Thursday, 15 October 2020
Department of Health
Cross-Border Health Initiatives
Under the terms of the Cross Border Directive it is a person's Member State of affiliation which is responsible for reimbursement of the cost of treatment. According to Article 7(1) of the Directive, a persons Member State of affiliation is the State which would be responsible for providing them with healthcare under Article 2 of Regulation 883/2004. However, Article &(1) must be interpreted with Article 7(2)(b) of the Directive. This Article states that pensioners whose Member State of origin is not listed in Annex IV to Regulation 883/2004 (the UK is not listed) will have their healthcare reimbursed by the “Member State of affiliation” (i.e. Member State of residence under Regulation 883/2004) except in the following particular cases: firstly, where the healthcare is received in the Member State of origin (in this case the UK) and secondly, where it is not subject to any prior authorisation scheme. In these case it will be the Member State of origin (in this case the UK) who is responsible for assuming the cost of healthcare.
In Ireland only one treatment, enzyme replacement, is subject to prior authorisation and, therefore, with the exception of enzyme replacement, it is the UK which is the pensioners Member State of affiliation and the State which will be responsible for reimbursing them. Accordingly, they should seek the advice of the UK as to their options for treatment under the Cross Border Directive.