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The Directive 2011/24/EU on cross border healthcare

The Health and Social Care Board (HSCB) will consider applications under Directive 2011/24/EU Cross Border Healthcare in another European Economic Area (EEA) country in either the state or private sector.

The cross border healthcare route is one where an individual (i.e. not the HSCB or the HSC Trust) seeks access to treatment in another European Economic Area (EEA) country in either the state or private sectors. Unlike other options, this arises where the Board considers treatment is available locally or within the rest of the UK within a medically/clinically appropriate time period, but a patient has nonetheless opted to seek treatment elsewhere.

In essence, you are able to seek healthcare services in any EU state outside the UK, as long as you would have been eligible for the same services in Northern Ireland.

The Directive covers all aspects of health care except the following:

What the Directive does not mean

The Directive does not mean that you will automatically receive funding for treatment in another EU state. Your home state retains the right to pre-authorise treatment and you must comply with the rules and regulations in order to make an application. There are set circumstances under which that application can be refused.

The Directive does not alter the right of a member state to define the benefits that they choose to provide for their citizens, and so if your treatment is not funded locally by your healthcare provider, you cannot expect them to fund it for you in another country.

Responsibility

In choosing to access healthcare in another Member State, the home patient is effectively stepping outside of the HSC system and using their rights under EU law to seek healthcare elsewhere. At this point, the patient is taking individual responsibility for ensuring that the service they obtain is appropriate and safe within the laws of the country of treatment (not under UK legislation). The HSC, under this legislation, will not be formally commissioning services from providers abroad and therefore will not be liable for the outcome of the treatment provided.

Reimbursement

Where you have opted to seek treatment under the provisions of the Directive:

Under the Directive, if your health service refuses to fund your treatment in another state, or if another state refuses to accept you for treatment, you must be given a full explanation as to why. The circumstances under which such refusals are allowed are clearly set out in the Directive.

If you are seeking treatment within the country’s state system you cannot expect to receive treatment in preference to a patient already within the country’s state healthcare system. This means you may have to observe local waiting times or the country’s guidance on particular treatments.

Prior Authorisation

Directive route applications must be authorised by HSCB prior to treatment if subject to “prior authorisation”.

Please note: There are commissioning restrictions on certain services and the Board, under Effective Use of Resources policies, do not commission certain procedures. Patients are therefore strongly advised to contact the Board in advance of travelling to discuss whether prior authorisation is required, as well as levels of reimbursement.

The Board recommends that you should ensure that you have comprehensive medical insurance for your journey for treatment. The cost of such insurance is not reimbursable by the health service. You should also ensure that you have a valid EHIC (European Health Insurance Card) for use in the event of medical emergency unrelated to the planned treatment. Please note that the EHIC card does not allow you to go abroad for the purpose of receiving planned treatment and does not cover the costs of private healthcare or services that are not part of the state healthcare system.

The HSCB can only process claims for people ordinarily resident in Northern Ireland and entitled to access health and social care services. Applicants are asked to provide proof of residency and entitlement to health and social care services (see application for details of documentation to be submitted).

It can take up to 20 working days for a fully completed application form to be processed and a decision made. You will be informed of the outcome of your application once a decision has been reached. If approved, the reimbursement can take up to a further 30 working days to be processed.

The patient is responsible for providing accurate and complete information to support the decision-making process. Incomplete applications will cause delay in processing your request.

Applications and supporting information must be in English. Costs of translation are a matter for the patient.

It is the HSCB’s expectation that you will pay the provider directly and submit original receipts as proof of payment to the HSCB. Reimbursement will be made when you provide proof of having received the service and incurred the cost.

For further information contact:

National Contact Point
Health and Social Care Board
12-22 Linenhall Street
Belfast BT2 8BS
Email: NationalContactPoint@hscni.net
Telephone: +44 (0)28 9536 3152

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