NHS Optical Benefits in the UK

The means to check optical benefits lies mainly with the opticians themselves, and for others it has been difficult to know the details of the system. Government advice would seem to have delegated all of the technical detail to others, it being more difficult to know from them the method to apply than the actual rates that are payable.

For those who want to know the detail of optical benefit assessment - read on.

Purpose

Many who could claim optical benefits would do so if they knew of them. Many others who might feel uncomfortable about claiming state aid, would do so if they could first assure themselves that the amounts justified a change of heart. Still others among the great inquisitive public feel a slight unease for things that they cannot work out for themselves.

With the above set in mind, this page lists the benefit amounts for single vision spectacles, that is to say other than bifocals, and explains how to estimate the NHS optical voucher amounts from eye prescriptions.

The page does not intend to describe the full range of general optical services (GOS), for which the optician's practice is the best port of call. Nor is this page intended to replace professional advice in any regard. You should know that your optician and optometrist are the best sources of advice on all optical matters. In particular, they can advise on the entire range of benefit services.

[edit] Health Benefit Entitlements

The various groups that can receive free NHS health benefits are listed in NHS Health Benefits in the UK: Brochure HC11   , and their up to date monetary amounts are to be found in NHS Health Benefit Rates in the UK: Brochure HC12   . These NHS brochures are available from doctors' surgeries and hospitals in the UK, from benefits and state pension offices, and from some post offices. They are also available from the Health Benefits section of the Department of Health. Opticians and dentists in the UK can also advise on their respective health benefits.

The main entitlement points are these:

• At the most general level optical (and dental) benefits are given to those claimants who can show that they have a low income.
• Claimants who already receive a means-tested benefit will usually have entitlement.
• Claimants without means-tested benefits may still receive partial assistance, depending on their income and savings. A graduated scale applies.
• To demonstrate an entitlement to health benefits for a dentist or optician, those with means- tested benefits show a recent entitlement letter, and those without benefits provide a form from the Health Benefits Section of the Department of Health.

Those claimant groups with entitlement to optical (and dental) benefits in 2009 are listed in the drop-box below, though for the official listings, interested parties should refer to the above-referenced brochures.

[edit] Prescription Terminology

This section introduces the notion of prescription shorthand and mentions a few of the entries on the form. An understanding of this terminology is not strictly necessary, but some may find it of general interest.

Two fictitious prescriptions have been produced in Tables 1 and 2. These make glasses that are identical, though they look quite different in their number content. They are typical of formats used throughout the world, though in the UK the version in Table 1 is by far the most common. Notice that both lenses in the prescription in Table 1 have higher Sphere values that the ones in Table 2. This format with the higher set of sphere powers is the one that is needed for looking up the NHS voucher values, and it is perhaps this factor that has directed the UK's choice of format.

When an optician encounters a prescription that is not in the format of highest spherical power he simply transposes it. The method used is called flat transposition, and it consists of just a few simple sums. Because a person new to these ideas might become confused by an alternative format, the method to check and transpose prescriptions is included in a separate section.

Another task that your optician would take for granted is the modifying of the distance prescription for near or intermediate use. For voucher checking this just involves adding some numbers so it has been included also.

Refer again to the prescription in Table 1. The main data of interest here describe the powers of the correction lenses. In fact powers are expressed in dioptres. Because dioptre values can be added directly, opticians prefer these to the difficulty of adding focal lengths. The focal lengths are the reciprocals of dioptres.

The figures seen in the Sphere, Cylinder, and Add boxes of the prescription are all power values; they are used by the optician to work out the details of lens grinding. Large power values also tell him that more material and more work will be needed to grind the lenses.

• There are shorthand methods to express lens prescriptions. One such method for lenses is shown below. Notice that it is written in the sequence sphere, cylinder, then axis. The example describes the two distance lenses of Table 1. The word prescription itself is often just written as Rx.

   +6.5   -1.5 X 95   RIGHT EYE, and
   +5.5   -1   X 85   LEFT EYE.

• The Sphere column describes the uniform curvature of each lens. It is quite common for the left and right eyes to need different corrections. These curvature components can best be imagined as if they were sliced from the surface of a sphere.
• The Cylinder column is not always used. Only those with astigmatism will have these entries. When this is the case, these figures describe the extent to which the eyes' functions deviate from the true spheres. These too are often different for each eye.
• The signs for the various lens powers can differ. When we refer to lens powers for benefits vouchers we really mean to say the magnitude of the power, that is to say without regard to the signs of the numbers. Although the signs have importance for the lens-maker and for some calculations, the voucher tables do not need them. It may still be of interest to know however, that for the lens-maker, negative and positive powers relate to divergent and convergent lens behaviour respectively.
• The Add values are power increments. These are added to their respective sphere figures for reading glasses (near), or for screen viewing glasses (intermediate). These increments are invariably positive and as such their signs are often missing.
• The Axis entry states the angle for the cylinder function. It tells the optician the angle from the horizontal at which to add the cylindrical compensation, and although it is of importance for lens-making it does not affect the benefit amount. These often differ for each eye.

In making a lens with a given sphere or cylinder power, it would be possible to have the back of the lens flat and all of the spherical or cylindrical functions on the front. However, this would make a thick-looking lens. In fact the lens maker splits his efforts between the back and front of the lens, so that the two surfaces combine to make the require prescribed values. The ability to do this makes for thinner lenses.  

[edit] Method Summary

The section provides an overview of the method to use in choosing the correct voucher value for a new pair of single-vision glasses. The sequence is as follows:

• Inspect the prescription to make sure that both lenses in the distance eye prescription are written in the format of highest spherical power. If they are not, then transpose them so that they both are.
• Add the respective sphere increments if the glasses are for near or intermediate use, to make a new prescription.
• Conduct a trial-lookup of the voucher tables, noting the category for each lens.
• Select the higher of the two category values to be the voucher category for the glasses.

The sections below explain how to adjust a distance prescription for near or intermediate glasses, how to know whether or not a prescription is in the right format to interpret the voucher table, and if it is not, explains how to transpose it to the format that is. Two sets of benefits tables are included.

[edit] Near and Intermediate

If the glasses are for near or intermediate work the respective increments in the add boxes of the prescription must be added to the sphere powers of the distance listing. For example, if glasses for near or intermediate use were needed for the subject in Table 1, their prescriptions could be formed as follows:

            NEAR GLASSES

    LEFT EYE             RIGHT EYE 

 To the 'distance' prescription:

  +5.5 -1 X 85        +6.5 - 1.5 X 95 

 Add these 'near' values to the sphere:

     +1.75                 +1.5

 To give the 'near' prescription:

  +7.25 -1 X 85       +8 -1.5 X 95    

          INTERMEDIATE GLASSES

    LEFT EYE             RIGHT EYE 

 To the 'distance' prescription:

  +5.5 -1 X 85        +6.5 - 1.5 X 95 

 Add these 'intermediate' values to the sphere:

     +1.25                 +1

 To give the 'intermediate' prescription:

  +6.25 -1 X 85       +7.5 -1.5 X 95    

Sometimes glasses for near or intermediate work will fall into a higher voucher category than distance glasses, owing to these increments. Higher voucher categories attract higher benefits.

It may also be of interest to know that because increments are invariably positive, they can be added either before or after transposition, without affecting their use in voucher tables.

[edit] Highest Spherical Power

Participating opticians deliver vouchers based on a prescription that produces the highest spherical power for each lens. This assures that the highest possible voucher payment is made. Its intention is as follows:

• It concerns the comparing of the two writing formats for a prescription, to get both lens descriptions so that they each depict their highest spherical power. This is done separately for each lens. The signs are ignored in looking up voucher tables; it is just the power magnitudes, the number parts that are of interest. An ability to transpose prescriptions allows this comparison, and it is described in the next section.
• When the correct lens formats have been found, trial voucher values are sought for each lens separately, and the voucher that is the higher of these two is taken as the benefit award for the glasses as a whole.

The consequences of using other than the correct prescription format for the voucher tables can be seen from the following example:

Assume that the available prescription is the one in Table 1, and that distance glasses are intended. The entries of Table 1 are already in highest spherical power notation. Comparing the data for each lens with the voucher table, it is found that the RIGHT lens belongs to voucher category B, and the LEFT to category A. Selecting the higher of these two vouchers gives category B for the glasses as a whole.

Now, assume instead that the prescription of Table 2 were used. This format is known to be in a different format and has not been transposed. It is however, for the same patient as that of Table 1. When we look up the voucher values in this format, the glasses as a whole would be in category A. This use of the wrong format would understate the benefit amount by about twenty pounds, ($30).

Although opticians routinely handle the matter without confusion and do much of the conversion in their heads, others are best served by a more methodical approach. In deciding whether or not a prescription is right, there is no harm in writing out both forms before making the necessary comparison and choice.

There is an exception to the use of the highest spherical power rule for vouchers, and that is for a prescription made by an NHS hospital under the HES scheme. These must be assigned voucher values using the format in which they are written, even if this has a monetary disadvantage to the patient. This applies to a prescription issued in a hospital even if the patient is there for another purpose; best put off an eye test until you leave!

Transposition is described in the next section.

[edit] Transposing the Format

As was mentioned above, there are two optical prescription formats in use. It should not be a surprise to learn that both of these formats make an identical lens. One type of lens prescription will have a greater sphere figure than the other, and within such a highest spherical power prescription, the respective sphere and cylinder for each lens can be found. As an example, the prescriptions in Tables 1 and Table 2 are identical, but Table 1 is written in highest spherical power format and Table 2 in the complementary format. The conversion method is described below.

With practice, these sums can be done in your head, but for those who are unfamiliar with prescriptions, it is best to do a trial calculation in any case, then check to see which of the two has the greater sphere powers. The method is as follows:

For each eye in the distance data:

• Add the sphere and cylinder powers, observing their signs; this sum is the new sphere power for the trial format; make sure that you take the signs into account in doing the sum; later, for looking up the voucher table we will use only the magnitude of the found number.
• The new cylinder power is found by using the same cylinder power but with a reversed sign; if it was negative then make the new value positive; if positive, then make it negative.
• The new axis value is found by adding 90 degrees to the existing value. If the result is greater than 180, then subtract 180 from the number found so that the eventual number does not exceed 180 degrees.
• Make a note of the new format in the sequence sphere, cylinder, then axis, and make a note as to which eye it is for.

For example; +10 -3 X 50: right eye.

[edit] Transposition Examples

The following two glasses examples show test-transposition and the rewritten results. It is unusual for lenses to be specified in different formats within the same pair of glasses, but it was deemed appropriate here to better demonstrate the method, and to generate worthy examples.

              Original            Transposed         Version with     Rewritten
            Prescription         Prescription       Highest Sphere   Prescription  

 LEFT:     +10  -3.5 X 70  =   +6.5 +3.5  X 160      Original       +10  -3.5 X 70
 RIGHT:    +9   +2   X 80  =   +11  -2    X 170      Transposed     +11  -2   X 170         

 LEFT:     -3   -1   X 70  =   -4   +1    X 160      Transposed     -4   +1   X 160 
 RIGHT:    +5.5 +1.5 X 30  =   -4   -1.5  X 120      Original       +5.5 +1.5 X 30   

[edit] The UK Benefit Rates

The vouchers for single vision spectacles are given in four categories; A, B, C, and D. The table below lists the amounts for 2008 and 2009; the scales start on the first of April of the respective year.

Where vouchers do not cover the cost of the selected product, they reduce the cost at their face value. Although these voucher values are the maximum amounts that opticians can recover from the NHS, they might well make additional marketing offers of their own. See the external site Optical Voucher Values for a full NHS listing that includes a wide range of optical products.

For those who prefer a less wordy table refer to the drop-box below. Note that although the image in the drop box includes amounts for bifocals, the remainder of this page is restricted to single vision spectacles. It may be of interest to know that bifocal vouchers are awarded on the distance prescription alone, and are given on the assumption that the one pair replaces both distance and near glasses.

2009 Voucher Amounts

[edit] Worked Example

The general method for awarding benefit is repeated here for the convenience of the reader, and fully worked examples for near and distance glasses are given, starting from the prescription of Table 2, i.e., starting from a prescription in other than the correct format.

The method is:

1. Inspect the prescription to make sure that both lenses in the distance eye prescription are written in the format of highest spherical power. If they are not, then transpose them so that they both are.
2. Add the respective sphere increments if the glasses are for near or intermediate use, to make a new prescription.
3. Conduct a trial-lookup of the voucher tables, noting the category for each lens.
4. Select the higher of the two category values to be the voucher category for the glasses.

                                
                                LEFT EYE       RIGHT EYE 

A. 'Distance' prescription:  +4.5  +1 X 175   +5   +1.5   X 5  

   A quick look at the numbers shows that neither of the lens
   prescriptions is in the format of ''highest spherical power''.
   Applying the method shown in the section Transposing the Format
   we obtain the correct format as:   

   'Distance' transposed:    +5.5  -1 X 85    +6.5 - 1.5 X 95     (1) 


B. Now add the ''near'' increments to the ''distance'' sphere values
   to make the reading prescription: 


   Add ''near'' increments:      +1.75            +1.5


   Gives 'near' prescription:  +7.25 -1 X 85    +8  -1.5  X 95    (2)   


C. Then making a trial-lookup for both of these 'near' lenses in the
   voucher table gives:                      

   Trial-lookup 'near' categories:     B               B

               
D. Select the highest 'near' category; 'near' category is:     B  
   

E. Now conduct a trial-lookup for the 'distance' glasses in the
   voucher table:  (using expression (1) )  

   Trial-lookup 'distance' categories: A               B


F. Select the highest 'distance' category; 'distance' category is: B


G. For this claimant, both the 'near' and the 'distance' glasses are
   given a category B optical voucher.  A similar method could be used
   to find the voucher for the intermediate case. 
     

These examples do not go into the details of complex lens benefits, bifocals, varifocals, or other GOS services like repairs. You should know that your optician is the best source of advice on all such optical matters, and that participating opticians, that is to say, all of the largest companies in the UK, can advise on the amount of benefits due for a particular claimant; there is no need to understand all of these details before claiming.

Nonetheless, this description will hopefully allow interested readers to estimate the basic optical benefits for themselves, and perhaps check that the benefits that they have received are correct. In the event that you disagree with an award of benefit, first ask the dispensing optician to review the matter. Beyond that, whether or not there is a right of appeal for optical benefits is unclear.

[edit] See Also

• Eyeglass prescription  : Wikipedia article
• NHS optical voucher values in the UK  : NHS voucher tables from Optometry.co.uk
• NHS Health Benefits in the UK: Brochure HC11  : NHS pdf download describing health benefit entitlements, including glasses
• NHS Health Benefit Rates in the UK: Brochure HC12  : NHS pdf download with the health benefit rates for the current year
• Directgov UK government portal  : links to most UK government services; Direct.gov.uk
• How to transpose prescriptions  : An external tutorial at Opticianworks.com
• FODO Survey 2007-8: Well presented statistics on dispensing from fodo.com
• Making Accurate Voucher Claims An opticians' guide on the NHS scheme.