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Healthcare abroad paid by HSE if you live in Ireland

Healthcare abroad paid by HSE if you live in Ireland

As a resident of Ireland, you have the choice to access healthcare in countries within the European Union (EU), European Economic Area (including Iceland, Liechtenstein, and Norway), or Switzerland. The HSE may provide coverage or reimbursement for your expenses.

While it’s advisable to seek prior approval before receiving treatment abroad, we understand that unforeseen situations, such as accidents during a trip, may make this challenging.

To assist you in understanding your options, we’ve provided information on all state-funded healthcare choices and potential reimbursement if you’ve already incurred expenses for treatment abroad.

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

If you’ve received emergency or necessary treatment abroad through the state system using the European Health Insurance Card (EHIC), here’s what you need to know:

The EHIC grants you access to state-provided, medically necessary healthcare in other EU/EEA countries. The cost of treatment is the same as it would be for residents of that country, and, in some cases, it may even be free. EHIC coverage includes emergencies, chronic or pre-existing conditions, 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 coverage from the HSE.

To apply for a refund through the EHIC route:

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

Keep these important details in mind 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 for Post-Treatment – Planned, Emergency, or Necessary Medical Treatment in a Private Clinic Abroad

If you have received and paid for medical treatment in a private clinic or hospital abroad, you can apply for a refund through the Directive Route. This option 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 as you would in Ireland. This includes prescriptions, medical devices, and treatment. However, in some cases, the HSE may require you to have followed the same steps as you would in Ireland. For instance, a refund may be refused 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 seek 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 have the option to receive those services in another EU/EEA country.

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

  1. Be eligible for public healthcare in Ireland.
  2. Obtain a referral letter from a public health professional in Ireland.
  3. Arrange a consultation with a doctor abroad (if undergoing surgery).
  4. Travel abroad for healthcare.
  5. Apply for an HSE refund for treatment in a private clinic abroad.

Please note that it’s advisable to seek prior approval from the HSE, which will provide information about the potential refund amount. Keep in mind that the HSE will refund only 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

The S2/E112 route allows you to apply for permission to travel abroad to receive planned healthcare in a state clinic or hospital.

If you’re a resident of Ireland and require medical treatment that is not available in the country, you may have the option to utilize the Treatment Abroad Scheme (S2/E112). This scheme enables you to receive the necessary treatment in another country within the European Union (EU), the European Economic Area (EEA, which includes Iceland, Liechtenstein, and Norway), or Switzerland.

Under the S2/E112 scheme, you won’t be required to pay for your treatment in full. Most payments will be handled between the HSE and the hospital. The hospital will request payment from you only if patients from their country are also required to pay. For instance, if in the country of your treatment, a patient is expected to pay 100 EUR for a hospital stay, you will be asked to pay the same amount.

All treatments conducted under the S2/E112 route must comply with Irish law and meet specific criteria:

  1. The treatment should either not be available in Ireland or not be available within a medically justified time in Ireland. The determination of medically justified time is made by your HSE consultant, who considers your current health and the expected course of your illness or condition.
  2. Your consultant must confirm that you need treatment abroad, and the treatment should be medically necessary, meeting your needs.
  3. The treatment must not be experimental or a test treatment.
  4. The treatment should be performed in the public sector.
  5. You will receive treatment in a hospital that accepts the ‘EU/EEA form E112 (IE).’
  6. The cost of the treatment will be covered under the scheme.

To apply for treatment under the HSE S2/E112 scheme, please follow the relevant procedures.

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:

  • do 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 usually provide high-quality service and go the extra mile;
  • look on the internet and ask a question you are concerned about;
  • contacting Medrefund prior to treatment could reduce your costs 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 has 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 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 should the EU, 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.