Treatment Benefit


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Introduction

The Treatment Benefit Scheme is run by the Department of Employment Affairs and Social Protection (DEASP) and provides dental, optical and aural services to qualified people.

The Treatment Benefit Scheme is available to insured workers, the self-employed and retired people who have the required number of PRSI contributions.

Under the Treatment Benefit Scheme, you may qualify for:

  • Dental benefit
  • Optical benefit
  • Hearing aids

You should contact the DEASP (see ‘Where to apply’ below) or your treatment provider to check your eligibility before proceeding with any treatment.

Treatment Benefit in the EU

If you choose to have treatment in another EU member state, the Department will pay an amount equivalent to the rate paid for similar treatments carried out in Ireland or, the amount actually paid for the treatment - whichever is the lower. You must still have the qualifying PRSI contributions.

Contact the Treatment Benefit Section before you travel to get an application form and details of the amounts the Department will pay.

Rules

Contribution conditions

You must have paid Class A, E, P, H or S social insurance contributions.

The amount of social insurance you need depends on your age.

(1) Aged under 21

If you are aged under 21, you may qualify if you have paid at least 39 contributions at any time.

(2) Aged 21-24

Between these ages you may qualify if you have paid at least 39 contributions and

  • At least 39 paid or credited in the governing contribution year (2015 is the governing contribution year for claims made in 2017) or
  • 26 paid contributions in each of the second and third last contribution years. For claims made in 2017, the second last contribution year is 2015 and the third last contribution year is 2014.

(3) Aged 25-65

From the age of 25 onwards, you must have at least 260 paid contributions and

  • At least 39 paid or credited contributions in the governing contribution year (2015 is the governing contribution year for claims made in 2017) or
  • 26 paid contributions in each of the second and third last contribution years. For claims made in 2017, the second last contribution year is 2015 and the third last contribution year is 2014.

(4) Aged 66 and over

There are special rules for people aged 66 and over. To qualify, you must have 260 contributions paid at any time, and you must have either 39 paid or credited in any of the two contribution years before reaching age 66, or 26 contributions paid in both the relevant contribution year and the year immediately before it.

There are, however, a number of exceptions to this:

If you reached age 66 before 1 October 1987, you need 156 paid contributions instead of 260; if you reached 66 between 1 October 1987 and 6 July 1992, you need 208 paid contributions.

If you are getting a State pension the PRSI contribution requirements vary according to age as follows:

If you were: You must have at least:
Aged 66 before 1 October 1987 156 weeks PRSI paid since first starting work and 26 paid or credited in either of the last 2 complete tax years before you reached age 66.
Aged 66 between 1 October 1987 and 6 July 1992 208 weeks PRSI paid since first starting work and either 39 weeks paid or credited in either of the last 2 complete tax years before you reached age 66, or 26 contributions paid in both the relevant tax year and the year immediately before it.
Aged 66 on or after 6 July 1992 260 weeks PRSI paid since first starting work and either 39 weeks paid or credited in either of the last 2 complete tax years before you reached age 66, or 26 contributions paid in both the relevant contribution year and the year immediately before it.

If you satisfy these conditions when you reach pension age, you will remain qualified for life.

Qualified at 60 and over

If you qualify for benefit at age 60–65, you retain that entitlement for life. If you have retired on grounds of ill health or you are considered to be unemployed, you can apply for Illness Benefit or Jobseeker's Benefit, subject to satisfying the statutory conditions. Your entitlement to these benefits may also lead to your being awarded credited contributions, which can be taken into account to extend coverage for treatment benefits for further periods.

Spouse, civil partner or cohabitant

A spouse, civil partner or cohabitant may, of course, qualify in their own right if they have enough social insurance contributions.

If your spouse, civil partner or cohabitant does not have enough social insurance contributions he/she may still qualify for Treatment Benefit on your social insurance record. To do this, you must qualify for Treatment Benefit and your spouse, civil partner or cohabitant must be dependent on you.

A dependent spouse, civil partner or cohabitant must:

  • Have a gross income of €100 or less per week. If earning more than €100 per week, he/she must have been dependent on you before entering or resuming insurable employment (at Class A, E, H, P or S).
  • Not be getting a social welfare payment (except Disablement Pension, Supplementary Welfare Allowance, Carer's Benefit or Child Benefit). If getting Carer's Allowance or State Pension (Non-Contributory), he/she can qualify if he/she was dependent on you immediately before getting the Allowance or Pension.

If an insured person dies and the dependent spouse or civil partner was entitled to benefit at the time of the death, they retain entitlement for as long as they remain widowed or a surviving civil partner.

Dental Benefit

Under this scheme, the Department pays the full cost of an oral examination once a calendar year.

Since 28 October 2017, a payment of €42 towards either a scale and polish or - if clinically necessary - periodontal treatment, is also available once a calendar year. If the cost of either cleaning or periodontal treatment is more than €42, you must pay the balance - capped at €15 for a scale and polish. There is no cap on the balance charged for periodontal treatment.

Treatment is provided by private dentists who are on the Department of Employment Affairs and Social Protection's panel. Lists of dentists on the panel are available on welfare.ie. Most dentists are on the panel so you should not have any difficulty finding one. The dentist will be able to check your eligibility and make a claim for you. The claim form will require details such as your Personal Public Service Number (PPS number), date of birth and signature. If you are a dependent spouse or civil partner, you should give the PPS number of the insured person, who will also be required to sign the claim form.

Optical Benefit

The Treatment Benefit Scheme entitles you to a free eyesight test, once every second calendar year. However, sight tests for VDUs, driving licences, etc., are not covered under the scheme.

Since 28 October 2017, you can get a payment, once every second calendar year, towards either one pair each of reading and distance spectacles, one pair of bifocal or varifocals or one pair of contact lenses (including disposables). Cost will vary depending on the frames you choose. Basic frames are free. If you choose more expensive frames, the Department will pay €42 towards the overall cost of the spectacles and you pay the balance.

The examination is provided by opticians/optometrists who have a contract with the Department of Employment Affairs and Social Protection.

Medical lenses

If you need contact lenses on medical grounds, the Department will pay half the cost up to a maximum of €500, provided you have a doctor's recommendation. This applies to a small number of eye conditions that make wearing glasses impossible. Contact lenses are not available on purely cosmetic grounds. Contact lenses for optical purposes are available through the Optical Benefit scheme above.

Hearing aids

Hearing aids may be provided by suppliers who have a contract with the Department of Employment Affairs and Social Protection. The Department pays half the cost of a hearing aid subject to a fixed maximum of €500 for each hearing aid once every fourth calendar year. It also pays half the cost of repairs to aids, up to a maximum of €100, once every fourth calendar year.

Tax relief

You may get tax relief on certain non-routine dental treatments.

Treatment Benefit Scheme and EU Regulations

If you were previously insurably employed in a country covered by EU Regulations and you do not qualify on your Irish PRSI record, your social insurance record in the other EU country may be used to help you qualify for Treatment Benefit. You must have paid at least one reckonable PRSI contribution (Classes A, E, H, P and S) since your return to Ireland.

How to apply

Claims are made through your provider (dentist, optician or audiologist), who can check your entitlement in advance of treatment and claim payment afterwards.

Your provider will require some information to identify you, such as your date of birth and PPS number. Prior to treatment, you will need to sign a Consent Form agreeing to your provider having this information and giving your consent to have this information supplied to the Department of Employment Affairs and Social Protection, to enable payment of your claim.

If you are claiming as a dependant under the PRSI record of your spouse, civil partner or cohabitant, both you and your spouse or partner will need to sign the Consent Form.

For treatment received in other EU member states, you contact the Treatment Benefit Section at the address below to confirm your eligibility. If eligible, you send your receipts to the Treatment Benefit Section along with a letter containing your contact information and details of your bank account (account name, number and sort code) into which payment will be made.

Where to apply

Treatment Benefit Section

Department of Employment Affairs and Social Protection
St. Oliver Plunkett Road
Letterkenny
Donegal
Ireland

Tel: (074) 916 4480 (If calling from outside the Republic of Ireland please call +353 74 916 4480)
Locall: 1890 400 400 (Note: the rates charged for using 1890 (Lo-call) numbers may vary)
Homepage: http://www.welfare.ie

You can email the Treatment Benefit section using the secure enquiry form.


Last modified:17/11/2017
 

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