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Annual Report of the Ombudsman 2008 (text version)

6.4.1 HSE Selected Cases - UK social security pension/Irish occupational pension holder has automatic entitlement to medical card confirmed

A woman approached my Office after she had been refused a medical card on the grounds that her income was in excess of the guidelines.  Her appeal was also refused on the same grounds.  She was in receipt of a social security pension from the United Kingdom of stg £0.24 per month and an occupational pension from Ireland, which was not subject to social insurance.

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 getting an Irish social welfare payment or are not subject to social insurance.

In response to my enquiries about her eligibility, the HSE said that she did not qualify automatically under EU regulations due to the fact that:

1. she was not UK pension dependent, and
2. the bulk of her income comes by way of payment through a public service pension with a tax liability to the State.
   

I referred the HSE to a case study contained in their medical card / general practitioner visit card national assessment guidelines of March 2007 which was also available on their website.  In this case study, the applicant for a medical card was in receipt of a United Kingdom social security pension of £1,000 per annum, a HSE pension of €40,000 per annum and had savings of €200,000.  The question posed in this case study was whether that person was entitled to a medical card under EU legislation.  The answer was that the person was entitled to a medical card because he had a social security pension from another EU member State and his other income and savings did not include a contributory social security payment from the Department of Social and Family Affairs.

Furthermore, his additional income was not liable for social insurance.  As there was no reference in either this case study or the legislation to the necessity of being dependent on the social security pension from the other member State, I requested that the HSE review its decision to refuse my complainant a medical card.  I am pleased to say that, in response, the HSE accepted that she did have an automatic entitlement under EU regulations and a medical card was awarded.

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