Help With Health Costs
Most services and treatment provided by the NHS are free but charges are made for some things which include: NHS dental charges; eye tests, glasses and contact lenses; wigs and fabric supports. However, you may qualify for help with these health costs. Also, for help with travel costs to hospital for NHS treatment.
Note: this leaflet gives a brief summary of help with health costs and is for guidance only. It does not cover all situations, nor is it a full statement of the law. Sources of further, more detailed information are given at the end.
Who qualifies for help with health costs?
You automatically qualify for help because:
- You are entitled to, or named on, a valid NHS tax credit exemption certificate.
- You have a low income and are named on an HC2 or HC3 certificate.
- You are a war pensioner and the treatment is for your pensionable disablement.
- You receive, or your partner receives, one of the following:
- Income Support.
- Income-based Jobseeker's Allowance.
- Income-related Employment and Support Allowance.
- Pension Credit Guarantee Credit.
- Universal Credit (England and Wales).
You may also qualify because of your age or because you have a health condition (see the specific charges below).
Optometrist charges cover NHS sight tests and costs towards glasses and contact lenses.
Who gets free NHS sight tests?
As well as the eligibility conditions above, you automatically qualify for free sight tests if you:
- Are aged under 16, or under 19 and in full-time education.
- Are aged 60 or over.
- Are registered blind or partially sighted.
- Have diabetes.
- Have glaucoma.
- Are advised by a hospital eye specialist (an ophthalmologist) that you are at risk of glaucoma.
- Are aged 40 or over and have a close relative (parent, brother, sister, son, or daughter) with glaucoma.
- Are eligible for an NHS complex lens voucher (your optician will advise).
- Are a prisoner on leave from prison.
Note: all residents in Scotland are entitled to free NHS sight tests.
Free sight tests for workers who use computers and VDUs
If you work at a computer screen or VDU as part of your job you are entitled to obtain a voucher for the full cost of the sight test. This is laid down in the Health and Safety (Display Screen Equipment) Regulations 1992. You need to let your optician know that you have a voucher before you have the sight test. You may also be entitled to a voucher towards the cost of your glasses but not towards the cost of contact lenses. Your optician will be able to advise you.
NHS optical vouchers
Following a sight test, an optometrist will issue a prescription if you need glasses or contact lenses. He or she will also give you a voucher if you qualify for help with the cost of glasses or contact lenses. The voucher is intended to cover the full cost of glasses or contact lenses but if you want certain styles you may need to top it up with your own money. You do not have to buy the glasses or contact lenses from the optometrist who did the sight test.
Everyone is entitled to NHS dental treatment. However, not all dentists provide NHS dental treatment. If you are unable to find a dentist offering NHS dental treatment you should contact your local NHS England area team. You must tell the dentist you want NHS treatment when you make the appointment.
There are three bands of NHS dental charges (April 2015 rate):
- Band 1: £18.80 covers an examination, diagnosis and advice. If necessary, it also includes X-rays, a scale and polish and planning for further treatment.
- Band 2: £51.30 covers all treatment covered by Band 1, plus additional treatment, such as fillings, root canal treatment and removing teeth (extractions).
- Band 3: £222.50 covers all treatment covered by Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges.
Who gets free NHS dental treatment?
If you qualify for help with NHS dental treatment it is important that you check with the dentist beforehand. As well as the eligibility conditions in the first section, you automatically qualify for free dental treatment if you:
- Are aged under 18.
- Are aged under 19 and in full-time education.
- Are pregnant, or have had a baby in the 12 months before treatment starts.
- Are an NHS inpatient and the treatment is carried out by the hospital dentist.
- Are an NHS Hospital Dental Service/Community Service outpatient (there may be a charge for dentures and bridges).
Note: in Scotland NHS dental examinations are free to anyone normally resident in the UK and in Wales they are free to anyone under 25 or over 60 on the day they are examined in Wales.
Travel to hospital costs
Some patients and parents of children attending hospital or other NHS premises for NHS-funded treatment may qualify for help with travel costs to and from hospital.
Who gets help with travel costs?
The eligibility conditions in the first section apply for help with travel costs.
Children and young adults:
- If the patient is a child under 16, it is the parental income that counts even if someone else takes them to hospital.
- If the patient is 16 or over but under 19 (under 20 in England) and is counted as a dependant of someone getting benefits.
- If the patient is 16 and over and not a dependant of a person who gets benefits or credits, they can make their own claim, even if they live with their parents.
What form of transport can I use?
You should use the cheapest available means of transport, using public transport where possible. Petrol costs equivalent to public transport costs will be reimbursed if a private car is used instead of available public transport. If public transport is unavailable, full petrol costs will be reimbursed. Taxis may be used if there is no alternative or if the patient is unable to use public transport.
How can I claim help for the travel costs?
The hospital fares office should be able to reimburse you the return fare at the time of your visit. Ask at reception if necessary. Make sure that you keep all tickets and receipts. You need to show evidence of benefits or exemption (certificate HC2 or HC3). If you are unable to pay a fare in advance, check with the hospital, because you may be able to receive a payment before the appointment.
You can also make a claim on an HC5 form up to three months after the appointment.
NHS wigs and fabric supports
NHS wigs and fabric supports (including spinal or abdominal supports or a surgical brassiere) are free to everyone in Northern Ireland, Scotland and Wales.
In England the eligibility criteria in the first section apply plus:
- If you are aged under 16, or under 19 and in full-time education.
- If you are a hospital inpatient.
How can people on a low income apply for help with health costs?
Some people on a low income may qualify for help with NHS health costs. Your entitlement to help is based on your circumstances, such as your level of income, savings, etc. Your entitlement will also apply to your partner and any dependent young people.
You will have to fill in an HC1/HC1W/HC1(SC) form, 'Claim for Help with Health Costs', giving various details of your circumstances and then send it off in the prepaid envelope provided.
If you qualify for help, you will be sent an HC2 certificate for full help, or an HC3 certificate for partial help, which you will need to produce when paying. The certificate will tell you whom it covers, how long it lasts and how much you will have to pay towards your health costs.
Can I claim a refund for charges already paid?
If you are issued with an HC2 or HC3 certificate, you may be able to claim a refund if you have recently paid for optometrist charges. You will need to keep your receipt and you will need to claim using an HC5 form. Claims must be received within three months of your paying the charge.
How can I get the claim forms?
You can obtain forms HC1/HC1W or HC5 as follows:
- Online (see 'Further help & information', below).
- From Jobcentre Plus offices.
- From most hospitals, GP surgeries, dentists and opticians.
How can I find out more?
This leaflet only gives a brief summary of how to obtain help and is for guidance only. It does not cover all situations nor is it a full statement of the law. The official information booklet 'Help with health costs' (HC11 in England, Northern Ireland and Wales and HCS1 in Scotland) provides more full information. The booklet can be downloaded online (see next section) and you should be able to obtain a leaflet from your Jobcentre Plus offices, most hospitals, GP surgeries, dentists and opticians.
Further help & information
Further reading & references
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Hayley Willacy