S.I. No. 23/1953 - Social Welfare (Treatment Benefit) Regulations, 1953.

S.I. No. 23 of 1953.

SOCIAL WELFARE (TREATMENT BENEFIT) REGULATIONS, 1953.

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 subsections (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, 1953.

2 Commencement.

2.—(1) These Regulations shall (except in so far as they relate to dental benefit) come into operation on the 5th day of January, 1953.

(2) These Regulations shall, in so far as they relate to dental benefit, come into operation on such date as may be fixed by the Minister for that purpose.

3 Regulations

3. 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, hospital and convalescent home benefit, medical and surgical appliances benefit, optical benefit, or specialist medical and surgical 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 ;

" dental treatment " and " dentist " have the meanings assigned to them in article 14 ;

" hospital " and " convalescent home " have the meanings assigned to them in article 17 ;

" hospital and convalescent home benefit " means the payment of the whole or part of the cost of hospital and convalescent home treatment ;

" institution " has the meaning assigned to in article 37 ;

" medical and surgical appliances benefit " means the payment of the whole or part of the cost of medical and surgical appliances specified in article 32 ;

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

" optician " means a person who has entered into an agreement with the Minister to provide optical appliances under the Act ;

" specialist medical and surgical benefit " means the payment of the whole or part of the cost of specialist medical and specialist surgical treatment specified in article 38 ;

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

4 Benefit to be provided.

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

(a) dental benefit,

(b) hospital and convalescent home benefit,

(c) medical and surgical appliances benefit,

(d) optical benefit,

(e) specialist medical and surgical benefit.

5 Limitation on benefit for a claimant serving in Defence Forces.

5.—(1) A claimant who is serving in the Defence Forces shall be entitled to dental benefit and optical benefit to the extent specified in sub-articles (2) and (3) of this article and to no other benefit.

(2) The dental benefit to which a claimant serving in the Defence Forces shall be entitled shall be so much of the cost, specified in the scale of charges, of the provision of dentures, repairs, additions and alterations thereto and remodelling thereof as may from time to time be fixed by the Minister for the purposes of the benefit.

(3) The optical benefit to which a claimant serving in the Defence Forces shall be entitled shall be so much of the cost, specified in the scale of charges, of the provision of optical appliances as may from time to time be fixed by the Minister for the purposes of the benefit.

6 Contribution conditions for entitlement to benefit.

6.—(1) In this article, the expressions "insurance" and " employment contributions " (in addition to the meaning assigned to the latter expression by section 5 of the act) include insurance and contributions paid outside the State which are treated as insurance and employment contributions in pursuance of any reciprocal arrangements under the Act relating to disabilitybenefit and maternity benefit.

(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 day on which benefit is claimed, 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 last complete contribution year before the beginning of the benefit year which includes the day on which benefit is claimed.

7 Travelling expenses and cost of medical certificates.

7. A claimant for benefit may be paid—

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

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

8 Time limit for obtaining benefit.

8.—(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.

9 Refusal of claim for benefit.

9. 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.

10 Amount of payment by the Minister and the claimant.

10.—(1) The payment to be made by the Minister in respect of dental benefit, hospital and convalescent home benefit, optical benefit and specialist medical and surgical benefit shall be so much of the cost of the appropriate treatment, service or appliance 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.

(2) The payment to be made by the Minister in respect of medical and surgical appliances 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.

(3) The payment to be made by the Minister in respect of optical 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.

11 Panels.

11.—(1) The Minister shall, from time to time, prepare and publish lists of the dentists, hospitals, convalescent homes, opticians and institutions affording specialist medical and surgical treatments with whom agreements are made or deemed to have been made under these Regulations for the provision of treatment benefit.

(2) The lists referred to in the preceding sub-article shall be known respectively as the Dental Panel, the Hospital Panel, the Convalescent Home Panel, the Optical Panel and the Specialist Medical and Surgical Panel.

12 Decisions on claims.

12.—(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.

13 Payment by the Minister.

13. 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.

14 Definitions.

14. In 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 preparatoryto 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.

15 Claimant to claim benefit before commencement of treatment.

15.—(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 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.

16 Change of dentist.

16. Where a claimant elects to change his dentist after benefit has been granted and dental treatment has been approved, such election shall be treated as a new claim for benefit.

PART III. HOSPITAL AND CONVALESCENT HOME BENEFIT.

17 Definitions.

17.—(1) In these Regulations—

(a) " hospital " means a private hospital or nursing home or any other hospital or nursing home (not being a hospital or nursing home of a class specified in sub-article (2) of this article) which is in the State and which provides hospital medical and surgical treatment or a district institution under the Public Assistance Act, 1939 (No. 27 of 1939) as respects which regulations under section 37 of that Act are for the time being in force ;

(b) " convalescent home " means any convalescent home in the State (not being a convalescent home of a class specified in sub-article (2) of this article) which provides restorative treatment or facilities for convalescence.

(2) The following hospitals and convalescent homes shall not be hospitals and convalescent homes for the purpose of these Regulations—

(a) sanitoria and tuberculosis hospitals,

(b) district institutions under the Public Assistance Act, 1939 , as respects which regulations under section 37 of the said Act are not in force.

(c) hospitals, including mental hospitals, and convalescent homes providing for the treatment of chronic diseases of incapacity, and

(d) private hospitals and nursing homes providing for maternity cases only.

18 Claimant to claim benefit before admission to hospital or convalescent home.

18.—(1) A claimant shall not be entitled to benefit unless, before admission to the hospital or convalescent home, he has duly made a claim for the benefit and a decision to grant the benefit has been made.

(2) Where a claimant is admitted to a hospital or convalescent home 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 his admission to the hospital or convalescent home.

19 Recommendation by medical practitioner.

19. Every claim for benefit shall be accompanied by a recommendation from the medical practitioner attending the claimant.

20 Limitation on benefit for women.

20. A woman shall not be entitled to benefit in respect of any period during which she is a patient in a hospital or convalescent home for the sole purpose of her confinement.

21 Compliance with rules of hospital or convalescent home.

21. A claimant admitted to a hospital or convalescent home in pursuance of these Regulations shall comply with the rules and regulations of the hospital or convalescent home.

22 Agreements with hospitals and convalescent homes.

22.—(1) The governing body of a hospital or convalescent home shall be deemed to have made an agreement with the Minister to provide benefit if the governing body or any duly authorised officer informs the Minister in writing that the governing body will provide benefit in accordance with these Regulations and on the terms and subject to the conditions contained in these Regulations.

(2) Any agreement deemed under this article to have been made between the Minister and the governing body of a hospital or convalescent home for the purposes of these Regulations may be terminated by either party giving to the other one month's notice in writing of the intention to do so.

23 Refusal of admission by hospital or convalescent home.

23.—(1) Notwithstanding anything contained in these Regulations the governing body of a hospital or convalescent home may refuse to admit to the hospital or convalescent home a claimant suffering from or recovering from an illness for which treatment is not ordinarily provided in the hospital or convalescent home.

(2) Nothing contained in these Regulations shall be construed as affecting or restricting the powers of the governing body as to the admission of patients.

(3) Nothing contained in these Regulations shall be construed as implying that the services of the honorary medical staffs to claimants in public wards are being paid for. Such services will be rendered voluntarily.

24 Obligations of hospital or convalescent home to claimant admitted under these Regulations.

24. The governing body of a hospital or convalescent home shall provide every claimant admitted to the hospital or convalescent home in accordance with these Regulations with accommodation, food, nursing, medicines and attendance as if such claimant had been admitted to a public ward of the hospital or convalescent home as a paying patient.

25 Period for which benefit is payable.

25.—(1) The period in a hospital for which benefit shall be payable shall not exceed six weeks in respect of any continuous period in a hospital.

(2) The period in a convalescent home for which benefit shall be payable shall not exceed two weeks in respect of any continuous period in a convalescent home.

26 Notification to hospital or convalescent home of grant of claim.

26. The governing body of the hospital or convalescent home to which a claimant is to be admitted shall be notified by the Minister of the sum which and the period for which the Minister shall be liable for payment in respect of the benefit.

27 Application by hospital or convalescent home for payment.

27. The governing body of a hospital or convalescent home in which a claimant has, in accordance with these Regulations, been given benefit shall apply to the Minister for payment in respect of such benefit on the form prescribed by the Minister for that purpose as soon as possible after the discharge of the claimant or the expiration of the period for which the Minister is liable to pay, whichever shall first occur.

28 Payment of benefit.

28. The payment to be made by the Minister in respect of the benefit shall be made to the governing body of the hospital or convalescent home but the Minister may, if he thinks fit, make a payment in respect of the benefit in respect of a claimant admitted to a hospital to the claimant instead of to the governing body of the hospital.

29 Payments by Minister and claimant to cover all charges.

29. The governing body of a hospital or convalescent home shall accept payment at the rates fixed by the Minister in the scale of charges in full discharge of any claim in respect of a claimant admitted to the hospital or convalescent home under these Regulations and, save where the claimant elects to be admitted to a private or semi-private ward, shall not make any demand upon the claimant for any sum in excess of the amount (if any) which the claimant is required under these Regulations to pay.

30 Claimants admitted to private wards of hospital or convalescent home.

30. Where a claimant for benefit elects to be admitted to a private or semi-private ward of a hospital or convalescent home, the payment to be made by the Minister in respect of the benefit shall be the same as if he had been admitted in accordance with these Regulations to a public ward.

31 Payment of benefit in exceptional circumstances.

31. Where exceptional circumstances so warrant, benefit may be granted by the Minister to a claimant who has been admitted as an intern patient to a hospital as respects which the Minister has not been informed under article 22 that the governing body will provide benefit in accordance with these Regulations.

PART IV. MEDICAL AND SURGICAL APPLIANCES BENEFIT.

32 Definitions.

32. In these Regulations, " medical and surgical appliances " means abdominal belts, arch supports, artificial eyes, artificial limbs, caliper splints, colostomy belts, contact lenses, crutches, elastic knee caps, elastic stockings, hearing aids, insulin syringes, spinal braces and frames, surgical boots and shoes and extensions thereto, and trusses.

33 Claimant to claim benefit before obtaining an appliance.

33.—(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.

34 Special provisions relating to benefit

34.—(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 V. OPTICAL BENEFIT.

35 Claimant to claim benefit? before obtaining treatment or appliance.

35.—(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 benefitmay 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.

36 Special provisions relating to benefit.

36.—(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.

PART VI. SPECIALIST MEDICAL AND SURGICAL BENEFIT.

37 Definitions.

37. In these Regulations—

" institution " means a hospital, clinic or institution which provides any treatment or treatments specified in article 38 of these Regulations and the governing body of which is deemed to have entered into an agreement with the Minister in accordance with these Regulations.

38 Treatments for which benefit is obtainable.

38. The treatments in respect of which benefit may be obtained shall be x-ray examination, x-ray treatment, ultra-violet radiation and infra-red radiation, massage and manipulation, galvanism, faradism, ionisation, diathermy and short-wave treatments.

39 Claimant to claim benefit before commencement of treatment.

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

(2) Where the treatment is commenced 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 the commencement of the treatment.

40 Agreements with institutions for the provision of benefit.

40.—(1) The governing body of an institution shall be deemed to have made an agreement with the Minister to provide a treatment in respect of which benefit may be obtained, if the governing body or any duly authorised officer informs the Minister in writing that the governing body will provide such a treatment in accordance with these Regulations and on the terms and subject to the conditions contained in these Regulations.

(2) Any agreement deemed under this article to have been made between the Minister and the governing body of an institution for the purposes of these Regulations may be terminated by either party giving to the other one month's notice in writing of the intention to do so.

41 Recommendation by medical practitoner.

41. A claimant for benefit shall submit with the claim a recommendation from the medical practitioner attending him.

42 Report by institution.

42. The governing body of an institution shall supply to the Minister free of charge whenever so required a report on the condition of any claimant who is receiving or who has received a treatment under these Regulations.

43 Notification to institution of grant of claim.

43. Where a claim for benefit is granted, the Minister shall notify the institution, in which the claimant is to receive the treatment, of the nature and extent of the treatment and the sum which the Minister will be liable to pay in respect of the treatment.

44 Application by institution for payment.

44. The governing body of an institution in which a claimant has, in accordance with these Regulations, been given a treatment shall apply to the Minister for payment in respect of the treatment on the form prescribed by the Minister for that purpose as soon as possible after completion of the treatment.

45 Payment of benefit.

45. The governing body of an institution shall accept payment at the rates fixed by the Minister in the scale of charges in full discharge of any claim for a treatment given to a claimant under these Regulations and shall not make any demand upon the claimant for any sum in excess of the amount (if any) which the claimant is required under these Regulations to pay.

46 Treatment by claimant's own doctor, physiotherapist, masseur or masseuse.

46. Where a claimant for benefit has received a treatment in an institution and the medical superintendent in charge of the institution recommends that the treatment be continued outside the institution by the claimant's own medical practitioner or by a physiotherapist or masseur or masseuse recommended by such medical superintendent, the Minister may allow the claimant so to obtain such further treatment if the person by whom the treatment is to be given agrees to accept payment therefor at the rates fixed by the Minister in the scale of charges in full discharge of any claim in respect of the treatment and not to make any demand upon the claimant for any sum in excess of the amount (if any) which the claimant is required under these Regulations to pay.

GIVEN under the Official Seal of the Minister for Social Welfare, this 5th day of January, One Thousand Nine Hundred and Fifty three.

SEAMAS Ó RIAIN,

Minister for Social Welfare.