Hello again, and welcome to this week’s edition of our On The Money newsletter. I’m returning this week to something we looked at before Christmas – money the State has agreed to pay us but which people fail to claim. In this case, we’re looking at treatment benefits – free dental, optical and aural care that is available to most people paying PRSI.
And there have been some changes to the scheme in recent years which mean that you may now be eligible for treatment where previously you might not have been. There has also been some expansion of the benefits provided.
How do I qualify for PRSI treatment benefits?
The department estimates that some 2.25 million people qualify for treatment benefits as a result of the PRSI payments they make on their pay. However, on the basis of claims figures, it appears that around a third of those workers do not appear to avail of the free services on offer.
People paying PRSI under Class A, E, P, H or S can qualify though, confusingly, their entitlement is based not on the social insurance stamps paid this year, or even last year, but rather two years before the current tax year. So, for anyone looking to avail of free treatment under the scheme this year, it is their PRSI record in 2023 that will be assessed. If they had gone looking for the treatment a couple of weeks ago in December, it would have been their 2022 record that was relevant.
So a whole tranche of younger workers will now be able to avail of the benefit.
Class A covers most private sector PAYE employees up to the point at which they start drawing down a State pension. It also covers public service workers recruited since April 6th, 1995.
Class E is effectively ring-fenced for Church of Ireland ministers while Class P is paid by certain trawler workers. Class H is paid by Defence Forces personnel up to and including non-commissioned officers, though they are eligible only for some of the treatments.
Class S covers people who are self-employed.
Adding further confusion to things, the number of PRSI payments you need to have made to qualify for treatment benefit changes according to your age.
If you are under the age of 21, you can access benefits once you have paid at least 39 weekly contributions.
Over the age of 21 and below the age of 29, you still need that 39 stamp minimum but those 39 stamps must have been paid or credited in the “governing year” – two years before the year in which you are looking to claim. Credited PRSI payments are those you can claim while you are on Jobseekers if you lose your job, for instance.
Alternatively, you can qualify with 26 paid contributions in the second and third years before the year of claim – so, in 2025, the relevant years would be 2022 and 2023.
Previously anyone over the age of 25 needed have paid PRSI for five years before qualifying for the scheme but that was reduced to nine months in 2022 in a move that was seen as benefiting 80,000 young workers.
Over the age of 28, the rules change again. People looking to access benefits between the ages of 29 and 65 are still required to have a minimum of 260 paid contributions – five years’ worth. Otherwise the rules are the same for those people over the age of 21.
And once you turn 66, there is yet another adjustment to the qualification rules. The key thing here is that, provided you qualify at age 66, you will remain qualified for life even if you never accrue another PRSI stamp.
You will need the five years minimum of paid contributions and either 39 paid or credited contributions in the second last complete tax year before you turned 66 or in the year immediately before that or, alternatively, 26 paid contributions in both of those years.
So, if you were turning 66 this year, the relevant years would again be 2023 and 2022.
So, four different rules depending on your age.
And if you do not have enough PRSI payments but are a citizen of another EU country or Norway, Iceland and Liechtenstein and have a social insurance record in one of those countries, it can be used to hit the qualification thresholds. The same applies to UK nationals or people from other qualifying countries who have worked there.
What treatment can you get under PRSI benefits?
Assuming you qualify, the obvious question is what you can get under treatment benefit? Well, free dental and optician check-ups for a start, as well as free hearing aids and, for some people, free wigs. Let’s take them in turn.
How much dental care will PRSI cover?
At the dentist, you can get one check-up a year free of charge and up to €42 towards the cost of either a scale and polish or, if clinically necessary, periodontal treatment. The dentist can charge you up to an additional €15 for the scale and polish and they can also charge a top-up on periodontal treatment so it is always worth checking what that might be before you start.
The big “if” here is whether your dentist operates under the scheme. Many don’t, citing the poor rates they bare offered for the service. And choosing a dentist is a very personal thing. Few people relish the experience and the trust between dentist and patient is important. So the idea of going to a separate person just for a free annual check-up, if their own dentist is not signed up to the scheme, would be a step too far for many people.
You can check if your dentist will provide the service on this list compiled by the Department of Social Protection.
Will PRSI cover eyetests and glasses?
You also get a free eyesight test but this is available only every second year – and it does not cover eye tests required for a driving licence or computer screen use. If clinically necessary – a phrase that understandably pops up frequently when discussing the treatment benefit scheme – up to three repeat examinations can also be covered.
In addition, it covers the cost of either a pair each of reading plus a separate pair of distance spectacles, one pair of bifocal/varifocal glasses or one pair of contact lenses. Basic frames are free under the service but if you want to upgrade from that, they will pay €42 towards the cost.
It will also cover up to two repairs to glasses in the two-year period.
If you require contact lenses for medical reasons, rather than simply preferring them, the Department will pay up to €500 per lens (i.e. €1,000 for a pair) once every two years. This was another benefit improved in June 2022: before that the payment was sanctioned only once in four years.
Defence Force personnel do not qualify for either optical or dental care on the basis that the Department of Defence is supposed to offer those services free anyway.
Can you get hearing aids on PRSI?
The four-year rule remains in place when it comes to hearing aids. Your stamps will get you €500 towards the cost of each hearing aid, so €1,000 if you require one for each ear.
You can also get €100 to defray the cost if you require repair work on hearing aids within that four-year window.
Again there is a list of approved suppliers which is worth checking before you embark on what can be an expensive purchase.
Can you get hairpieces on PRSI?
Finally, people living with cancer or alopecia can get up to €500 towards the cost of a wig after hair loss under the expansion of the scheme in mid-2022.
Once again, there is a list of approved suppliers.
Given the cost of glasses, dental check-ups, hearing aids and wigs, it make sense to make sure you avail of the free services to which you are entitled. As you can see from the payment limits, it can deliver significant savings for you.
Making a claim for free treatment is very straightforward and, for most people, is done through the service provider – i.e. the dentist, optician etc.
They will need your PPS number and date of birth and you will need to sign a form consenting to them having that information and passing it on to the Department of Social Protection which oversees the scheme.
If you are applying on the basis of a social insurance record compiled in part outside the State, you will probably need to pay in advance and sent your receipts into the Treatment Benefit Section at the Department of Social Protection, St Oliver Plunkett Road, Letterkenny, Co Donegal, together with a letter providing your personal details and those of the bank account into which you would like the payment made.
You can contact us at OnTheMoney@irishtimes.com with personal finance questions you would like to see us address. If you missed last week’s newsletter, you can read it here.
