Medical Card and GP Visit Card

Medical Card and GP Visit Card Form MC1 1 Medical Card and GP Visit Card ƉƉůŝĐĂƟŽŶ&Žƌŵ Dϭ Who should use this form? Anyone applying for either a ...
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Medical Card and GP Visit Card Form MC1 1

Medical Card and GP Visit Card ƉƉůŝĐĂƟŽŶ&Žƌŵ Dϭ

Who should use this form? Anyone applying for either a Medical Card or a GP Visit Card – you will be assessed for both.

How do I apply for a Medical Card or a GP Visit Card? Step 1. Complete this form. Read this page and the next page for help. Step 2. Include all the documents we ask for in Part 3 and Part 4. Please send photocopies only. ^ƚĞƉϯ͘ ZĞĂĚĂŶĚƐŝŐŶƚŚĞĚĞĐůĂƌĂƟŽŶŝŶWĂƌƚϱ͘ Step 4. Ask your doctor of choice to complete Part 6A and, if appropriate, ask your spouse’s or partner’s doctor to complete Part 7A. ^ƚĞƉϱ͘ ZĞĂĚĂŶĚƟĐŬƚŚĞĐŚĞĐŬůŝƐƚŽŶƉĂŐĞϭϮ͘ ^ƚĞƉϲ͘ ^ĞŶĚƚŚĞĐŽŵƉůĞƚĞĚĂƉƉůŝĐĂƟŽŶĨŽƌŵĂŶĚĐŽƉŝĞƐŽĨall the documents we ask for, to:

ůŝĞŶƚZĞŐŝƐƚƌĂƟŽŶhŶŝƚ͕WKŽdžϭϭϳϰϱ͕&ŝŶŐůĂƐ͕ƵďůŝŶϭϭ͘

What can I do to avoid delaying the process? /ĨLJŽƵƐĞŶĚƵƐĂĨƵůůLJĐŽŵƉůĞƚĞĚĨŽƌŵĂŶĚĂůůƚŚĞĚŽĐƵŵĞŶƚƐǁĞĂƐŬĨŽƌ͕ǁĞǁŝůůĚĞĂůǁŝƚŚLJŽƵƌĂƉƉůŝĐĂƟŽŶƋƵŝĐŬůLJ ĂŶĚǁŝůůůĞƚLJŽƵŬŶŽǁǁŝƚŚŝŶϭϱǁŽƌŬŝŶŐĚĂLJƐŝĨLJŽƵĂƌĞĞŶƟƚůĞĚƚŽĂĐĂƌĚ͘^ŽƚŽĂǀŽŝĚĚĞůĂLJ͕ĞŶƐƵƌĞƚŽĚŽƚŚĞ following: ͻ ƚĂŬĞĐĂƌĞƚŽĮůůŝŶĂůůLJŽƵƌĚĞƚĂŝůƐĐŽƌƌĞĐƚůLJ͕ ͻ ŝŶĐůƵĚĞĐŽƉŝĞƐŽĨĂůůƚŚĞĚŽĐƵŵĞŶƚƐǁĞĂƐŬĨŽƌŝŶWĂƌƚϯĂŶĚWĂƌƚϰ͕and ͻ ŵĂŬĞƐƵƌĞƚŚĞĚŽĐƵŵĞŶƚƐLJŽƵƐĞŶĚƵƐĂƌĞƵƉƚŽĚĂƚĞ͘ /ĨLJŽƵĚŽŶŽƚŝŶĐůƵĚĞĂůůƚŚĞŝŶĨŽƌŵĂƟŽŶǁĞĂƐŬĨŽƌ͕ǁĞǁŝůůŚĂǀĞƚŽǁƌŝƚĞƚŽLJŽƵĨŽƌƚŚĞŵŝƐƐŝŶŐŝŶĨŽƌŵĂƟŽŶ͘

Need help? ZĞĂĚƚŚŝƐƉĂŐĞĂŶĚƚŚĞŶĞdžƚƉĂŐĞĨŽƌŚĞůƉ͘/ĨLJŽƵŶĞĞĚĨƵƌƚŚĞƌŚĞůƉĐŽŵƉůĞƟŶŐƚŚŝƐĨŽƌŵ͕ƉŚŽŶĞ ĂůůƐĂǀĞϭϴϵϬϮϱϮϵϭϵŽƌǀŝƐŝƚLJŽƵƌ>ŽĐĂů,ĞĂůƚŚKĸĐĞ.

MC1 Sept 2013

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Medical Card and GP Visit Card Form MC1

,ĞůƉĂŶĚŝŶĨŽƌŵĂƟŽŶ Who can apply for a Medical Card or a GP Visit Card? Anyone who is ‘ordinarily resident’ in the Republic of Ireland ĐĂŶĂƉƉůLJͲĨĂŵŝůŝĞƐ͕ƐŝŶŐůĞƉĞŽƉůĞ͕ĞǀĞŶƚŚŽƐĞǁŽƌŬŝŶŐĨƵůů ŽƌƉĂƌƚƟŵĞ͚͘KƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚ͛ŵĞĂŶƐƚŚĂƚLJŽƵĂƌĞůŝǀŝŶŐ ŚĞƌĞĂŶĚŝŶƚĞŶĚƚŽůŝǀĞŚĞƌĞĨŽƌĂƚůĞĂƐƚŽŶĞLJĞĂƌ͘ /ĂŵĂŐĞĚďĞƚǁĞĞŶϭϲĂŶĚϮϱ͘,ŽǁĚŽ/ĂƉƉůLJ͍ ϭ͘/ĨLJŽƵŚĂǀĞĂǁĞĞŬůLJŝŶĐŽŵĞŽĨůĞƐƐƚŚĂŶΦϭϲϰ and LJŽƵĂƌĞĞŝƚŚĞƌůŝǀŝŶŐǁŝƚŚLJŽƵƌƉĂƌĞŶƚ;ƐͿorůŝǀŝŶŐĂǁĂLJ ĨƌŽŵƚŚĞŝƌŚŽŵĞĂƩĞŶĚŝŶŐƐĐŚŽŽůŽƌĐŽůůĞŐĞ͕ĂŶĚLJŽƵƌ ƉĂƌĞŶƚ;ƐͿhas a Medical Card or a GP Visit Card, you ŵƵƐƚĐŽŵƉůĞƚĞWĂƌƚƐϭ͕ϭ͕ϭ͕ϱ͕ĂŶĚϲŽĨƚŚŝƐĨŽƌŵ͘ Your doctor of choice must complete Part 6A. Ϯ͘/ĨLJŽƵŚĂǀĞĂǁĞĞŬůLJŝŶĐŽŵĞŽĨůĞƐƐƚŚĂŶΦϭϲϰĂǁĞĞŬ ĂŶĚLJŽƵĂƌĞĞŝƚŚĞƌůŝǀŝŶŐǁŝƚŚLJŽƵƌƉĂƌĞŶƚ;ƐͿŽƌůŝǀŝŶŐ ĂǁĂLJĨƌŽŵƚŚĞŝƌŚŽŵĞĂƩĞŶĚŝŶŐƐĐŚŽŽůŽƌĐŽůůĞŐĞ͕ĂŶĚ LJŽƵƌƉĂƌĞŶƚ;ƐͿdon’tŚĂǀĞĂDĞĚŝĐĂůĂƌĚŽƌĂ'WsŝƐŝƚ Card, your parent(s) must complete all parts of this form. ϯ͘/ĨLJŽƵŚĂǀĞĂǁĞĞŬůLJŝŶĐŽŵĞŽĨΦϭϲϰŽƌŵŽƌĞ͕LJŽƵmust complete all parts of this form. ϰ͘/ĨLJŽƵůŝǀĞĂǁĂLJĨƌŽŵLJŽƵƌƉĂƌĞŶƚĂůŚŽŵĞĨŽƌĂŶLJƌĞĂƐŽŶ ŽƚŚĞƌƚŚĂŶĂƩĞŶĚŝŶŐƐĐŚŽŽůŽƌĐŽůůĞŐĞ͕LJŽƵŵƵƐƚ complete all parts of this form. How do I qualify for a Medical Card or a GP Visit Card? &ŝƌƐƚůLJ͕ǁĞǁŝůůůŽŽŬĂƚLJŽƵƌŚŽƵƐĞŚŽůĚŝŶĐŽŵĞĂŌĞƌƚĂdž͕ WZ^/ĂŶĚƚŚĞhŶŝǀĞƌƐĂů^ŽĐŝĂůŚĂƌŐĞ;h^ͿŚĂǀĞďĞĞŶ deducted. We also take rent, mortgage, childcare and ƚƌĂǀĞůƚŽǁŽƌŬĐŽƐƚƐŝŶƚŽĂĐĐŽƵŶƚ͘/ĨƚŚĞƌĞƐƵůƟŶŐĮŐƵƌĞŝƐ ůĞƐƐƚŚĂŶƚŚĞŝŶĐŽŵĞƋƵĂůŝĨLJŝŶŐůŝŵŝƚƐ͕LJŽƵĂŶĚLJŽƵƌĨĂŵŝůLJ dependants will be issued with a card. &ŽƌŝŶĨŽƌŵĂƟŽŶŽŶƚŚĞĐƵƌƌĞŶƚŝŶĐŽŵĞƋƵĂůŝĨLJŝŶŐůŝŵŝƚƐ that apply to your family size, ĂůůƐĂǀĞϭϴϵϬϮϱϮϵϭϵ or see our website ǁǁǁ͘ŵĞĚŝĐĂůĐĂƌĚ͘ŝĞ. tŝůůŵLJƐĂǀŝŶŐƐĂŶĚŝŶǀĞƐƚŵĞŶƚƐďĞƚĂŬĞŶŝŶƚŽ account when assessing my income for Medical Card or 'WsŝƐŝƚĂƌĚĞůŝŐŝďŝůŝƚLJ͍ tĞǁŝůůŶŽƚƚĂŬĞŝŶƚŽĂĐĐŽƵŶƚƐĂǀŝŶŐƐŽƌŝŶǀĞƐƚŵĞŶƚƐŽĨ amounts: ͻ ƵƉƚŽΦϯϲ͕ϬϬϬĨŽƌĂƐŝŶŐůĞƉĞƌƐŽŶ͕Žƌ ͻ ƵƉƚŽΦϳϮ͕ϬϬϬĨŽƌĂĐŽƵƉůĞ͘ Also, ǁĞǁŝůůŶŽƚƚĂŬĞŝŶƚŽĂĐĐŽƵŶƚĂŶLJĂŵŽƵŶƚƌĞĐĞŝǀĞĚ ĨƌŽŵĐĞƌƚĂŝŶƐƚĂƚĞƐƉŽŶƐŽƌĞĚĐŽŵƉĞŶƐĂƟŽŶŽƌƌĞĚƌĞƐƐ ƐĐŚĞŵĞƐŽƌĂŶLJŝŶƚĞƌĞƐƚĞĂƌŶĞĚŽŶƚŚĞŝŶǀĞƐƚŵĞŶƚŽĨƚŚĞƐĞ funds.

What if my household income is over the qualifying limits? If this is the case, you and your family dependants may ďĞŐƌĂŶƚĞĚĂDĞĚŝĐĂůĂƌĚŽƌĂ'WsŝƐŝƚĂƌĚŝĨLJŽƵŚĂǀĞ ĚŝĸĐƵůƚƉĞƌƐŽŶĂůĐŝƌĐƵŵƐƚĂŶĐĞƐƚŚĂƚĐĂƵƐĞLJŽƵĮŶĂŶĐŝĂů pressure - for example a family member with a chronic ŝůůŶĞƐƐ͘zŽƵŶĞĞĚƚŽƐĞŶĚĞǀŝĚĞŶĐĞǁŝƚŚLJŽƵƌĐŽŵƉůĞƚĞĚ ĂƉƉůŝĐĂƟŽŶĨŽƌŵŝŶƐƵƉƉŽƌƚŽĨƚŚĞƐĞĐŝƌĐƵŵƐƚĂŶĐĞƐ͕ for example, a medical report and or medical expense receipts. /Ĩ/ŐĞƚĂDĞĚŝĐĂůĂƌĚŽƌĂ'WsŝƐŝƚĂƌĚ͕ĚŽĞƐŝƚĐŽǀĞƌŵLJ family too? /ĨLJŽƵƌĨĂŵŝůLJŝŶĐŽŵĞĨĂůůƐǁŝƚŚŝŶƚŚĞƋƵĂůŝĨLJŝŶŐŝŶĐŽŵĞ ůŝŵŝƚƐ͕ƚŚĞĐĂƌĚǁŝůůĐŽǀĞƌLJŽƵ͕LJŽƵƌƐƉŽƵƐĞŽƌƉĂƌƚŶĞƌ͕ĂŶĚ your children ƵŶĚĞƌϭϲLJĞĂƌƐŽĨĂŐĞ͘ /ĨLJŽƵƌĐŚŝůĚƌĞŶĂƌĞĂŐĞĚϭϲƚŽϮϱĂŶĚĂƌĞƌĞĐĞŝǀŝŶŐǁĞĞŬůLJ ŝŶĐŽŵĞůĞƐƐƚŚĂŶΦϭϲϰ͕ĂŶĚůŝǀŝŶŐǁŝƚŚLJŽƵŽƌůŝǀŝŶŐĂǁĂLJĨƌŽŵ LJŽƵƚŽĂƩĞŶĚƐĐŚŽŽůŽƌĐŽůůĞŐĞ͕ƚŚĞLJǁŝůůĂůƐŽŐĞƚĂĐĂƌĚ͘dŚĞLJ ŵƵƐƚĮůůŽƵƚƚŚĞŝƌŽǁŶĂƉƉůŝĐĂƟŽŶĨŽƌŵĂŶĚƐĞŶĚŝƚƚŽƵƐƚŽ ƌĞĐĞŝǀĞĂĐĂƌĚ͘ How do I qualify for a Medical Card under European hŶŝŽŶ;hͿZĞŐƵůĂƟŽŶƐ͍ zŽƵǁŝůůƋƵĂůŝĨLJĨŽƌĂDĞĚŝĐĂůĂƌĚƵŶĚĞƌhZĞŐƵůĂƟŽŶƐŝĨ you meet allŽĨƚŚĞĨŽůůŽǁŝŶŐƌĞƋƵŝƌĞŵĞŶƚƐ͗ ͻ LJŽƵĂƌĞŽƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚŝŶƚŚĞZĞƉƵďůŝĐŽĨ/ƌĞůĂŶĚ͕ ͻ LJŽƵĂƌĞŝŶƐƵƌĞĚƵŶĚĞƌƚŚĞƐŽĐŝĂůƐĞĐƵƌŝƚLJůĞŐŝƐůĂƟŽŶ ŽĨĂŶŽƚŚĞƌhͬŵĞŵďĞƌƐƚĂƚĞŽƌ^ǁŝƚnjĞƌůĂŶĚ͕ƚŚĂƚ ŵĞĂŶƐƌĞĐĞŝǀŝŶŐĂƐŽĐŝĂůƐĞĐƵƌŝƚLJƉĞŶƐŝŽŶĨƌŽŵƚŚĂƚ state or working and paying social insurance in that state, and ͻ LJŽƵĂƌĞŶŽƚƐƵďũĞĐƚƚŽ/ƌŝƐŚƐŽĐŝĂůƐĞĐƵƌŝƚLJůĞŐŝƐůĂƟŽŶ ͲLJŽƵĂƌĞƐƵďũĞĐƚƚŽ/ƌŝƐŚƐŽĐŝĂůƐĞĐƵƌŝƚLJůĞŐŝƐůĂƟŽŶŝĨ LJŽƵĂƌĞƌĞĐĞŝǀŝŶŐĂĐŽŶƚƌŝďƵƚŽƌLJ Irish social welfare payment or if you are subject to PRSI in the Irish state. /ĨLJŽƵŵĞĞƚƚŚĞĂďŽǀĞƌĞƋƵŝƌĞŵĞŶƚƐ͕LJŽƵĐĂŶĐůĂŝŵLJŽƵƌ ĞŶƟƚůĞŵĞŶƚƚŽĂDĞĚŝĐĂůĂƌĚďLJƐĞŶĚŝŶŐƵƐ͗ ͻ ͻ

Ă ĐŽŵƉůĞƚĞĚĂƉƉůŝĐĂƟŽŶĨŽƌŵ͕ĂŶĚ ƚŚĞƌĞůĞǀĂŶƚŽƌ^ĨŽƌŵŝƐƐƵĞĚďLJƚŚĞhͬ ŵĞŵďĞƌƐƚĂƚĞ;Žƌ^ǁŝƚnjĞƌůĂŶĚͿLJŽƵĂƌĞŝŶƐƵƌĞĚǁŝƚŚ͘

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