Optical Charges and Payments Regulations (Northern Ireland) 1997

Statutory Rules of Northern Ireland

1997 No. 191

HEALTH AND PERSONAL SOCIAL SERVICES

Optical Charges and Payments Regulations (Northern Ireland) 1997

Made

28th March 1997

Coming into operation

1st April 1997

The Department of Health and Social Services, in exercise of the powers conferred on it by Articles 62, 98, 106 and 107(6) of, and Schedule 15 to, the Health and Personal Social Services (Northern Ireland) Order 1972(1) and of all other powers enabling it in that behalf, with the approval of the Department of Finance and Personnel, and after consultation with such organisations as appeared to the Department to be representative of medical practitioners practising as ophthalmic medical practitioners and of ophthalmic opticians, as required by Article 62(3) of the said Order, hereby makes the following Regulations:

Part I General

Citation, commencement and interpretation

1.—(1) These Regulations may be cited as the Health and Personal Social Services (Optical Charges and Payments) Regulations (Northern Ireland) 1997 and shall come into operation on 1st April 1997.

(2) In these Regulations—

“the Agency” means the Northern Ireland Central Services Agency for the Health and Social Services established under Article 26 of the Order;

“capital limit” means the amount prescribed for the purposes of Part VII of the Social Security Contributions and Benefits (Northern Ireland) Act 1992(2) as it applies to income support;

“complex appliance” means an optical appliance at least one lens of which—

(a)

has a power in any one meridian of plus or minus 10 or more dioptres or

(b)

is a prism-controlled bifocal lens;

“disability working allowance” means disability working allowance under Part VII of the Social Security Contributions and Benefits (Northern Ireland) Act 1992;

“eligible person” is to be construed—

(a)

for the purposes of Part III, in accordance with regulation 3(2);

(b)

for the purposes of Parts IV and V, in accordance with regulation 8(2) to (5);

“face value” means, in relation to a voucher on which is marked a letter code specified in column 2 of Schedule 1, the amount specified in relation to it in column 3 of that Schedule, plus the amount of any increase provided for by paragraph 1 of Schedule 2;

“family credit” means family credit under Part VII of the Social Security Contribution and Benefits (Northern Ireland) Act 1992;

“health service sight test fee” means, in relation to a testing of sight carried out either by an ophthalmic medical practitioner or by an optician—

(a)

at a place where the patient normally resides, an amount of £37·83; or

(b)

in any other case, an amount of £13·71;

“an income-based jobseeker’s allowance” has the meaning given to it by Article 3(4) of the Jobseekers (Northern Ireland) Order 1995(3);

“income support” means income support under Part VII of the Social Security Contributions and Benefits (Northern Ireland) Act 1992;

“minimum complex appliance payment” means, in relation to an optical appliance, the amount specified as such for the appliance in paragraph 2 of Schedule 2;

“notice of entitlement” means a notice issued under regulation 7 of the Remission Regulations for the purposes of remission of charges under the Order;

“ophthalmic list” means a list, prepared and published pursuant to Regulations made under Article 62 of the Order of medical practitioners and opticians who undertake to provide general ophthalmic services(4);

“Ophthalmic Services Regulations” means the General Ophthalmic Services Regulations (Northern Ireland) 1986(5);

“optician” means an ophthalmic optician;

“Order” means the Health and Personal Social Services (Northern Ireland) Order 1972;

“patient” means a person whose sight has been tested whether under the Order or otherwise;

“patient’s contribution” is to be construed as follows—

(a)

for the purposes of Parts III, IV and V, where a patient’s resources are less than his requirements, the contribution shall be nil;

(b)

for the purposes of Part III, where the patient’s resources exceed his requirements, the contribution shall be an amount equal to that excess;

(c)

for the purposes of Parts IV and V, where the patient’s resources exceed his requirements, the contribution shall be an amount equal to twice that excess;

“patient’s resources” means a person’s resources as calculated in accordance with regulation 6 of, and Schedule 1 to, the Remission Regulations;

“redemption value” is to be construed—

(a)

for the purposes of Part III, in accordance with regulation 7;

(b)

for the purposes of Part IV, in accordance with regulation 15;

(c)

for the purposes of Part V, in accordance with regulation 20;

“the 1989 Regulations” means the Optical Charges and Payments Regulations (Northern Ireland) 1989(6);

“the Remission Regulations” means the Travelling Expenses and Remission of Charges Regulations (Northern Ireland) 1989(7);

“replacement” does not include the replacement of an optical appliance rendered unserviceable by fair wear and tear;

“small glasses” means glasses the lens apertures of which have datum centres not more than 56 millimetres apart; and for this purpose “datum centre” is to be construed in accordance with Part I of British Standard 3521/91 (Glossary of Terms relating to Ophthalmic Lenses) published by the British Standard Institution as effective immediately before 28th March 1997;

“supplier” includes a person replacing or repairing an optical appliance;

“supply” includes the replacement of an optical appliance rendered unserviceable by fair wear and tear;

“voucher” for the purposes of enabling a payment to be made under these Regulations, means—

(a)

in Part III, a voucher form supplied to those whose names are included in the ophthalmic list by the Agency;

(b)

in Part IV, a voucher form supplied—

(i)

where a testing of sight is carried out otherwise than by an HSS trust, by the Agency to the person who carries it out,

(ii)

where a testing of sight is carried out by an HSS trust, by that HSS trust;

(c)

in Part V, a voucher form supplied to a supplier, by the Agency.

(3) For the purposes of Schedule 1—

(a) where an optical appliance has lenses described in different paragraphs in column 1 of Schedule 1, the face value of a voucher for the appliance shall be determined according to whichever lens would provide the greater face value; and

(b) where an optical appliance has a bifocal lens, the power of the lens shall be determined according to the power of that segment of the lens designed to correct a defect in distant sight; and

(c) a monocle shall be treated as though it were glasses.

Part II Charges

Charges for optical appliances supplied by an HSS trust

2.—(1) A charge of such sum as is provided by this regulation shall be made and recovered in accordance with paragraph (2) in respect of the supply of an optical appliance by an HSS trust.

(2) Where a charge is payable by virtue of paragraph (1), an HSS trust, or other person on its behalf, that supplies or is to supply the optical appliance may—

(a) on arranging to supply the optical appliance, make the charge; and

(b) on supplying the optical appliance or having it available for supply, recover the charge from the patient (if it has not previously been paid).

(3) The charge for the supply of contact lenses shall be £39·80 for each contact lens supplied.

(4) Subject to paragraphs (5) and (6) the charges for glasses shall be the aggregate of the following—

(a) an amount which represents the cost to the HSS trust, or other person on its behalf, of the purchase of the glasses or their components; and

(b) an amount which represents the cost to the HSS trust, or any other person on its behalf, of the dispensing of the lenses.

(5) Where the aggregate of—

(a) the element of the amount mentioned in paragraph (4)(a) which represents the cost of the lenses; and

(b) the amount mentioned in paragraph (4)(b) exceeds, in the case of glasses each lens of which is a single vision lens, £48·80 and, in any other case, £79·40, the charge for glasses shall be the aggregate of that £48·80, or, as the case may be, £79·40, and, except in a case to which paragraph (6) applies, the element of the amount mentioned in paragraph (4)(a) which represents the cost of the frames.

(6) Where any patient requires, on clinical grounds, a frame the cost of which is more than the cheapest frame in the range supplied by the HSS trust, or other person on its behalf, the element of the amount mentioned in paragraph (4)(a) which represents the cost of the frames shall not exceed the amount equal to the cost of that cheapest frame.

(7) This regulation shall not apply to the supply of optical appliances to a patient for the time being resident in a hospital.

Part III Payments Towards Cost of Sight Tests

Eligibility — sight tests

3.—(1) A payment shall be made as provided for by this Part to contribute to the cost of a testing of sight which the Agency accepts as having been incurred by an eligible person.

(2) An eligible person is a person whose income resources, as calculated in accordance with regulation 6 of, and Schedule 1 to, the Remission Regulations for the purposes of remission of charges under the Order, exceed his requirements as so calculated, but whose patient’s contribution does not exceed the sight test fee and whose capital resources as so calculated do not exceed the capital limit.

Completion and use of voucher — sight tests

4.—(1) A person who wishes a payment to be made by virtue of this regulation in his case shall—

(a) apply to the Department for a notice of entitlement;

(b) apply for his sight to be tested by an ophthalmic medical practitioner or optician whose name is included in the ophthalmic list;

(c) indicate to that practitioner or optician that he is an eligible person at the time of the application;

(d) show to him a current notice of entitlement and permit him to copy such details as may be required for the purposes of regulation 5(2)(b)(ii).

(2) The ophthalmic medical practitioner or optician may then duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth and the date of the testing of sight.

(3) The person whose sight is or is to be tested shall sign on the voucher a declaration in writing to the effect that he is an eligible person.

(4) The ophthalmic medical practitioner or optician may use the voucher as being in substitution for payment by the patient of an amount equal to its redemption value, being part of the cost incurred for the testing of sight.

Payments to sight testers

5.—(1) The Agency shall, if the conditions specified in paragraph (2) are fulfilled, make a payment of the voucher’s redemption value to an ophthalmic medical practitioner or optician who has used a voucher in accordance with regulation 4(4).

(2) The conditions referred to in paragraph (1) are that—

(a) the patient has signed the declaration referred to in regulation 4(3);

(b) the ophthalmic medical practitioner or optician has—

(i) made a claim for a payment on a duly completed voucher to the Agency within the period of 3 months beginning with the date of the testing of sight, and

(ii) informed the Agency of the amount of the patient’s contribution.

Payments to patients in respect of sight tests

6.—(1) A payment may be made by way of refund under this regulation by the Agency to an eligible person who incurs the cost of a testing of sight by an ophthalmic medical practitioner or optician whose name is included in the ophthalmic list, without a voucher being completed in accordance with regulation 4.

(2) A patient who wishes to receive a payment under this regulation must—

(a) make a claim to the Department for a payment within 3 months after payment of the sight test fee, or within such further period as the Department may for good cause allow, and that claim must be made on a form provided by or on behalf of the Department for that purpose; and

(b) produce such evidence as the Agency may reasonably require in support of the claim including the receipt for any fee paid for the testing of sight.

(3) Where the Department is satisfied that the patient is entitled to a refund under paragraph (1) it shall authorise in writing the refund of the amount in question to the patient by the Agency.

(4) On receipt of an authorisation under paragraph (3), the Agency shall make a refund to the patient of an amount equal to the redemption value of the voucher which could have been completed under regulation 4 if the patient had satisfied the requirements of regulation 4(1).

Redemption value of voucher for sight test

7.  For the purposes of this Part the redemption value of a voucher is the amount, if any, by which the patient’s contribution falls short of the lesser of—

(a) the health service sight test fee; or

(b) the full cost which would have been incurred by the patient for the sight test but for these Regulations.

Part IV Payments for Cost of Supply of Optical Appliances

Eligibility — supply of optical appliances

8.—(1) A payment shall be made as provided for by this Part to meet, or to contribute towards, the cost incurred (whether by way of charge under the Order or otherwise) for the supply of an optical appliance for which a prescription has been given in consequence of a testing of sight of an eligible person—

(a) which took place under the Order; or

(b) which took place otherwise than under the Order.

(2) An eligible person is a person who at the time of the supply of the optical appliance is any of the following:—

(a) a child;

(b) a person whose resources are treated, in accordance with paragraph (3), as being less than his requirements;

(c) a person whose income resources, as calculated in accordance with regulation 6 of, and Schedule 1 to, the Remission Regulations for the purposes of remission of charges under the Order, are equal to or exceed his requirements as so calculated but whose patient’s contribution is nil or is less than the face value of a voucher issued to him under this part and whose capital resources do not exceed the capital limit;

(d) a person for whom a prescription is issued for a complex appliance.

(3) A person’s resources shall be treated as being less than his requirements if—

(a) he is in receipt of income support;

(b) he is a member of the same family as a person who is in receipt of income support;

(c) he is in receipt of family credit;

(d) he is a member of the same family as a person who is in receipt of family credit;

(e) his income resources as calculated in accordance with regulation 6 of, and Schedule 1 to, the Remission Regulations for the purposes of remission of charges under the Order, are less than his requirements as so calculated and his capital resources as so calculated do not exceed the capital limit; or

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

(g) he is in receipt of disability working allowance;

(h) he is a member of the same family as a person described in head (g);

(i) he is in receipt of an income-based jobseeker’s allowance; or

(j) he is a member of the same family as a person described in sub-paragraph (i).

(4) In paragraph (3), “family” (in reference to membership of the same family) has the meaning given to it by section 133(1) of the Social Security Contributions and Benefits (Northern Ireland) Act 1992—

(a) as it applies to income support(8), in the case of paragraph (3)(b) and (f);

(b) as it applies to family credit(9), in the case of paragraph (3)(d); and

(c) as it applies to disability working allowance(10), in the case of paragraph (3)(h)

and has the meaning given to it by Article 2(2) of the Jobseekers (Northern Ireland) Order 1995(11) in the case of paragraph (3)(j).

(5) For the purpose of regulation 11 and other provisions of this Part as they apply to payments where the testing of sight was by an HSS trust, a person is also an eligible person if, because of the frequency with which the condition of his eyes changes, he is considered by the HSS trust to be non-tolerant of his existing optical appliance.

Issue of vouchers by ophthalmic medical practitioners or opticians

9.—(1) An ophthalmic medical practitioner or optician who, following a testing of sight under the Ophthalmic Services Regulations, issues a prescription for an optical appliance to a patient—

(a) who has indicated that he may be an eligible person; or

(b) who (whether or not he has so indicated) is issued with a prescription for a complex appliance,

shall, in the circumstances described in paragraph (3) but subject to paragraph (5), issue to the patient a voucher relating to the optical appliance prescribed on the same occasion as he issues the prescription in accordance with paragraph 10(1) of Schedule 1 to the Ophthalmic Services Regulations.

(2) The ophthalmic medical practitioner or optician issuing the voucher shall sign it and shall—

(a) mark on it the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance prescribed as set out in column 1 of that Schedule;

(b) duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth, particulars of the prescription issued to the patient, the date on which the patient’s sight was tested and the date of issue of the voucher.

(3) The circumstances referred to in paragraph (1) are where the ophthalmic medical practitioner or optician, having consulted any records which he has relating to the patient and made such enquiry of the patient as he considers relevant, is satisfied that—

(a) the patient requires an optical appliance for the first time or an optical appliance to a prescription the particulars of which differ from those relating to his existing appliance; or

(b) the patient requires an optical appliance because his existing optical appliance has been rendered unserviceable by fair wear and tear.

(4) Where a patient requires an optical appliance to a prescription the particulars of which differ from those relating to his existing appliance only because the patient is non-tolerant of that appliance, and has been so since it was supplied to him, no voucher shall be issued unless the Agency, being satisfied that the prescription for that existing appliance was clinically correct, has authorised the issue of a voucher.

(5) Unless regulation 11 applies, not more than one voucher shall be issued to a patient in respect of any one optical appliance prescribed.

Issue of vouchers by HSS trusts

10.—(1) An HSS trust which, following a testing of sight, issues a prescription for an optical appliance to a patient—

(a) who has indicated that he may be an eligible person;

(b) who (whether or not he has so indicated) is issued with a prescription for a complex appliance; or

(c) who is an eligible person by virtue of regulation 8(5);

shall issue to the patient a voucher relating to the optical appliance prescribed.

(2) The HSS trust issuing the voucher shall—

(a) mark on it the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance prescribed as set out in column 1 of that Schedule;

(b) duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth, particulars of the prescription issued to the patient, the date on which the patient’s sight was tested and the date of issue of the voucher.

Issue of replacement vouchers by the Agency or an HSS trust

11.—(1) Where, on an application by a patient within 6 months of a voucher having been issued to him under regulation 9(1) or 10(1), the Agency or HSS trust is satisfied, having made such enquiries as it considers relevant, that the voucher has been lost or destroyed without having been presented to a supplier of optical appliances, it may issue to the patient a replacement voucher completed in accordance with Regulations 9(2)(a) and (b) or 10(2)(a) and (b), but with the date of issue of the voucher being that on which the replacement is issued.

Use of vouchers for supply of optical appliances

12.—(1) Subject to paragraphs (4) and (5), a patient to whom a voucher, duly completed in accordance with regulation 9, 10 or 11, has been issued may present it to a supplier who supplies or is to supply him with an optical appliance, provided that the arrangements for supply are made within 6 months of the date on which the voucher was issued.

(2) A supplier may accept the voucher in substitution for payment by the patient of an amount equal to its redemption value, being the whole or part of the cost incurred for the supply of an optical appliance.

(3) A voucher relating to glasses may be accepted in connection with the supply of contact lenses.

(4) Before presenting the voucher to the supplier the patient shall sign on the voucher—

(a) a declaration in writing to the effect that he is an eligible person, indicating the grounds of his eligibility;

(b) an undertaking in writing to the effect that, if he is unable to show that he is an eligible person, he will pay to the Agency an amount equal to the voucher’s redemption value.

(5) A patient who is an eligible person only by virtue of regulation 8(2)(c) or by virtue of his resources being treated in accordance with regulation 8(3)(e) or (f) as being less than his requirements shall—

(a) before presenting the voucher to the supplier, apply to the Department for a notice of entitlement; and

(b) on the same occasion as he presents the supplier with a voucher in accordance with paragraph (1), show a current notice of entitlement to the supplier and permit him to copy such details as may be required for the purposes of regulation 13(2)(c)(iii).

Payments to suppliers

13.—(1) The Agency shall, if the conditions specified in paragraph (2) are fulfilled, make a payment of a voucher’s redemption value to a supplier who has accepted the voucher from a patient in accordance with regulation 12.

(2) The conditions referred to in paragraph (1) are that—

(a) the patient has signed the declaration and undertaking referred to in regulation 12(4) and acknowledged receipt on the voucher of the optical appliance supplied to him;

(b) the optical appliance is not sold or supplied in contravention of section 21(1) of the Opticians Act 1989(12);

(c) the supplier has—

(i) made and kept a written record of the supply and issued to the patient a receipt for any money received from the patient,

(ii) made a claim for a payment on a duly completed voucher to the Agency, within the period of 3 months beginning with the date of supply of the optical appliance,

(iii) where the patient has shown a notice of entitlement to him, informed the Agency of the amount of the patient’s contribution, if any, and

(iv) where the claim relates to a voucher the value of which is increased in accordance with paragraph 1(1)(e) of Schedule 2, certified that the glasses supplied were small glasses.

Redemption value of voucher for supply of optical appliances

14.—(1) Where an optical appliance was supplied otherwise than under the Order the redemption value of a voucher is, subject to paragraphs (3) to (5), the lesser of—

(a) the full cost which would have been payable by the patient for the supply but for this Part;

(b) the face value of the voucher.

(2) Where an optical appliance was supplied under the Order, the redemption value of a voucher is, subject to paragraphs (3) to (5), the lesser of—

(a) the amount of the charge pursuant to regulation 2 which would have been payable by the patient for the supply but for this Part;

(b) the face value of the voucher.

(3) In relation to payments to be made because of a person’s eligibility by virtue of regulation 8(2)(d), the amounts taken for the purposes of paragraph (1)(a) and (b) or paragraph (2)(a) and (b) shall, subject to paragraph (4), be reduced by the amount of the patient’s contribution.

(4) If a reduction made under paragraph (3) in the case of a patient for whom a prescription was issued for a complex appliance would render the redemption value of the voucher less than the minimum complex appliance payment, that value shall be the minimum complex appliance payment.

(5) Where the patient was an eligible person only because a prescription was issued for him for a complex appliance, the redemption value of a voucher shall be the minimum complex appliance payment, except that where—

(a) the appliance was supplied under the Order; and

(b) in accordance with regulation 2(1), the amount of charge made for the supply under Schedule 15 to the Order would, but for any maximum charge specified in that regulation, have exceeded by any amount the charge actually made,

the redemption value shall be reduced by the amount of the excess.

Part V Payments for Cost of Replacement or Repair of Optical Appliances

Eligibility — replacement or repair

15.—(1) A payment shall be made as provided for by this Part to meet, or contribute towards, any cost accepted by the Agency as having been incurred (whether by way of charge under the Order or otherwise) for the replacement or repair of an optical appliance for which a prescription is given in consequence of a testing of sight of—

(a) a child, where the appliance needs replacement or repair in consequence of loss or damage;

(b) a person of any description specified in regulation 8(2)(b), (c) or (d) suffering from illness, where the appliance needs replacement or repair in consequence of its loss or damage and the Agency is satisfied, after making such enquiries as it considers relevant, that the loss or damage would not have occurred but for that illness.

(2) No payment shall be made by virtue of paragraph (1)(a) or (b) unless the Agency is satisfied, after making such enquiries as it considers relevant, that the full cost of replacement or repair cannot be met under the terms of any warranty, insurance or other arrangement made with its supplier or manufacturer.

Completion of vouchers

16.—(1) A patient who considers that a payment may be made under this Part in his case in respect of the replacement or repair of his optical appliance may indicate to the supplier that he wishes such a payment to be made.

(2) In the case of a replacement, the supplier may—

(a) mark on a voucher the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance to be replaced as set out in column 1 of that Schedule;

(b) duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth and the date of issue of the voucher.

(3) In the case of a repair, the supplier may—

(a) mark on a voucher the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance to be repaired as set out in column 1 of that Schedule;

(b) indicate on the voucher the nature of the repair of the appliance to be undertaken and, in particular, whether it comprises—

(i) the replacement or repair of one or more lenses included in the appliance, and, if so, of how many,

(ii) the repair of a frame and, if so, whether it is of the whole frame, the front of a frame or one or both sides of a frame;

(c) duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth and the date of issue of the voucher.

(4) The patient shall sign on the voucher—

(a) a declaration in writing to the effect that he is an eligible person, indicating the grounds of his eligibility;

(b) a declaration in writing to the effect that the optical appliance cannot be replaced or repaired free of charge under the terms of any warranty, insurance or other arrangement made with its supplier or manufacturer; and

(c) an undertaking in writing to the effect that, if he is unable to show that he is an eligible person, he will pay to the Agency an amount equal to the voucher’s redemption value.

(5) A patient who is an eligible person only by virtue of regulation 8(2)(c) or only by virtue of his resources being treated in accordance with regulation 8(3)(e) or (f) as being less than his requirements shall show a current notice of entitlement to the supplier and permit him to copy such details as may be required for the purposes of regulation 18(2)(b)(iv).

(6) In a case to which regulation 15(1)(b) applies, a supplier intending to use the voucher under regulation 17 shall first submit it to the Agency so that it may be satisfied as to the circumstances in which the loss or damage occurred and give its approval to the use of the voucher.

Use of vouchers for replacement or repair

17.  The supplier may use the voucher as being in substitution for payment by the patient of an amount equal to its redemption value, being the whole or part of the cost incurred for the replacement or repair.

Payment to suppliers for replacement or repair

18.—(1) The Agency shall, if the conditions specified in paragraph (2) are fulfilled, make a payment of a voucher’s redemption value to a supplier who has used a voucher in accordance with regulation 17.

(2) The conditions referred to in paragraph (1) are that—

(a) the patient has signed the declarations and undertaking referred to in regulation 16(4) and acknowledged on the voucher that the optical appliance has been replaced or repaired; and

(b) the supplier has—

(i) made and kept a written record of the replacement or repair and issued to the patient a receipt for any money received from the patient;

(ii) obtained any prior approval required by regulation 16(6);

(iii) made a claim for payment on a duly completed voucher to the Agency within the period of 3 months beginning with the date of the replacement or repair of the optical appliance; and

(iv) where the person has shown a notice of entitlement to him, informed the Agency of the amount of the patient’s contribution, if any.

Redemption value of voucher for replacement or repair

19.—(1) Subject to paragraph (4), the redemption value of a voucher shall, in the case of a replacement, be the lesser of—

(a) the full cost which would have been payable by the patient for the replacement but for this Part;

(b) the face value of the voucher or, in the case of the replacement of one only of a pair of contact lenses, £39·80.

(2) Subject to paragraph (4), the redemption value of a voucher shall, in the case of the repair of an appliance be the lesser of—

(a) the full cost which would have been payable by the patient for the repair but for this Part;

(b) the amount specified in column 2 of Schedule 3 which relates to the type of optical appliance repaired (identified in that column by reference to the relevant letter code as specified in Schedule 1) and to the nature of the repair specified in column 1 of Schedule 3, together with any increase provided for by Schedule 2.

(3) Where more than one repair is made to an appliance the amount taken for the purposes of paragraph (2)(b) as being specified in Schedule 3 shall be the aggregate of the relevant amounts ascertained in accordance with Schedule 3, except that the element of the value of a voucher which relates to the repair of a frame shall not exceed £10·20.

(4) In the case of a person who was eligible for a payment to be made in his case only by virtue of regulation 8(2)(c), the amounts taken for the purpose of paragraphs (1)(a) and (b) and (2)(a) and (b) shall be reduced by the patient’s contribution.

Part VI Payments to Patients

Payments to patients in respect of the supply, replacement or repair of optical appliances

20.—(1) A payment may be made under this regulation to a person of a description prescribed by regulation 8(2) or 15(1) who pays for the supply, repair or replacement of an optical appliance without exercising his right under regulation 9(1), 10(1) or 15(1) to a payment to meet or contribute towards the cost incurred for the supply, replacement or repair of such optical appliance.

(2) A patient who wishes to receive a payment under this regulation must—

(a) make a claim to the Department if he considers that he falls within the description specified in regulation 8(2)(b) or (c); or

(b) in all other cases, make a claim to the Agency.

(3) Any such claim must be made within 3 months after the date of the supply or repair of the optical appliance, or within such further period as the Department or the Agency may for good cause allow, and that claim must be made on a form provided by or on behalf of the Department or the Agency for that purpose.

(4) It is a further condition of entitlement to a refund under paragraph (1) that the patient produces in support of his claim such evidence as the Department or the Agency may reasonably require including the receipt for any fee paid for the supply or repair.

(5) Where the Department is satisfied that the patient is entitled to a refund as a result of a claim under paragraph (2)(a), it shall authorise in writing the refund of the amount in question to the patient by the Agency, and on receipt of such authorisation, the Agency shall make a refund to the patient of an amount equal to the redemption value of the voucher which could have been completed under regulation 9, 10 or 16 if the patient had satisfied the requirements of regulation 9(1), 10(1) or 16(4) as the case may be.

(6) Where the Agency is satisfied that the patient is entitled to a refund as a result of a claim under paragraph (2)(b), it shall make a refund to the patient of an amount equal to the redemption value of the voucher which could have been completed under regulation 9, 10 or 16 if the patient had satisfied the requirements of regulation 9(1), 10(1) or 16(4) as the case may be.

Part VII Miscellaneous

Amounts wrongly paid

21.—(1) Where a person who is not an eligible person declares on a voucher that he is an eligible person and in consequence the Agency makes a payment under these Regulations, the person who makes the declaration shall repay the amount of that payment to the Agency.

(2) Where a supplier makes a claim for payment to the Agency, representing that the conditions specified in regulation 5(2), 13(2) or 18(2) are fulfilled, but those conditions are not fulfilled and the Agency makes a payment to the supplier under these Regulations, it may recover the amount of that payment from the supplier.

Signatures and claims for payments

22.—(1) A signature required by these Regulations may be given, and a claim for a refund pursuant to regulation 6 or 20 may be made—

(a) on behalf of any child by either parent or, in the absence of both parents, the guardian or other adult person who has the care of the child;

(b) on behalf of any person who is incapable of giving the signature, by a relative or other adult who has the care of that person; or

(c) on behalf of any person under 18 years of age who is—

(i) in the care of an authority to whose care he has been committed under the provisions of the Children (Northern Ireland) Order 1995(13), by a person duly authorised by that authority;

(ii) in the care of a voluntary organisation, by that voluntary organisation or a person duly authorised by it; or

(iii) in a training school, by the Manager of that training school.

Transitional provisions

23.—(1) Where, before 1st April 1997, a person has been issued with a voucher pursuant to regulation 9, 10, 11 or 16 of the 1989 Regulations but that voucher has not been accepted or used before that date, then such a voucher may be accepted or used in accordance with the provisions of regulation 12 or 18 of the 1989 Regulations as though they remained in operation.

(2) The amounts specified in regulation 19(1)(b) and (3), column 3 of Schedule 1 and Schedules 2 and 3 shall apply only to a voucher accepted or used on or after 1st April 1997 pursuant to regulation 12 or regulation 17.

(3) Where, before 1st April 1997, a person has made an application in pursuance of the provisions of regulation 6, 10 or 14 of the 1989 Regulations and his application has not been determined before that date, his application shall be determined in accordance with the provisions of those Regulations as though they remained in operation.

Revocations

24.  The Regulations specified in column (1) of Schedule 4 are hereby revoked to the extent specified in column 3 of that Schedule.

Sealed with the Official Seal of the Department of Health and Social Services on

L.S.

J. R. Kearney

Assistant Secretary

28th March 1997.

The Department of Finance and Personnel hereby approves the foregoing Regulations.

Sealed with the Official Seal of the Department of Finance and Personnel on

L.S.

V. N. Hewitt

Assistant Secretary

28th March 1997.

Regulations 1(2), 9(2)(a), 10(2)(a), and 16(2)(a) and (3)(a)

SCHEDULE 1 Voucher Letter Codes and Face Values — Supply and Replacement

1	2	3
Type of optical appliance	Letter Code	Face value of voucher
1.  Glasses with single vision lenses— (a) of a spherical power of not more than 6 dioptres with a cylindrical power of not more than 2 dioptres; (b) of a spherical power of not more than 2 dioptres with a cylindrical power of more than 2 dioptres and not more than 4 dioptres.	A	£27·20
2.  Glasses with single vision lenses— (a) of a spherical power of more than 2 dioptres but not more than 6 dioptres with a cylindrical power of more than 2 dioptres but not more than 4 dioptres; (b) of a spherical power of more than 6 dioptres but less than 10 dioptres with a cylindrical power of not more than 2 dioptres.	B	£41·30
3.  Glasses with single vision lenses— (a) of a spherical power of 10 or more dioptres but not more than 20 dioptres with a cylindrical power of not more than 6 dioptres; (b) with a spherical power of not more than 10 dioptres with a cylindrical power of more than 4 dioptres but not more than 6 dioptres; (c) of a spherical power of more than 6 dioptres but less than 10 dioptres with a cylindrical power of more than 2 dioptres but not more than 4 dioptres.	C	£56·30
4.  Glasses with single vision lenses— (a) of a spherical power of more than 20 dioptres with any cylindrical power; (b) of a spherical power of not more than 20 dioptres with a cylindrical power of more than 6 dioptres.	D	£110·60
5.  Glasses with bifocal lenses— (a) of a spherical power of not more than 6 dioptropes with a cylindrical power of not more than 2 dioptres; (b) of a spherical power of not more than 2 dioptres with a cylindrical power of more than 2 dioptres and not more than 4 dioptres.	E	£46·90
6.  Glasses with bifocal lenses— (a) of a spherical power of more than 6 dioptres but less than 10 dioptres with a cylindrical power of not more than 2 dioptres; (b) of a spherical power of more than 2 dioptres but not more than 6 dioptres with a cylindrical power of more than 2 dioptres but not more than 4 dioptres.	F	£59·70
7.  Glasses with bifocal lenses— (a) of a spherical power of 10 or more dioptres but not more than 14 diopres with a cylindrical power of not more than 6 dioptres; (b) of a spherical power of not more than 10 dioptres with a cylindrical power of more than 4 dioptres but not more than 6 dioptres; (c) of a spherical power of more than 6 dioptres but less than 10 dioptres with a cylindrical power of more than 2 dioptres but not more than 4 dioptres.	G	£71·90
8.  Glasses with prism-controlled bifocal lenses of any power or with bifocal lenses— (a) of a spherical power of more than 14 dioptres with any cylindrical power; (b) of a spherical power of not more than 14 diopres with a cylindrical power of more than 6 dioptres.	H	£121·60
9.  Glasses not falling within any of paragraphs 1 to 8 for which a prescription is given in consequence of a testing of sight by an HSS trust.	I	£121·60
10.  Contact lenses for which a prescription is given in consequence of a testing of sight by an HSS trust.	J	£39·80 (per lens)

Regulation 1(2), 19(2)(b)

SCHEDULE 2 Prisms, Tints, Photochromic Lenses, Small and Special Glasses and Complex Appliances

1.—(1) The amounts in column 3 of Schedule 1 and column 2 of Schedule 3 and in paragraph 2(a) and (b) shall be increased as follows:—

(a) by £5·30 in respect of each single vision lens containing a necessary prism;

(b) by £6·50 in respect of each other lens containing a necessary prism;

(c) by £2·80 in respect of each necessary single vision tinted lens;

(d) by £3·30 in respect of each necessary other tinted lens;

(e) in respect of small glasses—

(i) by £44·80 in the case of supply or replacement of the glasses or repair or replacement of the whole frame,

(ii) by £39·80 in the case of repair or replacement of the front of the frame, and

(iii) by £21·50 in the case of repair or replacement of a side of a frame;

(f) where the voucher is issued or completed by an HSS trust, by £2·80 in respect of each necessary single vision photochromic lens and by £3·30 in respect of each necessary other photochromic lens;

(g) where the voucher is issued or completed by an HSS trust, by £44·80 in respect of glasses the frame of which is certified by the HSS trust as being required to be specially manufactured on account of the patient’s facial characteristics.

(2) The increases provided for by sub-paragraph (1)(e), (f) and (g) do not apply in the case of a voucher relating to glasses if it is accepted in connection with the supply or replacement of contact lenses.

(3) In sub-paragraph (1) “necessary” in relation to a prism or a tinted or photochromic lens means that the prism, tint or photochromic quality has been prescribed on the basis of clinical need.

(4) Where the face value of a voucher is increased in accordance with sub-paragraph (1)(g) of this paragraph, it may not be further increased in accordance with sub-paragraph (1)(e).

2.  The minimum complex appliance payment is—

(a) for a complex appliance with single vision lenses only, £4·50;

(b) for any other complex appliance, £24·10;

plus, in each case, the amount of any increase provided for by paragraph (1).

Regulation 19(2) and (3)

SCHEDULE 3 Voucher Value — Repair

Letter Codes — Values
Nature of repair to appliance	A	B	C	D	E	F	G	H & I
	£	£	£	£	£	£	£	£
Repair or replacement of one lens	8·50	15·60	23·10	50·20	18·40	24·70	30·80	55·60
Repair or replacement of 2 lenses	17·00	31·20	46·20	100·40	36·80	49·40	61·70	111.40
Repair or replacement of:
the front of a frame	8·80	8·80	8·80	8·80	8·80	8·80	8·80	8·80
a side of a frame	5·20	5·20	5·20	5·20	5·20	5·20	5·20	5·20
the whole frame	10·20	10·20	10·20	10·20	10·20	10·20	10·20	10·20

Regulation 24

SCHEDULE 4 Regulations Revoked

Column 1	Column 2	Column 3
Regulations revoked	Reference	Extent of revocation
Optical Charges and Payments Regulations (Northern Ireland) 1989	S.R. 1989 No. 114	The whole Regulations
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1990	S.R. 1990 No. 99	The whole Regulations
Optical Charges and Payments (Miscellaneous Amendments) Regulations (Northern Ireland) 1991	S.R. 1991 No. 115	The whole Regulations except regulation 6
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1991	S.R. 1991 No. 332	The whole Regulations
Optical Charges and Payments (Amendment No. 2) Regulations (Northern Ireland) 1991	S.R. 1991 No. 496	The whole Regulations
Optical Charges and Payments (Miscellaneous Amendments) Regulations (Northern Ireland) 1992	S.R. 1992 No. 155	The whole Regulations except regulation 6
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1992	S.R. 1992 No. 242	The whole Regulations
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1993	S.R. 1993 No. 141	The whole Regulations
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1994	S.R. 1994 No. 31	The whole Regulations
Optical Charges and Payments (Amendment No. 2) Regulations (Northern Ireland) 1994	S.R. 1994 No. 100	The whole Regulations
Optical Charges and Payments (Amendment No. 3) Regulations (Northern Ireland) 1994	S.R. 1994 No. 388	The whole Regulations
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1995	S.R. 1995 No. 16	The whole Regulations
OpticalCharges and Payments (Amendment No. 2) Regulations (Northern Ireland) 1995	S.R. 1995 No. 114	The whole Regulations
Optical Charges and Payments (Amendment No. 3) Regulations (Northern Ireland) 1995	S.R. 1995 No. 358	The whole Regulations
Optical Charges and Payments (Amendment) Regulations (Northern Ireland) 1996	S.R. 1996 No. 124	The whole Regulations
Optical Charges and Payments (Amendment No. 2) Regulations (Northern Ireland) 1996	S.R. 1996 No. 424	The whole Regulations
Optical Charges and Payments (Amendment No. 3) Regulations (Northern Ireland) 1996	S.R. 1996 No. 484	The whole Regulations

Explanatory Note

(This note is not part of the Regulations.)

These Regulations consolidate with amendments the Optical Charges and Payments Regulations (Northern Ireland) 1989 (“the 1989 Regulations”) which provided a scheme for payments to be made by means of a voucher system, in respect of costs incurred by certain categories of persons in connection with sight tests and the supply, replacement and repair of optical appliances.

The 1989 Regulations and all subsequent amendments to them are revoked by regulation 24 and Schedule 4. The Regulations, contained in the Statutory Rules referred to in Schedule 4, which amended Regulations other than the 1989 Regulations remain in operation.

The amendments made to the 1989 Regulations are as follows:—

Amendments to update references to various enactments including, in particular, references to the Opticians Act 1958 (which has been replaced by the Opticians Act 1989); references in regulation 22 of the 1989 Regulations (signatures in respect of persons under disability) to the Children and Young Persons Act (Northern Ireland) 1968 consequential on the introduction of the Children (Northern Ireland) Order 1995, and references to the Social Security (Northern Ireland) Order 1986 (which has now been replaced, in part, by the Social Security Contributions and Benefits (Northern Ireland) Act 1992).

Amendments to the definition of “patient’s contribution” (regulation 1(2)) as a result of the abolition of the linkage between the patient’s contribution in respect of a sight test and the value of voucher for an optical appliance supplied under these Regulations. This linkage was previously contained in regulation 15(3) of the 1989 Regulations which is omitted in these Regulations. As a result of this amendment, any sight test conducted on or after 1st April 1997 will be a separate transaction from the optical appliance supplied as a result of that test. The changes, which will simplify the arrangements for helping people entitled to partial remission of their optical costs, ensure that no one eligible for help will pay more than they would have done had the arrangements under the 1989 Regulations continued.

Amendments to extend payment provisions (regulation 6) for patients who are eligible for a contribution to be made towards the cost of their sight test (ie those who are entitled to partial remission of health service charges) and to introduce payments (regulation 20) for patients who are entitled to a voucher towards the cost of the supply, replacement or repair of an optical appliance. Patients who establish entitlement to a voucher as at the date of the sight test, supply, replacement or repair of their optical appliance but who have paid a fee for that sight test, supply, replacement or repair may claim a payment within 3 months (which may be extended for good cause) of the sight test, supply, replacement or repair either by applying to the Department (where they have low income entitlement) or to the Agency in all other cases. In the case of sight tests, the amount of the payment will be calculated in accordance with regulation 7; in the case of supply of an optical appliance the amount of the payment will be calculated in accordance with regulation 14; and in the case of replacement or repair of an optical appliance the amount of the payment will be calculated in accordance with regulation 19.

Amendments to the voucher values specified in those Regulations and Schedules providing for the level of payment (regulation 20, and Schedules 1, 2 and 3) under the scheme. These amendments increase the value of the vouchers issued under the Regulations. All voucher values and supplements are increased by 2 per cent.

British Standard 3521/91, referred to in regulation 1(2) of these Regulations, may be obtained from the British Standards Institution at 389 Chiswick High Road, London, W4 4AL.

(1)

S.I. 1972/1265 (N.I. 14); Article 62(1) was amended by Article 3(1)(a) of the Health and Social Security (Northern Ireland) Order 1984 (S.I. 1984/1158 (N.I. 8)) and Article 8(1) of the Health and Medicines (Northern Ireland) Order 1988 (S.I. 1988/2249 (N.I. 24)); Article 62(2) was amended by Article 3(1)(b) of, and paragraph 1 of Schedule 1 and Schedule 6 to S.I. 1984/1158 (N.I. 8) and Part I of Schedule 5 to the Health and Personal Social Services (Northern Ireland) Order 1991 (S.I. 1991/194 (N.I. 1)); Article 98 was amended by Part II of Schedule 5 to S.I. 1991/194 (N.I. 1); Schedule 15 was amended by Article 3(2) of and paragraph 3 of Schedule 1 to, and Article 17 of and Schedule 6 to S.I. 1984/1158 (N.I. 8); Article 8(4) and (5) of S.I. 1988/2249 (N.I. 24); Article 14(2) of the Social Security (Northern Ireland) Order 1988 (S.I. 1988/594 (N.I. 2)) and Article 34 of and Part II of Schedule 5 to, S.I. 1991/194 (N.I. 1)

(2)

1992 c. 7; the capital limit is prescribed for the purposes of income support in regulation 45 of S.R. 1987 No. 459. Whilst £8,000 is applicable in most cases, there is a limit of £16,000 in certain cases prescribed in regulation 53(1B). Regulation 45 was substituted by regulation 11(1)(a) of S.R. 1996 No. 93 and regulation 53(1B) was inserted by regulation 11(1)(b)(ii) of S.R. 1996 No. 93

(3)

S.I. 1995/2705 (N.I. 15)

(4)

See S.R. 1986 No. 163, regulation 8

(5)

S.R. 1986 No. 163

(6)

S.R. 1989 No. 114

(7)

S.R. 1989 No. 348

(8)

See S.R. 1987 No. 459, Regulations 14 to 16; relevant amending Regulations are S.R. 1988 No. 146, S.R. 1989 No. 139, S.R. 1990 Nos. 131 and 387, S.R. 1993 Nos. 149 and 373, and S.R. 1996 Nos. 199 and 405

(9)

See S.R. 1987 No. 463, Regulations 6 to 9; relevant amending Regulations are S.R. 1988 No. 131, S.R. 1990 Nos. 138 and 387 and S.R. 1993 No 373

(10)

See S.R. 1992 No. 78, Regulations 8 to 11 as amended by S.R. 1993 No. 373

(11)

See S.R. 1996 No. 198, Regulations 76 to 78 as amended by S.R. 1996 No. 358

(12)

1989 c. 44

(13)

S.I. 1995/755 (N.I. 2)