Health Insurance Fair Deal – Financial Reassessment After One of A Couple Dies.

twofor1

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Anyone with family / friends where both members of couple have availed of Fair Deal might be interested in a recent case that I am familiar with.

Let’s call this couple Biddy & Miley.

Biddy went into a nursing home under Fair Deal in 2013, as one of a couple Biddy’s contribution based on the family home was assessed @ 7.5% of 50% of the house value. In 2016 Biddy’s contribution based on 50% of the family home was disregarded as she had reached the 22.5% cap.

In 2017 Miley went into a nursing home under Fair Deal, again as one of a couple, Miley’s contribution based on the family home was assessed @ 7.5% of 50% of the house value. All good so far.

Soon after Biddy passes away. Miley is then reassessed on 100% of the house value.

The family did not think this was right as it meant that Biddy’s 50% of the house was been assessed for a second time. If Miley lived for 3 years, the amount contributed or borrowed would be 22.5% plus the 11.25% already contributed or borrowed by Biddy, so in total 33.75%.

This issue was taken up with their local Nursing Homes Support office who did the financial assessments. They confirmed that when Miley was first assessed he owned 50% of the family home, as Biddy had since passed away Miley now owned 100% of the home and was reassessed accordingly.

The family appealed this decision to the HSE’s National Appeals Office arguing that Biddy’s 50% of the family home was now being assessed for a second time, should Miley live for 3 years, they as a couple would be contributing 33.75% of the house value. The rules clearly state there is a 3 year cap on the family home and 22.5% is the maximum percentage a couple should contribute to their care.

The appeal was allowed and the local Nursing Homes Support office was told to reassess Miley on 50% of the house value backdated to when they started to apply the 7.5% on 100% of the house value.

Anyone concerned about Fair Deal’s financial assessments should question them and if not satisfied go to the HSE’s National Appeals Office. In this case the reassessed amount on the family home reduces by over €200 weekly, if Miley lives for 3 years when the cap kicks in, it will be a saving of over €30K, all it took was 2 short letters.
 
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