• If you receive the guarantee credit part of Pension Credit, Income Support or income-based Job Seeker’s Allowance you are automatically entitled to all ‘health benefits’: free prescriptions, dental treatment, sight tests and ‘vouchers’ for glasses or contact lenses, wigs and fabric supports, and travel to hospital. You do not need to apply for this help. If you only receive the savings credit part of Pension Credit you are not automatically entitled to these health benefits. See below for other ways to qualify.
  
• If you receive Working Tax Credit (including the disability or severe disability element) or Child Tax Credit and you have an income of less than £15,050 a year, as specified by your award letter you will automatically be entitled to all health benefits, as above. You should receive a certificate of exemption from health costs with your award details. If you are unsure about entitlement you can call the NHS Business Services Authority, Patient Services on 0845 850 1166 or read leaflet HC11, Help with health costs (HC11W if you live in Wales). You can download this from the Department of Health website www.dh.gov.uk (In Northern Ireland contact your local Jobs and Benefits office.)
  
• If you get a war disablement pension, have a war pension exemption certificate and need treatment because of the disability for which you get the pension, then you are also automatically entitled to free prescriptions and wigs and fabric supports. You may also be able to get money back for dental treatment, sight tests and vouchers for glasses or contact lenses, and hospital travel costs. For more information contact the Treatment Group, Service Personnel and Veterans Agency, Norcross, Blackpool FY5 3WP or call its freephone helpline on 0800 169 2277.
  
• If you are aged 60 or over, you are automatically entitled to free prescriptions and free sight tests. You may also be able to get help with other charges on grounds of low income. If you are in Wales or Scotland you will also be entitled to free dental examinations.
  
•  If you don’t automatically qualify for help with other health costs but are over 60 and have a low income, you may still be able to get help with these charges. You need to have less than £16,000 savings, or £21,500 if you are living permanently in a care home. (If you live in Wales these figures are slightly different; you need to have less than £17,250 savings or £22,000 if you are living permanently in a care home*.) Depending on your income, you may get things such as dental care completely free, or you may pay a reduced charge. However, you do need to make a claim for this help. The next section explains how to make a claim.

*If you are reading this after May 2008 you should check to see if the capital limits have changed.

• Finally, even if you don’t fall into any of the categories mentioned, you may be exempt from paying charges for particular treatments. For example, someone with diabetes would be entitled to a free sight test because of their diabetes, but would still have to pay all other charges, unless they were exempt for other reasons. These exemptions are listed later on in this information sheet.

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How to claim help with health charges if you are on a low income

It is best to apply for help with health charges before you actually need the treatment. Otherwise, you may have to pay the full cost of the treatment and reclaim the money later. Clearly, this is a lot more inconvenient, and in certain cases, refunds are not available. Another person can apply on your behalf if you are not able to do so for medical reasons.

To apply for help with health charges, fill in form HC1 which should be available from your local Jobcentre Plus office or by calling the Department of Health on 0845 610 1112. It is also stocked by hospitals and some doctors, dentists and opticians. The address to send it to is given on the form. If you have difficulty filling in the form, ask a Citizens Advice Bureau or your local benefits office to help you; or call the NHS Business Services Authority Patient Services on 0845 850 1166, which can either help you to fill in the form over the phone or it will complete the form on your behalf and send it to you to check and sign.

If you are living permanently in a care home, and your place is partly or fully funded by your local council, you can apply on a special short form HC1(SC). Ask your home manager, your care worker or social services for the form.

The NHS Business Services Authority, Patient Services will then compare your ‘requirements’ (the money they think you need to live on) with your ‘income’ (the money you have coming in). If your income is the same as your requirements, or less, then you should not have to pay your health charges. Even if your income is slightly higher than your requirements you may still get full help or only have to pay part of the charges. If your income is considerably higher than your requirements you won’t receive any help and will have to pay the full charges.

If you are over 60 and have more than £16,000 in savings (£17,250 in Wales) or £21,500 in savings if you are living permanently in a care home (£22,000 in Wales), you will not be entitled to any help with these charges.

If you are entitled to full help with your health charges, you will receive certificate HC2. This certificate will state that you are entitled to all health benefits: free prescriptions, dental treatment, sight tests, vouchers for glasses or contact lenses, wigs and fabric supports and travel to hospital.

If you are entitled to some help with your health charges, you will receive certificate HC3. This certificate will state the maximum amount you will have to pay for any one course of health care (for example, for a course of dental treatment or for a sight test). This certificate doesn’t give help with prescription charges, but if you are 60 or over you are automatically entitled to free prescriptions anyway.

You should take your certificate with you on all visits to the dentist, optician and hospital.

How long will your HC2 or HC3 certificate last?

Your certificate will be valid for 12 months if you are single and aged 64 and under. If you are single and aged 65 or over, your certificate will be valid for five years. If you are part of a couple and one of you is aged 60 and over and the other is aged over 65, your certificate will also be valid for five years (but only if you have no dependent children, are not earning any income or getting a personal or occupational pension, or receiving an annuity.

If you have a certificate which is valid for 12 months, and there is a change in your circumstance during this time, for example, you start work, you will still be able to use your certificate until it expires. However, if your certificate is valid for five years, and your circumstances change, you must inform the issuing authority of these changes. If your circumstances change and you think this may entitle you to more help (for example, if your income is reduced in some way), you can make a new claim. Make this claim in the same way as before, on form HC1.

New and repeat claims

New and repeat claims on grounds of low income must be made every 12 months, if you have a 12-month certificate. If you have a certificate which is valid for five years, you can re-apply for a new assessment before the certificate expires. This allows the NHS Business Services Authority, Patient Services to reassess your circumstances. Make your claim on form HC1 before your current certificate runs out. It may be worth keeping a copy of your previous HC1 form to refer to when you make a new claim – you will then only have to change how you fill it in if your circumstances have changed.

If you are not happy with this decision you do not have a right to appeal, but you can write to the NHS Business Services Authority and ask them to reconsider its decision.

As a rule, if you consider your income to be low and your savings are under £16,000 (£17,250 in Wales) or under £21,500 if you are in a care home (£22,000 if you are in a care home in Wales), it is worth claiming for help with health charges. If you know that you will be needing dental or eye care treatment or will have to travel to hospital in the near future, make a claim for help now. People on low incomes are entitled to this help and you can’t lose by claiming. If you are unhappy with the outcome of your claim you can ask the Review Section at the NHS Business Services Authority to review your claim.

If you have any queries about getting help with health costs ring the NHS Business Services Authority, Patient Services on 0845 850 1166.