5. Except as provided in paragraph 6, the premiums specified in Part 4 are, for the purposes of paragraphs 1(1)(d) and 2(e) of Schedule 6, to be applicable to an applicant who satisfies the condition specified in paragraphs 9 to 14 in respect of that premium.
6. Subject to paragraph 7, where an applicant satisfies the conditions in respect of more than one premium in this Part of this Schedule, only one premium is to be applicable to the applicant and, if they are different amounts, the higher or highest amount is to apply.
7. The following premiums, namely—
(a)a severe disability premium to which paragraph 11 applies;
(b)an enhanced disability premium to which paragraph 12 applies;
(c)a disabled child premium to which paragraph 13 applies; and
(d)a carer premium to which paragraph 14 applies,
may be applicable in addition to any other premium which may apply under this Schedule.
8.—(1) Subject to sub-paragraph (2), for the purposes of this Part of this Schedule, once a premium is applicable to an applicant under this Part, a person is to be treated as being in receipt of any benefit for—
(a)in the case of a benefit to which the Social Security (Overlapping Benefits) Regulations 1979(1) applies, any period during which, apart from the provisions of those Regulations, that person would be in receipt of that benefit; and
(b)any period spent by a person in undertaking a course of training or instruction provided or approved by the Secretary of State or the Welsh Ministers under section 2 of the Employment and Training Act 1973(2) or by Skills Development Scotland, Scottish Enterprise or Highlands and Islands Enterprise under section 2 of the Enterprise and New Towns (Scotland) Act 1990(3) or for any period during which that person is in receipt of a training allowance.
(2) For the purposes of the carer premium under paragraph 14, a person is to be treated as being in receipt of carer’s allowance by virtue of sub-paragraph (1)(a) only if and for so long as the person in respect of whose care the allowance has been claimed remains in receipt of attendance allowance, or the care component of disability living allowance at the highest or middle rate prescribed in accordance with section 72(3) of the SSCBA or the daily living component of personal independence payment payable under Part 4 of the Welfare Reform Act 2012, or AFIP.
9. The condition is that—
(a)where the applicant is a single applicant or a lone parent, the applicant has not attained the qualifying age for state pension credit and the additional condition specified in paragraph 10 is satisfied; or
(b)where the applicant has a partner, either—
(i)the applicant has not attained the qualifying age for state pension credit and the additional condition specified in paragraph 10(1)(a) or (b) is satisfied by the applicant; or
(ii)the applicant’s partner has not attained the qualifying age for state pension credit and the additional condition specified in paragraph 10(1)(a) is satisfied by the applicant’s partner.
10.—(1) Subject to sub-paragraph (2) and paragraph 8, the additional condition referred to in paragraph 9 is that either—
(a)the applicant or, as the case may be, the applicant’s partner—
(i)is in receipt of one or more of the following benefits: attendance allowance, disability living allowance, personal independence payment, AFIP, the disability element or the severe disability element of working tax credit as specified in regulation 20(1)(b) and (f) of the Working Tax Credit (Entitlement and Maximum Rate) Regulations 2002(4), mobility supplement, long-term incapacity benefit under Part 2 of the SSCBA or severe disablement allowance under Part 3 of that Act but, in the case of long-term incapacity benefit or severe disablement allowance, only where it is paid in respect of the applicant; or
(ii)was in receipt of long-term incapacity benefit under Part 2 of the SSCBA when entitlement to that benefit ceased on account of the payment of a retirement pension under that Act and the applicant has since remained continuously entitled to—
(aa)council tax benefit (in relation to the period to 1 April 2013), or
(bb)a reduction under an authority’s scheme (in relation to the period commencing 1 April 2013), and
if the long-term incapacity benefit was payable to the applicant’s partner, the partner is still a member of the family; or
(iii)was in receipt of attendance allowance or disability living allowance but payment of benefit has been suspended in accordance with regulations made under section 113(2) of the SSCBA or otherwise abated as a consequence of the applicant or the applicant’s partner becoming a patient within the meaning of paragraph 21(11)(i) of Schedule 6 (treatment of child care charges); or
(iv)was in receipt of personal independence payment, but payment of that benefit has been suspended in accordance with section 86 of the Welfare Reform Act 2012 as a consequence of the applicant becoming a patient within the meaning of paragraph 21 of Schedule 6 (treatment of child care charges); or
(v)was in receipt of AFIP, but payment has been suspended in accordance with any terms of the armed and reserve forces compensation scheme which allow for suspension because a person is undergoing medical treatment in a hospital or similar institution; or
(vi)is provided with an invalid carriage or other vehicle by the Secretary of State or a clinical commissioning group under paragraph 9 of Schedule 1 to the National Health Service Act 2006(5) or, in Scotland, under section 46 of the National Health Service (Scotland) Act 1978(6) (provision of services by Scottish Ministers) or, in Wales, under section 5 of, and Schedule 1 to the National Health Service (Wales) Act 2006(7) or, in Northern Ireland, is provided with an invalid carriage or other vehicle by the Department of Health, Social Services and Public Safety under article 30(1) of the Health and Personal Social Services (Northern Ireland) Order 1972, or receives payments by way of grant from the Secretary of State under paragraph 10(3) of Schedule 1 to the Act of 2006(8) (provision of vehicles for disabled persons) or, in Scotland by the Scottish Ministers under section 46 of the Act of 1978; or
(vii)is blind and in consequence registered in a register compiled by a local authority under section 29 of the National Assistance Act 1948(9) (welfare services) or, in Scotland, has been certified as blind and in consequence the applicant is registered in a register maintained by or on behalf of a council constituted under section 2 of the Local Government (Scotland) Act 1994(10); or
(b)the applicant—
(i)is, or is treated as, incapable of work in accordance with the provisions of, and regulations made under, Part 12A of the SSCBA (incapacity for work); and
(ii)has been incapable, or has been treated as incapable, of work for a continuous period of not less than—
(aa)in the case of an applicant who is terminally ill within the meaning of section 30B(4) of the SSCBA, 196 days;
(bb)in any other case, 364 days.
(2) For the purposes of sub-paragraph (1)(a)(vi), a person who has ceased to be registered as blind on regaining that person’s eyesight is nevertheless to be treated as blind and as satisfying the additional condition set out in that sub-paragraph for a period of 28 weeks following the date on which that person ceased to be so registered.
(3) For the purposes of sub-paragraph (1)(b), once the disability premium is applicable to an applicant by virtue of the applicant’s satisfying the additional condition specified in that provision, if the applicant then ceases, for a period of 8 weeks or less, to be treated as incapable of work or to be incapable of work the applicant is, on again becoming so incapable of work, to immediately thereafter be treated as satisfying the condition in sub-paragraph (1)(b).
(4) For the purposes of sub-paragraph (1)(b), once the disability premium is applicable to an applicant by virtue of the applicant satisfying the additional condition specified in that provision, the applicant is to continue to be treated as satisfying that condition for any period spent by the applicant in undertaking a course of training provided under section 2 of the Employment and Training Act 1973 or section 2 of the Enterprise and New Towns (Scotland) Act 1990 or for any period during which the applicant is in receipt of a training allowance.
(5) For the purposes of sub-paragraph (1)(b), where any two or more periods of incapacity are separated by a break of not more than 56 days, those periods are to be treated as one continuous period.
(6) For the purposes of this paragraph, a reference to a person who is or was in receipt of long-term incapacity benefit includes a person who is or was in receipt of short-term incapacity benefit at a rate equal to the long-term rate by virtue of section 30B(4)(a) of the SSCBA (short-term incapacity benefit for a person who is terminally ill), or who would be or would have been in receipt of short-term incapacity benefit at such a rate but for the fact that the rate of short-term incapacity benefit already payable to that person is or was equal to or greater than the long-term rate.
(7) In the case of an applicant who is a welfare to work beneficiary (a person to whom regulation 13A(1) of the Social Security (Incapacity for Work) (General) Regulations 1995(11) applies, and who again becomes incapable of work for the purposes of Part 12A of the SSCBA)—
(a)the reference to a period of 8 weeks in sub-paragraph (3); and
(b)the reference to a period of 56 days in sub-paragraph (5),
is in each case to be treated as a reference to a period of 104 weeks.
(8) The applicant is not entitled to the disability premium if the applicant has, or is treated as having, limited capability for work.
11.—(1) The condition is that the applicant is a severely disabled person.
(2) For the purposes of sub-paragraph (1), an applicant is to be treated as being a severely disabled person if, and only if—
(a)in the case of a single applicant, a lone parent or an applicant who is treated as having no partner in consequence of sub-paragraph (3)—
(i)the applicant is in receipt of attendance allowance, or the care component of disability living allowance at the highest or middle rate prescribed in accordance with section 72(3) of the SSCBA or the daily living component of personal independence payment payable at either rate under Part 4 of the Welfare Reform Act 2012, or AFIP; and
(ii)subject to sub-paragraph (4), the applicant has no non-dependants aged 18 or over normally residing with the applicant with whom the applicant is normally residing; and
(iii)no person is entitled to, and in receipt of, a carer’s allowance under section 70 of the SSCBA in respect of caring for the applicant;
(b)in the case of an applicant who has a partner—
(i)the applicant is in receipt of attendance allowance, or the care component of disability living allowance at the highest or middle rate prescribed in accordance with section 72(3) of the SSCBA or the daily living component of personal independence payment payable at either rate under Part 4 of the Welfare Reform Act 2012, or AFIP; and
(ii)the applicant’s partner is also in receipt of such an allowance or, if the applicant is a member of a polygamous marriage, all the members of that marriage are in receipt of such an allowance; and
(iii)subject to sub-paragraph (4), the applicant has no non-dependants aged 18 or over normally residing with the applicant or with whom the applicant is normally residing,
and either a person is entitled to and in receipt of a carer’s allowance in respect of caring for only one member of a couple or, in the case of a polygamous marriage, for one or more but not all the members of the marriage, or as the case may be, no person is entitled to and in receipt of such an allowance in respect of caring for either member of a couple or any member of a polygamous marriage.
(3) Where an applicant has a partner who does not satisfy the condition in sub-paragraph (2)(b)(ii), and that partner is blind or is treated as blind within the meaning of paragraph 10(1)(a)(vii) and (2), that partner is to be treated for the purposes of sub-paragraph (2)(b)(ii) as if that person were not a partner of the applicant.
(4) For the purposes of sub-paragraph (2)(a)(ii) and (2)(b)(iii) no account is to be taken of—
(a)a person receiving attendance allowance, or disability living allowance by virtue of the care component at the highest or middle rate prescribed in accordance with section 72(3) of the SSCBA, or the daily living component of personal independence at either rate prescribed in accordance with Part 4 of the Welfare Reform Act 2012, or AFIP; or
(b)a person who is blind or is treated as blind within the meaning of paragraph 10(1)(a)(vii) and (2).
(5) For the purposes of sub-paragraph (2)(b) a person is to be treated—
(a)as being in receipt of attendance allowance, or the care component of disability living allowance at the highest or middle rate prescribed in accordance with section 72(3) of the SSCBA or the daily living component of personal independence payment payable at either rate under Part 4 of the Welfare Reform Act 2012, or AFIP, if that person would, but for that person’s being a patient for a period exceeding 28 days, be so in receipt;
(b)as being entitled to and in receipt of a carer’s allowance if that person would, but for the person for whom that person was caring being a patient in hospital for a period exceeding 28 days, be so entitled and in receipt.
(6) For the purposes of sub-paragraph (2)(a)(iii) and (2)(b), no account is to be taken of an award of carer’s allowance to the extent that payment of such an award is back-dated for a period before the date on which the award is first paid.
(7) In sub-paragraph (2)(a)(iii) and (b), references to a person being in receipt of a carer’s allowance are to include references to a person who would have been in receipt of that allowance but for the application of a restriction under section 6B or 7 of the Social Security Fraud Act 2001(12) (loss of benefit provisions).
12.—(1) Subject to sub-paragraph (2), the condition is that—
(a)the Secretary of State has decided that the applicant has, or is to be treated as having, limited capability for work-related activity; or
(b)the care component of disability living allowance is, or would be payable at the highest rate prescribed under section 72(3) of the SSCBA, but for a suspension of benefit in accordance with regulations made under section 113(2) of the SSCBA or but for an abatement as a consequence of hospitalisation, in respect of—
(i)the applicant; or
(ii)a member of the applicant’s family,
who has not attained the qualifying age for state pension credit; or
(c)the daily living component of personal independence payment is, or would be payable at the enhanced rate prescribed in accordance with section 78(2) of the Welfare Reform Act 2012, but for a suspension of benefit in accordance with section 86 of the Welfare Reform Act 2012 in respect of—
(i)the applicant; or
(ii)a member of the applicant’s family,
who has not attained the qualifying age for state pension credit: or
(d)AFIP is payable in respect of—
(i)the applicant; or
(ii)a member of the applicant’s family,
who has not attained the qualifying age for state pension credit.
(2) Where the condition in sub-paragraph (1) ceases to be satisfied because of the death of a child or young person, the condition is that the applicant or partner is entitled to child benefit in respect of that child or young person under section 145A of the SSCBA (entitlement after death of child or qualifying young person).
(3) The condition is not satisfied if the person to whom sub-paragraph (1) refers is—
(a)an applicant who—
(i)is not a member of a couple or a polygamous marriage; and
(ii)is a patient within the meaning of paragraph 21(11)(g) of Schedule 6 (treatment of child care charges) and has been for a period of more than 52 weeks; or
(b)a member of a couple or a polygamous marriage where each member is a patient within the meaning of paragraph 21(11)(g) of Schedule 6 and has been for a period of more than 52 weeks.
13. The condition is that a child or young person for whom the applicant or a partner of the applicant is responsible and who is a member of the applicant’s household—
(a)is in receipt of disability living allowance or personal independence payment or is no longer in receipt of such allowance because the child or young person is a patient, provided that the child or young person continues to be a member of the family; or
(b)is blind or treated as blind within the meaning of paragraph 10; or
(c)is a child or young person in respect of whom section 145A of the SSCBA (entitlement after death of child or qualifying young person) applies for the purposes of entitlement to child benefit but only for the period prescribed under that section, and in respect of whom a disabled child premium was included in the applicant’s applicable amount immediately before the death of that child or young person, or ceased to be included in the applicant’s applicable amount because of that child or young person’s death; or
(d)is in receipt of AFIP.
14.—(1) The condition is that the applicant or the applicant’s partner is, or both of them are, entitled to a carer’s allowance under section 70 of the SSCBA.
(2) Where a carer premium is awarded but—
(a)the person in respect of whose care the carer’s allowance has been awarded dies; or
(b)in any other case the person in respect of whom a carer premium has been awarded ceases to be entitled to a carer’s allowance,
the condition for the award of the premium is to be treated as satisfied for a period of eight weeks from the relevant date specified in sub-paragraph (3).
(3) The relevant date for the purposes of sub-paragraph (2) is to be—
(a)where sub-paragraph (2)(a) applies, the Sunday following the death of the person in respect of whose care a carer’s allowance has been awarded or the date of death if the death occurred on a Sunday;
(b)in any other case, the date on which the person who has been entitled to a carer’s allowance ceases to be entitled to that allowance.
(4) Where a person who has been entitled to a carer’s allowance ceases to be entitled to that allowance and makes an application for a reduction, the condition for the award of the carer premium is to be treated as satisfied for a period of eight weeks from the date on which—
(a)the person in respect of whose care the carer’s allowance has been awarded dies;
(b)in any other case, the person who has been entitled to a carer’s allowance ceased to be entitled to that allowance.
15. For the purpose of determining whether a premium is applicable to a person under paragraphs 10 to 14, any concessionary payment made to compensate that person for the non-payment of any benefit mentioned in those paragraphs is to be treated as if it were a payment of that benefit.
16. For the purposes of this Part of this Schedule, a person is to be regarded as being in receipt of any benefit if, and only if, it is paid in respect of that person and is to be so regarded only for any period in respect of which that benefit is paid.
Sub-paragraph (3) was amended by section 17 of the Health and Social Care Act 2012 (c.7).