OC – Universal Credit Updated Guidance

Action

This replaces guidance originally issued in February 2016.

In any cases of uncertainty please contact your Optical Confederation representative body (see Help below)

Issue

Universal Credit is the new single payment system which is gradually being phased in across the UK. It replaces the old income-related benefits system¹ for people who are looking for work or on low incomes. Other entitlements e.g. patients under 16, patients over 60, patients diagnosed with diabetes or glaucoma etc., remain unchanged.

As with the old system many people on Universal Credit will be entitled to an NHS (GOS) sight-test and assistance towards the cost of spectacles or contact lenses via a GOS voucher.

This guidance sets out what you should do when a patient claims an NHS sight test and/or voucher on the grounds that they are in receipt of Universal Credit.

Key Steps

Handling Universal Credit eligibility for GOS – What you should do

As previously and with other entitlements, the responsibility is on the patient to declare that they are in receipt of Universal Credit and within the relevant earnings thresholds, by ticking and signing the appropriate GOS form and ideally showing proof of eligibility.

Evidence

Universal Credit beneficiaries should have an award letter from the Department for Work and Pensions or their local Jobcentre bearing their name – either as recipient or partner or child of recipient

– stating that they are in receipt of Universal Credit.

¹ Benefits that are being replaced by Universal Credit include: income-based Jobseeker’s Allowance, income- related Employment and Support Allowance, Income Support, Working Tax Credit, Child Tax Credit and Housing Benefit. Full rollout of Universal Credit is not expected to be completed until March 2022.

The format may vary from region to region but all will be dated and date-limited.

Not Seen

If the patient cannot produce evidence of entitlement, you should still provide the NHS care the patient needs and, as with other entitlements, you should put a cross in the Evidence Not Seen option (below the boxes for the claimant’s National Insurance (NI) number).

GOS Claims

If your practice management system or GOS form does not yet include an option for Universal Credit

you should use the Income Based Job Seeker’s Allowance option.

Other Benefits

As the new system is being rolled out in stages, the old benefit entitlements continue to be valid for NHS eligibility (if in date) as does a Universal Credit entitlement in an area where Universal Credit has not yet been introduced.

A practice may therefore see some patients with old benefit entitlements and some with Universal Credit entitlements. No patient should have both however and, if they do, in-date Universal Credit takes precedence.

Eligibility Criteria (from 1 December 2016)²

A patient qualifies for help with health costs, including free sight tests and NHS vouchers for optical appliances, if they received Universal Credit and they (together with any joint claimant with whom they claim Universal Credit):

• Had earnings of £435 or less in their last Universal Credit assessment period, and don’t receive a Universal Credit element for a child
• Had earnings of £935 or less in their last Universal Credit assessment period, and do receive a Universal Credit element for a child; or
• Had earnings of £935 or less in their last Universal Credit assessment period, and they and/or their partner was assessed as having limited capability for work.

If a patient is not sure of their eligibility, they can self-check against the above thresholds.

Vouchers

If a patient now receiving Universal Credit had already been issued with an optical voucher this will still be valid and may still be accepted provided it has not already been used.

Has Universal Credit been rolled out to my area yet?

An updated list of Jobcentre areas where Universal Credit can be claimed is available at www.gov.uk/guidance/jobcentres-where-you-can-claim-universal-credit

As Universal Credit is being introduced stage-by-stage to different groups – single people, couples, and then families – even when it is available in specific areas, not everyone will be able to access it immediately.

² The details of the eligibility criteria are laid out in The National Health Service (Exemptions from Charges, Payments and Remission of Charges) (Amendment and Transitional Provisions) Regulations 2016. Accessed at www.legislation.gov.uk/uksi/2016/1045/made on 16 January 2018.

Help

In any cases of uncertainty please contact your Optical Confederation representative body:

• ABDO – Debbie McGill dmcgill@abdo.org.uk
• AOP – regulation@aop.org.uk
• FODO – info@fodo.com

Further information

Government advice www.gov.uk/guidance/universal-credit-toolkit-for-partner-organisations

Universal Credit national expansion www.gov.uk/government/uploads/system/uploads/attachment_data/file/453657/universal- credit-national-expansion-tranche-three-and-four.pdf

NHS Choices website www.nhs.uk/uc-healthcosts

Universal Credit Regulations 2013 www.legislation.gov.uk/ukdsi/2013/9780111531938/pdfs/ukdsi_9780111531938_en.pdf

The National Health Service (Exemptions from Charges, Payments and Remission of Charges) (Amendment and Transitional Provisions) Regulations 2016 www.legislation.gov.uk/uksi/2016/1045/made