Orthodontic Benefits - Questions and Answers for Patients
August 2004
1. What is the Non-Insured Health Benefits (NIHB) Program?
The Non-Insured Health Benefits (NIHB) Program is a public health
program funded by Health Canada. The Program covers a limited range
of orthodontic benefits for approximately 749,000 eligible First
Nations and Inuit when these benefits are not available through
other public or private programs and when Program criteria are
met.
2. Is all orthodontic treatment covered under NIHB?
No it is not. Orthodontic treatment provided under NIHB is health-based.
Clients must meet the clinical criteria and guidelines established
by the NIHB Program for their orthodontic treatment to be funded.
Funding for orthodontic treatment is determined based on the severity
of the patient's condition. The orthodontic treatment funded
by the NIHB Program is targeted at conditions that directly impact
health.
3. How do I know if the orthodontic treatment my dental
provider recommends will be covered?
The NIHB Program can only determine if a client's treatment
request meets our funding criteria by reviewing the client's
records and treatment plan. We ask orthodontists to help individuals
submit the required information. Unfortunately, the NIHB Program
cannot provide orthodontic treatment funding if the required records
and treatment plans are not submitted for review.
4. My treatment plan has been accepted by NIHB for coverage.
Who pays for these services?
Health Canada prefers dental providers bill NIHB directly for
services so there are no upfront charges to patients. However,
providers have the choice to request the patient pay and seek reimbursement
from our Program. Therefore NIHB asks providers to explain their
office policies to potential patients up front, as they do with
other patients.
5. What are the orthodontist's responsibilities?
Your orthodontist will give you information on available treatment
options appropriate to your dental care needs, regardless of the
nature and extent of your dental plan coverage. It is important
to understand that not all treatment recommended by your orthodontist
may be covered by NIHB. Your orthodontist will assist you by supplying
information required for NIHB to determine funding.
Your orthodontist should also clearly explain any financial responsibilities
for the orthodontic treatment, and whether he or she is prepared
to assist you in obtaining reimbursement.
6. My treatment plan has been accepted by NIHB for coverage.
How do I seek reimbursement from NIHB for the cost of these services
if my provider does not bill the Program directly?
Health Canada prefers that providers bill NIHB directly for services
so there are no upfront charges to patients. However, if you must
pay and seek reimbursement from the NIHB Program, the following
information is required:
- a completed and signed Dent-29 form
- the original receipt (as proof of payment for the service)
This information should be submitted to the Health Canada's
Orthodontic Review Centre:
Orthodontic Review Centre
First Nations and Inuit Health Branch
Graham Spry Building
250 Lanark Avenue, 6th Floor
Address Locator 2006C
Ottawa, Ontario K1A 0K9
Need help?
NIHB clients are encouraged to contact Health Canada's
Orthodontic Review Centre:
Toll-free phone: 1-866-227-0943
Toll-free fax: 1-866-227-0957
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