PRSI Contributes Finally Benefit the Self-Employed
The Treatment Benefit Scheme is a scheme run by the Department of Employment Affairs and Social Protection (DEASP) 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.
The extended Optical and Dental services under the scheme will be available to qualified PRSI contributors, including employees and the self-employed, and their dependent spouses/partners was put into effect on Saturday, 28th of October 2017. This is a further improvement to the Treatment Benefits scheme, which was extended to the self-employed earlier last year.
The “reckonable contributions” for Treatment Benefit are payment of Class A, E, P, H or S social insurance contributions. The amount of social insurance you need depends on your age. For example, there are special rules for people aged 66 and over. Generally speaking, you must have 260 contributions paid at any time, and you must have either 39 paid or credited in any of the two contribution years before reaching age 66, or 26 contributions paid in both the relevant contribution year and the year immediately before it.
Under the Treatment Benefit Scheme, you may qualify for:
- DENTAL BENEFIT
- OPTICAL BENEFIT
- HEARING AIDS
Under the Dental Benefit scheme, the Department pays the full cost of an oral examination once a calendar year. From 28/10/17, a payment towards either a scale and polish or, if clinically necessary, periodontal treatment, is also available once per calendar year (depending on the normal cost of the cleaning, there may be a balance to be paid the customer). You may get tax relief on certain non-routine dental treatments.
The Treatment Benefit Scheme entitles you to a free eyesight test once every second calendar year. However, specific sight tests such as those for VDUs (visual display units) or driving licences, are not covered under the scheme.
Since 28/10/17, payment is also available, every second calendar year, towards either:
- one pair each of reading and distanc spectacles
- OR one pair of bi-varifocals,
- OR one pair of contact lenses.
On top of dental and optical Benefits, those with aural needs can also receive contributions. As part of this benefit, the Department will pay half the c of a hearing aid subject to a fixed maximum of €500 for each hearing aid every fourth calendar year. It also pays half the cost of repairs to aids, up to a maximum of €100, once every fourth calendar year.
There is also an option to have treatment in another EU member state. If so, 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. The lower of these amounts will be covered. You must however, still have the qualifying PRSI contributions. To do this, you must contact the Treatment Benefit Section before you travel to get an application form and for details of the amount, the Department will pay.
Claims may be made through your provider (dentist, optician, or audiologist), who will be able to check your entitlement in advance of treatment, and claim payment afterwards.
To allow for this, your provider will need certain identifying information about you; for example, your date of birth and PPS Number. You must sign a Consent Form to say that you agree to your provider having this information, and supplying it to this Department as necessary to complete the claim for payment.
If your spouse, civil partner, or cohabitant does not have enough social insurance contributions, he/she may still qualify for Treatment Benefit on your social insurance record. For this to happen, you must qualify for Treatment Benefit and your spouse, civil partner or cohabitant must be dependent on you.
Where you are claiming as a dependent under your spouse or partner’s PRSI record, both you and your spouse/partner will need to sign the consent form in advance.
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