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Prescription Charges/Health Benefits

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Disability Rights UK Factsheet F14

Introduction

The National Health Service (NHS) generally provides health care free of charge. However there are some fixed charges that must be paid for prescriptions, dental treatment, sight tests, glasses, wigs and fabric supports. You may be entitled to help with these charges.

You may be able to get vouchers that can be used to buy fresh milk, infant formula or fresh/frozen fruit and vegetables. You can also get help with travel costs for treatment on the NHS provided you fit into certain categories. The information below outlines the type of help you may be able to get, depending on your personal circumstances and where you live.

1. Prescription Charges

Prescriptions are free in Northern Ireland, Scotland and Wales, but cost £8.60 in England. You do not have to pay for prescriptions if you are in one of the following categories (if you are not entitled to free prescriptions, you may benefit from buying a ‘prescription prepayment certificate’ – see below). You are:

  • getting income-related employment and support allowance (ESA), income support, income-based jobseeker’s allowance (JSA) or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants, and one of the following applies:

 

  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • aged under 16;
  • aged under 19 and in full-time education;
  • aged 60 or over;
  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • an NHS hospital in-patient;
  • receiving treatment for a sexually transmitted infection if the medication is supplied by a hospital or an appropriate clinic;
  • receiving treatment for tuberculosis - the drugs in relation to your treatment are free;
  • subject to a community treatment order - the drugs in relation to your treatment are free.

You are entitled to an exemption certificate for free prescriptions if you:

  • are pregnant or have had a baby during the last twelve months. Get form FW8 from your doctor, midwife or health visitor;
  • a war/service pensioner and the prescription is for your accepted disablement;
  • are undergoing treatment for cancer or the effects of cancer or the effects of cancer treatment.

If you are a cancer patient, your certificate will last for five years and will entitle you to all your prescriptions free of charge, not just those relating to cancer. This certificate can be renewed as many times as necessary and will not have to be returned if your condition changes.

You are also entitled to a medical exemption certificate for free prescriptions if you have one of the following specified health conditions:

  • you have a continuing physical disability that prevents you from leaving home without the help of another person (excluding temporary disabilities);
  • you have a permanent fistula (e.g. colostomy) requiring continuous surgical dressing or an appliance;
  • you have diabetes mellitus (except where treatment is by diet alone), myxoedema, hypoparathyroidism, diabetes insipidus or other forms of hypopituitarism, forms of hypoadrenalism (including Addison’s disease) for which specific substitution therapy is essential, and myasthenia gravis;
  • you have epilepsy, requiring continuous anti-convulsive therapy.

To get an exemption certificate for one of these health conditions, you need to claim on form FP92A, available from your doctor, hospital or pharmacist.

You (and your partner) are entitled to free prescriptions if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. See section 8 below for details.

Prepayment certificates

In England, a prescription pre-payment certificate costs £29.10 for three months or £104 for 12 months. If you purchase a 12-month prepayment certificate, you have the option of paying by monthly direct debit stretched over a period of 10 months. You can apply for a pre-payment certificate by calling 0300 330 1341 or got to www.nhsbsa.nhs.uk/help-nhs-prescription-costs/prescription-prepayment-certificates

Minor ailments scheme

Some pharmacies run a minor ailment scheme which enables you to get certain prescription medicines without the need to contact your doctor. If you don't pay for prescriptions, you can go to a pharmacy running this scheme and be given a medicine for a range of minor ailments, free of charge, on the NHS.

Minor ailments could include coughs, colds, headaches, hay fever, insect bites and stings, eczema, earache and diarrhoea.

Pharmacies can help in other ways, such as offering repeat dispensing services for any medicines you have which are regularly prescribed, again without the need to attend a doctor’s surgery. Speak to your local pharmacist about what they can offer. For more information see www.nhs.uk/Livewell/Pharmacy/Pages/Yourpharmacy.aspx

2. Dental Charges

Dentists can provide private dental treatment or NHS dental treatment and many provide a combination of both. You can get free NHS dental treatment (including check-ups, fillings, extractions and provision of dentures) if any one of the following applies. You are:

  • getting income-related ESA, income support, income-based JSA or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants, and one of the following applies:

 

  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • aged under 18;
  • aged under 19 and in full-time education;
  • living in Wales and are aged under 25 or over 60 (free examination only);
  • living in Scotland (free examination only);
  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • an NHS in-patient and the treatment is carried out by a hospital dentist;
  • pregnant or have had a baby in the past year;
  • an outpatient of an NHS Hospital Dental Service (but there may be a charge for dentures and bridges).

You (and your partner) are entitled to free NHS dental treatment if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. An HC3 certificate will entitle you to partial help. See section 8 below for details.

If you are receiving a war/service pension, you can claim money back for dental charges if the treatment is for your accepted disability. Call 0808 1914 218 for details.

Note: that you are entitled to free NHS dental treatment if you meet the qualifying conditionss at the time the arrangements for the treatment are made, or the time the relevant charges are made. You remain entitled for the course of treatment even if your circumstances change before the charges are made.

3. NHS Sight Tests

You can get free sight tests if you fit into any one of the following categories. You are:

  • getting income-related ESA, income support, income-based JSA or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants and one of the following applies:

 

  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • aged under 16;
  • aged under 19 and in full-time education;
  • aged 60 or over;
  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • an NHS hospital in-patient;
  • registered blind, severely sight impaired, sight impaired or partially sighted;
  • prescribed complex or powerful glasses with at least one lens which has a power in any one meridian of plus or minus 10 or more dioptres or is a prism-controlled bifocal lens;
  • a patient of the Hospital Eye Service;
  • a diagnosed glaucoma patient;
  • aged 40 or over and are the parent, brother, sister, son or daughter of a person with diagnosed glaucoma;
  • advised by an ophthalmologist that you are at risk of glaucoma;
  • a diagnosed diabetic;
  • living in Scotland.

You (and your partner) are entitled to free eyesight tests if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. An HC3 certificate will entitle you to partial help. See section 8 below for details.

If you are receiving a war/service pension, you can claim money back for sight tests if the treatment is for your accepted disability. Call 0808 1914 218 for details.

4. NHS Optical Vouchers

You can get vouchers towards the cost of glasses or contact lenses. If your glasses or contact lenses cost more than your voucher value, you will have to pay the difference. You can get this help if you fit into any one of the following categories. You are:

  • getting income-related ESA, income support, income-based JSA or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants and one of the following applies:
  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • aged under 16;
  • aged under 19 and in full-time education;
  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • an NHS hospital in-patient;
  • prescribed complex or powerful glasses with at least one lens which has a power in any one meridian of plus or minus 10 or more dioptres or is a prism-controlled bifocal lens;
  • a patient of the Hospital Eye Service needing frequent changes of glasses or contact lenses.

You (and your partner) are entitled to full help with the vouchers if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. An HC3 certificate will entitle you to partial help. See section 8 below for details.

If you are receiving a war/service pension, you can claim money back for glasses or contact lenses if the treatment is for your accepted disability. Call 0808 1914 218 for details.

5. Wigs and Fabric Supports

These items will be prescribed by a hospital consultant as clinically necessary. You will be able to get this help free if you fit into any one of the following categories. You are:

  • getting income-related ESA, income support, income-based JSA or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants and one of the following applies:

 

  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • aged under 16;
  • aged under 19 and in full-time education;
  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • receiving a war/service pension and the treatment is for your accepted disablement;
  • an NHS hospital in-patient.

You (and your partner) will also get this help free if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. An HC3 certificate will entitle you to partial help. See section 8 below for details.

6. Healthy Start scheme

The ‘Healthy Start’ scheme provides weekly vouchers that can be used to buy fresh milk, infant formula milk or fresh or frozen fruit and vegetables through general retail outlets. It also provides coupons to claim vitamin supplements. The scheme operates throughout the whole of the United Kingdom.

You can use the vouchers wherever you see the Healthy Start sign.

Those who will display this sign include milkmen, greengrocers, market stalls, chemists, corner shops and supermarkets.

You qualify automatically for the scheme if you fit into any one of the groups mentioned below. You are:

  • pregnant for ten or more weeks, under the age of 18 and not subject to immigration control;
  • pregnant for ten or more weeks and anyone in your family is getting one of the following:

 

  1. income support;
  2. income-based JSA;
  3. income-related ESA;
  4. child tax credit - providing your gross income at the time of the award does not exceed £16,190 and you do not get working tax credit. However, you can get vouchers for the four-week ‘run-on’ period when working tax credit continues after you have stopped or reduced work below 16 hours a week.

 

  • you have a child under 4 and anyone in your family receives one of the above benefits.

You can also get help under the Healthy Start scheme if you are:

  • a pregnant woman who is over 18 and you are entitled to universal credit (with a monthly earned income of £408 or less);
  • a pregnant woman over the age of 18 and you are the responsibility of a person who is entitled to universal credit (with a monthly earned income of £408 or less);
  • a mother who has a child under the age of 1 and you are entitled to universal credit (with a monthly earned income of £408 or less);
  • a mother who has a child under the age of 1 and you are the responsibility of a person who is entitled to universal credit (with a monthly earned income of £408 or less);
  • a child under the age of 4 and you are the responsibility of a person who is entitled to universal credit (with a monthly earned income of £408 or less);
  • a child under the age of 4 and you are the responsibility of a child who is in turn the responsibility of a member of the same household who gets income support, income-based JSA, child tax credit (with an award of £16,190 or less and not entitled to working tax credit) or universal credit (with a monthly earned income of £408 or less).

You can apply for the vouchers by filling in the form on the healthy start website at www.healthystart.nhs.uk/, or by phoning the Healthy Start Helpline 0345 607 6823.

7. Travel to hospital for NHS Treatment

You can get help with fares or other travel expenses for yourself and anyone who needs to travel with you if you are incapable of getting to hospital on your own. You can also get help if you need to accompany a child. The cost covered is normally that by the cheapest method of transport available. If you cannot use public transport because of your disability, you can claim the cost of taxi fares or the cost of car fuel (you should get the agreement of the hospital first).

You can get this help if you fit into any one of the following: You are:

  • getting income-related ESA, income support, income-based JSA or pension credit guarantee credit;
  • awarded universal credit, either as a single claimant or as one of joint claimants and one of the following applies:

 

  1. The award does not include a child amount, you (or your partner) do not have any limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £435.
  2. The award includes the child amount, and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.
  3. You (or your partner) have a limited capability for work and, if you (or your partner) work, your monthly earnings (or combined earnings) are no more than £935.

 

  • getting child tax credit or working tax credit and are named on a valid NHS tax credit exemption certificate;
  • living in the Isles of Scilly and need to travel to a mainland hospital;
  • living in the Scottish Islands or Highlands and have to travel at least 30 miles by land or 5 miles by sea to get to hospital;
  • getting NHS treatment abroad. Costs can be met up to the embarkation point as per normal travel expenses. The overseas travel is part of the treatment costs - this must be agreed beforehand by the health authority.

You (and your partner) are entitled to full help with fares or other travel expenses if you have a valid HC2 certificate (full help with health costs) under the Low Income scheme. An HC3 certificate will entitle you to partial help. See section 8 below for details.

If you are receiving a war/service pension, you can claim money back for NHS travel expenses if the treatment is for your accepted disability. Call 0808 1914 218 for details.

8. Help under the NHS Low Income scheme

If you are on a low income, you can get full or partial help with all NHS charges, including prescription charges, by completing form HC1, available from your local Jobcentre Plus office, NHS hospitals, dentists, opticians and pharmacists, by phoning 0300 330 1343 or from the NHS Business Services Authority website at www.nhsbsa.nhs.uk/nhs-low-income-scheme

If your income is low enough, you will be sent certificate HC2 for full help with NHS charges, or certificate HC3 for partial help. Young care leavers maintained by a local authority and people living permanently in a care home funded wholly or partly by a local authority are entitled to an HC2 certificate by making a claim under the Low Income scheme without having to satisfy the means test. Asylum seekers (and their dependants) supported by the government should automatically be issued with HC2 certificates.

The assessment process to work out if you are entitled to either an HC2 certificate or an HC3 certificate is similar to that for income support but is slightly more generous (in the treatment of housing costs for example). For more information, see our Disability Rights Handbook.

9. Refunds

You can apply for a refund if you pay for a prescription item or service that you could have received free, or at a reduced cost.

For a refund of prescription charges, ask your pharmacist for form FP57.

For a refund of dental charges, ask your dentist for form FP64 or a receipt that shows the amount of the NHS charge and the date you paid. You will also need to complete an HC5 refund form (www.nhs.uk/NHSEngland/Healthcosts/Documents/2016/HC5(D).pdf )

For sight test refunds ask the person who tests your sight for a receipt that shows that you paid for the test and the date of payment. Complete an HC5 refund claim form, making sure you put the date of your sight test on it (www.nhs.uk/NHSEngland/Healthcosts/Documents/2016/HC5(O).pdf).

10. Healthcare equipment

Health Authorities, hospitals and GPs can provide various items of equipment and appliances such as special beds, commodes, urinals, continence pads, special footwear, leg appliances, surgical supports, wheelchair and hearing aids.

11. Other information

This factsheet is a basic overview of the prescription charges/health benefits scheme. You can find out more detailed information in our Disability Rights Handbook. This and all our other publications are available from our shop at https://www.disabilityrightsuk.org/shop

You can also place orders by contacting Disability Rights UK.

You can get help and information at your local advice centre, such as Citizens Advice. You can get more information about where to get personal advice from our Factsheet F15 - Getting advice. All our factsheets are free to download on our website at disabilityrightsuk.org.

Ian Greaves and Martin Inch
13 June 2017