Benefits Information
Health Canada provides eligible First Nations people and Inuit
with a specified range of medically necessary health-related goods
and services when they are not covered through private insurance
plans or provincial/territorial health and social programs.
Non-Insured Health Benefits (NIHB) include prescription drugs,
over-the-counter medication, medical supplies and equipment, short-term
crisis counselling, dental care, vision care, and medical transportation.
Benefit Criteria
A benefit will be considered for coverage when:
- The item or service is on a NIHB Program benefit list or NIHB
schedule;
- It is intended for use in a home or other ambulatory care
settings;
- Prior approval or predetermination is obtained (if required);
- It is not available through any other federal, provincial,
territorial, or private health or social program;
- The item is prescribed by a physician, dental care provider,
or other health professional licensed to prescribe; and
- The item is provided by a recognized provider.
Who is an Eligible Recipient?
An eligible recipient is someone who is entitled to receive benefits
such as vision care, prescription drugs or other benefits or services
from the NIHB Program.
An eligible recipient must be identified as a resident of Canada
and one of the following:
- A registered Indian according to the Indian Act;
- An Inuk recognized by one of the Inuit Land Claim organizations;
or
- An infant less than one year of age, whose parent is an eligible
recipient.
When recipients are eligible for benefits under a private health
care plan, or public health or social program, claims must be submitted
to these plans and programs first before submitting them to the
Non-Insured Health Benefits Program.
Eligible Client Population by Region - 2005/2006
Recipient Reimbursement
Service providers are encouraged to bill the Program directly
so that recipients do not face charges at the point of service
when receiving health care goods or services.
When a recipient does pay directly for goods or services, he or
she may seek reimbursement from the NIHB Program. Requests for
reimbursement must be received on a NIHB Client Reimbursement Request
Form, within one year from the date of service or date of purchase.
The form information is available in HTML and Portable Document
Format (PDF). The HTML
version of the NIHB Client Reimbursement Request Form is not
an actual form. It displays the information found on the form for
viewing purposes only and will not be accepted if used to request
reimbursement.
If you wish to submit a request, you must use only the PDF
version of the NIHB Client Reimbursement Request Form.
All requests for reimbursement of eligible benefits must include:
- Original receipts with cost breakdown (for example: dispensing
fees, unit cost, and the Drug Identification Number (DIN) for
drugs);
- Recipient's name, address, identification number (the treaty/status,
nine or ten digit number, 'N' or 'B' number), band name and family
number or other health care number;
- A copy of the prescription; and
- A completed recipient authorization section on the NIHB Client
Reimbursement Request Form.
To obtain a print version of the NIHB Client Reimbursement Request
Form, contact
the nearest Regional Office, or a local First Nations and Inuit
Health Authority.
Non-Insured Health Benefits Expenditures - 2005/2006
Not reflected in the $817.7 million in NIHB
Benefits in 2005/06 is approximately $32 million in administration
costs.
Appeal Process
Recipients may initiate an appeal when a benefit has been denied
by the NIHB Program. Appeals must be initiated by recipients or
their representative at each level of appeal. There must also be
supporting information from a health care provider(s) as required.
A written explanation of the decision taken will be provided to
the recipient, or representative, at each level of the appeal process.
Refer to the Non-Insured
Health Benefits Appeal Procedures or contact
the nearest Regional Office for more information.
Resources
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