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Provinces and territories are responsible for delivering health care services, guided by the provisions of the Canada Health Act. Health care services include insured hospital care and primary health care, such as physicians and other health professional services. First Nations people and Inuit access these insured services through provincial and territorial governments, like any other resident. There are a number of health-related goods and services, however, that are not insured by provinces and territories or other private insurance plans. To support First Nations people and Inuit in reaching an overall health status that is comparable with other Canadians, Health Canada's Non-Insured Health Benefits (NIHB) Program provides coverage for a limited range of these goods and services when they are not insured elsewhere. The Non-Insured Health Benefits Program is Health Canada's national, needs-based health benefit program that funds benefit claims for a specified range of drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention mental health counselling, and medical transportation for eligible First Nations people and Inuit. Benefits Information Health Canada provides eligible First Nations people and Inuit with a specified range of medically necessary health-related goods and services when they are not covered through private insurance plans or provincial/territorial health and social programs. Non-Insured Health Benefits include prescription drugs, over-the-counter medication, medical supplies and equipment, short-term crisis counselling, dental care, vision care, and medical transportation. Benefit Criteria A benefit will be considered for coverage when:
Who is an Eligible Recipient? An eligible recipient is someone who is entitled to receive benefits such as vision care, prescription drugs or other benefits or services from the NIHB Program. An eligible recipient must be identified as a resident of Canada and one of the following:
When recipients are eligible for benefits under a private health care plan, or public health or social program, claims must be submitted to these plans and programs first before submitting them to the Non-Insured Health Benefits Program. Recipient Reimbursement Service providers are encouraged to bill the Program directly so that recipients do not face charges at the point of service when receiving health care goods or services. When a recipient does pay directly for goods or services, he or she may seek reimbursement from the NIHB Program. Requests for reimbursement must be received on a NIHB Client Reimbursement Request Form, within one year from the date of service or date of purchase. The form information is available in HTML and Portable Document Format (PDF). The HTML version of the NIHB Client Reimbursement Request Form is not an actual form. It displays the information found on the form for viewing purposes only and will not be accepted if used to request reimbursement. If you wish to submit a request, you must use only the PDF version of the NIHB Client Reimbursement Request Form. All requests for reimbursement of eligible benefits must include:
To obtain a print version of the NIHB Client Reimbursement Request Form, contact the nearest Regional Office, or a local First Nations and Inuit Health Authority.
Short-term crisis intervention mental health counselling may be provided by a recognized professional mental health therapist when no other services are available to the recipient. What is covered?
Who can provide crisis intervention mental health counselling? Crisis intervention mental health counselling must be provided by therapists registered with a regulatory body from the disciplines of clinical psychology or clinical social work, in the province or territory in which the service is provided. In exceptional circumstances, service providers from disciplines other than clinical psychology or clinical social work may be considered. How do eligible recipients access crisis intervention mental health counselling? Recipients should contact the Regional Office or a local First Nations and Inuit Health Authority to determine if community mental health programs are available. If no programs are available, recipients will be provided with a list of approved providers. Is there an appeal process when a benefit is not funded? Eligible recipients can appeal a decision to decline funding for a benefit. Please refer to the Appeal Procedures section for more details. Coverage for dental services is determined on an individual basis, taking into consideration the current oral health status, recipient history, accumulated scientific research, and availability of treatment alternatives. What is covered?
Who can provide dental benefits? Dental services must be provided by a licensed dental professional such as a dentist, dental specialist, or denturist. See the Dental Health Provider Information section for details on the benefit policies, procedures and resources for health providers. How do eligible recipients access dental benefits? Recipients must make an appointment with a dental provider who will complete an examination, establish a treatment plan, and discuss the services required with the recipient; The dental provider will indicate what is funded by the Non-Insured Health Benefits (NIHB) Program (certain services may need predetermination which is prior approval). If the provider is not aware, the recipient should contact the Regional Office and speak to dental benefit staff to determine what is funded. Is there an appeal process when a benefit is not funded? Eligible recipients can appeal a decision to decline funding for a benefit. Please refer to the Appeal Procedures section. Resources Questions and Answers - July 2005 Dental Benefits Changes Dental Policy Framework Dental Policies Orthodontic Benefits - Questions and Answers The Non-Insured Health Benefits (NIHB) Program funds prescription and over-the-counter medications that are not covered by other private or provincial/territorial health insurance plans. What is covered?
The NIHB Program covers the 'lowest cost alternative drug' which is commonly known as a generic drug. The policy of the NIHB Program is to reimburse only the best price alternative or equivalent product in a group of interchangeable drug products. The NIHB Program will pay for prescription drugs with a higher cost if the recipient cannot take the generic drug as a result of an adverse reaction to the generic drug. How do eligible recipients access drug benefits?
Recipients may contact the Regional Office should they require more information. Is there an appeal process when a benefit is not funded? Eligible recipients can submit an appeal when funding for a benefit is declined. Please refer to the Appeal Procedures section. Who can prescribe under the NIHB Program? A doctor or other health professional licensed to prescribe by a province or territory. Who can provide drug benefits? Drug benefits must be provided by a registered pharmacist. Is prior approval required before billing the NIHB Program for a prescription? The NIHB Program maintains a comprehensive Drug Benefit List. In most cases, the drugs that are prescribed are on the list and the pharmacist can dispense them immediately. However, the pharmacist must obtain approval when the:
See the Drug/Pharmacy Health Provider Information section for details on the benefit policies, procedures and resources for health providers. Vision care benefits are funded in accordance with the policies set out in the Non-Insured Health Benefits Vision Care Framework. What is covered?
How do eligible recipients access vision care benefits?
Is there an appeal process when a benefit is not funded? Eligible recipients can appeal a decision to decline funding for a benefit. Please refer to the Appeal Procedures section. Who can prescribe vision care benefits? The vision care benefit must be prescribed by a licensed vision care professional who has studied a specific program, passed the exams and received a certificate that entitles him/her to work in that field (for example an optometrist or ophthalmologist). Who can provide vision care benefits? Vision care benefits must be provided by a licensed optometrist, an optician or an ophthalmologist. See the Health Provider Information section for details on the benefit policies, procedures and resources for health providers. Vision Care Framework Medical Supplies and Equipment Benefits Medical supplies and equipment benefits are funded in accordance with the Non-Insured Health Benefits policies. What is covered?
Recipients may contact the Regional Office should they require more information. How do eligible recipients access medical supplies and equipment benefits?
Is there an appeal process when a benefit is not funded? Eligible recipients can appeal a decision to decline funding for a benefit. Please refer to the Appeal Procedures section. Who can provide medical supplies and equipment benefits? Providers differ across the provinces and territories. Please contact the Regional Office for information on eligible providers. Who can prescribe medical supplies and equipment benefits? Medical supplies and equipment must be prescribed by a licensed doctor or medical specialist. See the Medical Supplies and Equipment Provider Information section for details on the benefit policies, procedures and resources for health providers. Medical Transportation Benefits Medical transportation benefits are funded in accordance with the policies set out in the Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework to assist eligible recipients to access medically required health services that cannot be obtained on the reserve or in the community of residence. What is covered? Ground Travel
Water travel
Air travel
See the Health Provider Information section for details on the benefit policies, procedures and resources for health providers. How do eligible recipients access medical transportation benefits?
Is there an appeal process when a benefit is not funded? Eligible recipients can appeal a decision to decline funding for a benefit. Please refer to the Appeal Procedures section. Medical Transportation Policy Framework Medical Transportation Benefits - Questions and Answers
Guide to Accessing Non-Insured Health Benefits The Assembly of First Nations has developed a Guide to accessing Non-Insured Health Benefits, which can be found here:
Assembly of First Nations’ First Nations Action Plan for Non-Insured Health Benefits The First Nations Action Plan for Non-Insured Health Benefits (NIHB) is aimed at ensuring that First Nations can access services based on their needs and as per their Treaty and Inherent Rights to Health, and Crown’s fiduciary duty. Access must be sustainable and flexible, and must be founded on a community health approach. Improved access to NIHB is essential to addressing systemic inequities between First Nations and Canadians in health status and access to quality care, at individual, community and Nation levels. In order to advance this vision, meaningful participation of First Nations is immediately required in all NIHB related activities of the First Nations and Inuit Health Branch, Health Canada. Link to: |