If you are ordinarily resident in Ireland and require specific
hospital treatment that is necessary and is not available in
Ireland, the Health Service Executive may authorise the provision
of this treatment in another EU/European Economic Area (EEA)
member state or Switzerland if certain conditions are met.
Someone who is "ordinarily resident" in Ireland is someone who
is living here and intends to continue to live here for at least a
European Court of Justice cases may mean that the rules can be
applied more extensively but this is not yet fully clear. (View
further information on this issue in the section 'The European
Court of Justice and the Watts Case', below).
The other EU member states are Austria, Belgium, Denmark,
Germany, Finland, France, Greece, Italy, Luxembourg, The
Netherlands, Portugal, Spain, Sweden, Great Britain, the Czech
Republic, Hungary, Poland, Malta, Cyprus, Estonia, Latvia,
Lithuania, Slovakia and Slovenia.
The EEA member states are Iceland, Liechtenstein and Norway.
The Health Service Executive may refer patients to other
countries (i.e., outside the EU/EEA or Switzerland) and may agree
terms for that referral but this is outside the scope of the EU
The rules on entitlement to hospital treatment in another EU/EEA
country or Switzerland rules apply in each member state.
The regulations do not deal with entitlement to services in
your own country nor do they require any country to provide any
particular treatment for its residents.
They do provide that you can be referred to another Member
State for treatment in certain circumstances. There is no
legislation in Ireland on the circumstances in which you may be
entitled to be referred abroad. The
Department of Health and Children have issued guidelines to
the Health Service Executive on the use of these provisions.
EU regulations provide that an individual from one Member State
is entitled to medical benefits on the same basis as nationals in
another Member State if authorised by the competent institution in
his/her own state. The competent institution in Ireland is the
Health Service Executive.
This authorisation may not be refused if
- the treatment in question is
among the benefits provided for in the home state's legislation
- the individual cannot be given
this treatment within the time normally necessary for obtaining
it in the home state, taking account of his/her current state of
health and the probable course of the disease.
It should be noted that any member state may grant
authorisations for treatment in another member state on a much
wider basis. The regulation only stipulates when such
authorisations may not be refused, it does not lay down the limits
to when they may be granted.
The cost of such treatment is covered initially by the Member
State providing it but that state is refunded by the home state.
Guidelines to the Health Service Executive (HSE)
The Department of Health and Children's guidelines for the
Health Service Executive (HSE) set out the conditions for referral
to another EU/EEA country or Switzerland:
- Your application must be assessed before you go abroad,
although some leeway may be allowed in extremely urgent cases.
- A hospital consultant must provide medical evidence of the
details of your condition. The consultant must certify that:
- the treatment concerned is not available in this country
- there is urgent medical necessity for the treatment
- there is a reasonable medical prognosis
- the treatment is regarded as a proven form of medical
- the treatment abroad is in a recognised hospital or other
institution and is under the control of a registered medical
The usual procedure is that a person who is authorised to go to
another member state for treatment is issued with a Form E112 to
establish his or her entitlement to the treatment. The issue of
Form E112 implies a commitment by the Health Service Executive (HSE)
to pay the cost of treatment.
Arrangements that are made outside the terms of the EU
Regulations, e.g., arrangements to send a patient to a non-EU or a
non-EEA country or private arrangements for treatment, are
considered to be outside the terms of the Regulations and the
Health Service Executive (HSE) is
not obliged to meet any of the costs involved. However, in
exceptional circumstances, the HSE may may pay a contribution
towards the cost of the service. It may, for example, pay the
costs of treatment in private institutions in other EU/EEA
countries or Switzerland that are made available to the health
authorities in these countries for the treatment of public
patients on a contract basis. In such cases, HSE Areas may have to
verify that the charges are similar to the charges levied on
patients from the home country.
European Court of Justice (ECJ) and the Watts Case
On 16 May 2006 the ECJ delivered an important decision in a
case involving the rights of EU nationals to travel to other
member states to avail of services. That case, (the Watts case)
related to the rights of an EU national to apply for an E112
authorisation in order to travel abroad to avail of health
services in another member state. Under the E112 scheme, a member
state cannot refuse an application for an E112 authorisation where
the health treatment is normally available in the home member
state but cannot be provided in the individual's case without
The decision of the ECJ was that in order to refuse an E112
authorisation on the grounds of waiting times, the public health
service must establish that the waiting time does not exceed the
time acceptable, given an objective medical assessment of the
clinical needs, etc. of the person concerned.
View the judgement of the ECJ in the Watts case here (pdf) .
It is not possible to download
a Form E112. You must contact
contact your Local HSE Office for more information in relation
to referral for treatment abroad.
If you have been referred for treatment abroad, the HSE will
authorise this treatment by issuing you with Form E112.