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- The Non-Insured Health Benefits (NIHB) program provides registered First Nations and recognized Inuit with coverage for a range of medically necessary health benefits including prescription drugs and over-the-counter (OTC) medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access medically required health services that are not available on reserve or in the community of residence.
sac-isc.gc.ca/eng/1683039690813/1683039973755Non-Insured Health Benefits program: First Nations and Inuit ...
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Non-insured health benefits for First Nations and Inuit. Learn about the Non-Insured Health Benefits (NIHB) program and how to access it. Also search for important health-related resources, contact information and the Drug Benefit List.
- Benefits and Services
Learn about coverage for drugs, dental and vision care,...
- Client Reimbursement
If your NIHB medical transportation or other benefits are...
- About The Program
A First Nations or Inuit community, self-government or...
- Drug Benefit List
Express Scripts Canada provides claims processing and...
- Who is Eligible
Find out who can receive benefits under the Non-Insured...
- Benefits and Services
The Non-Insured Health Benefits (NIHB) program provides registered First Nations and recognized Inuit with coverage for a range of medically necessary health benefits including prescription drugs and over-the-counter (OTC) medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to ...
Health Information and Claims Processing Services (HICPS): 2020 to 2021. Claims for NIHB pharmacy, dental and MS&E benefits provided to eligible First Nations and Inuit clients are processed via the Health Information and Claims Processing Services (HICPS) system.
- NON-INSURED HEALTH BENEFITS (NIHB)
- Contents
- Benefits
- INTRODUCTION
- THE NON-INSURED HEALTH BENEFITS PROGRAM
- THE ASSEMBLY OF FIRST NATIONS HEALTH AND SOCIAL SECRETARIAT
- What is covered?
- Remember
- Who may be involved in providing this care?
- Exceptions or Special Cases
- What is not covered / Exclusions
- For additional information
- Remember
- Predetermination:
- Emergency dental services:
- Who may be involved in providing dental care?
- About the Process
- For additional information
- What is covered?
- Modes of Transportation
- Escorts (General)
- Remember
- General Principles
- Exceptions
- What is not covered / Exclusions
- What is covered?
- Prescription
- Palliative Care Formulary
- Remember
- General Principles
- Prior approval
- Who can prescribe drugs?
- Exceptions
- For additional information
- What is covered?
- General Medical Supplies and Equipment Categories
- Remember
- General Principles
- Equipment
- Who may be involved in prescribing medical supplies and equipment?
- Exceptions
- What is not covered / Exclusions
- For additional information
- What is covered?
- Who may be involved in providing this care?
- What is not covered / Exclusions
- For additional information
- Supplemental Health Insurance Premiums
- Transportation to Medical Services
- General Principles
- What is covered?
- What is not covered / Exclusions
- For additional information
- 8. PROCEDURE FOR APPEALS
- Level 1
- Level 1
- Level 2
- 9. PROTECTING YOUR INFORMATION
- Withdrawal of Consent
What types of health benefits can eligible First Nations clients access under the NIHB Program?
Introduction The Non‐Insured Health Benefits Program The Assembly of First Nations Health and Social Secretariat
Eye and Vision Care Benefits Dental Benefits Medical Transportation Benefits Drug Benefits Medical Supplies and Equipment (MS&E) Benefits Short‐Term Crisis Intervention Mental Health Counselling Benefits Approved Health Benefits Outside of Canada
The purpose of this handbook is to provide First Nations clients with information on prescription and over‐the‐counter drugs, dental care, eye and vision care, medical supplies and equipment, short‐term crisis intervention mental health counselling and medical transportation to access medically necessary services for eligible First Nations covered ...
The Non‐Insured Health Benefits (NIHB) Program is a national program that provides coverage to registered First Nations and recognized Inuit to support them in reaching an overall health status that is comparable with other Canadians. The Non‐Insured Health Benefits Program provides coverage for a limited range of medically necessary goods and serv...
The Assembly of First Nations (AFN) is responsible to protect, maintain, promote, support, and advocate for First Nations inherent, treaty and constitutional rights, (w) holistic health, and the well‐being of our nations. This is achieved through policy analysis, communications, and, most importantly, lobbying on behalf of First Nations’ communitie...
The following benefits are covered by the NIHB Program except when provided as an insured service by the province or territory (e.g., eye exams for children, elderly and diabetic clients in some provinces/territories). Payment is made to the provider in the areas listed below. All eye and vision care benefits require prior approval from the Health ...
The rules about what is covered may vary by region. Prior approval is needed to access any vision care benefit under the NIHB Program.
Licensed optometrists Ophthalmologist (Eye Specialist) Opticians (Prepares the eyeglasses that have been prescribed)
All cases as described below require prior approval and a written prescription with proper medical justification that will be provided by the health practitioner.
Vision care goods and services covered by provincial/territorial health insurance plans Additional carrying cases for glasses or contact lenses Cleaning kit Esthetic products Shampoo (e.g., “no more tears” type shampoo solution) Vision exams required for a job, a driver’s license or to engage in a sports activity Vision exams at the request of a 3r...
Contact lens solution Industrial safety frames or lenses for sports or professional use Sunglasses with no prescription Progressive or trifocal lenses Photocromic/photocromatic lenses Replacements or repairs as a result of misuse, carelessness or negligence Implants (e.g., punctual occlusion procedure) Refractive laser surgery Treatments with inves...
The rules about what is covered may vary by region depending upon provincial/territorial insured services. Predetermination is needed to access all dental services listed in Schedule B and certain dental services listed in Schedule A that exceed eligibility limits. Please note: These schedules are not comprehensive. While most services under the ca...
Predetermination is a process of prior approval that reviews cases against established NIHB policy criteria and guidelines. Predetermination or prior approval is required on certain dental services. More complex dental procedures and dental services above frequency limitations require predetermination. For example: crowns, dentures and root canal t...
n Emergency dental services do not require predetermination. Services consist of acute dental problems including associated examinations and radiographs, procedures for the immediate relief of pain and infection (pulpotomies and pulpectomies, open and drain), arresting haemorrhage, and preliminary care of trauma to the mouth.
n Licensed practitioners with authorization to provide dental services within their scope of practice in their province or territory and that are recognized by the NIHB Program (such as dentists, dental specialists and denturists).
Your dental provider has a complete list of eligible services (Schedule A and B). The NIHB Program strongly encourages dental providers to bill the NIHB Program directly. If your dental provider chooses not to bill the NIHB Program directly, please contact the appropriate Health Canada regional ofice, which may provide you with a list of alternate ...
NIHB Dental Benefits information can be found at: http://www.hc‐sc.gc.ca/fniah‐spnia/nihb‐ssna/benefit‐prestation/dent/index‐eng.php http://www.hc‐sc.gc.ca/fnih‐spni/pubs/dent/ortho‐individual beneficiaries/index_e.html Orthodontic Benefits – Questions and Answers for Patients: http://www.hc‐sc.gc.ca/fniah‐spnia/nihb‐ssna/benefit‐prestation/ortho/q...
Assistance with the payment of transportation to the nearest appropriate health professional or health facility for clients to access eligible medically necessary health services that cannot be obtained on the reserve or in the community of residence. This may include assistance with meals and accommodation when these expenses are incurred while in...
Ground travel: private vehicle, commercial taxi, fee‐for‐service driver and vehicle, Band vehicle, bus, train, snowmobile taxi or ground ambulance. Water travel: motorized boat, boat taxi or ferry. Air travel: scheduled and chartered flights, helicopter, air ambulance or Medevac where not provincially insured. The most eficient and economical mode ...
May include transportation, accommodations and meals for medical and non‐medical escorts. Prior approval is required, and the length of time is determined by the client’s medical condition or legal requirements. Criteria for Escorts The client has a physical/mental disability, or has legally been declared “mentally incompetent” and is, therefore, u...
The rules about what is covered may vary by region depending upon provincial/territorial insured services. Prior approval is needed to access any medical transportation benefit under the NIHB Program.
Clients must have prior approval to access medical transportation benefits. In emergency situations, when prior approval has not been obtained, expenses may be reimbursed (Required: appropriate medical justification and approval after the fact). Clients must provide proof or confirmation from the health care provider or representative that they hav...
(May be considered on an exceptional basis with justification.) Diagnostic tests for educational purposes (e.g., hearing tests for children required by the school). Speech assessment and therapy, when coordinated with other approved NIHB medical travel to a provincially/territorially insured service. Medical supplies and equipment benefits where a ...
Certain types of travel, benefits and services will not be covered under the NIHB Program under any circumstances and are not subject to the NIHB appeal process. These include: Travel and related benefits (e.g., meals and accommodation, ambulance) where they are the responsibility of another party or provided as an insured service. Compassionate tr...
When not covered by another program/plan, payment is made for eligible benefit items directly to the NIHB‐approved provider or reimbursed to the client at NIHB rates in the areas listed below.
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
The NIHB Program no longer makes use of any information that was gathered during the consent initiative. However, for those clients who may have signed a NIHB consent form in the past and wish to withdraw their consent, withdrawal of consent must be made in writing to:
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Access the First Nations and Inuit home and community care program, health services and nursing care. Also find support for former students of Indian residential schools.
As of March 31, 2021, there were 898,839 First Nations and Inuit clients eligible to receive benefits under the NIHB program, an increase of 1.6% from March, 2020.
rst Nation/Inuit individuals who must travel within Canada to attend medically required health services not available on reserve or in their community of residence. Such services include: appointments with physi. ians/medical practitioners, hospital care, tests, treatments, a.
