Follow the steps to fill out the Esb Medical Benefits form online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling in your name as the ESB employee or pensioner and provide your staff number. If known, include the date of your entry into the Superannuation Scheme.
3. Include your phone number and current location/address to ensure accurate contact information.
4. If you have previously worked outside of ESB and paid full PRSI, indicate this and provide the dates of that employment.
5. Complete the section for claims made on behalf of a spouse or child dependant, if applicable. Specify the name of the person for whom the benefit is claimed and their relationship to you.
6. If your spouse is employed, they must first apply to the Department of Social & Family Affairs; provide their employment details if necessary.
7. For child dependants, enter the child's birth date. Remember, only children under 16 years are eligible for claims.
8. State whether you or your spouse received or are entitled to receive any social welfare or medical scheme benefits related to this application.
9. Indicate whether you or your spouse have a Medical Card.
10. Review your provided information carefully and declare its accuracy by signing the form.
11. The dentist should complete the opposite section, detailing all treatments received, costs, and necessary signatures.
12. Finalize your submission by saving, downloading, printing, or sharing the completed form according to your needs.

Complete your Esb Medical Benefits form online to ensure your claims are processed promptly.