Private Health Insurance and Contributory ESA

I know this wont apply to many people, and everyone/case is different and needs to be approached as such, but I have read recently on an insurance website

that if a claimant is put into the WRAG and PHI is paid out and the employee is still technically employed and paid through the employer, as NI is still being paid, then following the 12 month period contributory based ESA it could be claimed again after 12 weeks.

Sorry, if this is something that everyone else knows, but thought it might be of interest. Of course I dont know if this is a fact, but it seems a reasonable interpretation.

Hi Bonnie, Private health insurance and critical illness insurance are two separate things. PHI just pays for private diagnosis and, sometimes, treatment, but in the case of an incurable illness such as MS, mine only covered me up to and including the point of diagnosis. They weren’t going to pay for life, for something that can’t be cured, so from that point, I was on my own - or, more accurately, back on the NHS. However, technically, if another (unrelated) health issue had arisen, whilst I was technically still employed with the company (whether or not off sick), then my PHI policy should still have been current, and there would have been nothing to stop me being privately diagnosed (& possibly treated) for the new thing. This would be of limited usefulness to most people, though, unless they were unlucky enough to get a new thing right on top of the MS. I’m wondering if you actually mean statutory sick pay - the mechanism that means your salary continues to get paid when you’re off sick? Most people who claim ESA without actually being dismissed do so because SSP has ended. Some employment contracts allow for “enhanced sick pay”, which is either better, or lasts longer (or both!) than SSP. But this is not “private health insurance”, which is quite a different thing. Tina

I’m wondering if you mean PERMANENT Health Insurance (PHI) ie income protection? X

Yes, thats it permanent - income protection. Doh!

Hi Bonnie, I am curious. Could you post a link re what you have read? I ask as I have been on PHI via my employer for a year. It is likely to be until I am due to retire, so a while yet! It’s not great, but must grumble, as with ms I was uninsurable as a private individual. They also pay in to my company pension. It is taxable & subject to income tax, as I am still technically an employee. Just sent off forms for continuation of the claim. There is however, I could be retired off their books due to ill-health, so I ought to get my ducks I a row… I have found ESA explanation via the dwp website. I have not looked at it in detail.

I’ve just seen this post and wonder whether anyone has any answers.

My partner is in a very similar situation in that she receives employer PHI which is paid via her payroll - she is therefore still ‘employed’, although there is no likelihood of her returning to work. She received Incapacity Benefit for many years and was switched to Contributory ESA in June last year. She is in the WRAG and would not qualify for the support group as far as I can see.

Her 365 days will be up in June and she therefore loses the Contributory ESA at this point. Because of the PHI she will not be entitled to Income Based ESA. This is income we simply cannot afford to lose.

She continues to pay NI, since her PHI is paid via her employer and therefore tax and NI are deducted at source. Since Contribution based ESA is supposedly dependant on NI contributions does anyone know if she can reapply for Contribution Based ESA after the 12 weeks have the end of her current claim? I have seen a lot of conflicting information on this online and wondered if anyone had any first hand experience. I have tried the local job centre and the CAB but neither were much help and didn’t understand the unusual nature of the claim, i.e. still being ‘employed’ but also receiving ESA.

Any help would be much appreciated



Have just seen this, yes I definately read that on an insurance providers website and have just tried to find the link but without success. Money Saving Expert has a thread that covers this topic and posters are saying the same thing - that after 12 weeks it is possible to claim ESA fresh if you have been paying NI. Perhaps have a word with the insurers?

One thing I would say is that you cannot or rather should not be dismissed if you are losing your contractual obligations. Ill health retirement is a dismissal and PHI is a contractual benefit. If you have access to a union might be worth joining if you think it might be on the horizon.