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Home Our Work Patients travelling outside Northern Ireland for treatment Waiting List Reimbursement Scheme Frequently Asked Questions – Waiting List Reimbursement Scheme

Frequently Asked Questions – Waiting List Reimbursement Scheme

Frequently Asked Questions

Waiting List Reimbursement Scheme

The scheme opened to new applicants on 2 June 2025.  

  • 1 What is the Waiting List Reimbursement Scheme?

    A new Waiting list Reimbursement Scheme was announced by the Minister for Health on 6 May 2025.

    An initial £10m will be invested in this scheme , allowing people to claim back costs when they receive medical treatments outside Northern Ireland, subject to qualifying criteria.

    Beginning on 2 June 2025, it will apply to procedures obtained in the Republic of Ireland.

    A second phase of the scheme will take place in the autumn. This will see the geographical scope extended to all European Union (EU) countries.  The scale of available funding may be limited by take-up levels for the first phase. Details will be made available at a later date.

    Download – Waiting List Reimbursement Scheme application form

  • 2. Who is eligible to apply for this scheme?

    There are two eligibility criteria for the scheme.

    • You must be an ordinary resident in Northern Ireland who has been diagnosed as having a clinical need for treatment by an NI HSC clinician. Further information on what constitutes an ‘ordinary resident’ can be accessed on the GOV.UK website – Ordinary residence tool – GOV.UK.
    • You must have been waiting for treatment for over 2 years on a local Health and Social Care Trust waiting list.
  • 3. What procedures can I get reimbursed for?

    Treatments/procedures which a patient would ordinarily expect to receive from local Health and Social Care services in Northern Ireland can be applied for with the exception of the following:

    • Long term care that assists with routine tasks i.e. social care
    • Access to and allocation of organs (for transplantation)
    • Public vaccination programmes against infectious diseases
    • Clinical trials

    The Waiting List Reimbursement Scheme is a prior approval scheme. That means you must apply for authorisation from the Department of Health for your treatment before you receive it otherwise it will not be reimbursed.

    Applications will be reviewed to ensure they meet the qualifying criteria under the remit of the reimbursement scheme and if approved, you will be advised about the amount of reimbursement you are likely to receive.

  • 4. Where can I get treatment and be reimbursed?

    It is important you do not pay for treatment or receive treatment without obtaining prior authorisation from the Department of Health.

    In this initial phase of the scheme, private treatment can be obtained in the Republic of Ireland (RoI).  You will be responsible for making your own arrangements for treatment, including selecting an appropriate provider.

    Further information on accessing healthcare services in RoI can be found via the accessing services section of the HSE website – Accessing Healthcare in Ireland under CBD – HSE.ie

    Alternatively contact the RoI National Contact point as follows;

    National Contact Point
    Cross-Border Healthcare Directive Department
    HSE
    St Canice’s Hospital
    Dublin Road
    Kilkenny

    Email: crossborderdirective@hse.ie

  • 5. How do I apply for this reimbursement scheme?
    • You will need to fill in an application form – Waiting List Reimbursement Scheme application form.
    • Seek a letter from a local HSC Trust in NI confirming you are on the surgical waiting list for 2 years or more, for the treatment you wish to be reimbursed for. This is required to support your application.
    • Ensure you get prior approval from the Department of Health before proceeding with your treatment.
    • Source your own healthcare provider in the Republic of Ireland.
    • Schedule your surgery directly with the Private provider for the treatment you need.
    • Submit your invoices/receipts once your treatment has been completed.

    Download – Waiting List Reimbursement Scheme application form.

  • 6. How do I know which waiting list I am on and how long I have been on it for?

    To enable us to process an application we require confirmation that you have been diagnosed by a NI Health and Social Care Consultant as having a clinical need for the treatment and have been placed on the Health and Social Care Trust inpatient waiting list for the surgery/treatment.

    A copy of a clinical letter can be obtained from your Health and Social Care Trust or consulting team by whom you have been assessed and confirmed that treatment or surgery is required.

    The time you have waited will be calculated from the date you are placed on the treatment waiting list. This does not include the date you have been placed on an outpatient waiting list, or referred by a GP, had x-rays, or physio appointments.

  • 7. Do I need to get prior approval before proceeding with my treatment?

    Yes.
    You will need to obtain prior approval from the Department of Health before proceeding with your treatment if you want to be reimbursed for your procedure.
    Retrospective applications will not be considered.

    Download – Waiting List Reimbursement Scheme application form.

  • 8. What happens if I do not get prior approval before my treatment?

    Your treatment will not be eligible for the scheme and you will not be reimbursed for any treatment you have received.

  • 9. Will I be reimbursed in full for the cost of my treatment?

    Reimbursement under this scheme will only be up to the equivalent of the actual cost of the same treatment in Northern Ireland, or the HSC NI average cost (whichever is lesser amount).

    Initial consultation, surgery and immediate post-operative review is covered under the scheme and must be carried out by the provider.

    All treatment will need to take place within the Republic of Ireland. A second phase of the scheme will take place in the autumn. This will see the geographical scope extended to all European Union (EU) countries.  The scale of available funding may be limited by take-up levels for the first phase. Details will be made available at a later date.

    You will not be reimbursed for any treatment provided within NI nor will you be reimbursed for any associated travel or accommodation costs.

  • 10. How do I access post-operative care?

    It is recommended that all patients advise their GP and their local HSC Trust of their intention to travel outside of NI for treatment before receiving it.

    Post-operative care should be discussed and arranged between the patient and the local HSC Consultant or GP in Northern Ireland before completion of the application.

    This includes physiotherapy, ongoing prescriptions and general monitoring of post-operative condition.

     

  • 11. How long does the approval process take to complete?

    It can take up to 6 weeks for a fully completed application to be processed and a decision made. Sometimes it may take longer than 6 weeks to process and approve applications dependent upon the information received, the need for follow-up, the volume of applications received and the resources available to complete the process.

    You will be informed of the outcome of your application by letter once a decision has been reached and if approved, the letter will also give you an indication on the level of reimbursement you can expect to receive. You will be sent a form to complete for the reimbursement costs.

    You should not arrange an outpatient appointment or treatment dates until your application has been approved otherwise you will not be reimbursed.

  • 12. Can I pre-arrange treatment before my application is approved/processed?

    No.
    You should not arrange an appointment or treatment dates until your application has been approved otherwise you will not be reimbursed.

    Applications will not be prioritised for applicants with pre-arranged appointments treatment dates. In the interests of fairness, applications will be processed in order of date received.

  • 13. How long will it take before I am reimbursed for my treatment costs?

    The reimbursement process can take 6-8 weeks from receipt of proof of payment

    Processing times may be extended depending on the volume of claims received and the level of resources available to process.

    When your claim has been processed you will receive a letter confirming the amount you will reimbursed.

    Payment will be made by cheque following receipt and authorisation of your completed reimbursement form.

  • 14. Do I need to organise travel insurance before travelling for treatment?

    It is recommended that patients obtain the necessary travel insurance to cover their journey to and from their chosen provider for the duration of their stay in Republic of Ireland.

    It is important that you clearly state that you are travelling to undergo treatment when applying for travel insurance.

    It is also recommended that you also obtain a valid GHIC card.

    The UK Global Health Insurance Card (GHIC) lets you get necessary state healthcare in the European Economic Area (EEA), and some other countries, on the same basis as a resident of that country. This may be free or it may require a payment equivalent to that which a local resident would pay.

    Further information is available on the NHS.UK website –

    (https://www.nhs.uk/using-the-nhs/healthcare-abroad/apply-for-a-free-uk-global-health-insurance-card-ghic/)

  • 15. What if my consultant recommends attending local clinics for pre or post operation appointments?

    Some consultants providing treatment in Republic of Ireland may be based in Northern Ireland and may offer follow-up appointments at local clinics, however, all appointments and treatment episodes must take place outside of Northern Ireland to be eligible for reimbursement.

    Appointments attended within NI are not eligible for reimbursement under the scheme thus will be at the patient’s own expense.

  • 16. Can I submit a claim for reimbursement of prescription expenses?

    Yes.
    A reimbursement claim for medication relating to a treatment episode may be submitted by patients who have received treatment outside of Northern Ireland (i.e. pain relief/antibiotics etc).  However, it is important to note that the HSC equivalent of prescriptions (i.e. the amount reimbursed) may be significantly lower than the cost of a private prescription.

  • 17. Can I apply to the Waiting List Reimbursement Scheme and travel to wider Europe for treatment?

    At the moment the scheme is only available for treatment to be undertaken in Republic of Ireland.

    A second phase of the scheme will take place in the autumn. This will see the geographical scope extended to all European Union (EU) countries.  The scale of available funding may be limited by take-up levels for the first phase. Details will be made available at a later date.

  • 18. Who is administering the scheme?

    Funding for the scheme is being provided by the Department of Health.

    The administration process is being managed by the Strategic Planning and Performance Group within the Department of Health.

    More information on the scheme is available on the HSC Online website: https://online.hscni.net/our-work/travelfortreatment/

    Contact information
    National Contact Point
    Strategic Planning and Performance Group
    Department of Health
    3rd Floor
    12-22 Linenhall Street
    Belfast BT2 8BS

    Email: NationalContactPoint@hscni.net

    Tel: 02895 368303 (9am-5pm)

  • 19. What happens if I need help or assistance to access the information and application form?

    If you need help to access the guidance and information regarding the Waiting list Reimbursement Scheme you can contact the Department of Health’s National Contact Point team and they will go through the options available with you.

    Contact information
    National Contact Point
    Strategic Planning and Performance Group
    Department of Health
    3rd Floor
    12-22 Linenhall Street
    Belfast BT2 8BS

    Email: NationalContactPoint@hscni.net

    Tel: 02895 368303 (Mon-Fri 10am-4pm)

  • 20. What happens if I need assistance in completing my application form?

    Should you need assistance in completing your Waiting list Reimbursement application form, you should first contact the Department of Health’s National Contact Point team and one of the team will go through the process and options available to you.

    Contact information
    National Contact Point
    Strategic Planning and Performance Group
    Department of Health
    3rd Floor
    12-22 Linenhall Street
    Belfast BT2 8BS

    Email: NationalContactPoint@hscni.net

    Tel: 02895 368303 (Mon-Fri 10am-4pm)

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