NHS low income scheme

I cannot find the regulation/rules/formula for calculating whether someone qualifies for a HC2 or HC3 certificate, or not. Can anyone point me to them please?

Thanks.

https://www.legislation.gov.uk/uksi/2016/1045/pdfs/uksiem_20161045_en.pdf

Does this help?

I doesn’t i have just read it

This is the best that I can find online
https://www.nhs.uk/nhs-services/help-with-health-costs/nhs-low-income-scheme-lis/   

but it’s short on detail.  You could try the helpline number at the bottom of the webpage.

There’s also a chapter in the CPAG handbook on Health benefits - it’s ch 31 in the 22/23 edition

The calculation is laid out on pages 654 and 655 of the 2022/2023 CPAG Welfare Benefits Handbook. 

It is a similar calculation to Housing Benefit where there is income in excess of the applicable amount but there are differences.  For health benefits,  the applicable amount is called ‘requirements’ and consists of a personal allowance and premiums.  Any rent or Council Tax which is not covered by benefits is also added in to the ‘requirements’ calculation.  Income is calculated in the same way as for Income Support but again there are differences, for example for people in a permanent care placement, tariff income starts from £14,250 and there is an upper capital limit of £23,250.

If income exceeds requirements by less than 50% of the current prescription charge (£4.83) then an HC2 will be issued which will allow full help with charges.  If income exceeds requirements by more than £4.83 then an HC3 will be issued which allows only partial help with charges at an amount depending upon the specific type of help required (e.g. dental, optical, travel etc.).  An HC3 form does not help with prescription charges.