It started with a directive: 2011/24/EU. The scheme is called the Cross Border Healthcare Directive (CBD) and has been available here since June 1st 2014. To date, Irish people have travelled for orthopaedic operations like hip and knee replacements, dental treatment, urology, ear, nose and throat treatments and general surgery.
The UK and Northern Ireland have been common choices, along with Eastern European countries like Lithuania and Poland.
In October 2015 then-Minister for Health Leo Varadkar confirmed that 17 patients were issued with refunds for consultations outside the State, following a referral from a GP but HSE figures issued to Irish Country Living state that 157 reimbursements were processed under this scheme in total in 2015, to a value of €571,632. That’s an average of €3,641 per applicant.
Interestingly, 4,083 enquiries were received and 1,593 application forms issued – but only 157 reimbursements processed. In all, 215 applications for prior authorisation were processed in that time frame also, so it would appear that not everybody followed through on their applications.
Awareness of the scheme is obviously increasing, however, as figures for the first quarter of 2016 already show that 165 people have been reimbursed for treatment to a value of €401,643. That’s more applications in three months than the whole of last year, with an average of €2,434 per person being paid out.
The scheme particularly opened up options for people wanting to avail of services like dental treatment in Northern Ireland. That may change following Brexit, depending on how quickly Britain’s departure from the EU occurs.
What the process involves
The scheme means that your GP can refer you, as a public patient, to a hospital in EU or EEA countries, where you can be treated in either a public or private facility.
You may not have to go through an extra medical assessment to avail of the scheme, and you don’t have to be on a waiting lists for ages before you go.
You do need to have the money upfront, however, and your travel and subsistence expenses won’t be paid but you can then apply for a refund from the HSE for your medical treatment when you come home.
The healthcare you get must be healthcare which is available and funded in the public healthcare system in Ireland.
In the case of CBD, you will need prior approval if the treatment involves an overnight stay in the hospital abroad, but check what’s needed by contacting the National Contact Point in Ireland.
You’ll also need prior approval if the treatment required is highly specialised or expensive or provides a particular risk for you or the population.
Don’t forget that it takes 15 to 20 working days for completed applications to be processed, so plan in time. You will be notified of the HSE decision by letter.
Your GP can refer you, as can the consultant you are seeing in the public health system.
The HSE is also obliged to tell you about this scheme if you enquire about waiting lists for seeing a consultant.
The referral letter should specify the healthcare required, the health professional abroad you are being referred to and their clinic, hospital or other location.
You, or the clinician referring you, should be satisfied that the healthcare provider abroad is qualified and suitable. You will be directed to EU websites to help you check this.
When you come home you complete the HSE CBD pro-forma invoice and submit it to the HSE with your (special) invoice from the doctor/hospital abroad along with the receipt.
Examples of healthcare available under the CBD
Acute/psychiatric hospital services.Community-based outpatient care.Dental and orthodontic services (with exceptions).Speech and language services.Occupational therapy services (with exceptions).• Psychology services.• Physiotherapy services.• Disability services.• Ophthalmic services.• Mental-health services.• Methadone programme.• Addiction care.healthcare Not covered by the CBD
• Organ transplantation.• Long-term care; for example in a nursing home.CBD contact information
The National Contact Office for the administration of the CBD is:
National Contact Point
Cross-Border Healthcare Directive Department
St Canice’s Hospital
Dublin Road
Kilkenny
Ireland
(056) 778 4546
Email: crossborderdirective@hse.ie
Notes on CBD scheme
1. Please ensure you have taken out appropriate insurance while travelling abroad and tell your insurer you are travelling for health treatment.2. Private patients will need to revert to public patient status in order to avail of their entitlements under the CBD. A referral from a consultant seeing a patient in a private capacity won’t be accepted for the purposes of the CBD.3. You can avail of healthcare in a public or a private facility abroad, but you’ll only be reimbursed to up to the cost of that healthcare in the public system in Ireland 4. The HSE says it will endeavour to ensure reimbursements are processed “without undue delay”.5. Prescription charges can’t be reclaimed under the CBD, but you can avail of normal Drugs Payment Scheme regulations, where you pay the first €144 per month yourself and get any medication over that amount for free.6. Your travel and subsistence expenses won’t be covered.7. If treatment isn’t successful you can return for follow-up treatment and be reimbursed. 8. If complications arise you will be able to get follow-up care in Ireland. CL>> Case study
Mrs Brown from Ireland goes to France to have a hip replacement. The cost in Ireland is €10,000 with a €75-per-night hospital charge. If the cost in France is €11,000 and Mrs Brown was in hospital there for five nights, then the reimbursement rate will be €10,000 less €375 (€75x5 = €375 that she would have had to pay as a public patient in Ireland anyway). She is therefore reimbursed €9,625.
Treatment Abroad Scheme (TAS)
The Treatment Abroad Scheme (TAS) is slightly different. You may remember RTÉ’s Tommie Gorman talking about it on the Late Late Show, related to his cancer treatment. The treatment he needed wasn’t available in Ireland, so he was able to travel to Sweden for it and get it paid for by the HSE. To see a video of his experience using the scheme see www.netpatientnetwork.ie
The TAS is for when the treatment you need isn’t available in Ireland but is available in another EU or EEA country (includes Iceland, Liechtenstein and Norway) and Switzerland.
It gives you the right to go as a public patient, have the treatment you need, and be refunded. Unproven, experimental or test treatments are not covered.
The treatment you have abroad must be public healthcare under a registered medical practitioner in a recognised hospital or other institution that accepts form S2 (E112). Form S2 authorises treatment abroad, so the patient does not have to make any payment to the healthcare provider. You must provide confirmation of every appointment you are due to attend, so the HSE can issue this S2 form that will cover the cost of your visit.
This scheme may provide assistance with travel costs for the patient and a travelling companion, where appropriate.
In all, 619 people had treatment abroad under this scheme at a cost of €10,219,938 – or an average of €16,510 per patient.
How to apply
The consultant treating you as a public patient must refer you. GPs can’t.An application form must be completed and a copy of your referral letter included.Your application must be approved by the HSE before you travel or start treatment abroad.You’ll get a decision within 15-20 working days.You can appeal if it is refused.TAS Contact
See www.hse.ie Look under “benefits and schemes”.
Notes on Tas
It started with a directive: 2011/24/EU. The scheme is called the Cross Border Healthcare Directive (CBD) and has been available here since June 1st 2014. To date, Irish people have travelled for orthopaedic operations like hip and knee replacements, dental treatment, urology, ear, nose and throat treatments and general surgery.
The UK and Northern Ireland have been common choices, along with Eastern European countries like Lithuania and Poland.
In October 2015 then-Minister for Health Leo Varadkar confirmed that 17 patients were issued with refunds for consultations outside the State, following a referral from a GP but HSE figures issued to Irish Country Living state that 157 reimbursements were processed under this scheme in total in 2015, to a value of €571,632. That’s an average of €3,641 per applicant.
Interestingly, 4,083 enquiries were received and 1,593 application forms issued – but only 157 reimbursements processed. In all, 215 applications for prior authorisation were processed in that time frame also, so it would appear that not everybody followed through on their applications.
Awareness of the scheme is obviously increasing, however, as figures for the first quarter of 2016 already show that 165 people have been reimbursed for treatment to a value of €401,643. That’s more applications in three months than the whole of last year, with an average of €2,434 per person being paid out.
The scheme particularly opened up options for people wanting to avail of services like dental treatment in Northern Ireland. That may change following Brexit, depending on how quickly Britain’s departure from the EU occurs.
What the process involves
The scheme means that your GP can refer you, as a public patient, to a hospital in EU or EEA countries, where you can be treated in either a public or private facility.
You may not have to go through an extra medical assessment to avail of the scheme, and you don’t have to be on a waiting lists for ages before you go.
You do need to have the money upfront, however, and your travel and subsistence expenses won’t be paid but you can then apply for a refund from the HSE for your medical treatment when you come home.
The healthcare you get must be healthcare which is available and funded in the public healthcare system in Ireland.
In the case of CBD, you will need prior approval if the treatment involves an overnight stay in the hospital abroad, but check what’s needed by contacting the National Contact Point in Ireland.
You’ll also need prior approval if the treatment required is highly specialised or expensive or provides a particular risk for you or the population.
Don’t forget that it takes 15 to 20 working days for completed applications to be processed, so plan in time. You will be notified of the HSE decision by letter.
Your GP can refer you, as can the consultant you are seeing in the public health system.
The HSE is also obliged to tell you about this scheme if you enquire about waiting lists for seeing a consultant.
The referral letter should specify the healthcare required, the health professional abroad you are being referred to and their clinic, hospital or other location.
You, or the clinician referring you, should be satisfied that the healthcare provider abroad is qualified and suitable. You will be directed to EU websites to help you check this.
When you come home you complete the HSE CBD pro-forma invoice and submit it to the HSE with your (special) invoice from the doctor/hospital abroad along with the receipt.
Examples of healthcare available under the CBD
Acute/psychiatric hospital services.Community-based outpatient care.Dental and orthodontic services (with exceptions).Speech and language services.Occupational therapy services (with exceptions).• Psychology services.• Physiotherapy services.• Disability services.• Ophthalmic services.• Mental-health services.• Methadone programme.• Addiction care.healthcare Not covered by the CBD
• Organ transplantation.• Long-term care; for example in a nursing home.CBD contact information
The National Contact Office for the administration of the CBD is:
National Contact Point
Cross-Border Healthcare Directive Department
St Canice’s Hospital
Dublin Road
Kilkenny
Ireland
(056) 778 4546
Email: crossborderdirective@hse.ie
Notes on CBD scheme
1. Please ensure you have taken out appropriate insurance while travelling abroad and tell your insurer you are travelling for health treatment.2. Private patients will need to revert to public patient status in order to avail of their entitlements under the CBD. A referral from a consultant seeing a patient in a private capacity won’t be accepted for the purposes of the CBD.3. You can avail of healthcare in a public or a private facility abroad, but you’ll only be reimbursed to up to the cost of that healthcare in the public system in Ireland 4. The HSE says it will endeavour to ensure reimbursements are processed “without undue delay”.5. Prescription charges can’t be reclaimed under the CBD, but you can avail of normal Drugs Payment Scheme regulations, where you pay the first €144 per month yourself and get any medication over that amount for free.6. Your travel and subsistence expenses won’t be covered.7. If treatment isn’t successful you can return for follow-up treatment and be reimbursed. 8. If complications arise you will be able to get follow-up care in Ireland. CL>> Case study
Mrs Brown from Ireland goes to France to have a hip replacement. The cost in Ireland is €10,000 with a €75-per-night hospital charge. If the cost in France is €11,000 and Mrs Brown was in hospital there for five nights, then the reimbursement rate will be €10,000 less €375 (€75x5 = €375 that she would have had to pay as a public patient in Ireland anyway). She is therefore reimbursed €9,625.
Treatment Abroad Scheme (TAS)
The Treatment Abroad Scheme (TAS) is slightly different. You may remember RTÉ’s Tommie Gorman talking about it on the Late Late Show, related to his cancer treatment. The treatment he needed wasn’t available in Ireland, so he was able to travel to Sweden for it and get it paid for by the HSE. To see a video of his experience using the scheme see www.netpatientnetwork.ie
The TAS is for when the treatment you need isn’t available in Ireland but is available in another EU or EEA country (includes Iceland, Liechtenstein and Norway) and Switzerland.
It gives you the right to go as a public patient, have the treatment you need, and be refunded. Unproven, experimental or test treatments are not covered.
The treatment you have abroad must be public healthcare under a registered medical practitioner in a recognised hospital or other institution that accepts form S2 (E112). Form S2 authorises treatment abroad, so the patient does not have to make any payment to the healthcare provider. You must provide confirmation of every appointment you are due to attend, so the HSE can issue this S2 form that will cover the cost of your visit.
This scheme may provide assistance with travel costs for the patient and a travelling companion, where appropriate.
In all, 619 people had treatment abroad under this scheme at a cost of €10,219,938 – or an average of €16,510 per patient.
How to apply
The consultant treating you as a public patient must refer you. GPs can’t.An application form must be completed and a copy of your referral letter included.Your application must be approved by the HSE before you travel or start treatment abroad.You’ll get a decision within 15-20 working days.You can appeal if it is refused.TAS Contact
See www.hse.ie Look under “benefits and schemes”.
Notes on Tas
1. You can’t download an application form. You have to request one from treatmentabroad.scheme@hse.ie or by contacting the HSE TAS office by telephone.2. Care reverts to your Irish-based consultant when you come home.3. If the hospital abroad wants to do additional treatment, you may have to pay for it yourself or have it done using your European Health Insurance Card (EHIC), formerly the E111.4. If your Irish-based consultant decides you need further treatment abroad, a new TAS application will have to be made. 5. If organising travel arrangements is too challenging, your consultant may ask the hospital social worker to help you. 
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