The contact lens subsidy is available to optometrists and dispensing opticians if they have an agreement with the Ministry of Health, who fit or supply patients who, for medical reasons, cannot wear glasses.
How do I establish an agreement with the Ministry of Health?
If you are either an optometrist or ophthalmologist and wish to supply contact lenses to a person who you may think are able to claim a contribution for these costs under the subsidy then you will need to establish a contract prior to fitting and supplying the contact lenses.
Sector Operations can not process a claim for contact lenses issued prior to the commencement of the agreement with the Ministry of Health.
There can only be one legal identity, payee number and bank account per agreement.
Where do I send the ‘Application for a New Contact Lens Agreement’?
The form must be completed electronically and then signed:
A copy is then either:
- Posted to:
Ministry of Health
Private Bag 1942
- Or scan a signed copy to: [email protected]
- Or fax a signed copy to: (03) 474 8582.
I have not been paid for an entire contact lens claim, what should I do?
Contact the Sector Operations Contact Centre (0800 855 066 – option 2) to find out whether the claim has been received and if so whether payment has been stopped due to an error with the claim or a processing problem.
If the claim has not been received it will need to be resubmitted to Sector Operations via the usual routes – if the claim is now over six months old it will need special approval from the Ministry of Health before Sector Operations can process it.
The claim has been received, but not been paid, why would this be?
If the contract number is not valid or if the payee number is not correct a payment may be stopped or may be directed to the wrong account.
The claim has been received but not been fully paid – the variance report is showing error messages – what do these messages mean?
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.
Are the fitting fees and corresponding claim codes GST inclusive or exclusive?
The fees are the same as those set out in the previous contract, the only difference is that these are GST inclusive.
For the replacement of lost or damaged lenses, does Sector Operations meet two thirds of the cost or the total costs of the lenses?
Sector Operations will meet 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 meet the total supply cost of the lens, as evidenced by a copy of the lens supplier's invoice (use claim code S1).
Does the client or does Sector Operations fund the cost of a check up by an opthamologist?
If no lenses were fitted and it was only an eye examination then the client pays.
Can we either do away with the ‘copy of invoice’ requirement for silsoft and patch lenses, or can another process be agreed to?
You can send us a copy of the bulk supply invoice and indicate on this how many lenses you are claiming for.
Does Sector Operations fund the provision of disposable contact lenses?
Sector Operations does fund this as long as the following criteria are adhered to:
- disposable lenses are a clinically appropriate selection for the client
- disposable lenses are as cost effective as permanent lenses.
When will my claims be paid?
Payment will be made within 20 working days of receiving a valid claim.
Where do I send my contact lens claim forms?
Your claim ‘schedule B’ form should be sent to:
P O Box 1026
Please ensure to attach a copy of the Contact Lens Supplier’s invoice to each claim form.
I have run out of claim forms, where can I get some more?
Claim forms are available free by:
You will need to provide your payee number.
Please note: you should not rely solely on the answers provided here; the contracts applicable to each provider and all relevant legislation must be consulted to determine the full rights & liabilities applicable to any service provider or funder.