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Healthcare abroad paid by HSE if you live in Ireland

Healthcare abroad paid by HSE if you live in Ireland

If you are resident in Ireland you can choose to access healthcare abroad in other countries in the European Union (EU), the European Economic Area (the EEA also includes Iceland, Liechtenstein and Norway) or Switzerland and HSE could pay or refund your expenses.

We will always advise you to ask for prior approval before you receive treatment abroad. But we realise that not in all cases is possible, for example when you had an accident whilst on holiday.

Below you will find all possible state-funded healthcare options and refund options if you had already paid for your treatment.

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

EHIC route – apply for a refund if you already had received healthcare.  It applies only to emergencies or treatments provided without delay. In addition, providers abroad had to be in public, not private.

The European Health Insurance Card (EHIC) gives you the right to access medically necessary, state-provided public healthcare in another EU/EEA state. Treatment provided is under the same conditions and at the same cost (free in some countries) as people insured in that country. EHIC gives you access to healthcare during a temporary stay. The benefits covered include, for example, emergency treatment, treatment of chronic or existing illnesses as well as pregnancy and childbirth. You can use EHIC when you are travelling abroad or when you are on holiday in another EU/EEA State.

The healthcare provider did not accept your EHIC card or you were not able to use it? You are still able to apply for a refund or ask HSE to cover the bill.

Things to remember in order to apply for a refund via the EHIC route:

  • Treatment had to be state-provided;
  • The provider had to have an agreement with the state to provide this service;
  • You did visit the country temporarily (work, holidays etc.) 

Planned, emergency or necessary medical treatment in 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.

You can claim a refund for treatment received abroad. You had to pay for treatment in a private clinic or state hospital abroad as a private (paying) patient? The EU directive route is giving all people legally living in Ireland receive a refund for treatment abroad. Within the Directive route, you can receive planned and emergency treatment provided by any clinic or hospital. In other words, you can get a refund if treatment received would be offered to you in Ireland.

The EU cross-border directive covers all healthcare provided or prescribed. The Directive route covers the same or equivalent healthcare that would be available for you in the same situation in the Republic of Ireland. That means if you would have access to medical treatment In Dubin, you can access it in Rome. The EU cross border directive also covers medicine prescription and medical devices. 

In some situations, the HSE could insist that you had undergone the same steps if you would receive treatment in Ireland. It means HSE has a right to refuse a refund if you had surgery without having prior consultation. This is the path every patient within the HSE system has to undergo.

Compared to the EHIC the EU directive route gives you access to emergency and necessary treatment in the private sector. In case your health condition worsened and there were no state hospitals nearby, you can use the directive route refund claim. Private hospitals do not usually accept EHIC, but paying for treatment and claiming a refund is possible. 

Planned medical treatment in private clinic abroad– DIRECTIVE ROUTE

Directive route (planning to go abroad) – apply for permission to travel abroad. You can apply and receive permission to receive planned healthcare abroad in a private clinic/hospital.

If you are entitled to public health services by HSE in the Republic of Ireland, you may choose to buy those medical services in another member state of the European Union (EU) or European Economic Area (EEA), which also includes Iceland, Liechtenstein and Norway. You will have to pay upfront and will be repaid the cost by the HSE. HSE refund requirements. This is provided for by the Cross-Border Healthcare Directive (EU Directive 2011/24/EU, pdf).

You will be refunded the cost of the public healthcare treatment in Ireland, or the cost of your treatment abroad if that is less. It does not include other costs such as travel.

In order to qualify for a refund for health services in another country under the Directive you have to:

  1. Qualify for public healthcare in the Republic of Ireland.
  2. Have a letter of referral from a public health professional in Ireland. You can use a referral from your GP or specialist for public healthcare in Ireland to access healthcare abroad.
  3. Arrange a consultation with a doctor abroad. You must have a consultation abroad if you are having surgery.
  4. Travel abroad for healthcare.
  5. Receive prior approval from HSE (it is not mandatory, but advised. HSE will inform you about possible refund amount).

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 that 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.