About the Contact Lens Subsidy
You must have an agreement with Te Whatu Ora before you can make a Contact Lens Subsidy claim.
Note: You should not rely solely on the answers provided here. The full rights and liabilities applicable to any service provider or funder must consult the contracts applicable to each provider and all relevant legislation.
Te Whatu Ora's Sector Operations will cover two thirds of the cost of the replacement lenses when the lenses have been damaged or lost (use claim code S2).
In all other cases, Sector Operations will cover the total supply cost of the lens, as evidenced by a copy of the lens supplier's invoice (use claim code S1).
Sector Operations funds disposable lenses as long as:
- disposable lenses are a clinically appropriate selection for the client; and
- disposable lenses are as cost effective as permanent lenses.
The fees are the same as those set out in the previous contract, the only difference is that these are GST inclusive.
If no lenses were fitted and it was only an eye examination then the client pays.
When you get paid
Payment will be made within 20 working days of receiving a valid claim.
How to make a Contact Lens Subsidy claim
If you are either an optometrist or ophthalmologist who wants to supply contact lenses to a person you think is eligible for this subsidy, you need to get a contract with Te Whatu Ora before fitting and supplying the contact lenses.
Sector Operations will not process any claims for contact lenses issued before the agreement with Te Whatu Ora.
To get an agreement with Te Whatu Ora, you must complete a Contact Lens Benefit Application Form.
There can only be one legal identity, payee number and bank account per agreement.
Scan a signed copy to firstname.lastname@example.org or to:
Te Whatu Ora - Health New Zealand
Private Bag 1942
Where to send your claims
Your claim ‘schedule B’ form should be sent to:
P O Box 1026
Please attach a copy of the Contact Lens Supplier’s invoice to each claim form, otherwise your claim might not be processed.
You can also send us a copy of the bulk supply invoice and let us know how many lenses you want to claim for.
Where to get more claims forms
What to do if you have problems getting paid
You haven't been paid
If you haven't been fully paid for a contact lens claim, contact the Sector Operations Contact Centre (0800 855 066 – option 2) to find out whether we've received your claim received or if there's been a processing error (such as a wrong contract number or payee number).
If we haven't received your claim, you'll have to submit a new one.
If the claim is over six months old, you'll need special approval from Te Whatu Ora before we can process it.
We've received your claim but the variance report is showing an error message
Error 0513 – Invalid Provider (Registration) Number
The Provider number given has expired or is not in Sector Operations’ database. If the Provider number is correct then Sector Operations will need to check that the optician’s Registration number is still valid and covers the dates of service of the claim.
Error 0520 – Invalid service for contract
The Contract number given has expired or is not in Sector Operations’ database. If the Contract number is correct then Sector Operations will need to check that the optician’s Registration number is still valid and covers the dates of service of the claim.