Once a claim form has been submitted online it is sent to the Mutual Fund Team mailbox in the form of an email. This email is then processed within 5 workings days into the Mutual Fund database. If a field has been completed incorrectly then the claim form will be rejected by the database, and the Mutual Fund team will contact the school via email or phone to ascertain the correct data. The claim will then be processed and either accepted, accepted with an adjustment or rejected. This will create a PDF file notification which will be sent via AnyComms within the Finance Information Community to the school regarding the claim. Should the claim be accepted or accepted with an adjustment the PDF file will state the amount to be paid and the reason for the adjustment. If the claim has been rejected, the PDF file will state the reason for its rejection. All Mutual Fund payments will then be paid at the end of the month and another PDF file will be sent to the school via the AnyComms System which will also list all school adjustments and payments.

All claims for long term sickness must be completed and submitted by the provided claim deadline dates on the main Schools Mutual Fund web page. Each claim will need to span a single period/month and must be submitted by the published deadline for that given month. Members must complete the online claim form.

Depending on the level of cover purchased and the type of school you will be subject to a waiting period: a number of days at the beginning of the absence for which you cannot claim – in effect an excess. This only affects the first claim period of any absence. Thereafter reimbursement is made at the relevant rates for teachers and support staff.

The cost of membership is based on the number of full-time equivalent staff employed at the school and the level of cover purchased. Premiums for teachers and support staff are set and reimbursed at different rates. A calculator for yearly premiums can be found at the top of the page under the Mutual Fund heading. Information regarding the levels of cover and reimbursement rates can be found on the Mutual Fund Website.

For a phased return claim to be paid an independent report from IMASS (Industrial Medical & Safety Services Ltd) will be required, confirming that a phased return is necessary. Additional details such as the length, start date, end date, type (physical or mental) and total number of days absent will be required when completing the claim form linked on the Mutual Fund Webpage.

Covered

• Any long-term sickness covered by certificate (including stress)
• Suspension from duties (including gardening leave)
• Full cost of staff transferring to half-pay for 6 months absence
• Paternity Leave
• Phased Return

Not Covered

• Pre existing conditions *
• Trade union activities
• Jury Service
• Reserve Forces activities
• Maternity leave
• Compassionate leave

* Applies only to schools joining the scheme for the first time or re-joining the scheme after a break of a year or more.

Staff Covered

Teachers and all support staff if the support cover option has been added.

How do I claim once a member of Staff moves onto half pay after 6 months of absence?

Where a claim has been submitted for an individual for 6 months, relating to the same absence, the member school must discontinue claim submission via the online claim form and follow the process shown below:

• School must contact the Payroll Team and identify the individual in question and advise that they are moving to half pay.
• Payroll then calculate the monthly pay accordingly and contact the Education Finance Team directly with the information.
• A claim will be processed and paid from the Mutual Fund, internally by the Education Finance Team.

In line with standard Mutual Fund terms, 50% of the claim amount is paid upfront, with the final 50% following at the end of the financial year.

All schools currently in the Mutual Fund will automatically be assumed to be scheme members for the following year, unless the school completes the ‘Leave the School Mutual Fund’ form by 28th February.

Those schools wishing to join the Mutual Fund scheme need to apply on an annual basis. Reminders and links to the online form will be sent out towards the end of each financial year via the School Blog. Please subscribe to the Blog for updates regarding the Schools Mutual Fund. New applications should be returned by 31^st March each year and can be made using the join the mutual fund form.

Membership is not compulsory. However, those schools choosing not to join the scheme need to consider entering into an arrangement with an external provider or risk meeting the cost of cover from within their delegated budgets.
Note: Not all external insurers cover all medical conditions.

Yes, the school can join the Schools Mutual Fund or add coverage during the year. The school will be subject to a 7% joining fee if they were not part of the scheme the previous year. In these circumstances, the premium itself will be pro-rated from the point of joining the scheme, with the 7% joining fee calculated at the annual premium charge*0.07.

It is recommended that every school have in place cover to make sure that Mutual Fund claims are submitted on time and that late claims submitted due to the lack of support cover within the school, will not be accepted as an exceptional circumstance as to why the claim was submitted late.

A claim will only be accepted if the individual was subject to a qualifying absence reason as stated. Please see the mutual fund page for more information.

This is not a valid reason for a late claim to be submitted and will be rejected by the board. As all schools (including academies, free or maintained) currently in the scheme will automatically be enrolled in the Mutual Fund for the following year unless the Mutual Fund is informed otherwise, prior to 28th February. All schools remaining in the Mutual Fund or joining the scheme for the following year will be provided with a premium notification via AnyComms during April. All schools will be given two weeks in which to contact the Mutual Fund team to raise any query relating to their premium. The Mutual Fund premium will then be raised in the middle of May with a further confirmation sent via the Finance Information Community by AnyComms and all claims received for April and May, will then be processed and paid by the end of May.

With this type of claim if an individual has been absent for a long period of time, the school will need to check with the Payroll Team to check when half pay can be claimed. If the individual has returned to work as a phased return and then falls ill again with a different illness, the date of the half pay entitlement will be delayed and therefore a new claim will need to be submitted to the Mutual Fund that will include the waiting days.

If a teacher is returning to work and IMASS (Industrial Medical & Safety Services Ltd)/Medigold referral report states that the School has to provide supply teacher/teaching assistant cover in order to work with and assist the returning Teacher throughout their Phased Return, then you are able to claim for this through the Mutual Fund. If this occurs, please email the Mutual Fund Team, who will be able to assist you. The Mutual Fund Team will require a timetable of the arrangement to calculate how many days you will be able to claim for. The school must hold the referral report and present this if requested by the Mutual Fund Team.

If you are claiming for a phased return for an individual, an independent report must be received by IMASS (or similar) confirming that a Phased return is necessary for 7 weeks or more. This claim will then be put forward to our Mutual Fund Appeals Board as it is above and beyond normal practice. Submit your claim via the online claims form on the Mutual Fund webpage. You will also need to email the Mutual Fund Team providing details of the absence, why a phased return of greater than 6 weeks is necessary and details of how many days per week for each week the member of staff will be at work for. For example, week 1 the member of staff worked 1 day a week, week 2 the member of staff worked 1.5 days a week and so on. The board meets 3/4 times a year, and your claim will then be heard at the next meeting.

The Education Finance Team uses the following method to calculate Mutual Fund Claims. Number of days claimed X Pay Factor Rate X Reimbursement rate (£136.68 per day for teachers and £56.10 per day for support staff). The total number of days that you are claiming will be every working day the school is open in the period you’re claiming for, even if the member of staff is part time and wouldn’t have worked all of the dates that are being claimed. This is because we then multiply the number of days claimed by the member of staff’s Full Time Equivalent

A few examples of claims;

• If you are claiming for a whole month’s absence (for example 20 days) for a teacher whose pay factor rate is 0.4 the claim would be worked out as follows.
• 20 Days X 0.4 pay factor rate X £136.68 Teachers Reimbursement Rate = £1093.44
• If the teacher’s pay factor rate is 1.0, the claim would be worked out in the same way, as follows.
  20 Days X 1.0 pay factor rate X £136.68 Teachers Reimbursement Rate = £2733.60

Yes, if the individual has been dismissed or resigns then you may claim for the period of their notice.

A school can only claim for the day that the individual returned to work, if a return to work form was completed and the individual was sent home on the same day they returned to work. If no return to work form was completed and the individual went off absent several days later, then this would be classified as a new absence and the waiting days would start again.

If the individual requires additional time off with the same illness on top of the phased return, the school can claim for the additional days. However, if the added days out of work is due to an unrelated illness then the waiting days still apply as this is classified as a new absence.

Unfortunately, if a member of staff is already absent prior to the initial premium being paid then you cannot claim for this individual. If however, the individual does come back to work but unfortunately goes absent due to a new illness, then you can claim for that individual.

Membership periods run in line with the financial year, running from 1st April to 31st March each year. This has previously been discussed by the Mutual Fund Board and no changes are to be made at this time.

Each year, the Mutual Fund balance is rolled forward and the premiums adjusted accordingly. Therefore, whether the fund is in surplus or deficit at year end, schools will not receive a refund.