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Help With Health Costs

Who qualifies for help with health costs?

See separate leaflets called ‘Free or Reduced Cost Prescriptions’, ‘Free Wigs and Fabric Supports’, ‘Help With Dental Charges’, ‘Help with Optometrist Charges’, ‘Help with Travel Costs to Hospital’ for more details on each of these costs and who may not have to pay them. Briefly, some people automatically qualify for help. For example:

  • You may be automatically exempt from paying certain health costs for reasons such as age, if you have certain health conditions, pregnancy, or recent childbirth. For example: the under 16s and the over 60s do not pay prescription charges; pregnant women do not pay NHS dental charges; etc.
  • If you receive Income Support, income based Jobseeker’s Allowance, or Pension Credit Guarantee Credit, you are entitled to help with certain health costs.
  • If you receive certain Tax Credits you may be entitled to help with certain health costs if your income is low enough.
  • If you have a low income, you may also be eligible for help.

How can I apply for help with health costs?

If you are on a low income and are not automatically exempt from a charge, you may be eligible for help with health costs. Your entitlement to help is based on your circumstances such as your level of income, savings, etc. You will have to fill in an HC1 form ‘Claim for Help with Health Costs’ giving various details of your circumstances and then send it off in the pre-paid 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 means you will need to pay some of the costs yourself.

The certificate will tell you who it covers and how long it lasts. If your circumstances change for the better you can continue using the certificate until it expires. If your circumstances change for the worse during the period of the certificate you should make another claim. If your circumstances will remain unchanged after the time period, then make a new claim before the current certificate expires.

How can I claim a refund for a health cost already paid?

If you are issued with certificate HC2 or HC3, you may be able to claim a refund if you have recently paid for a health cost mentioned above.

For a refund of prescription charges you must get a receipt form from the pharmacist (FP57 England, PS7 Northern Ireland and HCS(R) Scotland). You must get this when you pay for your prescription, you cannot get one later. Fill the form in and send it off to claim the refund. You have to apply for a refund within three months of paying for the prescription.

For a refund on all other health costs you will need to get a receipt at the time you paid the charge, showing you have paid the charge and you should use the appropriate HC5 claim form (D for dental charges, O for optometrist charges, etc) to apply for the refund. You have to apply for a refund within three months of paying the charge.

How can I get the claim forms?

To get the forms HC1 or HC5 mentioned above:

  • Contact your local office of the Department of Work and Pensions (the local Jobcentre Plus or ‘social security’ office) for a claim form. Find your local office in the phone book under ‘Jobcentre Plus’, OR
  • Get them from an NHS hospital, OR
  • Your dentist or optometrist may stock them, OR
  • Phone the NHS Formsline on 0845 610 1112, textphone number 08700 102 870, OR
  • Phone the Department of Health Publications Orderline on 0300 123 1002 (minicom 0300 123 1003) and ask for a form to be sent to you.

How can I find out more?

Further information

This leaflet only gives a brief summary of how to obtain help with health costs. 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 and Northern Ireland, and HSC1 in Scotland) provides more details for people on a low income. Your local Jobcentre Plus office, NHS hospital, pharmacist, doctor, dentist or optician may have a leaflet on help with health costs and relevant claim forms. The booklet is available as a download from:
Web: www.nhsbsa.nhs.uk/HealthCosts/1558.aspx (England and Scotland) and
Web: www.dhsspsni.gov.uk/hc11_help_with_health_costs.pdf (Northern Ireland).

Directgov

Web: www.direct.gov.uk
Directgov brings together the widest range of public service information and services online.
Produced by the Central Office of Information, Directgov provides information from government departments on topics ranging from travel safety and parental leave, to special educational needs, local NHS services, and benefits. The site also brings together an increasing number of online government services – including being able to download and/or complete certain benefit claim forms online. See the Health costs section of the website.

NHS Business Services Authority – Help with Health Costs

Web: www.nhsbsa.nhs.uk/HelpWithHealthCosts.aspx
Help with Health Costs provides exemption certificates to those entitled and sells Prescription Pre-payment Certificates. They have phone lines that deal with various queries:

  • NHS Low Income Scheme
    Tel: 0845 850 1166
  • Prescription Pre-payment, Medical and Maternity Exemption Certificates
    For general queries before you apply: Tel: 0845 850 0030
    For specific queries after you’ve applied: Tel: 0845 601 8076
  • NHS Tax Credit Exemption Certificates
    Tel: 0845 609 9299

Benefit Enquiry Line – BEL

England, Wales and Scotland – Tel: 0800 88 22 00 Textphone: 0800 24 33 55
Northern Ireland – Tel: 0800 220 674 Textphone: 0800 243 787
For people with disabilities, their carers and representatives. It is part of the Department for Work and Pensions. BEL offers confidential advice and information on benefits and how to claim them. In addition they can also send out an extensive range of leaflets and claim packs, and help you to complete a claim form over the phone.

Citizens Advice Bureau

Provides independent advice on many issues including benefits. Listed in the phone book under ‘Citizens Advice Bureaux’. Also, see their excellent website: www.citizensadvice.org.uk

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