E121 - Long Term Incapacity Benefit At Retirement

[rothrugby]

Hi,

Could anyone clarify what happens when a holder of an E121 due to long term incapacity reaches U/K state retirement age. My understanding is that the incapacity E121 has to be exchanged for a retirement E121 & that entitlement to benifits in both U/K & France would be affected.

We are trying to establish the facts & procedures for the members of our association, Charente Limousine Exchange.

If anyone has any information or has experience of this situation we would be pleased to hear from you.

www.charente-limousine-exchange.com

Tony

 

[Benjamin]

Mrs Benjamin was in a similar situation a couple of years ago when she reached 60.

Her Long Term Incapacity Benefit ceased and she moved directly on to her State Retirement pension, although what may be different is that she had a full qualifying period for her State pension.

You can't have both as a pal of mine in the UK a couple of years ago discovered when he reached 65 years and he also lost his Carer's Allowance for looking after his very elderly Mum!

[ebaynut]

As I understand it, Incapacity Benefit is only available for people of working age, (and who have paid the required amount of NI contributions), who are unable to work, and therefore surrendered when you become eligible for state retirement pension, which is in effect a replacement benefit.

If you are in receipt of Disability Living Allowance, this is replaced at pensionable age with Attendance allowance, neither of which is means tested, and continues to be paid during retirement, and is also one of the benefits under review by DWP regarding eligibility for exportation following the ECJ ruling of October 2007.

[David]

I think that there is an aspect of rothrugby's question which is a very valid point, which has not yet been answered, and which may apply to many people who have been forced to take early retirement on health grounds.

When a person reaches official retirement age, I am clear that monetary payments from UK such as incapacity benefit, carers allowance, old age or state pensions, etc. will change.  For example the incapacity benefit will be replaced by the state pension.

However, if we consider only the benefit entitlement that an E121 brings to the holder of the E121 in France what, if any, medical benefits might change?

That is, on reaching state retirement age will an E121, which was awarded due to invalidity, be replaced by an E121 awarded for reaching state retirement age? If so what are the differences in benefit under the French health system?

For example, a person who has an E121 due to invalidity, will receive in France 100% reimbursement of CPAM allowed scale of charges (convention) on ALL medical items, for ALL illnesses, except blue label medicines which is 35%, spectacles and dentists.  Also any hospital, doctor or specialists costs which exceed 100% of convention are not covered.

I doubt if a top up insurer would be pleased to insure such a person reaching state retirement age, particularly if they were keeping poorly and incurring a lot of medical costs.  If they did I imagine that they would charge a fortune in premiums, but I have not asked, and I am not asking that question on this thread.

When that person reaches 60 or 65 will their E121, which is based on invalidity, be replaced by an E121 based on state retirement age?

If so will they lose their 100% allowance?  After all they are still an invalid, and not a healthy retiree!

Or does the E121 based on retirement age also give cover of 100% of CPAM approved scale of charges on all items?

If not, any ideas why not?

David

[David]

Benjamin,

Mrs. Benjamin seems to have direct experience of exchanging her long term incapacity benefit E121 for a state retirement age E121.

If it is not too personal a question, can you tell us what, if any, differences she found in medical allowances in France based on the different E121 forms?

David

[Benjamin]

[quote user="David"]

Benjamin,

Mrs. Benjamin seems to have direct experience of exchanging her long term incapacity benefit E121 for a state retirement age E121.

If it is not too personal a question, can you tell us what, if any, differences she found in medical allowances in France based on the different E121 forms?

David

[/quote]

There was no change at all when Mrs benjamin moved from Incapacity Benefit to state Retirement Pension at the age of 60.

A new E121 was not issued by the UK nor was one requested by CPAM. Her 100% reimbursement (because her disability counts as an ALD in France) continues exactly the same. You should be aware thar even if a person receives Incapacity Benefit from the UK it does not automatically entitle them to 100% reimbursement in France. As a starting point their disability must be on the list of 30 or so ALDs.

There are other points in your earlier posting which I will reply to later today.

[cooperlola]

I was discussing exactly this point with Larry Fulton of Exclusive Healthcare.  His take on this is the same as David's.  The major implication being that one loses the 100% on any claims not related to an ALD.  Apparently, in the old days, many people never bothered to do the changeover, and just left the ICB E121 running so that they continued to get 100% on everything.  However, there has been a clamp-down recently and CPAMs are seemingly catching on and demanding the pension related E121s as soon as the appropriate age is reached.  Then the person should get top-up for all conditions not related to the ALD as the state will no longer fund them.

[David]

Hi Benjamin,

Thanks for your very helpful reply.  I agree with your point that receipt of an incapacity benefit does not automatically give entitlement to 100% reimbursement in France.

However, if your E121 is issued for "Invalidity", then this does give entitlement to 100% reimbursement on all matters, not just the 30 or so ALDs.

 

Coops,

I fear you have it exactly correct.  On reaching state retirement age, an E121 issued for invalidity would have to be exchanged for an E121 based on reaching state retirement age.  It seems to me that the main difference is that, as you say, the change will mean losing the 100% allowance on illnesses not on the ALD list, and having to take out top up insurance.

 

This seems to me to be a bit harsh, as the invalid is still an invalid, rather than a healthy retiree.  Further, a UK person (I do not know about France) having been an invalid for a lengthy period of time, the invalid's private or company pension, if they have one, is likely to be much less than that of a healthy retiree.  If the people only have the basic state pension for income, then how can they afford top up insurance?  Will the top up insurance be more expensive for an invalid than a healthy retiree?

I really cannot see the justifiable reasoning of taking away the 100% allowance on non ALD illnesses, just because an invalid reaches state retirement age.  After all, there is no change in work status.

I wonder if, when CPAM ask for the replacement E121, there is any way for an invalid to appeal to the UK, and request a replacement E121 based on invalidity so they can retain the 100% allowance on all matters?  Has anyone researched this aspect?

David

 

[cooperlola]

Certainly, it is a UK matter.  If one can keep one's head down - as in Benjamin's o/h's case - then fine, but if CPAMs are clamping down then this issue will raise its head again and again.

We (FHI) asked elsewhere for suggestions for where our group might go next, and I think this subject is worthy of scrutiny, at least.  I'm pretty certain this is why Mr Fulton mentioned it to me!

[David]

[quote user="cooperlola"]

Certainly, it is a UK matter.  If one can keep one's head down - as in Benjamin's o/h's case - then fine, but if CPAMs are clamping down then this issue will raise its head again and again.

We (FHI) asked elsewhere for suggestions for where our group might go next, and I think this subject is worthy of scrutiny, at least.  I'm pretty certain this is why Mr Fulton mentioned it to me!

[/quote]

That would be excellent Coops.  If your group could take this up, I am sure many deserving people would benefit at a time when they might need it most.

All best,

David

[Benjamin]

You pop out for the morning to do a bit of shopping and you come back to this , now, complicated thread.  [:D]

My posting of this morning regarding no change to the E121 is exactly what happened as far as Mrs Benjamin is concerned but in the light of the strong views expressed about a changed E121 I have just had long conversations with Incapacity Benefits Section and International Pensions Centre in Newcastle.

The outcome is that a new E121 should definitely be issued when the benefit changes, in Mrs Benjamin's case, from Incapacity to State Retirement Pension. A new one will now be issued to her, still with me listed as a dependent, within 28 days. They can offer no explanation why a replacement E121 was not issued when she reached 60 years apart from a "well these things do happen".

This, and other comments made by David and Cooperlola, throw into doubt certain other things which I believed were true. The major one was that being granted ALD status only covered you for 100% reimbursements for whatever your ALD was issued for, but other ailments were covered on the 70/30 basis.

I had a conversation with the English speaking CPAM helpline last Autumn when a Nurses' feuilles des soins for flu jabs were reimbursed 70% for me but 100% for Mrs Benjamin. The explanation I was given was that the 100% was given because the individual CPAM would have taken the view that catching the flu could have been detrimental to Mrs Benjamin's ALD. I was really asking the question from the point of view of ascertaining if it was really necessary to continue with Mrs Benjamin'e top-up insurance but I was advised that we should keep it going as it was only the ALD that was covered 100%. I am now begining to wonder if prior to her reaching 60 years it was necessary to have her top-up.  That's history now and I stand corrected but I hope the confirmation from Newcastle clarifies this topic for others.

[cooperlola]

No, Benjamin, when she was on an   ICB E121, it was not necessary for her to have top up as all her medical needs are covered by the UK in that case as I understand it. However, I'll check with a couple of people I know who have them, just to be sure.  But that was certainly what Larry F told me and he should know as he's in the business of making money out of these things when he can! On a retirement E121 this is no longer the case.  Whether the UK pays more per capita for the former, and this is the reason, I do not know.   The DWP is correct of course, it should have been changed in theory, but it's much better if they forget!

[Benjamin]

[quote user="cooperlola"]

Certainly, it is a UK matter.  If one can keep one's head down - as in Benjamin's o/h's case - then fine, but if CPAMs are clamping down then this issue will raise its head again and again.

[/quote]

I don't for one minute think you intended this to be what it sounds like.

It was never our intention to "keep our heads down", more a case of incompetence by two UK Government departments and ignorance born out of simply not knowing on our behalf.

As you can see, as soon as it was hinted at we took appropriate action to regularise the situation and will be trotting off to CPAM with the replacement E121 as soon as it arrives.  [:D]

Edit: Our postings crossed.

[cooperlola]

No, sorry, I certainly did not mean it in that way. [:$] However, I have heard of a couple of cases where people were told by CPAM officials "not to bother" as they would be worse off!!!  Certainly, nobody seems to get penalised - if the DWP and the French authorities miss the fact that one should have changed then, imo, that's their problem, not yours![:D]

[Benjamin]

Hi Coops

After your conversation with David F this ought to go as a sticky. I'm normally quite clued up about this sort of thing but it certainly caught me out.

Best regards Benjamin.

[David]

Benjamin,

Thanks.

What gracious and reasonable postings you have made today, being prepared to listen and check.  I wish some other posters could take note of a reasoned discussion without getting up on high horses, declaring incorrect "facts", and then leaving the thread without comment when they are shown to be wrong.

David

[5-element]

[quote user="cooperlola"]No, Benjamin, when she was on an   ICB E121, it was not necessary for her to have top up as all her medical needs are covered by the UK in that case as I understand it. ![/quote]

That is correct. If you are on an ICB E121, you "get the 100%" for everything (except the hospital daily fee). As far as CPAM is concerned, ICB E121 is  the equivalent of their Allocation d'Adulte Handicape - which in France is means-tested. So in France, if you are receiving AAH, you automatically get 100% of all your medical expenses (bar the hospital daily fee, about 14 or 15 euros?).

Sorry if this post is written too late in the discussion to be relevant now.[:$]

[David]

I have had a pm from someone asking about 100% cover for a particular item of hospital surgery.  It seems they have an E121 issued for long term incapacity benefit, but they have been making enquiries about cover ahead of time and been told that a particular item is not covered, even though it actually relates to a condition on the ALD list.

The edited question was:-

Quote

xxxxxx receives long term Incapacity benifit from the Uk For most stuff he does get 100 but when there is a queerie as to a condition for example he has to have an operation in a few weeks time on an internal problem which we know is a result of his "xxxx - item on ALD list", seems there is a ? as to whether Securite sociale will cover it 100%, however if it should be that due to his E121 he gets it all covered perhaps I've not used a 'magic' word to get them to understand this. As it stands at the moment, we are going to see our GP next week and ask him for an attestation to say he shoudl reeive 100%.

Unquote

It seems to me that this is a problem of medical suppliers such as doctors, pharmacies, hospitals etc, rather than CPAM,  not understanding about 100% reimbursement, and giving wrong advice.  I also wonder if this is where the misconception that the 100% cover only applies to the ALD list comes from, and perhaps this is leading to widespread confusion, so I decided to edit the pm for anonimity and post it here.

I therefore answered as follows:-

Quote

I am afraid that I am not an expert on these matters, and you should really ask Cooperlola about this.

I can only speak for myself, and what I have found.

Do you have a written attestation from your CPAM office, as well as your plastic carte vitale (cv)?  You should receive one of these each year.  This attestation should clearly state that you receive 100%.

We live in an area with few Brits, and few of them on 100%, and few unfit French people (they all seem to be super fit farmers who never take a day off sick) thus the local doctors, pharmacies, hospitals, etc are not familiar with this 100% allowance on all items.  They go into automatic ALD list mode.

However, when we produce the written attestation they seem then to understand, and give the allowance, albeit with some amount of disbelief.  I have also seen them, particularly at the blood test laboratory and small pharmacies, look disbelieving at their screens when the cv tells them there is no charge.  They have even refused to give me the products without charge and told me that my cv was faulty!  This is usually, but not always, solved by showing them the attestation.  Here I have learnt to go with the flow, let them charge me, and wait for the reimbursement from CPAM.

However, for a potentially large item such as yours, you must be certain, therefore you really should check with Cooperlola, and I suggest you also go to your local CPAM office, and ask their advice.

Unquote.

Perhaps I should have said at the end, check with CPAM and not your GP, as your GP will not understand the 100%, and will only refer to the ALD list.

I wonder if Coops would like to comment on this - I would be grateful if Coops would correct me if I have given poor advice.

David

[cooperlola]

Well, my information, like yours, is only gleaned from other sources!  I think your advice is correct and that they need to go back to their CPAM - the GP is not the place to start.  As you say, their attestation should already say that they receive the 100% across the board, if they are on an ICB E121, and this is not something which the GP governs in this case - unlike the standard 100% for ALDs only which those not on ICB may have access to.  I think your advice is bang on, myself.[:)]

[Benjamin]

I spoke to the International Pensions Centre in Newcastle again this morning and asked them what date they would be putting on Mrs Benjamin's replacement E121 to be told that it would be the date of her 60th birthday just over two years ago.

I pointed out that this could cause us some problems with the French authorities as it could look as if we'd been sitting on it for over two years. The point was accepted but I was told that was the only date they could use.

I then asked for a covering letter, in English and in French, explaining that they had failed to issue the replacement E121 at the correct time. I've just had a call back from a departmental supervisor (name freely given) and we can expect both letters in about two weeks time.

A good result I'd say!

[rothrugby]

Hi All,

As the person who started this thread I would like to thank everyone who has contributed to this discussion. Our organisation will incorporate this information into a handout for our members.

Tony Ackland ( aka rothrugby )

www.charente-limousine-exchange.com

 

[cooperlola]

Tony, Larry phoned me about this this morning.  There's a bit more info' on this which may help.

The E121 apparently has several boxes on the back, and which is ticked governs what kind of cover you get in France.  There are 4 options : One is "Age" for which one gets the standard 70% odd, then "IB" for which one gets 100% for everything (with a few exceptions like private room suplements, hospital food charges etc) and then two more for Industrial Disease and Industrial Injury.  The latter two only carry 100% re-imbursement for illnesses and conditions related to the incapacity or disease in question.  Hope this helps.

[Grecian]

Hi Coops, not getting too carried away here with the info you have just posted, regarding the magic E121 piece of paper. Are you saying that if the receipient is in receipt of industrial injury benefit, then they are entitled to an E121, on the terms you have stated, i.e. 100% cover for the injury, and then 70% ish for the rest. This could be very beneficial to our situation if this is the case, this would mean that if my wife were to lose her IB, thus her E121, the fact that she is also in receipt of industrial injury benefit, could save the day for us regarding healthcare cover in the first 5 years.

Nothint to do with this thread, but is anybody else experiencing difficulty accessing the forum, or is it just me?

 

 

[cooperlola]

Grecian : You should check with the UK, but it could be... As you may guess, this is a first for me!  I'll do a bit of research for you.

[Grecian]

After telephoning Newcastle this morning regarding the E121 situation, and Industrial Injury Benefit, I was informed that for the industrial injury, DWP issue a separate 'E' form which is an E123. This form alas, only covers healthcare for the injury sustained, and no other part of healthcare in France. The lady I spoke to did not know anything about the section on the back of the E121, which Larry alluded to, and had to ask somebody else regarding the situation with industrial injury, so I only hope I have been given the right information, regarding a matter as serious as this.

I also telephone the DLA helpline enquiring if anything had been decided regarding the ECJ ruling on exporting the benefit, the gentleman I spoke said that they had not been informed of the decision regarding payment, but hopes it will be forthcoming shortly. I then proceeded to ask him a hypothetical question, that if the benefit is deemed exportable would this qualify for an E121, he seemed to think that it would, but I got the feeling that it was only his opinion. I know ebaynut is hot on this case, so I hope he/she has more luck that me, in trying to get an answer to the DLA/E121 position.

Starting a gite business however small, just to qualify to join CMU, seems the best/safest option at the moment.