Healthcare Reimbursement Guide
EU Cross Border Healthcare Directive
MedTrip Poland helps patients living in Ireland explore private consultations, diagnostics and selected procedures in Poland.
Under the EU Cross Border Healthcare Directive, eligible patients may be able to apply to the HSE for reimbursement of eligible healthcare costs after receiving treatment in another EU or EEA country.
This guide explains the key points in simple language, including eligibility, referrals, prior notification, payment, reimbursement and official HSE guidance.
What this guide covers
- Who may be eligible
- When a referral may be required
- Which treatments may qualify
- How prior notification works
- How reimbursement is claimed
- What costs are usually not covered
What is the Cross Border Healthcare Directive?
The Cross Border Healthcare Directive allows eligible patients who are entitled to public healthcare in Ireland to access certain healthcare services in another EU or EEA country and then apply to the HSE for reimbursement.
It is important to understand that reimbursement is not automatic. The treatment must meet HSE requirements, and the patient must follow the correct process before and after travelling.
Examples of HSE reimbursement limits
Below are a few examples of MedTrip Poland prices compared with the maximum reimbursement limits published by the HSE under the Cross Border Healthcare Directive.
| Procedure | MedTrip Poland Price | Maximum HSE Reimbursement* |
|---|---|---|
| Gastroscopy | From €300 | Up to €726 |
| Colonoscopy | From €300 | Up to €1,001 |
| Umbilical Hernia Surgery | From €2,300 | Up to €9,046 |
| Inguinal Hernia Surgery | From €2,300 | Up to €9,046 |
| Septoplasty | From €2,950 | Up to €8,812 |
*These are just a few examples. Reimbursement depends on the individual treatment, eligibility, documentation and the HSE assessment. Many other consultations, diagnostics and procedures may also qualify.
Before You Travel
Referral and medical assessment may be required
For many hospital treatments, patients may need a referral from a GP or from a public hospital consultant before travelling for treatment abroad.
Some treatments may also require an in-person consultation, additional medical documentation or prior notification from the HSE. Requirements can vary depending on whether the treatment is outpatient, day-case or inpatient care.
How It Works
How does the reimbursement process work?
Although every patient's situation is different, the application process usually follows a number of important steps. Understanding these steps before arranging treatment may help avoid unnecessary delays and ensure that the correct documentation is available when applying for reimbursement.
Check Your Eligibility
Confirm that you are entitled to public healthcare in Ireland and that the treatment you are considering may fall within the scope of the Cross Border Healthcare Directive.
Obtain a Referral (if required)
Depending on the type of treatment, you may require a referral from your GP or from a public hospital consultant. Some treatments may also require prior notification before travelling.
Arrange Your Treatment
Once you have the necessary documentation, you can arrange your consultation or procedure with your chosen healthcare provider abroad.
Pay the Clinic
Patients normally pay the clinic directly. Keep all invoices, receipts and medical documentation, as these may be required when applying for reimbursement.
Submit Your Application
After treatment, submit your reimbursement application together with the required documentation to the HSE within the applicable time limits.
HSE Assessment
The HSE will assess your application and determine whether reimbursement is available under the scheme and, if applicable, the amount that may be reimbursed.
What documents may be needed?
The documents required may vary depending on the type of treatment and your individual circumstances. In many cases, patients should keep copies of referrals, consultation notes, invoices, receipts, medical reports and any additional documentation requested by the HSE.
Having complete documentation before and after treatment can help make the reimbursement process smoother.
Eligibility
Who may be eligible?
The Cross Border Healthcare Directive is intended for people who are ordinarily resident in Ireland and entitled to receive public healthcare through the Irish health system.
In general, the treatment should also be one that is available within the Irish public healthcare system. Eligibility and reimbursement are always assessed individually by the HSE.
Because every patient's circumstances are different, we recommend checking the current HSE requirements before arranging treatment abroad.
Important Information
What is usually not covered?
The reimbursement scheme does not automatically cover every expense related to travelling for treatment.
Travel costs, accommodation, meals, insurance and other personal expenses are generally not reimbursed. The HSE determines which healthcare costs may qualify under the scheme.
Prior notification
Certain hospital treatments may require prior notification before travelling. Whether this applies depends on the type of treatment and the current HSE requirements.
If prior notification is required, patients should ensure that the necessary approval has been obtained before arranging treatment abroad.
GP or Consultant Referral
Some treatments require a referral from a GP or from a consultant treating you within the Irish public healthcare system. The type of referral required depends on the treatment being planned.
Medical Documentation
Keep copies of referrals, consultation letters, invoices, receipts and medical reports, as these documents may be required when submitting your reimbursement application.
Payment First
Patients usually pay the healthcare provider directly. Any reimbursement application is submitted to the HSE after treatment has been completed.
Individual Assessment
Every application is assessed individually by the HSE. Meeting the basic criteria does not automatically guarantee reimbursement.
Frequently Asked Questions
Common Questions About the Cross Border Healthcare Directive
Do I need a referral before travelling?
Depending on the treatment, you may need a referral from your GP or from a public hospital consultant. Some hospital treatments may also require prior notification before travelling.
Will the HSE pay the clinic directly?
No. In most cases, patients pay the healthcare provider directly and then submit an application for reimbursement to the HSE after treatment.
Will all of my costs be reimbursed?
Not necessarily. Reimbursement depends on the treatment received, HSE eligibility criteria and the level of funding available for the equivalent treatment within the Irish public healthcare system.
Are flights and accommodation included?
Travel, accommodation and other personal expenses are generally not covered by the Cross Border Healthcare Directive.
Do all treatments qualify?
No. Eligibility depends on the individual treatment and whether it falls within the scope of the HSE scheme. Certain hospital treatments may also require prior notification before travelling.
How long does reimbursement take?
Processing times may vary depending on the complexity of the application and the documentation provided to the HSE.
Important to remember
The information provided on this page is intended as a general guide only and should not replace the official guidance published by the Health Service Executive (HSE).
Requirements, reimbursement rules and eligibility criteria may change. Patients should always check the latest information published by the HSE before arranging treatment abroad.
Need help understanding the process?
If you're considering treatment in Poland and have questions about the Cross Border Healthcare Directive, referrals or reimbursement, MedTrip Poland will be happy to help you understand the process before you make any decisions.
While we cannot determine your eligibility or make decisions on behalf of the HSE, we can explain the treatment pathway, help you understand the required documentation and direct you to the appropriate official resources.
contact@medtrippoland.ie
