Prescription Charges/Health Benefits

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 also be able to get free milk and vitamins and 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.

There are no savings/capital rules for Health Benefits.

1. Prescription Charges

You will 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 qualify for free prescriptions if any one of the following applies. You are:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 16;
• aged under 19 and in full-time education;
• aged 60 or over;
• live in Wales or you are a Welsh resident holding a ‘prescription charge entitlement card’
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• a war/service pensioner and the prescription is for your accepted disablement;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• an NHS hospital in-patient;
• a young care leaver in England who is being maintained by a local authority;
• able to qualify under the low income scheme (see paragraph 8);
• an asylum seeker, or their partner or dependent child, supported by the National Asylum Support Services (NASS);
• pregnant or have had a baby during the last twelve months and hold a valid maternity or valid medical exemption certificate;
• receiving treatment for a sexually transmissible infection if the medication is supplied by a hospital or Primary Care Trust 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;
• suffering from a specified condition (see list below);

You are entitled to an exemption certificate if you have one of the specified health conditions listed below:

• A continuing physical disability that prevents you from leaving home without the help of another person (excluding temporary disabilities);
• A permanent fistula requiring continuous surgical dressing or an appliance (e.g. colostomy);
• 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;
• Epilepsy, requiring continuous anti-convulsive therapy.
• You 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 5 years and will entitle you to all your NHS 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.

Note: The government also intends to move towards exempting patients with long-term conditions over the next few years.

To get an exemption certificate you need to claim on form FP92A (England), FP92W (Wales), EC92A (Scotland) or HS151(C) (Northern Ireland), available from your doctor, hospital or pharmacist.

If you are not able to claim an exemption on any of the above grounds you may be entitled help with some or all of the charges on the grounds of low income (see paragraph 8).

Prescription costs and prepayment certificates

The cost of a prescription is:

• £7.20 in England
• £3.00 in Northern Ireland (Prescriptions will be free of charge by April 2010)
• £4.00 in Scotland (Prescriptions will be free of charge by April 2011)
• free in Wales.

In England a prescription pre-payment certificate PPC costs £104.00 for 12 months or £28.25 for three 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. If you need to pay for more than 3 prescription items in 3 months or 14 items in 12 months may find it cheaper to buy a pre-payment certificate (PPC).

In Northern Ireland a four-month prescription pre-payment certificate (PPC) costs £9.00 and a 12 month PPC costs £25.00. If you need to pay for more than 3 prescription items in 4 months or 8 items in 12 months may find it cheaper to buy a pre-payment certificate (PPC).

In Scotland a 12 month PPC costs £38 and a 4 month PPC costs £13. You may find it cheaper to buy a PPC if you need to pay for more than 4 prescription items in 4 months or 10 items in 12 months .

Those who live in Scotland but receive primary care medical services from a GP practice in England will benefit from the reduced cost of prescriptions in Scotland if they present an English prescription together with an entitlement card.

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:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 18;
• aged under 19 and in full-time education;
• living in Wales and are aged under 25 or aged 60 or over (free examination only);
• living in Scotland (free examination only);
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• receiving a war/service pension and the treatment is for your accepted disablement ;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• an NHS hospital in-patient;
• a young care leaver in England or Wales who is being maintained by a local authority;
• able to qualify under the low income scheme (see paragraph 8);
• an asylum seeker or the dependant of an asylum seeker who is getting support from the National Asylum Support Service (NASS) or a local authority;
• pregnant or have had a baby during the last twelve months;
• an outpatient of an NHS Hospital Dental Service or a patient of the Community Dental Service (but there may be a charge for dentures and bridges);
• in prison or a young offenders’ institution.

Note: that you are entitled to free NHS dental treatment if you meet the qualifying requirements 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:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 16;
• aged under 19 and in full-time education;
• aged 60 or over;
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• receiving a war/service pension and the treatment is for your accepted disablement;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• an NHS hospital in-patient;
• a young care leaver in England or Wales who is being maintained by a local authority;
• able to qualify under the low income scheme (see paragraph 8);
• an asylum seeker or the dependant of an asylum seeker who is getting support from the National Asylum Support Service (NASS) or a local authority;
• registered blind 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 opthalmologist that you are at risk of glaucoma;
• a diagnosed diabetic;
• in prison or a young offenders’ institution;
• living in Scotland.

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:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 16;
• aged under 19 and in full-time education;
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• receiving a war/service pension and the treatment is for your accepted disablement;
• an asylum seeker or the dependant of an asylum seeker who is getting support from the National Asylum Support Service (NASS) or a local authority;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• an NHS hospital in-patient;
• a young care leaver in England or Wales who is being maintained by a local authority;
• able to qualify under the low income scheme (see paragraph 8);
• 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;
• in prison or a young offenders’ institution

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:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 16;
• aged under 19 and in full-time education;
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• able to qualify under the low income scheme (see paragraph 8);
• receiving a war/service pension and the treatment is for your accepted disablement;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• an asylum seeker or the dependant of an asylum seeker who is getting support from the National Asylum Support Service (NASS) or a local authority;
• an NHS hospital in-patient;
• in prison or a young offenders’ institution.

6. Healthy Start Scheme

The Healthy Start Scheme provides weekly vouchers, worth £3.10 each a week, that can be used to buy liquid milk, infant formula or fresh fruit and vegetables through general retail outlets. 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 and under the age of 18.
• pregnant for ten or more weeks and anyone in your family, is in receipt of one of the following:
• income support;
• income-based jobseeker's allowance;
• income-related employment and support allowance;
• child tax credit - providing your gross income at the time of the award does not exceed £16,040 and you do not get working tax credit. You can also get vouchers for the four-week period when working tax credit continues after stopping or reducing work below 16 hours a week.
• a child under age 4 who is a member of the family of someone who receives one of the following:
• income support;
• income-based jobseeker's allowance;
• income-related employment and support allowance;
• child tax credit - providing their gross income at the time of the award does not exceed £16,040 and he or she does not get working tax credit. You can also get vouchers for the four-week period when working tax credit continues after stopping or reducing work below 16 hours a week.

You can apply for the vouchers by filling in the form on the healthy start website at www.healthystart.nhs.uk/ , or by asking your midwife, health visitor or other health professional for an application form. Leaflet racks in some GP surgeries also hold copies. You can also get a form by phoning 08701 555 455 .

Asylum seekers cannot get healthy start vouchers but you may get similar extra help from the National Asylum support Service (NASS) if you are in financial hardship.

You can still get free milk under the old Welfare Food scheme if you have a child under 5 who is looked after for at least 2 hours a day by a registered childminder, daycare provider, local authority or school, or by a workplace provider exempt from registration. A disabled child aged 5-16 who is not a school pupil may also receive free milk.

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:

• in receipt of income-related employment and support allowance, income support, income-based jobseeker’s allowance or pension credit guarantee credit (including partners);
• aged under 16;
• aged under 19 and in full-time education;
• getting child tax credit, or working tax credit and in receipt of an NHS tax credit exemption certificate;
• receiving a war/service pension and the treatment is for your accepted disablement;
• a permanent resident in a care home and your place is wholly or partly funded by a local authority;
• a young care leaver in England and Wales who is being maintained by a local authority;
• able to qualify under the low income scheme (see paragraph 8);
• an asylum seeker or the dependant of an asylum seeker who is getting support from the National Asylum Support Service (NASS) or a local authority;
• an NHS hospital in-patient when the wig or fabric support is supplied;
• a patient at a genito-urinary medicine clinic more than 15 miles from your home or more than 5 miles if you need to attend on a weekly basis;
• 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;
• get NHS treatment abroad under under section 3 of the National Health Service Act 1977 or in accordance with arrangements made under section 23 of that Act or paragraph 13 of Schedule 2 to the National Health Service and Community Care Act 1990. These acts apply to England and Wales only.

Note that it is possible to claim a Community Care Grant to assist you and/or a member of your family with travel expenses in the UK (including overnight accommodation charges) to visit someone who is ill whether they are in hospital or elsewhere. (Generally, you must be in receipt of income support, income-based jobseeker’s allowance or pension credit guarantee credit to be eligible for a Community Care Grant).

8. Further Information

You can call the Health Literature Line on 0870 155 54 55 to request any of the forms mentioned in this factsheet.

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 (HC1W in Wales) available from your local jobcentre plus offices, NHS hospitals, dentists, opticians and pharmacists, by phoning 0845 850 1166 or online from the NHS Business Services Authority website at www.nhsbsa.nhs.uk.

If your income is low enough you will be sent a certificate HC2 (HC2W in Wales) for full help or HC3 (HC3W in Wales) for partial help with NHS charges.

The assessment process 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.

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. Ask your pharmacist for form FP57 (WP57 in Wales, HCS(R) in Scotland, PS7 in Northern Ireland).

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.

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.

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.

Getting your prepayment certificate, medical exemption certificate/card

Issued by:

• In England: You can order a prepayment certificate online from the NHS Business Services Authority website at www.nhsbsa.nhs.uk or by phoning 0845 850 0030. ;
• In Northern Ireland: You can purchase a Prescription Pre-payment Certificate from most pharmacies (medical exemption certificates are issued by the Central Services Agency);
• In Scotland: The Practitioner Services Division area offices (Form EC95 contains details of what to do. You may also be able to buy a Prescription Pre-payment Certificate at a pharmacy or doctor’s surgery).

Updated July 2009