Chapter 11: Health benefits

CPAG

This chapter covers:

1. What are health benefits (below)

2. Who is eligible (here)

3. Claiming health benefits and refunds (here)

4. Challenging a decision (here)

5. Overseas students (here)

Basic facts

– People under 19 and in full-time education can get free prescriptions, sight tests, vouchers for glasses and dental treatment.

– Prescriptions are free in Wales. In addition, you can get a free dental examination if you are under 25, or are 60 or over. Prescriptions in Northern Ireland are also free.

– Other students can get help if they are on a low income or in certain other circumstances.

1. What are health benefits

This chapter outlines the rules on health benefits and focuses on issues relevant to students. For more detailed information, see CPAG’s Welfare Benefits and Tax Credits Handbook.

Although most health treatment is free under the NHS for UK residents, there are fixed charges for some NHS services and treatments. These include:

•prescriptions;

•sight tests;

•glasses or contact lenses;

•dental treatment; and

•wigs and fabric supports.

You may also have fares to pay to get to hospital. You are exempt from the charges in specified circumstances, or if your income is sufficiently low, and may get help with the fares. As a student, you are not automatically exempt from paying these charges unless you come into one of the categories listed on here. Otherwise, you can apply for a ’remission certificate’ under the low income scheme (see here). If you get a remission certificate, part or all of the charges are waived, depending on how much income you have. For information about claims, see here.

Note: you may also qualify for vouchers for Healthy Start food and for free vitamins. See here for further information.

2. Who is eligible

You are exempt from NHS charges if:1Regs 3-5 NHS(TERC) Regs; regs 3-5 NHS(TERC)(W) Regs

•you or a member of your family receive income support (IS), income-based jobseeker’s allowance (JSA), income-related employment and support allowance (ESA) or the guarantee credit of pension credit (PC);

•in England and Wales, you or a member of your family receive universal credit (UC) and either have no earnings or your earnings are no more than £435 a month (£935 if you have a child or a limited capability for work or limited capability for work-related activity element included in your UC);

•you or a member of your family receive:

◦child tax credit (CTC); or

◦CTC and working tax credit (WTC); or

◦WTC including a disabled worker or severe disability element.

To be exempt because you receive tax credits, your gross annual income must be £15,276 or less a year.

There are other categories of people who are exempt from NHS charges – eg, if you are a permanent resident in a care home, a hospital inpatient, an asylum seeker (see here), aged 16 or 17 and being financially maintained by a local authority, a war disablement pensioner and you need the item or service because of your war disability, or if you are in prison or a young offenders’ institution.

You may also be exempt from some charges because of your age or a specific health condition – see the individual types of charges on here–here.

If you are not exempt on any of the grounds listed above or below, you may be entitled to a full or partial remission of charges on grounds of low income - this includes if you are claiming UC in Northern Ireland (see here).

1 Regs 3-5 NHS(TERC) Regs; regs 3-5 NHS(TERC)(W) Regs »

If you are exempt because you receive tax credits

If you are exempt from NHS charges because you receive tax credits, you should automatically be sent an NHS tax credit exemption certificate. This could be up to six weeks after you are awarded tax credits. If you have a tax credits award, but have not yet been sent your certificate, you can sign the relevant treatment forms to say you do not have to pay. You can use your award letter as evidence of this. If this is not accepted and you are charged, keep your receipts so you can claim a refund (see here). Get advice if there is a delay in getting your exemption certificate.

If you are getting CTC but are exempt from charges because you are getting IS, income-based JSA, income-related ESA or the guarantee credit of PC, you do not get an NHS tax credit exemption certificate. However, if you stop getting IS, income-based JSA, income-related ESA or the guarantee credit of PC because of, for example, your student income, you need a certificate. You should let HM Revenue and Customs know about your change in circumstances as soon as possible. It notifies the NHS Business Services Authority (NHSBSA) in Newcastle upon Tyne, which issues you with a certificate.

Free prescriptions

The cost of a prescription in England is £9.35 (April 2021). Prescriptions are free if you live in Wales or Northern Ireland.

In England, you qualify for free prescriptions if:1Regs 3-6 NHS(CDA) Regs; regs 4 and 5 NHS(TERC) Regs; NHS(FP&CDA)(W) Regs

•you are in one of the exempt groups listed on here; or

•you are aged under 16, or under 19 and in full-time education (see here); or

•you are aged 60 or over; or

•you are pregnant or have given birth within the last 12 months; or

•you are undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment;

•you have one or more of the following specific medical conditions:

◦a continuing physical disability which prevents you from leaving home except with the help of another person;

◦epilepsy requiring continuous anticonvulsive therapy;

◦a permanent fistula, including caecostomy, ileostomy, laryngostomy or colostomy, needing continuous surgical dressing or an appliance;

◦one of the following conditions: diabetes mellitus (except where treatment is by diet alone), myxoedema, hypoparathyroidism, diabetes insipidus and other forms of hypopituitarism, forms of hypoadrenalism (including Addison’s disease) for which specific substitution therapy is essential, or myasthenia gravis;

◦a sexually transmitted disease; or

•your income is low enough (see here).

Full-time education

’Full-time education’ is full-time instruction at a recognised educational establishment – eg, a school, college or university. If you are studying elsewhere, or you have finished your A levels and are waiting to start college or university, check whether you are exempt because you are on a low income.

1 Regs 3-6 NHS(CDA) Regs; regs 4 and 5 NHS(TERC) Regs; NHS(FP&CDA)(W) Regs »

Prepayment certificates

Prepayment certificates are available in England and can save you money if you are likely to need a lot of prescriptions, but are not exempt from paying for them. You do not have to pay any further charges for prescriptions for the duration of the certificate, regardless of how many are required.1Reg 9 NHS(CDA) Regs

A three-month certificate saves money if you need four or more items in the three-month period, while a 12-month certificate saves money if you require more than 12 prescriptions in a year. Apply by post on Form FP95, available from chemists, some doctors’ surgeries and relevant health bodies. Applications can also be made by telephone on 0300 330 1341 or online at nhsbsa.nhs.uk and at registered pharmacies. The cost of 12-month certificates can be split over 10 direct debit instalments.

1 Reg 9 NHS(CDA) Regs »

Free sight tests

You qualify for a free NHS sight test if:1Reg 13 NHS(GOS) Regs; reg 3 NHS(OCP) Regs

•you are in one of the exempt groups listed on here; or

•you are aged under 16, or under 19 and in full-time education (see here); or

•you are aged 60 or over; or

•you are registered as blind or partially sighted; or

•you have been prescribed complex or powerful lenses; or

•you have diabetes or glaucoma or are at risk of getting glaucoma; or

•you are 40 or over and are the parent, sibling or child of someone who has glaucoma; or

•you are a patient of the Hospital Eye Service; or

•in England, if you are on leave from prison or a young offenders’ institution; or

•your income is low enough (see here).

Note: you may also qualify for a voucher towards the cost of buying or repairing glasses or contact lenses.2Regs 9 and 15 NHS(OCP) Regs

1 Reg 13 NHS(GOS) Regs; reg 3 NHS(OCP) Regs »

2 Regs 9 and 15 NHS(OCP) Regs »

Free dental treatment and dentures

If you live in Wales and are under 25 or are 60 or over, you qualify for free dental examinations.1Reg 3 NHS(DC)(W) Regs Otherwise, you qualify for free dental treatment (including check-ups) and appliances (including dentures) if:2Regs 4 and 5 NHS(TERC) Regs; regs 4 and 5 NHS(TERC)(W) Regs; Sch 2 and 3 NHS(DC) Regs; reg 9 and Sch 5 NHS(DC)(W) Regs

•you are in one of the exempt groups listed on here; or

•you are aged under 18, or are under 19 and in full-time education (see here); or

•you are pregnant or have given birth within the last 12 months; or

•you are a patient of the community dental service; or

•your income is low enough (see here).

1 Reg 3 NHS(DC)(W) Regs »

2 Regs 4 and 5 NHS(TERC) Regs; regs 4 and 5 NHS(TERC)(W) Regs; Sch 2 and 3 NHS(DC) Regs; reg 9 and Sch 5 NHS(DC)(W) Regs »

Free wigs and fabric supports

In Wales and Northern Ireland, wigs and fabric supports are free. In England, you qualify for free wigs and fabric supports if:1Regs 4 and 5 NHS(TERC) Regs; NHS(CDA) Regs; NHS(FP&CDA)(W) Regs

•you are in one of the exempt groups listed on here; or

•you are under 16, or under 19 and in full-time education (see here); or

•you are a hospital inpatient when the wig or fabric support is provided; or

•your income is low enough (see here).

1 Regs 4 and 5 NHS(TERC) Regs; NHS(CDA) Regs; NHS(FP&CDA)(W) Regs »

Fares to hospital

You qualify for help with the costs of travel to hospital or any other establishment for NHS treatment or services if:1Regs 3, 5 and 9 NHS(TERC) Regs; regs 3 and 5 NHS(TERC)(W) Regs

•you are in one of the exempt groups listed on here; or

•you live on the Isles of Scilly; or

•your income is low enough (see here).

Note: in some cases, you can get help with the costs of travel to obtain NHS treatment abroad.

1 Regs 3, 5 and 9 NHS(TERC) Regs; regs 3 and 5 NHS(TERC)(W) Regs »

Healthy Start food and vitamins

You can get free Healthy Start food vouchers and vitamins if:1Reg 3 HSS&WF(A) Regs

•you are aged 18 or over and pregnant and you or your partner get IS, income-based JSA or income-related ESA, or get CTC (but not WTC, except during the four-week run-on) and have an income for tax credit purposes of £16,190 or less; or

•you are aged under 18 and pregnant, whether or not you get any of the above benefits; or

•you have a child under four and get IS or income-based JSA, or get CTC (but not WTC, except during the four-week run-on) and have an income for tax credit purposes of £16,190 or less; or

•you are 18 or over and pregnant or have a child under four, and get UC with an earned income of £408 or less per assessment period.

1 Reg 3 HSS&WF(A) Regs »

The low income scheme

You may be entitled for help with NHS charges if you have a low income. The NHSBSA has a means test to determine whether you qualify for either full or partial remission. The means test is roughly based on the applicable amounts for IS (see Chapter 13), but there are some differences.

See here for how to apply.

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 £9.35, so £4.67), 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:

•personal allowance

◦single person aged under 25, £59.20;

◦single person aged under 25 entitled to an ESA component, or incapable of work for 28 weeks since 27 October 2008, £74.70;

◦single person aged 25–59, £74.70;

◦single person aged 60 or over, £177.10;

◦lone parent aged under 60, £74.70;

◦lone parent aged 60 or over, £177.10;

◦couple aged under 60, £117.40;

◦couple aged 60 or over, £270.30;

•premiums

◦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 £39.40 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 £4.67 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 £4.67 higher than your needs, you do not get free prescriptions, but you might get partial help with other charges.

Examples

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 (£59.20) plus her weekly rent (£110). This gives a total of £169.20. 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 (£59.20) plus her weekly rent (£150). This gives a total of £209.20. Her income therefore exceeds her requirements by £10.80, 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 £10.80 of any sight test, a sum equal to her excess income, while she must pay the first £21.60 of any glasses or lenses, a sum equal to twice the excess.

1 Sch 1 NHS(TERC) Regs; Sch 1 NHS(TERC)(W) Regs »

2 Reg 5 NHS(TERC) Regs; reg 5 NHS(TERC)(W) Regs »

3 Reg 6 NHS(TERC) Regs; reg 6 NHS(TERC)(W) Regs »

4 Reg 16 and Sch 1 NHS(TERC) Regs; reg 15 and Sch 1 NHS(TERC)(W) Regs »

5 Reg 17 and Sch 1 NHS(TERC) Regs; reg 16 and Sch 1 NHS(TERC)(W) Regs »

3. Claiming health benefits and refunds

How and where you claim help with NHS charges depends on your circumstances.

Under 19 and in full-time education

•To claim an exemption from NHS prescription charges, you must sign the declaration form on the back of the prescription.

•To claim a free sight test, you must sign the optician’s form before your test.

•To claim free dental treatment, you must tell the receptionist before your treatment that you think you are exempt from charges and complete a form at this point. Remember, in Wales, if you are under 25 you qualify for free dental examinations.

Pregnant women and women who have recently given birth

•To claim free dental treatment and prescriptions, you must apply for a maternity exemption certificate on Form MATB1, available from your midwife, health visitor or doctor.

•You must claim Healthy Start food and vitamins in writing. Complete Form HS01 in the Healthy Start application leaflet, available from maternity clinics and some doctors’ surgeries or from 0345 607 6823. A downloadable claim form is also available at . Your claim form must be countersigned by a health professional (eg, a midwife or health visitor), certifying that you have been given appropriate advice about healthy eating and breastfeeding.

Prescribed medical condition

To claim free prescriptions because you have a prescribed medical condition, you must apply for an exemption certificate on a form available from your doctor, hospital or pharmacist.

The low income scheme

Applications for help under the low income scheme should be made to the NHS Business Services Authority on Form HC1 (HC1W in Wales), available from Jobcentre Plus offices, NHS hospitals, some doctors’ surgeries, some chemists, many students’ union advice centres or at .

Refunds

If you pay for an item or service that you could have got free of charge or at a reduced cost, you can apply for a refund. You must apply within three months of payment, although the time limit can be extended if you can show a good cause for applying late – eg, you were ill.1Reg 11 NHS(TERC) Regs; reg 10 NHS(TERC)(W) Regs; reg 10 NHS(CDA) Regs; Sch 1 para 1 NHS(FP&CDA)(W) Regs; regs 6 and 20 NHS(OCP) Regs; reg 10 NHS(DC) Regs; reg 10 NHS(DC)(W) Regs

For a refund of prescription charges, use Form FP57, which you must get when you pay for the prescription at the pharmacy or dispensing chemist.

For other items and services, use Form HC5 (HC5W in Wales), available from post offices, Jobcentre Plus offices, NHS hospitals and some doctors’ surgeries.

If you wish to have your costs refunded on the basis of low income, but do not already have an HC2 or an HC3 remission certificate (see here), send a completed Form HC1 with Form HC5.

1 Reg 11 NHS(TERC) Regs; reg 10 NHS(TERC)(W) Regs; reg 10 NHS(CDA) Regs; Sch 1 para 1 NHS(FP&CDA)(W) Regs; regs 6 and 20 NHS(OCP) Regs; reg 10 NHS(DC) Regs; reg 10 NHS(DC)(W) Regs »

4. Challenging a decision

If you think a decision about your health benefits is wrong, you can ask for a review. Write to the Service Improvement Team, NHS Help with Health Costs, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne NE1 6SN. You can also request a review at .

If you think a decision is wrong because it was based on your circumstances at the time you applied for a remission certificate and these have now changed, consider making a fresh claim, or reporting the change, if you think you would now be entitled to more help with NHS charges.

If there are delays in obtaining a certificate, you can complain to the customer services manager. If necessary, you could pay for the treatment or items you need, then apply for a refund (see above).

5. Overseas students

Many overseas students can get certain types of treatment free from the NHS. However, since April 2015, there are charges for non-European Economic Area (EEA) students (see below).

Asylum seekers

If you are an asylum seeker or a dependant of an asylum seeker and receiving support from either the Home Office or a local authority, you are exempt from NHS charges. If you are getting asylum support, you should be sent an HC2 certificate with your first support payment. If you are not supported by the Home Office or a local authority, apply using Form HC1.

European Economic Area students and Swiss nationals

Following the UK’s exit from the European Union (EU), students from the EEA and Switzerland are no longer entitled to NHS treatment during a temporary stay using their European health insurance card (EHIC). Whether you can access healthcare depends on your exact status, when you entered the UK and other factors. See the guidance at for more details. If you are unable to access free treatment you may be required to make payments towards your treatment as with other overseas students (see below). You are strongly advised to check that you have adequate sickness insurance if required.

Other overseas students

Since April 2015, non-EEA international students have been subject to charges for some types of treatment, and may have to make a payment towards health costs as part of any visa application. Whether you are required to make this payment, or whether a specific treatment is free or a charge applies, depends on several factors. These include your specific immigration status, your length of stay in the UK, your country of origin and the type of treatment. It can also depend on whether you are living in England, Wales or Northern Ireland. Detailed information is available at .

All overseas students can get emergency treatment, treatment for certain communicable diseases and compulsory psychiatric treatment free of charge through the NHS. Nevertheless, you are strongly advised to take out adequate medical insurance for the duration of your stay in the UK.

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