night hospital charge.

If the cost in France is €11,000 and you were in hospital for 5 nights then you can claim for €9,600. This is €10,000 less the inpatient charge of €400.

If the cost in France was €5,000 and you were in hospital for 5 nights, then you can claim €5,000 as this is less than the €10,000 it would have cost in Ireland minus €400.

To apply for repayment under the Cross Border Directive, you and your healthcare provider abroad should complete the CBD pro forma invoice.

Before leaving the hospital ask the consultant to fill in part B of the pro forma invoice.

Repayments are made only to the patient or their parent or guardian if the patient is under 18.

The executor of the patient’s estate can apply for repayment if the patient is dead.

You’re breaking the law if you enter any false or misleading information on the pro forma invoice.

If you are paid money based on false or misleading information the HSE will reclaim the money from you.

We recommend completing a CBD pro forma invoice. This is because it has all the information we need to make a prompt repayment.

You and your healthcare provider abroad need to complete the pro forma invoice in English.

If any part of the invoice is completed in another language you’ll have to pay for and submit a certified translation.

You can’t claim for the translation cost.

Your consultant abroad must put in the correct DRG (Diagnosis-Related Group) code for your healthcare.

You can find all the correct DRG codes effective from 01 August 2020 in:

• Inpatient treatment costs in Ireland are set out in a document called the 'Admitted Patient Price List Summary (Inpatient)'.
• Day case treatment costs in Ireland are set out in a document called the 'Admitted Patient Price List Summary (Day case)'.

If you had inpatient treatment before 31 July 2020, you will need to use the:

• 2019 Admitted Patient Price List Summary (Inpatient)
• 2019 Admitted Patient Price List Summary (day case)

We may check the DRG code your consultant abroad sends us. If we think it is wrong, it will be independently reviewed. If this review suggests a different code should have been used, we will use the outcome of that independent review.

You must submit your:

• completed CBD pro forma invoice
• hospital's original invoice and receipt
• referral letter from the GP or public consultant who referred you
• proof of travel such as a plane ticket receipt - this is to show you travelled abroad for your healthcare

Your referral letter must be:

• signed by your GP or public consultant - it can't be signed by their nurse or secretary
• issued and dated before you had your initial appointment abroad
• addressed to the named doctor and hospital or clinic your GP or public consultant had referred you to

We usually aim to repay patients within 30 working days of getting all the completed documents.

If you've already applied for repayment you can contact the Cross Border Directive office in Ireland for an update.

Telephone:

• surnames beginning with A to C: 056 773 4822
• surnames beginning with D to H: 056 778 4546
• surnames beginning with I to Mc: 056 778 4012
• surnames beginning with M to R: 056 773 4808
• surnames beginning with S to Z: 056 778 4546

Email: crossborderdirective@hse.ie

If your application is refused you can appeal that decision by writing to the:

General Manager

Commercial Unit of the Acute Hospitals Division

HSE

Kilcreene Office Complex,

Kilkenny

Co. Kilkenny

National Contact Point,

Cross-Border Healthcare Directive Department,

HSE,

St Canice's Hospital,

Dublin Road,

Kilkenny

General enquiries: 056 778 4546

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

For applications for prior authorisation:

All enquiries regarding prior authorisation: 056 778 4547

If you've already applied for repayment

Surnames beginning with A-C: 056 778 4427

Surnames beginning with D-H: 056 772 0560

Surnames beginning with I-Mc: 056 778 4012

Surnames beginning with M-R: 056 772 0558

Surnames beginning with S-Z: 056 772 0556

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

Email: crossborderdirective@hse.ie