Medical Transportation Fact Sheet - July 2005

The NIHB Program provides supplementary health benefits, including
medical transportation, for registered Indians and recognized Inuit
and Innu throughout Canada.

The Non-Insured Health Benefits (NIHB) Program provides a limited range of medically necessary health-related goods and services not provided through other federal or provincial/territorial health and social programs, other publicly funded programs (such as workers' compensation) or private insurance plans. The benefits, available to eligible registered First Nations and recognized Inuit, include drugs, dental care, vision care, crisis intervention mental health counselling and medical transportation, and payment of health premiums in Alberta and British Columbia.

The medical transportation component of the NIHB Program assists clients to access needed medical professionals, tests, dental and other treatment and services when these services are not available where the client lives. This can include arranging for transportation to be available for clients, providing financial assistance to transport themselves, or arranging for these medical services in the community. Services are provided either by First Nations and Inuit Health Branch Regional Offices or by First Nations and Inuit organizations (including territorial governments) who receive funding from Health Canada to administer medical transportation benefits under a signed contribution agreement.

This fact sheet is a summary of medical transportation policies and benefits under the NIHB Program. For complete information, please refer to the full NIHB Medical Transportation Policy Framework, available through FNIHB Regional Offices or on the NIHB Web site at: www.hc-sc.gc.ca/fnihb/nihb

Medically Necessary Health Services

Medical transportation benefits enable clients to access the following types of services:

• Provincial/territorial insured medical services (e.g., doctors' appointments, hospital care, diagnostic tests)
• Alcohol, solvent, drug abuse and detox treatment
• Transportation to traditional healers
• Health benefits (dental, vision and crisis intervention mental health counselling) available under the NIHB Program.

Benefit Eligibility

Clients may be eligible for medical transportation benefits when the following conditions are met:

• The client has used up all transportation benefits they may be eligible for from other federal, provincial/territorial or private programs;
• Travel is to the nearest appropriate health facility;
• The most economical and efficient means of transportation is used, taking into consideration the urgency of the situation and the client's medical condition;
• A FNIHB or First Nations/Inuit health authority/organization representative or on-site medical professional has determined that medically required health services are not available on the reserve or in the community of residence;
• Where possible, transportation is coordinated with other appointments to ensure maximum cost-effectiveness;
• Benefits are approved ahead of time by a FNHIB or First Nations/Inuit health authority/organization or approved after the fact with medical justification if they otherwise meet the criteria;
• Service is not available in the community of residence; and
• Public transit is not available.

Benefits Available

Medical transportation benefits include transportation and assistance with the cost of meals and accommodation when the client is required to be out of the community overnight or for an extended period of time. Assistance with the cost of meals may also be provided where the person is away from home more than 6 hours, or less if there is a medical reason. Emergency ambulance (land or air) benefits include only those costs not covered by provincial/territorial or third party insurance plans.

Coordinated Travel

The most efficient and economical mode of transportation, depending on the urgency of the situation and the client's medical condition, must always be used. Where possible, travel should be coordinated with other trips the client may take to access health services outside the community. Clients who choose to use a more expensive mode of transportation must pay the difference in cost between the two. In cases where scheduled or coordinated van service is the most efficient and economical method of transportation, clients who choose to use another method are responsible for the full cost.

Client Escorts

The Program allows for medical or non-medical escorts to travel with clients who are unable to travel alone for medical or legal reasons. A medical escort is approved where the health of a client must be monitored during travel and this is not covered by the provincial/territorial health or social program, other publicly funded program, or private insurance. A non-medical escort may be approved, following a doctor, nurse or community health professional's request, where the patient:

• has a physical/mental disability such that he or she cannot travel without help
• is medically incapacitated
• is a minor and needs to be accompanied
• requires legal consent by a parent or guardian
• needs translation, if translation services are not available at the health facility
• requires instructions on necessary medical procedures that cannot be given to the client
• has been declared 'mentally incompetent' by a court.

Exceptions

There are certain types of travel and benefits that are funded on an exceptional basis, with justification. For more information on program exceptions, please refer to sections 11 and 12 of the Medical Transportation Policy Framework or contact your local FNIHB Regional Office or First Nations/Inuit health authority/organization.

How to Access Benefits

Clients within a First Nations or Inuit community should contact their local health or Band Office, or a local First Nations/Inuit health authority/organization for further information. Off-reserve clients should contact the FNIHB Regional Office or the responsible First Nations/Inuit health authority/organization.

Appeals

In cases where a request for a medical transportation benefit is denied, a three-level appeal process is available (a joint appeals structure may also be in place). Appeals must be submitted in writing by the client, legal guardian or interpreter. For more information about the appeal process, contact the NIHB Regional Manager at your local FNIHB Regional Office.

For more information on medical transportation benefits, please contact the FNIHB Regional Office or go to the NIHB Web site at: www.hc-sc.gc.ca/fnihb/nihb