Healthcare abroad paid by HSE if you live in Ireland

Emergency or necessary treatment abroad received in the state system EHIC route.

The European Health Insurance Card (EHIC) gives you access to state-provided, medically necessary healthcare in other EU/EEA countries. The cost of treatment is the same as for those insured in that country, and in some cases, it may be free. The EHIC covers emergencies, chronic or existing illnesses, pregnancy and childbirth, and other benefits during a temporary stay.

If your healthcare provider did not accept your EHIC card or you were unable to use it, you can still apply for a refund or request HSE coverage.

To apply for a refund via the EHIC route:

1. The treatment must have been provided by the state.
2. The provider must have an agreement with the state to offer the service.
3. You must have visited the country temporarily, such as for work or holidays.

Remember these important details when applying for a refund through the EHIC route.

Planned, emergency or necessary medical treatment in a private clinic abroad– DIRECTIVE ROUTE POST TREATMENT

Directive route (healthcare already received) – apply for a refund. If you had received and paid for healthcare abroad in a private clinic/hospital.

If you received medical treatment in a private hospital abroad and paid for it, you can apply for a refund through the Directive Route. This route is available to all individuals legally residing in Ireland and covers both planned and emergency medical treatment provided by private clinics or hospitals.

The EU Cross-Border Directive ensures that you have access to the same or equivalent healthcare that would be available to you in Ireland. This includes prescriptions and medical devices, as well as treatment. However, in some cases, the HSE may require you to have undergone the same steps as you would have in Ireland. For example, HSE may refuse a refund if you underwent surgery without a prior consultation.

Compared to the EHIC, the Directive Route allows you to access emergency and necessary treatment in the private sector, even if a state hospital is not nearby. Private hospitals typically do not accept EHIC, but you can still claim a refund for the treatment received.

The Directive Route allows you to apply for permission to receive planned medical treatment in a private clinic abroad. If you are eligible for public healthcare services provided by the HSE in Ireland, you may choose to receive those services in another EU/EEA country.

To qualify for a refund under the Cross-Border Healthcare Directive, you must:

• Be eligible for public healthcare in Ireland
• Have a referral letter from a public health professional in Ireland
• Arrange a consultation with a doctor abroad (if having surgery)
• Travel abroad for healthcare
• Apply for HSE refund for treatment in a private clinic abroad.

Note: It is advisable to receive prior approval from the HSE, who will inform you about the potential refund amount. Keep in mind, HSE will only refund the cost of public healthcare treatment in Ireland or the cost of treatment abroad, whichever is less. Travel costs are not included.

Planned medical treatment in state system abroad– S2/E112 ROUTE

S2/E112 route – apply for permission to travel abroad to receive planned healthcare abroad in the state clinic/hospital.

If you are living in Ireland and require treatment that is not available to you in Ireland, you may be able to use the Treatment Abroad Scheme (S2/ E112). To get the treatment you require in another country in the European Union (EU), the European Economic Area (the EEA also includes Iceland, Liechtenstein and Norway) or Switzerland.

You will not be required to pay for your treatment in full with S2/E112. Almost all payments will be done between HSE and the hospital. The hospital will ask you to pay only if the patient of their country would be asked to pay. For example, if in the country of your treatment patient needs to pay 100 EUR for a hospital stay so will you!

All treatments under S2/E112 must be within Irish law and either not available in Ireland, or not available within medically justified time in Ireland. Only your HSE consultant can make decisions on medically justified time. He will take into account your current health and the likely course of your illness or condition.

Your consultant will have to confirm that you need treatment abroad. The consultant must also confirm the:

• service is medically necessary and will meet your needs.
• treatment is not an experimental or test treatment.
• treatment will be performed in the public sector.
• you will receive treatment in a hospital that will accept the form ‘EU/EEA form E112 (IE).
• cost of treatment.

Why should you go for private treatment abroad?

You can get private treatment abroad for any medical condition, provided you can pay for it. This could include treatment abroad in a private specialised hospital, by a clinic or state hospital abroad. It could also include dental treatment, cosmetic surgery and orthopaedic surgery, gynaecological surgery, fertility treatment or vein varicose treatment.

Why go for private treatment abroad?

You might want to get private health treatment abroad when:

• you want to choose the date for the hospital operation. By going abroad you can choose when to have it, so it does not interfere with your life and plans
• there’s a long HSE waiting list and you don’t want to wait. In general, you should receive surgery on HSE within 18 weeks, but this often tends to be longer
• if you wish to be treated by a consultant of your choice. You will be able to pick a doctor who is an expert in the field of medicine, not one who just started to practice
• the treatment that you need that isn’t available on the HSE. For example, for cosmetic surgery, dental treatment, fertility treatment or vein varicose treatment
• you want a second opinion on the treatment you’ve had at the HSE, many legal actions have proven that the decision that was made by HSE might not be the right one if you feel that doctor is wrong going abroad could be an option for your
• health screening is not available on HSE, but abroad cost for a full body checkup can be done in one day, and it can be combined with your short city break.

Things to know about surgery abroad

Before getting private treatment abroad, you might want to think about:

• whether you can afford it. The cost is likely to be very high in private clinics in Ireland, but abroad the same or even better service is available for fraction of the cost – 50% or even -80%
• whether you would like to have just private treatment abroad or you would like to combine it with holidays;
• chose a specialised private hospital or chose a multidisciplinary hospital abroad that could deal with any complications;
• opposite private treatment in Ireland, patients who received treatment abroad in the EU are entitled to HSE treatment after private treatment.

How to get private health treatment abroad

To find a private medical clinic abroad you could:

• make your research, and decide your possible destination country;
• contact Medrefund LTD and ask for advice, as we do work only with the best clinics in the country and in doctors. Clinics that offer medical tourism services are usually providing high-quality service and going the extra mile;
• look on the internet and ask a question you are concerned about;
• contacting Medrefund prior to treatment could reduce your cost even more as part of the costs could be refunded by the HSE.

Charges at a private clinic abroad

You should ask the clinic abroad what the charges will be in advance and what would be included. Private treatment abroad can include a full package that would include all starting from flight, accommodation, surgery, aftercare, or just treatment. Clinics usually do not charge more if an operation takes twice as long as it should.

We can check with the HSE if the treatment you are planning to receive is covered by the HSE and will be refunded. The first sight that you can have private treatment abroad paid for by HSE is that you are on the waiting list.

A private clinic abroad has a legal duty of care towards you. This means that in an emergency, they must take reasonable steps to provide necessary treatment, even if this hasn’t been agreed upon in advance. You might not be charged for it if you have a European Health Insurance Card, and receive treatment in the clinic that accepts it.

If you go to a private hospital abroad

When you go to the hospital for a private operation abroad, you will not be charged separately:

• your surgeon consultation;
• an anaesthetist service;
• accommodation, meals, laundry, nurses, drugs, medication, X-rays and blood tests.

Savings for having treatment abroad

The actual cost savings you can make by having private treatment abroad will vary depending on the procedure you want and the country you want to go to. Many popular treatment destinations offer savings of half or even more compared to the cost of private general surgery in Ireland.
Why private treatment abroad is cheaper
Private treatment abroad is cheaper because their costs of service are lower. The wages paid to the specialists and private clinic staff abroad can be far less than those paid in Ireland. It is far less expensive to run a private clinic abroad than it is to run one of a similar standard here in Ireland, so clinic abroad does not cut their prices they don’t have to charge as much for their services.

Why do patients go abroad for treatment?

There is more than one reason depending on diagnosis, required treatment, costs and others, these reasons include:
• Costs of private treatment abroad – private treatment abroad can often be found at a fraction of the price in Ireland.
• No waiting times –HSE are having long waiting lists for treatment, but by travelling you can get treatment significantly sooner. And in some cases get a refund for general surgery abroad.
• New surgery treatments – HSE often offers the cheapest available surgery, but in a private clinic abroad you and your doctor can choose the best available service.
• Specialist services – private clinics abroad tend to offer specialised medical staff and medical equipment. Cause if you are paying you are expecting a high-level surgeon and that is what private medical clinics abroad do offer.
• Service is not available on HSE – there is more than one treatment for the same diagnoses and we think you should be given a choice, and so do the EU, now you can choose specialists and clinics abroad and HSE will have to partly or fully cover costs of treatment according to EU directive.

Why choose a private clinic abroad not in Ireland

• Costs will be lower and by lower, we mean 50-80 lower than in the Ireland clinic
• You can combine holidays with treatment
• Possible refund from HSE
• Treatment quality abroad  is the same or even better
• guaranteed aftercare from HSE if necessary.

Private treatment abroad can be covered by the HSE and can be refunded, even if it was planned and was received in a private clinic abroad. Treatment abroad could be an alternative you can afford, and it can help you avoid the HSE waiting list.