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The Treatment Benefit Scheme may help you meet the cost of:
Insured workers, the self-employed and retired workers who have the necessary PRSI contributions can qualify for this benefit. A dependant spouse, civil partner or cohabitant of qualified person may also be entitled to Treatment Benefit.
To qualify, you must have paid class A, E, P, H or S social insurance (PRSI) contributions. The amount of social insurance contributions you need depends on your age. There are four age ranges listed below.
If you are under 21, you may qualify if you have paid at least 39 contributions at any time.
Between these ages you may qualify if you have paid at least 39 contributions and have:
OR
From the age of 29 onwards you must have at least 260 paid contributions
AND
OR
If you qualify for benefit at age 60–65, you keep that entitlement for life.
People aged 66 and over must have:
(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)
OR
If you satisfy either of these conditions when you reach pension age, you will remain qualified 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.
If you don’t qualify for Treatment Benefit on your Irish social insurance (PRSI) record and you were previously in insurable employment in a country covered by EU or UK Regulations, you might be able to use your social insurance record in the other EU country or the UK to help you qualify.
You must have paid at least one reckonable social insurance (PRSI) contribution (classes A, E, H, P and S) since your return to Ireland.
A spouse, civil partner or cohabitant may qualify if they have enough social insurance contributions.
If they don't have enough of their own PRSI contributions, they may also qualify for Treatment Benefits on the social insurance record of their spouse, partner or cohabitant if they are their dependants.
A dependant spouse, civil partner or cohabitant must:
- Disablement Pension
(If getting Carer's Allowance or State Pension (Non-contributory) they can qualify if they were dependant on you immediately before getting the allowance or pension.)
If a qualified insured person dies and their 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.
Application forms are only available from the Treatment Benefit provider or from the Treatment Benefit Section .
For contact details, please see Make a claim.
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:
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. Your dentist will check if you qualify for treatment.
The Treatment Benefit Scheme entitles you to a free eyesight test once every second calendar year. Sight tests for visual display units like computer screens and driving licences are not covered.
Once every second calendar year, you can get a payment towards one pair of:
Choosing frames
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 treatment provider.
Under the Treatment Benefit Scheme, you can’t get contact lenses for purely cosmetic reasons. You can get contact lenses for optical (seeing) purposes only.
These specialised lenses are used to treat certain eye conditions and medical evidence is required in order to access the grant.
How much is covered
If you need contact lenses for medical reasons, the department will pay a maximum of €500 towards the cost of each medical lens once every second calendar year, provided you have a ophthalmologist’s recommendation.
Only ophthalmologists who have a contract with the department can provide the treatment. Please check with your treatment provider.
Suppliers may provide or repair hearing aids once every four calendar years if they have a contract with the department.
The department covers:
AND
Suppliers may provide a non-surgical scalp hair replacement product once per calendar year if they have a contract with the department.
What costs are covered
The department covers a maximum of €500 towards the cost of a non-surgical scalp hair replacement product where hair loss results from a disease or treatment of a disease such as cancer or alopecia.
Types of alopecia which qualify are:
You may get tax relief on certain non-routine dental treatments like crowns or tip replacing.
You can make a claim through your treatment benefit provider (dentist, dispensing optician, optometrist, ophthalmologist, audiologist or hair replacement provider).
They will check if you qualify before you get a treatment and they can claim payment afterwards.
The provider will need information to identify you including your:
Before treatment, you will need to sign a consent form allowing your treatment provider to have your identification details and for this information to be passed on to this government department so that your fees can be paid.
Claiming as a dependant
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 it to the Treatment Benefits section for approval.
Treatment in EU or UK
For treatment received in other EU member states or the UK, you need to contact the Treatment Benefit Section at the address below to confirm you qualify.
If you qualify, you should send the below details to the Treatment Benefit section:
A list of treatment providers is available below:
Operational guidelines describe the processes and procedures that staff in the department follow when carrying out their work.