Dáil Éireann Debate, Tuesday - 28 January 2014
756. Deputy Arthur Spring asked the Minister for Health the reason, in the event of a delay of a medical card being renewed, that payments are not backdated to the time of the expiry of the medical card, thus leaving the patient who is worthy of a medical card to pay for medical services when he or she cannot afford to do so; and if he will make a statement on the matter. [4080/14]
View answerAll medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility.
Ordinarily, three months before an individual’s existing medical card/GP visit card eligibility expiry date, a review notification issues to the individual (or their parents, in the case of a child). A review notification will indicate that either a self assessment is completed by the card holder themselves or request that the card holder return evidence of household income, assessable outgoings, and medical circumstances to enable a full review assessment be conducted by the HSE.
A reminder letter is issued a month later if the requested review form details have not been received at that point. If a person does not return their review form within the time specified, their continuing eligibility cannot be confirmed and their medical card/GP visit card cannot be reissued. In these circumstances, or where the review process establishes that a person no longer holds eligibility, the eligibility ceases.
Persons are requested to return their completed review forms, at least one month in advance of the due expiry date of their existing eligibility in order to give the HSE sufficient time to carry out the review and/or to get back to the person if the application is incomplete or requires any further details to be provided.
A person (and their dependants, if it applies), the subject of a medical card/GP visit card eligibility review assessment, will continue to have their eligibility extended pending the outcome of a review assessment, provided
1. they have returned their review form within the time specified, and
2. are engaging with the HSE in enabling their review assessment to complete.
The medical card/GP visit card holder does not need to take any action other than genuinely co-operate with the review process and communicate with the HSE on an ongoing basis throughout the process. If the HSE is made aware that a person has a disability or special needs, assistance will be afforded to help that person complete the review application and explain the support documentation they need to send. The local health office can be contacted or LoCall 1890 252 919 to request this assistance.
A medical card/GP visit card holder who genuinely engages with the review will not have their eligibility withdrawn before that review is complete.
In addition, GPs are advised three months in advance of the review dates of their patients’ GP visit cards/medical cards, and subsequently the following month, and the month after that, if the patient has not returned their review form by that time.
GPs have full electronic visibility of their GP visit/medical card panel of patients and have the facility to electronically allow temporary extension of eligibility for expiring cards where a sensitive renewal is appropriate, or where they are aware that a person is still availing of services but there may be something that prevents them from carrying out a standard review, e.g. a blind person with little family support. GPs can also add new babies to existing cards. All GPs have appropriate electronic access to the medial card eligibility database and they do not have to confirm medical card details by contacting HSE PCRS.
The HSE also undertakes reviews of medical card/GP visit card eligibility, whereby selected cardholders are asked to confirm that they are ordinarily resident in Ireland. Being ordinarily resident in Ireland is a prerequisite for medical card/GP visit card eligibility. Approximately 10,000 letters are issued each month and the cardholder is asked to sign and return to the HSE a Declaration of Residency form. On receipt of this Declaration, eligibility to the GMS Scheme continues. If a person does not return the Declaration of Residency form, their eligibility ceases.
An individual must have approved medical card eligibility in order to avail, free of charge (except for payment of prescription charge) of social and medical services provided under the General Medical Card scheme, at the time they present for such services. Medical card/GP visit card eligibility is approved with effect from the date a person’s application/review application is assessed as meeting the criteria to qualify for a medical card/GP visit card. If an individual allows their eligibility to lapse by not responding in time to a review application, a future renewal of eligibility will date only from when the review assessment is updated.
To avoid letting their eligibility lapse and avoid incurring costs that would otherwise be covered under GMS eligibility, persons that are the subject of a review notification must co-operate in returning a completed review form so that their eligibility is extended pending the review decision.
In addition, a person (and their dependants, if any) that is assessed on review as ineligible for medical card/GP visit card renewal and makes appeal of this decision within the time allowed, will retain their eligibility pending the appeal decision.
