Treatment Benefit Scheme

The Treatment Benefit Scheme may help you meet the cost of:

• dental care
• optical care
• hearing aids and repairs
• hair replacement products (non-surgical scalp products for those who have suffered hair loss due to cancer or certain types of alopecia)

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.

Under 21 years

If you are under 21, you may qualify if you have paid at least 39 contributions at any time.

Aged 21-28

Between these ages you may qualify if you have paid at least 39 contributions and have:

• at least 39 paid or credited contributions in the governing contribution year (Example: 2020 is the governing contribution year for claims made in 2022)

OR

• 26 paid contributions in each of the second and third last contribution years (Example: For claims made in 2024, the second last contribution year is 2022 and the third last contribution year is 2021)

Aged 29-65

From the age of 29 onwards you must have at least 260 paid contributions

AND

• at least 39 paid or credited contributions in the governing contribution year (2022 is the governing contribution year for claims made in 2024)

OR

• 26 paid contributions in each of the second and third last contribution years (for claims made in 2024, the second last contribution year is 2022 and the third last contribution year is 2021.)

If you qualify for benefit at age 60–65, you keep that entitlement for life.

Aged 66 and over

People aged 66 and over must have:

• 260 social insurance (PRSI) contributions paid at any time and 39 paid or credited contributions in the relevant tax year or the year immediately before it.

(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

• 260 social insurance (PRSI) contributions paid at any time and 26 paid contributions in both the relevant tax year and the year immediately before it. (The relevant tax year is the second last completed tax year before reaching 66 years of age)

If you satisfy either of these conditions when you reach pension age, you will remain qualified for life.

Qualifying for Treatment Benefit if you retire due to illness or are unemployed

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.

Qualifying if you worked in the EU or UK

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.

Qualifying as a spouse, civil partner or cohabitant

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:

• have a gross income, before deductions, of €100 or less per week. (If earning more than €100 per week, they must have been dependant on you before entering or resuming insurable employment at class A, E, H, P or S)
• not be receiving a social welfare payment, except:

- Disablement Pension

- Supplementary Welfare Allowance

- Carer's Benefit

- Child Benefit

(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 provideror from the Treatment Benefit Section.

For contact details, please see Make a claim.

View a detailed list of what fees are covered under the Treatment Benefit Scheme.

Dental Benefit

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:

• a scale and polish
• a periodontal treatment (if clinically necessary)

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.

Optical Benefit

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:

• reading and distance spectacles
• bifocal or varifocals
• contact lenses (including disposables)

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.

Medical lenses

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.

Hearing aids

Suppliers may provide or repair hearing aids once every four calendar years if they have a contract with the department.

The department covers:

• a maximum of €500 towards the cost of each hearing aid

AND

• one repair per aid in a four year period, up to a maximum of €100 per aid

Hair Replacement (Non-Surgical Scalp Product)

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:

• alopecia areata (which includes alopecia totalis/universalis, diffuse alopecia areata, alopecia ophiasis)
• primary scarring alopecias (also known as cicatricial alopecias)
• frontal fibrosing alopecia and lichen planopilaris (scarring alopecia)
• chemotherapy induced alopecia (anagen effluvium)
• alopecia resulting from surgery or trauma, including burns

Tax Relief

You may get tax relief on certain non-routine dental treatments like crowns or tip replacing.

For further information on health expenses and tax relief, please see www.revenue.ie

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:

• PPS Number
• date of birth

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:

• your receipts
• a letter with your contact information
• the bank account name, number and sort code you want to receive the payment into

A list of treatment providers is available below:

• Dentists
• Medical Appliance Suppliers - Hearing Aids
• Medical Appliance Suppliers - Contact Lenses
• Ophthalmologists
• Opticians
• Hair Replacement Product Suppliers

This list does not include Medical Card scheme providers.

The Medical Card is a separate scheme operated by the HSE. For further information please contact the HSE.

Operational guidelines describe the processes and procedures that staff in the department follow when carrying out their work.

• Operational Guidelines: Treatment Benefit Scheme
• Operational Guidelines: Payment-related issues