What is the cross border waiting list reimbursement scheme, who can apply and how to tell if you are eligible?

• A new cross border health scheme has opened to patients.
• To be eligible you must have been on a waiting list for at least two years.
• The scheme can reimburse the costs for treatment carried out in Ireland, for those are eligible.

Patients who have been waiting for over two years on a waiting list for hospital treatment can now apply to a cross border health reimbursement scheme.

The initiative which is an effort to tackle Northern Ireland’s lengthy waiting lists, will fund £10m towards treatments in Ireland.

It will offer those eligible an opportunity to claim back costs of treatments outside of NI, with a second phase of the scheme expected to extend to cover EU countries from autumn.

Health Minister Nesbitt said: “This £10m investment is an important step in addressing the serious challenges posed by long hospital waiting lists.

“As I outlined to the Assembly, this Scheme is part of a much wider package of initiatives to reduce backlogs and deliver better outcomes for patients. It gives those who have waited two years or more the opportunity to seek treatment privately with the reassurance that costs will be reimbursed up to the HSC equivalent rate.

“I will continue to bring forward further measures to ensure patients across Northern Ireland get the care they need more quickly.”

Who is eligible?

To be eligible for the scheme, the following criteria must be met by patients:

• the patient is an ordinary resident of Northern Ireland.
• the patient has been diagnosed as having a clinical need for the treatment and has been on the treatment or surgical inpatient waiting list in Health and Social Care Northern Ireland (HSC NI) services for more than 104 weeks or 2 years.
• the treatment for which the patient is seeking reimbursement is one which is commissioned by the Department of Health for the diagnosis.
• the patient needs the treatment purchased based on HSC criteria i.e. the treatment is one the patient would have received within the HSC in the same clinical circumstances.
• the treatment will initially be paid for by the patient.
• no other source of reimbursement has been sought.
• the patient has sought and received prior approval from the Department of Health for the treatment under the scheme.

How to apply?

If you meet the criteria and want to apply for the scheme there is a process you must follow.

Firstly you must decide that you wish to access and pay for private treatment in Ireland, you then need to source a provide healthcare provider or hospital where you plan to undergo this treatment or surgery.

The next step is to apply to the Department of Health’s National Contact Point Team for prior authorisation using the application form available on the HSCNI website.

If approved, the patient or carer must arrange the treatment, and pay directly to the private provider for treatment.

Reimbursement is then sought from the Department of Health using the reimbursement form (issued with approval notification).

Applicants are asked to provide evidence in the form of a letter from a HSC Trust in Northern Ireland confirming their place on a treatment waiting list in addition to a Health and Care number to confirm GP registration and a National Insurance number.

How long does it take?

Once you have submitted your application form, it can take up to 20 working days or four weeks to be processed and decision to be made. You will then be informed of the outcome of your application in writing once a decision has been reached and a reimbursement form will be provided.

Will the full costs be covered?

If you decide to seek treatment under the scheme, you will have to pay the provider directly for the cost of treatment and submit original receipts as proof of payment to the Department of Health for reimbursement.

The Department of Health will reimburse the actual cost of treatment or the equivalent cost of treatment delivered locally in the HSC NI, whichever is the lesser amount.

If payment is approved, this can take up to six weeks. The Department of Health will not reimburse any additional costs such as accommodation or travel costs.

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What is not covered?

The scheme will not cover long-term care services to support people with routine, everyday tasks. Allocation of and access to organs for the purpose of organ transplants. Public vaccination programmes against infectious diseases which are exclusively aimed at protecting the health of the population or clinical trials.

Will it be extended to cover the rest of the EU?

A second stage of the scheme is expected to be introduced, which will see the scheme extended to cover other countries in the EU starting from autumn 2025, however, no date has been confirmed.

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