How the EU Cross-Border Directive works for Irish families.
Five steps, set out in EU law and administered by the HSE, take a patient from GP referral to reimbursement. Most families find the idea hard to believe at first, accessing private healthcare with public funding. It is real and used by thousands of Irish patients every year, and this page explains it end to end.
The pathway, step by step.
You can verify every part of this pathway independently with the HSE National Contact Point: Cross-Border Healthcare Directive Department, St Canice's Hospital, Kilkenny · (056) 778 4546 · crossborderdirective@hse.ie. We encourage it.
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Referral from the Public System
You need a referral letter from a GP or from a hospital consultant who sees the patient as a public patient. The letter should state the diagnosis, summarise the condition, explain why rehabilitation is needed, and carry a handwritten signature and a date. A private-only referral cannot support an HSE claim. If you are unsure what to ask your GP for, call us first; we will give you the exact wording the HSE expects.
Outpatient Consultation
Before inpatient treatment, the HSE requires an outpatient consultation. There are two ways to do it. It can happen in Ireland with a public hospital consultant, whose standard clinic letter satisfies the HSE. Or it can happen at Evexia Plus with our rehabilitation physician on the day before admission, so the family makes one trip. One rule matters more than any other: the referral letter must be dated before the consultation. The HSE checks this sequence on every claim.
Prior Notification (Optional, Strongly Recommended)
Prior Notification is an application to the HSE National Contact Point that confirms, in writing and in advance, how much you will be reimbursed. Under current HSE guidance it is optional for inpatient care, but we recommend it to every family: it removes the biggest unknown before anyone books a flight. Processing usually takes 15 to 20 working days, so allow for it in your planning. We prepare the application with you.
Travel, Treatment, Payment
The patient travels to Evexia Plus (free airport transfer from Thessaloniki International Airport, for patient and family), completes the inpatient programme, and pays the hospital directly on discharge. Keep every original document: itemised invoice, receipts, discharge summary. We hand you a complete, claim-ready file.
Apply for Repayment
Back in Ireland, you submit the claim to the HSE National Contact Point in Kilkenny: application form, pro-forma invoice, receipts and discharge documents. Incomplete files are what cause delays, which is why we assemble the file before you leave the hospital.
Referral from the Public System
You need a referral letter from a GP or from a hospital consultant who sees the patient as a public patient. The letter should state the diagnosis, summarise the condition, explain why rehabilitation is needed, and carry a handwritten signature and a date. A private-only referral cannot support an HSE claim. If you are unsure what to ask your GP for, call us first; we will give you the exact wording the HSE expects.
Outpatient Consultation
Before inpatient treatment, the HSE requires an outpatient consultation. There are two ways to do it. It can happen in Ireland with a public hospital consultant, whose standard clinic letter satisfies the HSE. Or it can happen at Evexia Plus with our rehabilitation physician on the day before admission, so the family makes one trip. One rule matters more than any other: the referral letter must be dated before the consultation. The HSE checks this sequence on every claim.
Prior Notification (Optional, Strongly Recommended)
Prior Notification is an application to the HSE National Contact Point that confirms, in writing and in advance, how much you will be reimbursed. Under current HSE guidance it is optional for inpatient care, but we recommend it to every family: it removes the biggest unknown before anyone books a flight. Processing usually takes 15 to 20 working days, so allow for it in your planning. We prepare the application with you.
Travel, Treatment, Payment
The patient travels to Evexia Plus (free airport transfer from Thessaloniki International Airport, for patient and family), completes the inpatient programme, and pays the hospital directly on discharge. Keep every original document: itemised invoice, receipts, discharge summary. We hand you a complete, claim-ready file.
Apply for Repayment
Back in Ireland, you submit the claim to the HSE National Contact Point in Kilkenny: application form, pro-forma invoice, receipts and discharge documents. Incomplete files are what cause delays, which is why we assemble the file before you leave the hospital.
The mistakes that delay or sink claims.
The HSE rejects or delays claims for predictable, avoidable reasons. Ireland's Ombudsman has published case after case. These are the failure modes, and how we close each one off:
The referral must come from the public system. We check yours before anything else happens.
The sequence matters: referral first, consultation second. We schedule around it.
The HSE needs to see exactly what was provided. Our invoices are itemised line by line as standard.
One missing page stalls a claim for weeks. You leave the hospital with a complete, claim-ready file.
What the HSE repays, and what it does not.
Under the EU Cross-Border Directive, patients pay Evexia directly on discharge and claim reimbursement from the HSE, against the equivalent Irish public-system rate.
What is reimbursed
What is not reimbursed
How the figure is set
Who can use the directive.
Bridging the upfront cost until the HSE reimburses.
The HSE reimburses after treatment, not before, and there may be a shortfall even then. Families handle this in different ways: savings, family support, and very often a credit union loan.
Irish credit unions offer personal loans for medical purposes. Terms and rates are a matter between you and them.
The loan settles the invoice directly with Evexia Plus when treatment ends.
The reimbursement offsets the loan, and the remaining balance is repaid over the agreed term.
Questions about the directive, answered straight.
Most families start with one phone call.
Tell us about your family member. Our Irish team explains the EU Cross-Border Directive, confirms whether Evexia fits, and outlines next steps. No referral or paperwork needed for the first call.