Your rights

What the Cross Border Directive is

The European Union directive on patients' rights in cross-border healthcare, from 2011, gives you the right to have planned treatment in another European Union country and to claim the cost back from your own health service. In Ireland the HSE runs this as the Cross Border Directive scheme.

1. 2011

   European Union law

   The directive on patients' rights in cross-border healthcare gives you the right.

3. Ireland

   The HSE

   Runs it as the Cross Border Directive scheme.

5. You

   Your treatment, paid back

   Planned treatment in another EU country, and the cost claimed back from your own health service.

Who can use it

You can use the Cross Border Directive if you have lived in Ireland for a year, or intend to live here for at least a year, and you are entitled to the treatment as a public patient in Ireland. You do not need a medical card, and having private health insurance does not rule you out.

If you are paid a State pension or income from another European Union country, different rules may apply, and if your pension or income comes from the United Kingdom or Switzerland you may not be able to use the scheme. The HSE asks you to check with it first. We ask you about this in our first conversation, before anything else happens.

What treatment is covered

Any treatment that is available in the Irish public system can be covered. Hip and knee replacements and cataract surgery are common examples. Organ transplants and long-term nursing care are not covered. Ablement helps with planned surgery only: we do not arrange emergency care, cosmetic treatment, dental care or physiotherapy.

You need a referral letter

Your GP (general practitioner), or a consultant who sees you as a public patient, must write a referral letter. A letter confirming that you are on a public waiting list for the same treatment also counts. A referral from a private consultant cannot be used.

The HSE's rules say the letter must name the specialty, for example orthopaedics, and the hospital or service you are referred to. The Ombudsman recommended in 2023 that a claim must not be refused because the letter is addressed to the specialty rather than a named hospital, and the HSE agreed; we tell your doctor what to write. The date matters: the letter must be dated before your first consultation with the consultant who will treat you.

You must see the consultant first

Before any treatment you must have an outpatient consultation: abroad with the consultant who will treat you, or in Ireland with a consultant who sees you as a public patient. For a day case the HSE accepts a consultation in person, by telephone or by video. For an operation with an overnight stay its rules say the consultation must be in person; it can take place at the hospital before you are admitted. We tell you which applies to your treatment and arrange it with the hospital.

What is paid back

You pay the hospital first. After the treatment the HSE pays you back the lower of two amounts: what the hospital charged you, or what the same treatment costs in the Irish public system. Before you decide anything, we show you the Irish public rate and the hospital's fixed price side by side, so that you know what, if anything, you would pay yourself.

The refund is paid to you only, into your own account. It does not cover travel, accommodation, a companion's costs, translation, or anything above the Irish rate. It does not cover any fee to a company that arranges treatment, which is why you never pay Ablement anything and why the hospital's invoice is always in the hospital's own name. If private health insurance pays any part of the treatment, the claim fails, so do not claim on your insurance for anything to do with it.

How and when you are paid back

The claim is made after the treatment. It needs the application form, your referral letter, the hospital's itemised invoice and receipt, and proof that you paid the hospital yourself. We fill in the form, collect the hospital's section and check every document. You sign the declaration; the claim is yours and the money is paid to you.

The HSE pays the refund in 45 days, on average (2024). We send your claim within five working days of your return home and follow it up until it is decided. We cannot promise an amount or a date.

45 daysfor the HSE to pay the refund, on average (2024)

Telling the HSE before you go

You can send the HSE a prior notification form before you travel. This is optional. It confirms that you are eligible to apply and gives an indication of the amount, not a final figure. It can only be sent after your consultation. We prepare it and send it for you, in parallel with the hospital booking; the booking does not wait for the answer.

If the claim is refused

You can appeal within three months of the decision, by post or e-mail, to the National Appeals Service of the HSE. If you are still not satisfied, you can complain to the Office of the Ombudsman. We draft the appeal for you, free of charge; you sign and send it. We cannot promise the result, and we cannot cover a shortfall.

3 monthsto appeal, from the date of the decision

Ablement is not part of the HSE

Ablement ApS is a private company registered in Denmark. We are not part of the HSE and we do not act for it. We are not a hospital and we give no medical advice. The hospital pays us; you pay nothing for our service.

You can call the HSE's Cross Border Directive office in Kilkenny on 056 778 4546 with any question about the rules, and you can schedule a free call with us or write to hello@ablement.eu.

Rules as published on the HSE's Cross Border Directive pages, read on 21 October 2026.