Non-Insured Health Benefits- Health Canada

Description:

The Non-Insured Health Benefits Program is Health Canada's national, medically necessary health benefit program that provides coverage for 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.

A benefit will be considered for coverage when:

The item or service is on a NIHB Program benefit list or NIHB schedule;
It is intended for use in a home or other ambulatory care settings;
Prior approval or predetermination is obtained (if required);
It is not available through any other federal, provincial, territorial, or private health or social program;
The item is prescribed by a physician, dental care provider, or other health professional licensed to prescribe; and
The item is provided by a recognized provider.

Region of Administration:

Federal

Government / Department:

Health Canada

Eligibility:

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:

A registered Indian according to the Indian Act;
An Inuk recognized by one of the Inuit Land Claim organizations; or
An infant less than one year of age, whose parent is an eligible recipient.

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.

Coverage:

Diagnostic services (e.g. examinations or x-rays);

Preventive services (e.g. cleanings);

Restorative services (e.g. fillings);

Endodontics services (e.g. root canals);

Periodontal services (e.g. deep cleanings);

Prosthodontic services (e.g. removable dentures);

Oral surgery services (e.g. removal of teeth);

Orthodontic services (e.g. braces); and

Adjunctive services (e.g. general anaesthetics or sedation).

Providers:

Dentists, Dental therapists

Therapeutic Responsibility:

Dentists, Dental therapists

Compensation:

Fee-for-service

How it Works:

First, you must be an eligible client under the Non-Insured Health Benefits Program. Then, you must be examined by a dental provider who will establish a treatment plan and discuss with you the services that you will require.

The dental provider should tell you what is covered by the NIHB Program, because certain services may need to be pre-approved by the NIHB Program.

If your provider doesn't know whether the service is covered by the NIHB Program, you can obtain that information by contacting the Health Canada regional office, or the National Dental Predetermination Centre (NDPC) for those regions which have been centralized, and asking the dental benefits staff what is and is not covered.

What does "predetermination" mean?

Predetermination, also known as pre-approval, is the process of obtaining approval in advance. This process involves a review of the case against established NIHB policies, criteria and guidelines before the service is rendered.
Predetermination or pre-approval is required on certain dental services.
All cases requiring predetermination must be sent by your dental provider's office to the appropriate Health Canada regional office, or NDPC for review and a coverage decision before treatment begins.