According to the EU Cross-Border Healthcare Directive 2011/24/of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare,
you can reclaim the cost of healthcare abroad up to the maximum amount of its cost in your home EU country:
- You can’t claim for the cost of any prescription drugs you need after your healthcare
- You won’t be paid for any travel costs.
If you are having healthcare that involves an overnight stay in the hospital, we advise you to apply for prior authorization before you go abroad.
How much you can claim
You can claim repayment for whichever is the lesser:
- the cost of your healthcare abroad
- what the healthcare would have cost in your home EU country
If the healthcare costs less abroad than it would have in your home country you can only claim for what you paid.
Outpatient healthcare claims
- The maximum you can be repaid for an outpatient consultation in a hospital abroad is €130.
- Outpatient care is healthcare that doesn’t involve an overnight hospital stay.
Inpatient healthcare claims
Inpatient care abroad is healthcare that involves an overnight stay in the hospital.
How to apply
- To apply for repayment under the Cross Border Directive, you and your healthcare provider abroad should complete the CBD pro forma invoice.
- Before leaving the hospital ask the consultant to fill in part B of the pro forma invoice.
- Repayments are made only to the patient or their parent or guardian if the patient is under 18.
- The executor of the patient’s estate can apply for repayment if the patient is dead.
- You’re breaking the law if you enter any false or misleading information on the pro forma invoice.
The Cross Border Directive pro forma invoice
- We recommend completing a CBD pro forma invoice. This is because it has all the information for health insurance to make a prompt repayment.
- You and your healthcare provider abroad need to complete the pro forma invoice in English.
- If any part of the invoice is completed in another language you’ll have to pay for and submit a certified translation.
- You can’t claim the translation cost.
- Your consultant abroad must put in the correct DRG (Diagnosis-Related Group) code for your hospital treatment.
- Your health insurance will check the DRG code you provided and if this review suggests a different code should have been used, the insurance will pay the outcome of the evaluation.