Orthodontic Benefits - Questions and Answers for Providers
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. What orthodontic treatment will typically be covered
under NIHB?
Unlike a private insurer, the NIHB Program covers only a limited
range of orthodontic treatment. This includes coverage of:
- severe dento-facial anomalies such as cleft lip or palate
(no age restriction); and
- severe functional limitations (for individuals less than 18
years of age).
The NIHB Program will also consider coverage of individuals under
18 years of age who require interceptive treatment (e.g. cross-bite
appliance.)
For more details, please refer to NIHB's July 2004 Orthodontic
Bulletin.
3. Why isn't all orthodontic treatment covered
under NIHB?
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. The
orthodontic treatment funded by the NIHB Program is targeted at
conditions that directly impact health.
4. Why do I need to submit client diagnostic records
and a detailed treatment plan for NIHB's review?
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.
5. My patient's treatment plan has been accepted
by NIHB for coverage. Who pays for these services?
Health Canada prefers that 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 NIHB. Therefore NIHB asks providers to explain their office
policies to potential patients up front, as they do with other
patients prior to starting treatment.
6. How do I, or my client, seek reimbursement from NIHB
for the cost of these services?
The following information is required:
- a completed and signed Dent-29 form
- original receipt (as proof of payment for the service for
client reimbursement)
For provider reimbursement, the provider should forward
the Dent-29 form (i.e. the claim) directly to First Canadian Health
(the address is also indicated on the back of the Dent-29 form).
First Canadian Health Management Corporation
NIHB Claims Department
3080 Yonge Street,
Suite 3002,
Toronto, ON M4N 3N1
For client reimbursement, the 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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