Chapter 5: Health benefits

CPAG

Low income scheme

Basic facts

•Everyone in Scotland is entitled to free NHS eye and dental checks and free prescriptions.

•Everyone under 26 can get free NHS dental treatment.

•Full-time students under 19 can get free dental treatment and vouchers for glasses.

•Other students can get help if they have a low income or in certain other circumstances.

1. What are health benefits

There are charges for some NHS treatments and services including:

•glasses and contact lenses;

•dental treatment.

There are also often costs incurred in getting to hospital. You may be exempt from these charges or be able to claim help with them on low income grounds.1NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.59); The National Health Service (Optical Charges and Payments) (Scotland) Regulations 1998, No.642, as amended (most recently in 2019 by SI No.50); The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011, No.55, as amended (most recently in 2019 by SI No.145); The National Health Service (Dental Charges) (Scotland) Regulations 2003, No.158, as amended (most recently in 2011 by SI No.168)

There is no charge for NHS eye and dental checks, or for prescriptions. Note: if you have an English prescription form there may be a charge, but there are exemptions.2Reg 4 The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011, No.55, as amended (most recently in 2019 by SI No.145)

1 NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.59); The National Health Service (Optical Charges and Payments) (Scotland) Regulations 1998, No.642, as amended (most recently in 2019 by SI No.50); The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011, No.55, as amended (most recently in 2019 by SI No.145); The National Health Service (Dental Charges) (Scotland) Regulations 2003, No.158, as amended (most recently in 2011 by SI No.168) »

2 Reg 4 The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011, No.55, as amended (most recently in 2019 by SI No.145) »

2. Who is eligible

Low income scheme

Under age 19

If you are in full-time education, you are entitled to vouchers for glasses.

If you are in part-time education, you are not automatically exempt from NHS charges, but you might get help because you get a qualifying benefit, are in an exempt group or qualify under the low income scheme (see here).

Under age 26

If you are under 26, you are entitled to free NHS dental treatment. It does not matter if you are studying full time or part time, or not studying at all.

Older students

You are not automatically exempt from NHS charges because you are a student, but you might get help because you get a qualifying benefit, are in an exempt group or qualify under the low income scheme.

Qualifying benefits

You get free NHS dental treatment, vouchers for glasses and certain fares to hospital if you get:

•universal credit (UC) and you:1NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.59)

◦have no earnings; or

◦earn £435 or less a month (or, if you have a partner, your combined earnings are £435 or less a month); or

◦have a child element in your UC, or you or your partner (or both of you) have limited capability for work and earn £935 or less a month (or, if you have a partner, your combined earnings are £935 or less a month);

•income support (IS);

•income-based jobseeker’s allowance (JSA);

•income-related employment and support allowance (ESA);

•guarantee credit of pension credit;

•child tax credit (CTC) and your income for tax credit purposes is £15,276 or less; or

•working tax credit with a disabled worker element or severe disability element and your income for tax credit purposes is £15,276 or less.

1 NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.59) »

Exempt groups

Dental treatment

You are eligible for free NHS dental treatment if:

•you are pregnant or have given birth in the last year;

•you are under the Public Dental Service (for people who have difficulty getting treatment for reasons such as a disability);

•you are an asylum seeker getting asylum support;

•you get a war pension and need treatment for your war disablement; or

•you are a care leaver getting support from the local authority under section 29 of the Children (Scotland) Act 1995.

Vouchers for glasses or contact lenses

You are eligible for vouchers for glasses if:

•you are aged under 16;

•you have a prescription for complex lenses;

•you are a Hospital Eye Service patient;

•you are an asylum seeker getting asylum support;

•you get a war pension and need treatment for your war disablement; or

•you are a care leaver getting support from the local authority under section 29 of the Children (Scotland) Act 1995.

Fares to hospital

You are eligible for help with fares to hospital if:

•it is 30 miles or more away, or involves a journey of five miles or more by sea, and you live in the Highlands or Islands – ie:

◦the Highland region, Western Isles, Orkney Islands, Shetland Islands;

◦Arran, Great Cumbrae, Little Cumbrae;

◦the area formerly covered by Argyll and Bute District Council;

◦parts of Moray (Aberlour, Cabrach, Dallas, Dyke, Edinkillie, Forres, Inveravon, Kinloss, Kirkmichael, Knockando, Mortlach, Rafford, Rothes);

•you are an asylum seeker getting asylum support;

•you get a war pension and need treatment for your war disablement; or

•you are a care leaver getting support from the local authority under section 29 of the Children (Scotland) Act 1995.

Low income scheme

If you are on a low income, you may be eligible for help under the low income scheme, even if you do not qualify on other grounds.

Under the low income scheme, your income is worked out in almost the same way as for an IS assessment and compared with your needs in the form of premiums and allowances, as in IS but with certain housing costs added.

Step one: capital

You do not qualify if your capital is over £16,000. If your capital is between £6,000.01 and £16,000, add £1 to your income for every £250, or part of £250, between these limits.

Step two: work out your requirements

This is an amount for basic weekly needs. See Chapter 7 for details of how to qualify for each premium. Your requirements are made up of:

•personal allowances

◦single person aged under 25	◦£61.05
◦single person aged under 25, entitled to an ESA component or incapable of work for 28 weeks since 27 October 2008	◦£77.00
◦single person aged 25 or over	◦£77.00
◦single person aged 60 or over	◦£182.60
◦lone parent aged under 60	◦£77.00
◦lone parent aged 60 or over	◦£182.60
◦couple, both aged under 60	◦£121.05
◦couple, one or both aged 60 or over	◦£278.70

•premiums

◦carer (as for IS);

◦disability (as for IS, except that this is included after 28 weeks of incapacity for work, rather than 52 weeks). You 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 have been getting ESA for at least 28 weeks, or have had limited capability for work for at least 28 weeks since 27 October 2008. The amount of the disability premium increases to £40.60 if you are single or a lone parent and get ESA with the support component, get the disability living allowance middle or highest rate care component or get the standard or enhanced rate of the daily living component of personal independence payment, and have been incapable of work for 28 weeks since 27 October 2008;

◦enhanced disability for an adult (as for IS) and also if you (or your partner) are under 60 and get ESA with a support component;

◦severe disability (as for IS);

•weekly rent less any housing benefit (HB) and non-dependant deductions;

•weekly council tax, if you are liable, less any council tax reduction;

•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;

•amounts for children. If you have children, you are likely to be exempt from charges through getting a qualifying benefit like UC (with no/low earnings), IS, JSA or CTC (see here). If you get CTC but are not exempt from charges, your children are not included in the low income assessment.

Step three: work out your weekly income

Income is calculated in a very similar way as it is for IS. Your income is taken into account, as well as the income of your partner. Information about how your income is calculated and how student income is treated is in Chapter 19.

Step four: deduct weekly income from requirements

If your income is less than your requirements or no more than £4.67 (half the cost of an English prescription) higher, you are entitled to maximum help with health benefits. If your income is more than £4.67 higher than your needs, you might get partial help.

You are expected to contribute your ‘excess income’ (the amount by which your income exceeds your needs) towards hospital fares, and can get help with the rest of the costs up to the maximum amount allowed. You are expected to contribute twice your excess income towards help with glasses or contact lenses and three times your excess income towards help with dental charges.1Reg 5 NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.5); regs 14 and 19 The National Health Service (Optical Charges and Payments) (Scotland) Regulations 1998, No.642, as amended (most recently in 2019 by SI No.50)

Examples

Madhu is a second-year undergraduate aged 20. She has a student loan of £5,750 and a young students’ bursary of £2,000. She is single, has no children and pays £65 rent a week. She gets no HB. Under the low income scheme, her requirements are £124.20 (£59.20 personal allowance, plus £65 rent). Her income from her student loan is £97.25 (see here). Her income is below her requirements so she is entitled to free NHS dental treatment and vouchers for glasses.

Lewis is 26 and is a second-year undergraduate. He needs dental treatment costing £90. His weekly income for health benefits is £116.48 student loan, plus £50 earnings, making a total of £166.48 (see here). His needs are £74.70 personal allowance plus £75 weekly rent, a total of £149.70. His excess income is £16.78. He must contribute £50.34 (three times his excess income) to his dental treatment. The other £39.66 is paid for him under the low income scheme.

1 Reg 5 NHS(TERC)(S) Regs, as amended (most recently in 2017 by SI No.5); regs 14 and 19 The National Health Service (Optical Charges and Payments) (Scotland) Regulations 1998, No.642, as amended (most recently in 2019 by SI No.50) »

3. Claiming health benefits

If you are exempt from charges because you are a student under 19 (or, for dental treatment, under 26), you are under 18 or because you get a qualifying benefit, you should fill in the form when you go for treatment.

If you need to claim on low income grounds and do not get a qualifying benefit, you should claim in advance on Form HC1. You can get this from surgeries, hospitals, opticians, pharmacies and Jobcentre Plus offices, or you can apply online or download a form from the NHS Business Services Authority website at . You must provide details of your student loan, grant or bursary, and include a copy of your award letter.

If you have already paid for treatment, claim a refund on Form HC5 within three months.

4. Challenging a decision

If you are claiming under the low income scheme, you can ask for a formal review of the decision on your claim by writing to the NHS Business Services Authority, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne NE1 6SN, or online at .

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