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PRSI

Contribution conditions

The Treatment Benefit Scheme is available to insured workers, the self-employed and retired people who have the required number of PRSI contributions.

Under the Treatment Benefit Scheme, you may qualify for:

Dental benefit / Optical benefit /Hearing aids

You should contact the DEASP (see ‘Where to apply’ below) or your treatment provider to check your eligibility before proceeding with any treatment.

Treatment Benefit in the EU

If you choose 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, H or S 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 (2015 is the governing contribution year for claims made in 2017) or

26 paid contributions in each of the second and third last contribution years. For claims made in 2017, the second last contribution year is 2015 and the third last contribution year is 2014.

(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 (2015 is the governing contribution year for claims made in 2017) or

26 paid contributions in each of the second and third last contribution years. For claims made in 2017, the second last contribution year is 2015 and the third last contribution year is 2014.

(4) Aged 66 and over

There are special rules for people aged 66 and over. To qualify, 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.

There are, however, a number of exceptions to this:

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.

If you are getting a State pension the PRSI contribution requirements vary according to age as follows:

If you were: You must have at least:

Aged 66 before 1 October 1987 156 weeks PRSI paid since first starting work and 26 paid or credited in either of the last 2 complete tax years before you reached age 66.

Aged 66 between 1 October 1987 and 6 July 1992 208 weeks PRSI paid since first starting work and either 39 weeks paid or credited in either of the last 2 complete tax years before you reached age 66, or 26 contributions paid in both the relevant tax year and the year immediately before it.

Aged 66 on or after 6 July 1992 260 weeks PRSI paid since first starting work and either 39 weeks paid or credited in either of the last 2 complete tax years before you reached age 66, or 26 contributions paid in both the relevant contribution year and the year immediately before it.

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 retain 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, subject to satisfying the statutory conditions. Your entitlement to these benefits may also lead to your being awarded credited contributions, which can be taken into account to extend coverage for treatment benefits for further periods.

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

A dependent spouse, civil partner or cohabitant must:

Have a gross income of €100 or less per week. If earning more than €100 per week, he/she must have been dependent on you before entering or resuming insurable employment (at Class A, E, H, P or S).

Not be getting a social welfare payment (except Disablement Pension, Supplementary Welfare Allowance, Carer’s Benefit or Child Benefit). If getting Carer’s Allowance or State Pension (Non-Contributory), he/she can qualify if he/she was dependent on you immediately before getting the Allowance or Pension.

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

Dental Benefit

Under this scheme, the Department pays the full cost of an oral examination once a calendar year.

Since 28 October 2017, a payment of €42 towards either a scale and polish or – if clinically necessary – periodontal treatment, is also available once a calendar year. If the cost of either cleaning or periodontal treatment is more than €42, you must pay the balance – capped at €15 for a regular scale and polish. There is no cap on the balance charged for periodontal treatment.

The Dentist will be able to check your eligibility and make a claim for you. The claim form will require details such as your Personal Public Service Number (PPS number), date of birth and signature. If you are a dependent spouse or civil partner, you should give the PPS number of the insured person, who will also be required to sign the claim form.