Cross Border Directive- Overview

Introduction

In 2011 the European Parliament introduced the European Directive on cross-border healthcare in order to better define the rights of EU citizens when seeking treatment in EU states other than their own. The Directive was implemented in Ireland by SI 203/2014 - European Union (Application of Patients’ Rights in Cross-Border Healthcare) Regulations 2014 and SI 65/2015 European Union (Application of Patients’ Rights in Cross-Border Healthcare) (Amendment) Regulations 2015. 

Throughout the website, we will refer to the Directive and the implementing Regulations collectively as the “Cross-Border Directive”.

The Cross-Border Directive aims to establish rules for facilitating access to safe and high quality cross-border healthcare in the European Union. 

The Cross-Border Directive means that an EEA resident has the right to medical treatment in any EEA country and to be treated on the same basis as they would in their home state. Therefore, provided certain criteria are met, EEA residents are entitled to request healthcare treatment in another EEA country and then receive reimbursement of the cost of the qualifying treatment from their home healthcare system. 

The Cross-Border Directive covers planned healthcare as opposed to emergency treatment which is usually covered through the European Health Insurance Card (EHIC) system.   Access to treatment that is not available in a patient’s home country is covered by the Treatment Abroad Scheme.

HSE Cross Border Directive Scheme

The HSE operates the Cross-Border Healthcare Directive (CBD), for persons entitled to public patient healthcare in Ireland who are seeking to avail of that healthcare in another EU/EEA* member state under Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patient’s rights in cross-border healthcare, as per the procedures set out in governing EU Regulations and Directives and Irish legislation. A private outpatient appointment in the Republic of Ireland may not be used under any circumstances to exercise rights for the purposes of reimbursement under the provisions of the Cross Border Healthcare Directive. The attendance of a private appointment in Ireland deems the patient a private patient and not a public patient for the purpose of provisions the Cross Border Directive.

Within these governing EU Regulations and Irish legislation, the CBD provides for the cost of publicly funded healthcare in Ireland to be availed of in a EU/EEA* member state and the costs to be reimbursed subject to compliance with the applicable administration processes adopted by the HSE in the administration of the CBD.   Patients must familiarize themselves with the administration requirements of the HSE prior to availing of cross border healthcare in order to confirm entitlement or otherwise to reimbursement of treatment costs.  The HSE has established a National Contact Point (NCP) office for the administration of the CBD in Ireland and the contact details for the NCP are:

National Contact Point, Cross-Border Healthcare Directive Department, HSE Cross Border Directive, St Canice's Hospital, Dublin Road, Kilkenny Tel: 056 778 4546 Email: crossborderdirective@hse.ie

The CBD allows for patients that are normally resident in Ireland and availing of public health services to be referred to and avail of healthcare funded publicly in Ireland in another EU/EEA* member state.  It will be a matter for the patient and his/her referring doctor to identify the clinician abroad and satisfy him/herself in relation to the qualifications, quality and safety of the services being availed of in the other jurisdiction.  Funding will only be reimbursed for healthcare that is publicly funded and available in Ireland and which is not contrary to Irish legislation.  Reimbursement will be made in line with published reimbursement rates available from the NCP.

For details on how to apply to receive healthcare in another EU/EEA* member state under CBD or reimbursement procedures, click here

Further Information

The provision of health services in Ireland is governed by legislation including the Health Act 1970-2013 (As amended); under the Health Act 1970-2013 (As amended) everyone who is ordinarily resident in Ireland qualifies for public health care.

In March 2011, the European Directive on the application of patients’ rights, commonly referred to as the Cross Border Directive, was adopted by the European Parliament.  The Directive clarifies the rights of EU citizens to seek healthcare in other EU member states and the framework for such access. 

In general in the case of Ireland and people ordinarily resident in Ireland, the Directive will provide for public patients to exercise an option to have the healthcare they would have been entitled to under the public health system in Ireland in another EU/EEA* country.  The health service that Irish public patients may wish to access abroad can be availed of in the public or private sector in the other EU/EEA* State and the patient can seek reimbursement for that service upon return to Ireland.  Reimbursement will be at the cost of the healthcare abroad or the identified cost here in Ireland, which ever is the lesser.