Revenue Tax Briefing Issue 68, April 2008

ASSOCIATE WITH Taxes Consolidation Act 1997 s469

Health Expenses - Guidelines and Procedures on claims

1. Introduction

Section 469 of the Taxes Consolidation Act [TCA] 1997 (as amended by subsequent Finance Acts) provides for tax relief in respect of health expenses. This article consolidates and updates information on such tax relief (and therefore replaces the earlier article on this topic published in Issue 33 of Tax Briefing).

2. General information on claims

2.1 Claims for tax relief in respect of health expenses

Individuals may claim the tax relief by:

claiming online via Revenue’s Online Service (ROS); or
by completing Form Med 1 and submitting it to their local Revenue Office; or
if an individual uses a Form 11 to make a tax return and claim reliefs and credits, the amount of the health expenses claim may be entered at Panel I on the Form 11 and there is no need to complete a Form Med 1.

If the claim includes a claim in respect of non-routine dental treatment (see Paragraph 3.17 and Appendix 2), the individual must hold a Form Med 2 which is signed and certified by the dental practitioner.

Receipts and Form Med 2 need not be submitted with a health expenses claim. However, they should be retained for a period of six years and need only be submitted in the context of a credibility check or if the claim is chosen for detailed examination.

2.2 Processing of claims/confidential service re detailed examination

Subject to a credibility check, claims for health expenses are accepted and processed on the basis of the information shown on the claim. In cases of doubt, the claimant will be contacted to clarify matters.

If a health expenses claim comes up for examination under an audit programme, the claimant has the option of having the claim examined by a Revenue office other than his/her local Revenue office. This option is available only where the claimant does not wish his/her local Revenue office to know the nature of the medical condition.

2.3 Advance allowance of relief in cases of hardship

The statutory requirement that relief is to be given by way of repayment after the end of the tax year may be modified in cases of hardship to allow tax relief during the tax year. For example, a PAYE taxpayer may be granted relief during the tax year in respect of qualifying nursing home fees paid by him/her. All such cases will, of course, be subject to lodgement of an end of year claim in the normal way.

2.4 More than one individual contributing to the cost of qualifying health care

Where more than one individual contributes to the cost of qualifying health care, each individual can claim relief in respect of the portion paid by him/her.

2.5 Effect of relationships on health expenses claims

Claims for the tax years up to and including 2006:

For these tax years, an individual may claim tax relief in respect of Health Expenses incurred in respect of:

self and spouse;
a child of the claimant (or any other child who, for the year of the claim, is in custody of and maintained by the claimant) who is under 18 years of age, or if over 18 years of age, is receiving full-time education;
a relative;
an individual who is aged 65 years (or over) or who is permanently incapacitated by reason of mental or physical infirmity.

Claims for the tax year 2007 and subsequent tax years:

The required relationship between the claimant and the subject of the claim has been abolished.

2.6 The de minimis limits

Tax years up to and including 2006:

The first €125 of any medical expenses incurred in any tax year is borne by the customer. In the case of an individual claiming relief in respect of two or more persons, the customer must bear the first €250 him/herself.

Tax year 2007 and subsequent tax years:

The de minimis limit has been abolished for health expense claims relating to the tax year 2007 and subsequent tax years.

2.7 Health care outside the State

As regards treatment outside the State, the following expenses qualify for tax relief:

the cost of qualifying treatment carried out by a practitioner (GP, consultant or dentist) provided such practitioner is entitled under the laws of the country in which the care is provided to practise medicine or dentistry there; and
the cost of maintenance or treatment in a hospital, nursing home or clinic is allowable provided that the institution is on the Revenue approved list.

Where the relevant qualifying health care is only available outside of the State, then the cost of reasonable travelling and accommodation expenses are also allowable. In such cases, the expenses of one person accompanying the patient may also be allowed where the condition of the patient requires it. Where the patient is a child, the expenses of one parent may generally be allowed and, exceptionally, of both parents where it is clear that both have to be in attendance.

2.8 Treatment of damages

Section 469(3)(c) TCA 1997 provides that expenses are not regarded as having been defrayed by the claimant in so far as they are recouped in any way, either by the claimant or by any of his/her dependants, from a public or local authority or under a contract of insurance or by way of compensation or otherwise. Where an individual receives damages for personal injury, the amount awarded may cover a variety of items including medical expenses. The medical expenses involved may comprise a specific award for known expenses and/or a lump sum award to cover potential expenses.

A specific award will, generally, be vouched amounts applicable to specific expenditure incurred before the award is made. In dealing with claims for medical expenses, no relief is given in so far as the expenses incurred are covered by a specific award.

A lump sum award will usually be invested and the expenses paid out of the income generated by the investment. Medical expenses other than those covered by a specific award are treated as being paid primarily out of the claimant’s income (from whatever source) and accordingly a medical expenses claim in respect of expenses incurred after the date of the award, and which are not covered by a specific award, would not be restricted on account of a lump sum award.

3. Items of Expense

3.1 Overview of the tax relief in respect of health expenses

Only health expenses incurred in the provision of health care qualify for tax relief.

Health care

Section 469 of the Taxes Consolidation Act 1997 defines ‘health care’ as meaning the prevention, diagnosis, alleviation or treatment of -

an ailment;
an injury;
an infirmity;
a defect; or
a disability

and includes care received by a woman in respect of a pregnancy as well as routine maternity care.

Health Expenses includes the cost of:

Doctors’ and consultants’ fees;
Diagnostic procedures carried out on the advice of a practitioner;
Drugs/medicines prescribed by a doctor/dentist/consultant;
Maintenance or treatment in a hospital or approved nursing home (the hospital/nursing home must be approved by the Minister for Health and Children or approved for the purposes of health expenses relief by the Minister for Finance after consultation with the Minister for Health and Children);
Supply, maintenance or repair of any medical, surgical, dental or nursing appliance used on the advice of a practitioner;
Physiotherapy or similar treatment prescribed by a practitioner;
Orthoptic or similar treatment prescribed by a practitioner;
Speech and language therapy carried out by a Speech and Language Therapist for a qualifying child, where a Speech and Language Therapist means an individual approved by the Minister for Health and Children;
Transport by ambulance;
Educational psychological assessments for a qualifying child, carried out by an Educational Psychologist who is registered with the Minister for Education and Science;
Certain items of expenditure in respect of a child suffering from a serious life threatening illness;
Kidney patients’ expenses (up to a maximum amount depending on whether the patient uses hospital dialysis, home dialysis or CAPD);
Specialised dental treatment;
In vitro fertilisation.

The following paragraphs outline the main issues that arise in health expenses claims.

3.2 Hospital / nursing home / maternity home or other similar institution

Only payments in respect of maintenance and treatment in a hospital, nursing home/maternity home or other similar instituion approved by the Minister for Finance (after consultation with the Minister for Health and Children) for the purposes of Section 469 TCA 1997 qualify for relief. In practice, the Department of Health and Children notifies Revenue of the ‘approved’ hospitals, nursing homes, maternity homes or other similar institutions and a list of such institutions is available on the Revenue website.

3.3 Diagnostic procedures carried out on the advice of a practitioner

The meaning of ‘practitioner’ is set out in Section 469(1) TCA 1997.

Claims for relief under this heading generally refer to the cost of procedures or treatments carried out by persons who are not qualifying practitioners on patients who are referred for such procedures or treatment by their own doctor. However, whilst tax relief may be allowed in respect of procedures or treatments carried out, relief is not due in respect of the cost of drugs, medicines, lotions etc., prescribed by the person providing the treatment.

In the case of a psychologist/psychotherapist, relief can only be allowed where the psychologist/psychotherapist is a qualified practitioner as defined by Section 469 TCA 1997 or where a patient is referred by a psychiatrist for a diagnostic procedure.

3.4 Allowable Treatments - physiotherapy

Examples of allowable treatments under the heading physiotherapy include treatment by a chiropractor, osteopath and bonesetter. Acupuncture treatment is not allowable unless carried out by a person who is a qualified practitioner as defined in Section 469 TCA 1997.

3.5 Drugs and medicines supplied on the prescription of a practitioner

Only the cost of drugs and medicines supplied by a pharmacist, on prescription from a medical practitioner, qualify for relief. (However, see below re coeliacs and diabetics).

3.6 Coeliacs

Tax relief in respect of the cost of gluten-free food for coeliacs is an allowable expense for the purposes of a health expenses claim. A letter from a doctor stating that the individual in respect of whom the claim is made has the condition is acceptable. If receipts are requested, qualifying receipts are not confined to those from a chemist - receipts from shops, supermarkets, etc., in respect of gluten-free food products manufactured specifically for coeliac patients are also acceptable.

3.7 Diabetics

Tax relief in respect of the cost of food products manufactured specifically for diabetics is an allowable expense for the purposes of a health expenses claim. A letter from a doctor stating that the individual in respect of whom the claim is made is diabetic is acceptable. If receipts are requested, qualifying receipts are not confined to those from a chemist, doctor, etc. - receipts from shops, supermarkets, etc., in respect of food products manufactured specifically for diabetics are also acceptable.

3.8 Health expenses claims - educational psychologists and speech and language therapy

Section 469 TCA 1997 provides for relief for expenditure incurred in respect of an educational psychological assessment carried out by an educational psychologist and incurred in respect of speech and language therapy carried out by a speech and language therapist.

For the purposes of Section 469, ‘educational psychologist’ means a person who is entered on a register maintained by the Minister for Education and Science in accordance with guidelines set down by that Minister with the consent of the Minister for Finance.

For the purposes of Section 469, a ‘speech and language therapist’ means a person approved by the Minister for Health and Children in accordance with guidelines set down by that Minister with the consent of the Minister for Finance. Unlike educational psychologists, speech and language therapists will not be included on a register but will instead be approved by the Minister for Health and Children for the purposes of Section 469 TCA 1997. Confirmation of approval may be obtained from the Department of Health and Children.

Note: Many of the claims relating to children with dyslexia or autism relate to the cost of -

training teachers to train children; or
providing education for such children.

There is no provision in tax law to allow relief for either item.

3.9 Home nursing

In cases of serious illness where qualified nurses are engaged on the advice of a medical practitioner to provide constant nursing care in the patient’s home, tax relief under the heading of health expenses may be allowed where the following conditions are satisfied:

A medical certificate can be provided if requested which -
1. shows the nature of the patient’s illness,
2. states that constant nursing care by fully-qualified nurses in the patient’s home is required, and
3. covers the full period for which home nursing is being claimed;
the nurses providing the nursing care are fully qualified and their full names, addresses and qualifications can be supplied;
receipts can, if requested, be provided in respect of all payments to the nurses and, where necessary, a breakdown of the payments is provided. This is to ensure that relief is given only in respect of the amounts paid which directly relate to the rendering of nursing care and not to the nurse’s expenses.

3.10 Special nursing

Where the claim is in respect of a patient in a hospital or nursing home, relief under Section 469 TCA 1997 may also be allowed in respect of payments made to qualified nurses to provide additional nursing care over and above that ordinarily provided by the institution if -

the conditions at (ii) and (iii) outlined for ‘Home Nursing’ are satisfied; and
a medical certificate can, if requested, be submitted which -
1. shows the nature of the patient’s illness;
2. states that constant nursing care over and above that ordinarily provided in the institution is required, indicating the necessity for such additional care; and
3. covers the full period for which the nursing care is being claimed.

3.11 The supply, maintenance or repair of any surgical, dental or nursing appliance

Relief is allowed on the costs incurred on the supply, maintenance or repair of any medical, surgical, dental or nursing appliance used on the advice of a practitioner. Where there is any doubt that the appliance in question is a medical, surgical, dental or nursing appliance, a certificate from a medical practitioner may be requested. The certificate should:

state the nature of the patient’s illness,
confirm that the appliance is being used on the advice of the medical practitioner; and
outline how the appliance will help to prevent, diagnose, alleviate or treat the ailment, injury, infirmity, defect or disability from which the patient is suffering.

The claim will be considered in the light of the information submitted and relief given where Revenue is satisfied that the appliance may be regarded as a medical, surgical, dental or nursing appliance.

Examples of appliances for which relief is allowable
Glucometer machine	The cost of the provision of a glucometer machine on the advice of a medical practitioner for a diabetic is allowable
Hearing aid	The cost of the provision of a hearing aid on the advice of a medical practitioner is allowable.
Orthopaedic bed/chair	Where the patient is suffering from a specific illness or disability the cost of the provision of an orthopaedic bed or chair, on the advice of a medical practitioner, is allowable.
Wheelchair/wheelchair Lift	Expenses incurred in the provision of wheelchair or wheelchair lift for a disabled person, on the advice of a medical practitioner, are allowable, but no relief is due for alteration to the building to facilitate a lift.
Exercise bicycle	Where medical evidence indicates that this is necessary in the circumstances set out in this paragraph [3.11], the cost may be allowed.
Computer	Where medical evidence is produced that a computer is necessary to alleviate communication problems of a severely handicapped person, the cost may be allowed.
False eye	The cost of a false eye is regarded as an expense incurred on the purchase of a medical applicance and is allowable.
Wig	Where medical evidence indicates that it is necessary, in the circumstances set out in this paragraph [3.11], the cost may be allowed.
Examples of Appliances for which relief is NOT allowable
Car (for disabled person)	The cost of the provision of a specially adapted car for a disabled person is not an allowable health expense.
Construction work	The cost of structural alterations or improvements to a private residence to facilitate an incapacitated person is not an allowable health expense.
	The installation of a telephone, the rental of same or the cost of calls is not an allowable health expense.
	Exception
Telephone	See paragraphs 3.15 and 3.16 re certain categories of kidney patients, child oncology patients, children with life threatening illnesses and children with permanent disabilities.

3.12 Expenses of travelling and accommodation

Section 469 TCA 1997 provides for tax relief in respect of the cost of transport by ambulance and accommodation in an ‘approved’ hospital or other similar institution (see paragraph 3.2 above). Travelling and accommodation expenses within the state other than as outlined above are not normally allowed.

However, where regular continuing treatment or consultation is required and the patient has to travel long distances, tax relief for the expenses may be granted. It is not the intention that tax relief be granted for minor local travelling expenses or occasional travelling [e.g. to undergo an operation (unless by ambulance)].

In addition to these, please refer to -

Paragraph 2.7 concerning health care outside the State;
Paragraph 3.15 concerning health care for kidney patients;
Paragraph 3.16 concerning health care for children with life threatening illnesses (including child oncology patients) and children with permanent disabilities.

3.13 Blind person’s guide dogs

Where a blind person maintains a trained guide dog supplied by the Irish Guide Dog Association, an annual sum of €825 may be claimed as a health expense under Section 469 TCA 1997. Relief is available at the taxpayer’s marginal rate of tax.

Claimants need not vouch such claims. However, a letter from the Irish Guide Dog Association confirming that the claimant is the registered owner of a guide dog should be submitted with the first claim for relief. The Association has been notified of this requirement.

It should be noted that assistance dogs provided to autistic children do not qualify for the relief.

3.14 In vitro fertilisation

Relief may be claimed in respect of the cost of in vitro fertilisation provided the hospital or clinic carrying out the treatment appears on the approved list of hospitals.

3.15 Kidney patients

Relief under the heading of health expenses may be granted under specific headings in respect of certain expenses incurred by kidney patients as follows:

hospital dialysis (where the patient attends hospital for treatment);
home dialysis (where the patient uses a dialysis machine at home); and
chronic ambulatory peritoneal dialysis - CAPD (where the patient has treatment at home without the use of a dialysis machine).

Hospital dialysis patients

Tax relief in respect of the cost of travelling to and from hospital is an allowable expense for the purposes a health expenses claim. Where a private car is used, the claimant should specify the number of trips undertaken and the kilometres (or mileage) involved. See paragraph A of Appendix 1 for rates.

Home dialysis patients

Relief may be allowed under the following headings and at the rates shown in paragraph B of Appendix 1:

Electricity
Laundry and protective clothing
Telephone
Travelling: Qualifying number of kilometres (mileage) at the appropriate rate per km/mile.

Chronic ambulatory peritoneal dialysis (CAPD) patients:

Relief may be allowed under the following headings and at the rates shown in paragraph B of Appendix 1:

Electricity
Telephone
Travelling: Qualifying number of kilometres (mileage) at the appropriate rate per km/mile.

When making a tax relief claim for health expenses for a kidney patient, claimants should identify the appropriate category. Revenue is aware that it is possible for a patient to move from one category to another, depending on his/her condition.

Where a change takes place during the course of a year, relief for each category should be apportioned as appropriate.

3.16 Children with life threatening illnesses (including child oncology patients) and children with permanent disabilities

The oncology units in children’s hospitals are concerned with the care and treatment of children with cancer or other diseases of the blood/marrow [e.g. severe anaemia].

Apart from obvious health related expenditure, tax relief is also available in respect of other expenditure incurred in respect of children with life threatening illnesses (including child oncology patients) and children with permanent disabilities who require constant or regular hospital care. Constant or regular hospital care does not necessarily mean being permanently in hospital. However, it does imply regular hospital attendance or supervision appropriate to the serious illness. The qualifying items of expenditure are -

A. Travel

The cost incurred for the following qualifies for relief -

the cost incurred in transporting [unlimited journeys] the child and accompanying parents/guardians to and from any approved hospital in respect of the patient, and
the cost incurred by the parents/guardians of the child in visiting the hospital when the child is an ‘inpatient’ where such trips are shown to be essential to the treatment of the child.

If a private car is used, the cost of travel is determined at a rate as per kidney patients at Appendix 1.

B. Telephone

Where the child is being treated at home, a flat rate of €300 to include telephone rental and calls may be claimed where the expenses are incurred for purposes directly connected with the treatment of the child. The rate available in previous years is as follows:

2004	€260
2005	€270
2006	€285
2007	€300

C. Overnight accommodation

Payments made by the parent/guardian to a hospital, hotel or B & B in respect of overnight accommodation in or near the hospital where the child is a patient where such overnight stay is necessary for the treatment of the child.

D. Hygiene products and special clothing

The cost incurred in respect of these items subject to a maximum of €500 per year.

Note: Claims in respect of the cost of minding brothers/sisters of the patient while the parents/guardians attend the hospital are not allowable.

3.17 Dental treatment

Overview

Section 469 TCA 1997 specifically excludes relief for expenditure incurred on the extraction, scaling and filling of teeth and the provision and repairing of artificial teeth or dentures. These items are excluded from relief even if there is an underlying medical condition that gives rise to the dental treatment or if the treatment in a particular case is considered to be of a nonroutine nature.

A treatment for which relief is claimed must be considered in the light of the above exclusion (i.e. relief for the cost of any work carried out may not be allowed where the treatment is the extraction, scaling or filling of teeth, etc.)

If, however, the treatment is, for example, of an orthodontic nature, involving the extraction of a tooth as part of that treatment, relief would be allowed for the cost of the orthodontic treatment excluding the cost of the extraction. An exception to this rule is the cost of the surgical extraction of impacted wisdom teeth, which is allowable.

The surgical removal of impacted teeth carried out either in a hospital or in a dental surgery is not to be regarded as ‘routine dental treatment’ within the meaning of Section 469 TCA 1997. Relief should, therefore, be allowed for the cost of such surgical removals.

Claims for non-routine dental treatment

An individual claiming relief on Form Med 1 for non-routine dental treatment must furnish, if required, a Form Med 2 (Dental) which is signed and certified by the dental practitioner. The forms are supplied to dentists through the Irish Dental Association.

A list of treatments for which relief may be allowed is included in Appendix 2.

Non-routine dental treatment outside the State

Non-routine dental treatment obtained outside the State may be allowed provided the dentist is a qualified practitioner (i.e. entitled under the laws of the country in which the care is provided to practice dentistry there). A Form Med 2 must be completed by the dentist.

Appendix 1

Kidney Patients

A. Hospital dialysis patients (where the patient attends hospital for treatment)

Relief in respect of expenditure incurred travelling to and from hospital (unlimited journeys for all years) may be allowed at the following rates-

2004	€0.35 per mile
2005	€0.35 per mile or €0.22 per km
2006	€0.35 per mile or €0.22 per km
2007	€0.36 per mile or €0.23 per km

B. Home dialysis patients (where the patient uses a dialysis machine at home).

Relief may be allowed in respect of expenditure up to the following amounts -

	2004	2005	2006	2007
Electricity	€1380	€1440	€1505	€1565
Laundry & Protective Clothing	€1735	€1780	€1855	€1950
Telephone	€260	€270	€285	€300
Travelling	€0.35 per mile	€0.35 per mile or €0.22 per km	€0.35 per mile or €0.22 per km	€0.36 per mile or €0.23 per km

C. Chronic Ambulatory Peritoneal Dialysis (CAPD) patients (where the patient has treatment at home without the use of a dialysis machine)

Relief may be allowed in respect of expenditure incurred up to the following amounts:

	2004	2005	2006	2007
Electricity	€1090	€1140	€1185	€1235
Telephone	€260	€270	€285	€300
Travelling	€0.35 per mile	€0.35 per mile or €0.22 per km	€0.35 per mile or €0.22 per km	€0.36 per mile or €0.23 per km

Note: It is possible for a patient to move from one category to another. Where this happens, relief for each category may be apportioned as appropriate.

Appendix 2

Dental Treatments for which Tax Relief is Allowable

A. Crowns

These are restorations fabricated outside the mouth and are permanently cemented to existing tooth tissue.

B. Veneers/Rembrant Type Etched Fillings

These are a form of crown.

C. Tip Replacing

This is regarded as a crown where a large part of the tooth needs to be replaced and the replacement is made outside the mouth.

D. Gold Posts/Fibreglass posts

These are inserts in the nerve canal of a tooth, to hold a crown.

E. Gold Inlays

These are a smaller version of a gold crown. (Only allowable if fabricated outside of the mouth).

F. Endodontics - Root Canal Treatment

This involves the filling of the nerve canal and not the filling of teeth.

G. Periodontal Treatment

Root Planing is a treatment of periodontal (gum) disease. Currettage and Debridement is part of root planing. Gum Flaps is a gum treatment. Chrome Cobalt Splint if used in connection with periodontal treatment (If it contains teeth, relief is not allowable). Implants following treatments of periodontal (gum) disease, which included bone grafting and bone augmentation.

H. Orthodontic Treatment

This involves the provision of braces and similar treatments.

I. Surgical Extraction of Impacted Wisdom Teeth

The surgical removal of impacted teeth carried out either in a hospital or in a dental surgery is not regarded as ‘routine dental treatment’ and relief is therefore allowed for the cost of such surgical removals.

Note: An impacted tooth is one, which is so firmly lodged in its socket that it cannot emerge through the gum in the normal way. The impaction may be caused by an overlying bone, or because the tooth has grown in such a way that it has become wedged in against another tooth.

J. Bridgework

Dental treatment consisting of an enamel-retained bridge or a tooth-supported bridge is allowable.

Note: Tax relief is not available for the cost of scaling, extraction and filling of teeth or the provision of artificial teeth or dentures.