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Benefits Blog

by Tombenefits

news and thoughts from the world of welfare rights
10 November 2017 at 18:57

UC and help with health costs

A reminder of help with health costs and how the new Universal Credit fits into the picture

One of the many confusions around Universal Credit (UC), relates to where it fits into the scheme of things when it comes to qualifying you for help with health costs.

These include prescription charges in England or help with eg fares to hospital, dental and optical costs and wigs and fabric supports.

Problems in this area can really hit hard if you get a stroppy letter with a wrong penalty attached whilst struggling with delays or problems with your UC payment. It can get to feel that you are under siege from a combination of the Department for Work and Pensions (DWP) and the NHS Business Services Authority 

The basic system of help with health costs hasn't changed at all so this Benefits Blog might still be relevant to most of you not yet touched by UC :-). For full NHS expanations of help with health costs you can follow links

   - for England, click here

   - for Scotland click here

   - for Wales, click here

   - for Northern ireland, click here

The added bit in this blog is: Where does UC fit into it this unchanged scheme?

 

1. Free prescriptions if you have cancer

1.1 Getting free prescriptions in England

If you have a cancer diagnosis, then you can get a medical exemption certification that frees you from the strange English practise of charging for prescriptions :-).

This applies regardless of income across a number of medical conditions

Ask your GP to give you a countersigned an FP92A form - it looks like te one here -  and send it in, to swap for a 5 year exemption certificate from prescription charges.

But this certificate does not cover

  - other members of your family if they face prescription charges,

  - nor does it help you or them any other health costs.

However help may be available on more general low income grounds, which could include temporarily reduced income that can often happen along the way for households affected by cancer. 

1.2. Charges across borders

What happens if you live in one nation and have a prescription issued there, but need to get it dispensed in another?

Take Scotland as an example - people don't normally need a medical exemption certificate, but you can get one - an EC92a - if you need to get a Scots prescription dispensed in England

Visitors to Scotland from Wales or N.Ireland bringing prescriptions from those nations can get them dispensed free in Scotland by reciprocal arrangement.

However, bearers of English issued prescriptions would have to pay the English charge, unless they had their medical exemption certificate or would otherwise meet English criteria for free prescriptions.

See the NHS Scotland site here 

 

2. Who gets low income help with health costs

Help is available for anyone elses' prescriptions or everyone's other health costs in two ways:

   - by receiving a qualifying benefit  - you tick a box to say you which one and sometimes may need to prove eligibility; or

  - via the NHS Low Income Scheme if you dont get one of the specific benefits,  but are still on a low income . You complete an HC1 form (or its devolved equivalent). In return you may get either an HC2 (full help) or HC3 (partial help) certificate.

 

3. Is UC a qualifying benefit?

Yes and No :-)

Universal Credit (UC) joins the list of potentially exempting benefits, but is complicated by straddling two different categories in the "legacy benefits" system

So you might be getting UC either  :

   - as a basic safety net benefit while not earning (which under the old system would have been Income Support, Income-related ESA or Income-based JSA) - where everyone would qualify; or

   - instead of tax credits which might cover those who are earning or e.g parents who are not earning but have other income such as non-means tested benefits. Here some qualify others don't. You need to have an annual tax credit gross income of £15,276 or less and be either: 

         = just getting Child Tax Credit or

         = getting Working Tax Credit that includes a disability element 

Under the old system - that most people are still on -  you often just need to tick a box for "out of work" benefits though it helps if you have proof of that . If its based on tax credits you might well need to show a 6 monthly exemption certificate issued by HMRC

 

5. Which UC claimants qualify?


The actual criteria for whether your UC qualifies you directly for full help with health costs are:

  - you are on UC and not earning; or

  - you are on UC and earning, but this is either: 

        = less that £435 a month; or

        = under £935 month if your UC claim includes either child elemements or one of the two limited capability elements (the equivalent of ESA components).

The official explanation for England - which has the widest range of health charges - is here It's the same in other nations, just the health costs concerned may be different

 

5. Practical issues for UC claimants

 

5.1 No UC tick box

The first problem for UC claimants, is that the NHS BSA haven't got round to reprinting forms with relevant UC boxes on them.

The NHS BSA  advice is to tick the Income-based JSA box instead. So know you know, the best way is to follow that advice. 

However, if you have ticked a different - and perhaps more relevant box - it seems entirely unreasonable and possibly unlawful - for this to be considered as a somehow incorrect claim. All the options are incorrect for you, so really it's just to indicate that you are eligible based on receipt of a qualifying benefit. 

 

4.2 Everyone on UC needs evidence of entitlement

The second issue, is they are asking all those on UC to evidence their entitlement, not just those who would have been on tax credits in the old system. 

And because UC can vary month to month, there is no equivalent of the tax credit certificates. You will need your last UC statement, which you can print off from your UC journal.

In general, these rather makeshift arrangements may wll be working in most cases. So, to claim help with health costs on the basis of UC:

  - take along your last UC statement

  - and where there is no UC box to tick then choose Income-based JSA

 

6. But don't accept wrongful penalty charges

However, problems are occurring partly perhaps as the newness and confusion of UC also happens to coincide with an NHS BSA crackdown on fraud. 

In general, there is quite a no nonsense approach: if in any doubt, they suggest you pay the charge and get an NHS form receipt FP57 and then claim costs back. See the infographic here

But it's rather different if Andrew - in that example - knows he is entitled through his UC, but just has no no correct box to tick to indicate this

There have been instances of perfectly correctly entitled claims being caught up in the net, sometimes even when they have followed the BSA's own advice.

And people report back varying success around trying to sort matters out. Sometimes the person at the BSA is a bit hazy on UC generally or sometimes can take a jobsworth approach, based on you not having ticked the right wrong box :-)

The reasonable - and possibly the only lawful-  approach ought to focus on :

  - whether or not you were actually entitled to that help at that time or not. 

  - and if not, given confusions and process gaps - whether it is reasonable to apply a penalty in your particular case. 

So, please don't just accept any demand to repay without querying it  and especially not if there is an added civil penalty 

Do let me know if you have any problems around this.

I hope it will only be an occasional issue, but if it does perhaps I can help resolve the issue while encouraging a more measured approach generally.

 

So...

  - nothing has changed in the very useful help with health costs scheme

  - there is a bit of confusion amongst claimants, health professionals, the DWP and the NHS BSA processes,  about where UC fits in.

  - getting UC could qualify you for full help with health costs, but not always - see the criteria above

  - the NHS BSA are asking you to make an incorrect statement (to tick the Income-based JSA box)  to indicate your eligibility, but that is a work around from the days when most UC claimants were jobseekers

  - it is then not acceptable for them to pick you up if you had ticked another box. The question is whether or not you were correctly entitled, not how you dealt with an inadequate form. 

Please do post any general queries, thoughts or experiences around help with health costs in general - or claiming that help when on UC - in particular by joining the Conversation here

And please do feel free to message me if you have an individual query or are getting any difficulties with either UC or the NHS BSA. 

Best wishes,

Tom :-)

 



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