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NHS in England - help with health costs

Universal Credit

Universal Credit is a single system of means tested support for people of working-age in and out of work. Universal Credit (UC) was first introduced in 2013 by the Department of Work and Pensions and is slowly being rolled out to include more people. 

UC will replace some existing means-tested benefits, including income-based Jobseeker's Allowance, income-related Employment and Support Allowance, Income Support, Working Tax Credit, Child Tax Credit and Housing Benefit.

For more information about claiming Universal Credit visit GOV.UK.

During the early stages of UC, all those who received it were automatically entitled to help with health costs, but now that numbers are increasing, revised arrangements have been put in place.

Help with health costs provides:

Help with health cost entitlement criteria

Since November 1 2015, you are entitled to help with health costs if:

  • you get Universal Credit and had no earnings or net earnings of £435 or less during the most recent assessment period
  • you get Universal Credit which includes an element for a child and/or limited capability for work or limited capability for work related activity, and had no earnings or net earnings of £935 or less during the most recent assessment period

Your assessment period will run for a calendar month from the date of your claim for Universal Credit (which will be shown on your award notice), and between the same dates each month after that.

What is the earning threshold for couples?

At the moment, the earning threshold as described above is based on individual incomes and not the combined income of a couple. For example, if you earn £300 and your partner £200 then both of you are meeting the criteria for Help with Health costs even if the combined income exceeds £435.
But, if one of you earns above the threshold only the person earning £435 or less will be entitled to help with health costs.

Changes for 2016

The arrangements for Help with health costs for those getting Universal Credit, will be changed in 2016 so that, like other benefits, the combined earnings from both partners are treated as income available to the whole household.

This section will be updated when the change is made.

Note: You need to make sure you are claiming correctly before you sign any of the NHS forms. Checks are made on these forms and patients found to have wrongly claimed may have to pay a penalty charge, as well as the charge due. Read the section about paying NHS charges.

When you claim help with health costs because you receive Universal Credit you will be asked to show your award notice to support your claim. You should think about whether your earnings are still within the threshold limits before you claim.

If you cannot get help with health costs through Universal Credit look at the other pages in this section to find out if any of the other eligibility criteria apply to you.

How to claim help with health costs if you get Universal Credit

You can claim help with health costs in the same way as those getting other qualifying benefits, such as income-based Jobseeker's Allowance. You will need to sign the NHS form to say you do not have to pay. This could be a prescription form given to you by your doctor, or a dental treatment form given to you by your dentist's receptionist.

If you claim exemption, the healthcare professional will ask to see your Universal Credit award notice to support your claim.

Most forms will not yet have a box for Universal Credit. If this is the case, you should tick the box for income-based Jobseeker's Allowance.

If you are unsure whether you are entitled to help with health costs, for example because you are waiting for your Universal Credit claim to be decided or to receive an award notice, you should pay the relevant charge and ask for a refund form at the same time. For prescription charges, you will not be able to get the refund form (FP57) at a later stage.

Once you have received your UC award notice and can prove your entitlement to help with health costs, you may claim a refund.

Since 1 November 2015 the arrangement that Universal Credit automatically qualifies you for help with health costs, no longer applies. However, if you received Universal Credit and paid or incurred relevant health costs before 1 November 2015, you may be able to claim a refund.

Important numbers

Dental services helpline – 0300 330 1348

NHS Low Income Scheme helpline – 0300 330 1343

Prescription services helpline – 0300 330 1349

Queries about medical exemption certificates – 0300 330 1341

Queries about prescription prepayment certificates (PPCs) – 0300 330 1341

Queries about tax credit certificates – 0300 330 1347

Call 0300 123 0849 to order a paper copy of the HC12, HC5 and HC1 (SC) forms

Call 0300 330 1343 for all other queries

Page last reviewed: 23/12/2015

Next review due: 23/12/2017

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