Subject to the section, costs of medical care reasonably and necessarily incurred by an insured person for injury or disease sustained while insured under this Part are payable from the Social Insurance Fund to the extent not met under the Health Acts 1947 to 2005, the Mental Health Acts 1945 to 2001, or regulations made under section 138. Where an insured person is eligible for those services or treatment benefit but does not avail of them, payment is limited to the amount that would have been payable had they availed themselves. For in‑patient care payment shall not exceed the maximum chargeable under section 53 of the Health Act 1970 or section 231A of the Mental Treatment Act 1945, as appropriate; for other care the Minister may pay an amount reasonably appropriate having regard to necessity and customary charge. An insured person may be required to submit to medical examination and failure to do so prevents payment; payments may be made to persons the Minister thinks fit, including the Executive, and regulations may apply benefit and claim provisions with any modifications. Subsection (5) is deleted.

For the purposes of this section, "medical care" comprises general practitioner and specialist care including domiciliary visiting; nursing care at home except where cost is met by an increase under section 78 for constant attendance, and nursing care and maintenance in hospitals, convalescent homes, sanatoria or other medical institutions; pharmaceutical and other medical or surgical supplies including prosthetic and aural appliances prescribed by a registered medical practitioner, kept in repair and replaced where necessary; dental and optical treatment and appliances; care given on the prescription of a registered medical practitioner by professions allied to medicine including physiotherapists and chiropodists; and conveyance to and from the place where such care is provided.