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Treatment Benefit Scheme

From: Department of Employment Affairs and Social Protection

What the Treatment Benefit Scheme is

The Treatment Benefit Scheme provides dental, optical and aural services to insured workers, the self-employed and retired people who have the required number of social insurance (PRSI) contributions. Under the scheme, you may qualify for:

  • dental benefit
  • optical benefit
  • hearing aids

You should contact your treatment provider to check if you qualify before getting any treatment. Before 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 government. This is needed to pay your claim.

If you decide to have treatment in another EU member state, an amount will be paid that is equivalent to the rate paid for similar treatment in Ireland, or the amount actually paid for the treatment – whichever sum is lower. You must still have the qualifying social insurance (PRSI) contributions.

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

Treatment Benefit Section

Address:
Department of Employment Affairs and Social Protection, St Oliver Plunkett Road, Donegal, Letterkenny, F92 T449

How to qualify

To qualify, you must have paid class A, E, P, H or S social insurance (PRSI) contributions.

The amount of social insurance you need depends on your age. There are four age ranges listed below. Find your age range and read the relevant information.

Under 21 years

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

Aged 21-24

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

  • at least 39 paid or credited contributions in the governing contribution year (Example: 2017 is the governing contribution year for claims made in 2019)

OR

  • 26 paid contributions in each of the second and third last contribution years (Example: For claims made in 2019, the second last contribution year is 2017 and the third last contribution year is 2016)

Aged 25-65

From the age of 25 onwards, you must have:

  • at least 260 paid contributions
  • at least 39 paid or credited contributions in the governing contribution year (2017 is the governing contribution year for claims made in 2019)

OR

  • 26 paid contributions in each of the second and third last contribution years. For claims made in 2019, the second last contribution year is 2017 and the third last contribution year is 2016

Aged 66 and over

There are special rules and exceptions for people aged 66 and over. You must also be in one of the following situations:

  • You have 260 social insurance (PRSI) contributions paid at any time and 39 paid or credited contributions in the relevant tax year or the year immediately before it. Note: The relevant tax year is the second last completed tax year before reaching 66 years of age. Example: If you were 66 in 2010, the relevant tax year is 2008. If you were 66 in 2012, the relevant tax year is 2010.
  • You have 260 social insurance (PRSI) contributions paid at any time and 26 paid contributions in both the relevant tax year and the year immediately before it. The relevant tax year is the second last completed tax year before reaching 66 years of age.

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 keep 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 if you satisfy certain conditions. If you qualify for these benefits, you may also be awarded credited contributions, which can be taken into account to extend coverage for Treatment Benefits.

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, they may still qualify for Treatment Benefits on your social insurance record. To do this, you must qualify for Treatment Benefits and your spouse, civil partner or cohabitant must be dependent on you.

A dependant spouse, civil partner or cohabitant must:

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

Coverage

Dental Benefit

Under this scheme, the department pays the full cost of an oral examination once a calendar year. Since October 2017, a payment of €42 is provided towards either:

  • a scale and polish
  • a periodontal treatment– if clinically necessary

If the cost of either cleaning or periodontal treatment is more than €42, you must pay the rest. This is capped at €15 for a scale and polish. There is no cap on the balance charged for periodontal treatment.

You can get these treatments from private dentists who are on the department’s panel. Most dentists are on the panel, so you should find it easy to find a dentist. The dentist will check to see if you qualify for treatment. They will need details from you like your:

  • Personal Public Service (PPS) Number
  • date of birth
  • signature

A dependant spouse or civil partner will qualify if thy satisfy the conditions under the dependant spouse scheme. They should give the PPS Number of the insured person they are dependent on. They will also have to sign the claim form.

Optical Benefit

The Treatment Benefit Scheme entitles you to a free eyesight test once every second calendar year. But, sight tests for visual display units like computer screens, driving licences and so on are not covered.

Once every second calendar year, you can get a payment towards one pair of:

  • reading and distance spectacles
  • bifocal or varifocals
  • contact lenses (including disposables)

Basic frames are free. If you choose more expensive frames, the department will pay €42 towards the overall cost and you pay the balance. Only opticians, optometrists or ophthalmologists who have a contract with the department can provide the treatment. Please check with your provider.

Medical lenses

If you need contact lenses for medical reasons, the department will pay half the cost up to maximum of €500, provided you have a doctor’s recommendation. Under the Treatment Benefit Scheme, you can’t get contact lenses for purely cosmetic reasons. You can get contact lenses for optical (seeing) purposes through the Optical Benefit scheme.

Hearing aids

Suppliers may provide hearing aids if they have a contract with the department. In this case, the department pays half the cost:

  • of a hearing aid up to €500 for each hearing aid; or
  • of repairs to aids, up to €100.
Tax Relief

You may get tax relief on certain non-routine dental treatments like crowns or tip replacing.

Treatment Benefit Scheme and EU Regulations

Don’t qualify for Treatment Benefit on your Irish social insurance (PRSI) record and you were previously insurably employed in a country covered by EU Regulations? You might be able to use your social insurance record in the other EU country to help you qualify, but you must have paid at least one reckonable social insurance (PRSI) contribution (classes A, E, H, P and S) since your return to Ireland.

Make a claim

You can make a claim through your provider (dentist, dispensing optician, optometrist, ophthalmologist or audiologist). They will check if you qualify before you get a treatment and they can claim payment afterwards. Your provider will require some information to identify you, such as your:

  • PPS Number
  • date of birth

Before 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 government to enable payment of your claim.

If you are claiming as a dependant under the social insurance (PRSI) record of your spouse, civil partner or cohabitant, both you and your spouse or partner will need to complete a dependant spouse application form and send to Treatment Benefits section for approval.

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

Treatment Benefit Section
Address: Department of Employment Affairs and Social Protection, St Oliver Plunkett Road, Letterkenny, Donegal, F92 T449
Phone: 07491644801890400400

Operational Guidelines