Exemption Certificates / Help With Health Costs (AG)

• A claimant contacts you by telephone or letter regarding Exemption Certificates for one of the following reasons, provide assistance to the claimant and where appropriate amend the details on the claim

• Their address has changed, follow the guidance in Changes

• Their name has changed, follow the guidance in Changes

• They want to report a death in the family, follow the guidance in Changes

• Their child details are incorrect or they have had another child, follow the guidance in Changes

• They are querying whether their entitlement to tax credits means they can get an Exemption Certificate, go to step 2

• They have not yet received their Exemption Certificate, they have contacted the Helpline for Exemption Certificates and their details are not on the computer, go to step 2

• They have received their Exemption Certificate, but they are not entitled to it as their details have been captured incorrectly on the tax credit computer, go to step 9

• They are awaiting the outcome of an Appeal and are enquiring about health charges, go to step 10

• They have lost their Exemption Certificate, go to step 11

• They have rece ived multiple certificates, or they suspect they have had their identity hijacked, go to step 12

• You receive correspondence from the Prescription Pricing Authority (PPA) that tells you that post has been returned undelivered or that the addressee has gone away

• Follow the guidance in RLS Items – Post Award / Annual Declaration (Renewals)

Note: If you are dealing with correspondence that has been passed over from the Prescription Pricing Authority (PPA), you must not return the correspondence to them. Instead send it to storage. Follow the guidance in Preparing And Sending Documents For Storage

• Name

• Address

• Child(ren)'s name(s) and date(s) of birth

Note: You must ensure that all the personal details for the claimant(s) and child(ren) are in the correct format. Follow the guidance in the Rejected Data part of The Role Of HMRC on the Information Page relating to this guidance

And

• If they are in receipt of IS, JSA or ESA

Then

• Go to step 3

• Hours

• Earnings

• Benefits in Kind

• Self Employed Profits

• Social Security Benefits

And

• Other Income

• If any of the details are incorrect or have changed, go to step 4

• If the details are correct or have not changed, check that the claimant satisfies one of the criteria to be entitled to receive an Exemption Certificate, go to step 5

• Where a correction is needed to the original details, follow the guidance in  Changes

• Once you have amended the details, HMRC will notify the PPA of the correct details on the next automatic transfer of information, only where the claimant satisfies one of the three set criteria, go to step 5

• Criteria 1

• Use Function VIEW AWARD to see it the family’s gross income is below the earnings threshold (see the Note below for the earnings threshold)

And

• Use Function VIEW AWARD to see if the family is in receipt of WTC and CTC. To do this, select the latest claim and go to the Award Summary screen, click on the [View Calculation] button and then click on the [View Elements] button

And

• Use Function VIEW APPLICATION to see if the family is not in receipt of IS, JSA(IB) / ESA(IR) or PC

• Criteria 2

• Use Function VIEW AWARD to see if the family’s gross income is below the earnings threshold (see the Note below for the earnings threshold)

And

• Use Function VIEW AWARD to see if the family is receiving WTC with a disability element. To do this, select the latest claim and go to the Award Summary screen, click on the [View Calculation] button and then click on the [View Elements] button

And

• Use Function VIEW APPLICATION to see if the family is not in receipt of IS, JSA(IB) / ESA(IR) or PC

• Criteria 3

• Use Function VIEW AWARD to see if the family’s gross income is below the earnings threshold (see the Note below for the earnings threshold)

Note: Each tax year the earnings threshold may change. The details of the earnings thresholds for the previous, the current and the next tax years are

2003 / 2004 - £14,200

2004 / 2005 - £14,600

2005 / 2006 - £15,050

2006 / 2007 - £15,050

2007 / 2008 - £15,050

2008 / 2009 - £15,050

2009 / 2010 - £15,276

• Use Function VIEW AWARD to see if the family is receiving CTC only. To do this, select the latest claim and go to the Award Summary screen, click on the [View Calculation] button and then click on the [View Elements] button

And

• Use Function VIEW APPLICATION to see if The family is not in receipt of IS, JSA(IB) / ESA(IR) or PC

Note: If the claimant is in receipt of IS, JSA(IB) or ESA(IR), the claimants details will not be passed over to the PPA by HMRC. DWP is responsible for the Exemption Certificate in these cases

• If the claimant satisfies criteria 1, criteria 2 or criteria 3, they are entitled to an Exemption Certificate, go to step 6

• If the claimant does not satisfy criteria 1, criteria 2 or criteria 3 inform the claimant they are not entitled to an Exemption Certificate. However, they may be able to claim help through the NHS Low Income Scheme, anyone can claim but their entitlement will depend on their circumstances at the time they claim.  They can get claim form HC1 from their local Job Centre Plus office (Local Social Security Office in Northern Ireland) or they can phone 08701 555 455 and ask for form HC1

• If the claimant wants to order a prescription prepayment certificate, they should phone 0845 850 0030.  Take no further action

Note: It should take no more than 8 weeks from the date HMRC process the tax credit claim to the date the claimant receives their Exemption Certificate

• If 8 weeks has passed since the award notice was issued, which entitled the claimant to an Exemption Certificate, go to step 7
   
• If 8 weeks has not passed since the award notice was issued, which entitled the claimant to an Exemption Certificate

• Inform the claimant that they must telephone again once the 8 weeks has passed if they have still not received their Exemption Certificate

Note: Where a claimant is entitled to receive an Exemption Certificate, but they have not yet received it, the claimant is able to use their tax credits award notice as proof of entitlement

And then

• Go to step 7

• That the personal details and circumstances that are recorded on the tax credits computer are correct (steps 2 and 3 above)

And

• You have established that entitlement to receive an Exemption Certificate exists (step 5 above)

And

• You have checked that 8 weeks has passed since the award that entitles the claimant to receive an Exemption Certificate was issued (step 6 above)

Note: If all the steps above have not been followed, for example, 8 weeks has not passed, there is nothing the PPA can do for the claimant and the claimant will be re-directed to HMRC

• Refer the claimant to the PPA. The telephone number for PPA is 0845 609 9299. This is a national helpline (including Northern Ireland) which also gives general advice about the scheme and information on how to use the Exemption Certificate

Note: Claimants telephoning PPA will be advised about whether an Exemption Certificate has been issued. The PPA can only inform claimants once they have received the information from HMRC and cannot advise on individual assessments And then

• Go to step 8

• Inform the claimant to refer to the leaflet HC11, which advises them that they can sign NHS treatment forms to say that they are exempt

And

• Inform the claimant that they must take the leaflet HC11 (TC) and their tax credit award notice when they go for treatment as evidence of entitlement

Note: Where the claimant satisfies the criteria for an Exemption Certificate, the claimant can use the Exemption Certificate for the duration of the certificate even if their circumstances change. For example, if their income increases above the earnings threshold (see the Note at step 5 for the earnings threshold)

• The information on the computer was captured incorrectly

And

• The claimant's earnings are actually above the earnings threshold (see the Note at step 5 for the earnings threshold)

Then

• The claimant is not entitled to a NHS Exemption Certificate. They should send it back to the address below, stating the reason that it has been returned

Prescription Pricing Authority
PO Box 1011N
Newcastle Upon Tyne
NE99 2ZP

Note: If you suspect there is evidence of identity fraud, follow the guidance in Identity Fraud

• Inform the claimant that they will have to pay NHS charges until the appeal is decided

And

• Inform the claimant that, if their income is reduced to below the earnings threshold (see the Note at step 5 for the earnings threshold)

• They can claim a refund of any health costs paid if they have receipts

And that

• They need to get receipts when they pay for treatment if they think their income might be reduced on appeal

Note: Normally the claimant must claim a refund within 3 months of paying the charges. If their appeal takes longer than this, their refund can be considered as long as they claim any refund as soon as they hear the outcome of their appeal

• If the claimant wants to claim a refund for prescription charges, explain

• That they will require a form FP57 (form WP57 in Wales) or for other health costs form HC5

And that

• They must send this form together with any receipts and a letter stating their NINO and an explanation of why they are claiming outside the 3 months, to

Prescription Pricing Authority
Exemption Issue Office
PO Box 1011
Newcastle Upon Tyne
NE99 2ZP

• That they must inform the PPA about what has happened to their Exemption Certificate

• The PPA will issue a duplicate

• They do not normally need to report this loss to the Police

And

• The address to write to is

Exemption Issue Office
PO Box 1011
Newcastle Upon Tyne
NE99 2ZP

• That they must return the certificates with a covering letter to the PPA at the address below

• The address to write to is

Exemption Issue Office
PO Box 1011
Newcastle Upon Tyne
NE99 2ZP

• Use Function MAINTAIN HOUSEHOLD NOTES recording details of the conversation

Notes:

You must follow the guidance in How To Correctly Complete Application And Household Notes when you record the note

And also

Follow the guidance in Maintain Household Notes

• Complete Form TC648 (This text has been withheld because of exemptions in the Freedom of Information Act 2000)