Enable New Zealand
The Enable Children’s Spectacle Subsidy helps families with the cost of certain vision services for eligible children 15 years or under. The Ministry of Health (MoH) provides this subsidy to eligible children that meet the clinical guidelines. Optometrists must register as Approved Assessors to claim the spectacle subsidy payment for customers via the Enable Online Specs App system.
Subsidies
The total Standard Subsidy amount available each year for an eligible child is $287.50 (incl. GST). Of the $287.50, the maximum of $138 (incl. GST) can be used towards frames. Additional funding of $51.11 (incl. GST) is available if the child requires adult size frames. There is no limit on other individual items.
A Higher Level Subsidy can be accessed for children with more complex vision needs. This will be assessed by the Optometrist. There is a $250 annual limit for frames but there is no limit on other items (e.g. lenses or eye patches) that may be clinically required for the customer’s prescription, however the most cost-effective lenses must be provided to the customer.
For the Enable Standard Subsidy, the anniversary date for the annual claim is 12 months after their first purchase. For example, if the glasses are claimed on 1 December 2019, their next annual entitlement of $287.50 will not be available until 1 December 2020.
For an overview of the subsidy, click on the Enable Children’s Spectacle Subsidy brochure for Parents/Guardians. This brochure is available in store and can be used to explain the subsidy to customers.
Eligibility Criteria
To be eligible for the subsidy, customers must:
- Be aged 15 years or under
- Have a Sight Test completed by an Optometrist (who is an Approved Assessor for the MoH)
- Meet all clinical guidelines (found here)
- Hold a valid Community Services Card or High Use Health Card in the name of the child and be the parent/ guardian of that child
Click below to see all the details of the Enable Requirements.
Tip for frame selection
$299 (2 for 1) is a popular dispense for best value. Enable customers can pay any amount over the subsidy of $287.50 (unlike MSD customers who are not permitted to “top up” above $249 under the contract).
Have a look at the example shown here. The subsidy available is $287.50. The customer selects the $299 (2 for 1) glasses. When processing the claim, the frame and spectacle lens cost is split in half to give two prices at $149.50 totalling $299. Once the Enable subsidy is subtracted from the total cost, the parent/guardian only pays $11.50.
How to process the Enable subsidy
The Enable transaction is first processed through Genesys, then through the Specs App to make the claim on behalf of the customer.
Take a look at the ‘Enable Customer – Genesys Process’ for the Genesys part of the process.
To process claims through the Specs App, you need to know how to allocate the frame and lens costs. Use the ‘Enable SV Frame & Lens Cost Table’ to allocate frame and lens costs.
If it is part of your role to submit Enable claims directly, use the Enable ‘Specs App’. To view the training videos about how to submit claims through the Specs App.
For example
If a customer who is entitled to the standard subsidy, selects a $69 frame, the cost is split evenly between the frame and lenses of $34.50 for each. The customer doesn’t need to pay any part because the total is below the available subsidy of $287.50.
The table also shows how the $299 price point is evenly split between the frame and lenses (for reporting purposes) of $149.50 for each. Given that the available subsidy is only $287.50, the customer will pay the extra $11.50.
It’s important to know how to split the costs correctly when processing claims to ensure we can report our claims accurately to the Ministry of Health. For Higher Level Subsidy claims, Enable closely monitors frames greater than $250.
Customer Example:
Let’s look at how to work out the subsidy of a typical Enable customer.
Case Study:
Now it’s your turn. Print the following case study and fill in the responses required. Once completed, check with your Manager or In-Store Trainer to make sure you’ve got the correct answers.
Online Quiz:
Want to check how much you have learnt?
Click below to view Tommy’s Enable experience.
Click below to view and print the case study
Click below to take a short quiz on Enable.
Further Enable Information:
For more information about The Enable Children’s Spectacle Subsidy, go to the following websites:
- Online Specs App (email: Enable@Enable.co.nz for information about the Online Specs App)
- Ministry of Health Children’s Spectacle Subsidy
- Spectacle Subsidy Manual & Clinical Guidelines
If customers require more information or assistance about their eligibility or entitlement, you can refer them to the Enable contact centre: