Residents of the Republic of Ireland can access planned private healthcare in Northern Ireland and claim reimbursement from the HSE through the Northern Ireland Planned Healthcare Scheme (NIPHS). Here’s how the scheme works and how to apply.
How the scheme works
- Pay upfront. You must pay the Northern Ireland healthcare provider directly for your treatment before applying for a refund.
- HSE reimbursement. After treatment, you submit your invoice to the HSE to claim back costs, usually up to the amount the HSE pays for the same public procedure in Ireland.
- Public eligibility. The treatment you receive must be a type that is publicly available in the public system in Ireland.
- No waiting list required. You do not need to be on an official public hospital waiting list in Ireland to apply.
- Exclusions. Travel, accommodation, and outpatient prescription costs are not covered by the scheme.
Who can apply
To qualify for approval, you must meet these criteria:
- Irish residency. You must be living in the Republic of Ireland for at least one year (or intend to) and have a valid PPS number.
- Public service mirror. The procedure must be a treatment that is standard and publicly available within the HSE system.
- The outpatient requirement. You must have a documented outpatient consultation with your treating Northern Ireland consultant before you can undergo any surgery or inpatient treatment.
While applying for pre-approval is technically optional for day cases, it is highly recommended for all inpatient (overnight) treatments. Getting prior notification ensures the HSE confirms you are eligible and provides an official estimate of how much money you will get back before you spend anything.
Step-by-step: how to apply
- Secure a referral. Visit your local GP or a public hospital consultant in Ireland. Request a formal referral letter stating the exact medical treatment or surgical procedure you require.
- Book an outpatient consultation in Northern Ireland. Contact a private hospital or clinic in Northern Ireland. Book and attend an initial outpatient consultation with the surgeon or specialist who will be operating on you. Keep the invoice and proof of payment for this visit, as you will need it for the HSE paperwork.
- Submit the Prior Notification Form (if overnight). If your specialist confirms you need an overnight stay, you must submit paperwork before booking the surgery date. Download the HSE NIPHS Prior Notification Form and complete it along with your original GP referral letter and proof of your initial outpatient consultation.
- Pay and undergo treatment. Once you receive written confirmation from the HSE (or immediately if bypassing this for a quick day-case procedure), schedule your surgery date. You must pay the private facility fully upfront, usually via credit card, bank draft, or electronic transfer.
- Claim your reimbursement. After your treatment, gather your final hospital invoices, medical discharge summaries, and bank receipts proving you paid the hospital out of pocket. Complete the official HSE NIPHS Healthcare Costs Application Form and send it away. The HSE generally processes and refunds these claims within a few weeks to 3 months.
Please contact me for more information on (01) 969 2020 or shay.brennan@oireachtas.ie.