{"id":19862,"date":"2022-10-31T22:04:37","date_gmt":"2022-10-31T22:04:37","guid":{"rendered":"https:\/\/legalblog.ie\/?p=19862"},"modified":"2024-04-08T18:10:26","modified_gmt":"2024-04-08T18:10:26","slug":"treatment-benefits","status":"publish","type":"post","link":"https:\/\/legalblog.ie\/treatment-benefits\/","title":{"rendered":"Treatment Benefits"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_63 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title \" >Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/#Overview\" title=\"Overview\">Overview<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/#Glasses_Hearing_Aid\" title=\"Glasses &amp; Hearing Aid\">Glasses &amp; Hearing Aid<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/#Qualification\" title=\"Qualification\">Qualification<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/#Qualification_Issues\" title=\"Qualification Issues\">Qualification Issues<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/#Dependent_Spouse_etc\" title=\"Dependent Spouse etc.\">Dependent Spouse etc.<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/2\/#SWCA_2005\" title=\"SWCA 2005\">SWCA 2005<\/a><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/2\/#Treatment_Benefit_s_138\" title=\"Treatment Benefit (s. 138)\">Treatment Benefit (s. 138)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/legalblog.ie\/treatment-benefits\/2\/#Description_of_benefits\" title=\"Description of benefits.\">Description of benefits.<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h3><span class=\"ez-toc-section\" id=\"Overview\"><\/span>Overview<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Treatment benefit is a social insurance-based benefit. \u00a0A person may be entitled to treatment benefits in other EU states.\u00a0 A person from another EU State may qualify for treatment benefits on the basis of social insurance contributions in other EU states.\u00a0 See generally the European Union section in relation to social insurance benefits in the EU.<\/p>\n<p>Treatment benefit is an addition to general, dental, ophthalmic and aural services available from the HSE by medical card holders.\u00a0 See separately in connection with the entitlement to health services.<\/p>\n<p>Treatment benefit covers dental benefit, optical benefit and hearing aids.\u00a0 In some cases, the Department may sanction treatment in another EU state.\u00a0 A prior application and approval is necessary.<\/p>\n<p>An application is required for dental, optical and aural services.\u00a0 There are different forms which must be completed and returned to the Department of Social Protection \u00a0office or treatment benefit section.\u00a0 The relevant contribution is two years prior.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Glasses_Hearing_Aid\"><\/span>Glasses &amp; Hearing Aid<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Treatment benefit entitles the qualifying person to a free eyesight test.\u00a0 This does not cover applications for driving licences and certain other sight tests.\u00a0 It is provided by opticians and optometrists under contract with the Department.<\/p>\n<p>The Department pays up to half the cost to a maximum of \u20ac500 \u00a0for prescribed contact lenses.\u00a0 This is only available in respect of contact lenses on medical grounds where wearing glasses are difficult.\u00a0 They are not available on cosmetic grounds nor are temporary lenses covered.<\/p>\n<p>Hearing aids may be provided by suppliers under contract.\u00a0 The Department pays half the cost to a maximum of \u20ac500 \u00a0every five years together with half the cost of repair.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Qualification\"><\/span>Qualification<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Treatment benefit is based on social insurance contributions. The applicant must have paid class A, E, P or H social insurance contributions.\u00a0 Persons under 21 years may qualify with 39 contributions or more.\u00a0 Persons between 21 and 24 require at least 39 contributions paid and at least 39 paid or credited in the governing year and 13 paid in the last \u00a0contribution year or 26 contributions made in each of the \u00a0second or third-last contribution years.<\/p>\n<p>In the case of \u00a0persons between 25 and 66 years of age, they must have 260 paid contributions and at least 39 paid or credited contributions in the governing contribution year i.e. two years earlier and 13 paid in a recent contribution year.\u00a0 Alternatively, they may have 26 paid contributions in each of the second and third last contribution years i.e. two and three years before, respectively.<\/p>\n<p>Persons over 66 years are entitled to treatment benefit if they have paid 260 contributions at any time.\u00a0 At least 39 must be paid or credited in any of the two contribution years before reaching 66 years and 33 paid in a recent contribution year relative to age 66.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Qualification_Issues\"><\/span>Qualification Issues<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>There are exceptions for persons who retire prior to 1992 and 1987 respectively.\u00a0 A lower number of contributions sufficed.\u00a0 The recent contribution year rule requires 13 paid contributions in a recent year.\u00a0 This may be the same as the year in which 39 paid or credited contributions have been made and the 13 paid may be the part of the 39.\u00a0\u00a0 Alternatively, it may be one of the two proceeding years or subsequent year.<\/p>\n<p>Persons who have certain allowances do not require 13 recently paid contributions including long-term illness benefit, state pension transitional, \u00a0long-term job seeker\u2019s allowance, pre-retirement allowance, a combination of jobseekers benefit and job allowance, invalidity pension.<\/p>\n<p>If a person qualifies at 60, he may retain entitlement for life.\u00a0 If a person between 61 and 65 years does not meet the qualifying conditions of 60 years, he may meet the conditions before 65 years.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Dependent_Spouse_etc\"><\/span>Dependent Spouse etc.<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>A spouse, civil \u00a0partner or co-habitant may qualify in his or her own right. \u00a0If he\/ she \u00a0does not have sufficient social insurance contributions, he may qualify on the basis of the pension of their spouses, civil partners or co-habitants entitlement, if they are dependent on the latter.<\/p>\n<p>A dependent spouse, civil partner or a cohabitant must<\/p>\n<ul>\n<li>have a gross income of less than 100 \u00a0per week.<\/li>\n<li>Earn more but be dependent before entering or resuming insurable employment<\/li>\n<li>not get a social welfare payment (except disablement supplementary welfare, child benefit or carer\u2019s benefit.)<\/li>\n<li>have a carer\u2019s allowance or state non-contributory pension and be dependent on the qualifying person before obtaining the allowance or the benefit.<\/li>\n<\/ul>\n<p>Under the scheme, the cost of an oral examination once a year is covered.\u00a0 Examination is provided by private dentists on the Departmental panel.<\/p>\n<p><!--nextpage--><\/p>\n<h2>SWCA 2005<\/h2>\n<p>Chapter 22<\/p>\n<h4>Treatment Benefit (s. 138)<\/h4>\n<p>138.<\/p>\n<p>General provisions as to benefit.<br \/>\n(1)A person shall, subject to satisfaction of the prescribed conditions, be entitled to such treatment benefit as may be specified by regulations.<\/p>\n<p>(2)The regulations, for the purposes of this section, may specify the payment of the whole or any part of the cost of any of the following:<\/p>\n<p>(a)dental treatment;<\/p>\n<p>(b)optical treatment and appliances;<\/p>\n<p>(c)appliances provided under the scheme commonly known as the Medical Appliances Scheme;<\/p>\n<p>(d)non-surgical hair replacement for persons suffering from hair loss (other than physiological hair loss) resulting from a disease, or treatment for a disease.<\/p>\n<p>(3)The payments referred to in subsection (2) shall not exceed in the aggregate such sums as may from time to time be agreed on between the Minister and the Minister for Public Expenditure and Reform.<\/p>\n<p>(4)This section shall remain in force until the day appointed under subsection (5) and shall then expire.<\/p>\n<p>(5)The Minister may by order appoint a day to be the day on which this section expires.<\/p>\n<p>39.<\/p>\n<h4>Description of benefits.<\/h4>\n<p>(1)Benefits under this Part shall be of the following descriptions and are so described in this Act &#8211;<\/p>\n<p>(a)illness benefit,<\/p>\n<p>(aa)partial capacity benefit,<\/p>\n<p>(b)maternity benefit,<\/p>\n<p>(c)health and safety benefit,<\/p>\n<p>(d)adoptive benefit,<\/p>\n<p>(da)paternity benefit,<\/p>\n<p>(db)parent&#8217;s benefit,<\/p>\n<p>(e)jobseeker\u2019s benefit,<\/p>\n<p>(ea)jobseeker\u2019s benefit (self-employed),<\/p>\n<p>(eb)Covid-19 pandemic unemployment payment,<\/p>\n<p>(f)occupational injuries benefit comprising injury benefit, disablement benefit and death benefit,<\/p>\n<p>(g)carer&#8217;s benefit,<\/p>\n<p>(h)State pension (contributory),<\/p>\n<p>(i)State pension (transition),<\/p>\n<p>(j)invalidity pension,<\/p>\n<p>(k)widow&#8217;s (contributory) pension, widower&#8217;s (contributory) pension and surviving civil partner&#8217;s (contributory) pension,<\/p>\n<p>(l)guardian\u2019s payment (contributory),<\/p>\n<p>(m)bereavement grant,<\/p>\n<p>(n)widowed or surviving civil partner grant (paid by virtue of receipt of a benefit under Part 2).<\/p>\n<p>(2)Subject to section 138 and so long as that section remains in force, benefit shall, in addition to including the benefits referred to in subsection (1), also include treatment benefit under that section.<\/p>\n<p>&nbsp;<\/p>\n<!--themify_builder_content-->\n<div id=\"themify_builder_content-19862\" data-postid=\"19862\" class=\"themify_builder_content themify_builder_content-19862 themify_builder tf_clear\">\n    <\/div>\n<!--\/themify_builder_content-->\n","protected":false},"excerpt":{"rendered":"<p>Overview Treatment benefit is a social insurance-based benefit. \u00a0A person may be entitled to treatment benefits in other EU states.\u00a0 A person from another EU State may qualify for treatment benefits on the basis of social insurance contributions in other EU states.\u00a0 See generally the European Union section in relation to social insurance benefits in 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