3 OUTPATIENT BENEFITS
3.1 Drugs/Medicines/Sleep Apnea
♦ Drugs and medicines obtained on prescription and having a drugs code and the hire of a sleep Apnea machine may be
claimed. We will refund a maximum of €70 per month per family under this benefit. You pay the first €20 per month
and any amount over €90 per month. This benefit is treated as a family benefit. Discuss with your G.P. the possibility
of prescribing Generic Drugs which are much cheaper on you and also compare drug prices with other pharmacies in
your area as some of them are much dearer than others.
3.2 Visits to Doctor
♦ Visits to or from recognised registered medical practitioners are paid to a maximum of €35 per visit and a maximum of
50 visits per family per annum. Itemised receipts from the doctor showing the name of the patient, date of visits and
the cost of each visit must accompany claims. Serving members are excluded as they are provided for by the State
who pays the Doctor directly for treating the member. You should encourage your G.P. to register to provide this
service to avoid having to pay him upfront and having to pay income tax on the refund from your Superintendant.
3.3 Dental Benefit
♦ Claims must be supported by receipts and completed dental chart giving details of work carried out, the date and cost
of each item and the name of the patient. The following cover is provided:
Veneers/Etch/Rembrandt Fillings - paid to a maximum of €36.00. Extractions incl wisdom - paid to a max of €40
Fissure sealing paid to a maximum of €20.00 per tooth
Periodontal Treatment 65% of the cost to a maximum of €180 per annum in respect of any one person.
Root Treatment 65% of the cost to a maximum payment of €300 per patient per annum
Note: Periodontal & Root Treatment must be carried out by a Periodontist or Endodontist for payment to be made.
Crowns 65% of the cost to a maximum of €220.00 per crown
Orthodontic incl. x-rays 65% of the cost paid to a maximum of €1700 as a once off payment in respect of
any one person
Bridging 65% of the cost to a maximum of €170.00 per unit
Dental Examinations/Cleaning and Scaling are not covered.
In Patient Dental Treatment. The Society will cover the cost of surgical dental procedures requiring
hospitalisation where it is certified that it was medically necessary such as the removal of wisdom teeth under
general anesthetic etc and at the “participating professional fee rate” that applies in such cases.
3.4 Optical Eye Laser Benefit.
♦ The Society pays 65% of the cost to a maximum of €400 per eye towards the cost of eye laser treatment if deemed
medically necessary, once in a lifetime against paid receipts
♦ Surgical procedures and treatment for eye diseases are covered.
♦ A grant of €150 towards spectacles/contact lenses is payable once every two years only when medically prescribed.
Eye Examinations are not covered. Members who joined after 06/04/95 and their spouses have class A PRSI
and may be entitled to some optical benefit. Consult your optician who will advise and claim your entitlements.
3.5 Fees for Out-Patient Consultations
♦ The Society will pay 65% of the cost of a Consultant visit including Psychiatric Consultants to a maximum of €80.
♦ The Society will pay a maximum of 65% of the cost of out-patient treatment including x-rays to a max of €50, blood
tests to a max of €30 and pathological tests when ordered by a Consultant. This provision does not apply to treatment
provided in Private A&E’s as outlined at 3.8 below where a maximum payment for all services provided of €75
applies.
♦ The Society will pay 65% of the cost of Physio/Physical Therapy treatments – to a maximum of €35 per treatment and
subject to a maximum of 12 visits in a calendar year. The Society will pay 65% of the cost of artificial limbs.
3.6 Hearing Aids
The Society will pay 65% of the cost of Hearing Aids after deduction of your PRSI entitlement which your supplier
will claim for you subject to a maximum payment of €1,000 per ear once every three years. Members and their
spouses have class A PRSI are entitled to some benefit towards hearing aid costs. Consult your audiologist who
will advise and claim your entitlements.
3.7 Restricted Cover
♦ The following are covered and are restricted to 65% of the cost and subject to a maximum payment of €30 per visit
and subject to a maximum of 10 visits in a calendar year.
(a) Counselors/Psychologists (b) Acupuncture (c) Speech Therapy (d) Osteopathy (e) Chiropractic’s (f) Chiropody.
3.8 General Benefits
♦ The Society provides 65% of the cost of ordinary or motorised wheelchairs to a maximum payment of €750.
♦ The Society provides 65% of the cost of orthotics to a maximum of €250 per annum.
♦ The Society provides 65% of the cost of consultations/investigation/harvesting/storing/thawing and any other
treatment/advice/consultation re male/female infertility (IVF and/or IUI) to a maximum payment of €2300 per couple
(€1150 if only one of the couple on cover). It is not available for the first year of membership and is confined to a
maximum of three payments totaling €6900 and is confined to the member together with his/her spouse/partner on
cover with the Society for at least 12 months. (Receipts must clearly state if it is the 1st 2nd or 3rd treatment.)
♦ The Society pays €75 towards the cost of attendance at Public and Private A&E type facilities such as Swiftcare,
Beacon Clinic, Galway Clinic, Blackrock Clinic, Whitfield Clinic, Hermitage Clinic and Sports Injury Clinic
including the cost of all tests, X rays etc carried out. You will incur major expense in attending a Private A&E as
compared to attending at a Public Hospital A&E.
3.9 Convalescent and Post Operative Care
♦ The Society contributes to the cost of post operative care in a nursing home for a maximum period of two weeks in a
12 month period immediately following hospitalisation for acute medical conditions or major surgery against paid
receipts, if the need is medically certified by your treating Consultant and approved by the Society before admission
and subject to a maximum payment of €700 per week which covers all costs incurred during your stay such as
Physiotherapy, Drugs etc.
3.10 Out Patient Scans – MRI and CT Scans.
♦ The Society has a direct payment arrangement with providers of these scans and pays them on your behalf when the
scan is ordered by a Consultant or a G.P. The maximum level of cover applying where the provider of the service
does not have an agreement with the Society; MRI Scan – Cost covered to maximum of €250 per scan. CT Scan
– Cost covered to maximum of €200 per scan. See circular of 8th December 2011 on Notice Board Section of the
website
www.medicalaid.ie for contact details/phone numbers of the various suppliers.
3.11 Ambulance Cover – Maximum Allowable €1200.
♦ The Society will cover the cost of an ambulance where a doctor certifies that it is medically necessary because the
patient is seriously ill or disabled and where the ambulance is used to transfer a patient between hospitals. Journeys
from Home to Hospital or from A&E Departments in Private Hospitals are not covered.