Depending on your circumstances you may qualify for full or partial help with health charges such as prescriptions, sight tests, dental treatments and so on.
Who qualifies for help
Low income scheme
Prescription charges
Sight tests and glasses
Dental treatment
Travel costs to hospital or a clinic for treatment
Claiming a refund
You qualify automatically for full help if you or your partner receive Employment and Support Allowance (income related), Income Support, Jobseekers Allowance income based, or Pension Credit Guarantee. Some war and service pensioners and prisoners also qualify automatically for full help.
You can also get full help if you get:
and in each case your annual income is £15,276 or less (2009/10 figure) and you have a valid NHS tax credit exemption certificate.
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If none of the above apply but you are on a low income and you have less than £16,000 savings, you can claim under the low income scheme.
The low income assessment
The low income assessment compares your income with your "requirements". Your requirements are worked out in a similar way to Income Support, plus an amount for housing costs. If your income is the sasme as or less than your requirements plus half the current prescription charge you qualify for full help with health costs, incuding free prescriptions. You will be sent an HC2 certificate.
If your income is above your requirements plus half the current prescription charge you do not qualify for free prescriptions. You may still get some help with other health costs. You will be sent an HC3 certificate showing the amount you have to contribute.
- For sight tests you will get the difference between the NHS sight test fee and your excess income.
- For glasses, the maximum voucher value is reduced by twice your excess income.
- For dental charges, your maximum contribution is three times your excess income.
- For fares to hospital for treatment, if your income is above the low-income level, but you would fall below it if you paid fares to hospital for treatment, you may still be eligible for help with part of the cost
Claims are dealt with by the NHS Business Services Authority at:
Sandyford House
Archbold terrace
Newcastle Upon Tyne
NE2 1DB
Phone: Customer enquiry line 0845 850 1166
Email: lis1@ppa.nhs.uk
NHS Business Services Authority website
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Some people who are not exempt from prescription charges because of their income can still get full help because of their circumstances.
People aged 60 or over, under 16 year olds and young people under 19 and in full time education are automatically exempt from prescription charges.
You can get a Medical Exemption Certificate if
You are pregnant or have given birth in the last year. You need to get form FW8 from your doctor, midwife or health visitor.
You are undergoing treatment for cancer.
You have one of the following specified medical conditions:
a continuing physical disability which means the person cannot go out 'without the help of another person'. A temporary disability does not count even if it lasts for several months
- a permanent fistula (for example caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing or requiring an applicance
- diabetes insipidus or other forms of hypopituitarism; forms of hypoadrenalism (for example Addison's disease) for which specific subsitution therapy is essential; diabetes mellitus except where treatment is by diet alone;hypoparathyroidism; myasthenia gravis; myxoedema
epilepsy requiring continuous anticonvulsive therapy
You claim on form FP92A, available from your doctor
Prepayment certificate
If you are not exempt from prescription charges it may be worth considering buying a prepayment certificate. It saves money if you need four or more items in three months or 14 or more items in a year.
Apply on form FP95, available from pharmacists or contact the NHS Business Services Authority.
Phone: 0845 8500030
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If you do not qualify for full help automatically, you can still get free NHS eyesight tests and vouchers for glasses or contact lenses if you:
You can also get free sight tests or examinations if you are:
aged 60 or over
live in Scotland
registered blind or partially sighted
diagnosed as having diabetes or glaucoma, or considered to be at risk of glaucoma, or aged 40 or over and the parent, brother, sister or child of a person with glaucoma
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If you do not qualify for full help automatically can still get free NHS dental treatment if you
are aged under 18, or under 19 and in full-time education
are pregnant, provided you were pregnant when the dentist acccepted you for treatment
have given birth in the past year, provided you start your dental treatment before your child's first birthday
get treatment carried out by the hospital dentist while you are an NHS inpatient
are a patient of the NHS Hospital Dental Service
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If you do not qualify for full or partial help with fares to hospital for treatment, help is also available if you:
If you need someone to travel with you, or have to accompany a child to hospital you may be able to get help with the travel costs of your companion, or as the child's parent.
If the hospital sends you home as part of your treatment or for their convenience, your fares should be met by the hospital. You cannot claim under the travel to hospital scheme in such a case.
You need to produce proof of your entitlement to help, for example a benefit award letter, tax credit exemption certificate or an HC2 or HC3 ceritficate, to get your fares refunded by the hospital.
The cost of visiting someone in hospital
If you need help with the cost of visiting someone who is ill you may be able to get a Social Fund community care grant.
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If you have paid for prescriptions or other health costs you can claim a refund if you should have been entitled to help at the time. You should claim the refund within three months. This can be extended if you had good cause for not claiming earlier. You should ask for a receipt if you think you are entitled to a refund. The receipt you get tells you how to claim a refund.
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More information
You can get more information about help with health costs from the NHS Business Services Authority or from NHS leaflet HC11 on help with health costs (pdf 2.8MB)