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.
Budget 2010 change
In 2010, the Treatment Benefit Scheme will be restricted to the medical and surgical appliances scheme, free dental examinations and free eyesight examinations. Treatment started in 2009 but which will not be completed until after 1 January 2010 will be covered under existing arrangements, provided eligibility has been established before 31 December 2009.
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 at least 39 contributions paid at any time.
(2) Aged 21 - 24
Between these ages you may qualify if you have at least 39 contributions paid and
- At least 39 paid or credited in the governing contribution year (2008 is the governing contribution year for claims made in 2010) 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 2010, the second last contribution year is 2008 and the third last contribution year is 2007.
(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 (2008 is the governing contribution year for claims made in 2010) 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 2010, the second last contribution year is 2008 and the third last contribution year is 2007.
(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 in receipt of a State Pension the PRSI contribution requirements vary according to age as follows:
| If you are: |
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.
Since May 2006, there has been an introduction of an alternative contribution condition for entitlement to Treatment Benefit (26 paid contributions in Relevant Tax Year and previous Relevant Tax Year).
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 or Partner
A spouse/partner may, of course, qualify in their own right if they have enough social insurance contributions.
If your spouse/partner 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/partner must be dependent on you.
A dependent spouse/partner must:
- Have a gross income of €76.18 or less per week
- Earn more than €76.18 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 was entitled to benefit at the time of the death, that spouse retains entitlement for as long as he/she remains widowed.
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 Protections' panel. Lists of dentists on the panel are available in DSP 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, 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 €760 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 €760 for each hearing aid every two 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.