The Department of Health has introduced a Waiting List Reimbursement Scheme (WLRS).
This new scheme opened on 2 June 2025 and is available to ordinary residents of Northern Ireland.
- A person is ordinarily resident if they are living in the United Kingdom lawfully, voluntarily or for settled purposes as part of the regular order of their life for the time being, whether for a long or short duration. Further information on what constitutes an ‘ordinary resident’ can be accessed on the GOV.UK website – Ordinary residence tool – GOV.UK
The scheme provides an option for those patients who may wish to access private treatment in the Republic of Ireland (RoI) and claim reimbursement for costs of treatment.
Reimbursement covers the actual cost of treatment or the Health and Social Care (HSC) Northern Ireland average cost (whichever is lower) provided the treatment is one which the patient could have been received in the NI HSC system.
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.
The scheme is based on the previous Republic of Ireland (RoI) Reimbursement Scheme and EU Cross Border Healthcare Directive.
Eligibility criteria
The Department of Health will reimburse treatment costs under the RoI planned treatment route provided the following criteria are 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.
Download – Waiting List Reimbursement Application Form
How it works
The eligible patient:
- decides that she/he wishes to access private treatment in RoI.
- sources an RoI provider i.e. private clinic/hospital they plan to undergo their treatment/surgery.
- applies to the Department of Health’s National Contact Point Team for prior authorisation using the application form.
- on approval, treatment is then arranged by the patient/carer.
- treatment is paid directly to the private provider by the patient.
- 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. (see application form for details of supplementary documents to be submitted).
It can take up to 20 working days or 4 weeks for a fully completed application form to be processed and a decision made.
You will be informed of the outcome of your application in writing once a decision has been reached. A reimbursement form will be provided at this stage of the process.
The patient/carer is responsible for providing accurate and complete information to support the decision-making process. Incomplete applications will not be processed.
It is important to note:
- reimbursement will be the actual cost of treatment or the HSC NI average cost (whichever is lower) provided the treatment is one which the patient would have received within the HSC.
- initial consultation, surgery and immediate post-operative review is covered under the scheme and must be carried out by the provider.
- any other 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.
Download – Waiting List Reimbursement Application Form
Responsibility
The treatment a patient receives in RoI under the scheme is not being arranged by the Department of Health but by the patient and no clinical responsibility is borne by the Department for the treatment.
In choosing to arrange healthcare themselves, the patient is effectively stepping outside of the HSC system. At this point, the patient is taking individual responsibility for ensuring that the service they obtain is appropriate and safe within the laws of RoI.
The Department of Health under this scheme will not be formally commissioning services from providers abroad and therefore will not be liable for the outcome of the treatment provided.
Prior approval
Applications must be authorised by the Department of Health prior to treatment. Retrospective applications will not be considered.
The Department of Health requires that patients seek prior approval:
- to ensure that such patients meet the same thresholds and qualifying criteria as those seeking treatment in the HSC.
- to protect the patient from the financial consequences of purchasing treatment for which they may not receive reimbursement.
Exemptions
This scheme will not apply to:
- 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.
- clinical trials.
Reimbursement
Where the patient has opted to seek treatment under the provisions of this scheme 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.
- the Department will not pay the provider directly.
The patient will;
- pay the provider directly for the cost of treatment.
- submit original receipts as proof of payment to the Department of Health for reimbursement.
Please read the following important information
- Reimbursement will be made when the patient provides proof of having received the service and incurred the cost. No other costs will be reimbursed including travel and accommodation costs.
- If approved, the reimbursement can take up to six weeks to be processed.
- The Department of Health recommends that patients should have the necessary comprehensive medical and travel insurance for the journey and treatment. The cost of such insurance is not reimbursable by the Department of Health.
- You should also ensure that you have a valid GHIC (Global Health Insurance Card) or EHIC for use in the event of medical emergency unrelated to the planned treatment.
- Please note that the GHIC or EHIC does not allow you to go abroad for the purpose of receiving planned treatment and does not cover the costs of private healthcare or services that are not part of the state healthcare system.
See Frequently Asked Questions here.
Contact information
National Contact Point
Strategic Planning and Performance Group
Hospital Care
Department of Health
12-22 Linenhall Street
Belfast BT2 8BS
Email: NationalContactPoint@hscni.net
Tel: +44 (0)28 9536 8303
ROI Providers
You may wish to seek further information on ROI providers and the services they offer.
The National Contact Point for cross border healthcare in ROI may be able to assist you.
National Contact Point,
Cross-Border Healthcare Directive Department,
HSE,
St Canice’s Hospital,
Dublin Road,
Kilkenny
Email: crossborderdirective@hse.ie