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Did you pay for care in Wales after 2003? You could claim a refund

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Sam McFaul
Sam McFaul
Editor
25 July 2014

If you lived in Wales between April 2003 and August 2013, and paid for care under the NHS or privately, you could reclaim £10,000s in fees. But hurry, as you must start the reclaiming process before Thursday.

If you or a relative stumped up cash to pay for care – either at home or in a specialist care home – then you may have done so unnecessarily.

This is because the NHS in Wales has to pay for this where the individual has a "primary health need".

If you think you've paid for care when you didn't need to, our Q&A explains everything you need to know.

Who is eligible for a refund of healthcare costs?

Here's the criteria you need to meet to claim under the Continuing NHS Healthcare scheme:

  • The individual receiving care must have been 18 or over at the time. Claims can still be made they have since died. Claims can also be made regardless of whether care was given in your own home, the individual's home or a care home.

  • The individual receiving care must have lived in Wales during the period for which the claim is being made. Claims can only be made for care paid for and received between 1 April 2003 and 31 July 2013.

  • The individual receiving care was assessed to have had a 'primary health need'. This was determined by the nature, intensity, complexity and unpredictability of the need and wasn't dependent on the diagnosis of a disease or condition. Crucially, even if you don't know if the individual had a primary health need during the relevant period, you can still make a claim. The NHS can assess whether or not the individual should have been eligible.

If you're not eligible to claim, you may still be able to reclaim nursing and healthcare costs under the Funded Nursing Care Scheme.

You can reclaim these costs by contacting your local health board for an assessment which will explain how much you are eligible for.

How much can I reclaim?

  • If the individual was cared for in their home or yours. The NHS will refund the cost of any care paid for, plus interest. (Despite multiple calls, the Welsh Government's Department for Heath and Social Care could not confirm at what rate interest will be paid.) Food and/or accommodation costs won't be refunded.

  • If the individual was cared for in a care home. The NHS will reimburse all care home fees incurred, including accommodation and food costs, plus interest.

How do I reclaim?

You must register your intent to make a claim by Thursday 31 July. You can do this by calling any of these numbers: 07817 885171, 07792 129703, 07805 811630 or 07805 811637. Or you can complete and send off the form on the NHS Wales website.

If your claim is accepted into the process, you'll be sent a questionnaire and an information booklet.

You'll also be asked to provide evidence to support your claim by 31 December.

The Welsh Government says no claim should take longer than two years to review from the date of acceptance.

Late applications made after 31 July may be accepted, but only under exceptional circumstances such as the claimant suffering critical illness, serving with the armed forces or living abroad. So if you think you're eligible – apply now.

Can I get help making a claim?

There's no need to pay a claims firm, where you're likely to lose 30% of what you're owed, to make a claim for you. You also don't need to employ a solicitor, as you can claim yourself.

If you need help, you can speak to the NHS in the first instance using the above contact details.

If you still need help, you can contact charity Age Cymru on its helpline: 08000 223 444.

Why is there a deadline to claim?

The Welsh Government introduced the 31 July cut-off date to clear any historic claims. It says the claims process has been advertised in NHS facilities and on its claims website.

What if my claim is already being assessed?

If your claim is already being assessed, or you're going through the appeals process, the 31 July cut-off date does not affect you.

What if I paid for care before 1 April 2003, or after 31 July 2013?

If you paid for care before 1 April 2003, you can no longer claim for this as the cut-off period to do so ended in 2009.

If you've paid for care since 31 July 2013, you can make a claim by contacting the NHS using the above details.

The Welsh Government has now introduced an annual rolling cut-off date. So if you want to make a claim for August 2013, you should register by 31 August 2014.

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