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Thread: ESA and help with health costs

  1. #1

    ESA and help with health costs

    I am having difficulty renewing my son’s HC2 and wonder if anyone else has encountered this problem.

    For many years I have renewed my son’s HC2 for help with health costs without difficulty but this year I received a letter querying whether he is on Contribution-based or Income-related ESA because, they say, the weekly amount he receives is too high for CB so it must be IR and therefore he does not need the HC2 as he qualifies automatically.

    He migrated from IB to ESA/CB support group in 2014. Then in January this year he started to receive an Enhanced Disability Premium (back-dated). I have checked the most recent DWP documents which are not crystal clear but I believe he is still on Contribution-based ESA with an Income-related element which is the Enhanced Disability Premium.

    If he doesn’t have an HC2 certificate I have no idea how to prove entitlement?? The HC2 is very convenient particularly when re-claiming travel costs at the hospital so I would prefer to have this if possible. Does anyone know if they can refuse to issue a new HC2 if a small part of his ESA is IR? Any guidance would be very much appreciated.

  2. #2
    Senior Member nukecad's Avatar
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    As he now has the disability premium in payment he has an Income Related ESA entitlement. So that automatically entitles him to exactly the same as the HC2 did.
    It doesn't matter if it's part CB and part IR, just having something IR counts.

    You just tick the box for IR ESA on the prescription and other forms, and show them your latest award or uprating letter if they ask.
    In fact any recent letter from the DWP saying that you are on ESA will usually do. (They then check with the DWP if it includes IR or not).

    If they want something more recent then you phone the DWP and ask them for a form ESA125 "Written details of ESA claim" and show them that.
    Maybe best to get one a few weeks before any hospital appointment, you can ask for one as often as you need it and as many times as you like.
    If you don't have any proof to hand then ask for a receipt and you can then claim it back later.

    You can find an example ESA125 to look at in this post: https://www.youreable.com/forums/sho...standard-forms
    Whilst it doesn't actually state on there if it's CB or IR ESA they can tell which it is by the weekly payment amount it says.

    I agree that the HC2 is much handier for travel to hospital costs; but NHS policy is that if you already qualify for health costs by other means then it's a waste of their time and money to issue you a HC2.

    Unfortunately as your son is now on their radar as having IR ESA they can just say "You don't need one, you already qualify through an Income Related benefit".
    (I just don't tell them my ESA is Income Related when I'm renewing my HC2, which I did last month. - shssh).
    Last edited by nukecad; 03-17-2019 at 01:29 PM.
    I don't know everything. - But I'm good at searching for, and finding, stuff.

    Migration from ESA to Universal Credit- Click here for information.

  3. #3
    Hi nukecad thank you for your reply. Their letter asked me to confirm which one and I have replied that it's CB because I honestly didn't understand it at the time so I await their response. Thanks for the information about an ESA125. Have tried to find out more about it online but it seems to be cloaked in secrecy. However, have come across a thread where you seem to indicate the expiry date of the ESA125 is the issue date so I would have to re-apply after every hospital appointment every 10-12 weeks! Just wondered if there was an update as that was 2 years ago.

  4. #4
    Senior Member nukecad's Avatar
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    The ESA125 only confirms that you have ESA on the date it is issued, and is valid for one month following that date.

    Whilst it is a PITA if you need to get a new one each month there is no form to fill in, and so a simple phone call suffices to get a new ESA125 when you need one.
    The DWP believe that this is sufficient.

    From a DWP reply to a freedom of information request:
    Whilst an ESA125 can only be accepted as evidence of receipt of benefit
    within a month of issue, an individual may request a new ESA125 at any time,
    so will be able to present a valid ESA125 to a pharmacist, etc. whenever it is
    needed for as long as they have a claim to ESA.
    Although pharmacists/dentist/hospital cashiers will not accept ESA125 if it is more than a month old, fortunately pharmacists do ask to see proof of benefits often, they trust you to tick the correct box if you are entitled.
    Dentists usually only ask at your check up appointment / the start of treatment.
    If you don't have proof if/when they ask, you need to get a receipt and fill in a HC1 to get a refund.

    Hospital cashiers will usually ask for proof every time if you want refunding there and then.
    Which is why I suggested asking for the ESA125 a few weeks before any appointments.

    If you go to an appointment and don't have current proof then you can get a receipt, a HC5 (T), and claim the travel cost back within 3 months.
    You can also use the HC5(T) to ask for travel costs in advance in some circumstances.
    You can see more and download a HC5(T) here: https://www.nhs.uk/using-the-nhs/hel...s-scheme-htcs/

    You don't need to supply proof with the HC5(T), just tick the box part 4 for IR ESA and the NHS will check it with the DWP.

    It is all a bit more work with travel costs when you don't have the HC2, but the system is there to get free proof before you go for an appointment and the HC5(T) is there as a backup.

    Have you considered asking for NHS non-emergency patient transport to and from your sons appointments?
    There is no harm in asking and from what you have told us before he should easily qualify.
    They use cars funded by the ambulance service (unless you particularly need ambulance transport), it's door to door - and it's free.
    I'm not sure which area you live in, so google patient transport service to find the link for your ambulance trust.
    You might ask his GP to refer him to them.

    Here's an example from North West Ambulance Service which I have used, the other ambulance trusts have similar non-emergency transport schemes:
    http://www.nwas.nhs.uk/our-services/...nsport-service

    I've used them the last 5 or 6 times I've had hospital appointments that were not at my local hospital (I have a disability bus pass for those) and more than once shared the car with someone who was a 'regular customer'.
    Once they knew me and that I was eligible I just rang them whenever I needed transport to/from another appointment.

    There are also local volunteer organisations who run transport services for hospital visits and other journeys.
    These usually charge, but at a low cost, usually per mile.
    Again google is the place to look, or ask at your doctors surgery, or possibly your pharmacy.
    Last edited by nukecad; 03-17-2019 at 08:06 PM.
    I don't know everything. - But I'm good at searching for, and finding, stuff.

    Migration from ESA to Universal Credit- Click here for information.

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