THE issue of travelling outside of the State for heathcare was back in the news in West Cork recently, so it seems an apt time to see how the rules apply to accessing services in other EU jurisdictions.
IF you are entitled to public health services in Ireland, you may choose to access those services in another member state of the European Union (EU) or European Economic Area (EEA), which also includes Iceland, Liechtenstein, and Norway, and be repaid the cost if you meet the requirements.
How does the scheme work?
In the same way that you would be referred to public health services in Ireland, you must be referred to the health service you require abroad. This may be, for example, by your GP (family doctor) or public hospital consultant. In the case of some community-based services, the appropriate referral could be by a Health Service Executive (HSE) professional such as a public health nurse, community dentist, or HSE orthodontist.
Funding will only be reimbursed for healthcare that is publicly funded and available in Ireland but the referral may be to a public or private health service in the other country. You pay the costs of treatment and then apply for a refund when you return to Ireland.
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 person referring you, should be satisfied that the healthcare provider abroad is qualified and suitable. If you wish to access information on services or service providers abroad, you should contact the national contact point for the other EU/EEA State. Make sure that the service you are seeking to access abroad is covered by the Cross-Border Healthcare Directive. Your referring clinician can advise you about this but if you are in doubt you can contact the national contact point in Ireland to check.
Can I access healthcare in Britain or Northern Ireland?
You can no longer use the Cross-Border Healthcare Directive to access healthcare in Britain. The Northern Ireland Planned Healthcare Scheme is a temporary scheme that allows you to receive healthcare in Northern Ireland in a similar way to the Cross-Border Healthcare Directive. The healthcare must be publicly available in Ireland. You must pay for the healthcare and then claim the cost from the HSE.
The Scheme is available until a permanent statutory scheme is approved. Residents of Northern Ireland can access healthcare in Ireland under the Republic of Ireland Reimbursement Scheme.
What healthcare treatments are available under the scheme?
Examples of healthcare that is available under the scheme include:
- Day, in-patient and out-patient care in acute hospital services, including psychiatric services
- Community-based out-patient 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
- Mental health services
- Methadone programme
- Addiction care
Some health services are not included, for example, organ transplantation and long-term care such as nursing home care.
If the treatment involves an overnight stay in hospital then it will need to be authorised in advance by the HSE. For other treatment it is advisable to check whether prior authorisation is required by contacting the national contact point.
The application form for prior authorisation must be completed by you and by the medical professional who is referring you for treatment abroad. Completed applications take 15 to 20 working days to process and you will be notified of the decision by letter.
Prior authorisation is also required for healthcare that involves highly specialised and cost-intensive medical infrastructure or equipment; treatments presenting a particular risk for the patient or the population; or accessing a healthcare provider that could give rise to serious and specific concerns relating to the quality or safety of the care.
How do I apply for the refund of costs?
To get a refund of the costs that you pay for your treatment, you and your healthcare provider abroad must complete the HSE Cross-Border Healthcare Directive Pro-Forma Invoice and submit it with the invoice from the healthcare provider and receipt. The refund will only be made to the patient (or to the parents of a child patient).
The HSE has published the refund amounts for different treatments. Treatments are listed according to a code – you can get the code for your treatment from the healthcare professional who has referred you.
If you prefer, or if your treatment is not listed, you can get details of the refund rates from the national contact point.
The maximum refund for a hospital outpatient consultation is €130. If you have more than one consultation on the same day with consultants in the same speciality, the daily limit is €130.
For in-patient treatment, the charges for public in-patients in public hospitals in Ireland will apply. These charges will be deducted from the amount of the refund.
What are the contact details for the National Contact Point office in Ireland?
It is based at St Canice’s Hospital, Dublin Road, Kilkenny. The telephone number is 056 7784546 and the email is [email protected]
If you need further information about any of the issues raised here or you have other questions, you can drop-in to your local Citizens Information Service in Bantry or Macroom or ring 0818 07 8390. They will be happy to assist you and meet with you. West Cork Helpline - 0818 07 8390. The Bantry office is staffed from 10am -5pm from Monday to Thursday and on Friday from 10am -4pm. Alternatively you can email on [email protected] or log on to www.citizensinformation.ie
