Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework
Appendix D - Privacy
The Non-Insured Health Benefits (NIHB) Program of Health Canada is committed to protecting an individual's privacy and safeguarding the personal information in its possession. When a benefit request is received, the NIHB Program collects, uses, discloses and retains an individual's personal information according to the applicable privacy legislation. The information collected is limited only to information needed for the NIHB Program to administer and verify benefits.
As a program of the federal government, NIHB must comply with the Privacy Act, the Canadian Charter of Rights and Freedoms, the Access to Information Act, Treasury Board policies and guidelines including, the Treasury Board of Canada Government Security Policy, and the Health Canada Security Policy. The NIHB Privacy Code addresses the requirements of these acts and policies.
Objectives of the NIHB Privacy Code:
- to set out the commitments of the NIHB Program to ensure confidentiality through responsible and secure handling of personal information collected for program delivery, administration and management; and
- to foster transparency, accountability, increased awareness of the NIHB Program's privacy procedures and practices.
The NIHB Privacy Code is based on the ten principles set out in the Canadian Standards Association, Model for the Protection of Personal Information (The CSA Model Code), which is also Schedule 1 to the Personal Information Protection and Electronic Documents Act (PIPEDA). This is commonly regarded as the national privacy standard for Canada.
The Privacy Code can be found on the Health Canada website at www.hc-sc.gc.ca/fnihb/nihb, or obtained from First Nations and Inuit Health Branch Regional Offices.
The Non-Insured Health Benefits Privacy Code will be reviewed and revised on an ongoing basis as Federal Government privacy policies, legislation and/or program changes require. The Program would be pleased to receive stakeholder advice on the Code at anytime.
Appendix E - Appeal Process
A client has the right to appeal a denial of a medical transportation benefit under the Non-Insured Health Benefits (NIHB) Program. There are three levels of appeal available. Appeals must be submitted in writing and can be initiated by the client, legal guardian or interpreter. At each stage, the appeal must be accompanied by supporting information to justify the exceptional need.
At each level of appeal, the information will be reviewed by an independent appeal structure that will provide recommendations to the program based on the client's needs, availability of alternatives and NIHB policies.
Level 1 Appeal
The first level of appeal is the NIHB Regional Manager, First Nations & Inuit Health Branch.
Level 2 Appeal
If the client does not agree with the Level 1 Appeal decision and wishes to proceed further, the second level of appeal is the Regional Director, First Nations & Inuit Health Branch. Joint regional review structures may be in place.
Level 3 Appeal
If the appeal is denied at Level 2 and the client does not agree with the decision, they may take their request to the final appeal level. The third and final level of appeal is the Director General, Non-Insured Health Benefits, First Nations and Inuit Health Branch, Jeanne Mance Building, Address Locator 1919A, Room 1909A, Tunney's Pasture, Ottawa, Ontario K1A 0K9
At all levels of the appeal process, the client will be provided with a written explanation of the decision taken.
Appendix F - NIHB Audit Program
Medical transportation benefit audits are performed to meet program accountability and verify compliance with program requirements and the terms and conditions of applicable contribution agreements.
The objectives of the NIHB Audit Program are to:
- detect billing/claim irregularities, whether through error or fraudulent claims;
- ensure that the services paid for were received by the NIHB client;
- ensure that appropriate documentation in support of each claim is retained, in accordance with the terms and conditions of the Program.
The audit activities are based on accepted industry practices and accounting principles and may be carried out up to a maximum of two years from the date of service. Providers must retain a copy of the original authorizing voucher/warrant and receipt in accordance with provincial or territorial requirements, and any other information to support a claim on file for two years from the date of service for audit purposes. Claims for which the original authorizing voucher/warrant and receipt or supporting documentation is not available for review, including those with prior approvals, may be recovered through the audit program.
Records relating to NIHB clients must be maintained and the authorizing voucher/warrant and receipt for all the services provided in accordance with all applicable laws. All records shall be treated as confidential so as to comply with all applicable provincial/territorial and federal privacy legislation.
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