Social Security
(Health Bonus Scheme) (Jersey) Regulations 2016
1 Interpretation
(1) In these Regulations,
unless the context otherwise requires –
“2014 Law” means the Social Security (Bonus) (Jersey) Law 2014;
“asset” has the meaning given in Regulation 2;
“chiropodist” means a person registered as a chiropodist
under Article 7 of the Health Care (Registration) (Jersey) Law 1995;
“dentist” means a person registered as a dentist under
Part 2 of the Dentistry (Jersey) Law 2015;
“determining officer” means a determining officer as
defined in the Income Support (Jersey) Law 2007 or as appointed in
accordance with an Order under Article 33 of the Social Security (Jersey) Law 1974;
“health bonus” means a bonus, up to the limit specified
in an Order made under Article 3 of the 2014 Law, payable in
respect of a person admitted to the health bonus scheme for –
(a) an
examination of, or treatment carried out on, that person by a chiropodist or a
podiatrist;
(b) an
examination of, or treatment carried out on, that person by a dentist;
(c) an
examination of that person carried out by an optician; or
(d) the prescription
of glasses or contact lenses by an optician for wearing by that person;
“health bonus scheme” means the scheme established under
Regulation 3 for the provision of a health bonus;
“health care service” means an examination, treatment or
prescription provided by a chiropodist, dentist, optician or podiatrist;
“Jersey 65+ health plan” means the plan referred to in
the States’ proposition P.153/2003 and approved by the States on 25th
November 2003;
“Jersey old-age pension” means a pension to which a
person is entitled under Article 25 of the Social Security (Jersey) Law 1974;
“Minister” means the Minister for Social Security;
“optician” means a registered optician within the
meaning of the Opticians (Registration) (Jersey) Law 1962;
“participating practitioner” means a practitioner
approved under Regulation 4;
“pensionable age” has the same meaning as in Article 1A
of the Social Security (Jersey)
Law 1974;
“podiatrist” means a person registered as a podiatrist
under Article 7 of the Health Care (Registration) (Jersey) Law 1995;
“practitioner” means a chiropodist, dentist, optician or
podiatrist;
“Royal Court” means the Inferior Number of the Royal
Court.[1]
2 Meaning
of “asset”
(1) In this Law,
“asset” means a person’s immovable or movable (whether
tangible or intangible) property excluding any of the following –
(a) personal
possessions;
(b) any
sums held on trust in a Jersey retirement trust scheme approved under Article 131CA
of the Income Tax (Jersey)
Law 1961 or a trust approved under Article 131E of that Law;
(c) income;
(d) assets
that are integral to a business owned by the person that is being run actively
as a going concern by the person.
(2) Paragraph (1)(a)
does not include any personal possession held wholly or mainly for investment
purposes.
(3) An asset may be
situated in or outside Jersey.
3 Establishment
and object of health bonus scheme
(1) There is established a
scheme, the object of which is to provide a health bonus to support the health
and well-being of individuals, who have reached their pensionable age, by contributing
to the cost of certain health care services.
(2) The Minister, having
regard to the object of the health bonus scheme, shall publish the principles
of the scheme that must be observed by a participating practitioner.
4 Approval
of practitioner as a participating practitioner
(1) A practitioner may
apply to the Minister to be a participating practitioner in the health bonus
scheme.
(2) On receiving an
application under paragraph (1), the Minister may –
(a) grant
the application; or
(b) refuse
the application.
(3) The Minister shall not
grant an application under paragraph (2)(a) unless he or she is satisfied
that the applicant, when admitted as a participating practitioner, will conduct
himself or herself in accordance with the principles published under Regulation 3.
(4) The Minister shall,
subject to paragraph (6), notify the applicant in writing of any decision
under paragraph (2) and shall give reasons for any decision to refuse the
application under paragraph (2)(b).
(5) If the Minister is
satisfied that a participating practitioner is not conducting himself or
herself in accordance with the principles published under Regulation 3, the
Minister may, subject to paragraph (6), notify the participating
practitioner that the Minister has determined that, from a date specified in
the notification, the participating practitioner shall cease to be a
participating practitioner.
(6) Before giving a
notification of a decision under paragraph (4) to refuse an application,
or of a determination under paragraph (5), the Minister must serve written
notice on the practitioner –
(a) giving
the reasons for the Minister’s proposed refusal or determination; and
(b) stating
that within such period as may be specified in the notice (not being less than
21 days beginning with the date of service of the notice) the person on
whom it is served may make objections or representations in writing to the
Minister concerning the proposal.
(7) A notification of a
decision to refuse an application under paragraph (4), or of a
determination under paragraph (5), may only be made after the Minister has
considered any objections or representations in accordance with paragraph (6)(b).
(8) If a person is
aggrieved by –
(a) a
decision of the Minister under paragraph (2); or
(b) a
determination under paragraph (5),
the person may appeal to the Royal Court no later than 28 days
after the date of receipt of the notification of the decision or determination,
as the case may be, on the ground that the decision or determination of the
Minister was unreasonable, having regard to all the circumstances of the case.
(9) Unless the Royal Court
so orders, the lodging of an appeal shall not operate to stay the effect of a
decision under paragraph (2) or a determination under paragraph (5)
pending determination of the appeal.
(10) On hearing the appeal, the
Court may confirm, reverse or vary the Minister’s decision or
determination.
5 Eligibility
for admission to health bonus scheme or payment under scheme
A person is eligible to be admitted to the health bonus scheme if
the person –
(a) is ordinarily resident
in Jersey;
(b) has attained his or her
pensionable age;
(c) is receiving a Jersey
old age pension or has Entitled status within the meaning of Part 2 the Control of Housing and Work (Jersey)
Law 2012; and
(d) does not have more than
the relevant total income or assets specified in an Order made under Article 3
of the 2014 Law for the purposes of these Regulations.
6 Application
and admission to health bonus scheme and entitlement to health bonus
(1) A person may apply to
be admitted to the health bonus scheme, in accordance with procedures specified
in an Order made under Article 3 of the 2014 Law, and his or her
application shall be determined in accordance with those procedures.
(2) A person must, when
applying to be admitted to the scheme, specify the participating practitioners
from whom he or she wishes to receive a health care service.
(3) A person –
(a) shall
be admitted to the health bonus scheme on the first day of the month following
the date on which his or her application for admission to the scheme is approved
under the procedures referred to in paragraph (1);
(b) shall
be entitled to a health bonus for a health care service received, in the amount
specified in an Order made under Article 3 of the 2014 Law, from
the date he or she is admitted to the health bonus scheme; and
(c) may
be entitled to the health bonus for a health care service received from a
participating practitioner undertaken before the date on which he or she was
admitted to the health bonus scheme if the determining officer considers that,
in all the circumstances, it is reasonable for the health bonus to be paid in
respect of that health care service.
(4) A person who,
immediately before the coming into force of these Regulations, was entitled to
receive payments under the Jersey 65+ Health Plan shall be admitted to the
health bonus scheme upon the coming into force of these Regulations without
needing to make an application.
(5) A person who is
admitted to the health bonus scheme under paragraph (4) shall, as soon as
reasonably practicable after the coming into force of this Regulation, specify
to the Minister the participating practitioners from whom he or she wishes to
receive a health care service.
(6) A person who is
admitted to the health bonus scheme shall be entitled to a health bonus under
the scheme if –
(a) he or
she has had a health care service provided to him or her by a participating
practitioner; and
(b) the
determining officer is satisfied that the health care service was provided in
accordance with the principles published under Regulation 3(2).
(7) A person’s
admission to the health bonus scheme and entitlement to a health bonus shall
cease immediately upon his or her circumstances changing such that he or she no
longer satisfies the conditions for eligibility under Regulation 5.
(8) A person whose
entitlement to the health bonus ceases under paragraph (7) may re-apply
for admission to the health bonus scheme if he or she becomes eligible for
admission again.
(9) The right to a health
bonus is not transferable.
(10) If the person’s
application under paragraph (1) is refused in accordance with procedures
referred to in that paragraph, or he or she ceases to be admitted to the health
bonus scheme, he or she may seek a redetermination or appeal in accordance with
the procedures contained in an Order made under Article 3 of
the 2014 Law.
7 Access
to health care services under health bonus scheme
(1) The Minister shall
notify a person who applies to be admitted to the health bonus scheme under
Regulation 6(1), or who is admitted under Regulation 6(4), and the
participating practitioners specified in the person’s application, of the
date that the person is admitted to the scheme and the date from which the person
shall be entitled to a health bonus under Regulation 6(3).
(2) Where a person intends
to receive a health care service from a participating practitioner who was not
specified in the person’s application made under Regulation 6(1),
the person, the participating practitioner who was specified in the
application, or the participating practitioner who intends to provide the health
care service, must notify the Minister of the intention of the person who
wishes to receive the health care service.
(3) Where a person admitted
to the health bonus scheme under Regulation 6(4) intends to receive a
health care service from a participating practitioner whom he or she has not
specified to the Minister under Regulation 6(5), the person, the
participating practitioner specified to the Minister under
Regulation 6(5), or the participating practitioner who intends to provide
the health care service, must notify the Minister of the intention of the
person receiving the health care service.
(4) The requirement to
notify the Minister under paragraph (2) or (3) shall not apply if the
participating practitioner referred to in that paragraph carries out the health
care service in the normal course of a business that is operated within the
same chiropody, dental, opticians’ or podiatry practice (as the case may
be) as the participating practitioner named in the person’s application,
or specified to the Minister under Regulation 6(5).
(5) If the Minister is not
notified, as required under paragraph (2) or (3), the determining officer
may refuse to pay a health bonus in respect of a health care service provided
by the participating practitioner who had not been specified in the
person’s application (or specified under Regulation 6(5)).
8 Payment
of health bonus
The determining officer shall pay any health bonus in respect of a
person admitted to the health bonus scheme to the participating practitioner
specified in the person’s application made under Regulation 6(1),
specified to the Minister under Regulation 6(5) or notified to the
Minister under Regulation 7(2) or (3) who carried out the health care service
on the person unless, in all the circumstances, the Minister considers that it
is appropriate to pay it to another person.
9 Verifying
entitlement to health bonus and recovery of health bonus wrongly paid
(1) The Minister may at any
time request further information or documentation from a person admitted to the
health bonus scheme for the purpose of satisfying himself or herself whether a
person is, or remains, eligible for admission to the health bonus scheme, or
entitled to a health bonus.
(2) If it is found at any
time that any health bonus has been paid that was not properly payable, the
Minister may require it to be repaid –
(a) if it
was paid to a person in his or her own right, by that person; or
(b) if it
was paid to a person on behalf of another person, by that other person.
(3) If it is found at any
time that any health bonus properly payable has been paid to a person not being
a person by whom it was properly receivable, the Minister may require it to be
repaid by the person to whom it was paid.
(4) In case of the death of
a person who could be required to repay a health bonus under this Regulation,
the Minister may require it to be repaid by the person charged with the
administration of the deceased person’s personal estate.
(5) Proceedings for the
recovery of any health bonus which a person is required under this Regulation
to repay to the Minister may be instituted by the Treasurer of the States and,
despite any enactment or rule of law to the contrary, any such proceedings may
be brought at any time within 10 years from the time when that health
bonus was paid, or, where the proceedings are for the recovery of a consecutive
series of health bonuses, within 10 years from the date on which the last health
bonus of the series was paid.
(6) Any health bonus which
a person is required under this Regulation to repay to the Minister may,
without prejudice to any other remedy, be recovered by means of deduction from
any other payment due under the health bonus scheme to the person to whom the health
bonus was paid, unless it was paid to that person on behalf of another, in
which case it may, without prejudice to any other remedy, be recovered by means
of deduction from any payment of health bonus due under these Regulations to
that other person.
10 Persons acting
on behalf of an applicant
(1) In this Regulation,
“applicant” includes a person who is unable to make an application
to be admitted to the health bonus scheme or to apply for or receive a health
bonus under that scheme.
(2) In the case of an
applicant in respect of whom none of the circumstances in paragraph (3)
apply, and who is unable to act in relation to an application or health bonus,
the Minister may appoint a person (which may include the Minister or a
determining officer) to act on the applicant’s behalf in relation to any
matter relating to an application or health bonus, including making an
application, specifying a participating practitioner and receiving a health
bonus on the applicant’s behalf.
(3) Those circumstances are
that the applicant –
(a) has
been received into guardianship in pursuance of a guardianship application
under Article 29 of the Mental Health (Jersey) Law 2016;
(b) is a
person in respect of whom –
(i) a delegate has
been appointed under Part 4 of the Capacity and Self-Determination (Jersey)
Law 2016, or
(ii) a
person is acting under the authority of a lasting power of attorney conferred
under Part 2 of that Law; or
(c) has a
tuteur.[2]
(4) An appointment under
paragraph (2) shall terminate –
(a) if
the applicant is received into guardianship, or has appointed, in relation to
him or her, such a person as mentioned in paragraph (3)(b) or a tuteur;
(b) at
the request of the person who has been appointed;
(c) if
revoked by the Minister; or
(d) if
the applicant becomes able to act in relation to the application or health
bonus.
(5) Where –
(a) an
applicant does not have another person acting for him or her under paragraph (2);
and
(b) none
of the circumstances in paragraph (3) apply,
the applicant may appoint a person (which may include the Minister
or a determining officer) to act on the applicant’s behalf in relation to
any matter relating to an application or health bonus, including making an
application, specifying a participating practitioner and receiving a health
bonus on the applicant’s behalf.
(6) An appointment under
paragraph (5) shall be in writing and copied to the Minister.
(7) A person appointed
under paragraph (5) may act on the applicant’s behalf until
whichever of the following happens first –
(a) the
applicant revokes the appointment;
(b) the
Minister makes an appointment under paragraph (2); or
(c) one
of the circumstances described in paragraph (3) apply to the applicant.
11 Cessation
of Jersey 65+ health plan
No person may be admitted to the Jersey 65+ health plan after
the coming into force of these Regulations.
12 Citation
These Regulations may be cited as the Social Security (Health Bonus
Scheme) (Jersey) Regulations 2016.