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Publication - Guidance

Help with health costs: a quick guide to help with health costs

Published: 2 Nov 2016
Part of:
Health and social care
ISBN:
9781786525246

Leaflet providing information on NHS dental charges, Optical Voucher values and help with health costs including travel costs.

16 page PDF

117.4kB

16 page PDF

117.4kB

Contents
Help with health costs: a quick guide to help with health costs
Can I get help with health costs?

16 page PDF

117.4kB

Can I get help with health costs?

Young People

Are you aged 16, 17 or 18 and in qualifying full-time education?

If the answer is yes, then you are entitled to the following NHS items and services free of charge:

NHS Dental Treatment (young people under 18 do not have to be in education to qualify)

Voucher towards the costs of glasses or contact lenses.

People Receiving Benefits

Are you included in an award of:

  • Income Support?
  • Universal Credit?
    • And had no earnings or net earnings (take-home pay) of £435 or less during the most recent assessment period;* or
    • Which includes an element for a child and/or limited capability for work or limited capability for work related activity, and had no earning (take-home pay) or net earnings of £935 or less during the most recent assessment period.*
  • Income-related Employment and Support Allowance?
  • Income-based Jobseeker's Allowance?
  • Pension Credit Guarantee Credit? or
  • Do you have an NHS Tax Credit Exemption Certificate?

*Your assessment period will run for a calendar month from the date of your claim for Universal Credit (which will be shown on your award notice), and between the same dates each month after that.

If the answer is yes to any of the above then you are entitled to the following:

Free NHS Dental Treatment

Vouchers towards the cost of glasses or contact lenses

A refund of any reasonable amount spent on travel to receive treatment at an NHS hospital.

To claim your entitlement when you have your treatment, tell the practitioner which benefit you are in receipt of. The practitioner will then ask you for evidence of your entitlement and ask you to sign a form.

What is the earnings threshold for Universal Credit for couples?

At the moment, the earnings threshold as described on page 2 is based on an individual's income and not the combined income of a couple. For example, if you earn £300 and your partner £200 then both of you are meeting the criteria for help with health costs even though your combined income exceeds £435. But, if one of you earns above the threshold only the person earning £435 or less will be entitled to help with health costs.

People on a Low Income

If none of the circumstances already mentioned applies to you, but you have difficulty paying NHS charges, you may qualify for help under the NHS Low Income Scheme. This is an income-related scheme which looks at your (and your partner's) weekly requirements and income to calculate how much, if anything, you should pay towards your health costs. Help with hospital travel costs may also be available.

The threshold for full help under the Scheme changes from time to time, so if you haven't claimed for a while, it may be worth making a new claim.

If you want to claim help under the Low Income Scheme, pick up form HC1 at Community Pharmacies, GP Practices, Citizens Advice Scotland Offices and Jobcentre Plus offices or on request by calling 0131 275 6386.

You can get advice on completing the form or information and general advice by calling a helpline on: 0300 330 1343 (calls are charged at local rate).

Women who are pregnant or who have given birth in the last 12 months

You are entitled to receive:

Free NHS Dental Treatment

To get this, you will need to apply for an NHS Maternity Exemption Certificate.

This certificate will also entitle you to free prescriptions if your prescriptions are dispensed in England. Application forms are available from your GP, midwife or health visitor. They will help you to complete the form and will send it to your NHS Board. You will receive your certificate by post.

What about prescription charges?

From 1 April 2011 prescription charges have been abolished in Scotland, therefore you do not have to pay for NHS prescriptions if you:

  • Present a Scottish prescription at a pharmacy in Scotland;
  • Present an English prescription, with a valid Entitlement Card, at a pharmacy in Scotland; or
  • Present an English prescription form at a pharmacy in Scotland and you qualify under exemption arrangements detailed in the NHS (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011.

If you present your prescription in Northern Ireland or Wales you will not be charged. If you present your prescription in England you will be required to pay unless you qualify for exemption under English arrangements.

Entitlement Cards

If you live in Scotland but are registered with a GP Practice in England you may apply for an Entitlement Card. This will serve as evidence that you are eligible for free prescriptions in Scotland.

Entitlement Cards will be issued free of charge to eligible applicants.

The Entitlement Card must be shown at the time the prescription is presented for dispensing to benefit from the abolition of prescription charges in Scotland. The address details on the Entitlement Card must match the address details on the prescription form.

How can I get one?

Please contact NHS National Services: Practitioner Services Division on 0141 300 1300 who will send you an application form.

Medical Exemption Certificates

If you have one of the following medical conditions, you may wish to apply for an NHS Medical Exemption Certificate that will entitle you to receive NHS prescriptions free of charge if presenting your prescription in England.

hypoparathyroidism

hypoadrenalism for which specific substitution therapy is essential ( e.g. Addison's Disease)

diabetes insipidus and other forms of hypopituitarism

diabetes mellitus except where treatment is by diet alone

myasthenia gravis

myxoedema (that is, hypothyroidism requiring thyroid hormone replacement)

epilepsy requiring continuous anti-convulsive therapy

or if you have a permanent fistula requiring continuous surgical dressing or requiring an appliance (also referred to as a stoma).

In addition to these conditions, if you have a continuing physical disability which means that you are unable to leave your home without the help of another person you might also qualify.

To apply for a Medical Exemption Certificate, ask the receptionist at your GP surgery. An application form EC92A will be completed at the surgery, and will be endorsed by your GP. The surgery will send off the application to your NHS Board and you will receive your certificate by post.

Refunds

Claims must be made within three months of the date you paid the charge.

If you have applied for help under the NHS Low Income Scheme but have not yet received a reply complete form HC5 and send it with the receipt to:

NHS Business Services Authority
Bridge House
152 Pilgrim Street
Newcastle-upon-Tyne
NE1 6SN

You can get an HC5 from:

  • your local Jobcentre Plus office
  • your local hospital
  • some dentists and opticians
  • www.ppa.nhs.uk - (it will be posted to you)
  • by request from Patient Services on: 0300 330 1343 (calls are charged at the local rate)

Hospital Travel Costs

You may be eligible to receive help with necessary travel costs (see pages 2-3).

The maximum you will pay if you live in the Scottish Highlands and Islands is:

Scottish Highlands and Islands £10.00

NHS dental treatment from 1 October 2016

Basic examination free*
Extensive clinical examination free*
Simple scale and polish £10.88
Two small X-rays and one small filling from £14.20
Two small X-rays and one large filling from £25.80
A precious metal crown from £109.64
Full set of plastic dentures from £150.28
An upper or lower metal denture from £132.48

You pay 80 per cent of the cost of the treatment up to a maximum of £384 if you can't get free treatment or help with the cost. The above are only examples of what you might pay for courses of treatment that start on or after 1 October 2016. The total cost of NHS treatment may be different from these examples because of the number, or types, of treatment involved. If you are registered for Continuing Care with your dentist, you may ask your dentist for a treatment plan. This is provided free of charge and explains what treatment your dentist recommends, the price for each part of the treatment, and the likely total cost.

* To people who are ordinarily resident in the UK or who belong in one of the categories for exemption from NHS charges set out in the NHS (Charges to Overseas Visitors) (Scotland) Regulations 1989.

Sight tests and eye examinations

NHS eye examination free*
NHS eye examination at home free*
Hospital eye department test free
Private sight test see your optician
Private sight test at home see your optician

NHS Vouchers for Glasses and Contact Lenses from 1 April 2016

Optical vouchers

Maximum value per pair of glasses or contact lenses

Single vision A £39.10
B £59.30
C £86.90
D £196.00
Bifocal E £67.50
F £85.60
G £111.20
H £215.50
Hospital eye department I £200.80
J (per lens) £57.00
Complex lens - single vision £14.60
Complex lens - bifocal £37.40

* To people who are ordinarily resident in the UK or who belong in one of the categories for exemption from NHS charges set out in the NHS (Charges to Overseas Visitors) (Scotland) Regulations 1989.

Supplements to vouchers where clinically necessary

per lens
Prism P Single vision £12.60
P Bifocal £15.40
Tint T Single vision £4.40
T Bifocal £4.90
Photochromic Single vision £4.40
Other lenses £4.90
Special frames per frame up to £64.20

Repairs/replacements of glasses or contact lenses

If, exceptionally, you are entitled to a voucher for repair or replacement, its value will be up to the figures show in this leaflet, depending on the part which needs replacing or repairing.

The Penalty Charge

A penalty charge may be imposed on patients who are found to have wrongly claimed total or partial help with health costs.

The penalty charge is five times the amount owed, up to a maximum of a £100. This is in addition to the original charge. For example:

Dental costs penalty charge

A patient who wrongly claims free dental treatment when the charge for the course of treatment is £30 will have to pay:

The original dental charge of £30
The maximum penalty charge of £100
Total £130

Counter Fraud Services ( CFS)

NHSScotland Counter Fraud Services offers a free and confidential service for reporting potential fraud. You can contact CFS on 08000 151628.

You can obtain an application form for an Entitlement Card from one of the following addresses:

If you live in Dumfries & Galloway please contact:

NHS National Services Scotland
Practitioner Services (Medical)
Meridian Court, 5 Cadogan Street
Glasgow
G2 6QE

Tel: 0141 300 1300

If you live in the Borders please contact:

NHS National Services Scotland
Practitioner Services (Medical)
Gyle Square, 1 South Gyle Crescent
Edinburgh
EH12 9EB

Tel: 0131 275 6000

Any queries regarding medical or maternity certificates should be directed to the relevant regional office of NHS National Services Scotland at the following addresses:

For Ayrshire & Arran, Dumfries & Galloway, Greater Glasgow & Clyde, Lanarkshire and Western Isles write to:

NHS National Services Scotland
Practitioner Services (Medical)
Meridian Court, 5 Cadogan Street
Glasgow
G2 6QE

Tel: 0141 300 1300

For Borders, Fife, Forth Valley and Lothian write to:

NHS National Services Scotland
Practitioner Services (Medical)
Gyle Square, 1 South Gyle Crescent
Edinburgh
EH12 9EB

Tel: 0131 275 6000

For Grampian, Highland, Orkney, Shetland and Tayside write to:

Practitioner Services (Medical)
Bridge View, 1 North Esplanade West
Aberdeen
AB11 5QF

Tel: 01224 358400

Other special needs

This leaflet can also be made available by request on audio cassette, on disk and in large print.

All of the numbers on this leaflet offer Typetalk for people who are hard of hearing. This is available Monday to Friday 8am to 6pm.

NHS Helpline on 0800 224488 will be able to provide both these services.

This is not a definitive guide to the help available. For more detailed information go to the following websites to access the booklet HCS 1, 'Are you entitled to help with health costs?': www.gov.scot/Publications or further information at www.NHSinform.co.uk


Contact

Email: Elizabeth Mclear

Phone: 0300 244 4000 – Central Enquiry Unit

The Scottish Government
St Andrew's House
Regent Road
Edinburgh
EH1 3DG