Is there an element of day to day expenses in the St Pauls scheme? If so is the family claiming this?
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.
There are a lot of cheap nasty shots being made surrounding the story. But I think the cheapest nastiest shot has to be the Sindos attack on the Mabs Advisor/Mabs. The indo oped takes 4th hand information attributed to the maps advisor and proceeds to bash the service with statements like "What exactly are these people being paid for if they cannot even do that?"
I have read fantastic, constructive advice here on AAM, over the years, especially where people have sought help in the Money Makeover section. I see no reason to believe that she would have got anything but a civilised helpful response had she sought advice on AAM, instead of having this article published. The articlle has backfired, in its intent, in my opinion. However that is a separate issue.I would hope that if the lady (and people like her) posted here she would get a civilised helpful response.
+1.hi aj
i agree that this attack is not justified. However, the piece overall is well written.
Brendan
Hi AJ
I agree that this attack is not justified. However, the piece overall is well written.
Brendan
Mabs are in a tough situation here, they cannot come out without predjucing client confidentiality, but I suspect they have been misrepresented in this case.
At least AAM is getting great publicity out of it, pity the the lady in question didn't come on here in the first place to do a post in the money make over section, she would have been sorted in no time and by now would be shopping in ALDI, buying the family clothes in Penny's and Dunnes and packing home made lunches for all the family!
You make it sound like there is a huge difference between the two families.yes she would have got very constructive advice here. I also think this story has backfired massively.
We have many hundreds of thousands of people who have lost their jobs in recent years and a family and two children are having to survive on circa €20,000 a year on Jobseekers Allowance not inluding what they getting on mortgage interest relief or rent allowance.
They have to feed cloth and educate their families in the same way as the above mentioned family who have a income of €65,000, in addition they would have had to give up their health insurance and rely on an already overstretch public health care system, one can only imagine how the unemployed are feeling reading this thread.
one can only imagine how the employed feel reading your post and mine.one can only imagine how the unemployed are feeling reading this thread.
The unemployed family receives 20K net plus rent allowance - so essentially 20K to live on excluding accommodation costs.
The 65K family gets 41,058 net after tax, levies, USC. They pay 1,400 interest only on their mortgage, leaving them 24,258 to live on excluding accommodation costs.
The difference doesn't look so huge now does it?
And the unemployed family get a medical card so free GP etc., back to school allowances, fuel allowances etc.
Why do you think we are talking only about victims of the recession? Do the feelings of other unemployed people not count? I was responding to cashier’s post which hadThis depends on the comparison being made. If we are talking about victims of the recession (which is effectively the issue of the Gardas family),
andone can only imagine how the unemployed are feeling reading this thread.
– that’s what I was responding to. My point is that cashier’s unemployed person on 20K plus accommodation who feels so aggrieved about the rich garda on 65K should compare net situations.We have many hundreds of thousands of people who have lost their jobs in recent years and a family and two children are having to survive on circa €20,000 a year on Jobseekers Allowance not inluding what they getting on mortgage interest relief or rent allowance.
Why do you think we are talking only about victims of the recession? Do the feelings of other unemployed people not count? I was responding to cashier’s post which had and – that’s what I was responding to. My point is that cashier’s unemployed person on 20K plus accommodation who feels so aggrieved about the rich garda on 65K should compare net situations.
THE FINANCIAL difficulties of middle-income families who bought their home during the property boom have been highlighted by the wife of a Garda sergeant in a letter to a number of Government ministers.
I thought we were talking about victims of the recession because the first paragraph of the IT piece on this story says
Why should a comparison only be with a recently unemployed person? And why two people recently unemployed with no mortgage interest help? Compare away if you think it adds to the debate.so I felt a comparison with someone unemployed on rent allowance wasnt really a valid comparison.
Wow that's quite a stereotype - we have the 'virtuous' unemployed and the dregs of humanity? What about the inbetweens? If you work one year and then not for 25, does your one year drag you off the bottom of the pile? Will the 'victims of the recession' eventually transition to being worthless layabouts undeserving of a voice in commenting on national finances? Is there a ratio of years worked to years unemployed at which point you flip from 'victim of recession' to unworthy kicking-boy and butt of dismissive comments? I really need a lie-down after all this left-wing defense.Sorry I didn't make it clear, I was referring to unemployed people who have been recent victims of the recession not the unemployed who have been on the dole all their lives with never any intention of doing a day's work.
A 65K public sector salary has the same take-home as a private sector 55K salary.
Well, the 'net situation' is currently being dissected over on the 'money makeover' thread that the individual concerned has started. I think this represents a good opportunity for the O.P. on that thread to 'crowd source' possible solutions to their financial bind through the collective contribution of AAM'ers. Furthermore - provided the O.P. fleshes out the detail, it will become clearer specifically what their net situation is. I am one of those that you indicated in relation to outlining that I was perplexed by this case study in that I do earn less than half of this individuals earnings. As the facts are teased out, I guess we will see if money is being wasted here - or whether 'cornflakes days' are justified/unavoidable.I’m not trying to see if the garda would be better off giving up work but responding to the many comments along the lines of ‘I earn half that working down’t pit and I still manage to eat caviar on a Friday night’ – and no-one has tried to look at a net situation
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