Help with Health Costs

The information provided here is an overview of the help and support available towards health related costs and is meant as a guide and brief overview. Full and up to date information on help with health costs can be found on the NHS website at:
Or, in the Help with Health Cost Leaflet (HC11 for residents in England, HCS1 for Scotland & HC11W for Wales), available from your local Jobcentre Plus, dentist, pharmacy, doctor or optician or you can download the booklet at:  www.nhsbsa.nhs.uk/HealthCosts/1558.aspx
 
Having a long-term medical condition means that you are likely to require frequent trips to the doctors, or hospital as well as the probably that you will require regular repeat prescriptions. All of which costs money and over the year can prove to be expensive.
 
Many patients on artificial nutrition are entitled to financial help with the costs incurred and may not always be made aware of this from their care team or believe that it is not available to them because of the over use of medical terminology or pages of fine print.
 
 
a)            Costs incurred as result of treatment
Many of services and treatments provided by the NHS are free, but charges are made for some things including Prescriptions, NHS dental charges, eye tests, glasses and contact lens, wigs and fabric supports. However, some people may qualify for help with such costs.
You may automatically qualify for help if:
       You may be automatically exempt from paying certain health costs for reasons such as age, if you have certain health conditions, pregnancy, or recent child birth.
       If you receive income support, income-based jobseeker’s allowance, or Pension credit guarantee credit, you may be entitled to help with certain health costs.
       If you receive 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.
If you do not automatically qualify, but your income is low enough you may still be entitled to help with health costs. You entitlement to help will be based upon your circumstances, such as your income, savings, etc.
To apply you will need to fill out form HC1 ‘Claim for Help with Health Costs’. This is to allow you to explain the relevant details of your circumstances. The information that you provide in form HC1 will be used to understand your needs and if you do qualify you will be awarded either a HC2 or HC3 certificate, to use as evidence of your entitlement. HC2 entitles you to full help with Health Costs, whilst HC3 entitles you to partial help. The certificate will inform you how long it is valid for.
Changes in Circumstances:
   If your situation improves you are still entitled to continue claiming until it expires.
   If you situation changes for the worse while the certificate is valid, you should make another claim.
   If your situation remains unchanged when the certificate expires, you should file a new claim.
If issued with a HC2 or HC3 certificate you will be able to claim back help with health costs, by using for HC5 ‘Claim Form’, there are four separate HC5 forms depending upon the type of health cost incurred.
   HC5 (D) is for Dental costs
   HC5 (O) is for Optical costs
   HC5 (W) is for Wigs and Fabric Support costs
   HC5 (T) is for Travel costs
You will need to ensure that you complete the appropriate form for the benefit that you are claiming for and if necessary two forms if you wish to claim for dental treatment; HC5(D) and the cost of the travel; HC5(T) to receive the treatment.
Ensure that you get all relevant receipts at the time of paying as you will not be able to get a receipt at a later date.
Forms HC1 and HC5 (all types) can be obtained from:
   Your local office of Department of Work and Pensions (the local Jobcentre Plus) OR
   An NHS hospital OR
   You dentist or Optometrist may stock them, OR
   Phone the NHS Formsline on 0845 610 1112 (textphone 08700 102870), OR
www.nhs.uk
b)            Travel Costs
The following groups of people can get help with necessary travel costs to receive NHS treatment:
       If you (or your partner) get one of the following benefits or allowances:
   Income Support
   Income-based Jobseeker’s Allowance
   Income-related Employment and Support Allowance, or
   Pension Credit Guarantee Credit
       If you are entitled to, or named on, a valid NHS tax credit exemption certificate.
       If you are a war pensioner – if treatment is connection with the pensionable disability.
       You are named on an HC2 (or HC3) certificate because of low income)
       Children & Young adults:
   If the patient is a child under 16, it is their parent’s 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 dependent of someone getting benefits.
   If the patient is 16 and over and not a dependent of a person who get benefits, or credits, they can make their own claim even if they live with their parents.
If you are not sure what travel costs you can get help with, as the hospital before you travel.
If you meet one of the listed criteria then you may be able to apply for part or all of your travel expenses incurred by attending your appointment at hospital. Typically you will be expected to use the cheapest form of public transport that you can manage and to utilise any concessions or promotions.
If you use private transport you can claim for your petrol (and car parking charges if unavoidable) and you will be informed of how much you can claim per mile from your hospital.
If public transport is impractical (due to issues with mobility) you will need to check with the hospital before you travel to ensure that they will cover the costs for using other services (such as a taxi).
People receiving Income Support or Income-based Jobseeker’s Allowance may be able to get help when visiting someone in hospital in certain circumstance. To find out if you qualify you will need to contact your local Jobcentre Plus office, hospital social services department, or other advice sources.
To claim at the NHS hospital or clinic at the times of your appointment, you will be paid back immediately and in cash, providing you have valid receipts for your travel costs and can provide proof of entitlement:
   Proof of a qualifying benefit (see above)
   A tax credit exemption certificate (given automatically when you qualify)
   A certificate showing you qualify for the NHS Low Income Scheme (HC2 or HC3).
 
Alternative you can file a claim at a later date using form HC5; available from your local office of the Department of Work & Pensions (local Jobcentre Plus), the NHS hospital or place of treatment or from the NHS formsline on 0845 610 1112. Claims can be made up to 3 months after the date of the hospital visit.
On the back of the prescription you get from the doctors is a list of all of the reason why you may not have to pay for your prescription, these include:
       If you are aged 60 or over
       If you are aged under 16
       If you are aged 16, 17 or 18 and in full-time education
       If you are pregnant, or have had a baby in the previous 12 months and have a ‘Maternity Exemption Certificate’.
       If you have a valid ‘Medical Exemption Certificate’
       If you (or your partner) get one of the following benefits:
   Income Support.
   Income-based Jobseekers Allowance
   Income-related Employment and Support Allowance
   Pension Credit Guarantee Credit.
       If you are entitled to, or named on, a valid NHS tax credit exemption certificate.
       Some people on low income who have a certificate HC2.
 
a)            MEDICAL EXEMPTION CERTIFICATE (MedEx)
A Medical Exemption Certificate (MedEx) are issued to people who have one of the following conditions:
   A permanent fistula (for example Caecostomy, colostomy, laryngostomy or ileostomy) requiring surgical dressing or requiring an appliance.
   A form of hypoadrenalism (eg Addison’s) for which specific substitution therapy is essential
   Diabetes insipidus or other form of hypopituitarism
   Diabetes mellitus, except where treatment is through diet alone
   Hypoparathyroidism
   Myasthenia Gravis
   Myxoedema (that is, hypothyroidism requiring thyroid hormone replacement)
   Epilepsy requiring continuous anticonvulsive therapy
   A continuing physical disability which means the person cannot go out without help of another person. Temporary disabilities do not count even if they last several months.
OR undergoing treatment for cancer:
    Including the effects of cancer; or
   The effects of current or previous cancer treatment.
Some patients who are on enteral feeding are entitled to a MEDICAL EXEMPTION CERTIFICATE and therefore entitled to free NHS prescriptions whether they are for nutritional feeds or regular medications.
This form can be obtained from your GP surgery; usually without the necessity to see your doctor, but should they dispute your eligibility, please draw their attention to the condition stating “permanent fistula”. There is still some confusion about what qualifies as a fistula, but be aware that a fistula is defined as:
)
Any Gastrostomy feeding tube (PEG, PEG-J or JEJ) is considered as a “Gastric Fistula” and covered under this exemption as it requires an appliance to administer the treatment for which it was surgically created.
Unfortunately this entitlement does not apply for patients who are fed via a naso-enteric tube (NG, NJ, etc.), on the basis that Naso-enteric tubes are considered as temporary; typically used for 4-16 weeks. However there are other forms of help that you may fulfil to achieve free or help towards prescription charges (see list above).
b)            Maternity Exemption Certificate
This entitles anyone who is pregnant or have had a child in the past year to be exempt from prescription charges for 12 months after the expected delivery date (extension can be provided if the baby is born late).
The form (FW8) is available from doctors, nurses, midwifes and health visitors, who are required to sign the form as proof that the information you have given on the form is correct.
a) Low Income
The Low Income scheme is available to help with the costs of prescriptions for those who are on a low income and in receipt of one or more of the following benefits:
If you or your partner (including civil partners) are names on, or are entitled to, an NHS tax credit exemption certificate or a valid HC2 certificate (full help with health costs), or you receive either:
   Income Support
   Income-based Jobseeker’s Allowance
   Income-related Employment and Support Allowance, or
   Pension Credit Guarantee Credit
 
b) Prescription Prepayment Certificate (PPC)
For those that do not meet the criteria for Medical Exemption; such as those who are on enteral feeding via the nasoenteric route (NG, NJ, etc) and who do not meet the eligibility for LOW INCOME; not in receipt of the necessary benefits (Income Support or Jobseekers allowance, etc.) there is the option to pay for a PRESCRIPTION PREPAYMENT CERTIFICATE (PPC).They are available as either 3 month; costing £29.10 or 12 months; costing £104.00.

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