Cross Border Directive

Written by Saher Shodhan. Every quote and figure on this page was read on the publisher's own page on 9 Nov 2026, unless a source says otherwise. This is general information, not legal or financial advice: check your own case with the HSE before you book or pay. Sources are numbered at the end.

How the Cross Border Directive works

The Cross Border Directive (CBD) comes from EU law, Directive 2011/24/EU on patients' rights in cross-border healthcare [15]. The HSE describes it as "a scheme to get planned healthcare in another European Union (EU) or European Economic Area (EEA) country" [2]. The EU's own guidance for patients says that if a treatment is covered by your public health system at home, "it is your right as an EU citizen to be reimbursed for the same treatment elsewhere in the EU (as long as you meet certain conditions)" [14].

In Ireland the HSE runs the scheme through its National Contact Point in Kilkenny [6]. The steps, in short:

1. You get a referral, as you would for public care in Ireland [2].
2. You have an outpatient consultation before any inpatient or day case treatment [2].
3. You can ask the HSE for prior notification, which is optional [4].
4. You pay the hospital or clinic abroad directly [5].
5. Afterwards, you send the HSE a healthcare costs application with your receipts [5].

The scheme covers the 27 EU countries and Iceland, Liechtenstein and Norway [2]. The HSE says: "You can no longer use the CBD to access healthcare in the UK. This is because the UK left the EU on 31 December 2020" [2].

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Who can use the Cross Border Directive

To apply through the HSE, it says you must [2]:

• "be living in Ireland for 1 year or intend to live in Ireland for at least 1 year"
• "be eligible for the healthcare you want in the public health system in Ireland"
• "have an outpatient consultation before inpatient or day case treatment"

Private health insurance does not rule you out, but the HSE says you cannot use it for the referral: "You can only use a referral from a GP or a consultant you see as a public patient" [2]. If you get an income or a state pension from another EU or EEA country, you may need to apply in that country instead, and if your income or pension comes from the UK or Switzerland you may not be eligible [2]. The HSE asks anyone in that position to contact it first [2].

What treatment the CBD covers

The HSE says "There is no list of specific healthcare you can get abroad" under the scheme, and that "Generally, if the healthcare is available publicly in Ireland, you can be referred for the same healthcare abroad" [3]. Its examples include [3]:

• day case, inpatient and outpatient care in acute hospital services
• "orthopaedic services, such as hip replacements"
• "ophthalmic services, such as cataract surgery"
• dental and orthodontic services, "with some exceptions"
• physiotherapy, psychology, and speech and language services
• fertility treatment (IVF, IUI or ICSI), on the same access criteria as in Ireland

It lists organ transplants, long-term care such as nursing home care, vaccinations, clinical trials and drug therapies not provided publicly in Ireland as examples of care you cannot get under the CBD [3]. For orthodontic treatment, usually only for children under 16, the most it repays is €2,200 [3].

How much the HSE repays

The HSE repays the smaller of two amounts: what you paid abroad, or what the same care costs in the Irish public system. Its own example: "if the healthcare abroad costs €2,000 and in Ireland it costs €1,500, you can claim €1,500" [1]. The HSE says you are "responsible for paying any shortfall" between the price abroad and what you can claim [4].

For inpatient and day case care, the Irish cost comes from a diagnosis-related group (DRG) code. The HSE assigns one code to your case, covering your diagnosis and every procedure and service in the admission, and reviews the prices every year [1]. These are the HSE prices for some common operations on its price list for claims from 1 September 2026 [7]:

Inpatient prices are the "inlier" price, for a stay of normal length. Sources: HSE Healthcare Pricing Office, ABF 2026 Admitted Patient Price List, linked from the HSE's claims page for claims from 1 September 2026 [7]; outpatient maximum from 1 May 2023 [1]. Read 9 Nov 2026.

The HSE says it can "only confirm the exact amount after your treatment" [4]. It sometimes sends claims to the Healthcare Pricing Office for an independent check of the code, and the correct code sets the most you can be repaid [1].

What the CBD does not pay for

The HSE says the scheme does not cover travel, accommodation, translation services or "any payment made to a third-party or intermediary", which it describes as "a company that organises treatment for a fee" [1]. Thera is free for patients, so there is no fee of ours to claim.

Step by step: referral, prior notification and your claim

1. The referral

The referral letter can be to a public service in Ireland, or to a public or private service abroad [5]. It must include your name, address and date of birth, the hospital or service and the speciality, a summary of your condition, the reason for the referral, and the referrer's signature [5]. The HSE says "The date on your referral letter must be before the date you had your outpatient consultation" [5].

2. The outpatient consultation

The HSE says the consultation can be "abroad, with your treating consultant" or "in Ireland, with a consultant treating you as a public patient" [2]. For inpatient treatment it must be in person; for day case treatment it can be in person, by phone or by video call [2].

3. Prior notification (optional)

For inpatient or day case treatment, you can apply for prior notification before you travel. The HSE says this lets it "confirm if you are eligible to apply for healthcare costs" and "give you an indication of how much you might get" [4]. You send the prior notification form (18 pages), with section 4 completed by the healthcare professional abroad, plus proof of your outpatient consultation and either a referral letter or a letter confirming you are on a public waiting list in Ireland [4].

Citizens Information still says treatment with an overnight stay needs prior authorisation from the HSE [11]. The HSE, which runs the scheme, calls its prior notification step optional [4]. Ask the National Contact Point which applies to your treatment before you pay a deposit.

4. Pay the provider yourself

Pay the hospital or clinic abroad directly, by card, bank transfer, bank draft or cash with a receipt. The HSE says "We must be able to identify the payee (the healthcare provider) and the payer (you)" [5]. A payment made through an agency may not show that.

5. Claim your healthcare costs

After treatment, send the healthcare costs application form (20 pages), again with section 4 completed by the healthcare professional abroad [5]. With it, the HSE asks for [5]:

• your referral letter, or a letter confirming you are on a public waiting list in Ireland
• an invoice showing your name and address, the provider's details, the treatment, the date, the amount paid and a breakdown of charges
• proof that you paid the provider directly, such as a bank or card statement

If any part is in another language, the HSE asks for a formal translation; read its exact wording on the claims page before you travel [5]. Payment goes only to the patient, or to a parent or guardian for a patient under 18 [5].

How long repayment takes

The HSE says: "We usually aim to repay you within 30 working days of getting all completed documents", and adds that "Due to high demand, processing times are longer" [5]. On 15 Oct 2026 the Minister for Health told the Dáil that the CBD office was "currently processing applications received in early April 2026", called a 6-month delay "clearly unacceptable", and said she had set the HSE a target of getting back to 30 days by the end of 2026 [8].

The same answer says there is "no provision within the scheme for the reimbursement of interest charges, borrowing costs or other consequential financial costs" [8]. If you borrow to pay for treatment, plan for the wait. You can ask for an update by phone or email, and you can appeal a decision within 3 months of getting it [6].

Cross Border Directive or Treatment Abroad Scheme?

Citizens Information says "It is important to apply under the correct scheme", and that if a treatment is covered by the Treatment Abroad Scheme, "you cannot get a refund for it under the Cross-Border Healthcare Directive" [10].

Sources: HSE and Citizens Information pages read 9 Nov 2026 [1] [2] [4] [5] [9] [10].

The HSE aims to decide a completed Treatment Abroad Scheme application in 15 to 20 working days, and says: "Do not schedule appointments before you get a decision on your application" [9].

Treatment in the UK and Northern Ireland

Since Brexit the CBD no longer covers the UK [2]. For private care in Northern Ireland there is a separate scheme, the Northern Ireland Planned Healthcare Scheme (NIPHS). The HSE says it is "a scheme to get planned healthcare in a private healthcare service in Northern Ireland" and that "You cannot use it to get healthcare in a public healthcare service" [12]. It works like the CBD: you pay, then claim the smaller of the Northern Ireland cost and the Irish public cost [12]. Citizens Information calls it "a temporary scheme" that is "available until a permanent statutory scheme is approved" [11].

Private care in Great Britain is not covered by either scheme [2] [12]. The Treatment Abroad Scheme can still cover approved public treatment in the UK when the treatment is not available in Ireland [9].

Where Irish patients go under the CBD

In a reply to a parliamentary question dated 31 July 2026, the HSE said 6,889 CBD treatments and 5,742 NIPHS treatments were reimbursed or approved in 2025 [13]. The countries with the most CBD treatments in 2025 were [13]:

• Spain: 4,609
• Poland: 808
• Lithuania: 579
• Germany: 355
• Romania: 112

We list hospitals in several of these countries, with their registers and published prices: Spain, Poland, Lithuania and Germany. For joint replacements, our guide to hip and knee replacement abroad from Ireland sets the HSE prices beside hospitals' own price lists.

Before you book: what to check

1. Ask the HSE National Contact Point whether your treatment is covered and which DRG code it expects (crossborderdirective@hse.ie, 056 778 4546) [6].
2. Get your referral letter dated before your outpatient consultation [5].
3. Send the prior notification form if you want an indication of the amount first [4].
4. Ask the hospital abroad for an itemised quote and confirm it will complete section 4 of both HSE forms [4] [5].
5. Pay the hospital directly, and keep the invoice and the bank or card record [5].
6. Budget for travel, a hotel and the months a repayment can take [1] [8].

The EU's guidance for patients says the best way to check whether you meet the conditions is to contact the National Contact Point in your home country [14]. Our 15 questions to ask a hospital abroad cover the checks on the hospital itself.

This guide is general information, not legal, medical or financial advice. The HSE decides every claim: check your own case with the HSE.

Written by Saher Shodhan

Saher Shodhan is the founder of Thera Travel, which publishes what the official records show about clinics abroad, each fact with the date it was checked, and answers patients' enquiries, free. More about Thera → How we write and check our guides →