The National Health Service (Travel Expenses and Remission of Charges) Regulations 2003

PART I E+W+S GENERAL AND INTRODUCTION

Citation, commencement and application E+W+S

1.—(1) These Regulations may be cited as the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 and shall come into force on 6th October 2003.

(2) These Regulations apply to England.

Interpretation E+W+S

2.  In these Regulations—

“the Act” means the National Health Service Act 1977;

“the 1990 Act” means the National Health Service and Community Care Act 1990 M1 ;

“abroad” means any place outside the United Kingdom;

[F1 “annuity contract” means a contract that provides for periodic payments starting from a stated or contingent date and continuing for a fixed period or for the life of the annuity;]

“capital limit”—

(a)

in the case of a person who lives permanently in a care home or in accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act 1948 M2 is the amount prescribed in regulation 20 of the National Assistance (Assessment of Resources) Regulations 1992 M3 , and

(b)

in the case of any other person, means the amount prescribed for the purposes of section 134(1) of the Social Security Contribution and Benefits Act 1992 M4 ;

“care home” has the meaning given in section 3 of the Care Standards Act 2000 M5 ;

[F2 “child” means a person under the age of 16;]

“child tax credit” means a child tax credit under section 8 of the Tax Credits Act 2002 M6 ;

“claimant” means a person who makes a claim in accordance with regulation 7 or regulation 11;

“the Charges Regulations” means the National Health Service (Charges for Drugs and Appliances) Regulations 2000 M7 ;

“couple” has the meaning given in section 137 of the Social Security Contributions and Benefits Act 1992;

“date of claim” means the date on which a claim made under regulation 7 or regulation 11 is received by the Secretary of State;

[F3 “dependant child or young person” means any child or young person who is treated as the responsibility of the claimant or his partner, where that child or young person is a member of the claimant’s household;]

“disability element” means the disability element of working tax credit as specified in section 11(3) of the Tax Credits Act 2002;

[F4 “earnings” has the meaning given in regulations 35 and 37 of the Income Support Regulations;]

“family” has the meaning given by section 137(1) of the Social Security Contributions and Benefits Act 1992 as it applies to income support, except that—

(a)

in regulation 5(1)(d), in relation to a person who is receiving income based jobseeker’s allowance it has the meaning given in section 35 of the Jobseekers Act 1995 M8 ,

(b)

in regulations 5(1)(e) and 8(2) it has the meaning assigned to it by regulation 2(2) of the Tax Credits (Definitions and Calculation of Income) Regulations 2002 M9 , and

(c)

where a claim has been made for support under Part VI of the Immigration and Asylum Act 1999 M10 , it means the asylum-seeker who has made that claim and any dependant, as defined in section 94 of that Act, whom he has included in that claim and the references to “family” in regulations 5(2)(c) and 8(1), (3) and (7) shall be construed accordingly;

“full rate” means the rate determined under section 26(2) of the National Assistance Act 1948;

“full time student” has the meaning given in regulation 61 of the Income Support Regulations;

“health care professional” means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002 M11 ;

[F5 “household” means—

(a)

a group of people who have a common address as their only or main residence and who either share one meal a day or share the living accommodation at that residence; or

(b)

the only or main residence of a single person who does not share either one meal a day or the living accommodation at that residence with another person;]

“income-based jobseeker’s allowance” has the meaning assigned to it by section 1(4) of the Jobseekers Act 1995;

“income support” means income support under Part VII of the Social Security Contributions and Benefits Act 1992, and includes personal expenses addition, special transition addition and transitional addition as defined in regulation 2(1) of the Income Support (Transitional) Regulations 1987 M12 ;

“the Income Support Regulations” mean the Income Support (General) Regulations 1987 M13 ;

“NHS charge” has the meaning given in regulation 4;

“NHS contract” has the meaning given in section 4(1) of the 1990 Act;

“NHS travel expenses” and “NHS foreign travel expenses” have the meanings given in regulation 3;

“NHS trust” has the meaning given in section 5 of the 1990 Act;

[F6 “occupational pension scheme” has the meaning given by section 1 of the Pension Schemes Act 1993;]

“partner” means where a claimant—

(a)

is a member of a married or an unmarried couple, the other member of that couple,

(b)

is married polygamously to two or more members of his household, any such member;

“pension credit guarantee credit” shall be construed in accordance with sections 1 and 2 of the State Pension Credit Act 2002 M14 ;

“pension credit savings credit” shall be construed in accordance with sections 1 and 3 of the State Pension Credit Act 2002;

[F7 “personal pension scheme” means a personal pension scheme—

(a)

as defined in section 1 of the Pension Schemes Act 1993; or

(b)

as defined in section 1 of the Pension Schemes (Northern Ireland Act) 1993;]

“port” includes an airport, ferry port or international train station in Great Britain from which an international journey begins;

“provider” means the provider of any services mentioned in regulation 3(1)(a);

“relevant date” means—

(a)

in the case of a claim under regulation 7, the date of the claim; and

(b)

in the case of a claim under regulation 11(2) the date when the NHS charge or NHS travel expenses were paid;

“relevant income” has the meaning given in section 7(2) of the Tax Credits Act 2002;

[F8 “severe disability element” means the severe disability element of working tax credit as specified in section11(6)(d) of the Tax Credits Act 2002 (maximum rate).]

[F9 “single person” means a person who does not have a partner and is not responsible for, and is not a member of the same household as, a child or young person;]

“standard rate” means the standard rate fixed in accordance with section 22(2) of the National Assistance Act 1948;

[F10 “State Pension Credit Regulations” means the State Pension Credit Regulations 2002;]

“trade dispute” has the same meaning as in section 35(1) of the Jobseekers Act 1995;

“week” means a period of 7 days beginning with midnight between Saturday and Sunday; and

“working tax credit” means working tax credit under the Tax Credits Act 2002.

[F11 “young person” has the meaning prescribed in regulation 14 of the Income Support Regulations;]

Textual Amendments

F1 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(2)

F2 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(3)

F3 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(4)

F4 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(5)

F5 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(6)

F6 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(7)

F7 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(8)

F8 Words in reg. 2 inserted (6.4.2004) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2004 (S.I. 2004/663), regs. 1(1), 5(2)

F9 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(9)

F10 Words in reg. 2 inserted (1.2.2005) by The National Health Service (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/26), regs. 1(1), 2

F11 Words in reg. 2 inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 15(10)

Marginal Citations

M1 1990 c. 19.

M2 1948 c. 29.

M3 S.I. 1992/2977, as amended.

M4 1992 c. 4. The relevant regulations are the Income Support (General) Regulations 1987 S.I. 1987/1967.

M5 2000 c. 14.

M6 2002 c. 21.

M7 S.I. 2000/620 as amended by S.I. 2000/2393, S.I. 2000/3189, S.I. 2001/746, S.I. 2001/2887, S.I. 2002/548, S.I. 2002/2352, S.I. 2003/585, S.I. 2003/699 and S.I. 2003/1084.

M8 1995 c. 18.

M9 S.I. 2002/2006.

M10 1999 c. 33.

M11 2002 c. 17.

M12 S.I. 1987/1969.

M13 S.I. 1987/1967.

M14 2002 c. 16.

NHS travel expenses E+W+S

3.—(1) In these Regulations “ NHS travel expenses” means the travel expenses which a person necessarily incurs—

(a) in attending—

(i) a health service hospital,

(ii) any other establishment managed by an NHS trust[F12 , an NHS foundation trust] or a Primary Care Trust, or

(iii) any other place in the United Kingdom,

for the provision of any services (except [F13 primary medical services provided under Part 1 of the Act] or personal dental services provided under section 28C of the Act) under the care of a consultant in accordance with Part I of the Act; and

(b) in travelling to a port in Great Britain for the purpose of travelling abroad in order to receive services provided pursuant to arrangements made under section 23 of the Act or paragraph 13 of Schedule 2 to the 1990 Act.

(2) In these Regulations “NHS foreign travel expenses” means the travel expenses which a person necessarily incurs in travelling abroad from a port in Great Britain in order to receive services pursuant to arrangements made under section 23 of the Act or paragraph 13 of Schedule 2 to the 1990 Act.

(3) NHS travel expenses and NHS foreign travel expenses include the travel expenses of a companion in a case where the person to whom services are provided is either—

(a) a child; or

(b) a person whose medical condition is such that, in the opinion of a doctor involved in the provision of the services or, where appropriate, another health care professional so involved, a companion is necessary.

(4) A person who wishes to rely on entitlement to NHS travel expenses must—

(a) unless he is a person who by virtue of regulation 5(1) is not required to make such a claim, make a claim to entitlement under regulation 7; and

(b) make an application for payment of travel expenses under regulation 10.

(5) The amount of any NHS travel expenses to which a person is entitled under these Regulations—

(a) must be calculated by reference to the cost of travelling by the cheapest means of transport which is reasonable having regard to the person’s age, medical condition and any other relevant circumstances; and

(b) where travel is by private car, may include a mileage allowance and car parking expenses.

(6) A person is entitled to payment of NHS foreign travel expenses only where the health service body which made the arrangements for the provision of services abroad agrees the mode and cost of travel and the necessity or otherwise for a companion before the costs are incurred.

Textual Amendments

F12 Words in reg. 3(1)(a)(ii) inserted (1.4.2004) by The Health and Social Care (Community Health and Standards) Act 2003 (Supplementary and Consequential Provision) (NHS Foundation Trusts) Order 2004 (S.I. 2004/696), arts. 1(1)(b), 3(4), Sch. 4

F13 Words in reg. 3(1)(a) substituted (1.4.2004) by The General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004 (S.I. 2004/865), art. 1(1), Sch. 1 para. 40

Remissible NHS charges E+W+S

4.—(1) In these regulations “ NHS charge” means any charge which would otherwise be payable—

(a) in accordance with regulations made under section 77(1) of the Act, for the supply of drugs, medicines, appliances and pharmaceutical services;

(b) in accordance with regulations made under section 78(1A) of the Act, for the supply of dentures and other dental appliances; and

(c) in accordance with regulations made under section 79(1) of the Act or section 20(1) of the National Health Service (Primary Care) Act 1997 M15 , for the provision of dental treatment.

(2) A person who wishes to rely on entitlement under these Regulations to remission of a NHS charge must—

(a) unless he is a person who, by virtue of regulation 5(1), is not required to make such a claim, make a claim to entitlement under regulation 7 or regulation 11; and

(b) provide any declaration or evidence of entitlement which is required under the Charges Regulations.

Marginal Citations

M15 1997 c. 46.

PART II E+W+S ENTITLEMENT TO PAYMENT OF NHS TRAVEL EXPENSES AND REMISSION OF NHS CHARGES

Entitlement to full remission and payment E+W+S

5.—(1) Subject to paragraph (3), a person is entitled, without making a claim under regulation 7 (claims to entitlement), to the payment in full of NHS travel expenses and the full remission of a NHS charge if—

(a) he is receiving income support;

(b) he is receiving income based jobseeker’s allowance;

(c) he is receiving pension credit guarantee credit;

(d) he is a member of the same family as a person who is receiving income support, income based jobseeker’s allowance or pension credit guarantee credit; or

(e) he is a member of a family one member of which is receiving—

(i) working tax credit and child tax credit,

(ii) working tax credit which includes a disability element [F14 or severe disability element], or

(iii) child tax credit, but is not eligible for working tax credit,

provided that the relevant income of the member or members to whom the tax credit is made under section 14 of the Tax Credits Act 2002 is determined at the time of the award not to exceed [F15 £15,050].

(2) Subject to paragraph (3), the following persons are entitled to the payment in full of NHS travel expenses and the remission in full of a NHS charge but are required to make a claim for such payment or remission in accordance with regulation 7 (claims to entitlement)—

(a) a person who lives permanently in—

(i) a care home, or

(ii) accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act 1948 (provision of accommodation),

and who has satisfied the authority that he is unable to pay for that accommodation at the standard rate or, as the case may be, the full rate;

(b) an asylum-seeker for whom support is provided under Part VI of the Immigration and Asylum Act 1999;

(c) a member of the same family as an asylum seeker described in sub-paragraph (b);

(d) a relevant child within the meaning of section 23A of the Children Act 1989 M16 whom a responsible local authority is supporting under section 23B(8) of that Act;

(e) any other person who satisfies the Secretary of State in accordance with Part IV that his capital resources do not exceed the capital limit and that his [F16 income resources do not exceed his requirements or exceed his requirements by fifty per cent or less of the amount of the charge specified in regulation 3(1)(b) (supply of drugs and appliances by chemists) of the Charges Regulations]; and

(f) a member of the same family as a person described in sub-paragraph (e).

(3) A person’s entitlement under paragraph (1) or (2) arises only where he is of a description mentioned in either of those paragraphs at the time when—

(a) the charge is made;

(b) the NHS travel expenses are incurred; or

(c) in the case of a charge for the supply of a denture or other dental appliance metioned in regulation 4(1)(b) or for dental treatment mentioned in regulation 4(1)(c), either—

(i) the arrangements for the treatment or course of treatment are made, or

(ii) the charge is made.

Textual Amendments

F14 Words in reg. 5(1)(e)(ii) inserted (6.4.2004) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2004 (S.I. 2004/663), regs. 1(1), 5(3)(a)

F15 Word in reg. 5(1)(e) substituted (6.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 16

F16 Words in reg. 5(2)(e) substituted (6.4.2004) by The National Health Service (Travel Expenses and Remission of Charges) and (Optical Charges and Payments) and (General Ophthalmic Services) Amendment Regulations 2004 (S.I. 2004/936), regs. 1(1), 2

Marginal Citations

M16 1989 c. 41.

Entitlement to partial remission and payment E+W+S

6.—(1) Subject to paragraphs (2) to (4), a person is entitled to the payment in part of any NHS travel expenses and remission in part of a NHS charge provided that at the time the travel expenses are incurred or the charge is made—

(a) his capital resources do not exceed the capital limit; and

(b) either—

(i) his income resources exceed his requirements by less than a third of the charge or, as the case may be, by less than the travel expenses, or

(ii) he is a member of the family of a person described in sub-paragraph (b)(i),

but is required to make a claim for such remission or payment in accordance with regulation 7 (claims to entitlement).

(2) In the case of a NHS charge mentioned in regulation 4(1)(a), the entitlement under paragraph (1) to partial remission applies only to a charge for the supply of an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs) and not to a charge for any other appliance or for drugs, medicines or pharmaceutical services.

(3) Subject to paragraph (4), the amount to which a person is entitled under paragraph (1) is—

(a) in the case of a NHS charge, the difference between the charge and three times the amount by which his income resources exceed his requirements; and

(b) in the case of recoverable travelling expenses, subject to regulation 9 (travel expenses of persons resident in the Isles of Scilly), the difference between the amount of the expenses incurred and the amount by which his income resources exceed his requirements.

(4) In the case of a NHS charge—

(a) for dental treatment or for the supply of a dental appliance under Part II of the Act (general dental services), or

(b) for dental treatment under Part I of the National Health Service (Primary Care) Act 1997 (personal dental services),

the charge which is partially remissible under this regulation and which must be used for the purposes of the calculation required under paragraph (3)(a) is the charge made for one course of treatment, including any charge made for a dental appliance supplied in that course of treatment.

Claims to entitlement E+W+S

7.—(1) Subject to paragraph (3), a person who wishes to claim entitlement under regulation 5(2) (entitlement to full remission and payment) or regulation 6(1) (entitlement to partial remission and payment) must make a claim to the Secretary of State on a form either provided for the purpose by him or approved by him.

(2) On a claim under paragraph (1), the claimant must provide such evidence and information as the Secretary of State may reasonably request within such time as the Secretary of State may reasonably request.

(3) A claim may be made on behalf of another person where that person is unable, by reason of mental or physical incapacity, to make the claim himself.

(4) Where a claimant does not comply with the Secretary of State’s requests in respect of evidence, information and timing mentioned in paragraph (2), the Secretary of State may notify the claimant that the claim will not be determined and must be regarded as closed.

Notices of entitlement E+W+S

8.—(1) Where the Secretary of State determines, on a claim made under regulation 7 (claims to entitlement), that the claimant and any member of his family are entitled to any remission of a NHS charge or any payment in respect of NHS travel expenses, he must issue a notice of entitlement to the claimant.

(2) Where a person is entitled to full remission of a NHS charge and payment in full of NHS travel expenses because he is a member of a family described in regulation 5(1)(e) (tax credit families), the Secretary of State must issue a notice of entitlement to that family and in such a case the notice shall apply to all the members of that family.

(3) A notice of entitlement issued under paragraph (1) applies to all members of the claimant’s family and must state—

(a) whether those persons are entitled to full or partial remission or payment; and

(b) in the case of partial remission or payment, the amount of any NHS charge or NHS travel expenses for which there is no entitlement to remission or payment.

(4) A notice of entitlement issued under paragraph (1) or paragraph (2) must state the length of time for which it is valid and the dates on which that time begins and ends.

(5) A notice of entitlement issued under paragraph (1) is valid for 12 months beginning on the date of the claim except that—

(a) in the case of a notice issued to a full time student in the final or only year of a course of study, it is valid from the date of the claim until the last day of that course;

(b) in the case of a notice issued to a relevant child, it is valid for 12 months or until the child’s 18th birthday, whichever is the later; and

(c) in the case of a notice issued to a person mentioned in regulation 5(2)(b) (asylum seeker), it is valid for 6 months beginning on the date of the claim;

[F17 (d) in the case of a notice issued to a person mentioned in paragraph (5A) it is valid for the length of time specified in that paragraph.]

[F18 (5A) A notice of entitlement issued under paragraph (1) is valid for 5 years beginning on the date of the claim where the claimant is—

(a) a single person aged not less than 65; or

(b) one of a couple where one partner is aged not less than 60 and one partner is aged not less than 65,

who does not receive any—

(i) earnings;

(ii) payments from an occupational pension scheme;

(iii) payments from a personal pension scheme; or

(iv) payments from an annuity contract.

(5B) Paragraph (5A) does not apply to a person who has a dependant child or young person as a member of his household.]

(6) A notice of entitlement issued under paragraph (2) is valid from such date and for such period as the Secretary of State may determine.

(7) Subject to paragraphs [F19 (7A),] (9) and (10), any change in the financial or other circumstances of a claimant, or of any member of his family, during the life of a notice of entitlement shall not affect its validity in respect of that period or, in the case of partial remission or payment, the amounts referred to in paragraph (3)(b).

[F20 (7A) A claimant who is issued with a notice of entitlement which falls under paragraph (5A) must notify the Secretary of State of any change in the composition of his family or household during the life of the notice of entitlement and the Secretary of State may withdraw the notice of entitlement or vary the amounts referred to in paragraph (3)(b) stated on the notice of entitlement if the claimant no longer meets the requirements of paragraphs (5A) and (5B).]

(8) A claimant who is issued with a notice of entitlement to partial remission may make a further claim in accordance with regulation 7 at any time during the life of the notice if he considers that by reason of a change in his financial circumstances, or those of any member of his family, the amounts referred to in paragraph (3)(b) should be reduced.

(9) A claimant to whom a notice of entitlement has been issued under this regulation must return it to the Secretary of State in any case where his claim is subsequently found to have been based on a false representation.

(10) A notice of entitlement issued under this regulation is effective only for the purpose of entitlement to remission of charges and payment of travel expenses in accordance with these Regulations.

Textual Amendments

F17 Reg. 8(5)(d) inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 17(2)

F18 Reg. 8(5A)(5B) inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 17(3)

F19 Word in reg. 8(7) inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 17(4)

F20 Reg. 8(7A) inserted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 17(5)

Travel expenses of persons resident in the Isles of Scilly E+W+S

9.—(1) Any person who—

(a) is resident in the Isles of Scilly;

(b) incurs NHS travel expenses; and

(c) is not entitled to payment in full of those travel expenses in accordance with regulation 5,

is entitled to payment of his NHS travel expenses but is required to make a contribution in accordance with paragraphs (2) and (3).

(2) A person who would be entitled to payment in part of NHS travel expenses in accordance with regulation 6(1) is required to contribute either the amount which he would have been required to pay under regulation 6(3)(b) or £5, whichever is the less.

(3) Any other person is required to contribute £5.

PART III E+W+S PAYMENTS AND REPAYMENTS

Payment of NHS travel expenses E+W+S

10.—(1) Subject to paragraphs (2) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses—

(a) he must make an application for payment to the provider; and

(b) the provider must calculate the actual amount payable in accordance with these Regulations and make the payment.

(2) Where services are provided pursuant to arrangements made under section 23 of the Act or paragraph 13 of Schedule 2 to the 1990 Act, the application for payment may be made to, and the calculation and payment may be made by, either the provider or the health service body which made those arrangements.

(3) In a case falling within regulation 3(1)(b) (travel to a port) the application for payment must be made to, and the calculation and payment must be made by, the health service body which made the arrangements referred to in that provision.

(4) A person who makes an application for payment in respect of NHS travel expenses must sign a declaration of entitlement and provide such evidence of his entitlement and of his travel expenses as the provider, or as the case may be, the health service body which made the arrangements, may require.

(5) Payment of NHS travel expenses may be made before the expenses are incurred.

Claims for repayment E+W+S

11.—(1) A person who is entitled under these Regulations to full or partial remission of a NHS charge or to full or partial payment in respect of NHS travel expenses and who pays such a charge or such travel expenses without exercising his right to remission or payment, is entitled to be repaid that amount which would have been remitted or paid.

(2) A person who wishes to exercise his right to repayment under paragraph (1) must make a claim to the Secretary of State on a form provided for the purpose by him or approved by him.

(3) A claim under paragraph (2) must be made within three months of the date on which the payment of the NHS charge or the NHS travel expenses was made or within such longer period as the Secretary of State may for good cause allow.

(4) Paragraphs (2) to (5) of regulation 7 (claims to entitlement) apply to a claim under this regulation.

Repayments E+W+S

12.—(1) Where the Secretary of State is satisfied that a claimant is entitled to any repayment under regulation 11, he must—

(a) in the case of a repayment to be made—

(i) in respect of a NHS charge made by an NHS trust[F21 , an NHS foundation trust] or a Primary Care Trust, for an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs), calculate the amount payable and notify in writing the NHS trust[F22 , NHS foundation trust] or the Primary Care Trust of the claimant’s entitlement and the amount to be paid,

(ii) in respect of NHS travel expenses incurred by a person in attending a hospital or any other place managed by an NHS trust[F21 , an NHS foundation trust] or a Primary Care Trust notify in writing the NHS trust[F22 , NHS foundation trust] or the Primary Care Trust of the claimant’s entitlement; or

(b) in a case falling within regulation 3(1)(b) (travel to a port) notify in writing the health service body which made the arrangements referred to in that provision of the claimant’s entitlement; or

(c) in any other case, cause a repayment to be made to the claimant in such manner as appears to the Secretary of State to be appropriate in the circumstances of the particular case.

(2) Where an NHS trust[F23 , an NHS foundation trust], a Primary Care Trust or other health service body receives notification as mentioned in paragraph (1), it must calculate any amount payable in respect of NHS travel expenses in accordance with these Regulations and make any repayment due to a claimant in respect of such travel expenses or NHS charge.

(3) A person who is entitled to repayment in respect of NHS travel expenses must sign a declaration of entitlement and provide such evidence of his entitlement and of his travel expenses as the health service body which is making the repayment may require.

[F24 (4) The Dental Practice Board, constituted under section 37 of the Act is authorised to—

(a) carry on any activity of the Secretary of State under paragraph (1)(a) or (c) of this regulation;

(b) receive on behalf of the Secretary of State a claim for repayment made in accordance with regulation 11(2); and

(c) exercise the Secretary of State’s power under regulation 11(3),

relating to the repayment of charges for dental appliances and dental treatment described in regulation 4(1)(b) or (c), including repayment of any amount due to a claimant.]

Textual Amendments

F21 Words in reg. 12(1) inserted (1.4.2004) by The Health and Social Care (Community Health and Standards) Act 2003 (Supplementary and Consequential Provision) (NHS Foundation Trusts) Order 2004 (S.I. 2004/696), arts. 1(1)(b), 3(4), Sch. 4

F22 Words in reg. 12(1) inserted (1.4.2004) by The Health and Social Care (Community Health and Standards) Act 2003 (Supplementary and Consequential Provision) (NHS Foundation Trusts) Order 2004 (S.I. 2004/696), arts. 1(1)(b), 3(3), Sch. 3

F23 Words in reg. 12(2) inserted (1.4.2004) by The Health and Social Care (Community Health and Standards) Act 2003 (Supplementary and Consequential Provision) (NHS Foundation Trusts) Order 2004 (S.I. 2004/696), arts. 1(1)(b), 3(4), Sch. 4

F24 Reg. 12(4) substituted (1.4.2005) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2005 (S.I. 2005/578), regs. 1(1), 18(1)

Reimbursement of payments made in respect of NHS travel expenses E+W+S

13.  Where a provider makes a payment under regulation 10(1) or (2) or a repayment under regulation 12(a) in respect of NHS travel expenses incurred by a person who is receiving services from the provider, the amount of the payment or repayment in question may be reimbursed to the provider by the health service body for which those services are provided.

Payment and repayment of NHS foreign travel expenses E+W+S

14.—(1) A person who wishes to claim entitlement to payment or repayment for NHS foreign travel expenses must apply in writing to the health service body which arranged the services referred to in regulation 3(2) within 3 months of the expenses having been incurred or such further period as that body may for good cause allow.

[F25 (2) Paragraphs (2) to (4) of regulation 7 (claims to entitlement) apply to a claim (whether for payment or repayment) made under this regulation as if the references to the Secretary of State in those paragraphs were references to the health service body which arranged the services referred to in regulation 3(2).]

Textual Amendments

F25 Reg. 14(2) substituted (6.4.2004) by The National Health Service (Charges for Drugs and Appliances) and (Travel Expenses and Remission of Charges) Amendment Regulations 2004 (S.I. 2004/663), regs. 1(1), 5(4)

PART IV E+W+S CALCULATION OF RESOURCES AND REQUIREMENTS

General U.K.

15.—(1) Where it is necessary that the resources or requirements of a person should be calculated for the purposes of these Regulations, they must be calculated by the Secretary of State according to the provisions of this Part and Schedule 1.

(2) The resources and requirements of a person must be calculated—

(a) in the case of a claim made under regulation 7 (claims to entitlement) by reference to his resources and requirements at the date of claim; or

(b) in the case of a claim for repayment made under regulation 11(2) (claims for repayment) by reference to his resources and requirements at the date when the NHS charge or NHS travel expenses were paid.

(3) Where a claimant is a member of a family, the resources and requirements of the other members of his family must be calculated in the same manner as those of the claimant and must be taken into account as if they were his resources and requirements, and in this Part and in the provisions referred to in Schedule 1, unless the context otherwise requires, any reference to the claimant includes the other members of his family.

(4) In a case where the earnings of any person are to be calculated and those earnings have been affected by a trade dispute, the earnings to be taken into account are the earnings which that person would have received if there had been no trade dispute.

(5) In the application of the Income Support Regulations as mentioned in regulation 16 and regulation 17, the provisions of those Regulations shall be applied as if—

(a) references to income support were to the remission of NHS charges and the payment of any NHS travel expenses,

(b) references in any of those provisions to any other of those provisions were to that other provision as modified in accordance with regulation 16(4) or, as the case may be, regulation 17(4); and

(c) the State Pension Credit (Consequential, Transitional and Miscellaneous Provisions) Regulations 2002 M17 had not been made.

Marginal Citations

M17 S.I. 2002/3019.

Calculation of resources U.K.

16.—(1) A claimant’s resources must be calculated in terms of income and capital.

(2) Income must be calculated on a weekly basis according to the method of calculating or estimating income prescribed by the provisions of the Income Support Regulations, subject to the modifications referred to in paragraph (4).

(3) Capital must be calculated according to the method of calculating or estimating capital as prescribed by the provisions of Chapter VI in Part V of, and Schedule 10 to, the Income Support Regulations, subject to the modifications referred to in paragraph (4).

(4) The provisions of the Income Support Regulations apply and those provisions specified in column 1 of Table A in Schedule 1 shall be applied in accordance with the modifications specified in the corresponding entries in column 2.

Calculation of requirements U.K.

17.—(1) A claimant’s requirements must be calculated as being the amount referred to in sub-paragraph (a) less, where applicable, the amount referred to in sub-paragraph (b) below, as follows—

(a) the amount which represents the aggregate of—

(i) the weekly applicable amount which would apply to him, including that in respect of any other member of his family, in connection with a claim for income support as specified by the Income Support Regulations, but subject to the modifications referred to in paragraph (4), and

(ii) subject to paragraph (2), the weekly amount of any council tax which the claimant or his partner is liable to pay under Part I of the Local Government Finance Act 1992 M18 ;

(b) the amount which represents the aggregate of the weekly amount of any housing benefit and the weekly amount of any council tax benefit to which the claimant or any member of his family is entitled under the provisions of Part VII of the Social Security Contributions and Benefits Act 1992.

(2) Subject to paragraph (3), where a claimant is jointly and severally liable for council tax in respect of a dwelling in which he is resident with one or more other persons, the claimant’s liability in respect of that tax for the purposes of these Regulations shall be the amount of that tax divided by the number of persons who are jointly and severally liable for that tax.

(3) Paragraph (2) shall not apply where a claimant is jointly and severally liable for council tax in respect of a dwelling with only his partner.

(4) The provisions of the Income Support Regulations apply and those provisions specified in column 1 of Table B in Schedule 1 shall be applied in accordance with the modifications specified in the corresponding entries in column 2.

Marginal Citations

M18 1992 c. 14.

PART V E+W+S CONCLUSION

Transitional Provisions E+W+S

18.—(1) Any claim made under the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 M19 which has not been determined before 6th October 2003 must be treated as if it were a claim under these Regulations and determined accordingly.

(2) A notice of entitlement to remission of a NHS charge or to payment of travelling expenses which has been issued under the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 remains valid until its expiry in accordance with the provisions of those Regulations.

Marginal Citations

M19 1988 S.I. 1988/551.

Repeals E+W+S

19.  The Regulations listed in column 1 of Schedule 2 are repealed to the extent indicated in column 2 M20 .

Marginal Citations

M20 References in any enactment to the regulations so repealed are to be construed as references to the re-enactment in these Regulations. See section 17(2) of the Interpretation Act 1978 (c. 30).

Signed by authority of the Secretary of State for Health

Rosie Winterton

Minister of State,

Department of Health