Help with health costs - Effective from 1 April 2009 Can you get help with the cost of

 
 
HC11

Help with
health costs
Effective from 1 April 2009

Can you get help with
the cost of:

         Prescriptions

         NHS Dental treatment

         Sight tests

         Glasses or
         contact lenses

         NHS Wigs and fabric
         supports

         Travel to receive NHS
         treatment
HC11 – Help with
health costs

This leaflet is an
interim version which
includes information
on Employment and
Support Allowance
and prescriptions for
cancer patients.
It not the finalised
publication.
Introduction                                HOW TO USE THIS BOOKLET

    This booklet gives guidance about NHS       You can quickly check if you are
    charging arrangements in England only.      entitled to free treatment by going to
                                                the Quick check guides which start on
    The National Health Service (NHS) is,       page 8.
    primarily, for the benefit of people
    resident in the United Kingdom (UK). If     For more detailed guidance you need
    a person is accepted for NHS treatment,     to go to the Contents list starting on
    eligibility for exemption from charges      page 5 and find the group you most
    for NHS treatment is based on the           easily fit into, then go to the page
    conditions described in this booklet.       number shown (for example, if you
                                                are 60 or over, go to page 16).
    Most NHS treatment is free, although
    there can be charges for some things.       After reading about the group that
    This booklet sets out information about     most applies to you, check to see if any
    who does not have to pay charges and        others also apply (you may fit into more
    also tells you about the help you might     than one group).
    get with the cost of the following if you
    are on a low income:                        For instance, you might be:
                                                • 60 or over and also have a low
    • NHS prescriptions
                                                  income
    • NHS dental treatment
                                                • pregnant and also have a low
    • NHS Sight tests
                                                  income.
    • Glasses and contact lenses
    • Necessary costs of travel to receive      If this applies to you, you need to make
      NHS treatment under the care of a         sure you read about both groups.
      consultant, or through a referral by a
      doctor or dentist                         When you have found the group, or
    • NHS wigs and fabric supports              groups, you belong to and what help
      (whenever we say ‘fabric supports’        you can get, go on to page 41. This tells
      we mean spinal or abdominal               you how to get help with NHS costs
      supports or surgical brassieres           when you go for treatment.
      supplied through a hospital).             REFUNDS There is also information
                                                about refunds in this booklet – read
                                                pages 48-55.

2       HC11 – Help with health costs                                         INTRODUCTION   3
PENALTY CHARGES If you are found to        Contents
    have made a wrongful claim for help
    with health costs, you will face penalty   QUICK CHECK GUIDES
    charges and may be prosecuted under        NHS prescriptions                           8
    powers introduced by the Health Act        NHS dental treatment                        9
    1999 – read page 48.
                                               NHS sight tests                            11
    CURRENT RATES The current rates of         NHS optical vouchers                       12
    NHS charges and optical voucher values     NHS travel costs                           13
    in England are listed in the separate
                                               NHS wigs and fabric supports               14
    leaflet HC12.

                                               AGE GROUPS
    Go to page 76 to find out how to get       Children under 16                          15
    this leaflet.
                                               Young people aged 16, 17
    THIS LEAFLET GIVES GENERAL GUIDANCE ONLY   and 18 in full-time education              15
    AND SHOULD NOT BE TREATED AS A COMPLETE    Other young people not
    AND AUTHORITATIVE STATEMENT OF LAW.        in full time education                     16
                                               People 60 or over                          16

                                               INCOME GROUPS
                                               People getting benefits or tax credits     17
                                               Income Support                             17
                                               Jobseeker’s Allowance                      18
                                               Employment and Support Allowance           18
                                               Pension Credit Guarantee Credit            19
                                               Other benefits                             20
                                               Tax credits                                20
                                               People with a low income                   24

                                               OTHER GROUPS
                                               War pensioners                             28
                                               People from abroad                         28
                                               People with a specified medical
                                               condition                                  30

4    HC11 – Help with health costs                                             CONTENTS   5
Pregnant women and those who have          CHECKS OF ENTITLEMENT
    had a baby in the previous                 Checking your entitlement                47
    12 months                             32
                                               PENALTY CHARGE                           48
    People who need lots of prescriptions 33
    People registered severely                 CLAIMING REFUNDS
    sight-impaired/blind or                    NHS prescription charges                 48
    sight-impaired/partially sighted      34   Prescription prepayment
    People who need complex lenses        34   certificate (PPC) fees                   49
    People who have lost or damaged            Other refunds                            51
    their glasses or contact lenses       35   NHS dental charges                       52
    People with impaired hearing          35   Sight test fees                          53
    People living in a care home          36   Glasses or contact lens costs            53
    People supported by a local                Travel costs to receive NHS
    authority after leaving care          36   treatment                                54
    NHS in-patients                       37   NHS wig and fabric support charges       54
    NHS out-patients/day patients         38   War pensioners                           55
    People who need to travel
    to receive NHS treatment              39   PROOF OF ENTITLEMENT TABLES
    NHS treatment abroad                  40   NHS prescriptions                        56
    Isles of Scilly                       41   NHS dental treatment                     62
                                               NHS sight tests                          68
    CLAIMING HELP WHEN YOU                     NHS sight tests and optical vouchers     72
    GO FOR TREATMENT
    NHS prescriptions                   41     ORDERING FORMS AND LEAFLETS              76
    NHS dental treatment                42
    Sight tests                         43     ADVICE LINES                             78
    NHS vouchers for glasses or contact
    lenses                              44
    NHS vouchers for repair or replacement
    of glasses or contact lenses        45
    Travel to receive NHS treatment     45
    NHS wigs and fabric supports        46

6    HC11 – Help with health costs                                           CONTENTS   7
Quick check guides                         • have a valid war pension exemption
                                                 certificate and the prescription is for
    NHS PRESCRIPTIONS                            your accepted disablement.

    You can get free NHS prescriptions if at   Supplied free:
    the time the prescription is dispensed     • medication given to you to take at a
    you:                                         hospital or an NHS Walk in Centre
    • are aged 60 or over                      • prescribed contraceptives
    • are under 16                             • medication personally administered
    • are aged 16, 17 or 18 in full-time         to you by a GP
      education                                • medication supplied at a hospital or
    • are pregnant, or have had a baby in        PCT clinic for the treatment of a
      the previous 12 months and have a          sexually transmissible infection (STI)
      valid exemption certificate              • medication supplied by a PCT or Trust
    • have a listed medical condition and        or by a Patient Group Direction for
      have a valid exemption certificate         the treatment of Tuberculosis
    • have a continuing physical disability    • medication supplied by a PCT or Trust
      which means you cannot go out              or by a Patient Group Direction to a
      without help from another person           person subject to a supervised
      and have a valid exemption                 community treatment order for the
      certificate                                treatment of a mental disorder.
    • are an NHS in-patient
    • get or are included in an award of       NOTE: if you need a wig or fabric support
      someone getting:                         read page 14.
      – Income Support
      – Income-based Jobseeker’s
         Allowance (Incapacity Benefit or      NHS DENTAL TREATMENT
         Disability Living Allowance do not    You can get free NHS dental
         count, as they are not income-        treatment if:
         related)
      – Income-related Employment and          • when the treatment starts you are:
         Support Allowance                       • aged under 18
      – Pension Credit Guarantee Credit          • aged 18 in full-time education
    • are entitled to, or named on, a valid      • pregnant, or have had a baby
      NHS tax credit exemption certificate         in the 12 months before treatment
    • are named on a valid HC2 certificate         starts
                                                 • an NHS in-patient and the

8    HC11 – Help with health costs                                     QUICK CHECK GUIDES   9
treatment is carried out by the       NHS SIGHT TESTS
         hospital dentist
       • an NHS Hospital Dental Service        You can get free sights tests if you:
         out-patient*                          • are under 16
                                               • are aged 16,17 or 18 in full-time
       * There may be a charge for                education
         dentures and bridges.                 • are aged 60 or over
                                               • are a diagnosed glaucoma patient
     • when the treatment starts or when       • have been advised by an
       the charge is made you:                    ophthalmologist that you are at risk
       • get or are included in an award          of glaucoma
         of someone getting:                   • are aged 40 or over and are a parent,
         – Income Support                         brother, sister, son or daughter of a
         – Income-based Jobseeker’s               diagnosed glaucoma patient
           Allowance (Incapacity Benefit       • have been diagnosed as diabetic
           or Disability Living Allowance      • are registered as severely sight-
           do not count as they are not           impaired/blind or sight-impaired/
           income-related)                        partially sighted
         – Income-related Employment and       • need complex lenses
           Support Allowance                   • are someone whose sight test is
         – Pension Credit Guarantee Credit        carried out through the hospital
     • are entitled to, or named on, a valid      eye department as part of the
       NHS tax credit exemption certificate       management of your eye condition
     • are named on a valid HC2 certificate.   • get or are included in an award of
                                                  someone getting:
     Partial help: if you are named on a          – Income Support
     valid HC3 certificate you might get          – Income-based Jobseeker’s
     some help towards the cost of your             Allowance (Incapacity Benefit or
     NHS dental treatment.                          Disability Living Allowance do not
                                                    count as they are not income-
     War pensioners – read page 28.                 related)
                                                  – Income-related Employment and
                                                    Support Allowance
                                                  – Pension Credit Guarantee Credit
                                               • are entitled to, or named on, a valid
                                                  NHS tax credit exemption certificate
                                               • are named on a valid HC2 certificate.

10    HC11 – Help with health costs                                   QUICK CHECK GUIDES   11
Partial help: if you are named on a valid   NHS VOUCHERS FOR REPAIR
     HC3 certificate you might get some help     OR REPLACEMENT OF GLASSES
     towards the cost of a private sight test.   OR CONTACT LENSES

     War pensioners – read page 28.              You can get vouchers if you:
                                                 • are under 16 (if you are 16 or over,
     NHS OPTICAL VOUCHERS                          conditions apply – read page 35).
     You can get vouchers towards the costs      NHS TRAVEL COSTS
     of glasses or contact lenses if you:
     • are under 16                              You can get help with necessary travel
     • are aged 16, 17 or 18 in full-time        costs to receive NHS treatment through
        education                                a referral by a doctor or dentist if you:
     • need complex lenses – read page 34        • get or are included in an award of
     • get or are included in an award of           someone getting:
        someone getting:                            – Income Support
        – Income Support                            – Income-based Jobseeker’s
        – Income-based Jobseeker’s                     Allowance (Incapacity Benefit or
          Allowance (Incapacity Benefit or             Disability Living Allowance do not
          Disability Living Allowance do not           count as they are not income-
          count as they are not income-                related)
          related)                                  – Income-related Employment and
        – Income-related Employment and                Support Allowance
          Support Allowance                         – Pension Credit Guarantee Credit
        – Pension Credit Guarantee Credit        • are entitled to, or named on, a valid
     • are entitled to, or named on, a valid        NHS tax credit exemption certificate
        NHS tax credit exemption certificate     • are named on a valid HC2 certificate
     • are named on a valid HC2 certificate.        (includes travel by your
                                                    dependent children)
     Partial help: if you are named on a valid
     HC3 certificate, you might get some         • are a war pensioner and the
     help.                                          treatment is for a disability that the
                                                    Service Personnel and Veterans
     NOTE: If your glasses or contact lenses        Agency accepts for treatment
     cost more than your voucher value, you
     will have to pay the difference.            Children under 16 and young people 16
                                                 and over – read pages 39-40.
     War pensioners – read page 28.

12    HC11 – Help with health costs                                      QUICK CHECK GUIDES   13
Partial help: if you are named on a       Age groups
     valid HC3 certificate you might get
     some help.                                CHILDREN UNDER 16 AND YOUNG
                                               PEOPLE AGED 16, 17 AND 18 IN
     NHS WIGS AND FABRIC SUPPORTS              FULL-TIME EDUCATION

     You can get free wigs and fabric          Qualifying full-time education means
     supports if you:                          you must be receiving full-time
     • are under 16                            instruction at a recognised educational
     • are aged 16, 17 or 18 in full-time      establishment or by other means
       education                               accepted as comparable by the
     • are a hospital in-patient               Secretary of State to a school, college or
     • have a valid war pension exemption      university. You will be covered between
       certificate and the wig or fabric       years or when changing schools if a
       support is for your accepted            letter is provided from the school /
       disablement                             college to be attended in September. If
     • get or are included in an award of      it is not a recognised establishment, you
       someone getting:                        still may be able to claim for help with
       – Income Support                        health costs under the NHS Low Income
       – Income-based Jobseeker’s              Scheme – read pages 24-27.
          Allowance (Incapacity Benefit or
          Disability Living Allowance do not   You are generally not considered to be
          count as they are not income-        receiving full-time education once you
          related)                             have finished A Level (or equivalent) as
       – Income-related Employment and         you will have come off a school or
          Support Allowance                    college register. If however you do
       – Pension Credit Guarantee Credit       intend to continue in full-time
     • are entitled to, or named on, a valid   education and have a letter offering
       NHS tax credit exemption certificate    you a higher education place for the
     • are named on a valid HC2 certificate.   term following your further education,
                                               you may be eligible during the
     Partial help: if you are named on a       vacation.
     valid HC3 certificate you might get
     some help.                                You get free:
                                               • NHS prescriptions
                                               • NHS dental treatment for any course
                                                 of treatment that starts before your
                                                 19th birthday

14    HC11 – Help with health costs                                         AGE GROUPS   15
• NHS sight tests                              Authority care – read page 36
     • NHS wigs and fabric supports.              • if you do not have much money to
                                                    pay other health costs, you can still
     You also get:                                  claim for help – read pages 24-27.
     • vouchers towards the cost of
       glasses or contact lenses                  PEOPLE AGED 60 OR OVER
       NOTE: If you have lost or damaged
       your glasses or contact lenses – read      You get free:
       page 35. If you need help with travel      • NHS prescriptions
       costs for NHS treatment – read pages       • NHS sight tests.
       39-40.
                                                  If you need help with other health
     YOUNG PEOPLE AGED 19 IN FULL TIME            costs, check to see if you fit into any of
     EDUCATION OR TRAINING                        the groups listed on pages 5–7.

     If someone (usually a parent) still          Income groups
     receives Child Benefit and tax credits for
     you, and their income is equal to or less    PEOPLE GETTING BENEFITS OR TAX
     than the qualifying level (please see        CREDITS
     page 21) you are entitled to the same
                                                  You, your partner and any dependant
     things as those aged under 19 in full
                                                  children and young people under 20
     time education - see above.
                                                  included in the award of the benefit or
                                                  credit are entitled.
     OTHER YOUNG PEOPLE NOT
     IN FULL-TIME EDUCATION                       If you are waiting for your claim to be
                                                  settled and need help urgently with any
     You get free:                                health costs – read pages 24-27.
     • NHS dental treatment for any course
       of treatment which starts before your      INCOME SUPPORT (IS)
       18th birthday.
                                                  If you are included in the award you
     You may also get help:                       get free:
     • with travel costs for NHS treatment –      • NHS prescriptions
       read pages 39-40                           • NHS dental treatment
     • if you are aged 16 or 17 and are           • NHS sight tests
       supported by a Local Authority             • NHS wigs and fabric supports.
       because you have recently left Local
16    HC11 – Help with health costs                                           INCOME GROUPS   17
You and your partner also get:              to the same things as people getting
     • a voucher towards the cost of glasses     Income Support – read page 17.
       or contact lenses
     • refunds of necessary travel costs to
                                                 CONTRIBUTION-BASED EMPLOYMENT
       receive NHS treatment under the care
                                                 AND SUPPORT ALLOWANCE – ESA(C)
       of a consultant, or through a referral
       by a doctor or dentist.
                                                 IMPORTANT: On its own, ESA(C) does not
                                                 entitle you to help with health costs. If
     INCOME-BASED JOB SEEKER’S
                                                 you have to pay health costs, check to
     ALLOWANCE – JSA (IB)
                                                 see if you are in any of the groups
     You, your partner and any dependent         listed on pages 5–7. You might be able
     children and young people under 20          to get help if you are on a low income –
     included in a JSA (IB) claim are entitled   read pages 24-27.
     to the same things as people getting
     Income Support – read page 17.              If you are not sure about the type of
                                                 ESA you are getting, ask at your
     CONTRIBUTION-BASED JSA – JSA(C)             Jobcentre Plus office.

     IMPORTANT: On its own, JSA(C) or            PENSION CREDIT GUARANTEE CREDIT
     contribution based Employment and
     Support Allowance does not entitle you      If you get:
     to help with health costs. If you have to   • Pension Credit Guarantee Credit
     pay health costs, check to see if you are   • Pension Credit Guarantee Credit with
     in any of the groups listed on pages           Savings Credit, or
     5–7. You might be able to get help if       • If you are aged under 60 and your
     you are on a low income – read pages           partner gets either of the above, you,
     24-27.                                         your partner and any dependent
                                                    children and young people under 20
     If you are not sure about the type of          included in a Pension Credit
     JSA you are getting, ask at your               Guarantee Credit claim are entitled to
     Jobcentre Plus office.                         the same help with health costs as
                                                    people getting
     INCOME-RELATED EMPLOYMENT AND                  Income Support – see page 17.
     SUPPORT ALLOWANCE – ESA(IR)
                                                 IMPORTANT: If you only get Pension Credit
     You, your partner and any dependent         Savings Credit on its own, this does not
     children and young people under 20          entitle you to help with health costs. If
     included in an ESA(IR) claim are entitled
18    HC11 – Help with health costs                                        INCOME GROUPS   19
you have to pay health costs, check to           TAX CREDITS
     see if you are in any of the other
     groups listed on pages 5–7. You might            These are:
     be able to get help if you are on a low          • Working Tax Credit (WTC)
     income – read pages 24-27.                       • Child Tax Credit (CTC)

                                                   1. If you meet the qualifying conditions
     How to check if you are getting                  (read paragraph 3 in this section) you
     Pension Credit Guarantee Credit                  will automatically be sent an NHS tax
     Your award notice tells you what type            credit exemption certificate by the NHS
     of Pension Credit you get. This is shown         Business Services Authority (NHSBSA).
     at item 5 on the page entitled ‘How              You do not need to apply for a
     your Pension Credit has been worked              certificate – but read paragraph 7.
     out’. If you have not received an award
     notice, or have mislaid it, you should        2. If you meet the qualifying conditions
     ring the Pension Centre on local call            you can get free:
     rate number 0845 6060 265 and ask for
     a copy.                                          •   NHS   prescriptions
                                                      •   NHS   dental treatment
     OTHER BENEFITS                                   •   NHS   sight tests
                                                      •   NHS   wigs and fabric supports.
     Only IS, JSA (IB), ESA(IR) and Pension
                                                      You also get:
     Credit Guarantee Credit give you, your
                                                      • vouchers towards the cost of glasses
     partner and any dependent children and
                                                        or contact lenses
     young people under 20 included in the
                                                      • refunds of necessary travel costs to
     claim automatic help with health costs.
                                                        receive NHS treatment under the care
     IMPORTANT: Other benefits, such as                 of a consultant, or through a referral
     Incapacity Benefit or Disability Living            by a doctor or dentist.
     Allowance, do not entitle you to help            This also applies to your partner or any
     with health costs. This is because they are      dependent children and young people
     not income related. If you have to pay           under 20 included in your Tax Credit
     health costs, check to see if you are in         assessment.
     any of the other groups listed on pages
     5–7. You can also get help if you are on      3. To qualify for help with health costs:
     a low income – read pages 24-27.
                                                      • your family income for tax credits
                                                        must be £15,276* or less (this is on

20    HC11 – Help with health costs                                               INCOME GROUPS   21
your tax credit award notice or decision         getting tax credits who are entitled to
     letter issued by HM Revenue and                  an exemption certificate. The NHSBSA
     Customs (HMRC)) and one of the                   will send out exemption certificates. You
     following applies:                               do not have to apply for one.
        – you are working and have children
          so you get WTC and CTC, or                  If you have an award but no certificate
        – you are working and disabled so you      7. The NHSBSA cannot send you an
          get WTC with a disability element or        exemption certificate until they receive
          severe disability element – check           the information from HMRC. This could
          your award notice or decision letter,       be up to six weeks after you get your tax
          or                                          credit award. If you meet the conditions
        – you are not eligible for WTC but            for help listed in paragraph 3, you can
          get CTC.                                    sign NHS treatment forms to say you do
                                                      not have to pay because you get tax
     * If you are reading this after 6 April          credits.
     2010, you should check to see if this
     figure has been increased.                       Use your award notice as evidence of
                                                      your entitlement until your certificate
     To find out more about Tax Credits visit         arrives.
     www.hmrc.gov.uk/taxcredits.
                                                   8. If you are still unsure about whether or
4. If you are unsure about the amount                 not you are entitled to an NHS tax
   of your income for tax credit purposes,            credit exemption certificate, ring the
   you can check this with HMRC’s Tax                 NHSBSA on 0845 609 9299, and have
   Credit Helpline on: 0845 300 3900.                 your tax credit award notice ready so
                                                      you can tell them what is on it.
     For people with hearing or speech
     difficulties, HMRC’s Helpline number is          If you lose your Tax Credit Exemption
     0845 300 3909.                                   Certificate
                                                   9. Tell the NHSBSA by writing to:
5. If you have made a claim for tax credit            Exemption Issue Office, PO Box 1011,
   but not yet received your award notice             Newcastle-upon-Tyne, NE99 2ZP, and let
   or decision letter, you should contact             them know what happened. They will
   the HMRC on the above number (not                  send you a duplicate.
   the NHSBSA).
                                                      If you do not qualify for help through
   NHS Tax Credit Exemption Certificates              Tax Credit Exemption
6. HMRC will send information to the              10. If you do not meet the conditions in
   NHSBSA each month about people                     paragraph 3, you may be able to claim
22    HC11 – Help with health costs                                              INCOME GROUPS   23
help through the NHS Low Income             will need to claim Child Tax Credit from
      Scheme – read pages 24-27.                  HMRC. To find out more about Tax
                                                  Credits visit www.hmrc.gov.uk/taxcredits
11. Ring HMRC’s Tax Credit Helpline on            or phone 0845 300 3900.
    0845 300 3900 for advice about other
    help (as well as help with health costs)      If you would like to find out if the NHS
    that might be available through tax           Low Income scheme can help you, pick
    credits.                                      up an HC1 form (claim for help with
                                                  health costs) from a Jobcentre Plus
      THE NHS LOW INCOME SCHEME                   office or NHS hospital. Your dentist or
                                                  optician may have copies too, or ring
      If you have to pay for any of the items     0845 610 1112 for one.
      listed on page 2 of this leaflet, and are
      on a low income (for example, on            You can fill in a special short claim form,
      Incapacity Benefit only), the NHS Low       the HC1(SC) if either of the following
      Income Scheme may be able to help           applies to you:
      you with health costs. But if you have      • you live permanently in a care home
      capital which is over the capital limits      and the local authority helps you
      which are currently £16,000 or £23,000*       with the cost
      for people who live permanently in a        • you are supported by the local
      care home, you cannot claim any help          authority because you are aged
      through this scheme.                          16 or 17 and recently left local
                                                    authority care.
      * If you are reading this after 7 April
      2009, you should check to see if the        Ask your home manager/local
      capital limits have changed.                authority/care worker for an HC1(SC)
                                                  claim form. Otherwise, use the normal
      If you have a partner, their property,      form, the HC1.
      savings and any other money is counted
      with yours.                                 If you are aged 16 or over, you can
                                                  make your own claim on an HC1, but
      A partner is a person you live with as      you needn’t do this if you count as a
      part of a couple of the same or             dependant of someone who is getting
      opposite sex, whether or not you are        any of the eligible benefits or credits
      married or have a civil partnership.        listed on pages 17–23.

      Children will not be included in the NHS    If a dependent child under 16 has to go
      Low Income Scheme assessment. You           to for NHS treatment under the care of

 24    HC11 – Help with health costs                                          INCOME GROUPS   25
a consultant, or through a referral by a    If you qualify for help you will be sent
     doctor or dentist, you can claim help       an NHS certificate HC2 for full help or
     with their travel costs. Any help will be   an NHS certificate HC3 for partial help
     based on the parent’s income, not the       with health costs. The certificate will
     child’s.                                    tell you who it covers and how long
                                                 it lasts.
     Fill in the HC1 or HC1(SC) and send it
     off in the envelope that comes with it.     If your circumstances change for the
     The claim form tells you what to do         better, you do not need to report it. If
     and may ask you to send in evidence         your circumstances change for the
     of your income.                             worse, you should make another claim.
     If you have any queries about how to        People seeking asylum and who are
     fill in these forms, what to send, or       supported by the Border and
     need help with translation you can call     Immigration Agency (BIA), including
     the NHSBSA on 0845 850 1166, or write       those on subsistence support only, will
     to:                                         be sent an NHS charges certificate (HC2)
     NHS Business Services Authority,            for full help with health costs with their
     Sandyford House,                            first support payments – also read pages
     Newcastle-upon-Tyne                         28-29.
     NE2 1DB
                                                 IMPORTANT: An HC2 certificate does not
     After you have sent off the claim form,     entitle you to NHS treatment. It entitles
     the NHSBSA use the information you          you to full help with health costs if you
     have supplied to work out how much          have been accepted for NHS treatment.
     help you might get towards your health
     costs.                                      If you need help urgently with any
                                                 health costs before IS, JSA (IB), ESA(IR),
     To work out your low income                 Pension Credit or tax credits are
     entitlement, your income will be            awarded, make a separate claim on an
     compared with your ‘requirements’,          HC1. Do not wait for your benefit or
     which include a personal allowance,         credit claim to be settled. But if you
     premiums, plus housing costs and            have a tax credit award notice, read
     council tax you have to pay. The HC1        pages 20-23 to see if you can get help
     tells you more about this and explains      without making a low income claim.
     what counts as income.
                                                 If you do not want to delay your NHS
     NHS Low Income Scheme Certificates          treatment or repair/replacement of

26    HC11 – Help with health costs                                          INCOME GROUPS   27
glasses (but read page 35 first) or need   remain in the UK and people accepted
     emergency NHS dental treatment, you        as coming to work or study in the UK),
     may need to pay and claim a refund         and who are accepted for NHS
     later.                                     treatment, may claim help with health
                                                costs in the same way as other
     If you want to claim a refund of any       residents.
     health cost – read pages 48-55.
                                                If you are accepted for NHS treatment,
     Other groups                               first check to see if you are in one
                                                of the groups listed on pages 5–7.
     WAR PENSIONERS                             Otherwise, you can make a claim
                                                under the NHS Low Income Scheme
     You get free NHS prescriptions and NHS     – read pages 24-27.
     wigs and fabric supports at the point of
     treatment if you have a valid war          Further information about people who
     pension exemption certificate and the      come from abroad can be found on the
     treatment is for your accepted             Department of Health website, at
     disablement.                               www.dh.gov.uk/overseasvisitors

     You can claim money back for dental        People seeking asylum and who are
     treatment, travel costs, sight tests,      supported by the Border and
     glasses or contact lenses if the           Immigration Agency (BIA), including
     treatment, or the reason for travel, is    those on subsistence support only, will
     for your accepted disablement.             be sent an NHS charges certificate (HC2)
     Write to: The Treatment Group, Service     for full help with health costs with their
     Personnel and Veterans Agency,             first support payments.
     Norcross, Blackpool FY5 3WP. You can
     get a pre-paid addressed envelope from     People seeking asylum, who are not in
     Post Offices.                              one of the groups listed on pages 5-7
                                                and are not supported by BIA or failed
     Otherwise, check if you are in any of      asylum seekers need to make a claim
     the groups listed on pages 5–7.            under the NHS Low Income Scheme -
                                                read pages 24-27.
     PEOPLE FROM ABROAD
                                                Information for health staff, service
     People who come from abroad and are        planners and agencies providing advice
     accepted as ordinarily resident in the     to asylum seekers is in Caring for
     UK (including those given leave to         dispersed asylum seekers – A resource

28    HC11 – Help with health costs                                         OTHER GROUPS   29
pack, a copy of which is available to      • because you are undergoing
     download from the Department of              treatment for cancer. Including for the
     Health’s website, at www.dh.gov.uk           effects of cancer or the effects of
     Please use the advanced search facility      previous or current cancer treatment.
     to look for the title.                       Exemption for this condition applies
                                                  from 1 April 2009 only.
     PEOPLE WITH A SPECIFIED MEDICAL
     CONDITION                                  NOTE: We ask doctors to advise you
                                                about free prescriptions, but it is up to
     You can get free:                          you to find out if you are entitled or
     • NHS prescriptions if you have a valid    not. Only the conditions listed count. If
       medical exemption certificate            you are unsure about the name of your
       because you have:                        condition, check with your doctor.
       – a permanent fistula (for example,
          caecostomy, colostomy, laryngos-      You can also get free:
          tomy or ileostomy) requiring          • NHS prescriptions for the treatment
          continuous surgical dressing or         of
          requiring an appliance                  – a sexually transmissible infection
       – a form of hypoadrenalism (for               (STI)
          example, Addison’s Disease) for         – for a patient subject to a
          which specific substitution therapy        community treatment order, in
          is essential                               respect of any drug supplied to
       – diabetes insipidus and other forms          that patient for the treatment of a
          of hypopituitarism                         mental disorder
       – diabetes mellitus, except where          – medication for the treatment of
          treatment is by diet alone                 tuberculosis
       – hypoparathyroidism                       when the medication is supplied at
       – myasthenia gravis                        a hospital or Primary Care Trust (PCT)
       – myxoedema (that is,                      clinic.
          hypothyroidism requiring thyroid      • NHS sight test if you:
          hormone replacement)                    – are a diagnosed glaucoma patient
       – epilepsy requiring continuous anti-      – are aged 40 or over and are the
          convulsive therapy                         parent, brother, sister, son or
       – you have a continuing physical              daughter of a person with
          disability which means you cannot          diagnosed glaucoma
          go out without the help of              – have been advised by an
          another person, or                         ophthalmologist that you are
                                                     at risk of glaucoma
30    HC11 – Help with health costs                                         OTHER GROUPS   31
– are a diagnosed diabetic.               that your certificate needs to be
                                                 renewed, but if not, it is your
     NOTE:  the medication to treat the          responsibility to ensure that it is
     STI is only free if it is supplied by the   renewed.
     hospital or PCT clinic. You will have
     to pay charges in the normal way if
     the hospital or clinic gives you a          PREGNANT WOMEN AND THOSE WHO
     prescription form to take to your ‘high     HAVE HAD A BABY IN THE PREVIOUS
     street’ pharmacy, even if the medication    12 MONTHS
     is for an STI. You will also have to pay
     charges in the normal way for any           You get free:
     other medication supplied by the            • NHS prescriptions – but only if you
     hospital or clinic.                           have a valid maternity exemption
                                                   certificate/card issued by the NHS
     Getting your medical exemption                Business Services Authority
     certificate
                                                 • NHS dental treatment if, when
     To apply for a medical exemption              you are accepted for a course of
     (Medex) certificate, ask your doctor for      treatment, you are pregnant or
     Form FP92A. The form tells you what to        have had a baby in the previous
     do. Your GP, hospital or service doctor       12 months.
     (or, if the GP chooses, a member of the
     GP’s practice who can access your           To apply for your maternity exemption
     medical records) will sign the form to      card ask your doctor, nurse, midwife or
     confirm your statement.                     health visitor for Form FW8. The form
                                                 tells you what to do. Your doctor, nurse,
     The certificate will start one month        midwife or health visitor will sign the
     before the date that the NHS Business       form to confirm your statement.
     Services Authority (NHSBSA) receives
     the application form (except for            Your exemption card will last until
     certificates for those receiving            12 months after the expected date of
     treatment for cancer, which cannot start    birth. If your baby is born early, you can
     before 1 April 2009). Your exemption        continue to use your exemption card
     certificate will be posted to you.          until it expires. If your baby is born late,
                                                 you can apply for an extension. If you
     Medical exemption certificates normally     apply after your baby is born, your
     last for five years and then need to be     exemption card will run for 12 months
     renewed. You may receive a reminder         from your baby’s birth.

32    HC11 – Help with health costs                                           OTHER GROUPS   33
PEOPLE WHO NEED LOTS OF                     PPC start date
     PRESCRIPTIONS BUT HAVE TO PAY               The PPC will start from the date your
     CHARGES: PRESCRIPTION PREPAYMENT            application is received unless you ask
     CERTIFICATES (PPC)                          for a different start date. This can be
     If you are not entitled to free             up to one month before or one month
     prescriptions and you think you will        later than the date your application
     have to pay for 4 or more items             is received.
     in 3 months or more than 14 items in 12
     months, you may find it cheaper to buy      PEOPLE REGISTERED SEVERELY
     a PPC.                                      SIGHT-IMPAIRED/BLIND OR SIGHT-
     To check the cost of a PPC you can          IMPAIRED/PARTIALLY SIGHTED
     either visit,
     www.nhsbsa.nhs.uk/healthcosts, ring         You get free NHS sight tests. If you
     0845 850 0030 or look in leaflet HC12       need help with other health costs,
     (available in some pharmacies or GP         check if you are in one of the groups
     surgeries).                                 listed on pages 5–7.
     You can choose to pay for a 12-month
     PPC by 10 monthly Direct Debit              PEOPLE WHO NEED COMPLEX LENSES
     instalments. If you pay using this option
     you are entering into a commitment to       You get free NHS sight tests if you’re
     pay all the instalments. If you use the     prescribed complex or powerful glasses
     PPC after failing to pay an instalment      with at least one lens which:
     you may have to pay a penalty charge.       • has a power in any one meridian of
     The PPC cannot be issued until the first      plus or minus 10 or more dioptres; or
     Direct Debit instalment is paid.            • is a prism-controlled bifocal lens.
     You can apply for a PPC:
                                                 You also get a voucher towards the
     • On- line at                               cost of glasses or contact lenses.
       www.nhsbsa.nhs.uk/healthcosts
     • By phoning 0845 850 0030                  PEOPLE WHO HAVE LOST OR
     • By filling in form FP95, available from   DAMAGED THEIR GLASSES
       your pharmacy. The form tells you         OR CONTACT LENSES
       what to do.
                                                 If you are under 16, you get a
     For other enquiries about applications      voucher towards the cost of repair
     for PPCs, or to report lost or stolen       or replacement.
     PPCs, please ring 0845 601 8076.
34    HC11 – Help with health costs                                         OTHER GROUPS   35
If you are 16 or over, you may be            all or part of the cost – read pages
     entitled to a voucher towards the cost       24-27
     of repair or replacement if your PCT       • otherwise, check to see if you are in
     agrees that:                                 any of the other groups listed on
     • the loss or damage was due to illness;     pages 5–7 or check to see if you can
        and                                       get help via the NHS Low Income
     • you can’t get any help through a           Scheme – read pages 24-27.
        warranty, insurance or after sales
        service; and                            PEOPLE SUPPORTED BY A LOCAL
     • you would be entitled to an NHS          AUTHORITY AFTER LEAVING CARE –
        voucher for glasses or contact          CARE LEAVERS
        lenses – read page 12.
                                                If you are aged 16 or 17 and supported
     If in doubt contact your PCT.              by a local authority because you
     This does not apply to disposable          recently left local authority care, you
     contact lenses.                            are entitled to full help with health
                                                costs through the NHS Low Income
     PEOPLE WITH IMPAIRED HEARING
                                                Scheme – read pages 24-27.
     You can get free, on loan, NHS hearing
     aids. The aids will be supplied with       If you are not supported by a local
     batteries (and replacements) and fitted,   authority and you are not getting
     serviced and maintained free of charge.    Income Support, Income-based
     If you want more information, please       Jobseeker’s Allowance, Income-related
     ask your GP.                               Employment and Support Allowance or
     PEOPLE LIVING IN A CARE HOME               Child Tax Credit, you may still be able to
                                                get help through the Low Income
     These were previously called residential   Scheme. Also check if you are in any of
     care homes or nursing homes. Living        the groups on pages 5–7.
     in care home does not automatically
     entitle you to help.
     • if you are under 60 and getting          NHS IN-PATIENTS
        Income Support or Income-related
                                                You get free:
        Employment and Support Allowance
                                                • all NHS treatment,
        – read pages 17-18
                                                • NHS wigs and fabric supports
     • if you are 60 or over and getting
                                                  supplied while in hospital
        Pension Credit Guarantee Credit
                                                • glasses or contact lenses supplied
        – read page 19
                                                  through the hospital eye department
     • if the local Authority helps you with

36    HC11 – Help with health costs                                         OTHER GROUPS   37
if clinically necessary (but you must        test as part of the management of
       choose the cheapest frame available).        your eye condition while you are
       If you choose a more expensive one           still a patient of the hospital eye
       (except for medical reasons), you will       department, that sight test is free.
       have to pay the difference                   If your consultant decides that for
     • medication given to you while you            clinical reasons a change of glasses or
       are still an in-patient to take home         contact lenses is needed shortly after
       with you when you leave hospital.            you have bought a pair, you will not
                                                    be charged for the second pair. You
     NOTE:  If you ask a dentist or optician to     may also get help towards the first
     visit you in hospital, you will have to        pair if you are in one of the groups
     pay the cost in the normal way, as if          entitled to a voucher – read page 12
     you were being treated at their              • medication supplied by a PCT or Trust
     practice. Read pages 5–7 to see if you         or by a Patient Group Direction for
     are in a group that can get free NHS           the treatment of Tuberculosis
     dental treatment, a free NHS sight test      • medication supplied by a PCT or Trust
     or vouchers towards your glasses.              or by a Patient Group Direction to a
                                                    person subject to a supervised
                                                    community treatment order for the
     NHS OUT-PATIENTS/DAY PATIENTS                  treatment of a mental disorder.
     You get free:                                PEOPLE WHO NEED TO TRAVEL TO
     • all medication given to take               RECEIVE NHS TREATMENT
       while you’re being treated at the
       hospital. But you pay a prescription       You may be entitled to help with your
       charge(s) for any medication you           travelling costs if:
       are prescribed to take at home,            • you attend a hospital, or other place,
       unless you’re entitled to free                to receive NHS treatment under the
       NHS prescriptions                             care of a consultant, or through a
     • medication supplied at a hospital             referral by a doctor or dentist. This
       to treat an STI                               includes tests and check-ups and visits
     • NHS dental treatment carried out at           for treatment of STIs
       the hospital (but there may be a           • you travel by the cheapest means
       charge for dentures and bridges               of transport which it is reasonable
       unless you are entitled to free NHS           for you to use
       dental treatment)                          • in the opinion of your doctor, you
     • sight tests. If your consultant refers        need someone to travel with you,
       you to an optometrist for a sight             your companion’s travel costs are

38    HC11 – Help with health costs                                          OTHER GROUPS   39
added to your travel costs and it’s     consultant, or through a referral by a
          your income that counts                 doctor or dentist – read pages 39-40.
     •    you are getting benefits or
          credits – read pages 17-23              Regardless of your income, you can get
     •    you have a low income – read            help with the cost of return travel from
          pages 24-27                             the point where you leave GB to where
     •    you are 16 or over but under 20         you are going to be treated. Your
          and are counted as a dependant          method of travel (e.g. air or rail) and
          of someone getting any of the           the cost must be agreed before you
          benefits/credits on pages 17-23, you    travel by the person arranging your
          get help via that benefit or credit     treatment. If the person arranging your
     •    you are 16 and over and not a           treatment considers that you need
          dependant of a person who gets          someone to travel with you, ask them
          benefits or credits, you can make       about help with your companion’s
          your own claim, even if you live with   travel costs.
          your parents – read pages 24-27
     •    the patient is a child under 16; it     OTHER TRAVEL ARRANGEMENTS
          is their parent’s income that counts.
          If someone else takes them to           The Isles of Scilly
          hospital, it is still the parents’      You get help with the cost of travel to a
          income that counts.                     mainland hospital for NHS treatment.
                                                  Leaflet HC12 tells you how much this is.
     If you are not sure what travel costs you    See your health centre before you
     can get help with, ask the hospital          travel.
     before you travel. For more information
     go to: www.dh.gov.uk and use the             There is a set maximum you have to pay
     advanced search facility to look up          unless you get free travel, or help with
     NHS travel costs.                            the costs. Leaflet HC12 tells you how
                                                  much this is.
     NHS TREATMENT ABROAD
                                                  Claiming help when you go for
     You may be able to get help with the         treatment
     cost of travel from your home to the
     international rail terminal, port or         NHS PRESCRIPTIONS
     airport where you leave Great Britain.
     The arrangements are the same as if you      People who do not have to pay should
     were travelling from home to receive         fill in the back of their prescription
     NHS treatment under the care of a            form. Put a cross in the first box in

40       HC11 – Help with health costs                   CLAIMING HELP WHEN YOU GO FOR TREATMENT   41
Part 1 that applies to you and complete    for details of charges.
     and sign Part 3 on the back of the
     prescription form. If someone else         If your circumstances change before you
     (your representative) goes to get your     are asked to pay, read page 9 to see if
     prescription, they should complete         you are entitled to free NHS dental
     the back of the prescription form. Or      treatment.
     you can do this before you give them
     the prescription form. You, or your        You will be asked to show proof of your
     representative, may be asked to show       entitlement to help with dental costs –
     proof of your entitlement to free          check the tables on pages 62-67 for
     prescriptions – check the tables on        more information about this.
     pages 56-61 for more information
     about this.                                When you claim help with the cost of
                                                your NHS dental treatment, you are
     If you are under 16 years of age or        responsible for knowing whether or not
     aged 60 or over and your date of birth     you are entitled and for the declaration
     is printed on the prescription form you    you make. If you are not sure you are
     do not need to make a signed               entitled to help then you must pay.
     declaration.                               You can claim a refund, make sure you
                                                keep all receipts (see page 51).
     NHS DENTAL TREATMENT
                                                SIGHT TESTS
     Tell the dentist you want NHS
     treatment when you make the                When you go for your sight test, tell
     appointment. Sign the form you are         the optician if you are entitled to a
     given when you go for treatment.           free NHS sight test and ask for Form
     If you do not have to pay, put a cross     GOS1 to apply for it.
     in the appropriate box. If you have        • If you have a valid HC2 certificate
     a valid HC2 certificate or Tax Credit         for full help or Tax Credit Exemption
     Exemption Certificate, write in the           Certificate, you must show it to your
     certificate number.                           optician.
                                                • If you are severely sight-impaired/
     If you have a valid HC3 certificate,          blind or sight-impaired/partially
     write in the certificate number and the       sighted, the name and address
     maximum your certificate says you can         of the Local Authority where
     pay. You will pay either what appears         you’re registered has to be put
     on the certificate or the actual charge,      on Form GOS1.
     whichever is the least. See leaflet HC12   • If you have diabetes or glaucoma,

42    HC11 – Help with health costs                     CLAIMING HELP WHEN YOU GO FOR TREATMENT   43
or have been advised by an                   and sign GOS3 when you order your
       ophthalmologist that you are at              lenses or glasses to say why you
       risk of glaucoma, the name and               are entitled to the voucher and to
       address of your doctor has to be             confirm that you have received your
       put on form GOS1.                            glasses or contact lenses. Show the
     • If you already need a complex lens, if       optician proof of your entitlement
       possible show the optician your last         to use a voucher.
       prescription or the glasses you            • If you have a valid HC3 certificate,
       are wearing.                                 you can ask for a GOS3 voucher form.
                                                    Show your HC3 to the optician when
     The optician will give you Form GOS2           you order glasses or contact lenses
     showing the results of your sight test.        and ask if you can get any help
                                                    towards the cost. Your voucher
     If you have a valid HC3 Certificate,           value will be reduced by the amount
     show it to the optician and ask if you         shown on your HC3.
     are entitled to any help with the cost
     of your private sight test. You apply        You may be asked to show proof of
     for this help on Form GOS5.                  your entitlement to a free sight test or
                                                  optical voucher. Check the tables on
     NHS VOUCHERS FOR GLASSES OR                  pages 68-75.
     CONTACT LENSES
                                                  NHS VOUCHERS FOR REPAIR OR
     • There is more information about            REPLACEMENT OF GLASSES OR
       using vouchers on the back of your         CONTACT LENSES
       GOS2 form.
     • You may be entitled to a GOS               Ask your optician for Form GOS4 – it
       voucher if you have a new or               tells you what to do.
       changed prescription, or your glasses
       need replacing on the grounds of fair      TRAVEL TO RECEIVE NHS TREATMENT
       wear and tear. Ask for a GOS3              UNDER THE CARE OF A CONSULTANT,
       voucher form when you have your            OR THROUGH A REFERRAL BY A
       sight test, or when you order your         DOCTOR OR DENTIST
       glasses or contact lenses. A GOS3
                                                  If you are referred for treatment under
       voucher form is valid for two years,
                                                  the care of a consultant, or referred by
       but you can only use it if you are still
                                                  a doctor or dentist, and you travel to
       entitled to a voucher for glasses or
                                                  receive that treatment you can claim
       contact lenses when you order them.
                                                  help with the cost of your travel on low
     • The optician will ask you to fill in

44    HC11 – Help with health costs                      CLAIMING HELP WHEN YOU GO FOR TREATMENT   45
income grounds. If you are referred by      For each item, the most you will pay
     a doctor or dentist to the same             will be the amount on the certificate or
     premises but on a different day you can     the actual cost – whichever is the least.
     claim for that travel cost.
                                                 Checks of entitlement
     When you go for treatment, tell the
     hospital (or place where you are being      If you are claiming free treatment, or
     treated) that you want to claim back        you are using an optical voucher, you
     the cost of your journey. Where your        should show proof of why you do not
     place of treatment has a cashier facility   have to pay or why you can use a
     you will be able to claim your money        voucher. For example, an entitlement
     back during your visit. You will be         letter, birth certificate or NHS
     asked to show proof of your                 exemption certificate. For more
     entitlement, such as your award notice,     information about this – read the
     your tax credit exemption certificate or    tables on pages 56-75.
     your HC2 certificate.

     Also keep any tickets or receipts you
     have as proof of the cost.                  If you cannot show proof, you will have
                                                 to sign to say why you do not have to
     Where your place of treatment does          pay (or can have an optical voucher)
     not issue payments (e.g. a GP practice      and you will get your NHS treatment
     or dental surgery) you will need to         free, or be able to use your optical
     claim your expenses using claim form        voucher. But your treatment form will
     HC5(T). It tells you what to do.            be marked as ‘no evidence seen’ so your
                                                 entitlement can be checked later. You
     NHS WIGS AND FABRIC SUPPORTS                won’t be able to get partial help unless
                                                 you show your HC3.
     Tell the person who fits your wig or
     fabric support that you are entitled        If you are not sure you are entitled to
     to it free, and show proof of your          help with health costs then you must
     entitlement or war pension exemption        pay. You can claim a refund, make sure
     certificate.                                you keep all receipts (see page 48).

     If you have a valid HC3 certificate, show   CHECKING YOUR ENTITLEMENT
     it to the person who fits your wig or
     fabric support and ask if you are           Checks will be made as follows:
     entitled to any help with the charge.       • Free prescriptions. The checks will be

46    HC11 – Help with health costs                                    CHECKS OF ENTITLEMENT   47
made by your local Primary Care          Claiming refunds
       Trust (PCT).
     • Full or partial help with NHS dental     NHS PRESCRIPTION CHARGES
       treatment. The checks will be made       Ask your pharmacist, hospital or doctor
       by the Dental Services Division of the   for an NHS receipt form FP57 when you
       NHS Business Services Authority.         pay – you can’t get one later. The
     • Free NHS sight tests and vouchers        receipt form tells you what to do. You
       towards the cost of glasses or contact   have to apply for a refund within 3
       lenses. The checks will be made by       months of paying the prescription
       your local PCT.                          charge.
                                                PRESCRIPTION PREPAYMENT
     The penalty charge                         CERTIFICATE (PPC) FEES
     Any patient found to have wrongly          Full refunds
     claimed help with health costs will face   The patient’s estate can get a full
     penalty charges and, in some cases,        refund if, within the first month of a 3
     prosecution under powers introduced by     or 12-month PPC:
     the Health Act 1999.                       • the PPC holder dies; or
     The penalty charge is a civil fine and     • goes into hospital and dies there
     may be imposed where a patient is             before the certificate runs out.
     found to have wrongly claimed total
     or partial help with health costs. The     Proportional refunds
     penalty charge is five times the amount    You can get a proportional refund of
     owed, up to a maximum of £100. This        your PPC if during the first month of a
     is in addition to the original charge.     3-month PPC or before the start of the
     Payment will be pursued by civil           last month of a 12-month PPC, any of
     recovery if necessary.                     the following happens:
                                                • you become entitled to free
     For further information about penalty         prescriptions and, if applicable,
     charges pick up leaflet HC12 A quick          you have a valid NHS exemption
     guide to help with health costs               certificate
     including charges and optical voucher      • you go into hospital and remain
     values, you may be able to get one from       there until the expiry of the
     your doctor. Or ring 0845 610 1112 to         prepayment certificate.
     order a copy, go to www.cfsms.nhs.uk,
     click on ‘Documents’ and go to ‘Penalty    The patients estate can receive a
     Charge Guidance’. Or ring 0845 850         proportional refund of the PPC if after
     1166 for advice.                           the first month of a 3 or 12-month PPC:

48    HC11 – Help with health costs                                      CLAIMING REFUNDS   49
• the PPC holder dies, or                   to claim a refund.
     • goes into hospital and dies there
       before the certificate runs out.          If you are paying by Direct Debit and
                                                 become exempt you will be required to
     The money refunded will be the              contact your bank or building society to
     difference between the amount due for       cancel the payments.
     the months before you became exempt
     and the amount actually paid. For
     example, a 12-month PPC starts in June,     Time limits for making PPC refund
     the holder dies in January, refund for      claims
     February to May of 4/12 of the fee paid.    You must make your claim for a refund
     Refunds where the full PPC price has        so it is received within the following
     not been paid                               time limits:
                                                 • Following the death of the PPC
     If the PPC holder chose to pay for a           holder – claim within 24 months
     12-month PPC by 10 monthly Direct              of death.
     Debit instalments and full payment has      • You go into hospital and remain
     not been made, the amount of refund            there until the certificate expires:
     you, or the patient’s estate if the PPC        claim must be received within 3
     holder dies, can get is:                       months of the PPC expiry date.
     • the amount of refund payable had          • If you become entitled to free
         the PPC holder paid in full, as            prescriptions: claim must be received
         outlined in previous paragraphs; plus      within 3 months of becoming
     • the amount the PPC holder has paid           exempt.
         to date; minus
     • the full 12-month PPC price.              OTHER REFUNDS
     Making the claim                            You will need a receipt which shows
                                                 you have paid for NHS treatment (see
     If you wish to claim a refund for any       following paragraphs for details). For
     of the reasons listed, send the original    income-based claims, use form HC5
     certificate to:                             appropriate to the charge you have
     NHS Business Services Authority             paid, available from Jobcentre Plus
     PO Box 854                                  offices, NHS hospitals, at
     Newcastle-upon-Tyne                         www.dh.gov.uk/helpwithhealthcosts or
     NE99 2DE                                    by calling 0845 610 1112. Your dentist
                                                 or optician may have one too. The HC5
     telling them the reason why you want        tells you what to do. You will need to
50    HC11 – Help with health costs                                       CLAIMING REFUNDS   51
write a letter (enclosing your receipt) to   dental treatment or sundry items such
     apply for a refund for other reasons.        as toothbrushes cannot be made.
     You will need to send this letter to the     Where a course of treatment is a
     Primary Care trust covering your home        mixture of NHS and private treatment a
     address. You have to claim a refund          refund of the NHS charge only can be
     within three months of paying the            made.
     health cost.
                                                  The Dental Services Division will check
                                                  that you received NHS treatment and
     NHS DENTAL CHARGES                           paid the charge claimed before sending
     Ask your dentist for NHS receipt form        out payment.
     FP64 or a receipt which shows the
     amount of the NHS charge and the date        SIGHT TEST FEES
     you paid.                                    Ask the person who tests your sight for
                                                  a receipt that shows that you paid for
     If you are claiming on the grounds
                                                  the test and the date of payment.
     of low income, complete form HC5(D).
                                                  Complete an HC5(O) refund claim form.
     It tells you where to send the
                                                  The HC5(O) tells you what to do next.
     completed form.
     If you want to claim a refund for            GLASSES OR CONTACT LENS COSTS
     another reason, for example, because         If you have already used a voucher
     you are pregnant, have had a baby in         towards the cost of your glasses or
     the previous 12 months, are aged under       lenses, you cannot get a refund unless it
     18 or are aged 18 in full-time education     was only a ‘complex lens’ voucher. Nor
     you will need to explain why you are         can you claim a refund of the difference
     claiming a refund. Enclose your receipt      between the voucher value and the
     and make sure you include your full          actual cost of your glasses or lenses,
     name and the address of your dentist,        even if they cost more than the voucher
     and write to:                                value.
     NHS Business Services Authority, Dental      If you want to claim a refund, ask the
     Services Division, Compton Place Road,       person who supplies your glasses or
     Eastbourne, East Sussex BN20 8AD.            contact lenses for a receipt which
                                                  shows how much you paid and the date
     If you are a War Pensioner - read page
                                                  of payment. Complete an HC5(O)
     28.
                                                  refund form and make sure you enclose
     NOTE:   Refunds of charges for private       your optical prescription and your

52    HC11 – Help with health costs                                        CLAIMING REFUNDS   53
receipt with your HC5(O) when you             NHS WIGS AND FABRIC SUPPORTS
     send it off. The form tells you what to       CHARGES
     do. The maximum refund you can get
     back will be the voucher value which          Ask the hospital for a receipt that shows
     matches your prescription.                    that you have paid an NHS charge, and
                                                   complete an HC5(W) refund claim form.
                                                   The form tells you what do.
     Lost or damaged glasses                       The HC5(W) is available at
     or contact lenses                             www.dh.gov.uk/helpwithhealthcosts
     If your glasses or contact lenses have
     been lost or damaged and you pay for          WAR PENSIONERS
     replacement or repairs, you will only
                                                   You can claim money back for dental
     be considered for a refund if you are
                                                   treatment, travel costs, sight tests, glasses
     entitled to a voucher. But, your Primary
                                                   or contact lenses if the treatment, or the
     Care Trust has to agree that the loss or
                                                   reason for travel, is for your accepted
     damage was due to illness before
                                                   disablement.
     payment can be made – read page 35.
                                                   Write to: The Treatment Group, Service
     TRAVEL COSTS TO RECEIVE                       Personnel and Veterans Agency, Norcross,
     NHS TREATMENT                                 Blackpool FY5 3WP. You can get a pre-paid
                                                   addressed envelope from Post Offices.
     If you receive NHS treatment under the
     care of a consultant, or through a
     referral by a doctor or dentist, usually an
     NHS hospital will give you your refund
     when you go for treatment. If this is not
     possible, ask the hospital for an HC5(T)
     refund claim form – it tells you what to
     do. If you receive NHS treatment under
     the care of a consultant, or through a
     referral by a doctor or dentist other than
     at an NHS hospital, ask for form HC5(T)
     when you go for treatment.

54    HC11 – Help with health costs                                              CLAIMING REFUNDS   55
FREE NHS PRESCRIPTIONS
Proof of entitlement
 You can get free            The proof you
                                                          Where and how to get proof
 prescriptions if you are:   need to have

 Under 16                    If your date of birth is     NHS medical cards are sent to you when you are
 60 or over                  printed on your              first registered as a patient with a GP. If you need
                             prescription you will        a card, contact your local Primary Care Trust.
                             not need to make a           NOTE: Some Primary Care Trusts no longer issue
                             declaration or show          NHS medical cards; in this case use one of the
                             proof. If your date of       other documents mentioned.
                             birth is not printed on
                             your prescription, show
                             your NHS medical card,
                             current Child Benefit
                             award notice, pension
                             award notice, passport,
                             birth certificate, driving
                             license, or any other
                             official papers
                             showing your name
                             and date of birth.

Aged 16, 17 or 18 in         A current Child Benefit      The Child Benefit Centre. 0845 302 1444.
full-time education          award notice. You can        Your school, college, university or local education
                             show proof of your           authority can give you proof that you are in
                             date of birth (which         qualifying full-time education (see page 15).
                             might be on your
                             prescription – see
                             above) and proof that
                             you are a full-time
                             student.

Aged 19 in full-time         A current Child Benefit      The tax credit award notice or decision letter
education or training        award notice and are         issued to the person receiving tax credits for you.
                             named on a qualifying
                             tax credit award notice
                             or decision letter.

56    HC11 – Help with health costs                                                        FREE NHS PRESCRIPTIONS   57
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