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:
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.
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
(3) Aged 25-65
From the age of 25 onwards, you must have at least 260 paid contributions and
(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 (before 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.
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.
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.
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:
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.
Under this scheme, the Department pays the full cost of an oral examination once a calendar year. The examination is provided by private dentists who are on the Department of 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 have the application forms. These forms require details such as your Personal Public Service Number (PPS number). If you are a dependent spouse or civil partner, you should give the PPS number of the insured person.
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.
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.
You may get tax relief on certain non-routine dental treatments.
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.
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 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.
If you have a question relating to this topic you can contact the Citizens Information Phone Service on 0761 07 4000 (Monday to Friday, 9am to 8pm) or you can visit your local Citizens Information Centre.