20^th Report by Ireland

in accordance with Article 76 of the

European Code of Social Security

For the period 1^st July 2014 to 30^th June 2016

Parts of the Code not specified in the ratification:

Part II             Medical Care

Part VI            Employment Injury Benefit

Part VIII         Maternity Benefit

Part IX            Invalidity Benefit

Part II. Medical Care

I

Medical Care is provided by the Health Service Executive under statutory provisions administered by the Department of Health. Private voluntary schemes are also available to provide additional benefits and refund of costs not covered by the Executive.

II

The Medical Care detailed herein is provided under the Health Acts, 1947 to 2015.

The following enactments were made during the period:

Health (General Practitioner Service) Act 2014

An Act to amend the Health Act 1970 to provide for the making available of a GP medical and surgical service to persons who are ordinarily resident in the State and who have not attained the age of 6 years; to amend a definition in the Nursing Homes Support Scheme Act 2009: to repeal and replace section 8 of the Opticians Act 1956 to provide for the years which are to be election years for the purposes of the Act; and to provide for related matters.

Enacted 28^th July 2014 http://www.irishstatutebook.ie/eli/2014/act/28/enacted/en/html

Health (General Practitioner Service) Act 2015

An Act to amend the Health Act 1970 to provide for the making available of a GP medical and surgical service to persons who are ordinarily resident in the State and who have attained the age of 70 years, and to certain other persons; and to provide for related matters.

Enacted 2^th June 2015 http://www.irishstatutebook.ie/eli/2015/act/19/enacted/en/html

Redress for Women Resident in Certain Institutions Act 2015

An Act to make provision for the making available without charge of certain health services to certain women who were admitted to and worked in certain institutions; to provide that those women shall not be required to pay charges for acute in-patient services and, for those purposes, to amend the Health Act 1970; to amend the Nursing Homes Support Scheme Act 2009; and to provide for related matters.

Enacted 18^th March 2015 http://www.irishstatutebook.ie/eli/2015/act/8/enacted/en/print

The following Statutory Instruments (Regulations) were made during the period:

S.I. No. 203 of 2014 – European Union (Application of Patients’ Rights in Cross-Border Healthcare) Regulations 2014

These Regulations implement three key provisions of the Directive on the Application of Patients’ Rights in Cross-Border Healthcare concerning the National Contact Point, the reimbursement process and the prior authorisation process.

http://www.irishstatutebook.ie/eli/2014/si/203/made/en/print

S.I. No. 65 of 2015 - European Union (Application of Patients’ Rights in Cross-Border Healthcare) Regulations 2015

These Regulations give further effect to the Directive on the Application of Patients’ Rights in Cross-Border Healthcare.

http://www.irishstatutebook.ie/eli/2015/si/65/made/en/print

1.      Scope

Everyone who is ordinarily resident in Ireland is eligible for health services.  The level of entitlement depends largely on the level of income.

There are two categories of eligibility for health services, i.e. Category 1 andCategory 2.

Category 1:  Persons with full eligibility receive a full range of primary care and acute hospital health services generally free of charge, subject to any charges imposed in accordance with the Health Act 1970, (as amended). A charge of €2.50 per item, up to a maximum of €25 per month has been introduced for all medicines dispensed to persons with Category 1 eligibility.

Under the Health Act, 1970, medical cards are issued to persons with full eligibility, if in the opinion of the Health Service Executive (HSE), they are unable, without undue hardship, to provide general practitioner, medical and surgical services for themselves or their dependants.  Income guidelines are used in determining a person’s eligibility. The guidelines are not statutorily binding and even if a person’s income exceeds the guidelines, a medical card may still be awarded if the HSE considers that the person’s medical needs or other circumstances would justify it.  Medical cards may also be awarded to individual family members on this basis.

http://www.hse.ie/eng/services/list/1/schemes/mc/about/

Approximately 37% of the population currently has Category 1 eligibility.

Category 2:Persons who are ordinarily resident in Ireland but do not qualify for a medical card have Category 2 eligibility, i.e. approximately 63 % of the population. Such people are eligible for hospital services, but are liable for charges in respect of out-patient and in-patient services in certain circumstances, as detailed in Level of Benefits below.

The following are exempt from various hospital charges.  They are:

-          Women receiving services under the Maternity and Infant Care Scheme;

-          Children up to six weeks of age;

-          Children receiving treatment for prescribed diseases and disabilities;

-          Children referred for treatment from child health clinics and school health examinations;

-          Persons receiving services in respect of prescribed infectious diseases;

-          Long-stay patients who are already being charged under the Health (Charges for In-Patient Services) Regulations;

-          Holders of a Health (Amendment) Act Card.

2.      Conditions for Entitlement to Benefits

Conditions for entitlement to the level of benefits available are based on the eligibility categories outlined above. 

3.      Level of Benefits

(a)        Not relevant.

(b)       The benefits available to each category are as follows:

Category 1:Persons with full eligibility, i.e. persons who receive a medical card that entitles them to the full range of public in-patient and out-patient hospital and primary care health services in accordance with the Health Act 1970, (as amended).

Category 2:Full range of hospital services in a public ward, including consultant services. The public hospital statutory in-patient charge is currently €75 in respect of each day during which a person is maintained, up to a maximum charge of €750 in any 12 month period.

Persons who attend an Accident & Emergency Department directly without a referral note from their General Practitioner (GP) are liable for a charge of €100, which applies to the first visit of any episode of care.  The charge does not apply where a person has been referred by their GP.

Assistance towards the cost of drugs and medicines (no individual or family is required to pay more than a certain level; currently €144 per calendar month on drugs and medicines).

Legislation to provide for charging all private patients in public hospitals

The Health (Amendment) Act, 2013 provided for the introduction of charges for all private in-patients, including those accommodated in public beds.   Everyone is entitled to use a public hospital. However, some people wish to be treated privately, in which case they have chosen to pay both the consultant and the hospital.  The single charge (from 1^st January 2014) is:

	Hospital Category	Daily charge where overnight accommodation is provided in a single occupancy room	Daily charge where overnight accommodation is provided in a multiple occupancy room	Daily charge where overnight service not provided
1	HSE Regional Hospitals, Voluntary & Joint Board Teaching Hospitals	€1,000	€813	€407
2	HSE County Hospitals Voluntary Non-Teaching Hospitals	€800	€659	€329

All categories:

Free maternity care and infant welfare services.  Free out-patient specialist services including x-ray examination.

Free hospital treatment of tuberculosis and other infectious diseases, free hospital in-patient and out-patient services for children suffering from intellectual disability; mental health issues; phenylketonuria; cystic fibrosis; spina bifida; hydrocephalus; haemophilia and cerebral palsy.

Approved prescribed medicines are available free to all persons who are suffering from intellectual disability; mental health issues (for persons under 16 years only); phenylketonuria, cystic fibrosis; spina bifida; hydrocephalus; haemophilia and cerebral palsy; epilepsy; diabetes mellitus; multiple sclerosis; muscular dystrophies; parkinsonism and acute leukaemia.

Additional services for children are provided free of charge as follows:

-          A health examination service for pre-school children and pupils of national schools;

-          All necessary follow-up services for defects discovered at such examinations.

(c)        Not applicable.  Periodic payments are not made under the medical care schemes.

4.      Miscellaneous

(a)  Information on the appeals process can be found at http://www.hse.ie/eng/services/yourhealthservice/Appeals/Appeals_Process/

(b) Almost 89% of the 2015 (i.e. non-capital) cost of providing health services was met from general taxation.

The balance is made up by hospital charges and by receipts from certain excise duties on tobacco products; recoupment of costs from EU countries in respect of health services provided to foreign nationals; recoupment of certain costs from the Social Insurance Fund; and other miscellaneous sources.

(c) The Department of Health oversees the application of the Health legislation.  The detailed administration is devolved to the Health Service Executive.

(d) Links to legislation set out at II above.

III

(a)     No modifications were made in the period under review with a view to giving effect to the provisions of the Code.

(b)     Ratification of this part of the Code is made difficult by:

·           the changes of the percentage of persons with Category 1 status because of changing levels of personal income and expenditure, employment levels and ageing population;

·           there is no provision for the capture of data related to the costs incurred for primary care by persons in category 2.  It cannot therefore be established whether (even on a global basis under the provisions of paragraph 5 of Addendum 2 to the Code) the percentage of GP costs borne by Category 2 persons falls within the standard set by paragraph 1 of Addendum 2.

       The Programme for a Partnership Government committed to reforming the current public health system by introducing Universal Health Insurance with equal access to care for all. As part of this reform programme, the Government is committed to introducing universal GP care without fees. The introduction of competition in the field of private medical insurance cover has increased available alternative protection for employees and the self –employed.

PARTS VI, VIII and IX

The following information applies to Parts VI, VIII and IX: 

I

The relevant schemes are statutory schemes based on social insurance contributions.

II

Principal Changes to Primary Legislation

Social Welfare and Pensions Act 2015

An Act to amend and extend the Social Welfare Acts; to amend and extend the Pensions Act 1990 to provide for the appointment, as Pensions Ombudsman, of the person who also holds the Office of Financial Services Ombudsman; and to provide for related matters.

No. 47 of 2015

                                                                                                                                               

Principal Changes to Secondary Legislation

Social Welfare and Pensions Act 2013 (Sections 13 and 14) (Commencement) Order 2014

Section 13 of the Social Welfare and Pensions Act 2013 provides for the recovery of the value of certain illness-related social welfare payments from compensation awards made to persons as a consequence of personal injuries claims. Section 14 of that Act makes consequential amendments to the Personal Injuries Assessment Board Act 2003 in the light of the recovery provisions contained in section 13.

This Order brings the provisions contained in sections 13 and 14 of the Social Welfare and Pensions Act 2013 into operation on 1 August 2014.

S.I. No. 308 of 2014

                                                                                                                                               

           

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 2) (Recovery of Certain Benefits and Assistance) Regulations 2014

Sections 13 and 14 of the Social Welfare and Pensions Act 2013 provide for the recovery of the value of certain illness-related social welfare payments from compensation awards made to persons as a consequence of personal injuries claims and for consequential amendments to the Personal Injuries Assessment Board Act 2003.

These provisions are being brought into operation with effect from 1 August 2014 by the Social Welfare and Pensions Act 2013 (Sections 13 and 14) (Commencement) Order 2014 (S.I. No. 308 of 2014). Under the new recovery of benefits arrangements, compensators in personal injury cases must apply to the Minister for Social Protection for a statement of recoverable benefits before making any payment of compensation to the injured person. Where there are recoverable benefits, the compensator is, in general, obliged to pay to the Minister the amount of the recoverable benefits before making any compensation payments.

These Regulations prescribe the information to be provided by compensators when applying for a statement of recoverable benefits for the purposes of identifying—

— the injured person, and

— the social welfare benefits that may have been paid to that person.

These Regulations also prescribe the manner in which an application for a statement of recoverable benefits is to be made.

S.I. No. 332 of 2014

                                                                                                                                               

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 5) (Recovery of Certain Benefits and Assistance) Regulations 2014

Under new arrangements introduced on 1 August 2014, compensators in personal injury cases must apply to the Minister for Social Protection for a statement of recoverable benefits before making any payment of compensation to the injured person. Where there are recoverable benefits, the compensator is, in general, obliged to pay to the Minister the amount of the recoverable benefits before making any compensation payments.

The Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 2) (Recovery of Certain Benefits and Assistance) Regulations 2014 (S.I. No. 332 of 2014) prescribed the information that must be provided by compensators when applying for a statement of recoverable benefits for the purposes of identifying—

— the injured person, and

— the social welfare benefits that may have been paid to that person.

These Regulations extend, with effect from 1 November 2014, the information that must be provided by compensators when applying for a statement of recoverable benefits to include the personal public service number of the injured person.

S.I. No. 497 of 2014

                                                                                                                                               

Social Welfare (Temporary Provisions) Regulations 2014

These Regulations provide for the payment of a bonus to recipients of long-term social welfare payments and to recipients of domiciliary care allowance during the month of December 2014.

The amount of the bonus in the case of recipients of long-term social welfare payments is 25% of the normal weekly payment payable during the first week in December 2014, subject to a minimum payment of €20. In the case of domiciliary care allowance, the amount of the bonus is 25% of the weekly equivalent of the amount of domiciliary care allowance payable during December 2014, subject to a minimum payment of €20.

The bonus payment applies to recipients of the following long-term social welfare payments—

(a) partial capacity benefit;

(b) disablement pension;

(c) death benefit under the Occupational Injury Benefit scheme payable to widows,

     widowers, surviving civil partners, orphans and dependant parents;

(d) carer’s benefit;

(e) State pension (contributory);

(f) State pension (transition);

(g) invalidity pension;

(h) widow’s, widower’s and surviving civil partner’s (contributory) pension;

(i) guardian’s (contributory) payment;

(j) jobseeker’s allowance in respect of a continuous period of unemployment of at

     least 15 months;

(k) pre-retirement allowance;

(l) State pension (non-contributory);

(m) blind pension;

(n) widow’s, widower’s and surviving civil partner’s (non-contributory) pension;

(o) guardian’s payment (non-contributory);

(p) one-parent family payment;

(q) deserted wife’s benefit and deserted wife’s allowance;

(r) carer’s allowance;

(s) disability allowance;

(t) farm assist.

S.I. No. 529 of 2014

                                                                                                                                               

Social Welfare (Variation of Rate of Living Alone Allowance) Regulations 2014

These Regulations provide for an increase of €1.30 in the weekly increase payable to recipients of certain long-term social welfare payments who are living alone (Living Alone Allowance). This will mean that the weekly rate of Living Alone Allowance will increase from €7.70 to €9, with effect from the first week in January 2015.

The Living Alone Allowance is payable to—

• people aged 66 years or over who are in receipt of social welfare payments, such as

  State pensions, widow’s and widower’s pensions etc., and

• people who are under 66 years of age who are in receipt of long-term illness and

  disability payments, such as disability allowance, invalidity pension, incapacity

  supplement and blind pension

who are living alone.

S.I. No. 568 of 2014

                                                                                                                                               

Social Welfare (Consolidated Occupational Injuries) (Amendment) (No. 2) (Manner of Payment) Regulations 2015

These Regulations update the provisions of the Social Welfare (Consolidated Occupational Injuries) Regulations 2007 (S.I. No. 102 of 2007) relating to the manner of payment of occupational injury benefits, including medical care, in the light of the discontinuance of payment by way of payable order at a post office or a bank.

The particular payment method that is employed in any particular case or class of case is determined by the Minister for Social Protection.

S.I. No. 374 of 2015

                                                                                                                                               

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 6) (Payments to Nominated Persons) Regulations 2015

Under the current arrangements applying to the payment of social welfare benefits, social welfare recipients can nominate another person to collect their social welfare payments on their behalf.

These Regulations extend the current payment arrangements in order to allow recipients of certain social welfare benefits to nominate their employer to receive payment of that benefit on their behalf. These provisions will facilitate employees who have occupational sick or maternity pay arrangements.

Under some occupational sick and maternity pay schemes, employees continue to receive full pay from their employer while on sick leave or maternity leave, but are obliged to remit any social welfare benefits to the employer. In such cases, the employee will be able to opt to nominate to have the social welfare benefit paid directly to the employer. However, the employee may withdraw such a nomination at any time, in which case the social welfare benefit will be paid directly to the employee.

These Regulations also make consequential amendments to social welfare payments arrangements to confirm that any social welfare benefits paid to the employer following a nomination by the employee will be a good discharge of the liabilities of the Minister and/or the Social Insurance Fund to the employee concerned.

S.I. No. 408 of 2015

                                                                                                                                               

Social Welfare (Consolidated Occupational Injuries) (Amendment) (No. 3) (Payments to Nominated Persons) Regulations 2015

Under the current arrangements applying to the payment of social welfare benefits, social welfare recipients can nominate another person to collect their social welfare payments on their behalf.

These Regulations extend the current arrangements relating to the payment of Occupational Injury Benefits in order to allow employees who have had an accident at work to nominate their employer to receive payment of Injury Benefit on their behalf. These provisions will facilitate employees who have occupational sick pay arrangements.

Under some occupational sick pay schemes, employees continue to receive full pay from their employer while on sick leave, but are obliged to remit any social welfare benefits to the employer. In such cases, the employee will be able to opt to nominate to have Injury Benefit paid directly to the employer. However, the employee may withdraw such a nomination at any time, in which case the Injury Benefit will be paid directly to the employee.

These Regulations also make consequential amendments to payments arrangements for Occupational Injury Benefits to confirm that any Injury Benefit paid to the employer following a nomination by the employee will be a good discharge of the liabilities of the Minister and/or the Social Insurance Fund to the employee concerned.

S.I. No. 409 of 2015

                                                                                                                                               

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 9) (Change in Rates) Regulations 2015

These Regulations provide for increases to the reduced personal rates of State Pension (Contributory), Widow’s (Contributory) Pension, Widower’s (Contributory) Pension and Surviving Civil Partner’s (Contributory) Pension, and Deserted Wife’s Benefit for those who have attained the age of 66.

The Regulations also provide for changes in the rates of tapered increases for the qualified adults of recipients of State Pension (Contributory), with a proportionally higher increase in the case of qualified adults over 66. In the case of recipients of Incapacity Supplement, the Regulations provide for changes in the tapered increases for qualified adults who have attained the age of 66 years.

In the case of Invalidity Pension recipients, the Regulations provide for increases in the tapered rates for a qualified adult who attained 66 years of age before 2 January 2014.

S.I. No. 598 of 2015

                                                                                                                                               

           

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 1) (Recovery of Certain Benefits and Assistance) Regulations 2015

Section 12 of the Social Welfare (Miscellaneous Provisions) Act 2015 provides for a number of amendments to the operation of the provisions relating to the recovery of the value of certain illness-related social welfare payments from compensation awards made to persons as a consequence of personal injuries claims, which were provided for in the Social Welfare and Pensions Act 2013 and which came into operation in August 2014.

Under the current arrangements, a statement of recoverable benefits can only be issued where the compensator makes an application to the Minister for Social Protection for the issuing of such a statement. Section 12 of the Social Welfare (Miscellaneous Provisions) Act 2015 enables the Minister to issue a statement of recoverable benefits directly to a compensator in cases where a compensator fails to apply for such a statement before making a compensation payment in respect of personal injuries. In addition, section 12 enables the Minister to issue a revised statement of recoverable benefits where an illness-related social welfare payment is awarded or varied subsequent to the issuing of the initial statement of recoverable benefits.

These Regulations prescribe the information to be provided by a compensator or an injured person to the Minister for the purposes of enabling such a statement or revised statement of recoverable benefits to be issued. This includes—

— information to assist in identifying the compensator involved or the agent or legal

                 representative of the compensator, and

— information to assist in identifying the injured person and the social welfare

     benefits that may have been paid to that person.

These Regulations also provide for a consequential amendment to the definitions contained in Part 9A of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007, which relates to the recovery of the value of certain illness-related social welfare payments from compensation awards, to include a definition of the term “revised statement of recoverable benefits”.

S.I. No. 177 of 2015

                                                                                                                                               

Social Welfare (Consolidated Occupational Injuries) (Amendment) (No. 1) (Disqualifications) Regulations 2015

These Regulations amend the Social Welfare (Consolidated Occupational Injuries) Regulations 2007 (S.I. No. 102 of 2007) in the light of section 3 of the Social Welfare (Miscellaneous Provisions) Act 2015.

Section 3 of the Social Welfare (Miscellaneous Provisions) Act 2015 provides for a new definition of the term “medical assessor” for the purposes of the Social Welfare Consolidation Act 2005 and for a number of consequential amendments to clarify the role of medical assessors in the social welfare decisions process. Article 2 of these Regulations provides for a consequential amendment to the provisions of the 2007 Consolidated Occupational Injuries Regulations relating to disqualification for Injury Benefit and Disablement Benefit where a person fails without good cause to see an officer of the Minister and to answer any reasonable enquiries made by such an officer relating to his or her claim.

In addition to seeing and answering enquiries of an officer of the Minister, article 2 of these Regulations provides that a person will also be disqualified for receipt of Injury Benefit and Disablement Benefit where a person fails without good cause to see a medical assessor and to answer any reasonable enquiries made by a medical assessor relating to his or her claim.

S.I. No. 178 of 2015

                                                                                                                                               

Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 3) (Medical Assessor and Medical Certification) Regulations 2015

 

These Regulations make a number of amendments to the provisions of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007 (S.I. No. 142 of 2007) relating to illness and disability payments in the light of sections 3 and 4 of the Social Welfare (Miscellaneous Provisions) Act 2015.

Section 3 of the Social Welfare (Miscellaneous Provisions) Act 2015 provides for a new definition of the term “medical assessor” for the purposes of the Social Welfare Consolidation Act 2005 and for a number of consequential amendments to clarify the role of medical assessors in the social welfare decisions process. Article 3 of these Regulations, together with the associated Schedule, provide for a number of consequential amendments to the provisions of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007 relating to disqualification for Illness Benefit, Partial Capacity Benefit, Invalidity Pension and Disability Allowance where a person fails without good cause to see an officer of the Minister and to answer any reasonable enquiries made by such an officer relating to his or her claim.

In addition to seeing and answering enquiries of an officer of the Minister, article 3 and the Schedule to these Regulations provide that a person will also be disqualified for receipt of Illness Benefit, Partial Capacity Benefit, Invalidity Pension and Disability Allowance where a person fails without good cause to see a medical assessor and to answer any reasonable enquiries made by a medical assessor relating to his or her claim.

Article 3 and the Schedule to these Regulations also align the relevant wording of the disqualifications for illness and disability payments where a person fails without good cause to attend for or submit himself or herself to any medical or other examination.

Section 4 of the Social Welfare (Miscellaneous Provisions) Act 2015 clarifies two aspects of the legislative provisions that apply to the Carer’s Benefit, Carer’s Allowance and Respite Care Grant schemes relating to—

(a) the circumstances in which a person is to be considered as requiring full-time care

     and attention for the purposes of qualifying for these schemes, and

(b) the determination of eligibility for these schemes by a deciding officer.

Section 4 of the Social Welfare (Miscellaneous Provisions) Act 2015, inter alia, deletes the regulatory powers enabling the Minister to prescribe the manner in which a registered medical practitioner is to certify the nature and extent of the disability of the person who requires full-time care and attention. As a consequence, article 4 of these Regulations revokes articles 55, 134, 140B and 170 of the 2007 Consolidated Claims, Payments and Control Regulations, which prescribe the manner for certification by a registered medical practitioner of the nature and extent of the person’s disability for the purposes of the Carer’s Benefit, Carer’s Allowance, Domiciliary Care Allowance and Respite Care Grant schemes.

S.I. No. 179 of 2015

Part VI - Employment Injury Benefit

1. Scope

Table A15 of the Annual Statistical Report for 2014 for the Department of Social Protection details the numbers and classes of insured persons.[1]

http://www.welfare.ie/EN/Policy/ResearchSurveysAndStatistics/Pages/StatInfoReportsIndex.aspx

Detailed explanations of the Classes can be accessed at: http://www.welfare.ie/EN/Publications/sw19/Pages/sw19_intro.aspx

Classes of employees who are covered for Occupational Injury Benefits:

·         Persons in Classes A, B, D and J– total 2,334,390

(Civil servants recruited prior to April 1995 and insured at Class B may only qualify for limited Occupational Injuries Benefits)

(Class J includes an unknown number of employees who are over pension age)

Classes of employees not covered for Occupational Injury Benefits:

·         Persons in classes C, E, H and P – total 8,310

Total number of employees = 2,342,700

Percentage insured for Occupational Injury Benefits = 99.6%

The following Classes are not counted as employees:

·         Class K applies to persons not employed but are paying a contribution on pension income;

·         Class S is for self-employed persons;

·         Class M applies to persons with no liability for a contribution.  Class M are covered in full for Occupational Injury Benefit;

·         Voluntary contributors are persons who have ceased employment but are contributing to maintain entitlements to long-term benefits such as pensions.

2.  Conditions for entitlement to Benefits:

The principal statute for the benefit is the Social Welfare Consolidation Act 2005 (as amended).

http://www.oireachtas.ie/documents/bills28/acts/2005/a2605.pdf

The following provisions specifically amend the conditions relating to benefits under this Part:

Social Welfare (Occupational Injuries) (Amendment) Regulations 2008 (S.I. 602 of 2008) and Social Welfare (Occupational Injuries) (Amendment) Regulations 2009 (S.I. 565 of 2009)	Increased the level of gratuities where disablement is less than 20%, and rates of injury benefit for persons under 16 years of age.
Social Welfare Act 2011 (Section 3)	Confined entitlement to occupational injury or disease sustained on or after 1 January 2012 and where the loss of faculty is 15% or higher.

Information regarding the Occupational Injuries Benefit, the definition of employment injury, the qualifying and waiting periods and the duration of benefits can be accessed via http://www.welfare.ie/en/Pages/oib.aspx

3. Level of benefits

(a)          Periodic Payments

Benefits are flat rate benefits and are compared with a reference wage selected in accordance with Article 66(4)(b) [2].  As advised in last year’s Annual Report on the European Code of Social Security the data is aligned to 2014.  The standard beneficiary is a man with wife and two children and the percentage benefit required is 50%.

(i)       Incapacity for work:

Table 1 - Reference Wage / Injury Benefit (Couple and 2 children)

* The family allowances for a worker in this column include Child Benefit and the rate of Family Income Supplement appropriate to a family with this level of income.[3]

** The family allowance for a beneficiary in this column includes only Child Benefit.

Total loss of earning capacity:

The person would be entitled to the benefit in the above table under either:

• Illness Benefit provisions if the relevant contribution were satisfied;

or

• Where an entitlement to Disablement Pension exists, under the Incapacity Supplement provision which is payable at the same rate.

Disablement Pension of €219.00 weekly would also be payable for 100% loss of faculty.  Where the loss of faculty is less than 100%, only a proportionally reduced amount of Disablement Benefit is payable.

(ii)     Survivor’s benefits:

The standard beneficiary is a widow and two children and the percentage benefit required is 40%.

Table 2 - Weekly rate of Death Benefit

Reference Wage / widow under 66 years of age plus 2 children

* The family allowances for a worker in this column include Child Benefit and the appropriate rate of Family Income Supplement to a family with this level of income.

** The family allowance for a beneficiary in this column includes only Child Benefit.

On the death of an insured person through occupational injury or disease, or where immediately before death the deceased was in receipt of a 50% Disablement Pension, a Death Benefit Pension of €218.50 per week is payable to the widow, widower or surviving civil partner under 66 years of age, or €234.70 per week is payable where they are over 66.  The rate for a qualified child is €29.80.  A weekly rate of €164.80 is paid in respect of an orphan. 

A Death Benefit (Funeral Grant) of €850 is also payable to the next-of-kin.

  

(b)       Medical care

The benefits listed in Article 34 are provided under the Health Acts (as in Part II) supplemented by the provisions of Section 86 of the Social Welfare Consolidation Act 2005.

(c)   Review of Payments

Account is not taken of other resources which a beneficiary may have, except that the qualified adult increase for a spouse or partner is progressively reduced if his/her earnings or income exceeds €100 weekly.

Periodic payments are reviewed each year in the context of the annual budget process.

Part VIII. Maternity Benefit

1. Scope

Table A15 of the Annual Statistical Report for 2014 for the Department of Social Protection details the numbers and classes of insured persons.^[4]

http://www.welfare.ie/EN/Policy/ResearchSurveysAndStatistics/Pages/StatInfoReportsIndex.aspx

Detailed explanations of the Classes can be accessed at: http://www.welfare.ie/EN/Publications/sw19/Pages/sw19_intro.aspx

Classes of employees who are covered for Maternity Benefit:

·         Persons in Classes A, E, and H – total 2,227,844

Classes of employees not covered for Maternity Benefit:

·         Persons in classes B, C, D, J and P – total 114,856

(Class J includes an unknown number of employees who are over pension age)

Total number of employees = 2,342,700

Percentage insured for Maternity Benefit = 95%

The following Classes are not counted as employees:

·         Class K applies to persons not employed but are paying a contribution on pension income;

·         Class S is for self-employed persons.  Class S is covered for maternity benefit;

·         Class M applies to persons with no liability for a contribution;

·         Voluntary contributors are persons who have ceased employment but are contributing to maintain entitlements to long-term benefits such as pensions.

2.      Conditions for entitlement to Benefits:

Maternity Benefit is a payment made for 26 weeks to employed and self-employed pregnant women who satisfy certain pay related social insurance (PRSI) contribution conditions in order to avoid the need for them to work pre and post-delivery of their baby.  The current weekly rate is €230.

Provisions relating to Maternity Benefit are contained in Part 2, Chapter 9, sections 47-51 of the Social Welfare Consolidation Act 2005 as amended.  Information regarding maternity benefit including the qualifying and waiting period can be accessed via http://www.welfare.ie/en/Pages/SW11.aspx. 

3.  Level of benefits:

(a)               Periodic Payments

In 2013 the minimum rate was €217.80 and the maximum was €262.00. Since 6 January 2014 Maternity Benefit is payable at a standard rate of €230 per week.

Maternity Benefit: The standard beneficiary is a woman and the percentage benefit required rate is 45%.

(b)               Medical Care – See Part II

(c)        Review of Payments

Increases for a qualified adult or qualified child are not payable with Maternity Benefit.  However, where an applicant for Maternity Benefit wishes to claim an increase for a qualified adult and/or a qualified child, a decision may be taken to award the applicant Illness Benefit.  Qualified adult and child rates apply to Illness Benefit.

As this is a time-limited scheme (26 weeks), once a person satisfies the qualifying conditions and is awarded Maternity Benefit, reviews of payment are not automatically carried out unless information is received warranting a review.

Periodic payments are reviewed each year in the context of the annual budget process.
Part IX.                      Invalidity Benefit

1. Scope

Table A15 of the Annual Statistical Report for 2014 for the Department of Social Protection details the numbers and classes of insured persons.^[5]

http://www.welfare.ie/EN/Policy/ResearchSurveysAndStatistics/Pages/StatInfoReportsIndex.aspx

Detailed explanations of the Classes can be accessed at: http://www.welfare.ie/EN/Publications/sw19/Pages/sw19_intro.aspx

Classes of employees who are covered for Invalidity Benefit:

·         Persons in Classes A, E and H– total 2,227,844

Classes of employees not covered for Invalidity Benefit:

·         Persons in classes B,C, D, J and P – total 114,856

(Class J includes an unknown number of employees who are over pension age)

Total number of employees = 2,342,700

Percentage insured for Invalidity Benefit = 95%

The following Classes are not counted as employees:

·         Class K applies to persons not employed but who are paying a contribution on pension income;

·         Class S is for self-employed persons;

·         Class M applies to persons with no liability for a contribution;

·         Voluntary contributors are persons who have ceased employment but are contributing to maintain entitlements to long-term benefits such as pensions.

2. Conditions for Entitlement to Benefits

(i) Invalidity Pension

To qualify for the award of an Invalidity Pension a person must satisfy both medical and Social Insurance conditions as follows:

(a) Medical Condition:  To qualify for Invalidity Pension, a person must be regarded as permanently incapable of work, which is defined as:

-          Incapacity for work of such a nature that the likelihood is that the person will be incapable of work for life

or

-          An incapacity which has existed for 12 months prior to the date of the claim, and where the Deciding Officer or an Appeals Officer is satisfied that the person is likely to be unable to work for 1 year from the date of the claim.

It is a condition for receipt of Invalidity Pension that the claimant should not engage in employment.  Since the introduction of the Partial Capacity Benefit scheme (see below) claimants of Invalidity Pension can now apply for the Partial Capacity Benefit scheme to take up employment opportunities while continuing to receive income support from the State.

(b) Social Insurance contributions conditions: To qualify for Invalidity Pension, a person must have:

-          A total of at least 260 weeks contributions paid since entry into social insurance,

and

-          48 weeks contributions paid or credited in the last complete tax year before the date of the claim.

Payment lasts as long as a person satisfies the above conditions, or until the claimant receives another social welfare pension.

(ii) Partial Capacity Benefit

The Social Welfare Act 2010 provided for the introduction of a Partial Capacity Benefit which was formally launched in February 2012.  The Partial Capacity Benefit provides an opportunity for people with disabilities to have their capacity for work assessed and receive an income support payment based on this assessment. Recipients can then avail of employment opportunities, with no restrictions on employment income, while continuing to receive this income support payment.  The scheme is open to people who are in receipt of an Invalidity Pension, or who have been in receipt of Illness Benefit for a minimum of 6 months.  Participation in the scheme is voluntary. 

Maximum Rates of Partial Capacity Benefit

Medical Assessment	Person previously getting Illness Benefit at the maximum personal rate €188.00	Person aged under 66 and previously getting Invalidity Pension at the maximum personal rate €193.50
Moderate	€94.00	€96.75
Severe	€141	€145.13
Profound	€188	€193.50

3.  Level of Benefits

(a)  Periodic Payments

For Part IX, the standard beneficiary is a man with a wife and two children, and the percentage benefit required is 40 %.

Invalidity Pension 

The current rate of Invalidity Pension for a person under 66 years of age is €193.50.  The rate for a qualified adult is €138.10.  The rate for a qualified child is €29.80.

Table 1 - Reference Wage / Invalidity Pension(Couple and 2 children)

* The family allowances for a worker in this column include Child Benefit and the rate of Family Income Supplement appropriate to a family with this level of income.

** The family allowance for a beneficiary in this column includes only Child Benefit.

(b)               Not applicable to this Part of the Code.

(c)                Review of Payments

Account is not taken of other resources which a beneficiary may have, however, the qualified adult increase for a spouse or partner is progressively reduced if his/her means exceeds €100 per week.  A qualified adult increase is not payable if means are in excess of €310 per week.  A qualified child increase is payable where the qualified adult’s means are less than €400 per week.

Periodic payments are reviewed each year in the context of the annual budget process.
PARTS VI, VIII and IX

The following information applies equally to Parts VI, VII and IX: 

4.  Miscellaneous

(a)    Any person who is unhappy with a decision in relation to their benefit entitlements has a right of appeal to the Social Welfare Appeals Office.  This applies to all benefits including Occupational Injuries Benefit, Maternity Benefit, Invalidity Pension and Partial Capacity Benefit.

The Appeals Office operates independently of the Department of Social Protection to provide an appeals service to persons who are dissatisfied with decisions of Deciding Officers or Designated Persons of the Department of Social Protection on questions relating to entitlement to social welfare payments and insurability of employment under the Social Welfare Consolidation Act 2005 (as amended).  The Appeals Officer will make a decision based on the evidence available taking account of the scheme qualifying conditions which are set out in legislation.

(b)   The Irish social insurance system is based on a unified contribution rate which gives a person entitlement to the range of benefits covered by the class of contribution they make.

Benefits are financed out of the Social Insurance Fund, and are funded by way of contributions paid by employers and their employees. Contributions from employees represented 22% of the income of the social insurance fund in 2014. Any deficit in the Fund is made up by State subsidy.

It is not possible to allocate contributions to the individual contingencies. The following table gives expenditure for 2014 and provisional expenditure for 2015 on each of the schemes dealt with in this report.

Scheme	Expenditure in 2014 €000	Provisional Expenditure in 2015 €000
Occupational Injury Benefit	16,537	16,988
Survivor’s Death Benefit	8,068	8,248
Maternity Benefit	269,930	259,791
Invalidity Benefit	651,666	649,220
Partial Capacity Benefit	9,972	11,310
Disablement	76,622	76,676
TOTAL	1,032,795	1,022,233

Total expenditure on all social welfare schemes in 2014 amounted to €19,831,452 million, of which €11,408,541 million was met from taxation and €8,422,911 million from the Social Insurance Fund. 

Provisional total expenditure on all social welfare schemes in 2015 amounted to € 19,965,886 million, of which €11,349,403 million was met from taxation and € 8,616,483 million from the Social Insurance Fund.   

(c)                The schemes are administered by the Department of Social Protection. The Administration of the social welfare system is managed by the Department of Social Protection which is a Government Department.  As part of the budget deliberations, the Minister for Social Protection annually hosts a Pre-Budget Forum with community and voluntary organisations representative of various social welfare groups (such as older people, people with an illness or disability, unemployed people and families with children).

(d)       Copies of the Acts and Regulations can be downloaded from the Department’s website: http://www.welfare.ie/en/Pages/Legislation_holder.aspx

III

(a)    The changes in legislation are listed above.

(b)   Occupational Injury Benefit: Over the period from 2009 to 2014 inclusive savings in the order of €4 billion were introduced to social welfare expenditure.  Since Budget 2015, there has been only limited scope for welfare improvements. The situation will be kept under review.

Maternity Benefit: The difficulties in relation to ratifying this Part of the Code have been set out in previous reports.  The revised reference wage data indicates that Ireland would not comply with the replacement rates required by the Code. 

Invalidity Benefits: Ireland’s position as indicated in previous reports regarding Article 54 of the Code is unchanged.

Calculation of Family Allowance for the purposes of the 2014/2013 Reference Wage

The computations for the calculation of family allowance for the purposes of the levels of benefits in Parts VI, VIII and IX are at Appendix 1.

Appendix 1

Calculation of Family Allowance for the purpose of the 2014 Reference Wage

Family allowances are calculated as follows for a family including 2 children:

Child Benefit in 2014 was payable at €130 per month per child for each of the first 2 children.  €130 x 2 x 12 / 52 = €60 per week.

Family Income Supplement (FIS) for a family with 2 children earning €559.86 per week is calculated as follows. 

The net income is calculated by deducting PRSI and USC from the person’s gross income.

 

For the period PRSI contributions were payable at 4% of earnings per week.    €559.86 x 4% = €22.39. 

Income tax payable on this level of earnings is minimal but the Universal Social Charge (USC) is payable. This is calculated on gross income and is payable as follows:

Standard Rate of USC 2014
Rate	Income band		Annual Reference Wage €559.86 per week X 52 =€29,113
2%	Up to €10,036		USC Charge Band 1		€200.72
4%	Between €10,036 and €16,016		USC Charge Band 2		€239.20
7%	Above €16,016		USC Charge Band 3		€916.77
			Total Annual USC Charge		€1,356.69
			Total Weekly USC		€26.09
FIS Allowance Calculation
Income		€559.86
PRSI Charge		€22.39
USC Charge		€26.09
Net Income for FIS		€511.38
FIS Income Limit (family with two children)		€602.00
Difference		€90.63
60% of Difference		€54.37

Net income for FIS purposes is therefore €559.86 - €22.39 - €26.09= €511.38.    FIS is payable at 60% of the difference between the net income and the appropriate threshold.  The threshold for a family with 2 children is €602. The rate of FIS in this case would therefore be €602 - €511.38 = €90.63 x 60% = €54.37.

Total income for such a family is therefore €674.23 (i.e. €559.86 + €60 + €54.37=€674.23).

Calculation of Family Allowance for the purpose of the 2013 Reference Wage

Family allowances are calculated as follows for a family including 2 children:

Child Benefit in 2013 was payable at €130 per month per child for each of the first 2 children.  €130 x 2 x 12 / 52 = €60 per week.

Family Income Supplement (FIS) for a family with 2 children earning €550.51 per week is calculated as follows. 

The net income is calculated by deducting PRSI and USC from the person’s gross income.

 

For the period PRSI contributions were payable at 4% of earnings per week.    €550.51 x 4% = €22.02. 

Income tax payable on this level of earnings is minimal but the Universal Social Charge (USC) is payable. This is calculated on gross income and is payable as follows:

Standard Rate of USC 2013
Rate	Income band	Annual Reference Wage €550.51 per week X 52 =€28,626
2%	Up to €10,036	USC Charge Band 1	€200.72
4%	Between €10,036 and €16,016	USC Charge Band 2	€239.20
7%	Above €16,016	USC Charge Band 3	€882.74
		Total Annual USC Charge	€1,322.66
		Total Weekly USC	€25.44

FIS Allowance Calculation
Income	€550.51
PRSI Charge	€22.02
USC Charge	€25.44
Net Income for FIS	€503.05
FIS Income Limit (family with two children)	€602.00
Difference	€98.95
60% of Difference	€59.37

Net income for FIS purposes is therefore €550.51 - €22.02 - €25.44= €503.05.    FIS is payable at 60% of the difference between the net income and the appropriate threshold.  The threshold for a family with 2 children is €602. The rate of FIS in this case would therefore be €602 - €503.05 = €98.95 x 60% = €59.37.

Total income for such a family is therefore €669.88 (i.e. €550.51 + €60.00 + €59.37 =€669.88).