Medical Transportation Benefits - Questions and Answers (Q&A's) - July 2005

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

1. What types of medical transportation may be funded under the Non-Insured Health Benefits (NIHB) Program?

Medical transportation benefits under the NIHB Program assist clients to access needed medical professionals, tests and other treatment and services when these are not available where the client lives. This can include arranging for transportation to be available for clients to travel, providing financial assistance to clients to transport themselves, or arranging for these medical services in the community. Transportation (i.e., by land, air or water) is to the nearest appropriate doctor, clinic, hospital or other health facility. This may include 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.

2. What types of health services can I access using medical transportation?

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, health programs provided to all provincial residents)
• Alcohol, solvent, drug abuse and detox treatment
• Health benefits (dental, vision and crisis intervention mental health counselling) available under the NIHB Program.

Travel to access certain other health services may be considered on an exceptional basis with the appropriate justification or where the trip is coordinated with other appointments.

3. Who is eligible for medical transportation benefits?

The Program is available to eligible registered First Nations, both on and off reserve, and recognized Inuit where 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;
• Transportation to health services is coordinated to ensure maximum cost-effectiveness;
• Benefits are approved ahead of time by a FNIHB 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.

4. What should I do if I need medical transportation benefits?

Clients should contact their FNIHB Regional Office or First Nations/Inuit health authority/organization (medical transportation coordinator) to explain the transportation they require as soon as possible to find out if transportation will be funded. Clients should also be sure to provide the medical transportation coordinator with any supporting documentation (e.g., doctor's medical referral, confirmation of medical need for escort). After the appointment, clients must provide the medical transportation coordinator with confirmation that the appointment has been completed.

Clients should notify the medical transportation coordinator immediately if they can't attend the appointment.

5. If I need an escort, will the Program pay?

The NIHB Program will cover eligible travel costs for medical or non-medical escorts in certain circumstances. A medical escort is usually either a physician or a registered nurse and is used in cases where it is essential to monitor the condition of a client during travel. A non-medical escort may be approved, following a 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.

6. How can I be sure my transportation will be covered?

Before your trip, you should contact your FNIHB Regional Office or First Nations/Inuit health authority/organization (medical transportation coordinator) to be sure your transportation will be covered for you and your escort, if one is required.

7. I have made a request for medical transportation benefits and it has been denied. What can I do?

There is an appeal process that clients can access when their request has been denied. Each level must be initiated by the client or his/her representative and supporting information should be provided.

8. How can I be certain that my personal information will be properly protected?

The NIHB Program is committed to protecting the privacy of each client's personal information, by meeting the requirements of the Privacy Act and the NIHB Privacy Code. The Program collects only the information required to verify and fund benefits.

9. Where can I get more information on medical transportation benefits?

You may contact your local FNIHB Regional Office or First Nations/Inuit health authority/organization.

You can also go to the NIHB Web site at: www.hc-sc.gc.ca/fnihb/nihb