Social Security (Health Bonus
Scheme) (Jersey) Order 2016
1 Interpretation
(1) In this Order, unless
the context otherwise requires –
“admission date”
means –
(a) the
date a person is admitted to the health bonus scheme under Regulation 6(3)
of the Health Bonus Regulations; or
(b) in
the case of a person admitted to the health bonus scheme under
Regulation 6(4) of the Health Bonus Regulations, the date that person was
admitted to the Jersey 65+ health plan;
“approved care home” shall be construed in accordance
with Article 6 of the Long-Term Care (Jersey) Law 2012;
“Comptroller of Revenue” has the meaning given by the Revenue Administration (Jersey) Law 2019;
“Health Bonus Regulations” means the Social Security (Health Bonus Scheme) (Jersey)
Regulations 2016;
“last period of entitlement” means the last period of
entitlement for a payment of a benefit under the Jersey 65+ health plan that
began before the coming into force of this Order;
“long-term care” means such care as a person is assessed
as needing under Article 5 of the Long-Term Care (Jersey) Law 2012;
“Registrar” shall be construed in accordance with Article 4
of the Social Security (Determination of Claims and
Questions) (Jersey) Order 1974;
“Tribunal” means the Social Security Tribunal
constituted under Article 8 of the Social Security (Determination of Claims and
Questions) (Jersey) Order 1974.[1]
(2) Expressions used in
this Order and in the Health Bonus Regulations shall have the same meaning as
in the Health Bonus Regulations.
2 Eligibility
for health bonus: income and capital thresholds
(1) For the purpose of Regulation 5(d)
of the Health Bonus Regulations –
(a) the specified
relevant total income is the total income of the person and his or her partner
(if any) above which the person or his or her partner (if any) is liable to be
charged to income tax; and
(b) the
specified relevant total assets are assets of the person and his or her partner
(if any) with a total aggregated maximum value of £64,000 on the
date that the person applies to be admitted (or re-admitted) to the health
bonus scheme.[2]
(2) For the purpose of paragraph (1)(a),
a person or his or her partner is not deemed to be liable to be charged to
income tax if –
(a) neither
the person nor his or her partner has been notified under Article 25 of
the Income Tax (Jersey) Law 1961 that he or she is liable to
be charged to income tax in respect of the year of assessment of the person or
his or her partner that immediately precedes the year in which the person
applies to be admitted (or re-admitted) to the health bonus scheme, or
(b) in
the case where no assessment has been made in respect of the year of assessment
referred to in sub-paragraph (a), neither the person nor his or her partner
has been notified under Article 25 of the Income Tax (Jersey) Law 1961 that he or she is liable to
be charged to income tax in respect of the year of assessment of the person or
his partner that immediately precedes the year of assessment referred to in paragraph (a).
(3) A person is the partner
of another person for the purposes of this Article if the person normally
occupies, as his or her principal residence, the same dwelling as that person
and –
(a) he or
she is married to that person (unless they are living separately in the dwelling under a formal
agreement) or in a marriage-like relationship with that
person; or
(b) he or
she has formed a civil
partnership with that person (unless they are living separately in the dwelling under a formal
agreement) or in a civil partnership-like relationship
with that person.
(4) For the purpose of paragraph (3),
where a person occupied as his or her principal residence the same dwelling as
his or her partner before receiving long term care in an approved care home, he
or she shall be treated as occupying as his or her principal residence the same
dwelling as his or her partner.
(5) When calculating the
value of the assets under paragraph (1)(b), the person’s principal
residence shall not be treated as an asset.
(6) For the purposes of the
Minister satisfying himself or herself as to the relevant total income or
relevant total assets of a person, the Minister may have regard to any
information provided to him or her by the Comptroller of Revenue or such other
information as the Minister may require to be provided to him or her by the
person.[3]
3 Value
of health bonus payable under the Health Bonus Regulations
(1) Subject to paragraphs (5)
to (10), the maximum value of a health bonus to which a person is entitled is
as specified in the table in the Schedule, so that a person shall be entitled
to a health bonus, up to the maximum value specified in Column 3 of that
Table –
(a) for
the treatment or assistance described in the same row in column 1 of that
Table;
(b) for
the period of entitlement for that treatment or assistance specified in the
same row in Column 2 of that Table.[4]
(2) [5]
(3) [6]
(4) [7]
(5) No health bonus shall
be payable to a person during any period when the total aggregated assets of
that person and his or her partner exceed £64,000.[8]
(6) No health bonus shall
be payable to a person during any 12 month period, beginning on the
anniversary of the person’s admission to the health bonus scheme under Regulation 6(3)
of the Health Bonus Regulations, after the first 12 months of his or her
admission (or in the case of a person admitted to the health bonus scheme under
Regulation 6(4) of the Health Bonus Regulations, beginning on the
anniversary of the day after the last day of the month that occurs 12 months
after the last period of entitlement under the Jersey 65+ scheme commenced)
(“subsequent period”) where –
(a) the person or his or
her partner has been notified under Article 25 of the Income Tax (Jersey) Law 1961 that he or she is liable to be charged to income tax in
respect of the year of assessment of the person or his or her partner that
immediately precedes the beginning of that subsequent period; or
(b) in the case where no
assessment has been made in respect of the year of assessment referred to in
sub-paragraph (a), neither the person nor his or her partner has been
notified under Article 25 of the Income Tax (Jersey) Law 1961 that he or she is liable to be charged to income tax in
respect of the year of assessment of the person or his partner that immediately
precedes the year of assessment referred to in paragraph (a).
(7) A person to whom the
health bonus has not been paid in any 12 month period, in consequence of
the operation of paragraph (6) shall be entitled to receive payment of the
health bonus for any subsequent period where –
(a) neither the person nor his or her partner has been notified under Article 25
of the Income
Tax (Jersey) Law 1961 that he or she is liable to be charged to income tax in respect
of the year of assessment of the person or his partner that immediately
precedes that subsequent year; or
(b) in
the case where no assessment has been made in respect of the year of assessment
referred to in sub-paragraph (a), neither the person nor his or her
partner has been notified under Article 25 of the Income
Tax (Jersey) Law 1961 that he or she is liable to be charged to income tax in respect
of the year of assessment of the person or his partner that immediately
precedes the year of assessment referred to in sub-paragraph (a).
(8) No health bonus shall
be payable to a person in respect of an appointment with a participating
practitioner where the person failed to attend the appointment when required to
do so.
(9) The value of a health
bonus to which a person is entitled in any one period has no value in respect
of another period.
(10) Where a person is re-admitted
to the health bonus scheme within 12 months of the person having withdrawn
from participation in that scheme or having become ineligible to remain in that
scheme –
(a) that
person shall, for the purpose of calculating the amount of any bonus payable to
him or her, be treated as if he or she had remained admitted to the scheme
during the period in which he or she had withdrawn, or was not eligible, as the
case may be; and
(b) where
the person has been paid a bonus during that 12 month period, the value
specified for an examination or treatment, or prescribed glasses, lenses or
contact lenses received, during that period shall be reduced by the amount of
benefit (if any) in respect of an examination or treatment, or prescribed
glasses, lenses or contact lenses received, by the same type of participating
practitioner.
(11) Despite paragraph (1),
if the period mentioned in Column 2 of the table in the Schedule started
before 1st September 2023, the value specified for treatment or assistance
received during that period is reduced by the amount of any benefit in respect
of treatment or assistance of the same type received in that period before 1st
September 2023.[9]
4 Application
for admission to health bonus scheme
(1) An application by a
person to be admitted to the health bonus scheme must be made in such form,
contain such particulars, and be accompanied by such information as the
Minister may reasonably require.
(2) An application is
treated as having been made on the day on which it is received by the Minister
at an office approved by the Minister.
(3) If an application is
defective at the date when it is received or has been made in a manner
otherwise than as required by paragraph (1), the Minister may refer the
application to the applicant or, as the case may be, supply him or her with the
form, and if the form is received properly completed within 14 days from
that date on which the application is so referred, or the form is so supplied
to the applicant, the Minister must treat the application as if it had been
duly made in the first instance.
(4) An applicant may, by
giving notice to the Minister in such form as the Minister may reasonably
require, amend an application at any time before the application is determined
and the Minister may treat the application as if it had been made as so amended
in the first instance.
5 Determination of claims
(1) An application for
admission to the health bonus scheme, or a decision as to whether a payment is
made under the health bonus scheme, must be determined by a determining officer
and, where required under Article 6, reconsidered by a second determining
officer.
(2) A determining officer
must notify the applicant in writing –
(a) of
his or her determination of the application for admission to the health bonus
scheme and, where the determining officer has determined to refuse that
application, the reasons for that determination;
(b) of
his or her determination of an application for a payment under the health bonus
scheme and, where the determining officer has determined to refuse the
application in whole or in part, the reasons for that determination; and
(c) in
either case, of the applicant’s right to challenge that determination, as
set out in sub-paragraph (3).
(3) In the case of a
refusal to admit a person to the health bonus scheme or to make a payment to a
person under the health bonus scheme, on a first determination, the determining
officer must notify the applicant in writing –
(a) of
the right of him or her to have the determination reconsidered by a second
determining officer;
(b) that
this right must be exercised within 21 days of the applicant receiving
notice of the determination; and
(c) that
if the right is not exercised in accordance with sub-paragraph (b), there
is no right of further appeal.
(4) Where a determining
officer has determined that the applicant is entitled to be admitted to the
health bonus scheme or to the payment of a health bonus he or she must allow
the applicant to be admitted or, in the case where he or she has determined
that the person is entitled to a payment, the payment must be made.
6 Reconsideration
by second determining officer
(1) If
an applicant is dissatisfied with any determination under Article 5 that
is made by a first determining officer considering the matter, he or she may
require the matter to be reconsidered by a second determining officer at any
time within 21 days of receiving notice of the determination.
(2) The
second determining officer must notify the applicant in writing –
(a) of
his or her re-determination and the reasons for it; and
(b) of
the applicant’s right to challenge the determination, as set out in paragraph (3).
(3) In
the case of a determination to uphold the determination of a first determining
officer under Article 5(2), the second determining officer must notify the
applicant in writing of the right to appeal to the Tribunal.
(4) Where
the second determining officer, has determined that the applicant is entitled
to be admitted to the health bonus scheme he or she must allow the applicant to
be admitted, and in the case where he or she has determined that the person is
entitled to a payment, the payment must be made.
7 Appeals
to Tribunal
(1) If an applicant is
dissatisfied with any redetermination by a second determining officer, he or
she may appeal to the Tribunal within 14 days of receiving notification of
the redetermination.
(2) An appeal made outside
the 14 day period, but within 28 days of receiving notification of
the re-determination, may be allowed with the consent of the chairman of the
Tribunal.
(3) Every application for
appeal must be made in writing to the Registrar on a form approved by the
Registrar for that purpose, or in such manner as the Registrar may accept as
sufficient in the circumstances of the case.
8 Further
particulars
(1) The Tribunal may at any
time require the applicant or a determining officer to furnish it with further
particulars in writing and within such time as it may direct with regard to any
appeal, and may at any stage of the proceedings allow the amendment of any
application for appeal or any statement or particulars and extend the time for
furnishing any statement or particulars.
(2) If, after the
expiration of the time, or where the time has been extended, expiration of the
extended time, for furnishing any statement or particulars under paragraph (1),
the applicant has failed to do so, the appeal is to be treated as having been
abandoned.
9 Special
procedure in cases of groundless appeals
(1) Where, in the opinion
of a determining officer, an application for appeal is made on grounds that are
bound to fail, the determining officer may, within 14 days of receiving
the application, request the Registrar to place the papers before the chairman
or deputy chairman of the Tribunal.
(2) If, on considering the
papers, the chairman or deputy chairman of the Tribunal is of the opinion that
the appeal is bound to fail, he or she must send a notice to the applicant
stating that –
(a) he or
she has considered the application for appeal and is of the opinion that the
appeal is bound to fail; and
(b) unless
the applicant renews his or her application to the Tribunal within 14 days
of receiving the notification, the appeal will be treated as having been
abandoned.
10 Decision
without a hearing
If the applicant and the Minister agree and the Tribunal thinks that
a matter before it can properly be determined on the particulars supplied by
the parties without a hearing, it may determine the matter without a hearing on
the particulars so supplied.
11 Procedure
of Tribunal
(1) The parties to an
appeal before the Tribunal are the applicant and the Minister and each party or
any person acting on behalf of that party may make representations to the
Tribunal.
(2) The Tribunal must sit
in public unless the Tribunal considers it necessary to sit in private.
(3) However, no person other
than the Registrar may be present while the Tribunal is considering its
decision.
(4) The Tribunal may
adjourn the hearing from time to time as it thinks fit.
(5) The Tribunal may, if it
thinks fit, admit any duly authenticated written statement or other material as
evidence of any fact in any case in which it thinks it just and proper to do
so.
(6) The Tribunal may, if it
thinks fit, call for such documents and examine such witnesses as appear to it
likely to afford evidence relevant and material to the issue, although not
tendered by either the applicant or the Minister.
(7) If, after notice of the
hearing has been duly given, the applicant or the Minister fails to appear at
the hearing, the Tribunal may proceed to determine the appeal notwithstanding the
absence of both or either of them, or may give such directions with a view to
the determination of the appeal as the Tribunal thinks just and proper.
(8) The Tribunal may
require any party to proceedings before the Tribunal under this Order or any
witness in the proceedings to give evidence on oath and, for that purpose, the
chairman or deputy chairman presiding over the Tribunal has power to administer
an oath.
(9) Where, in connection
with the determination of any appeal, there is before the Tribunal medical
advice or medical evidence relating to the applicant that has not been
disclosed to the applicant and, in the opinion of the chairman or deputy
chairman, the disclosure to the applicant of that advice or evidence would be
harmful to the applicant’s health, such advice or evidence is not
required to be disclosed to the applicant, but the Tribunal is not by reason of
such non-disclosure precluded from taking it into account for the purpose of
the appeal.
(10) On the appeal against a
re-determination under this Law, the Tribunal may confirm, reverse or vary the
decision of the second determining officer and must give its decision in
public.
(11) The decision of the majority
of the members of the Tribunal is the decision of the Tribunal and there must
be a written record of the decision signed by the chairman or deputy chairman
as the case may be which –
(a) includes
the names of the Tribunal members;
(b) includes
the reasons for the decision; and
(c) records
any dissent and the reasons for such dissent,
and the Registrar must send a copy of such written record to the
parties as soon as practicable after the appeal has taken place.
(12) Where the Tribunal has made a
decision adverse to the applicant, the applicant must be advised that the
decision on the facts is final but that he or she may appeal to the Royal Court
on a point of law.
(13) Subject to this Article, the
Tribunal may regulate its own procedure.
12 Appeals
and references
(1) A person aggrieved by a
decision of the Tribunal may, on a point of law only, appeal to the Royal
Court.
(2) An appeal under sub-paragraph (1)
may only be made with leave of the Tribunal or the Royal Court, and must be
made before the end of the period of 4 weeks beginning with the date of
the Tribunal’s written decision.
(3) An application for
leave to appeal under paragraph (2) may include an application to stay a
decision of the Tribunal pending the appeal.
(4) No appeal shall lie
from a decision of the Tribunal refusing leave for the institution or
continuance of, or for the making of an application in, proceedings by a person
who is the subject of an order under Article 1 of the Civil Proceedings (Vexatious Litigants)
(Jersey) Law 2001.
(5) The Tribunal or a
determining officer may refer any point of law to the Royal Court for the Royal
Court to give a ruling on the point.
(6) On hearing an appeal under
this Article the Royal Court may –
(a) confirm
the decision of the Tribunal wholly or in part;
(b) vary
the decision of the Tribunal;
(c) quash
the decision of the Tribunal wholly or in part; or
(d) remit
the decision, wholly or in part, to the Tribunal to be retaken.
13 Administrative
expenses
The Minister may pay to any member of the Tribunal who exercises any
functions under this Order, and any other person whose advice or assistance may
be required by the Tribunal or by a determining officer for the purposes of
this Order, such remuneration and expenses as the Minister may determine.
14 Citation
This Order may be cited as the Social Security (Health Bonus Scheme)
(Jersey) Order 2016.