Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework
"Appeal Process" is a three level process which allows clients to appeal a decision when they have been denied a medical transportation benefit.
"Band Driver and Vehicle" means a driver who is hired by a Band and who drives vehicles owned/leased and operated by a Band to drive clients to medically required health services.
"Boarding Home" means an establishment providing board, accommodation and associated support services while in transit.
"Client" means a recognized Inuit or registered Indian according to the Indian Act who is eligible to receive medical transportation benefits under the NIHB Program.
"Commercial Establishment " means for-profit commercial accommodation, such as hotels and motels, which provide overnight lodging.
"Community Health Professional" means a health professional who is a member in good standing of a professional association.
"Community of Residence" means the geographic or urban area in which the client resides.
"Exception" means goods, services and/or travel which are not defined benefits but which may be approved with appropriate justification.
"Exclusion" means goods, services and/or requested travel which will not be provided as benefits under the NIHB Program under any circumstances and are not subject to the NIHB appeal process.
"Fee-for-service Driver and Vehicle" means a driver who is recommended by Chief and Council, who is approved and recognized by FNIHB or a First Nations or Inuit Health Authority or organization and who uses their own vehicle to drive clients to medically required health services not available on the reserve or in the community of residence.
"First Nations or Inuit Health Authority or organization" means a First Nations or Inuit Health Authority or organization (including territorial government) who is accountable for the provision of medical transportation benefits to eligible clients and who receives funds from Health Canada in accordance with the terms and conditions of a signed Contribution Agreement.
"FNIHB" means the First Nations and Inuit Health Branch of Health Canada.
"Insured Service" means health care services and treatment as defined by the Canada Health Act and Provincial/Territorial Health Care program for the province/territory in which the client resides.
"Meal Allowance" means an allowance that is provided to assist with meal costs for clients
travelling away from home.
"Medevac" means a medical evacuation by air charter for clients in emergency situations.
"Medical Escort" means either a physician, registered nurse, paramedic or any other health professional (e.g., nurse practitioner).
"Medical Transportation Benefits" means the travel expenses incurred by clients and escorts for ground, water and air travel, meals, and accommodation to access medically required health services not available on the reserve or in the community of residence.
"Medically Incapacitated" means a client who is travelling immediately prior to or after medical
treatment and the physician or medical institution has indicated he/she is unable to travel without an escort.
"Medically Required Health Services" means those services that are required for medical reasons and are covered under a provincial/territorial health insurance plan and are not available on the reserve or in the community of residence.
"Nearest Appropriate Facility" means the facility located closest to the client's place of residence which is capable of providing the medically required health service appropriate to the client's medical condition. When health professionals are brought into the community to provide the service, the community facility is considered the nearest appropriate facility.
"NIHB" means the Non-Insured Health Benefits Program of the First Nations and Inuit Health Branch of Health Canada.
"Private Accommodation" means overnight accommodation that is not in a commercial establishment but rather at the home of a family relative, friend or acquaintance.
"Private Vehicle Kilometre Allowance" means a kilometre rate that is payable for the use of
privately owned vehicles to transport clients to medically required health services.
"Reserve" means land set aside by the federal government for the use and occupancy of an Indian group or band.
"Scheduled and/or Coordinated Medical Transportation Benefits" means medical transportation services that are provided on a regular basis from the community by FNIHB or First Nations or Inuit Health Authorities or organizations for the client to access services.
"Service Providers" means individuals or companies who provide medical transportation benefits and are reimbursed by FNIHB or First Nations or Inuit Health Authorities or organizations for the services they provide. They may include band and fee-for-service drivers, public transportation carriers, hotels, motels, boarding homes and restaurants.
Appendix B - Client Eligibility
To be eligible to receive medical transportation benefits under the Non-Insured Health Benefits Program, a person must be:
a) A registered Indian according to the Indian Act; or
b) An Inuk recognized by one of the Inuit Land Claim organizations - Nunavut Tunngavik Incorporated, Inuvialuit Regional Corporation, Makivik Corporation or Labrador Inuit Association. For Inuit residing outside of their land claim settlement area, a letter of recognition from one of the Inuit claim organizations and a long form birth certificate are required; or
c) An infant up to one year old of an eligible parent; and
d) Currently registered or eligible for registration, under a provincial or territorial health insurance plan.
Appendix C - Meal, Accomodation and Kilometre Allowances
Approved medical transportation benefits may include meal, accommodation and kilometre allowances when these expenses are incurred while in transit to access medically required health services at the nearest appropriate facility. For more information, refer to Section 9 (Meals and Accommodation).
Daily Meal Allowances
When no commercial establishments or boarding homes with negotiated arrangements are available, meals are to be taken in commercial establishments and a meal allowance as per the regional rates may be provided.
Weekly Food Allowance for Extended Stays
In cases where a client is required to be close to medical treatment for extended periods of time for ongoing medical care/treatment and is residing in a self-catering accommodation, a weekly allowance as per the regional rate may be provided to assist with the purchase of food items while away from home.
Accommodation Allowance
The most efficient and economical accommodation consistent with the medical condition of the client and the costs incurred to travel to and from the accommodation to the medically required health services is to be utilized at all times.
When an approved boarding home is available, accommodation in a commercial establishment will not be authorized. When a boarding home is not available or it is full, commercial accommodation will be authorized and reimbursement will be at the rate negotiated with the establishment. Clients who choose alternate accommodation will be responsible for the difference in costs between the two or the full cost if accommodation is not reimbursable.
When staying in private accommodation, to assist the host for the costs incurred in providing overnight accommodation, an allowance as per the regional rate may be provided.
In cases where an extended stay, up to a three month period, is required, every effort must be made to utilize the most efficient and economical medical transportation benefits, including self-catering accommodation.
Private Vehicle Kilometre Allowance
The most efficient and economical mode of transportation consistent with the urgency of the situation and the medical condition of the client is to be utilized at all times. This includes scheduled and/or coordinated medical transportation benefits provided by FNIHB or a First Nations or Inuit Health Authority or organization. When this mode of transportation is the use of a private vehicle, an allowance may be paid as per the regional rate to cover the operating costs of the owner's vehicle. Clients who choose to use their private vehicle when a more efficient and economical mode of transportation is available will be responsible for the difference in cost between the two.
Exceptions to the foregoing allowance may be considered by FNIHB, where it can be demonstrated that due to extreme conditions or unique community location the private vehicle kilometre allowance is clearly inadequate.
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