Information
The Treatment Benefit Scheme is a scheme run by the Department of Social
Protection (DSP) that provides dental, optical and aural services to qualified
people.
The Treatment Benefit Scheme is available to insured workers and retired
people who have the required number of PRSI
contributions.
Medical card
holders are legally entitled to more extensive dental,
ophthalmic
and aural
services from the Health Service
Executive (HSE) but, in practice, the availability of these services varies
from area to area.
Under the Treatment Benefit Scheme, you may qualify for:
- Dental benefit
- Optical benefit
- Aural benefit
- Hearing aids
Changes in 2012
Hearing aids can be claimed once every 4 years (was 2 years).
From 1 January 2012, the maximum grant available for one hearing aid is
€500 for one hearing aid, and €1,000 for two hearing aids.
Treatment Benefit in the EU
On 5 June 2005, the rules were amended to allow treatment sanctioned under
the scheme to be carried out in other EU member states. Where someone chooses
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 or H 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 (2010 is
the governing contribution year for claims made in 2012) and 13 paid
contributions in a recent contribution year or
- 26 paid contributions in each of the second and third last contribution
years. For claims made in 2012, the second last contribution year is 2010
and the third last contribution year is 2009.
(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 (2010 is the governing contribution year for claims made in 2012) and
13 paid contributions in a recent contribution year or
- 26 paid contributions in each of the second and third last contribution
years. For claims made in 2012, the second last contribution year is 2010
and the third last contribution year is 2009.
(4) Aged 66
There are special rules for people aged 66 and over. Basically, you must
have 260 contributions paid at any time; you must have 39 paid or credited in
any of the two contribution years before reaching age 66 and you must have 13
paid contributions in a recent contribution year (recent to reaching age 66).
There are, however, a number of exceptions to this:
If you reached 66 before 6 July 1992, you do not need 13 recently paid
contributions
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 39 weeks paid or credited in either of the last 2 complete tax
years before you reached age 66. |
| Aged 66 on or after 6 July 1992 |
260 weeks PRSI paid since first starting work
and 39 weeks paid or credited in either of the last 2 complete tax
years before you reached age 66. |
If you satisfy these conditions when you reach pension age, you will remain
qualified for life.
The recent contribution year rule for those under 66
In general, you must have 13 paid contributions in a recent contribution
year. This may be the same year as you have the 39 paid or credited
contributions and the 13 paid may be part of those 39. It may also be either of
the two preceding contribution years or a subsequent year.
If you are receiving any of the following payments, you do not need to have
13 recently paid contributions:
You do not need to have 13 recently paid contributions if you are on a Community
Employment Scheme, a Back to Work Scheme, a Vocational Training
Opportunities Scheme and a Community Employment Development Programme.
If you are aged 55 or over and are not getting any payment but are signing
on, you don't need the 13 recently paid contributions either.
Qualified at 60
If you qualify for benefit at age 60, you retain that entitlement for life.
If you are aged between 61 and 65 and you do not meet the qualifying conditions
at age 60, you must satisfy the qualifying conditions for the 25-65 age group.
However, 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/cohabitant may, of course, qualify in their own right
if they have enough social insurance contributions.
If your spouse/civil partner/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/cohabitant must be dependent on you.
A dependent spouse/civil partner/cohabitant must:
- Have a gross income of €100 or less per week
- Earn more than €100 per week and be dependent on you before entering or
resuming insurable employment (at Class A, E, H or P)
- Not get a social welfare payment (except Disablement
Pension, Supplementary Welfare Allowance, Carer's Benefit or Child Benefit)
- Have a Carer's Allowance or State Pension (Non-Contributory) and be
dependent on you immediately before getting the Allowance or Pension
If an insured person aged 60 or over 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 year. The examination is provided by private dentists who are on a
Department of Social Protection's panel. Lists of dentists on the panel are
available in the Department's offices. Most dentists are on the panel so you
should not have any difficulty finding one. The dentist or the Department will
have the application forms. These forms require details such as your Personal
Public Service Number (PPSN). If you are a dependent spouse or civil
partner, you should give the PPSN of the insured person.
Optical Benefit
The Treatment Benefit Scheme entitles you to a free eyesight test. However,
sight tests for VDUs, driving
licences, etc., are not covered under the scheme. The examination is
provided by opticians/optometrists who have a contract with the Department of
Social Protection.
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. Disposable lenses are not covered under the scheme. Contact lenses
are not available on purely optical or cosmetic grounds.
Aural Benefit
Hearing aids may be provided by suppliers who have a contract with the
Department of Social Protection. The Department pays half the cost of a hearing
aid subject to a fixed maximum of €500 for each hearing aid every 4 years. It
also pays half the cost of repairs to aids.
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 and P) since your return to Ireland.
How to apply
You will need to fill out form D1 if you are applying for dental services
under the Treatment Benefit Scheme (form D2 if you are a dependent spouse,
civil partner or cohabitant). Forms are available from your dentist.
You will need to fill out form O1 if you are applying for optical services
under the Treatment Benefit Scheme (form O2 if you are a dependent spouse,
civil partner or cohabitant). Forms are available from your optician, local Social
Welfare Services office or the Treatment Benefit Section
You will need to fill out form MA if you are applying for aural services
under the Treatment Benefit Scheme (form MA2 if you are a dependent spouse,
civil partner or cohabitant). Forms are available from suppliers or the
Treatment Benefit Section.
Application forms for dental, optical or aural services under the Treatment
Benefit Scheme in other EU states are different from those above. Contact
Treatment Benefit Section at the address below for copies of the forms and more
information.