CSI EXCESS, PREMIUM AND CASEWORKER

[sheraz7]

Good evening board,
As csi guideline says that private medical insurance cover in majority circumstances but it does not signal anything about its excess and premium. When you select more excess then monthly premium go down. Does caseworker especially see the policy excess and monthly premium for decision or casework only check the enough medical cover.
Contribute on this topic everybody.

[jotter]

Good evening board,
As csi guideline says that private medical insurance cover in majority circumstances but it does not signal anything about its excess and premium. When you select more excess then monthly premium go down. Does caseworker especially see the policy excess and monthly premium for decision or casework only check the enough medical cover.
Contribute on this topic everybody.

I shouldn't think it would matter, because the liability/risk of the excess is the policyholder's risk, not the State's. I'll update on this once my EEA4 case is decided, because we held a policy with low monthlies and high excess during our self-sufficient period, so if they accept that, then this is clearly a non-issue.

What it does do, I think, is show up the silliness of the UKBA's suggestion on holding private health insurance. The UK government makes no financial gain and a fat insurer pockets the cash. The UKBA would do much better requiring EEA self-sufficients/students to pay a premium for NHS services. That way the State would actually benefit (goodness knows the NHS could use the cash) while at the same time EEA citizens/families would know they were clear of the always rather ambiguously-worded CSI requirement.

[jotter]

Related threads from last year:
http://www.immigrationboards.com/viewtopic.php?t=87928
http://www.immigrationboards.com/viewtopic.php?t=88198

[Obie]

Having a low premium with high excess could backfire. For example a policy with excess of 2k will mean the person is not fully covered for lots of minor conditions and this could be considered as inadequte coverage, and the person could be rejected on the basis of not having a CSI.

[sheraz7]

There is no guideline regarding it so as much as possible and as many as more people (moderators, gurus and members) should throw the light and share experience on this issue applicable to vast number of people.

[jotter]

Having a low premium with high excess could backfire. For example a policy with excess of 2k will mean the person is not fully covered for lots of minor conditions and this could be considered as inadequte coverage, and the person could be rejected on the basis of not having a CSI.

Obie, do you have any actual example of that happening? My EEA4 application could stand or fall on that point.

[sheraz7]

but some companies policies have compulsory excess e.g £500, £1000 and £1500 and these policies i think many board members used and succeed but still this issue need to be solved with the personal experiences of more and more people.

[sheraz7]

Any moderator/guru/member to comment on this key issue.

[Directive/2004/38/EC]

I would guess you can get away with just about anything. They have no guidelines, so I doubt they could defend a refusal based on "not enough coverage".

[sheraz7]

But how about that if a self sufficient eea national and non-eea national keep the extra finance in account equivalent to that excess value. Is that not justify it?

[Obie]

The UKBA never use to pay much attention to details on these CSI, however i have seen about 4 refusals in the last 6 months, were the reason for refusal is that the person has not got a comprehensive cover, as they are not covered for the first, £500, £1000 or in some case £2000. The reasons given is that in the event of these people falling ill or receiving medical for certain condition, they will not be covered. They will be a burden on the NHS.

It seems discretionary, as there is no set guidelines on these.

It seems UKBA has been catching up on certain individuals who take up CSI for the sake of it. I have seen others who have indeed succeeded. It simply depends on the caseworker. I believe an argument can indeed be constructed for both sides.

[sheraz7]

You are saying right. This is the most tricky issue. But how about this assumption that excess is a mutual commitment between buyer and insurance company while on the other hand ukba check that the applicant has insurance in majority of circumstances and if the applicant has finance in bank account equivalent to that excess value to fulfill its part of commitment then whats wrong with ukba caseworker.

[Obie]

Well i don't support UKBA's restrictive approach. The point about the CSI is that someone holds an insurance, in case they require medical attention and cannot afford to pay up front.

Saying you have resource in the bank, may go toward proving self sufficiency in one way, but certainly not in order.

UKBA could argue that, if it was the intention of the legislator to make it an option of whether someone shows they have sufficient resource in the account to cover medical cost, or actually hold a medical insurance with comprehensive coverage, they would have done so.

It is a complex area i agree.

[sheraz7]

Thanks.
Because having the equivalent finance to excess value in bank account can enable the applicant to argue that he can meets its commitment and is not a burden on public money.
BUT THIS SILLY REQUIREMENT SHOULD BE ABOLISHED LIKE WRS SCHEME AND CERTIFICATE OF APPROVAL.

[sheraz7]

I have searched this forum extensively and found that mostly the UKBA caseworker tries to check that all family members are medical covered instead of focusing too much on excess value.

[jotter]

I was recently successful with a policy with 4 digit excess. A couple of things may have caused the caseworker to show discretion though. Firstly we were going for EEA4 and the self-sufficient period was around 20% of our qualifying period. Secondly the reason was childbirth and early months of our child. Both before and after that my wife was working the whole time. Still, perhaps this offers some comfort to others in a similar situation.

Attn Obie:
You mention above that you have 'seen about 4 refusals in the last 6 months'. Neither sheraz7 nor I could find any such cases in this forum so far. Any threads in evidence? Or have these cases come to your attention outside of this forum?

[sheraz7]

Congratulation jotter for achieving success. As i said before that there is no guideline about the csi excess figure and even many policies have 4 digit compulsory excess. What the generic believe is that caseworker do not pay attention too much over excess figure rather just make sure that policy covers all family members as because he himself also should not have any criteria/instruction about the excess figure. Moreover, excess is a commitment between the buyer and company only not caseworker.

[Obie]

That is a wonderful news jotter. Unfortunately the refusals are not from the forum. If i get the permission of one of the refused applicant i will publish it. I am working on getting different cases that are treated differently to point out the inconsistency in the HO's policy. Four cannot be random surely. Then perhaps the HO has issues with competent firm doing their jobs effeciently.

If it will not be a trouble, you could offer your case as evidence of inconsistent policy.

The refusal argue that the Secretary of State is obliged to ensure an applicant is sufficiently covered and that an excess of 3000 pounds means that the applicant will not be sufficiently covered, and may receive many treatment which will not be covered and this would result in burden to the NHS.

You case may not be exactly identical, as your wife was in employment for certain period, chances are, she may not have needed CSI if she fell into certain categories.

Again congratulations and best wishes for the future.

[sheraz7]

£3000 excess is really a big excess figure but another noteworthy point is that if caseworker says that the applicant is not sufficiently covered because of this large excess figure but on the other hand they must know that based on the present nhs situation who can be treated via free nhs equivalent to that excess figure then who have to pay eventually its the applicant only.

[jotter]

Thanks Obie. I must admit my excess was nowhere near £3000 - it was less than half of that, so perhaps the 'threshold of concern' for the UKBA is somewhat higher than what I had. You'll be a better judge of that than I.

Strictly interpreting the treaty rights legislation my wife did need CSI because before she gave birth she was a contractor and when she finished the firm paid her out a lump maternity pay sum and terminated her contract, so she had no job to go back to when she was home with the child - therefore we needed to prove self-sufficient. There was no question of her employability before and after that, though, and I've also noted the recent referral to the ECJ (posted in this forum) of a case arguing that the UKBA would be discriminating if EU citizens can still be considered workers if they leave the country for a period to give birth, but not if they stay in the UK between employment periods to give birth. Even though that's awaiting judgement, perhaps it influenced the 'discretion' as well.

[Obie]

Well in the circumstance you mentioned above, your wife would not have needed medical insurance as she was laid of, provided she had registered with the Employment agency. She would then have continued to retain her status. Therefore, perhaps your case will not be a good example to show. Thanks though for sharing your UKBA experience with us.

The CJEU case you mentioned involes the EEA national voluntarily quitting. In community law, there is a world of difference between someone quitting and being laid off. In some circumstances the length of time the person worked for before being laid of is a significant factor.

[jotter]

Well in the circumstance you mentioned above, your wife would not have needed medical insurance as she was laid of, provided she had registered with the Employment agency. She would then have continued to retain her status. Therefore, perhaps your case will not be a good example to show. Thanks though for sharing your UKBA experience with us.

The CJEU case you mentioned involes the EEA national voluntarily quitting. In community law, there is a world of difference between someone quitting and being laid off. In some circumstances the length of time the person worked for before being laid of is a significant factor.

I guess we could argue that she was laid off, though this was not a surprise to us - since she was contracting we knew months before the birth that it would happen that way. She did not register with the Employment agency at this time though because she was at home with a new-born and in no state to accept offers of work. She stayed at home with the baby for just on 12 months and then started looking for work again and found a new job very quickly. Do you still see an argument that she could have retained her worker status throughout? It's true she was working continuously in the UK for 3 years before this time.

[Obie]

I believe if she had registered at the job centre, then both of you would have been fine and no need for medical insurance, as status of worker would have been retained during that period. If you had a medical evidence that her pregnancy state preclude her from working, given the nature of her work, it is arguable, that she would have retained her status also

[sheraz7]

Keffer i still agree with you and your last 20% qualifying period was actually covered by being self sufficient but not by eea worker status. Would you like to share your experience to benefit board that what did you submit for self sufficiency such as bank statements, csi payment details etc. Were you (non-eea) supporting eea national for fulfilling this criteria.

[jotter]

Hi sheraz7,

For the period concerned I provided:
- policy schedule and details for our private health insurance policy which was taken out in my wife's name but covered the whole family including our new-born son.
- policy renewal letter after 12 months to prove that we had held the policy throughout and not just purchased and cancelled (though they could probably have got this from our bank statements)
- complete set of bank statements from our UK current account (in joint names). There was always a few thousand in the account.

Actually I also provided our UK EHIC cards, because I didn't realise at the time that only non-UK EHIC cards have any value in this scenario.

- One other point of interest is that after my wife went back to work she claimed Child Benefit (as entitled to do as an EEA worker), but Inland Revenue not only granted it but also granted about 3 months worth of back payments going back into the time that she was self-sufficient. So we had to go chasing Inland Revenue to insist that they let us pay the back payments back, which eventually they agreed to a couple of months later. So we included with our application a history of that whole palava as well. I guess Inland Revenue doesn't experience that very often.