Treatment Benefit Scheme Ireland : Citizens Information
Name of the Organization : Citizens Information Board
Type of Facility : Treatment Benefit Scheme
Country: Ireland
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Citizens Information Treatment Benefit Scheme
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.
Related : Citizens Information Board Medical Care Scheme Ireland : www.statusin.org/7155.html
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
** Hearing aids
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 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 (2013 is the governing contribution year for claims made in 2015) 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 2015, the second last contribution year is 2013 and the third last contribution year is 2012.
(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 (2013 is the governing contribution year for claims made in 2015) 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 2015, the second last contribution year is 2013 and the third last contribution year is 2012.
(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.
How to apply:
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.
Where to apply:
Treatment Benefit Section
Department of Social Protection
St. Oliver Plunkett Road
Letterkenny
Donegal
Ireland
Tel:(074) 916 4480
Locall:1890 400 400