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PART IIE+W+SENTITLEMENT TO PAYMENT OF NHS TRAVEL EXPENSES AND REMISSION OF NHS CHARGES

Entitlement to full remission and paymentE+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;

[F1(cc)he is receiving income-related employment and support allowance;]

(d)he is a member of the same family as a person who is receiving income support, income based jobseeker’s allowance[F2, income-related employment and support allowance] or pension credit guarantee credit; F3...

(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 [F4or 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 [F5£15,276][F6; or]

[F7(f)that person is a relevant universal credit recipient.]

[F8(1A) For the purposes of paragraph (1)(f) “relevant universal credit recipient” means a person who, in the relevant assessment period—

(a)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the award did not include the child element,

(ii)the single claimant or, as the case may be, both joint claimants, did not have limited capability for work, and

(iii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £435.00 or less;

(b)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the award included the child element, and

(ii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less;

(c)had an award of universal credit, either as a single claimant or as one of joint claimants, where—

(i)the single claimant or, as the case may be, one or both joint claimants, had limited capability for work, and

(ii)the single claimant had earned income or, as the case may be, the joint claimants had combined earned income, of £935.00 or less; or

(d)was a child or a qualifying young person for whom a person referred to in sub-paragraph (b) or (c) is responsible (within the meaning of Part 1 of the 2012 Act (universal credit) and regulations made thereunder).

(1B) Where paragraph (1C) applies, a person is to be treated as entitled to claim repayment of a NHS charge or NHS travel expenses under regulation 11.

(1C) This paragraph applies where the conditions specified in sub-paragraphs (a), (b), (c) or (d) of paragraph (1A) are satisfied in the assessment period in which the NHS charge or NHS travel expense is incurred and—

(a)there is no relevant assessment period; or

(b)none of those conditions were satisfied in the relevant assessment period.

(1D) For the purposes of paragraphs (1A) and (1C)—

“joint claimants” has the meaning given in section 40 of the 2012 Act (interpretation of Part 1);

“limited capability for work” means limited capability for work or limited capability for work and work-related activity as construed in accordance with regulations 39 and 40 respectively of the Universal Credit Regulations 2013 (limited capability for work; limited capability for work and work-related activity);

“relevant assessment period” means the assessment period immediately preceding that in which the NHS charge was paid or NHS travel expenses incurred; and

“single claimant” has the meaning given in section 40 of the 2012 Act (interpretation of Part 1).]

(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

[F9(ii)accommodation provided by a local authority under Part 1 of the Care Act 2014 (care and support),

where the personal budget for the person under section 26 of that Act specifies that the local authority must itself pay towards the cost of that accommodation;]

(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 1989M1 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 [F10income resources do not exceed his requirements or exceed his requirements by fifty per cent or less of the amount of the charge specified in [F11regulation 3(1)(b) or (c)] (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

[F12(c)in the case of a charge for relevant dental services—

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

(ii)the arrangements for the supply of dentures or other dental appliances under the Act otherwise than as part of relevant primary dental services are made, or

(iii)the charge is made.]

Textual Amendments

Marginal Citations