Delay processing couple’s application for medical cards despite clear entitlement

Background

A married couple applied for medical cards and provided a Revenue Tax Return to the HSE as evidence of income. They were subsequently informed by the HSE that their application form had been lost. They submitted a duplicate medical card application form along with a copy of their income tax return. The couple were then advised by the HSE that it required documentation of their capital assets. The couple brought all their share purchases including share certificates to the HSE office but did not hear anything further from the HSE for over twenty months. They made a complaint to my Office regarding the delay in processing their application.

Examination

In its report to my Office the HSE stated that the couple’s application required a considerable amount of processing due to the validation of share holdings and investments. The HSE also noted that this was the main cause of the protracted amount of communication between it and the couple. However, the couple disputed that there was ongoing contact between them and the HSE.

An entitlement to a medical card can arise in a number of ways. For example, under EU legislation persons who have a social security pension from another EU Member State and an occupational pension from Ireland (including civil service or public service pensions) are automatically entitled to a medical card without having to satisfy a means test provided they are not receiving an Irish social welfare payment or are subject to PRSI. I discovered that the couple were automatically entitled to Medical Cards under EU legislation, as both had UK pensions and were not in receipt of a State pension in Ireland. Although the HSE was aware of the couples UK pensions it did not approve the applications on this basis, but instead tried to ascertain whether they met the income thresholds for medical card approval.

Outcome

I requested that the HSE review the application and the entitlement under EU legislation. As a result, the HSE awarded medical cards backdated to 15 working days from receipt of the application and agreed to refund all medical, dental and optical expenses for the previous twenty months. I also contacted the Revenue Commissioners who said they would refund the Income Levy paid by the couple while the application was being processed on the basis that individuals who hold full medical cards are exempt from the Income Levy and any overpayments of the Universal Social Charge due to the delay on the part of the HSE.