All PRSI payers are entitled to dental subsidy

Universal free dental treatment is not available in Ireland, but what many PRSI contributors do not know mainly because their dentists have never informed them is that regardless of income, they and their dependant spouses have, since April of this year been officially entitled to many free or subsidised dental treatments. These include oral examinations, teeth cleaning, fillings, x-rays, extractions, dentures and denture repairs, root canals etc.

Last January, in his Budget speech, the Minister for Finance abolished the £35,000 income ceiling for dental benefits. But it was only last weekend that the Department of Social Welfare and the Irish Dental Association reached an agreement for compensation for the loss of the fee income from highearning patients. Seven months after the new ruling, higher earning PRSI contributors will finally benefit from the free/subsidised dental treatments.

It is welcome news that every eligible PRSI contributor and their dependant spouses (and civil and public sector workers who joined since 1995) will now benefit from the Dental Treatments Benefit Scheme to a greater or lesser degree (see accompanying panel). However, it may come as something of a surprise to many PRSI contributors earning less than £35,000 who believed erroneously as it turns out that they were not eligible for any free dental benefits because they either "earned too much" or because their dentist "was not a member of "the scheme".

Family Money has been told by official sources that there has been widespread underclaiming of free or subsidised dental benefits by PRSI contributors, especially those on higher incomes.

We have spoken to a number of recent dental patients who for several years have been paying for preventative and actual dental treatments which come under the Department scheme. This is despite the fact that their incomes were below £35,000, their PRSI contributions were up-to-date and uninterupted and their dentist was a member of the Dental Benefits scheme. (Of the 800 registered dentists who are members of the Irish Dental Association, 730 are participating members of the DSW scheme; the balance are either out of the country or retired or non-practising.)

Ms C from Dublin South told Family Money that her dentist, who has never itemised the cost of treatment but instead gives her a total figure, "told me not to worry since I'd get half the cost back by claiming the dental treatment on my income tax dental expenses form". He never asked her what her income was, or whether she was a qualifying PRSI contributor. Nor did he ever mention that there is a scale of fees and subsidies for specific treatments agreed with the Department of Social Welfare. Mr W from Rialto told us he has always paid his dentist because, "I think I'm over the income limit". (He earns under £30,000). His wife, who earns £15,000 said she was under the impression "my dentist does not participate in the Social Welfare scheme" (he does).

Meanwhile, Mr M who has just completed a course of treatment that included having his teeth de-scaled and polished, one tooth x-rayed and treated twice for fillings and another tooth treated for a minor filling, has paid nearly £150 for this work. According to the Department of Social Welfare's official Treatment Schedule and Scale of Fees, this treatment should have cost £116.05, of which the DSW would pay the dentist £91.50, leaving Mr M to pay just £24.55 for his portion of the treatments. Asked at the start of the visit if he paid PRSI, Mr M told us, "I said yes, but that I thought I was over the income limit," (he earns £32,000). "The dentist's secretary then told me I would have to pay for the treatment. She never asked me exactly how much I earned and I just assumed I wasn't eligible for any free benefits. I thought the earning limit was about £25,000."

This idea that the income limit is much lower than the £35,000 (now abolished) or that the dentist may not be a member of the DSW scheme "is widespread", we are told. Many dentists do not discuss fees in any detail with their patients before treatment begins and very few volunteer either that certain treatments are covered by the DSW scheme or the size of the contribution the Department makes per eligible treatment.

Dentists who do inform their patients about the Dental Treatment Benefits Scheme and many do not because of the long delay in getting payment from the Department say this level of misinformation is "widespread" among dental patients. One dentist we spoke to said he believes it should be a requirement of membership of the scheme that all dentists post a notice in their surgery waiting room explaining how the DSW scheme works.

It should include the list of treatments covered, which ones are paid in full by the Department, which ones are partly paid by the Department and by the patient on a 70/30 or 50/50 basis and which treatments are partsubsidised by the Department with the balance of the fee negotiated between the dentist and patient and paid by the patient.

Our sources all agreed that at the very least new patients should be verbally informed about the scheme and any PRSI requirements before they come in for their first appointment and should always bring their PRSI number with them. (For example, you need five years of PRSI contributions if you are over age 25 to qualify for DSW benefits.)

Free treatment under the Department scheme includes complete oral examination "of hard and soft tissue, medical and dental history, recording of missing teeth, diagnosis and a treatment plan". The Department pays the dentist £17.55 for this examination which may also include "any necessary intra-oral radiographs". Nor is there a charge to the patient for scaling and polishing of teeth, mild gum condition treatment or recontouring of fillings. For this the dentist receives a fee of £16.45.

The cost of many other treatments such as x-rays (£13.15 for one, £19.80 for two or more); simple or composite fillings (now £20 and £26.25 respectively) and extractions (£19.75), involve a 70/30 price split between the Department and the patient. A simple filling will therefore cost the Department £14 and the patient £6. Dentures and denture repairs involve a 50/50 split of the cost and a full upper and lower denture will cost the Department £120.60 and the patient £120.60. More advanced work, such as root canal treatment involves the Department paying a flat fee of £43.85 and the patient paying the balance, as negotiated with the dentist.

The Department of Social Welfare predicts that of the additional 25,000 people (PRSI contributors earning in excess of £35,000 and their dependant spouses who are now part of their Dental Benefits scheme), only 35 per cent of these will take up their benefits in any given year. The addition of extra public and civil servants (who joined the service since 1995) and their spouses will also raise the total expenditure.

For private sector workers, the total expenditure for dentistry payments in 1997 is expected to go up by only about £2 million.

Our sources suggest that these predictions seem "pretty conservative compared to the numbers of people who we believe are eligible for treatment and benefit under the scheme. If more people and their dependant spouses knew that their dental bill could be subsidised, there would probably be quite a bit larger takeup of the scheme."