Treatment Benefit Scheme

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 (2011 is the governing contribution year for claims made in 2013) 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 2013, the second last contribution year is 2011 and the third last contribution year is 2010.

(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 (2011 is the governing contribution year for claims made in 2013) 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 2013, the second last contribution year is 2011 and the third last contribution year is 2010.

(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 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:

• Invalidity Pension
• Carer's Allowance
• State Pension (Transition)
• Illness Benefit (for 12 months or more)
• Long-term Jobseeker's Allowance
• Pre-Retirement Allowance
• A combination of Jobseeker's Benefit and Jobseeker's Allowance for at least one year

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 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
• 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 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 (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.

Hearing aids

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.