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Statutory Instruments

2003 No. 2382

NATIONAL HEALTH SERVICE, ENGLAND

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

Made

14th September 2003

Laid before Parliament

15th September 2003

Coming into force

6th October 2003

The Secretary of State for Health, in exercise of the powers conferred on him by sections 37(1C), 83A and 126(4) of the National Health Service Act 1977 M1 and of all powers enabling him in that behalf hereby makes the following Regulations:

Marginal Citations

M11977 c. 49. Section 83A was inserted by section 14(1) of the Social Security Act 1988 (c. 7) and amended by section 25 of, and paragraph 6 of Schedule 2 to, the Health and Medicines Act 1988 (c. 49), section 41(10) of, and paragraph 19 of Schedule 2 to, the National Health Service (Primary Care) Act 1997 (c. 46), article 2 of S.I.1998/2385, article 3(1) of, and paragraph 13 of Schedule 1 to, S.I.2000/90, section 66(1) of, and paragraph 18(5) of Schedule 9 to, the National Health Service and Community Care Act 1990 (c. 19) (“the 1990 Act”), section 2(1) of, and paragraph 40 of Schedule 1 to, the Health Authorities Act 1995 (c. 17) and section 2(5) of, and paragraphs 1 and 32 of Part 1 of Schedule 2 to, the National Health Service Reform and Health Care Professions Act 2002 (c. 17). Section 126(4) was amended by section 65(2) of the 1990 Act and by paragraph 37(6) of the Health Act 1999 (c. 8).See section 28(1), as amended by section 26(2)(g) and (i) of the 1990 Act, for the definitions of “prescribed” and “regulations”. The functions of the Secretary of State under these provisions are, so far as exercisable in relation to Wales, transferred to the National Assembly for Wales; by article 2(a) of the National Assembly for Wales (Transfer of Functions) Order 1999, S.I. 1999/672, as amended by section 66(5) of the 1999 Act.

PART I E+W+SGENERAL AND INTRODUCTION

Citation, commencement and applicationE+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.

InterpretationE+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 M2;

[F1“the 2006 Act” means the National Health Service Act 2006;]

[F2“the 2012 Act” means the Welfare Reform Act 2012;]

“abroad” means any place outside the United Kingdom;

[F3“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 M3 is the amount prescribed in regulation 20 of the National Assistance (Assessment of Resources) Regulations 1992 M4, 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 M5;

“care home” has the meaning given in section 3 of the Care Standards Act 2000 M6;

[F4“CCG” means a clinical commissioning group;]

[F5“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 M7;

“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 M8;

“couple” has the meaning given in section 137 of the Social Security Contributions and Benefits Act 1992 [F6, except that in regulation 5(1)(f) it has the meaning given in section 39 of the 2012 Act (couples)];

[F7“course of treatment” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

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

[F8“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;

[F9“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 M9,

(aa)

[F10in regulation 5(1)(cc), in relation to a person who is receiving income-related employment and support allowance it has the meaning given in regulation 2 of the Employment and Support Allowance Regulations 2008],

(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 M10, and

(c)

where a claim has been made for support under Part VI of the Immigration and Asylum Act 1999 M11, 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 M12;

[F11“health service body” means an NHS trust, an NHS foundation trust, the Board or a CCG;]

[F12“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;

[F13“income-related employment and support allowance” means an employment and support allowance, entitlement to which is based on section 1(2)(b) of the Welfare Reform Act 2007;]

“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 M13;

“the Income Support Regulations” mean the Income Support (General) Regulations 1987 M14;

“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;

[F14“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 F15... 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 M15;

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

[F16“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);

[F17“the public health functions of the local authority” means the functions of a local authority under section 2B (functions of local authorities and Secretary of State as to improvement of public health) and 111 (dental public health) of, and paragraphs 1 to 7B of Schedule 1 (further provision about the Secretary of State and services under this Act) to, and pursuant to regulations made under section 6C (regulations as to the exercise by local authorities of certain public health functions) of, the 2006 Act;]

[F17“qualifying young person” has the meaning given in section 10(5) of the 2012 Act (responsibility for children and young persons);]

“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;

[F7“relevant primary dental services” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

[F18“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).]

[F19“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 [F20except that in regulation 5(1)(f) it is to be construed in accordance with section 1(2)(a) of the 2012 Act (universal credit)];]

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

[F21“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;

[F7 “urgent course of treatment” has the meaning given to it in regulation 2(1) of the National Health Service (Dental Charges) Regulations 2005;]

[F22“universal credit” means universal credit under Part 1 of the 2012 Act;]

“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.

[F23“young person” has the meaning prescribed in regulation 14 of the Income Support Regulations;]

Textual Amendments

Marginal Citations

M4S.I. 1992/2977, as amended.

M51992 c. 4. The relevant regulations are the Income Support (General) Regulations 1987 S.I. 1987/1967.

M8S.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.

NHS travel expensesE+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,

F24(ii). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(iii)any other place in the United Kingdom,

for the provision of any services [F25to which paragraph (1A) applies; or]

(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 [F26under the 2006 Act by a health service body or a local authority.]

[F27(1A) This paragraph applies to services under the 2006 Act which are—

(a)not primary medical services[F28, primary ophthalmic services] or primary dental services;

(b)provided pursuant to a referral by a medical practitioner[F29, ophthalmic practitioner] or dental practitioner; and

(c)not provided during the same visit and at the same premises at which the primary medical services[F30, primary ophthalmic services] or primary dental services which lead to the referral by a medical practitioner[F31, ophthalmic practitioner] or dental practitioner are provided.]

(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 [F32under the 2006 Act by a health service body or a local authority.]

(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[F33, road and toll charges] and car parking expenses.

(6) A person is entitled to payment of NHS foreign travel expenses only where the health service body [F34or local authority] 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

Remissible NHS chargesE+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;

[F35(b)in accordance with regulations made under section 79 of the Act in respect of charges for relevant dental services)]

(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.

Textual Amendments

PART II E+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;

[F36(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[F37, income-related employment and support allowance] or pension credit guarantee credit; F38...

(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 [F39or 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 [F40£15,276][F41; or]

[F42(f)during the period beginning on 29th April 2013 and ending on 31st October 2013—

(i)he is the recipient of an award of universal credit either as a single person or as a member of a couple,

(ii)he is a child or qualifying young person for whom a recipient referred to in paragraph (i) is responsible (within the meaning of Part 1 of the Welfare Reform Act 2012 and regulations made thereunder), or

(iii)he is a member of a couple, the other member of which is the recipient of an award of universal credit as a single person.]

(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 [F43income 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

[F44(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

Entitlement to partial remission and paymentE+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 [F45incurred in any week], 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.

[F46(4) In the case of a NHS Charge for relevant 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—

(a)for one course of treatment or urgent course of treatment, including any charge made for a denture or other dental appliance supplied in that course of treatment; or

(b)for the supply of dentures or other dental appliances under the Act otherwise than as part of relevant primary dental services.]

Textual Amendments

Claims to entitlementE+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.

[F47(3) A claim may be made on behalf of another person where that person—

(a)is unable by reason of physical incapacity; or

(b)lacks capacity within the meaning of the Mental Capacity Act 2005 (c.9),

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.

Textual Amendments

Notices of entitlementE+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;

[F48(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.]

[F49(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 [F50(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).

[F51(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

Travel expenses of persons resident in the Isles of ScillyE+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+SPAYMENTS AND REPAYMENTS

Payment of NHS travel expensesE+W+S

10.—[F52(1) Subject to paragraphs (3) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses in relation to services which are provided by a provider pursuant to arrangements made under the 2006 Act with the provider by a health service body—

(a)the person may make an application for payment to the provider or the health service body which made those arrangements; and

(b)either the provider or that health service body may calculate the actual amount payable in accordance with these Regulations and make the payment.]

[F53(2) Subject to paragraphs (3) to (5), where a person is entitled in accordance with regulation 5 or 6 to a payment in respect of NHS travel expenses in relation to services which are provided by a provider pursuant to arrangements made with the provider by a local authority in the exercise of the public health functions of the local authority under the 2006 Act—

(a)if the provider is an NHS trust or NHS foundation trust, the person may make an application for payment to that NHS trust or NHS foundation trust and that NHS trust or NHS foundation trust must calculate the amount payable in accordance with these Regulations; or

(b)if the provider is not an NHS trust or NHS foundation trust, the person may make an application for payment to the relevant CCG and the relevant CCG must calculate the amount payable in accordance with these Regulations and make the payment.]

[F54(3) In a case falling within regulation 3(1)(b) (travel to a port), the application for payment may be made to, and the calculation and payment must be made by—

(a)where the arrangements referred to in regulation 3(1)(b) were made by a health service body, the health service body which made those arrangements; or

(b)where the arrangements referred to in regulation 3(1)(b) were made by a local authority, the relevant CCG.]

(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.

[F55(6) In this regulation, “relevant CCG” means the CCG in whose area the person making an application under this regulation was usually resident at the time the application was made.]

Textual Amendments

Claims for repaymentE+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.

RepaymentsE+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 [F56or an NHS foundation 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 [F57or the NHS foundation trust] of the claimant’s entitlement and the amount to be paid,

[F58(ia)in respect of a NHS charge made by a provider of NHS services under regulation 6B of the Charges Regulations (supply of drugs and appliances by other providers of NHS services) for an appliance specified in Schedule 1 to the Charges Regulations (fabric supports and wigs), calculate the amount payable and notify in writing the health service body which arranged with the provider for the provision of those services of the claimant’s entitlement and the amount to be paid,]

[F59(ii)in a case falling within regulation 3(1)(a) where the services are provided by a provider pursuant to arrangements made under the 2006 Act with the provider by a health service body, notify in writing the health service body which made those arrangements of the claimant’s entitlement,]

[F60(iii)in a case falling within regulation 3(1)(a) where the services are provided by a provider pursuant to arrangements made with the provider by a local authority in the exercise of the public health functions of the local authority under the 2006 Act—

(aa)if the provider is an NHS trust or NHS foundation trust, notify in writing that NHS trust or NHS foundation trust, or

(bb)if the provider is not an NHS trust or NHS foundation trust, notify in writing the relevant CCG of the claimant’s entitlement, or]

[F61(b)in a case falling within regulation 3(1)(b) (travel to a port) notify in writing—

(i)where the arrangements referred to in regulation 3(1)(b) were made by a health service body, the health service body which made those arrangements, or

(ii)where the arrangements referred to in regulation 3(1)(b) were made by a local authority, the relevant CCG.]

(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[F62, an NHS foundation trust], [F63a relevant CCG] 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.

[F64(4) In this regulation—

“provider of NHS services” has the same meaning as in regulation 2 of the Charges Regulations; and

“relevant CCG” means the CCG in whose area the claimant was usually resident at the time the claim was made.]

F65(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Reimbursement of payments made in respect of NHS travel expensesE+W+S

13.  Where a provider makes a payment under regulation 10(1) F66... 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.

Textual Amendments

Payment and repayment of NHS foreign travel expensesE+W+S

14.—(1) [F67Subject to paragraph (1A), 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.

[F68(1A) A person who wishes to claim entitlement to payment or repayment of NHS foreign travel expenses, where the services in question are provided pursuant to arrangements made under the 2006 Act by a local authority, must apply in writing to the relevant CCG within 3 months of the expenses having been incurred or such further period as the relevant CCG may for good cause allow.]

[F69(2) Paragraphs (2) to (4) of regulation 7 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—

(a)in the case of a claim made under paragraph (1), references to the health service body which arranged the services referred to in regulation 3(2); or

(b)in the case of a claim made under paragraph (1A), references to the relevant CCG.]

[F70(3) In this regulation, “relevant CCG” means the CCG in whose area the claimant was usually resident at the time the claim was made. ]

Textual Amendments

PART IV E+W+SCALCULATION OF RESOURCES AND REQUIREMENTS

GeneralU.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.

[F71(6) Where the claimant is a member of a polygamous marriage, the resources and requirements of members of that marriage must be calculated in the same manner as those of the claimant and they must be taken into account as if they were the resources and requirements of the claimant, except that the applicable amount shall be calculated in accordance with regulation 18 of the Income Support Regulations.]

Textual Amendments

Marginal Citations

Calculation of resourcesU.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 requirementsU.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;

[F72(b)the amount which represents the weekly amount of any housing benefit to which the claimant or any member of his family is entitled under the provisions of Part 7 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.

Textual Amendments

Marginal Citations

PART V E+W+SCONCLUSION

Transitional ProvisionsE+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

RepealsE+W+S

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

Marginal Citations

M20References 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

Regulations 15, 16 and 17

SCHEDULE 1E+W+SMODIFICATIONS OF THE INCOME SUPPORT (GENERAL) REGULATIONS 1987

TABLE A

Column 1Column 2
Regulation 23

In paragraph (1) for “section 22(5) of the Act” substitute “ regulation 15(3) of the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 ”.

Regulation 25

For the whole of regulation 25 (liable relative payments) substitute—

“25.—(1) Where a claimant’s income consists of any payments made by a person, whether under a court order or not, for the maintenance of himself or any member of his family, and those payments are made or due to be made at regular intervals, his normal weekly income from those payments shall be determined—

(a)if before the relevant date those payments are made at regular intervals and in regular amounts, by reference to the normal weekly amount;

(b)if they are not so made, by reference to the average amount of such payments received in the 13 weeks immediately preceding the week which includes the relevant date.

(2) Any maintenance payment other than one to which paragraph (1) of this regulation applies shall be treated as capital.”.

Regulation 25AOmit this regulation.
Regulation 28

In paragraph (1) omit the words from “For the purposes” to “income support)”.

In paragraph (1)(a) for “the weekly amount of his income” substitute “ the normal weekly amount of his income at the relevant date ”.

Regulation 29Omit this regulation.
Regulation 30

In paragraph (1) omit the words “Except where paragraph (2) applies”.

In paragraph (1)(a) at the beginning insert the words “ except where sub-paragraph (b) or (c) applies, ”.

In paragraph (1)(b) at the beginning insert the words “ except where sub-paragraph (c) applies, ”.

After paragraph (1)(b) insert the word “ or ” and the following sub-paragraph—

“(c)where in respect of the employment the claimant provides a profit and loss account (and, where appropriate, a trading account or a balance sheet or both), and the profit and loss account is in respect of a period of at least 6 months but not exceeding 15 months and that period ends within the 12 months preceding the relevant date.”.

After paragraph (1) insert the following new paragraph—

“(1A) In paragraph (1)(c)—

(a)“balance sheet” means a statement of the financial position of the employment disclosing its assets, liabilities and capital at the end of the period in question;

(b)“profit and loss account” means a financial statement showing the net profit or loss of the employment for the period in question; and

(c)“trading account” means a financial statement showing the revenue from sales, the cost of those sales and the gross profit arising during the period in question.”.

Omit paragraph (2).

Regulation 31Omit this regulation.
Regulation 32

In paragraph (1) for “regulation 29” substitute “ regulation 28 ” and for “subject to paragraphs (2) to (7)” substitute “ subject to paragraph (6) ”.

In paragraph (6) omit “and has changed more than once”.

Omit paragraphs (3)–(5), (6A) and (7).

Regulation 35

Omit paragraphs (1)(c), (1)(g), (1)(i), (1A) and (2A).

In paragraph (1)(d) omit the words after “employment”.

In paragraph (2)(a) omit the words “subject to paragraph (2A)”.

Regulation 36

In paragraph (1) for “regulation 29 (calculation of earnings of employed earners)” substitute “ regulation 28 (calculation of income) ”.

Regulation 38

In paragraph (3) for “paragraph (9)” substitute “ paragraphs (3A) or (9) ”.

After paragraph (3) insert—

“(3A) For the purpose of paragraph (1)(a), in a case where earnings of the employment are calculated over a period determined under regulation 30(1)(c), the net profit of the employment shall, except where paragraph (9) applies, be calculated by taking into account the earnings of the employment relevant to that period (whether or not received in that period), less—

(a)subject to paragraphs (5) to (7), any expenses relevant to that period (whether or not defrayed in that period) and which were wholly and exclusively incurred for the purposes of that employment; and

(b)an amount in respect of—

(i)income tax,

(ii)social security contributions payable under the Contributions and Benefits Act, calculated in accordance with regulation 39 (deduction of tax and contributions for self-employed earners), and

(iii)one half of any premium paid in the period that is relevant under regulation 30 in respect of a retirement annuity contract or a personal pension scheme.”.

In paragraph (4) after “the net profit of the employment” insert “ , except where paragraph (3A) or (9) applies, ”.

Regulations 39A–39DOmit these regulations.
Regulation 40

In paragraph (1) for “regulation 29 (calculation of income other than earnings)” substitute “ regulation 28 (calculation of income) ” and for “paragraphs (2) to (3B)” substitute “ paragraphs (2) and (3) ”.

Omit paragraphs (3A) to (5).

[F73For paragraph (6) substitute the following paragraphs—

“(6) Where—

(a)the claimant is a member of a couple or a polygamous marriage;

(b)the claimant or the claimant’s partner (or either or any of them if the claimant has more than one partner) is receiving a contributory employment and support allowance; and

(c)that benefit has been reduced under regulation 63 of the Employment and Support Allowance Regulations,

that reduction shall not affect the amount of benefit that is to be taken into account.

(6A) Where—

(a)the claimant is a single claimant or a lone parent;

(b)the claimant is receiving a contributory employment and support allowance; and

(b)that benefit has been reduced under regulation 63 of the Employment and Support Allowance Regulations,

that reduction shall not affect the amount of benefit that is to be taken into

account.”]

Regulation 41

In paragraph (1) for “on the first day” to “the date of that supersession” substitute “ at the relevant date ”.

Omit paragraphs (3) and (4).

Regulation 42In paragraph (4) omit the words from “and in any case” to “(trade disputes) applies”.
Regulation 44

In paragraph (1) for “on the first day” to “the date of that supersession” substitute “ at the relevant date ”.

Omit paragraphs (2), (3), (8), and (9).

Regulation 45

For this regulation substitute—

“Capital Limit

45.  For the purposes of Regulations 5(2)(e) and 6(1)(a) of the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 the capital limit is—

[F74(a) for a claimant permanently residing in accommodation as defined in Regulation 19A— [F75£23,250]

(b)in any other case—£16,000.”].

Regulation 46In paragraph (1) omit the words from “For the purposes” to “income support”.
Regulation 48

In paragraph (2) omit the words from “Except” to “applies”.

In paragraph (5) omit the words “Subject to paragraph (6),”.

Omit paragraphs (6) and (10)(a) and (b).

Regulation 49

In sub-paragraph (b)(i) for “first day” to “date of that supersession” substitute “ relevant date ”.

Regulation 51Omit sub-paragraph (1)(b).
Regulation 51AOmit this regulation.
Regulation 53

In paragraph (1A) for “£10,000” on each occasion it appears substitute “ [F76£14,250] and for “£16,000” substitute “ [F77£23,250] .

For paragraph (1B) substitute—

“(1B) For the purposes of paragraph (1A) and regulation 45, the prescribed circumstances are that the claimant lives permanently in accommodation as set out in Regulation 19A.”.

In paragraph (3) for the reference to “regulation 60” substitute reference to “ regulation 25. ”

Regulations 54 to 60EOmit these regulations.
Regulation 61

In paragraph (1) in the definition of “academic year” after “September” insert “ , or 1st August in the case of a student attending a course in Scotland. ”

Regulation 62

[F78In paragraph (1) for “subject to paragraphs (2) and (2A)” substitute “subject to paragraphs (2), (2A) and (2C)”]

[F79After paragraph (2B) insert—

[F80“(2C)  There shall also be disregarded from a student’s grant income—

(a)any sum by way of maintenance grant available to a student under [F81regulations 57 to 60 of the Education (Student Support) Regulations 2011] which is not taken into account in the calculation of the maximum amount of a loan for living costs under Chapter 2 of Part 6 of those Regulations;

(b)any sum by way of maintenance grant available to a student under [F82regulations 38 to 41 of the Assembly Learning Grants and Loans (Higher Education) (Wales) (No.2) Regulations 2011] which is not taken into account in the calculation of the maximum amount of a loan for living costs under [F83regulations 48 to 52] of those Regulations; and

(c)any sum by way of maintenance grant available to a student under regulation 58 of the [F84Education (Student Support) (No.2) Regulations (Northern Ireland) 2009] which is not taken into account in the calculation of the maximum amount of a loan for living costs under regulation 66 of those Regulations.”]]

[F85For paragraph (3) substitute—

“(3) In calculating the weekly amount of the grant to be taken into account as income—

(a)except where sub-paragraph (b) or paragraph (4) applies, the grant shall be apportioned equally between 52 weeks; and

(b)in the case of a grant which is payable in respect of the final academic year of the course or if the course is only of one academic year’s duration, in respect of that year the grant shall be apportioned equally between the weeks in the period beginning with the start of the final academic year or, as the case may be, the single academic year and ending with the last day of the course.”]

F86...

F86...

F86...

[F87Omit paragraph (3A)].

Omit paragraph (3B).

[F88In paragraph (4), for “weeks in the period beginning” to “last day of the period of study” substitute “remaining weeks in that period of study.”]

Regulation 63In paragraph (2) omit the words “or, if there are 53 benefit weeks (including part-time weeks) in the year, 53”.
Regulation 64In paragraph (1)(c) omit the words “or if there are 53 benefit weeks (including part-time weeks) in the year, 53”.
Regulation 65

For the words “No part” substitute “ (1) Subject to paragraph (2), no part ”.

After paragraph (1) insert the following paragraph—

“(2) For the purposes of this regulation and paragraph 15 of Schedule 9, “voluntary payment” shall not include any payment made by a person whose income a Minister of the Crown or an education authority—

(a)would take into account in assessing the amount of a student’s grant or student’s loan if an application for it were to be made; or

(b)has taken into account in assessing the amount of a student’s grant or student’s loan and which is in excess of contributions as assessed by a Minister of the Crown or an education authority.”.

Regulation 66A

[F89For paragraph (1), substitute—

“(1) A student loan shall be treated as income unless it is—

(a)a hardship loan; or

(b)an additional loan, as described in the [F90[F91Student Support Information Guide 2012-13] issued by the Student Awards Agency for Scotland], paid pursuant to an application for a loan made under regulation 5(1) or (9) of the Education (Student Loans) (Scotland) Regulations 2007 (applications for loans),

in which case it shall be disregarded.”]

For paragraph (2) substitute—

“(2) In calculating the weekly amount of the loan to be taken into account as income—

(a)except where sub-paragraph (b) applies, the loan shall be apportioned equally between the 52 weeks in the academic year;

(b)in the case of a loan which is payable in respect of the final academic year of the course or if the course is only of one academic year’s duration, in respect of that year the loan shall be apportioned equally between the weeks in the period beginning with the start of the final academic year, or as the case may be, the single academic year and ending with the last day of the course,

and, in the case of a person to whom paragraph (2A), (2B) or (2C) applies, from the weekly amount so apportioned there shall be disregarded £10.”.

After paragraph (2) insert the following paragraphs—

“(2A) This paragraph applies to a student whose applicable amount includes any premium specified in Parts II and III of Schedule 2.

(2B) This paragraph applies where the claimant is a student to whom paragraph 12 of Schedule 1B applies.

(2C) This paragraph applies where the student is a partner of a claimant and the claimant is not also a student.”.

Schedule 8

[F92For paragraph 4(3) substitute the following paragraph—

(3) This paragraph applies where—

(a)the claimant is aged not less than 60; or

(b)the claimant is a member of a couple, where at least one partner is aged not less than 60.]

[F93In paragraph 4 omit sub- paragraphs (4) and (7).]

[F94After paragraph 4 insert—

“4A.—(1) Income is disregarded under this sub-paragraph where—

(a)the claimant is undertaking work which falls within the categories in regulation 45(2) to (4) of the Employment and Support Allowance Regulations;

(b)the partner of a claimant is in receipt of employment and support allowance and is undertaking work which falls within the categories in paragraphs (2) to (4) of regulation 45 of the Employment and Support Allowance Regulations but paragraph (c) is not applicable; or

(c)both a claimant and the partner of the claimant are in receipt of employment and support allowance and both are undertaking work which falls within the categories in regulation 45(2) to (4) of the Employment and Support Allowance Regulations.

(2) Where sub-paragraph (1)(a) or (b) applies, income is disregarded to the same extent as it would be disregarded under paragraphs 5 and 6 of Schedule 7 to the Employment and Support Allowance Regulations.

(3) Where sub-paragraph (1)(c) applies, the aggregate income of the claimant and the partner is disregarded to the same extent as it would be disregarded under paragraphs 5 and 6 of that Schedule in the case of an individual.

(4) The other disregards in paragraphs 4 to 9 are not applicable where income is disregarded under this paragraph.

(5) In this paragraph “employment and support allowance” means an employment and support allowance under Part 1 of the Welfare Reform Act.”]

In paragraph 6A(1) for “none of paragraphs 4 to 6 applies” substitute “ paragraph 4 does not apply ”.

In paragraph 7 for the words “none of paragraphs 4 to 6B” substitute “ none of paragraphs 4 or 5 or 6A or 6B ”.

In paragraph 8 omit “part-time”.

After paragraph 8 insert the following paragraph—

“8A.  In a case in which none of paragraphs 4 to 8 applies to the claimant and he is one of a married or unmarried couple and a member of that couple is engaged in employment, £10; but if this paragraph applies to a claimant it shall not apply to his partner except where, and to the extent that, the earnings of the claimant which are to be disregarded under this paragraph are less than £10.”.

In paragraph 9 for “8” substitute “ 8A ”.

Omit paragraphs 6, 10, 13 and 16.

Schedule 9

In paragraph 15, in sub-paragraph (1) omit the reference to “paragraph 37”, and

Omit sub-paragraph (3)(b).

In paragraph 16 for “paragraphs 36 and 37” substitute “ paragraph 36 ”.

In paragraph 19 for “£4.00” substitute “ £20.00 ” and omit sub-paragraph (b).

For paragraph 21(1) substitute “ Subject to paragraph (2), any income in kind. ”. omit paragraph 21(3).

In paragraph 28 omit the words from “Except” to “return to work)”.

For paragraph 29(1) substitute the following paragraph—

“(1) Subject to sub-paragraph (2), any payment received under an insurance policy taken out to insure against the risk of being unable to maintain payments of housing costs which qualify under paragraph 17(1)(zb) or (zc) of Schedule 3, or for repairs or improvements to the dwelling occupied as the home to the extent that it is used to meet—

(a)repayments of unsecured loans for the purposes of carrying out repairs and improvements to the dwelling occupied as the home; or

(b)any amount due by way of premiums on that policy.”.

Omit paragraphs 30, 34 and 37.

After paragraph 77 insert the following paragraph—

“77A.  Any payment of State Pension Credit Savings Credit as defined under sections 1 and 3 of the State Pensions Credit Act 2002.”.

Schedule 10

In paragraph 17 for the words from “Except” to “payment” substitute the words “ Any payment ”.

Textual Amendments

TABLE B

Column 1Column 2
Regulation 3

In paragraph (1) omit the words “or with whom a claimant normally resides”.

In paragraph (2B) omit the words “subject to paragraph (2C)”.

Omit paragraph (2C).

Regulation 17

In paragraph (1) for the words from “18 to 22A” to “urgent cases” substitute “ 18, 19A and 21 ”.

Omit paragraphs (1)(bb) and (g).

In paragraph (1)(e) omit the words “mortgage interest payments or” and “other”.

Regulation 18

In paragraph (1) for the words from “regulations 21 to 22A” to “urgent cases” substitute “ regulations 19A and 21 (special cases) ”.

[F95For regulation 18(1) (a) and (b) substitute—

“(a)where each member of the marriage is aged less than 60—

(i)the amount applicable to the claimant plus the amount applicable to one of the other members of the marriage determined in accordance with sub-paragraph (5) of paragraph 1 of Schedule 2; and

(ii)an amount equal to the difference between the amounts specified in sub-paragraphs (5) and (1) of paragraph 1 of that Schedule in respect of each of the members of the marriage who were not taken into account in determining the amount under (i) above;

(b)where any member of the marriage is aged 60 or more—

(i)the amount applicable to the claimant plus the amount applicable to one of the other members of the marriage determined in accordance with sub-paragraph (6) of paragraph 1 of Schedule 2; and

(ii)an amount equal to the difference between the amounts specified in sub-paragraphs (6) and (2) of paragraph 1 of that Schedule in respect of each of the members of the marriage who were not taken into account in determining the amount under (i) above;”]

Omit paragraph (1)(cc) and (h).

After Regulation 18 insert the following Regulation—

“Care Homes.

19A  Where the claimant lives permanently in—

(a)a care home within the meaning of Section 3 of the Care Standards Act 2000; or

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

and he is a resident of such accommodation due to his personal circumstances and not as a carer, then his weekly applicable amount shall be calculated in accordance with Part 1 of Schedule 4A.”.

Regulation 21

In paragraph (1) omit the words from “Subject to” to “amounts)”.

In paragraph (3) omit the definition of “partner of a person subject to immigration control”.

In paragraph (3) omit the definition of “person from abroad”.

Omit paragraphs (1B), (2), (3A), (3B), (3C), (3D), (3E), (3F), (4), (4A), (4B) and (5).

Regulations 21ZB and 22AOmit these regulations.
Schedule 2

[F96In column (1) of the Table for [F97sub-paragraphs (1) to (3)] substitute—

(1)

Single person or lone parent aged not less than 25;

(2)

Single person [F98or lone parent] aged not less than 60;

(3)

Lone Parent [F99aged less than 60];

(4)

Single person aged less than 25;

(5)

Couple;

(6)

Couple, where at least one partner is aged not less than 60.]

[F100In column (2) of the Table (amounts) substitute—

(a)

against sub-paragraph (1) of column (1), the amount prescribed in paragraph (1)(e) of column (2) in the unmodified regulations;

(b)

against sub-paragraph (2) of column (1), the amount prescribed in regulation 6(1)(b) of the State Pension Credit Regulations;

(c)

against sub-paragraph (3) of column (1), the amount prescribed in paragraph (1)(e) of column (2) in the unmodified regulations;

(d)

against sub-paragraph (4) of column (1), the amount prescribed in paragraph (1)(d) of column (2) in the unmodified regulations;

(e)

against sub-paragraph (5) of column (1), the amount prescribed in paragraph (3)(d) of column (2)in the unmodified regulations.

(f)

against sub-paragraph (6) of column (1), the amount prescribed in regulation 6(1)(a) of the State Pension Credit Regulations.]

[F101After paragraph 1 (personal allowances) insert—

“1ZA.—(1) A single claimant or lone parent aged less than 25 who—

(a)is entitled to an ESA component; or

(b)is incapable of work and has been incapable of work for a continuous period of not less than 28 weeks which begins no earlier than 27th October 2008,

has a personal allowance equal to the amount of the personal allowance which would apply if that person were not less than 25 years old.

(2) In sub-paragraph (1) “ESA component” means a support component or a work-related activity component within the meaning of section 4 of the Welfare Reform Act.”]

[F102Omit paragraphs 1A, 2A, 6(2), 9, 9A, 10, 12(1)(c), 12(4), 15(2), 15(2A) and 15(3).]

In paragraph 2(1) omit “for the relevant period specified in column (1)”.

In paragraph 3(1)(a) omit the words from “to whom” to “(3) apply” and omit sub-paragraphs (2) to (7).

F103...

F103  “. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .”

[F104For paragraph 11(1) substitute the following entries—

“11.—(1) Subject to sub-paragraph (2), the condition is that—

(a)where the claimant is a person aged less than 60 who is a single claimant or a lone parent, an additional condition specified in paragraph 12 is satisfied; or

(b)where the claimant has a partner and both the claimant and the partner are aged less than 60, an additional condition specified in paragraph 11A(1) or 12 is satisfied by at least one of them; or

(c)where the claimant is a person aged less than 60 who is a single claimant or a lone parent, an additional condition specified in paragraph 11A(2) is satisfied.”.

After paragraph 11 insert—

“11A.—(1) The additional conditions referred to in paragraph 11(1)(b) are—

(a)the claimant is a member of a couple and a member of that couple has been awarded employment and support allowance which includes an ESA component; or

(b)the claimant is a member of a couple and a member of that couple has been in receipt of employment and support allowance for 28 weeks, or is incapable of work and has been incapable of work for a continuous period of not less than 28 weeks which starts no earlier than 27th October 2008.

(2) The additional conditions referred to in paragraph 11(1)(c) are—

(a)the claimant is a single claimant or lone parent who is in receipt of an employment and support allowance which includes a support component;

(b)the claimant is a single claimant or lone parent who is in receipt of an employment and support allowance which includes a work-related activity component;

(c)the claimant is a single claimant or lone parent who has been in receipt of employment and support allowance for a period of 28 weeks, or is incapable of work and has been incapable of work for a continuous period of not less than 28 weeks which starts no earlier than 27th October 2008;

(d)the claimant is a—

(i)single claimant or lone parent;

(ii)severely disabled person within the meaning of paragraph 13(2)(a)(i); and

(iii)person who has been in receipt of employment and support allowance for a period of not less than 28 weeks, or is incapable of work and has been incapable of work for a continuous period of not less than 28 weeks which starts no earlier than 27th October 2008.

(3) In this paragraph—

“employment and support allowance” means an employment and support allowance under Part 1 of the Welfare Reform Act;

“ESA component” means either a support component or a work related activity component; and

“support component” and “work-related activity component” have the same meanings as in section 4 of that Act.”]

In cross heading to paragraph 12, omit “Higher Pensioner and”.

In paragraph 12(1)(a)(i) for the words “long term incapacity benefit” substitute “ incapacity benefit, where the claimant or partner has been in receipt of that benefit for at least 28 weeks, ” and omit the words from “but, in the case” to “in respect of him”.

In paragraph 12(1)(b) after the words “the claimant” insert “ or, as the case may be, his partner ” and for sub-head (ii) substitute the following sub-head—

“(ii)has been so entitled or so incapable for a continuous period of at least 28 weeks.”.

[F105In paragraph 12(1)(d)(ii) delete “higher pensioner premium or.]

In paragraph 12(6) after “sub-paragraph (1)(a)(i)” delete “or (c)(i)” and for “long-term incapacity benefit” substitute “ incapacity benefit, notwithstanding the requirement that the claimant or his partner has been in receipt of that benefit for at least 28 weeks, ”.

In paragraph 13(2)(a)(ii) and 13(2)(b)(iii) for “normally residing” substitute the words “ residing with him ” and delete “or with whom he is normally residing”.

[F106For paragraph 13A(1) (enhanced disability premium) substitute—

“13A.—(1) Subject to sub-paragraph (2), the conditions are that—

(a)the claimant is aged less than 60 and, where the claimant is a member of a couple, the claimant’s partner is aged less than 60; and

(b)the claimant or, as the case may be, the claimant’s partner is—

(i)in receipt of employment and support allowance which includes a support component;F107...

(ii)in receipt of the care component of disability living allowance at the highest rate prescribed under section 72(3) of the Contributions and Benefits Act or would be in receipt of that component at that rate but for either a suspension of benefit in accordance with regulations made under section 113(2) of that Act or an abatement as a consequence of hospitalisation[F108;]

[F109(iii)in receipt of the enhanced rate of the daily living component of a personal independence payment prescribed in accordance with section 78(3)(b) of the Welfare Reform Act 2012; or

(iv)in receipt of an armed forces independence payment under the Armed Forces and Reserve Forces (Compensation Scheme) Order 2011.”]

After 13A(2) insert—

“(3) In this paragraph “employment and support allowance” means an employment and support allowance under Part 1 of the Welfare Reform Act and “support component” has the same meaning as in section 4 of that Act.”

In paragraph 15(4)(a) (weekly amount of disability premium) for the entry in the left column substitute—

“(a)where the condition in paragraph 11(1)(a) is satisfied or the condition in paragraph 11(1)(c) and an additional condition in paragraph 11A(2) (b) or (c) are satisfied;”

After paragraph 15(4)(a) insert the following entry—

“(aa)where the condition in paragraph 11(1)(c) and an additional condition in paragraph 11A(2) (a) or (d) are satisfied;(aa)an amount equal to the support component in paragraph 13 of Schedule 4 to the Employment and Support Allowance Regulations.”

In paragraph 15(4)(b) (weekly amount of premium) for the entry in the left column substitute—

“(b)Where the condition in paragraph 11(1)(b) and an additional condition in paragraph 11A(1) or paragraph 12 are satisfied.”]
Schedule 3

In paragraph 1(1)(b) for “paragraphs 15 to 17” substitute “ paragraph 17 ”.

For paragraph 1(2) substitute—

“(2) In this Schedule “period of study” has the meaning specified in regulation 61 (Interpretation).”

For paragraph 1(3) substitute—

“(3) For the purposes of this Schedule a disabled person is a person—

(a)who satisfies a condition specified in paragraph 12(1)(a) or (b) of Schedule 2 and whose capital does not exceed the capital limit; or

(b)who is aged 75 or over and whose capital does not exceed the capital limit; or

(c)in respect of whom a disabled child premium is included in his applicable amount or the applicable amount of a person living with him.”.

For paragraph 2(1)(c) substitute—

“(c)he in practice shares the housing costs with other members of the household where no member of that household who is liable to meet those costs is a close relative of the claimant or his partner and it is reasonable in the circumstances that the claimant should be treated as sharing responsibility for those costs.”.

Omit paragraphs 1A, 2(2), 3(7) to (10), 6 to 16 and 18(7)(e).

In paragraph 3(12) for “not exceeding” substitute “ is not likely to exceed ”;

For paragraph 4 substitute—

“4.  No amount may be met under the provision of this Schedule where the claimant is in accommodation which is a care home or accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act except where he is in such accommodation during a temporary absence from the dwelling he occupies as his home and, in so far as they relate to temporary absences, the provisions of paragraphs 3(11) and (12) apply to him for those absences.”.

In paragraph 17—

(a)

in the cross heading for the word “Other” substitute the word “ Qualifying ”;

(b)

in sub-paragraph (1) omit head (f) and immediately before (a) insert—

“(za)any periodical payment which a person is liable to make by way of rent in respect of a dwelling he occupies as his home;

(zb)payments of interest and capital—

(i)of a mortgage or loan secured on the dwelling occupied as the home,

(ii)under a hire purchase agreement or other loan to buy the dwelling occupied as the home,

(iii)in respect of a loan taken out to adapt the dwelling occupied as the home for the special needs of a disabled person;

(zc)payments in respect of an endowment policy in connection with the purchase of the dwelling occupied as the home;”.

In sub-paragraph (2) omit head (c) and for “Subject to” to “amounts” substitute “ Subject to sub-paragraphs (3), (3A) and (3B), the deductions to be made from the weekly amounts in respect of the housing costs specified in heads (za) and (a) to (e) of sub-paragraph (1) ” and in head (a) omit the words from “unless the claimant” to the end of the head.

After sub-paragraph (3) insert the following new sub-paragraphs—

“(3A) Subject to sub-paragraph (3B), where arrangements are made for the housing costs mentioned in heads (za) and (a) to (e) of sub-paragraph (1) payable in respect of a period of study, to be paid irregularly or so that—

(a)no such costs are payable for or collected in the Christmas or Easter vacation within a period of study, or

(b)the costs in respect of the Christmas or Easter vacations within a period of study vary from those in the rest of that period of study,

the weekly amount shall be the amount payable in respect of a period of study divided by the number of weeks in that period of study.

(3B) Where the housing costs, to be calculated in accordance with sub-paragraph (3A), are subject to a deduction in accordance with sub-paragraph (2)(a) or (b), as the case may be, the weekly amount of the deduction shall be the proportion of the deduction calculated in accordance with sub-paragraph (2)(a) or (b), as the number of weeks in the period of study, excluding Christmas and Easter vacations, bears to the number of weeks in the period of study.”.

For paragraph 18(7)(f) substitute—

“(f)to whom paragraph (2B) of regulation 3 (definition of non-dependant) would apply;”.

Schedule 3B

After Schedule 3B insert the following schedule—

“Schedule 4AApplicable amounts of a person in accommodation within the meaning of Regulation 19A.

1.—(1) The applicable amount of a claimant to whom regulation 19A applies shall be the aggregate of—

(a)subject to paragraphs 1(2) and 2, the weekly charge for the accommodation, including all meals and services provided for him or, if he is a member of a family, for him and his family increased, where appropriate, in accordance with paragraph 2; and

(b)a weekly amount for personal expenses for him and, if he is a member of a family, for each member of his family determined in accordance with paragraph 2.

(2) Except where otherwise provided, no amount shall be included in respect of a child or young person who is a member of the claimant’s family if the capital of that child or young person calculated in accordance with Part V in like manner as for the Claimant would exceed £3,000.

2.—(1) The allowance for personal expenses for the claimant and his partner (where appropriate) shall be that set out in Schedule 9 of the Social Security Claims and Payments Regulations 1987 at paragraph 4(2A)(a).

(2) Where the claimant has a dependant child or children residing with him, the personal expenses allowed for each dependant shall be those set out in Schedule 9 of the Social Security Claims and Payments Regulations 1987 at paragraph 4 (2A)(a).”.

Schedule 7

Omit the references in paragraph 1 to sub-paragraph (g) of regulation 17(1) and sub-paragraph (h) of regulation 18(1).

Omit both columns of paragraphs 6, 7, 10A, 10B, 10C, 16A, 17 and 19A.

In the first column of paragraph 9 for sub-paragraphs (a)(i) and (ii) substitute the following—

“9   

(a) 

(i)in a care home, or

(ii)is in accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act 1948”.

In the first column of paragraphs 9(b)(iii) and (iv) substitute—

“9   

(b) 

(iii)in a care home, or

(iv)is in accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act 1948.”.

Textual Amendments

 After paragraph 10 insert the following paragraph—
 

“10ZA..  A claimant who is a lone parent who is temporarily in a care home or accommodation provided by a local authority under sections 21 to 24 and 26 of the National Assistance Act 1948.

Any amount applicable to the claimant under paragraphs 1(1)(a), (b) and (c) of Schedule 4A, determined as if he were a single claimant plus—

(a)

in respect of each child who is a member of his family, the appropriate amount in respect of him prescribed in paragraph 2 Schedule 2 or under this Schedule as appropriate; and

(b)

any amount which would be applicable to the claimant, if he were not living away from home, under regulation 17(1)(c) or (d) in so far as it relates to the F110... family premium under [F111paragraph 3] of Schedule 2.”.

Textual Amendments

Regulation 19

SCHEDULE 2E+W+SREVOCATIONS

Column 1Column 2
National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988, S.I. 1988/551.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1990, S.I. 1990/548.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment No. 2 Regulations 1990, S.I. 1990/1661.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1991, S.I. 1991/557.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1992, S.I. 1992/1104.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1993, S.I. 1993/608.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1995, S.I. 1995/642.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment No. 2 Regulations 1995, S.I. 1995/2352.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1996, S.I. 1996/410.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 2) Regulations 1996, S.I. 1996/1346.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Regulations 1996, Amendment (No. 3) S.I. 1996/2362.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1997, S.I. 1997/748.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 2) Regulations 1997, S.I. 1997/2393.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1998, S.I. 1998/2417.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1999, S.I. 1999/767.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 1999, S.I. 1999/2507.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 2000, S.I. 2000/621.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment No. 2 S.I. 2000/837.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2000, S.I. 2000/2870.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 2001, S.I. 2001/742.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 2) Regulations 2001, S.I. 2001/3065.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001, S.I. 2001/4043.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 2002, S.I. 2002/580.The whole regulations
The National Health Service (Travelling Expenses and Remission of Charges) Amendment Regulations 2003, S.I. 2003/671.The whole regulations
The National Health Service (Dental Charges) Regulations S.I. 1989/394. Regulation 7(2)
The National Health Service (Miscellaneous Dental ChargesAmendments) Regulations 2002 S.I. 2353.Regulations 2–6

Explanatory Note

(This note is not part of the Order)

These Regulations consolidate, with amendments, the provisions of the National Health Service (Travelling Expenses and Remission of Charges) Regulations 1988 (“the 1988 Regulations”). The 1998 Regulations and all subsequent amendments are repealed by regulation 19 and Schedule 2.

The Regulations make provision for people who are either in receipt of certain state benefits or who are on a low income to be reimbursed for travel expenses incurred in obtaining certain NHS services (NHS travel expenses) and for those same people to be exempt from the payment of certain NHS charges which would otherwise be payable. Regulation 3 defines NHS travel expenses and NHS foreign travel expenses. Regulation 4 identifies what NHS charges can be waived.

The principal changes in relation to travel expenses from the 1988 Regulations are as follows: the expenses of a companion can be claimed only where they are certified to be necessary in the opinion of a doctor or appropriate health care professional (regulation 3(3)); a person’s circumstances may be taken into account in determining the cheapest reasonable form of transport and in the case of car travel, a mileage allowance and parking expenses may be included (regulation 3(5)); and persons who seek to rely on their entitlement are required to sign a declaration of that entitlement and provide evidence both of the entitlement and of the travel costs incurred (regulation 10(4)).

Part II contains provision relating to entitlement. Regulation 5 governs entitlement to payment in full of travel expenses and full remission of charges. Regulation 6 makes provision for partial payment and partial remission. Those who are in receipt of certain state benefits or who are entitled to certain tax credits are not required to make a claim for entitlement under these Regulations on the basis that their income and capital resources will already have been assessed for the purposes of their entitlement to the benefit or tax credit. All others who wish to claim entitlement under the Regulations must make a claim under regulation 7. Regulation 8 makes provision for notices of entitlement to be issued to successful claimants. The principal change from the 1988 Regulations is that the provisions about validity have been considerably simplified. All notices of entitlement are now valid for 12 months from the date of the claim although there is provision for different time periods in the case of students, young people supported by a local Authority and asylum seekers (regulation 8(5)). Regulation 9 makes special provision for residents of the Isles of Scilly.

Part III contains provision about payment and repayment. Regulation 10 makes provision for payment of travel expenses. Once entitlement is established, the amount due is calculated and paid either by the provider of the services or by the health service body which made the arrangements for the services. Regulations 11 and 12 contain provision relating to repayment in any case where a person who is entitled to the payment of travel expenses or to the remission of a charge has in fact incurred the expense or paid the charge. Regulation 13 enables a provider of services who has made a payment in respect of some travel expenses to be repaid in cases where the services were provided under an agreement with another body. Regulation 14 deals with payment and repayment of NHS foreign travel expenses.

Part IV and Schedule 1 concern the method of determining certain people’s entitlement under the Regulations. In the case mainly of those people who are not automatically entitled because they are in receipt of certain state benefits, what is required is a calculation of the claimant’s and his family’s income, capital and requirements. This is done by the application of modified provisions of the Income Support (General) Regulations 1987 (“the 1987 Regulations”) as set out in Schedule 1. The reason for the disapplication in regulation 16(5))c) of the State Pension Credit (Consequential, Transitional and Miscellaneous Provisions) Regulations 2002, is that by virtue of those Regulations people over 60 are no longer entitled to income support and are excluded from the 1987 Regulations. In order to preserve their position in relation to the payment of travel expenses and remission of charges, the amendments made to the 1987 Regulations by the 2002 regulations are disapplied.

These Regulations also reflect a number of changes from the 1988 Regulations which are minor or consequential drafting amendments.