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How does this scheme work?

The Cross Border Directive (CBD) allow patients in the Republic of Ireland to travel to other European/EEA* countries for their procedure. After traveling abroad and having the surgery performed, through the CBD service, the patient can then be reimbursed for the cost of the surgery by the HSE.

Funding will only be reimbursed for healthcare that is publicly funded and available in Ireland and is in line with Irish legislation.

You can’t use a private outpatient appointment to use the Cross Border Directive. This is the same if you have already paid privately for your procedure. You also cannot access the CBD if you do not have a GP letter of referral specifically related to the procedure you need.


Who is eligible?

You are eligible for the Cross Border Directive if you are any of the following:

– You are a resident of the Republic of Ireland (i.e. you receive salary/pension/social welfare in Ireland.)

– You have a GP letter referring you to a public Consultant in a public hospital for your condition.

– You have seen a Consultant in a public hospital and placed on a public waiting list for your procedure.

Are there restrictions?

You are NOT eligible for the Cross Border Directive if you are any of the following:

A private healthcare patient.

– If you have attended private healthcare services for your condition.

If you have privately paid for your surgery.


How do I find out information on services abroad?

You can contact Charter Medical to inquire after the CBD services it offers. If you are interested in the service there will be a brief eligibility, phone-based, screen. If eligible an appointment will be arranged for you to come into Charter to meet with a patient liaison officer to proceed with the CBD.

Do I have to be a public patient?

Yes. The Cross Border Directive service is not available to private health care patients.

The attendance of private health care services means that you are a private patient and cannot use the Cross Border Directive pathway.


Does the fact that I have private health insurance preclude me from applying for this scheme?

No. Patients who have private health insurance can choose not to use it in favour of being treated as a public patient. It is your status as a public patient which entitles you to opt for services under the terms of the CBD.

However, any private patient can choose to be treated as a public patient, but only if their referral for surgery abroad comes from a public Irish Consultant or their GP.

Do I have to go to a public facility or can it be a private facility?

A patient may avail of healthcare in a public or private facility when having their surgery abroad. But the patient will only be reimbursed the cost of the surgery as if it were performed in an Irish public facility.

Can I access services outside Europe?

The scheme is only available to be used in other EU/EEA countries.*

*Excluding Switzerland.


If I am on a waiting list can I apply?


How do I apply?


What is the application process?

– Contact Charter Medical at 01 6579015 and you will be in contact with one of Charter’s patient liaison officer for a preliminary, phone-based, eligibility screening.

– The patient liaison officer will send you an information pack of necessary forms and information to send back to Charter Medical.

– If you are suitable after the first screen, Charter will schedule a health assessment in our clinic to ensure you can travel to your surgery abroad safely.

– On return from your surgery abroad Charter Medical will help in making sure the necessary forms are present and help you in getting reimbursed from the HSE.

Should I have a query in relation to completing the application form; can I call Charter Medical to speak to someone?

Feel free to get in contact with Charter Medical who will answer any queries about the CBD you may have.

Is the application form available in any other languages?

The application form is available in English language format only.

When I apply, how long does the decision process take?

A decision can be expected between 15 and 20 working days following the receipt of a completed application and any other information/clarification requested.

Does the Charter Medical organise the appointment or do I have to organise it myself?

Charter Medical will help organise any appointments (such as the GP health assessment) that are needed should you access the CBD through their pathway.

You do need to have a GP referral or have seen a consultant in a public hospital prior to contacting Charter about the CBD.

Do I have to be medically assessed before I apply (inpatient)?

No. You can be currently on the public inpatient HSE waiting lists and still apply. Charter supplies a clinical review prior to travel regardless of prior status.

Do I have to be financially assessed before I apply? 

Financial assessment is not required, and Credit Unions offer special rate loans for those who wish to access the CBD:

1) Loans up to €2,000 for people receiving Social Welfare (ideal for cataracts)

2) Loans up to €15,000, (ideal for all procedure types.)

– Payment of the cost of the procedure does have to be paid in full up to 10 days before your date of surgery.


Do I have to be referred by an Irish based consultant/doctor before I apply?

Yes. You must have a letter of referral from a GP or public Consultant before you apply. Either are sufficient.

Can I apply myself or do I need to get my GP or my Consultant to complete the application also? 

You cannot self-refer. You will need to be referred by your GP for your procedure or by a public Consultant to complete the application.

Must I be on a waiting list to qualify to use the CBD?

No, you do not have to be on a waiting list to qualify to use the CBD, you simply need a letter of referral from your GP in relation to your procedure. You can also access the CBD if you are on a waiting list for the same procedure you’d access the CBD for, but it is not a requirement.


How much does it cost?

Reimbursement to patients will be amount that the procedure cost. The cost varies depending on the surgery type and whether an inpatient stay in the hospital abroad is required.

Charter Medical introduces a no co-payment element to the patient pathway. However, after your assessment in the clinic and your date of surgery has been booked – along with flights and accommodation – a deposit of €250 will be required in the case of non-attendance on the departure date.

Flights are covered by Charter Medical and Ramsay Health Care, and Ramsay also provides up to €200 (up to one night) for accommodation costs.


How and where do I apply for reimbursement?

Charter Medical will assist you in receiving your reimbursement from the HSE once you have had your procedure.

Does the HSE pay upfront or do I have to pay and claim reimbursement?

Patients must pay the Ramsay Health Care provider upfront 10 days before their procedure date. Reimbursement can be claimed on your return from the HSE.

Will I get fully reimbursed and if so, how long will this process take?

You will get reimbursed for the cost of your procedure.

Once you have been supplied with all the necessary receipts as proof of your travel, you can then apply for reimbursement to the appropriate HSE department for processing. This will take approximately 60 days.

If I do not have the finances available to pay in advance, is there any scheme available for me to access?

No. The procedure needs to be paid for upfront before you travel for surgery. Only then can be reimbursed.

Credit Unions, however, offer reasonable loan rates even to patients on social welfare with 48-hour loan approval and cheap joiner fees.

Is the cost of all my medication covered, i.e. if I get a 6 month prescription dispensed under the scheme while abroad, can I get the cost back?

Prescription charges cannot be reclaimed under the CBD.

The HSE operates the Drugs Payment Scheme for patients entitled to funding for drugs.  The cost of medication availed for while accessing treatment under the CBD would be subject to the same terms and conditions of the Drugs Payment Scheme as if the treatment had been provided in Ireland.

Can I claim travel and accommodation expenses?

No. In Charter Medical’s CBD pathway flights are paid for at no cost to the patient. Our partners, Ramsay Health Care, also supply up to €200 (up to one night) for accommodation costs which in most cases is sufficient.

Due to the flights being at no cost to you, a deposit of €250 will be required if flights, accommodation, and a surgery date have been arranged by Charter, in the case of non-attendance on the date of departure.

Is there a limit to the amount of funding available for the procedure?

Yes. The maximum that a patient can claim for a procedure is the value that procedure would have cost in Ireland in a public facility.

If I availed of treatment prior to application, can I seek reimbursement retrospectively?

Yes, if the healthcare you availed of under the CBD without application would have met the terms of the CBD then it is likely your request for reimbursement would be approved. This is best settled by contacting the HSE directly and is not a service Charter Medical provides.

Treatment and Follow up

Can I avail of follow up care in Ireland or do I have to return to the EU country of treatment? 


In Ireland, Charter Medical offers the option to avail of a post-surgery physiotherapy program in the clinic 6 to 12 weeks after surgery and return to Ireland in a group-based class. A patient can be released to the public service waiting lists for physio if they wish to or pay for the service themselves privately.

Do I have to receive all my care abroad?

No, you simply need to have the surgical procedure abroad to be eligible for reimbursement if the rest of the criteria is also met.

If treatment is not successful, can I re-access the medical treatment in the EU country and will I get reimbursed?

Yes and yes.

If something goes wrong with my treatment/procedure, can I return for follow up treatment and will this be covered by the scheme?

Patients will be required to have an EHIC card (European Health Insurance Card) should they need to attend an emergency department when abroad, which will cover their attendance.

If a complication arises in Ireland after the procedure has been completed, you are advised to attend your nearest Emergency Department.

If there are complications with the procedure, can I access the Irish healthcare system to put it right?

Yes, if there are complications once you have arrived back in Ireland it is advised to visit your nearest Emergency Department for treatment.

In the unlikely event of fatality, does the HSE cover the cost of repatriation?


Would an interpreter be made available to me for any queries I might have?

Not by the HSE or Charter Medical. Services abroad may make interpreter services available to patients from another country accessing their services, but you would have to arrange for this personally.

Does the treatment/ procedure have to be available in Ireland already?

Yes, if treatment/procedure is not available in Ireland, patients should apply under the E112 scheme. This service does not cover cosmetic surgeries or organ transplants. Charter Medical does not offer it’s CBD service for paediatric cases.

Is there a limit to the amount of applications I can make?


If my application is refused, can I appeal?


Will my appeal be dealt with by a person independent to those administering the CBD scheme?

Yes, the CBD office is under the line management of the General Manager, Commercial Unit of the Acute Hospitals Division, HSE.  All appeals will be directed to the General Manager for her decision. Charter Medical will defer to them decision in this event.

Do I need to bring my EHIC with me?


It will be necessary to have an EHIC card on your patient pathway in the unlikely event that you need to attend an emergency department abroad in the country you are receiving your procedure, so that you do not have to pay undue costs in a case of emergency.

Does this replace the EHIC and Treatment Abroad Scheme?


The provision of healthcare under both these schemes will remain in place. You will only be entitled to access your care under one scheme at any given time and you will be advised which is the most advantageous scheme to your circumstances in accordance with the regulations.

If you have any further queries, or would like to speak to one of Charter Medical’s Patient Liaison Officers in relation to the CBD, do not hesitate to contact us at 01 6579015, or email at cbd@chartermedical.ie