Calculating your entitlement
To qualify for help, you must have less than
£16,000 capital.1Sch 1 NHS(TERC) Regs; Sch 1 NHS(TERC)(W) Regs
If your weekly income (see below) does not exceed your requirements (see below) by more than 50 per cent of the cost of an English prescription (currently 50 per cent of £9.15, so £4.57), you receive a full
remission certificate (an HC2 in England and Northern Ireland; HC2W in Wales).2Reg 5 NHS(TERC) Regs; reg 5 NHS(TERC)(W) Regs
If your income exceeds your requirements by more than this amount, you receive a partial remission certificate (an HC3 in England and Northern Ireland; HC3W in Wales). Depending on the level of excess, you may get:3Reg 6 NHS(TERC) Regs; reg 6 NHS(TERC)(W) Regs
•a remission of dental charges and charges for wigs and fabric supports which are higher than three times your excess income;
•a voucher for glasses or lenses, reduced by an amount equal to twice your excess income;
•a reduction in the cost of a sight test to the amount of your excess income, if lower, plus the amount by which the cost exceeds the NHS sight test fee;
•a reduction by the amount of your excess income in the amount you can get for hospital fares.
If you qualify for a remission certificate, it is normally valid for 12 months. If you are a full-time student, your certificate is normally valid until the end of your course or the start of the next academic year. You should make a repeat claim shortly before the expiry date. Remember that if you qualify for IS or income-based JSA over the summer vacation, you are automatically exempt from NHS charges during that period.
Calculating your income
Income is calculated in the same way as for IS, with some modifications.4Reg 16 and Sch 1 NHS(TERC) Regs; reg 15 and Sch 1 NHS(TERC)(W) Regs
Your and your partner’s income is taken into account. Your parents’ income is not taken into account. However, any money given to you by your parents may be taken into account when assessing your eligibility. See Chapter 24
for how your income is calculated and how student income is treated for IS.
Calculating your requirements
Your requirements are based on those used for calculating the applicable amount for IS.5Reg 17 and Sch 1 NHS(TERC) Regs; reg 16 and Sch 1 NHS(TERC)(W) Regs
This is an amount for your basic weekly needs. See Chapter 13
for more details.
Your requirements are made up of:
•single person aged under 25, £58.90;
•single person aged under 25 entitled to an ESA component, or incapable of work for 28 weeks since 27 October 2008, £74.35;
•single person aged 25–59, £74.35;
•single person aged 60 or over, £173.75;
•lone parent aged under 60, £74.35;
•lone parent aged 60 or over, £173.75;
•couple aged under 60, £116.80;
•couple aged 60 or over, £265.20;
•carer premium (as for IS);
•disability premium (as for IS, except that you can include a disability premium after 28 weeks of incapacity for work, rather than 52 weeks). You can also get a disability premium if you or your partner are under 60 and get ESA with a work-related activity or support component or you or your partner have been getting ESA for at least 28 weeks, or have been incapable of work for at least 28 weeks and have had the incapacity since 27 October 2008. The amount of the disability premium increases to £38.55 if you are single or a lone parent and either get ESA with the support component or get the disability living allowance middle or highest rate care component or personal independence payment and have been getting ESA or have been incapable of work, for 28 weeks since 27 October 2008 and your incapacity did not start before that date;
•enhanced disability premium for an adult (as for IS);
•severe disability premium (as for IS);
•weekly rent less any housing benefit (HB) and non-dependant deductions;
•weekly council tax;
•mortgage interest, endowment payments and capital repayments on your home, as well as on loans to adapt a home for a disabled person, deducting any non-dependant deductions.
If your income is £4.57 or less (half the cost of a prescription in England) higher than your needs, you are entitled to health benefits. If your income is more than £4.57 higher than your needs, you do not get free prescriptions, but you might get partial help with other charges.
Joni is 21, and a third-year full-time undergraduate in Wales. Her income is assessed to be £147.50 a week.
Her requirements are calculated as her personal allowance (£58.90) plus her weekly rent (£110). This gives a total of £168.90. This is more than her income, so she receives full help with health costs. As a Welsh-domiciled student, however, Joni already qualifies for free prescriptions and, as she is under 25, free dental examinations.
Louisa is 24, and a second-year full-time undergraduate in London. Her income is assessed to be £220 a week.
Her requirements are calculated as her personal allowance (£58.90) plus her weekly rent (£150). This gives a total of £208.90. Her income therefore exceeds her requirements by £11.10, more than half the cost of a prescription (£4.57), so her entitlement to health benefits is reduced. For example, she must pay the first £11.10 of any sight test, a sum equal to her excess income, while she must pay the first £22.20 of any glasses or lenses, a sum equal to twice the excess.