The rules and procedures to access medical treatment in another Member State differ depending on the purpose and duration of your stay there. You may be on a temporary stay, for example, a holiday or business trip. You may have gone to that country specifically for medical treatment because that treatment was not available in Ireland; or there are long delays to obtain the treatment in Ireland; or you may have taken up residence there.
Accessing medical treatment during a temporary stay - the European Health Insurance Card
The European Health Insurance Card makes it easier for people from the European Union’s 27 Member States, Iceland, Liechtenstein, Norway and Switzerland to access health and medical care services during temporary visits abroad.
If you are going on holiday, a business trip or a short break or are heading off to study abroad, remember to make sure that you have obtained a card. It will help save you time and money if you fall ill or suffer an injury while abroad.
What are the practical benefits of the card?
The card ensures that you will get the same access to necessary medical treatment under public sector health care (e.g., a doctor, a pharmacy, a hospital or a health care centre) as nationals of the country you are visiting. If medical attention is necessary in a country that charges for health care, you will be reimbursed either immediately or after you go home to your own country. The idea is that you are given the care you need to allow you to continue with your stay.
However, it is important to note that the card does not cover your health care costs while abroad if you are travelling to obtain treatment for an illness or injury that you had before travelling. Nor does the card cover you for private sector health care providers.
June is an Irish national and is resident in Ireland. She plans to go to Spain for a short holiday. While she is in good health, she is worried about healthcare if she becomes ill while abroad. As a citizen of the EU, does she have any entitlement to healthcare in Spain or in any other Member State of the EU?
As a resident of an EU Member State, June is entitled to free or reduced cost necessary medical treatment in any EU country as well as Iceland, Norway, Liechtenstein and Switzerland. If she falls ill, she should present at the nearest public hospital with her European Health Insurance Card. She will be given the same medical treatment as a Spanish national would receive.
Only publicly funded treatment is included in the European Health Insurance Card scheme – each country operates its own rules for medical provision. In some countries, medical treatment is free, in others you pay part of the cost; in others you pay the total cost and then claim a refund.
Where can I obtain a European Health Insurance Card?
You have the following options in applying for your European Health Insurance Card:
- You can apply online at http://www.ehic.ie/.
- You can apply in person by completing an application form at your local Health Office
- To apply by post, ask for an application form at your local Health Office, Community Care office or Health Centre. An application form can be posted to you from these offices or you can download it from http://www.ehic.ie/. Return the completed forms to your local Health Office.
If I am resident outside Ireland but receive my pension from Ireland, where do I apply for my European Health Insurance Card?
You should apply for your European Health Insurance Card from the country where you are paying to or benefiting from the social security system. This will not necessarily be your State of residence.
In practice this means that the HSE issues EHICs to all Irish insured persons or pensioners and their dependents resident in other Member States, e.g., a retired person receiving a contributory pension from the Department of Social Welfare but who lives in Spain should apply for his EHIC to the Irish authorities.
I am a British retiree resident in Ireland. I hold an EHIC from the UK. Is this card still valid for travel to EU Member States?
If you have a UK European Health Insurance Card (EHIC) it will be valid until the expiry date on the card. Once it expires, you should apply for a global health insurance card from the UK to replace it. Further details are available on this website.
I am Irish and have been resident and employed in the UK since 2019. My EHIC is due to expire next month. Can I apply for a further EHIC in the UK as an Irish national or should I make the application in Ireland?
When your EHIC expires, as an Irish national residing in the UK before 31st December 2020, you can apply for a UK GHIC. Further information is available on this website.
Is it necessary to obtain travel insurance in addition to the European Health Insurance Card?
It is advisable to take out travel insurance in addition to the European Health Insurance Card. Few countries pay the total cost of medical treatment even under reciprocal health service arrangements. Illness or accident abroad may mean extra travel, accommodation and repatriation costs for which you should be insured. Certain travel insurers will only honour a travel insurance claim for medical costs if the policy holder can produce evidence of the European Health Insurance Card.
Who should I call in case of emergency?
112 is the single European emergency number, reachable everywhere in the EU, from landlines and mobile phones, free of charge. 112 links the caller to the relevant emergency service (local police, fire brigade or medical services) and is available 24-hours a day. 112 is now operational in all EU Member States alongside existing national emergency numbers (like 999 or 110). 112 is also being used in a few countries outside the EU, such as Montenegro and Turkey.
See this website for further information.
What if I have a pre-existing medical condition requiring weekly medical treatment e.g., diabetes? Is it possible to visit a doctor in another State and who is responsible for the cost?
The cover provided by the European Health Insurance Card is not limited to emergency treatment. You should produce your European Health Insurance Card to the hospital to obtain the treatment. You may require supporting evidence from your GP of your condition. Consequently, you are recommended to bring a letter from your doctor confirming your condition.
Does a student undertaking study in another Member State have an entitlement to healthcare there?
Students are entitled to all health care benefits in kind e.g., healthcare and medicine during their studies in another Member State. To ensure that students can avail of these benefits, they should obtain a European Health Insurance Card from the health authorities in their home State prior to departure. Students are regarded as retaining their habitual residence in their home State and are treated as “staying” in the country of study. In these circumstances, the Commission has taken the view that the EHIC issued to students by their home State is valid and it guarantees to students studying in another Member State “any benefits in kind which become necessary on medical grounds during their stay, taking account of the nature of the benefits and the expected length of stay”.
When returning the application form, it should be accompanied by a letter from the student’s college confirming that the overseas semesters are part of a registered course.
If the student becomes ill while abroad, they should produce the European Health Insurance Card to the medical staff they consult at their local public hospital.
Where can I obtain further information on the European Health Insurance Card?
Further information on the European Health Insurance Card.
Accessing Planned Healthcare in another EU State
What is the significance of the Cross-Border Healthcare Directive?
The Cross-Border Healthcare Directive 2011/24/EU is designed to clarify patients' rights to access safe and good quality treatment across EU borders and be reimbursed for that treatment. Patients travelling to another EU country for medical care should enjoy equal treatment with the citizens of the country in which they are treated. If patients are entitled to that healthcare at home, then they will be reimbursed by their home country. The level of reimbursement will be up to the cost of that treatment, if obtained at home. In some cases, patients may need to seek authorisation before travelling for treatment, in particular, if the treatment requires an overnight stay at a hospital or highly specialised and cost-intensive healthcare.
How does the Cross-Border Healthcare Directive dovetail with existing provisions on obtaining health or medical care in another Member State under Regulations 883/2004/EC and 987/2009/EC?
If you are travelling temporarily to another Member State of the EEA or to Switzerland, and you require necessary medical care in that State, you can still rely on your European Health Insurance Card to obtain the medical care that you require during that temporary stay.
For planned medical care in another EU Member State, you can still apply under Regulation 883/2004/EC. This authorisation cannot be refused if you cannot be treated in your home country within a time limit which is medically justifiable. It is important to note that in Ireland, treatments that qualify for funding under the E112 Treatment Abroad Scheme (pursuant to Regulation 883/2004/EC) are excluded for reimbursement under the Cross-Border Healthcare Directive. Before applying for authorisation under either scheme, you should satisfy yourself that you are making the application under the correct scheme. To obtain advice, you should contact the Treatment Abroad Scheme office or the National Contact Point for the Cross-Border Healthcare Directive.
What is the added benefit of the Cross-Border Healthcare Directive over existing provisions on obtaining healthcare abroad under the social security Regulations?
First, the Directive covers all healthcare providers in the EU and is not limited to public providers. Second, prior authorisation will not be required in all cases as is currently the case for planned medical treatment under the social security Regulations. As a patient, you should be able to receive sufficient information to enable you to make an informed choice prior to making a decision to obtain treatment in another State. National contact points have been established to assist and advise patients on their options under the Directive.
The contact details for the Irish national contact point are: National Contact Point, Cross-Border Healthcare Directive Department, HSE, St Canice's Hospital, Dublin Road, Kilkenny.
General enquiries: 056 778 4546
When is prior authorisation from my national authority required under the Directive to receive treatment in another State?
National authorities are permitted to introduce a system of "prior authorisation" for going to another Member State for treatment in 3 cases:
- For healthcare which involves overnight hospital stay of at least one night
- For highly specialised and cost-intensive healthcare
- In serious and specific cases relating to the quality or safety of the care provided by the particular provider in question
If you are subject to Irish legislation, you will require prior authorisation from the HSE in all the above cases.
Can this authorisation be refused?
National health authorities can refuse authorisation if the treatment in question, or the healthcare provider in question, could present a risk for the patient. If the healthcare can be provided at home within a medically justifiable time limit, then authorisation can also be refused. However, Member States will need to explain why such a decision is necessary and will need to base their assessment of what is "medically justifiable" in your individual case.
What if I am refused authorisation?
Patients have the right to request a review of any administrative decision on cross-border healthcare for their individual case.
How much will I be reimbursed after receiving treatment abroad?
Patients will be reimbursed the same amount as they would receive in their own country for the same type of healthcare. Member States where care is free at the point of delivery, will need to inform patients about their reimbursement tariffs. If the treatment abroad is cheaper than in the home country, the reimbursement will reflect the real price of the treatment.
Can I seek healthcare abroad if the treatment is not available in my country?
Yes, but you will only be entitled to reimbursement if it falls within the "basket of benefits" you are entitled to according to the legislation or rules of your home country.
In Ireland, any service which is provided by the public health services in Ireland can be availed of under the Cross-Border Healthcare Directive, for example
- acute/psychiatric hospital services – day, inpatient, outpatient care,
- community based outpatient care e.g.:
- dental/orthodontics services (some exceptions i.e. dental screening services in schools)
- speech & language services or occupational therapy services (some exceptions i.e. assessment for aids at home)
- psychology services or physiotherapy services or disability services
- methadone programme
- ophthalmic (eye tests etc.) services
- mental health services
Do I need to pay for cross-border treatment upfront?
Yes, generally the patient pays upfront and is then reimbursed by their national authority as quickly as possible.
What should I do if something goes wrong whilst receiving treatment abroad?
The National Contact Point will be able to explain your rights and give information on the regime applicable in the country of treatment. Your home country is obliged to provide you with the same follow-up treatment it would have provided had the treatment taken place on its territory.
How can I be sure that the treatment I received abroad will be followed up properly on my return home?
Your home country has an obligation to ensure that the medical follow-up is of the same quality regardless of where in the EU the treatment took place.
Will my prescription be recognised in another EU Member State?
A prescription issued in another EU country should be recognised in a patient's country of residence and vice versa. This ensures that the healthcare provided in another EU country is properly followed-up on the patient's return home. The patient is entitled to obtain the prescribed medicine provided that the medicine in question is authorised for sale and available in the country where he or she wishes to have the product dispensed.
What information must be included in a prescription to ensure that the medication referred to can be obtained outside the Member State which issued it?
To be eligible for cross border use, the prescription must comply with the Annex to Directive 2012/52/EU. The name and surname of the prescribing professional must be set out together with their professional qualifications; their direct contact details; their work address and signature. The prescription should also include the date of issue; the patient’s name and surname; date of birth and information on the product prescribed. In relation to information on the product prescribed, the common name of the product should be provided (Directive 2001/83/EC); the brand name; the pharmaceutical formulation (tablet, solution, etc.), quantity; strength and dosage regime.
Where can I find further information on my rights in Ireland to obtain healthcare abroad?
You can find further information on obtaining healthcare abroad through the website of the HSE.
Further information is available here.
Accessing Health and Medical Care during residence in another State
How can I satisfy the Irish authorities that I have comprehensive sickness insurance when taking up residence in Ireland?
As Ireland operates a residence-based healthcare system, if you are entitled to use the Irish public healthcare service, this fulfils the requirement of comprehensive sickness under Directive 2004/38/EC. This is based on the ruling of the Court of Justice of the EU in Case C-247/20, VI. While the judgment was issued in the context of the UK, it applies generally to all EU Member States and EEA countries which operate residence-based healthcare systems.
What is my entitlement to health and medical care if I take up residence in another State?
You have the right to receive sickness benefits in kind, e.g., healthcare and medicines, in your country of residence, regardless of where you are actually insured on the same basis as nationals of that country.
If you are insured in a different country than the one where you reside, you should register with the local healthcare institution of your place of residence. To do so, you may need to ask the healthcare institution where you are insured for a Form S1. This form should then be presented to the institution where you live. This is typically the case for pensioners retiring to a different country than the one that pays their pension and where they are insured. It is not necessary for temporary stays.
Can I transfer benefits accrued in the country I have just left to my new country of residence?
The country where you are insured is responsible for paying your sickness, maternity or paternity benefits in cash, i.e., benefits that replace a wage that has been suspended due to sickness. These benefits will be paid according to the rules of the country where you are insured, regardless of where you are living or staying.
Whenever certain conditions have to be fulfilled before you become entitled to benefits, the institution examining your claim must take account of periods of insurance, residence or employment completed under the legislation of other countries. This is a guarantee that you will not lose your sickness insurance coverage when changing employment and moving to another country.
Where can I find out more about my health and medical care rights if I take up residence in another Member State?
You can access further detailed information on your health and medical care rights on taking up residence in another State here.
Further Legal Advice On Your Rights
Where can I obtain legal advice on my rights in the EU?
If you require legal advice on your rights in the EU, you may wish to contact the Your Europe Advice service. This is an EU advice service for the public. It consists of a team of 65 independent lawyers who cover all EU official languages and are familiar both with EU law and national laws in all EU countries. They will provide you with free and personalised advice in the language of your choice, within a week. The response received, either by email or telephone as selected by you, will clarify the European law that applies in your case and explain how you can exercise your EU rights.