Eye care funding in New Zealand, compared

You are not sure who, if anyone, helps with the cost

Your child needs glasses, or you do, or a contact lens for keratoconus has been quoted, and you have heard that there is a subsidy for something. The rules are spread across several government and insurer websites, each written for its own purpose, so it is hard to tell which one applies to you.

This guide puts the options side by side. For each one it says who it is for, what it can cover and where the current rule lives. It does not print subsidy amounts or benefit limits, because they change; the official page is linked for each. How we handle claims at the practice is on our insurance and funding page and is not repeated here.

Paying privately is the default for adults

In New Zealand you can book an optometrist directly, without a GP referral, and for most adults the exam, the glasses and the contact lenses are paid for privately. The Community Services Card lowers the cost of GP visits and prescriptions, but for glasses it only lists children under 16, so it does not reduce an adult eye exam or an adult pair of glasses on its own.

Knowing this up front helps. If you are an adult with a changing prescription and no injury, the question is usually not which subsidy applies but what drives the cost and where you can trim it. The cost drivers guide covers that, and our published fees are on the consultation fees page.

ACC: eye injuries from an accident

ACC is New Zealand's no-fault injury scheme. Healthify NZ states that most eye injuries are covered by ACC. ACC publishes the amounts it can pay optometrists for an initial eye examination and treatment after an injury, for example removing a foreign body or irrigating a chemical burn, for a visual field examination after an eye or head injury, and, with prior approval, for spectacle frames and lenses needed because of the injury.

The practical point: if something hit, scratched or splashed your eye, say so to whoever treats you, because the visit may sit under ACC rather than a private fee. ACC's own website could not be opened for this guide, so check acc.co.nz for what is and is not covered, and read the section below on when an eye injury needs an emergency department first.

Two government subsidies administered through optometrists

Enable New Zealand children's spectacle subsidy. Enable administers this for Disability Support Services. A child aged 15 or under is eligible if the child or a parent or guardian holds a valid Community Services Card, or the child holds a current High Use Health Card. It can be used for an eye examination, spectacles (frames and lenses), eye patches and repairs. The subsidy year starts from the child's first vision examination, unused balance does not carry over, and the optometrist submits the claim, with payment going to the provider. The current amount is on Enable's page. Our child glasses subsidy guide walks through the steps.

Health New Zealand contact lens subsidy. This subsidy is available through optometrists and dispensing opticians who hold an agreement with Health New Zealand. It applies to contact lenses supplied for medical need, including replacements for damaged or lost lenses, and disposable lenses are funded only where they are clinically appropriate and as cost-effective as permanent lenses. The provider submits the claim. We administer this subsidy at the practice; keratoconus is the most common reason it applies. Eligibility is assessed against the condition and the clinical need, so ask whether it applies to your case.

Work and Income: help in hardship, assessed case by case

Work and Income lists eye tests and glasses among the costs it may help with. On its glasses page it says you may get help if you are 16 or over, a New Zealand citizen or permanent resident, normally living here, and have an immediate and essential need. You do not have to be on a benefit, but income and asset limits apply, and the money usually has to be paid back.

The help is for a set list of items: an eye test, lenses, frames, a fitting service, repairs, and a cleaning cloth and case. Costlier frames, tints and lens coatings are not included. You need to call Work and Income before you buy, and if approved you receive a payment card to use with the optometrist you choose within a set number of days. The current figures and limits are on the Work and Income glasses page.

Southern Cross and nib: it depends on your plan

Private health insurance can help, but only if your plan includes optical benefits, and the limits vary. Southern Cross's vision cover factsheet says your policy document states whether vision benefits apply and the maximum amount per person each claims year. Where a plan includes them, the factsheet lists prescription glasses, prescription sunglasses, prescription contact lenses, contact lens fitting and optometry consultations including OCT and visual field tests. It excludes ready-made reading glasses from retail outlets, accessories and consumables, IPL treatment for dry eye, and exams required by a third party such as a driver licence check. Some plans carry a stand-down period for eye care benefits.

nib describes its Everyday plans as help with day-to-day costs such as GP visits, dental and optical, where you claim back a percentage of the cost up to the benefit limit and in line with your policy terms. The percentage, the limit and any waiting period depend on the plan level, so check your own policy document. For how claims work at our practice, including Southern Cross Easy Claim, see the insurance and funding page. Our post on whether Southern Cross covers Ortho-K covers that specific question.

• Check your policy document for the words optical, vision, glasses or contact lenses, and for any stand-down or waiting period.
• Ask your insurer whether a specialty fitting such as Ortho-K or scleral lenses counts as contact lens fitting under your plan.
• Bring your membership details to the appointment so a claim can be processed or your entitlement checked at the counter.

When this practice is the wrong place

None of the funding above matters if the eye needs emergency care. Sudden loss of vision, a shadow or curtain across part of your vision, flashes with a sudden shower of new floaters, a chemical splash, something that has pierced the eye, or a red and painful eye that cannot tolerate light need same-day care: call 111 or go to the nearest hospital emergency department. Healthify NZ advises flushing a chemical splash with clean running water for at least 15 minutes first. If you are unsure, Healthline on 0800 611 116 is free and open around the clock.

Hospital eye clinics are reached by referral, usually from an optometrist or GP, and public treatment such as cataract surgery or corneal cross-linking is arranged there rather than through a private practice. If you are on a low income and the cost of any eye care is the barrier, Work and Income is the right first call, not the practice.