What is the Treatment Benefit Scheme?
The Treatment Benefit Scheme was created by the Department of Social Protection (DSP) to provide ear and eye care services to insured workers, the self-employed and retired people who have met the required number of PRSI contributions.
What is PRSI: contributions and rates
Social insurance contributions in Ireland are referred to as PRSI (Pay Related Social Insurance). PRSI contributions go to the Social Insurance Fund (SIF) which helps to pay for Social Welfare benefits and pensions.
Most employers and employees between the ages of 16 and pensionable age pay PRSI contributions. The class and rate of contribution you pay is determined by the nature of your employment and your weekly earnings.¹
How to determine your PRSI class
PRSI contributions are divided into different categories, known as ‘PRSI classes’, based on your employment and weekly earnings. This determines the rate of PRSI you and your employer will pay, otherwise known as your ‘rate of contribution’.¹
There are currently 11 different PRSI classes: A, B, C, D, E, H, J, K, M, S and P. The class of PRSI that you pay determines the social welfare benefits that you might qualify for.
Each PRSI class is further divided into subclasses based on your weekly gross reckonable earnings. The subclasses don’t affect your entitlements under the social insurance system, but it does affect the amount of PRSI which you and your employer must pay.²
Will your PRSI contributions cover your spouse or partner?
A spouse, civil partner or cohabitant may qualify for the Treatment Benefit on your social insurance record if they don’t have enough PRSI contributions in their own right. To be eligible they must be dependent on you and pass the following criteria:
- Have a gross income of €100 or less per week
- Not be receiving a social welfare payment
There are some exceptions to the rules that mean they could still be eligible:
What are the eligibility criteria for the Treatment Benefit Scheme?
To be eligible you must have paid Class A, E, P, H or S PRSI contributions. The amount of social insurance payments required depends on your age.³
| Eligibility requirements | |
|---|---|
| Under 21 | Paid at least 39 contributions at any time. |
| 21 to 24 | Paid at least 39 contributions and: - at least 39 paid or credited in the governing contribution year; or - 26 paid contributions in each of the second and third contribution years. |
| 25 to 65 | Paid at least 260 contributions and: - at least 39 paid or credited contributions in the governing contribution year; or - 26 paid contributions in each of the second and third last contribution years. |
| 66 and over | There are special rules for this age category.To qualify you must have: - 260 PRSI contributions paid at any time and 39 paid or credited contributions in the relevant tax year or the year immediately before it; or - 260 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. (For example, if you were 66 in 2015, the relevant tax year is 2013). Exceptions to the above: - if you reached age 66 before 1 October 1987, you need 156 paid contributions instead of 260; - if you reached age 66 between 1 October 1987 and 6 July 1992, you need 208 paid contributions instead of 260. |
| 66 and over and receiving a State pension | If you were aged 66 before 1 October 1987 you must have at least: - 156 weeks PRSI paid since starting work and 26 paid or credited in either the relevant tax year or the year immediately before it. If you were aged 66 between 1 October 1997 and 6 July 1992 you must have at least: - 208 weeks PRSI paid since starting work and 39 weeks paid or credited in the relevant tax year or the year immediately before it; or - 208 weeks PRSI paid since starting work and 26 contributions paid in both the relevant tax year and the year immediately before it. If you were aged 66 on or after 9 July 1992 you must have at least: - 260 weeks PRSI paid since starting work and either 39 weeks paid or credited in the relevant tax year or the year immediately before it; or - 260 weeks PRSI paid since starting work and 26 contributions paid in both the relevant tax year and the year immediately before it. |
From June 2022 the minimum paid PRSI contributions required to qualify for Treatment Benefit will decrease from 5 years (260 weeks) to 9 months (39 weeks) for people aged between 25 and 28.
For claims made in 2022:
- 2020 is the governing contribution year
- 2020 is the second last contribution year
- 2019 is the third last contribution year
How to apply
Claims are made through your optician/optometrist/ophthalmologist or audiologist (depending on the required treatment), who can check your entitlement in advance of treatment and claim payment afterwards.
Your provider will require some information to identify you, such as your date of birth and PPS number. Prior to treatment, you will also need to sign a consent form agreeing to share this information with your provider and the DSP, this will enable payment of your claim. If you are claiming as a dependent under the PRSI record of your spouse, civil partner or cohabitant, you will both need to sign the consent form.³
Check out our information on how to claim a free eye test and glasses or free hearing aids under the PRSI Treatment Benefit Scheme.
What are medical cards?
PRSI and medical cards
Free eye test with PRSI
References
- Gov.ie. (22/05/2020). PRSI - Pay Related Social Insurance. [Online] Available at: https://www.gov.ie/en/publication/80e5ab-prsi-pay-related-social-insurance/ [Accessed 08/10/2021] (last updated 30/09/2021)
- Citizens Information. (11/05/2021). Social insurance classes. [Online] Available at: https://www.citizensinformation.ie/en/social_welfare/irish_social_welfare_system/social_insurance_prsi/social_insurance_classes.html [Accessed 08/10/2021]
- Citizens Information. (29/03/2021). Treatment Benefit Scheme. [Online] Available at: https://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/disability_and_illness/treatment_benefit_scheme.html#l1f4da [Accessed 08/10/2021]
- Citizens Information. (07/01/2021). Paying social insurance (PRSI). [Online] Available at: https://www.citizensinformation.ie/en/social_welfare/irish_social_welfare_system/social_insurance_prsi/employer_s_duty_to_pay_social_insurance_prsi.html [Accessed 08/10/2021]