S.I. No. 156/1954 - Social Welfare (Treatment Benefit) Regulations, 1954.

S.I. No. 156 of 1954.

SOCIAL WELFARE (TREATMENT BENEFIT) REGULATIONS, 1954.

The Minister for Social Welfare in exercise of the powers conferred on him by the Social Welfare Act, 1952 (No. 11 of 1952), and in particular by section 3 and sub-sections (1) and (2) of section 25 of the said Act hereby makes the following Regulations :—

PART I. PRELIMINARY AND GENERAL.

1 Citation.

1. These Regulations may be cited as the Social Welfare (Treatment Benefit) Regulations, 1954.

2 Commencement.

2. These Regulations (except article 31) shall come into operation on the 1st day of August, 1954.

3 Revocation.

3.—(1) The Social Welfare (Treatment Benefit) Regulations, 1953 ( S.I. No. 23 of 1953 ), shall be revoked as from the 1st day of August, 1954.

(2) Notwithstanding the revocation of the Social Welfare (Treatment Benefit) Regulations, 1953, medical and surgical appliances benefit, hospital and convalescent home benefit and specialist medical and surgical benefit may be granted under and in accordance with the said Regulations to a claimant in respect of any appliance obtained and any treatment or service commenced before the 1st day of August, 1954, for which a claim is made before the 1st day of January, 1955.

4 Definitions

4. In these Regulations—

" the Act " means the Social Welfare Act, 1952 ;

" the Minister " means the Minister for Social Welfare ;

" appliance " means an appliance provided as benefit under these Regulations including the repair thereof ;

" benefit " means, as may be appropriate, dental benefit, medical and surgical appliances benefit, or optical benefit ;

" contribution year " and " benefit year " have the same meanings as in the Social Welfare (General Benefit) Regulations, 1953 ( S.I. No. 16 of 1953 ) ;

" dental benefit " means the payment of the whole or part of the cost of dental treatment ;

" medical and surgical appliances benefit " means the payment of the whole or part of the cost of medical and surgical appliances specified in article 22 ;

" optical benefit " means the payment of the whole or part of the cost of optical treatment and appliances ;

" scale of charges " means, as respects any benefit, the scale of fees or charges appropriate to such benefit for the time being fixed by the Minister.

5 Scales of charges and rates of payment.

5. The scales of charges and the rates of payment fixed by the Minister for the purposes of dental benefit and optical benefit under the Social Welfare (Treatment Benefit) Regulations, 1953, shall, until the Minister otherwise determines, be the scales of charges and the rates of payment for the said benefits under these Regulations.

6 Agreements with the Minister

6. Each agreement made and entered into under and for the purposes of dental benefit or optical benefit under the Social Welfare (Treatment Benefit) Regulations, 1953, with a dentist or optician shall be deemed to have been made and entered into under and for the purposes of the said benefits under these Regulations and shall be enforceable accordingly until determined as therein provided.

7 Limitation on payment by the Minister.

7. The grant of a claim to hospital and convalescent home benefit or to specialist medical and surgical benefit under the Social Welfare (Treatment Benefit) Regulations, 1953, shall not operate so as to make any sum payable by the Minister in respect of any treatment or service obtained on or after the 1st day of August, 1954.

8 Application of Social Welfare (Treatment Benefit) (Transitional) Regulations, 1953, to claimants under these Regulations.

8. The Social Welfare (Treatment Benefit) (Transitional) Regulations, 1953 ( S.I. No. 22 of 1953 ), shall apply to claimants under these Regulations in the same manner as they applied to claimants under the Social Welfare (Treatment Benefit) Regulations, 1953.

9 Benefit to be provided.

9. The treatment benefit to be provided under section 25 of the act shall be—

(a) dental benefit,

(b) medical and surgical appliances benefit, and

(c) optical benefit.

10 Contribution conditions for entitlement to benefit.

10.—(1) In this article—

(a) " insurance " and " employment contributions " include (in addition to the meaning assigned to the latter expression by section 5 of the act) insurance outside the State and contributions paid outside the State being insurance and employment contributions for the time being treated as insurance and employment contributions in pursuance of any reciprocal arrangements under the Act relating to disability benefit and maternity benefit;

(b) " relevant contribution year " means the last complete contribution year before the beginning of the benefit year in which the relevant date occurs or, where the claimant is over pensionable age, either of the last two complete contribution years before the relevant date :

(c) " relevant date " means the date on which benefit is claimed or, where the claimant is over pensionable age, the date on which he attained pensionable age.

(2) The contribution conditions to be satisfied by a claimant for benefit shall be—

(a) that not less than one hundred and fifty-six employment contributions have been paid in respect of the claimant between the claimant's entry into insurance and the relevant date, and

(b) that not less than twenty-six employment contributions have been paid in respect of or credited to the claimant in respect of the relevant contribution year.

11 Limitation on benefit for a claimant who is a member of the Defence Forces.

11. A claimant who is a member of the Defence Forces shall be entitled to dental benefit and optical benefit to the extent specified respectively in articles 20 and 29 of these Regulations and to no other benefit.

12 Cost of medical certificates and travelling expenses.

12. A claimant for benefit may be granted—

(a) the cost of any medical certificate required by the Minister for the purposes of the claim, and

(b) such travelling and other expenses necessarily incurred for the purpose of enabling him to secure any treatment, service or appliance in respect of benefit as may be determined.

13 Time limit for obtaining benefit.

13.—(1) The Minister may fix a time within which any treatment, service or appliance is to be obtained.

(2) The Minister may, if he is satisfied that there are good grounds for so doing, extend the time within which any treatment, service or appliance is to be obtained.

(3) A grant of benefit which is not obtained within the time as fixed or extended by the Minister shall lapse to the extent to which the benefit has not been obtained.

(4) The Minister may, on such terms and subject to such conditions as he thinks fit, renew a grant of benefit which has lapsed.

14 Refusal of claim for benefit.

14. A claim for benefit may be refused in any particular case but it shall not be refused solely because the claimant has previously received benefit.

15 Decisions on claims.

15.—(1) The Minister shall cause due notice in writing of the decision on a claim for benefit to be given to the claimant.

(2) Unless his claim is refused, the claimant shall be given in writing particulars of the procedure to be complied with by him for the purpose of obtaining the benefit and of the sum which will be payable by the Minister in respect of the benefit and the sum, if any, which the claimant will be required to pay in respect thereof.

16 Payment by the Minister.

16. The Minister shall, on being informed in writing by the claimant that he has received to his satisfaction the treatment, service or appliance authorised in respect of benefit, pay the sum which the Minister is liable to pay in respect of the benefit under these Regulations.

PART II. DENTAL BENEFIT.

17 Definitions.

17. In this Part of these Regulations—

" dental treatment " means the performance of any dental operation and any examination, treatment, advice, opinion or attendance usually performed or given by a dentist preparatory to or for the purpose of, or in connection with the fitting, insertion or fixing of dentures and includes the extraction or filling, crowning or repair of natural teeth, gum treatment, the making and remaking and supplying of dentures and the administration of anaesthetics ;

" dentist " means a person registered in the Register of Dentists for Ireland established under the Dentists Act, 1928 (No. 25 of 1928), who has entered into an agreement with the Minister to provide dental treatment under the Act.

18 Dental Panel.

18.—(1) The Minister shall, from time to time, prepare and publish a list of the dentists with whom agreements have been made by the Minister for the provision of benefit.

(2) The list referred to in the preceding sub-article shall be known as the Dental Panel.

19 Claimant to claim benefit before commencement of treatment.

19.—(1) A claimant shall not be entitled to benefit unless, before the dental treatment is commenced, he has duly made a claim for the benefit and a decision to grant the benefit has been made.

(2) Where dental treatment is commenced before a claim for benefit or a decision to grant benefit is made benefit may be granted if there was a reasonable cause for the claimant's failure to make a claim or to await a decision on a claim before the commencement of the treatment.

20 Limitation on benefit for claimant who is a member of the Defence Forces.

20. The benefit to which a claimant who is a member of the Defence Forces shall be entitled shall be the provision of dentures and repairs, additions and alterations thereto and remodelling thereof.

21 Amount of payment by the Minister and the claimant.

21. The payment to be made by the Minister in respect of benefit shall be so much of the cost of the dental treatment in accordance with the scale of charges as may from time to time be fixed by the Minister and the remainder of the said cost (if any) shall be paid by the claimant.

PART III. MEDICAL AND SURGICAL APPLIANCES BENEFIT.

22 Benefit.

22. The appliances to be provided as benefit under this Part of these Regulations shall be contact lenses and hearing aids.

23 Claimant to claim benefit before obtaining an appliance.

23.—(1) A claimant shall not be entitled to benefit unless, before obtaining the appliance, he has duly made a claim for the benefit and a decision to grant the benefit has been made.

(2) Where a claimant obtains the appliance before a claim for benefit or a decision to grant the benefit is made, the benefit may be granted if there was reasonable cause for the claimant's failure to make a claim or to await a decision on a claim before obtaining the appliance.

24 Amount of payment by the Minister and the claimant.

24. The payment to be made by the Minister in respect of benefit shall be

(a) where the cost of providing or repairing an appliance does not exceed three pounds, two-thirds of the cost,

(b) where the cost of providing or repairing an appliance exceeds three pounds, so much of the cost as may be determined in any particular case,

and the remainder of the said cost shall be paid by the claimant.

25 Special provisions relating to benefit.

25.—(1) A claimant for benefit shall submit with the claim a recommendation from the medical practitioner attending him and an estimate of the cost of supply or repair, as may be appropriate, from a supplier approved by the Minister.

(2) The Minister may, if he thinks fit, dispense with the submission of a recommendation from the medical practitioner where the benefit claimed is in respect of the repair of an appliance.

(3) When a claim for benefit is granted, the Minister shall notify the claimant and the supplier.

(4) Benefit shall not be payable unless the appliance is, as may be appropriate, purchased from or repaired by a supplier approved by the Minister.

PART IV. OPTICAL BENEFIT.

26 Claimant to claim benefit before obtaining treatment or appliance.

26.—(1) A claimant shall not be entitled to benefit unless, before obtaining the treatment or appliance, he has duly made a claim for the benefit and a decision to grant the benefit has been made.

(2) Where a claimant obtains the treatment or appliance before a claim for benefit or a decision to grant the benefit is made, the benefit may be granted if there was reasonable cause for the claimant's failure to make a claim or to await a decision on a claim before obtaining the treatment or appliance.

27 Optical Panel.

27.—(1) The Minister shall, from time to time, prepare and publish a list of the opticians who have entered into agreements with the Minister for the provision of benefit.

(2) The list referred to in the preceding sub-article shall be known as the Optical Panel.

28 Special provisions.

28.—(1) Benefit shall not be payable unless the appliance is, as may be appropriate, purchased from or repaired by a person whose name is for the time being on the Optical Panel.

(2) The Minister may require a certificate of an ophthalmic surgeon to be submitted with a claim for benefit.

(3) Where a claim for benefit is granted, the Minister shall notify the claimant and the optician.

29 Limitation on benefit for claimant who is a member of the Defence Forces.

29. The benefit to which a claimant who is a member of the Defence Forces shall be entitled shall be the provision of optical appliances.

30 Amount of payment by the Minister and the claimant.

30. The payment to be made by the Minister in respect of benefit shall be—

(a) such sum as may from time to time be fixed by the Minister for examination, advice and, if necessary, prescription by an ophthalmic surgeon, and

(b) such sum as may from time to time be fixed by the Minister towards the cost of optical appliances.

PART V. AMENDMENT OF THE SOCIAL WELFARE (TREATMENT BENEFIT) REGULATIONS, 1953.

31 Amendment to the Social Welfare (Treatment Benefit) Regulations, 1953.

31.—(1) Article 6 of the Social Welfare (Treatment Benefit) Regulations, 1953, shall be deleted and the following shall be substituted therefor—

" 6. (1) In this article—

(a) ' insurance ' and ' employment contributions ' include (in addition to the meaning assigned to the latter expression by section 5 of the act) insurance outside the State and contributions paid outside the State being insurance and employment contributions for the time being treated as insurance and employment contributions in pursuance of any reciprocal arrangements under the Act relating to disability benefit and maternity benefit ;

(b) ' relevant contribution year ' means the last complete contribution year before the beginning of the benefit year in which the relevant date occurs or, where the claimant is over pensionable age, either of the last two complete contribution years before the relevant date ;

(c) ' relevant date ' means the date on which benefit is claimed or, where the claimant is over pensionable age, the date on which he attained pensionable age.

(2) The contribution conditions to be satisfied by a claimant for benefit shall bemdash;

(a) that not less than one hundred and fifty-six employment contributions have been paid in respect of the claimant between the claimant's entry into insurance and the relevant date, and

(b) that not less than twenty-six employment contributions have been paid in respect of or credited to the claimant in respect of the relevant contribution year."

(2) This article shall come into operation on the date of these Regulations.

GIVEN under the Official Seal of the Minister for Social Welfare this 30th day of July One Thousand Nine Hundred and Fifty-four.

BRENDAN CORISH,

Minister for Social Welfare.