This manual provides guidelines for Ministry of Health funding support for children aged 15 years and under accessing the spectacle subsidy service.  It includes clinical guidelines that are intended to show the typical range of prescribing spectacles for most children

Spectacle Subsidy Manual and Clinical Guidelines (PDF, 10 pages, 722KB)

About the Spectacle Subsidy

The Children’s Spectacle Subsidy is a Ministry of Health contribution intended to assist low income families towards the costs of certain vision services for eligible children 15 years of age and under.

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

• Eye examination
• Frames
• Lenses
• Eye patches
• Repairs.

The subsidy amount is $287.50 (including GST).  A further $51.11 (including GST) is available for children who require an adult size frame.

Optometrists or Ophthalmologists who are registered with Enable New Zealand will undertake the examination, the prescription, and the completion of the Spectacle Subsidy application. The spectacles themselves can be provided by dispensing Opticians following a referral from an Optometrist.

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

Claims for the Spectacle Subsidy must be submitted using the Enable Online with RTL services by a registered Optometrist or Ophthalmologist (referred to as Approved Assessors under the Ministry of Health’s EMS Assessor Accreditation Framework).

If you are interested in using this service, information is available on the Enable New Zealand website under the Enable Online section. Dispensing Opticians are not eligible to apply to be an Approved Assessor to apply for the Spectacle Subsidy.

Enable New Zealand
PO Box 4547
Palmerston North 4442
Phone:  0800 171 996
Email: moh.processing@enable.co.nz

Eligibility Criteria

To qualify for the Children’s Spectacle Subsidy, a child or young person must meet all of the following:

• be 15 years of age or under at the date of assessment
• have an identified sensory (vision) problem that is likely to continue for longer than 6 months and that has resulted in a loss of independence and participation with activities at home, school or the community
• their parent/guardian, or the child, must have a valid Community Services Card or the child must have a current High Use Health Card
• have had an examination with, and a prescription from, an Optometrist or Ophthalmologist who is registered under the Ministry of Health Accreditation Framework, and who has determined that:
  • spectacles, lenses or eye patches are required to enable the child to achieve a higher quality of vision or
  • the child or young person requires replacement spectacles as his/her current spectacles no longer meet their needs
• meet the Clinical Guidelines

For more detailed information about the subsidy term, exclusions, payment schedules and how to use the new Enable Online service to make a claim, please refer to the Manual or Clinical Guidelines.

Process

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

The outcomes from the examination may be that:

• Spectacles are not required however an application may be submitted via Enable Online for the cost of the examination.
• 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 is completed online and printed out so the child's parent/guardian/agent can sign the form.

Online applications undergo screening for eligibility and criteria checks according to the Ministry of Health criteria set out in their Manual. An individual invoice containing the confirmation reference is still required for each application submitted. All invoices must be presented for payment in accordance with New Zealand IRD taxation requirements.

Subsidy Criteria

The child's subsidy year commences from the date the first examination appointment occurred with an Optometrist or an Ophthalmologist. This date will become the child's Anniversary Date. Each year at this time the child may access another Spectacle subsidy of $287.50 providing the eligibility criteria are met.

If the child's glasses are lost or broken within the year, another claim can be made if the $287.50 per annum has not currently been claimed in total. The total amount of subsidy per annum, including replacement, is $287.50.

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

On the successful completion of the Spectacle Subsidy application, a purchase order number will automatically be sent via email. This number needs to be quoted on the invoice submitted to Enable New Zealand and, provided 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 for:

• Children with rapidly progressing myopia who require six monthly eye examinations and may result in six monthly changes to the spectacle prescription.
• Children with amblyopia or strabismus who require more extensive intervention.

Optometrists and Ophthalmologists who are registered as an EMS Assessor for the Spectacle Subsidy can access this subsidy for their clients by selecting the Higher Level subsidy in Enable Online.

Audit Process

The Optometrist or Ophthalmologist is considered an expert in their field, therefore an audit will only be initiated when there appear 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 situation 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.

Applications

Applications will only be accepted through the Enable Specs App

Clinical Guidelines

As part of the Spectacle Subsidy Review, a set of Clinical Guidelines was developed with expert input from an Optometrist and Ophthalmologist on the Children’s Spectacle Subsidy Reference Group. These members also consulted on specific content and sought advice from the University of Auckland’s School of Optometry and the NZ Paediatric Ophthalmology sector, among others.

Contact Details: Enable New Zealand
PO Box 4547
Palmerston North 4442
Call Free: 0800 362 253
Email enquiries: enable@enable.co.nz