Health Scheme
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The Health Scheme Medical and Pharmaceutical Benefits
Part One - Introduction
Jersey’s Health Insurance Scheme provides residents with two types of benefit:
· Medical Benefit - to help you with the cost of GP visits, either in the surgery or at your home, and
· Pharmaceutical Benefit – to help with the cost of prescription medicines from a Prescribed List of products.
You and your family are entitled to benefits from the Scheme for services provided in Jersey. The Health Scheme is funded by some of the contributions paid through the Social Security Scheme.
Part Two - How do I Qualify?
In most cases, to be eligible for the Scheme, you must be resident or gainfully employed in the Island and have paid the appropriate Social Security contributions for a qualifying period of six months.
However, even if you are exempt from paying contributions (please see the leaflet entitled People who need not pay contributions) you will still have to wait six months before you can make a claim.
Please note: You may be required to produce proof of your residency.
Part Three - The Health Card
When you qualify, a Health Benefits Card is issued showing your name and Social Security number. This card can be used for your children under 16 and those over 16 in full-time education; Children over 16, not in full-time education should have their own card. To ensure that your family receive the health subsidies to which they are entitled, we strongly advise that you register all your family members with the Social Security Department.
Please note: Your Health Benefits Card is evidence that you qualify for the Health Scheme, so you must show your card to your doctor or pharmacist if they ask you.
If you lose a card you should ask the Health Zone for a new one. The card must be given up if you leave the Island permanently, or for more than three months at a time.
Part Four - Visiting a doctor
You can choose your own doctor, and if you are new to the Island, it is recommended that you “register” as soon as possible. A list of GPs is available from the Health Zone; staff will not make any recommendations. Alternatively, doctors’ names can be found in the “yellow pages” of the local telephone directory.
General Practice in Jersey is private, so each practice will set its own fees. The amount you will be charged will depend on the type of services provided by your doctor. For example, additional charges may be made for injections and/or blood tests etc. A survey of fees is published each year in the Jersey Evening Post, usually in September, that allows you to compare basic charges, without identifying individual surgeries. A copy of the survey can also be obtained from the Health Zone.
Part Five - Medical Benefit
This is the amount of subsidy you receive towards the cost of seeing a doctor which can be claimed for each visit. It is a fixed amount, which is reviewed each year.
The current rate of medical benefit is shown on the leaflet called Contribution Levels Benefit Rates. Generally, the doctor will claim the medical benefit on your behalf and reduce your bill by the same amount. You cannot claim medical benefit unless you have paid your part of the bill. After you have seen the doctor, you will be asked to sign a form that confirms you qualify for the Scheme, have received medical services, and that you authorise the Social Security Department to pay your subsidy to the surgery.
On some occasions you may be asked to pay the doctor’s fees in full. When this happens, bring the receipted account to the Department to claim your medical benefit.
Part Six - Pharmaceutical Benefit
Pharmaceutical benefit pays for the main cost of prescription items. When you receive a Health Scheme prescription from your doctor or dentist, take it to a pharmacy of your choice to be dispensed free of charge.
The current rate of the Prescription Charge is detailed in the leaflet called Contribution Levels and Benefit Rates
Up to 30 days’ supply can be prescribed at any time. However, if you have a long-term illness, 3 copy prescriptions can also be issued, giving a total of four months’ supply. For some conditions, the doctor may prescribe up to 90 days’ supply on one prescription. Each prescription must have the doctor’s signature.
A number of pharmacies are open outside normal business hours, including Sundays and Bank Holidays. At Christmas, a formal rota is published in the Jersey Evening Post.
The Prescribed List
The Prescribed List is the list of medicinal products and appliances that are available for subsidy. It does not cover specialist therapies that may be used within the hospital.
The Social Security Department is advised what products should be included in the List by the Pharmaceutical Benefits Advisory Committee (PBAC). The PBAC is made up of local doctors and pharmacists as well as the Minister for Social Security and a lay Chairman. The PBAC meets two or three times a year to review the List and changes are published in the Jersey Evening Post.
If your doctor prescribes a product that is not on the List, then you will have to pay the full cost to the pharmacist.
Part Seven - Income Support
If you have a low income and meet certain other qualifying conditions, you may be entitled to additional help under the Income Support Scheme.
Income Support is an income-related benefit that provides financial support towards the costs of housing, ;iving, medical needs and childcare. Carers also receive support.
Income Support is available to individuals and families that satisfy conditions relating to residency in Jersey and employment.
The amount of Income Support payable depends on income, savings and assets, and on personal circumstances.
If you wish to apply, please telephone our Income Support Zone on 45505.
Part Eight - Gluten-Free Food Subsidy
A subsidy is also available under the Health Scheme for people who cannot take gluten in their diet.
This subsidy is to help anyone to buy essentials such as bread and pasta that are gluten free. As gluten has been removed, these products are expensive and so the subsidy is to help cover the additional cost.
Applications for this subsidy are approved on clinical grounds through the Public Health Services.
An application form can be obtained from the Social Security Department.
Full information can be found in the leaflet Gluten Free Food Subsidy
If you are in doubt or require a list of essential gluten-free products, please contact our advisers in the Health Zone.
Part Nine - Other Subsidies
The Social Security Department works in partnership with Family Nursing and Home Care (FNHC) who provide a range of additional subsidies. These include continence and dietary products, oxygen and feeding equipment for the community.
To access the scheme, clients are required to be members of FNHC with referrals being required from hospital dieticians, G.P's or community professionals. Clients pay only 20% of FNHC's product cost, with the remaining 80% being covered by the scheme. For further information, please contact telephone 789950.
Part Ten - Other Health Services
The Health Scheme covers GP services and prescriptions only and is administered by the Social Security Department. The secondary care services are run by the Health and Social Services Department at the Hospital. Most hospital and outpatient treatment is free to residents.
Visitors to the Island and residents who have lived on the Island for less than 6 months do not qualify for subsidy under the Health Scheme and so may be required to pay the hospital treatment, doctor’s fees and prescription costs in full.
If you wish to see a general practitioner you should telephone 616833 and you will be given the name and address of the rota surgery.
A charge may be made for your visit and for any prescriptions you require. Please check when you make an appointment.
Part Eleven - Travel Abroad
The Health Insurance Scheme covers GP services provided in Jersey only. If you are travelling abroad, you will have to pay the cost of any medical treatment in full. However these charges may be reduced in countries with which Jersey has a reciprocal agreement. For further information, please see the leaflet called The Jersey Traveller's Guide to Health. Please note: when you are travelling abroad, we always advise that you consider taking out private medical insurance.
Health agreements with other countries
When this leaflet was printed we had health agreements with the following countries:
Alderney |
Isle of Man |
Australia |
New Zealand |
Austria |
Norway |
Barbados |
Portugal |
France |
Sweden |
Guernsey |
United Kingdom |
Iceland |
|
Visiting France
If you are a British or French national and have visited France in the last few years we may have issued you with a Health Certificate, called an Attestation.
This Attestation entitles members of the family, temporarily resident in France for less than three months, to receive emergency hospital in-patient treatment in France under the same conditions as a French resident.
Please click here to download the attestation form
The certificate is usually issued in the husband’s name and includes the names of his wife and children.
For information and advice on health benefits and Attestation certificates please contact the Health Zone.
Part Twelve - Contacts
For further information about your rights and other sources of help, contact:
Citizen’s Advice Bureau
The Annexe
St Paul’s Community Centre
New Street
St Helier, JE2 3WP
Telephone 724942 or
0800 735 0249 (Freefone)
Part Thirteen - Further Information
This leaflet gives general information and does not try to give full details on any particular matter. It cannot be treated as a statement of the Law.
Please contact us if you have any questions or suggestions about the information contained in this leaflet.
Our staff are here to help you, please telephone us on 445505 or call into our office.
The Social Security Department is covered by the current Jersey Data Protection ( Jersey) Law.
Please note: calls to the Department may be monitored for training purposes.
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