Know Your Rights: Treatment Benefit Scheme and the self-employed

Question

I run a small business and pay Class S PRSI. My wife works part-time. Are we both entitled to medical benefits under the Treatment Benefit Scheme?

Answer

Since 27 March 2017, the Treatment Benefit Scheme has been extended to cover self-employed people who have paid sufficient Class S PRSI contributions. The scheme is run by the Department of Social Protection (DSP) and provides dental, optical and aural services to qualified people. You should contact the DSP or your treatment provider to check your eligibility before proceeding with any treatment. The number of PRSI contributions required depends on your age.

Your wife may qualify in her own right if she has enough contributions. If she doesn’t have enough, she may still qualify for Treatment Benefit on your social insurance record. To do this, you must qualify for Treatment Benefit and she must be dependent on you. To be considered dependent she must:

·         Have a gross income of €100 or less per week or

·         Earn more than €100 per week and have been dependent on you before entering or resuming insurable employment (at Class A, E, H, P or S) or

·         Not be getting a social welfare payment (except Disablement Pension, Supplementary Welfare Allowance, Carer’s Benefit or Child Benefit) or

·         Have a Carer’s Allowance or State Pension (Non-Contributory) and have been dependent on you immediately before getting this payment

Benefits under the scheme include an annual oral examination by private dentists on a DSP panel. Most dentists are on the panel so you shouldn’t have difficulty finding one. The scheme also provides for a free eyesight test but does not include sight tests for computer screens or driving licences. Half the cost of medically required contact lenses and hearing aids, up to a maximum amount, may also be covered. Opticians, optometrists or hearing aid suppliers providing the treatment or hearing products must have a contract with the DSP.

You can get detailed information on the Treatment Benefit Scheme on welfare.ie. Further information is available from the Citizens Information Service below.

Know Your Rights has been compiled by Boyle Citizens Information Centre which provides a free and confidential service to the public. Tel: 0761 07 6330

Address: Elphin Street, Boyle, Co. Roscommon

Information is also available online at citizensinformation.ie and from the Citizens Information Phone Service - 0761 07 4000