Questions and Answers - October 2005 Changes to Dental Benefits Requiring Prior Approval and the New Dental Policy Framework
Effective October 1, 2005, Health Canada's Non-Insured Health
Benefits (NIHB) Dental Program introduced changes to benefits requiring
prior approval through a revised NIHB Regional Dental Benefit Grid.
The Program also released a new Dental
Policy Framework which provides clear information about the
dental benefits available under the NIHB Program.
What is the Regional Dental Benefit Grid and why has it
been revised?
The purpose of the NIHB Regional Dental Benefit Grid is to outline
which services need prior approval or 'predetermination' before
they can be carried out by dental providers.
The revised Grid has been updated to reflect the administrative
changes introduced in the June 2005 NIHB Dental Bulletin. For further
information please see the Questions
and Answers - July 2005 Dental Benefits Changes.
Effective October 1, 2005, this new Grid replaces all previous
versions, with the exception of the denturists grids.
The NIHB Regional Dental Benefit Grid is being issued as part
of Health Canada's ongoing commitment to streamline administration
requirements and present the benefits of the NIHB Program more
clearly to providers.
How is the revised Grid different from the existing Regional
Dental Benefit Grid?
The NIHB Regional Dental Benefit Grid gives details of several
new and important changes to the Program.
The revised Grid shows which dental services need predetermination
and which dental services do not need predetermination by placing
benefits into one of two schedules:
- Schedule A lists services that may be provided and billed
directly to First Canadian Health (FCH) for payment, without
predetermination, while taking into account identified Program
limits; and
- Schedule B lists services that require predetermination. The
predetermination process remains unchanged and is administered
through the NIHB Regional Officers.
In addition, the revised Grid includes:
- Implementation of the Crown, Periodontic and Revised Endodontic
Policy; and
- Removal of program limits on selected services (e.g. retentive
pins).
Providers should refer to the NIHB Regional Dental Benefit Grid:
Schedule A and Schedule B for full details.
What is the NIHB Dental Policy Framework?
The Dental
Policy Framework sets out to clearly define and explain:
- Who is eligible to receive dental benefits under the NIHB Program;
and
- What types of benefits are provided and the policies under
which they will be funded.
For more information, contact
a Non-Insured Health Benefits Regional Office.
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