Health Insurance
(Medical Benefit) (Jersey) Regulations 2005
Made 1st November 2005
Coming into force 1st
January 2006
THE STATES, in pursuance of Articles 9 and 29 of the Health Insurance (Jersey) Law
1967,[1] have made the following
Regulations –
1 Interpretation
In these Regulations, unless the context otherwise requires –
“1974 Law” means the Social Security (Jersey) Law 1974;[2]
“Law” means the
Health Insurance (Jersey) Law 1967;
“public holiday”
means a day appointed to be observed as a public holiday by the Public Holidays
and Bank Holidays (Jersey) Act 1952.[3]
2 General
rate of medical benefit
The rate of medical benefit for the purposes of Article 9(1) of the
Law is £15.
3 Different
rate of medical benefit for certain classes of insured persons
(1) This
Regulation applies to an insured person –
(a) who
has been resident in Jersey for at least 5 years;
(b) who
is not eligible to pay employed persons’ primary Class 1 contributions
under the 1974 Law; and
(c) whose
weekly income (as assessed in accordance with paragraph 2 of Schedule 1) does
not exceed the amount applicable to that person as set out in paragraph 1 of
that Schedule.
(2) Despite
Regulation 2, the rate of benefit applicable to persons to whom this Regulation
applies is determined by adding the applicable rate prescribed in Part A of
Schedule 2 to the applicable rate (if any) prescribed in Part B of that
Schedule.
4 Date
of applicability of rates
The rates of benefit prescribed by these Regulations apply to
medical services provided on or after 1st January 2006.
5 Regulations
repealed
The Regulations set out in Schedule 3 are repealed.
6 Citation
and commencement
These Regulations may be cited as the Health Insurance (Medical
Benefit) (Jersey) Regulations 2005 and shall come into force on 1st January
2006.
a.h. harris
Deputy Greffier of the States.
SCHEDULE 1
(Regulation 3 (1))
assessment of eligibility for different
rate of medical benefit
1. Income
limits
(1) For
the purposes of Regulation 3(1)(c) the weekly income limits are –
(a) if
the person is over the age of 21 and single, £141.45;
(b) if
the person is over the age of 17 but under the age of 21 and does not live with
a parent or guardian or in a hostel, £115.70;
(c) if
the person is married, £234.55; and
(d) if
the person does not fall into clauses (a) to (c) and has sole responsibility
for a person under full age, £234.55.
(2) If
the person is maintaining a dependent child or young person there shall be
added to the applicable income limit set out in sub-paragraph (1) the following
amounts for each such child or young person–
(a) for
a young person aged 18-20 years, £69.20;
(b) for
a child aged 16 or 17 years, £54.15;
(c) for
a child under the age of 16, £43.65.
(3) However,
in the case of a person mentioned in sub-paragraph (1)(d), the first child
shall be disregarded.
(4) The
following shall be added to the applicable income limit set out in
sub-paragraph (1) –
(a) the
total of any amount paid by the person in rent;
(b) one
third of any amount paid by the person by way of board and lodging;
(c) in
the case of a person who is an owner occupier, an amount equivalent to the
minimum that would be charged by the Housing Committee by way of rent if the
person were a States tenant; and
(d) 25%
of any fee paid by an insured person –
(i) to a hospital or
care home for which the Health and Social Services Department is responsible;
or
(ii) to a home to
which the Nursing and Residential Homes
(Jersey) Law 1994[4] applies.
2. Income
assessment
(1) Subject
to sub-paragraph (2), the following sources of income are to be included when
assessing the weekly income of an insured person –
(a) earnings;
(b) an
amount in respect of income from savings of –
(i) £1 in
respect of savings of up to £7,092 in the case of a single person and up
to £11,773 in the case of a married person, and
(ii) 25 pence for each
£50 of savings over and above the amounts specified in clause (i);
(c) social
security benefits;
(d) pensions;
(e) any
deed or gift;
(f) maintenance
payments for the insured person or a dependent child;
(g) parish
welfare;
(h) income
from lodgers; and
(i) income from letting of
property.
(2) The
following are to be disregarded when assessing weekly income –
(a) in
the case of the earnings of an insured person who is a single parent or a
pensioner who works less than 25 hours a week, the first £20 earned and
half of the amount earned over £20 and under £40;
(b) in
the case of any training allowance paid by an employer training scheme
administered by the States, the same amount as described in clause (a) plus a
quarter of any allowance exceeding £40;
(c) income
from Therapeutic Work Scheme employment;
(d) 15%
of any allowance payable under the Family Allowances (Jersey) Law 1972[5] or £8, whichever is
the greater;
(e) disability
transport allowance (within the meaning of Article 2 of the Disability
Transport Allowance (Jersey) Law 1997[6]), attendance allowance (payable
under the Attendance Allowances (Jersey) Law 1973[7]) and any allowance payable
under the Invalid Care and Disability Allowances (Jersey) Law 1978;[8]
(f) the
first £20.75 of any maternity allowance or long term incapacity benefit
payable under the 1974 Law;
(g) in
the case of an insured person in receipt of an incapacity pension or an old age
pension under the 1974 Law –
(i) £23 in the
case of a single person, and
(ii) £38.15 in
the case of a married person;
(h) survivor’s
benefit under Article 24 of the 1974 Law;
(i) educational
grants and grants from charitable organisations;
(j) in
the case of income from lodgers –
(i) if the lodger
lives as a member of the family, £39.14,
(ii) if the lodger is
not provided with food, £31.37,
(iii) if the lodger is provided
with food, £35.65; and
(k) in
the case of income from property, 20% of the cost of exterior repairs and 40%
of the cost of all other repairs.
SCHEDULE 2
(Regulation 3(2))
part a
|
different Rates of benefit in respect
of medical services generally
|
|
Service
|
Rate of benefit
£
|
|
(1) For
medical services provided at the approved medical practitioner’s
surgery
|
18.85
|
|
(2) For
medical services provided elsewhere than at the approved medical
practitioner’s surgery, on any day other than a Sunday or public holiday,
between the hours of 8 a.m. and 8 p.m.
|
31.30
|
|
(3) For
medical services provided elsewhere than at the approved medical
practitioner’s surgery –
(a) on a Sunday or public
holiday, or
(b) on any day, between
the hours of 8 p.m. and 8 a.m. the following day
|
76.05
|
|
(4) For
medical services provided to an insured person at the same time and place as
medical services as specified in item (2) or item (3) are provided to a
different insured person
|
18.85
|
part b
|
Additional different rates of benefit in
respect of particular medical services
|
|
Service
|
Rate of benefit
£
|
|
(1) Injection (where drug supplied by medical
practitioner and syringe of disposable type used)
|
7.45
|
|
(2) Blood
test
|
7.45
|
|
(3) Insertion
of vaginal ring pessary (where appliance supplied by medical practitioner)
|
8.10
|
|
(4) Stitching
of minor wound, etc.
|
7.45
|
|
(5) Minor
operations (where no anaesthetic is used, or local anaesthetic only is used,
and including the cost of stitching but excluding the cost of any anaesthetic
used)
|
26.00
|
|
(6) Electrocardiogram
|
35.30
|
|
(7) Ear
syringing
|
7.45
|
|
(8) Pregnancy
urine test
|
16.40
|
|
(9) Letter
from a medical practitioner to a consultant or specialist at the General
Hospital referring a patient for examination
|
7.45
|
|
(10) Cervical
smear
|
8.10
|
|
(11) Cryo-surgery
|
7.45
|
SCHEDULE 3
(Regulation 5)
regulations repealed
Health Insurance (Medical Benefit) (Jersey) Regulations 1967[9]
Health Insurance (Medical Benefit) (No. 2) (Jersey) Regulations 1968[10]
Health Insurance (Medical Benefit) (No. 4) (Jersey) Regulations 1972[11]
Health Insurance (Medical Benefit) (No. 51) (Jersey) Regulations
2000[12]
Health Insurance (Medical Benefit) (No. 55) (Jersey) Regulations
2001[13]
Health Insurance (Medical Benefit) (No. 56) (Jersey) Regulations
2002[14]
Health Insurance (Medical Benefit) (No. 58) (Jersey) Regulations
2004[15]
Health Insurance (Medical Benefit) (No. 60) (Jersey) Regulations
2004[16]