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  • FIRST POST
    • turbocrazy
    • By turbocrazy 13th Jan 18, 4:36 AM
    • 1Posts
    • 0Thanks
    turbocrazy
    prescription penalty & benefit confusion
    • #1
    • 13th Jan 18, 4:36 AM
    prescription penalty & benefit confusion 13th Jan 18 at 4:36 AM
    i was wondering,based on the benifits below if you would be entitled to free prescriptions.
    the ESA reward notice doesnt make much sense to me as well as reading on the GOV.org website that you wouldnt receive contribution based ESA for longer than a 12month period.
    also read that depending on your disability dispite which ever benifit your claiming that doesnt entitle you to free prescriptions ,that in some cercumstances you would be entitled.{which includes needing assistance outdoors)

    ESA awards
    from 26/11/13 til present (on going)
    living expenses £73.10
    extra money because you are in a support group £36.55
    which gives you a total income related amount £109.65

    no income will be taken off your employment support allowance

    income and benefits
    your income related amount is £109.69 less £0.00 so you would have been £109.65
    however,because your entitled to contribution based employment and support
    allowance we will pay you £110.85
    top up payment
    included in your employment and support allowance is a top up payment £1.20
    so you wont see a reduction in the level of your benefit entitlement as a result of the change to employment support allowance

    *******************************
    DLA
    from 22/07/2013 til nov 2017(PIP) now being assessed.
    i have awarded you low rate of £20.55 a week as you need guiding or supervising when walking outside.
    help with getting around outdoors
    physical difficulty walking
    guidance or supervision
    you need help because of anxiety or panic attacks..
    you need someone to guide or supervise you to walk outside in places you dont know well.
    so you are entitled to low rate disability.
    ************************************************** ****
    industrial injuries disablement benifit
    awarded from 4/7/2011 to life
    ************************************************** *********
    i am enquiring on behalf of somebody else.
    i am their advocate.
    the person does not claim any other benefits and lives with his mum (pensioner)
    he has received several prescription penalty charges and as well as being the most honest person,he is in deep distress due to severe depression.
    i am in need of help on this one as i was not aware, and never questioned that he had to pay for his prescriptions.
    the charges are multiplying beyond means of affordability but i beleive that this person should not have had to pay for his medicine in first place taking the above into account.

    can someone please help
Page 1
    • poppy12345
    • By poppy12345 13th Jan 18, 6:09 AM
    • 1,901 Posts
    • 1,758 Thanks
    poppy12345
    • #2
    • 13th Jan 18, 6:09 AM
    • #2
    • 13th Jan 18, 6:09 AM
    i was wondering,based on the benifits below if you would be entitled to free prescriptions.
    the ESA reward notice doesnt make much sense to me as well as reading on the GOV.org website that you wouldnt receive contribution based ESA for longer than a 12month period.
    also read that depending on your disability dispite which ever benifit your claiming that doesnt entitle you to free prescriptions ,that in some cercumstances you would be entitled.{which includes needing assistance outdoors)

    ESA awards
    from 26/11/13 til present (on going)
    living expenses £73.10
    extra money because you are in a support group £36.55
    which gives you a total income related amount £109.65

    no income will be taken off your employment support allowance

    income and benefits
    your income related amount is £109.69 less £0.00 so you would have been £109.65
    however,because your entitled to contribution based employment and support
    allowance we will pay you £110.85
    top up payment
    included in your employment and support allowance is a top up payment £1.20
    so you wont see a reduction in the level of your benefit entitlement as a result of the change to employment support allowance

    *******************************
    DLA
    from 22/07/2013 til nov 2017(PIP) now being assessed.
    i have awarded you low rate of £20.55 a week as you need guiding or supervising when walking outside.
    help with getting around outdoors
    physical difficulty walking
    guidance or supervision
    you need help because of anxiety or panic attacks..
    you need someone to guide or supervise you to walk outside in places you dont know well.
    so you are entitled to low rate disability.
    ************************************************** ****
    industrial injuries disablement benifit
    awarded from 4/7/2011 to life
    ************************************************** *********
    i am enquiring on behalf of somebody else.
    i am their advocate.
    the person does not claim any other benefits and lives with his mum (pensioner)
    he has received several prescription penalty charges and as well as being the most honest person,he is in deep distress due to severe depression.
    i am in need of help on this one as i was not aware, and never questioned that he had to pay for his prescriptions.
    the charges are multiplying beyond means of affordability but i beleive that this person should not have had to pay for his medicine in first place taking the above into account.

    can someone please help
    Originally posted by turbocrazy
    Based on the above ESA it looks like he's recieving Contribution based. Free prescriptions are only if you're claim an Income related benefit. When placed in the Support Group ESA is paid for as long as you're kept in there. There' no time limits when in the Support Group. The PIP award wouldn't entitle him to free prescriptions.

    There's a form that can be filled out, which is for those on low income that will help with the cost off prescriptions etc. See this link. https://www.nhs.uk/NHSEngland/Healthcosts/Pages/nhs-low-income-scheme.aspx
    • antrobus
    • By antrobus 13th Jan 18, 6:10 AM
    • 15,357 Posts
    • 21,903 Thanks
    antrobus
    • #3
    • 13th Jan 18, 6:10 AM
    • #3
    • 13th Jan 18, 6:10 AM
    i was wondering,based on the benifits below if you would be entitled to free prescriptions.
    the ESA reward notice doesnt make much sense to me as well as reading on the GOV.org website that you wouldnt receive contribution based ESA for longer than a 12month period.
    also read that depending on your disability dispite which ever benifit your claiming that doesnt entitle you to free prescriptions ,that in some cercumstances you would be entitled.{which includes needing assistance outdoors)
    Originally posted by turbocrazy
    You are automatically entitled to free NHS prescriptions if you’re included in award for:

    Income Support
    Income-based Jobseeker’s Allowance
    Income-related Employment and Support Allowance

    ....

    If you’re receiving contribution-based Jobseeker’s Allowance, contribution-based Employment and Support Allowance, you are not automatically entitled to free NHS prescriptions. However, you could apply for help through the NHS Low Income Scheme.



    https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/free-nhs-prescriptions

    (Different rules apply if you’re getting Universal Credit, it depends on earnings during your last complete assessment period.)

    If this individual is receiving "contribution based employment and support allowance" then they are not automatically entitled to free NHS prescriptions. How long contribution based ESA can last depends on which group you are in. If you remain in the support group it can be paid indefinitely.

    PIP has no effect on prescription charges. I suspect that IIDB doesn't either.
    • TELLIT01
    • By TELLIT01 13th Jan 18, 8:55 AM
    • 4,405 Posts
    • 4,631 Thanks
    TELLIT01
    • #4
    • 13th Jan 18, 8:55 AM
    • #4
    • 13th Jan 18, 8:55 AM
    That's the first time I've seen an entitlement letter in full, and from reading it I'm not surprised that claimants get confused. Within the ESA section there is reference to Income Related benefit, but it certainly isn't clear whether or not the payment is IR or Conts based.
    To somebody who fully understands the system it can be determined that this is indeed a Conts based payment.
    What is needed is the addition of one additional sentence stating "You are receiving Contribution based benefit only" if that is the case. Unfortunately, that is not likely to happen due to the cost of any change to old systems such as ESA.
    • bspm
    • By bspm 13th Jan 18, 9:01 AM
    • 478 Posts
    • 698 Thanks
    bspm
    • #5
    • 13th Jan 18, 9:01 AM
    • #5
    • 13th Jan 18, 9:01 AM
    i was wondering,based on the benifits below if you would be entitled to free prescriptions.
    the ESA reward notice doesnt make much sense to me as well as reading on the GOV.org website that you wouldnt receive contribution based ESA for longer than a 12month period.
    also read that depending on your disability dispite which ever benifit your claiming that doesnt entitle you to free prescriptions ,that in some cercumstances you would be entitled.{which includes needing assistance outdoors)

    ESA awards
    from 26/11/13 til present (on going)
    living expenses £73.10
    extra money because you are in a support group £36.55
    which gives you a total income related amount £109.65

    no income will be taken off your employment support allowance

    income and benefits
    your income related amount is £109.69 less £0.00 so you would have been £109.65
    however,because your entitled to contribution based employment and support
    allowance we will pay you £110.85
    top up payment
    included in your employment and support allowance is a top up payment £1.20

    so you wont see a reduction in the level of your benefit entitlement as a result of the change to employment support allowance

    *******************************
    DLA
    from 22/07/2013 til nov 2017(PIP) now being assessed.
    i have awarded you low rate of £20.55 a week as you need guiding or supervising when walking outside.
    help with getting around outdoors
    physical difficulty walking
    guidance or supervision
    you need help because of anxiety or panic attacks..
    you need someone to guide or supervise you to walk outside in places you dont know well.
    so you are entitled to low rate disability.
    ************************************************** ****
    industrial injuries disablement benifit
    awarded from 4/7/2011 to life
    ************************************************** *********
    i am enquiring on behalf of somebody else.
    i am their advocate.
    the person does not claim any other benefits and lives with his mum (pensioner)
    he has received several prescription penalty charges and as well as being the most honest person,he is in deep distress due to severe depression.
    i am in need of help on this one as i was not aware, and never questioned that he had to pay for his prescriptions.
    the charges are multiplying beyond means of affordability but i beleive that this person should not have had to pay for his medicine in first place taking the above into account.

    can someone please help
    Originally posted by turbocrazy
    I am sure someone will explain this better than I can but ESA CB is £109.65 per week but this person gets an extra £1.20 which makes the payment £110.85 ...is this Income related? If so surely they aren't on CB ESA?
    • bspm
    • By bspm 13th Jan 18, 9:04 AM
    • 478 Posts
    • 698 Thanks
    bspm
    • #6
    • 13th Jan 18, 9:04 AM
    • #6
    • 13th Jan 18, 9:04 AM
    That's the first time I've seen an entitlement letter in full, and from reading it I'm not surprised that claimants get confused. Within the ESA section there is reference to Income Related benefit, but it certainly isn't clear whether or not the payment is IR or Conts based.
    To somebody who fully understands the system it can be determined that this is indeed a Conts based payment.
    What is needed is the addition of one additional sentence stating "You are receiving Contribution based benefit only" if that is the case. Unfortunately, that is not likely to happen due to the cost of any change to old systems such as ESA.
    Originally posted by TELLIT01
    Agree Tellit01 the letter is as clear as mud.
    • pmlindyloo
    • By pmlindyloo 13th Jan 18, 9:55 AM
    • 10,979 Posts
    • 12,877 Thanks
    pmlindyloo
    • #7
    • 13th Jan 18, 9:55 AM
    • #7
    • 13th Jan 18, 9:55 AM
    I think what has happened is that the OP's friend was transferred from Incapacity Benefit to ESA and was assessed as being awarded contribution based ESA with a 'top up' to make sure he did not receive less than they did when on IB.

    I believe this is a contribution based ESA claim as the friend is also receiving Industrial Injuries Disablement benefit. He would still receive this if on contribution based ESA but it would be counted as income for income based ESA.

    So my conclusion is contribution based ESA so no free prescriptions.

    Friend will have to apply for the low income scheme.

    As regards the penalties it may be worth appealing with a copy of the ESA award letter showing how the confusion arose.

    As their advocate you might be able to appeal on their behalf saying about their severe depression and how it is affecting them.

    https://www.nhsbsa.nhs.uk/challenge-penalty-charge-notice
    Last edited by pmlindyloo; 13-01-2018 at 10:05 AM.
    • mkcj
    • By mkcj 13th Jan 18, 11:28 AM
    • 50 Posts
    • 15 Thanks
    mkcj
    • #8
    • 13th Jan 18, 11:28 AM
    • #8
    • 13th Jan 18, 11:28 AM
    If you are talking about medical exemption the list is here:-




    https://www.nhsbsa.nhs.uk/exemption-certificates/medical-exemption-certificates


    "A medical exemption certificate:
    • entitles you to free NHS prescriptions only
    • doesn't cover dental treatment or help with other health costs
    • should be shown when you collect a prescription
    • is valid for five years (or until your 60th birthday, whichever is sooner)"


    "continuing physical disability which means you cannot go out without the help of another person"


    "If you're entitled to a certificate because of your medical condition, your doctor will give you an application form".
    Last edited by mkcj; 13-01-2018 at 11:35 AM.
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