Spectacles Subsidy Manual

Ministry of Health Spectacles Subsidy for Children Fifteen Years and Younger

This subsidy is for the provision of Disability Support Services assistance for children with vision problems in low-income families.

The five areas that can be accessed under the subsidy are:

Examination
Frames
Lenses
Eye patches
Repairs

The subsidy amount is $281.25 (including GST). A further $50.00 (including GST) is available for children that require an adult size frame.

Optometrists or Ophthalmologists that are registered with Enable New Zealand will undertake the examination, the prescription, and the completion of the Spectacles Subsidy application form.

The Spectacles Subsidy is paid directly to the provider of the examination or glasses. The provider then deducts the subsidy amount from their client's account.

The spectacles can be provided by optometrists and dispensing opticians.

The completed form is to be submitted to Enable New Zealand with an invoice attached. Applications may be submitted by post, fax or email.

Enable New Zealand
PO Box 4547
Palmerston North
Facsimile (0800) 171996
Email: moh.processing@enable.co.nz

ELIGIBILITY CRITERIA

To qualify for the subsidy the child must meet the following criteria:

the child must be 15 years old or younger
the parent/guardian or the child must have a valid Community Services Card or the child must have a current High Use Health Card
the child must have had an examination with an optometrist or ophthalmologist that is registered with Enable New Zealand
the child's prescription must be from an Optometrist or Ophthalmologist that is registered with Enable New Zealand who has determined that spectacles are required to enable the child to achieve a higher quality of vision
the child must have a disability as defined by the Ministry of Health; "A person with a disability is a person who has been identified as having a physical, intellectual, sensory or age-related disability (or a combination of these) which is likely to continue for a minimum of six months and result in a reduction of independent function to the extent that ongoing support is required."

PROCESS

The child sees an Optometrist or Ophthalmologist, who determines if the child meets the criteria for the Spectacles Subsidy.

The outcomes from the examination could be that:

Spectacles are not required. An application may be submitted for the cost of the examination.
That spectacles are required and a prescription is created.
Where a prescription is created a client may choose to remain with the examiner if they provide spectacles, or they may choose to go to an alternative provider.

The form must be completed and signed by both the child's parent/guardian/agent and the provider of the prescription.

The application must be submitted to Enable New Zealand with an invoice for processing and payment. An individual invoice is required for each child's application. Bulk invoices with multiple clients will not be accepted. All invoices must be presented for payment in accordance with New Zealand IRD taxation requirements.

SUBSIDY CRITERIA

The child is entitled to a maximum subsidy of $281.25 (inc GST) per year. A further $50.00 (inc GST) is available for children that require an adult size frame.

The child's subsidy year starts from the date of the first subsidy application received. This becomes the child's anniversary date. Each year at this time the child has another $281.25 to access if the eligibility criteria are still met.

If the child's glasses are lost or broken within the year, another claim can be made if the $281.25 per annum has not currently been claimed in total. The total amount of subsidy per annum including replacement is $281.25

Hospital-based eye examination services are already purchased by the Ministry of Health; therefore the Spectacles Subsidy cannot be accessed for examination fees from these public assessment services. However, the Spectacles Subsidy can be accessed to fill a prescription from a hospital based eye examination.

Dispensing Opticians are not able to register as a Specialised Assessor for the Spectacles Subsidy but they are able to access the subsidy with a form signed by the Specialised Assessor that provided the child's prescription.

On the condition that all relevant documentation is complete, Spectacle Subsidy payments are made on or about the 20^th of the month for invoices dated and received in the previous month.

HIGHER LEVEL SUBSIDY

The following high need areas have been identified where a Higher Level Subsidy can be provided:

Children with rapidly progressing myopia who require an eye examination six monthly and possible six monthly modifications to spectacles.
Children with amblyopia or strabismus who require more extensive intervention.

Prior approval is required for the Higher Level Spectacles Subsidy. Optometrists and Ophthalmologists that are registered as a Specialised Assessor for the Spectacles Subsidy can access this subsidy for their clients by submitting a Higher Level Spectacles Subsidy application form to Enable New Zealand. Consideration will be given to applications on a case by case basis. Once approval is given the standard Spectacles Subsidy application form will need to be submitted to Enable New Zealand with an invoice attached.

AUDIT PROCESS

The Optometrist or Ophthalmologist is considered an expert in their field, therefore an audit will only be initiated when there appears to be incorrect recommendations, ongoing instances of not following correct procedures or if there are other grounds to consider an audit. Enable New Zealand will contact the Optometrist or Ophthalmologist to discuss the case before proceeding with an audit. If the issue can be resolved between Enable New Zealand and the Optometrist or Ophthalmologist, no further action will be taken.

Where a full audit needs to be conducted, Enable New Zealand, on behalf of the Ministry of Health, reserves the right to seek the advice of a relevant professional person/s to conduct an independent audit. Any findings and recommendations will be referred to the Ministry of Health for their action.

APPLICATION FORMS

Applications will only be accepted on the correct application forms. These forms may need to be updated from time to time. Enable New Zealand will provide Specialised Assessors with a new master copy of the application form and advise of the date when only the new application form will be accepted. Enable New Zealand will only supply a master copy of the application forms. The Specialised Assessor will need to arrange copies for day to day use.

Contact Details:

Enable New Zealand
PO Box 4547
Palmerston North
Call Free 0800 ENABLE (362253)
Facsimile (0800) 171996
Email inquiries: enable@enable.co.nz
Email applications: moh.processing@enable.co.nz

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