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SOP 2.2 NHS Entitlement and Eligibility (England)

SOP 2.2

NHS Eligibility & Entitlement (England)

 

 

Eligibility for GOS services

 

Is the reason that the patient qualifies for NHS help towards their sight test and optical appliances costs. For more information reference making accurate claims document, Which can be found here Click Here (English Version) and Click Here (Welsh Version)

 

Who’s Eligible? Point of Service Checks

 

It is a GOS contractual requirement that practices are required to take reasonable steps to verify patients’ eligibility for a sight test or optical voucher. You are required to carry this out at the point of service by requesting evidence of eligibility. If a patient has any questions or queries about their eligibility they can be directed to the NHS choices website or HC11 leaflet (http://www.nhs.uk/using-the-nhs/help-with-health-costs/free-nhs-eye-test-and-optical-vouchers).

 

If a patient fails to produce evidence that proves their eligibility, this should not prevent them from accessing healthcare if you deem this clinically necessary. There is GOC duty to make care of patient a priority. Patient and public health interest supersedes administrative requirements; however evidence must be crossed as not seen on the patient’s record.  

 

For those patients who have diabetes or glaucoma, accurate GP details should be included on their GOS forms. Those patients who have a glaucoma relative, NHS eligibility documentation is unlikely therefore evidence not seen must be noted.

 

Patients who hold a HC2 OR HC3 certificate, the validity of this must be checked. The date of the certificate must be valid for the date of the sight test or date spectacles are ordered.

 

NHS England is empowered (but not required) to impose a financial penalty on patients who fraudulently claim GOS sight test or optical voucher.

  

Eligibility criteria for an NHS GOS Sight Test

 

·       Patients under 16

·       Patients aged 60 or over

·       Diabetic or glaucoma patients

·       Patients over 40 who are a direct relative of a glaucoma patient

·       Patients registered sight impaired or severely sight impaired

·       Prisoners on day release from prison

·       Complex lens patients (+/- 10D in any one meridian)

·       Patients under 19 and in full time education

·       Patients at risk of glaucoma by an ophthalmologist

 

 

Patients or named as partners of the following benefits:

 

·       Income support

·       Income based employment and support allowance

·       Income based job seekers allowance

·       NHS tax credit exemption certificate

·       HC2 certificate

·       HC3 may be entitled to help towards cost of private eye examination

·       Pension credit guarantee

·       Universal credit and now also meet the income criteria

 

Those that DO NOT qualify are those in receipt of the following

Housing benefit

Incapacity benefit

Invalidity benefit

Contribution based job seekers or employment and support allowance

Disability living allowance

Personal independence payment (PIP)

Patients with learning difficulties

Pregnant women not in receipt of an eligible benefit

 

Eligibility for an NHS optical voucher

 

Patients under 16

Patients under 19 and in full time education

Patients who have been prescribed complex lenses (supplement towards cost)

Prisoner on leave

 

Patients or named as partners of the following benefits:

Income support

Income based employment and support allowance

Income based job seekers allowance

NHS tax credit exemption certificate

HC2 certificate

HC3 may be entitled to help towards cost of spectacles

Pension credit guarantee

Universal credit and meets the income criteria

 

The value of the voucher is determined by the spectacles prescription. See below for voucher values for 2022.

 

English Voucher Values Click Here

 

Welsh Voucher Values Click Here





 


SOP 2.2 Ent Elg FV
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