Social Welfare (Consolidation) Act, 1993
|
Cost of medical care. |
[1981, s. 57(1); 1990, s. 23(2)] | |
65.—(1) Subject to this section, the cost of medical care which, in the opinion of the Minister, is reasonably and necessarily incurred by an insured person as a result of an injury or disease against which, when it was sustained or contracted, he was insured under this Part, shall be payable out of the Social Insurance Fund to the extent that such cost is not met under the Health Acts, 1947 to 1979, or the Mental Treatment Acts, 1945 to 1966, or regulations made under section 117. | ||
[1981, s. 57(2)] | ||
(2) Where an insured person is eligible to avail himself of services provided under the Health Acts, 1947 to 1979, or the Mental Treatment Acts, 1945 to 1966, or treatment benefit under regulations made under section 117 but does not do so, the amount payable under this section shall not exceed that which would have been payable had he availed himself of such services or benefit. | ||
[1981, s. 57(3)] | ||
(3) Where an insured person receives medical care during any period in which he is an in-patient in a hospital or similar institution, the amount payable under this section in respect of such care shall not exceed— | ||
(a) the maximum amount which would be chargeable under section 53 of the Health Act, 1970 , to an insured person to whom the institutional services provided under that section are made available for that period, or | ||
(b) the maximum amount which would be chargeable under section 231A of the Mental Treatment Act, 1945 , (inserted by section 71 of the Health Act, 1953 ) to an insured person to whom mental hospital assistance is made available for that period, | ||
as may be appropriate. | ||
[1981, s. 57(4)] | ||
(4) The amount payable under this section in respect of medical care provided otherwise than during a period in which the insured person is an in-patient in a hospital or similar institution shall be such sum as is, in the opinion of the Minister, reasonably appropriate to the care afforded, having regard to the reasonable necessity for such care and the customary charge therefor. | ||
[1981, s. 57(5)] | ||
(5) Where an insured person requires medical care as a result of an injury or disease against which, when it was sustained or contracted, he was insured under this Part, he or such other person as may be prescribed shall, within such period as may be prescribed, give notice in writing to the Minister of the care required by him, and shall furnish such particulars as may be required of such care, and no payment under this section shall be made unless the notice is given and, where any particulars are required as aforesaid, those particulars are furnished. | ||
[1981, s. 57(6)] | ||
(6) Where notice is given under subsection (5), the insured person may be required to submit himself to medical examination for the purpose of establishing that the medical care is necessary as a result of the relevant accident or disease and that it is reasonable in his case, and no payment shall be made under this section if he fails to comply with the requirement. | ||
[1981, s. 57(7)] | ||
(7) Payments under this section shall be made to such persons as the Minister thinks fit and, in particular, where the cost of the medical care payable under this section is due to a health board, payment may be made to that board. | ||
[1981, s. 57(8)] | ||
(8) Regulations may provide for applying in relation to payments under this section any of the provisions of this Part relating to benefit and to the making of claims, subject to any additions or modifications. | ||
[1981, s. 57(9)] | ||
(9) For the purposes of this section medical care shall comprise, subject to any additions which may be made by regulations— | ||
(a) general practitioner and specialist care, including domiciliary visiting, | ||
(b) nursing care at home except where the cost is met by an increase under section 57 in respect of constant attendance, and nursing care and maintenance in hospitals, convalescent homes, sanatoria or other medical institutions, | ||
(c) pharmaceutical and other medical or surgical supplies, including prosthetic and aural appliances, prescribed by a registered medical practitioner, kept in repair and replaced where necessary, | ||
(d) dental and optical treatment and appliances, | ||
(e) the care furnished, on the prescription of a registered medical practitioner, by members of professions allied to the medical profession, including physiotherapists and chiropodists, and | ||
(f) conveyance to and from the place where medical care as specified in this subsection is provided. | ||
Prescribed Diseases |