For GPs and consultantsFor referrers

The EU Cross-Border Directive, Step by Step.

Under the EU Cross-Border Healthcare Directive, you can have inpatient rehabilitation in another EU country and claim the cost back from the HSE. Here is who handles what, which forms you need and what the HSE repays, with the HSE's own page linked at every step.

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Where are you now?

Just starting: Start here: ask your GP for a referral letter, or call us first and we'll tell you what it should say. Step 1: the referral

I have a referral letter: Next: your outpatient consultation. Choose where to have it. Step 2: the consultation

I've had a consultation in Ireland: Next: your stay. Prior Notification is optional: you can apply now if you'd like the HSE's indication first. Step 3: your stay

I'm home and ready to claim: Next: send your claim. Here is what goes with it. Step 4: your claim

Your complete guide, from referral to repayment

Two parts of the route are your choice. The map opens on the route we recommend: nothing to wait for in Ireland before you travel. Change either choice to see how the route changes.

Your outpatient consultation

Prior Notification

Your route: four steps, with nothing to wait for in Ireland before you travel.

Your route: a consultation in Ireland first, then your stay. A public appointment can take some time to get.

Your route: a consultation in Ireland, then Prior Notification, then your stay. Allow time for both: the HSE's Prior Notification reply can currently take up to 4 months.

Your route: our consultation, then your stay. The Prior Notification form can only go after the consultation, so the HSE's reply usually arrives after your stay. The HSE assesses your claim after treatment either way.

1Referral
You and your familyRequest a referral letter.Hands over to your GP or consultant
Your GP or consultant in IrelandWrites a dated referral for inpatient rehabilitation.Hands over to the consultation
2Outpatient consultation
Your GP or consultant in IrelandAlternativeA consultant sees you in person, as a public patient, after the referral date.
Evexia PlusOur recommendationOur physician sees you in person, on a day before admission, and plans your stay with you.
OptionalPrior NotificationOptionalPrior Notification: not on your route.
You and your familyOptionalSend the HSE the Prior Notification form, with proof of your consultation. Our physician completes Section 4.Hands over to the HSE
The HSEReplies with an indication of what you might get back. Currently, the reply can take up to 4 months.
3Your stay
You and your familyPay the hospital: a booking deposit, then the rest during your stay.Payment to Evexia Plus
Evexia PlusYour inpatient rehabilitation programme.Evexia PlusAt discharge, the invoice in English, receipts, your discharge letter and the completed Section 4 of the claim form.Hands over to you
4Your claim
You and your familySend the claim form and copies of your documents to the HSE, by email or post.Hands over to the HSE
The HSEAssesses your claim and repays what you paid, up to the Irish public cost, into the patient's account.Payment to you
Read step 1What your referral letter must include
Read step 2Your outpatient consultation
Read about Prior NotificationPrior notification
Read step 3Proof you made the payment
Read step 4Apply for healthcare costs
Solid card: our recommended routeDashed card: alternative or optionalArrow: hands overCoin arrow: payment

Each card links to its step below.Download the route map (PDF)

Your two choices, weighed up

Both choices are yours, and the HSE allows all four combinations. Here is what each option gives you and what to weigh up, so you can decide.

Where to have your outpatient consultation

Benefits

  • No wait for an outpatient appointment in Ireland: you can start once our physician has reviewed your records.
  • The physician who sees you leads your programme and plans it with you, face to face.
  • The HSE notes that a consultation on a day before admission gives you time to decide whether you're comfortable with the consultant and the hospital.

Drawbacks

  • No time for Prior Notification: it requires proof of the consultation, and the consultation is just before admission, so you can't get the HSE's indication before your stay.
  • You travel before the consultation, so the final decision is made in person when you arrive.
  • You pay for the consultation; the HSE repays it at its outpatient rate.

Best if: you'd like to start soon, without waiting for an appointment in Ireland.

Benefits

  • Done close to home, before you travel.
  • It leaves time to apply for Prior Notification and get the HSE's indication before your stay, with the consultant's letter as proof of the consultation.

Drawbacks

  • You need an appointment in the public system, which can take some time to get, and your stay waits for it.

Best if: you already have a public appointment, or you want the HSE's indication before you go.

On hse.ieYour outpatient consultationDocuments you need for prior notificationOutpatient healthcare claims

Prior Notification

Benefits

  • Nothing to wait for before you travel: your admission date depends only on our physician's review of your records.
  • One form fewer: you apply for the costs after your stay either way.
  • The HSE assesses every claim after treatment, whether or not you applied for Prior Notification.

Drawbacks

  • You won't have the HSE's indication of the amount before you go.
  • You plan with our written estimate and the HSE's published rules.

Best if: you'd like to start without waiting, and you're comfortable planning with our estimate.

Benefits

  • The HSE gives you an indication of how much you might get back.
  • It gives you time to plan the payment, or arrange funding, before you travel.
  • It also confirms whether you are eligible.

Drawbacks

  • It's an indication, not the final amount: the HSE confirms the exact amount only after treatment.
  • Currently, the HSE's reply can take up to 4 months, which can hold back the start of your rehabilitation.
  • It needs proof of your outpatient consultation, so it fits the consultation in Ireland, or a public waiting-list letter.
  • You still apply for the costs after your stay.

Best if: you want the HSE's indication in writing before you decide, and you can wait for it.

On hse.iePrior notificationBenefits of prior notificationHow much you can claimDocuments you need for prior notification

What we recommend: the consultation with our physician, and no Prior Notification. Nothing to wait for in Ireland, and the HSE assesses your claim after treatment either way.

See this route on the map

What happens at each step

Four steps, plus one optional. The key line of each step is all most people need; the details are there when you want them.

1

Request a referral letter

Ask your GP, or a hospital consultant who sees you as a , for a letter that recommends a course of inpatient multidisciplinary rehabilitation.

What the letter must include

  • your name, address and date of birth
  • the hospital you are referred to, and the speciality: rehabilitation medicine
  • a summary of your condition and diagnosis
  • the reason for the referral
  • the doctor's signature (an electronic referral doesn't need one)

The letter must be dated before your outpatient consultation.

On hse.ieWhat your referral letter must includeWho can applyDocuments you need to provideIncome or pension from another country

In detail
  • A private referral can't be used. Private health insurance doesn't stop you using the Directive, but the referral must come from your GP or from a consultant you see as a public patient.
  • On a public waiting list? A letter confirming you are on a public waiting list in Ireland for the same care can be used instead of a referral.
  • Income or a pension from another country (another EU or EEA country, the UK or Switzerland) can change where you apply; the HSE checks this with you.
  • A referral from a GP abroad: contact the HSE first.
  • The letter doesn't need to state a length of stay. Our physician sets it at the consultation and reviews it during your stay.
2

Have your outpatient consultation

Before inpatient care, the HSE needs an , in person, dated after your referral. It is never on the day of admission.

Where to have it: with our physician, on a day before admission (our recommendation), or with a public consultant in Ireland. Both options are weighed up above, in Your two choices.

On hse.ieYour outpatient consultationDocuments you need for prior notification

In detail
  • The report: after a consultation with us, our physician writes a report to your referring doctor; you get a copy for your claim.
  • With the consultant in Ireland: their clinical letter from the consultation is your proof that it took place. It must be dated after the referral.
A doctor at a desk talking with a patient
On your routeNot on your route
Optional

Prior Notification

Before you travel, you can ask the HSE for an indication of how much you might get back. It is optional, and the HSE confirms the exact amount only after treatment.

Should you apply? We usually advise going ahead without it. Both options are weighed up above, in Your two choices.

How to apply: send the HSE the Prior Notification form, with proof of your outpatient consultation and a copy of your referral letter. Our physician completes Section 4.

On hse.iePrior notificationBenefits of prior notificationDocuments you needPrior Notification form, PDF

In detail
  • If your care changes: you can claim only for the care you actually have, which may differ from your Prior Notification.
  • On a public waiting list in Ireland? A letter confirming it can serve as the proof of consultation for Prior Notification.
3

Your stay, and paying the hospital

You travel to Evexia Plus for your programme: at least 3 hours of therapy a day, led by a rehabilitation physician. The airport transfer is free, and one family member stays free in your room.

You pay the hospital directly: a booking deposit confirms your admission date, and the rest is paid during your stay. The patient or a close family member can pay; the HSE must be able to see who paid.

At discharge, we give you every document the claim needs from us: the full list is below, in Every document.

Before you leave, fill in Section 2 of the claim form (your details): the HSE asks for it before our physician completes Section 4.

On hse.ieWhat your proof of payment must includeProof you made the paymentHealthcare costs application form, page 8Payments

In detail
  • Proof of payment: a bank or card statement, a card receipt, a transfer record, a bank draft or a cash receipt. The names and the amount must match the invoice.
  • When a family member pays: the HSE still repays the patient, and it must be able to see who paid.
  • Documents in another language need a certified translation. Everything we give you is in English.
A therapist and a patient smiling during hydrotherapy in the pool
4

Send your claim, and the HSE repays you

After your stay, send the HSE the healthcare costs application form, with copies of your documents, by email or post. You complete Sections 2, 3 and 5; Section 4 is already completed by our physician.

The HSE then assesses your claim and repays the patient. Repayment currently takes several months. What it repays is set out below.

On hse.ieApply for healthcare costsDocuments you need to provideWhen you can expect repaymentClaim form, PDF

In detail
  • The HSE may ask for more, for example the consultation report or the discharge letter. You have both from us.
Most families start with one phone call.01 263 3051orRequest a callback

Every document, and who gives it to you

Your claim needs only a few documents. Here is when each one comes to you, and who gives it. The list follows your route on the map.

  1. Before you travel

    • Your referral letter, dated before your outpatient consultation
    • The clinical letter from your outpatient consultation in Ireland
    • Your copy of the Prior Notification form, and the HSE's reply

    From your GP or consultant

    From your GP or consultant, and the HSE

  2. When you pay

    • Proof of each payment, made by the patient or a close family member: a bank or card statement, a card receipt or a transfer record

    From your bank or card provider

  3. At discharge

    • The invoice in English, with a breakdown of the charges
    • The receipts
    • Section 4 of the claim form, completed and signed
    • The report from your outpatient consultation with our physician

    From us

  4. Back home

    • Complete the rest of the claim form and send it to the HSE with copies of the documents above, by email or post

    Sent by you

On hse.ieWhat your referral letter must includeProof you made the paymentWhat your proof of payment must includeDocuments you need to provide

What the HSE repays

The HSE repays what you paid, up to what the same care would cost in the Irish public system. At Evexia Plus, we consciously aim to keep the cost of your stay below the Irish public cost. Before you commit, our team sends you a written estimate in English, so you can plan.

Reimbursable

  • Therapy, nursing care and your room in the hospital, as part of your inpatient programme
  • Medicines and tests during your stay
  • The outpatient consultation, at the HSE's outpatient rate

Not reimbursable

  • Flights and other travel
  • Family travel, and family accommodation outside the hospital
  • Medicines you take home

Private health insurance

You don't need it to use the EU Cross-Border Directive, and it plays no part in your claim.

On hse.ieHow much you can claimWhat is not coveredOutpatient healthcare claimsWho can apply

Funding the upfront cost

You pay the hospital before the HSE reimburses you, so some families arrange a loan to bridge the gap.

Some credit unions offer medical or EU Cross-Border Directive loans to help cover the upfront cost of treatment abroad.

Evexia Plus can give you the treatment details and a written estimate to support your application.

What a credit union usually asks for

  • Photo ID
  • Proof of address and income
  • Recent bank statements
  • A treatment quotation
  • Depending on the credit union, a referral letter, a letter from the HSE about your expected reimbursement, or both

Contact your credit union to confirm its requirements and repayment terms. Loans are subject to approval, and you remain responsible for the repayments, whatever the amount or timing of any HSE reimbursement.

Forms, and how to contact the HSE

Each HSE form opens on the HSE's website, so you always get its latest version.

HSE form · PDFHealthcare costs application formThe claim formAfter your stay. PDF, 20 pagesOpens hse.ieHSE form · PDFPrior Notification application formOptional, before you travel. PDF, 18 pagesOpens hse.ieEvexia Plus · downloadThe route mapWho handles what, on one page. PDFDownload

Contact the HSE

For questions about your application, contact the HSE's EU Cross-Border Directive office:

crossborderdirective@hse.ie
056 778 4546

On hse.ieContact and appeals

For GPs and consultants: writing a referral for the EU Cross-Border DirectiveWhat the HSE needs from the referral, who to address it to and how to send it.
Doctors around a table reading papers together

What the HSE needs

  • The patient is seen as a public patient. A private referral can't be used for the Directive.
  • The letter includes the patient's name, address and date of birth; the hospital and the speciality; a summary of the condition and diagnosis; and the reason for the referral.
  • It is signed, or sent electronically (then it needs no signature).
  • It is dated before the outpatient consultation.
  • It doesn't need to state a length of stay.

Addressed to

If the patient would like the outpatient consultation with us, please address the letter to:

Consultant in Physical and Rehabilitation Medicine
Evexia Plus Rehabilitation Hospital
35th km Old National Road Thessaloniki to Nea Moudania
63080 Lakoma, Greece

A named consultant: we don't name our consultants on the website. If you'd like to address the letter to one of them by name, call 01 263 3051 or email info@evexia.ie and we'll give it to you.

How to send it: give it to the patient, or email it to info@evexia.ie.

If you are the consultant seeing the patient in Ireland: your clinical letter from the consultation is the patient's proof that it took place. Please date it after the referral.

What you receive from us: our consultation report and, at the end of the stay, the discharge letter.

Questions: 01 263 3051 · info@evexia.ie

On hse.ieWhat your referral letter must includeWho can applyDocuments you need for prior notification

Is something still unclear?

Talk to us about your route

Tell us about the patient and where you are in the process. We'll explain the EU Cross‑Border Directive for your situation, what the referral letter should say and the next steps. No referral or paperwork needed for the first call. We call back Monday to Friday, 9am to 5pm Irish time.
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Questions about the EU Cross-Border Directive

Who can use the EU Cross-Border Directive from Ireland?

Anyone who lives in Ireland, or intends to, for at least a year, and is eligible for the same care in the public system. You don't need a medical card, and private health insurance doesn't exclude you. The claim is made in the patient's name.

On hse.ieWho can apply

Is rehabilitation covered by the EU Cross-Border Directive?

Yes. The HSE lists physiotherapy, occupational therapy, speech and language, and psychology services among the care available under the Directive. Inpatient rehabilitation at Evexia Plus is reimbursable this way. Long-term care for everyday tasks, such as nursing home care, is not covered.

On hse.ieHealthcare available under the DirectiveHealthcare not available under the Directive

Do I need Prior Notification?

No, it is optional. We usually advise going ahead without it; both options are weighed up above, in Your two choices.

On hse.iePrior notification

Can my referral come from a private consultant?

No. The referral must come from your GP, or from a consultant who sees you as a public patient. If you see a consultant privately, ask your GP for the referral instead.

On hse.ieWho can apply

Where should I have the outpatient consultation?

Either with our physician, in person, on a day before admission, or with a consultant in Ireland who sees you as a public patient. We recommend the first; both options are weighed up above, in Your two choices.

On hse.ieYour outpatient consultation

How much does the HSE repay?

What you paid, up to what the same care would cost in the Irish public system.

On hse.ieHow much you can claim

When does the HSE repay?

After it has assessed your claim. Repayment currently takes several months, so plan to pay for the stay first.

On hse.ieWhen you can expect repayment

Can a family member pay for my stay?

Yes, a close family member can pay. The HSE repays the patient, or a parent or guardian if the patient is under 18, and it must be able to see who paid.

On hse.iePayments

Does the HSE pay for flights or my family's stay?

No. Travel and accommodation are not covered. At Evexia Plus, one family member stays free in your room, and the airport transfer is free for you and your family.

On hse.ieWhat is not covered

Can I get a loan for the cost before the HSE reimburses me?

Some credit unions offer medical or EU Cross-Border Directive loans. They usually ask for photo ID, proof of address and income, recent bank statements and a treatment quotation, and some also ask for a referral letter or a letter from the HSE. We can give you the treatment details and a written estimate for your application. You remain responsible for the loan repayments, whatever the HSE reimburses and whenever it does.

What if the HSE turns down my claim?

You can appeal within 3 months of the decision, to the HSE's National Appeals Service.

On hse.ieAppeal a decision

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01 263 3051info@evexia.ie35th km Thessaloniki - Nea Moudania, 63080 Chalkidiki, Greece

Evexia Plus is a 287-bed specialist rehabilitation hospital near Thessaloniki, Greece, family-run since 1996. Consultant-led multidisciplinary teams treat neurological, orthopaedic and paediatric conditions, and Irish patients access care under the EU Cross-Border Healthcare Directive, reimbursable by the HSE, with our Irish team alongside from first call to homecoming.

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