NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM

Transcription

1 NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM Information for First Nations Child and Family Services Agencies WHAT IS THE NON-INSURED HEALTH BENEFITS PROGRAM? The N on-insured H ealth Benefits (N IH B) Program provides coverage to registered First N ations and recognized Inuit for a range of medically necessary items and services. WHO IS AN ELIGIBLE CLIENT OF THE NIHB PROGRAM? An eligible client must be a resident of Canada and one of the following: a registered Indian according to the Indian Act an Inuk recognized by an Inuit Land Claim organization an infant less than 18 months of age, whose parent is an eligible client HOW DO I OBTAIN NIHB BENEFITS FOR A CHILD UNDER MY CARE? The NIHB Program provides coverage for prescription drugs, over-the-counter medication, medical supplies and equipment, mental health counselling, dental care, vision care, and medical transportation. Many health service providers (such as pharmacists, dentists, optometrists and mental health counsellors) are enrolled with NIHB to bill directly, so clients and caregivers do not have to pay out-of-pocket for eligible benefits. In order to submit benefit claims to N IH B, service providers require a valid client identification number. For registered First N ations, the IN A C registration number (the 10 digit number shown on the Indian status card) is used. Inuit clients are issued an identification number known as their "N" number (it begins with the letter "N" and is followed by 8 digits).

2 NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM 2 Many items or services covered by the NIHB Program are open benefits. This means that prior approval is not required, and an enrolled provider can provide the service right aw ay. Some items or services require prior approval. If required, the provider submits a prior approval request to the NIHB Program. Most providers enrolled with NIHB are familiar with NIHB policies and prior approval requirements. The N IH B Program can help caregivers of eligible children in care to access benefits. Information on how to contact the NIHB office nearest you can be found at the end of this document. WHAT IS COVERED BY THE NIHB PROGRAM? Drugs and pharmacy products NIHB covers most drugs and medications, including prescription medications as well as over-the-counter (OTC) medications (such as acetaminophen or allergy medications) when they are prescribed by a health professional. Most medications are covered as open benefits: when a valid prescription for an NIHB client is presented at a pharmacy enrolled w ith N IH B, the medication is provided and the pharmacy bills the Program directly. For more information on NIHB pharmacy benefits, please contact the NIHB Drug Exception Centre at (toll free). Dental care N IH B provides coverage for a w ide range of dental services. Dental providers w ho are enrolled w ith the N IH B Program can bill directly for these services. Categories of N IH B dental benefits include: Diagnostic services (such as examinations and x-rays) and preventive services, (such as polishing, scaling and sealants) Restorative services (such as fillings and crow ns) Endodontic services (root canal treatments) Periodontal services (such as scaling and root planing) Oral Surgery (for example, extractions) A djunctive services, (such as general anesthesia, sedation and facility services) Prosthodontic services (for example, removable dentures) Orthodontic services may also be covered for clients under 18 years of age w ho have severe irregularities of the teeth or jaws, or clients of any age with cleft lip or palate Prior approval (also known as pre-determination') is not required for emergency dental care, or preventive services (e.g. check-ups, cleaning) w ithin Program guidelines. Some dental benefits do require predetermination, which means that the dentist submits information to NIHB for approval before providing these services. For more information, or for assistance finding an enrolled dental benefit provider, please contact the N IH B Dental Predetermination Centre at (toll-free).

3 NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM 3 Medical supplies and equipment (MS&E) The N IHB Program covers a w ide range of medical supplies and equipment benefits prescribed by a physician, nurse practitioner, or specialized health professional (depending on the type of item). N IH B covers the follow ing types of MS&E benefits: General MS&E (such as mobility, dressing and incontinence supplies, and feeding aids) Audiology benefit items, such as hearing aids and supplies Orthotics and custom footwear Oxygen equipment and supplies, including oxygen systems Pressure garments and pressure orthotics Prosthetics, such as limb and ocular prostheses Respiratory equipment and supplies Some types of MS&E benefits require prior approval. For more information, and to find an enrolled provider who can bill NIHB directly, please contact the NIHB office in your region at one of the toll-free phone numbers listed below. Eye and vision care N IHB provides coverage of the following types of vision care benefits: Eye examinations Eyeglasses and eyeglass repairs Eye prosthesis and low vision aids Other vision care benefits, depending on specific medical needs of the client A vision care provider (such as an optometrist or optician) who is enrolled with NIHB can bill directly. To find an enrolled vision care provider in your area, please contact the N IH B office in your region. Mental health counselling The NIHB Program provides coverage for professional mental health counselling. Mental health counsellors (including psychologists and social workers with clinical counselling certification) can enrol with NIHB to bill the Program directly. No prescription or referral is required. The Program will cover up to 22 hours of counselling per year, including individual, family, or group counselling, and requests for additional counselling w ill be considered on a case-by-case basis. To support timely access to services and to allow for an assessment, the first 2 hours of counselling do not require prior approval. To find an enrolled mental health counsellor in your area, please contact the NIHB office in your region.

4 NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM 4 Medical Transportation NIHB provides medical transportation funding assistance to help clients access health services that are not available in their community. This may include travel by land, air or water, as well as living expenses (meals and accommodations). A ssistance may be provided to access the follow ing types of health services: Medical services, diagnostic tests and medical treatments insured by provincial/ territorial health plans (e.g., appointments with physician, hospital care) Publicly-funded alcohol, solvent, drug abuse and detox treatment; Traditional healers Non-Insured Health Benefits (vision, dental, mental health, medical supplies and equipment) Publicly-funded preventative screening Coverage for medical transportation benefits may also be provided so that a family member or caregiver can travel w ith a client w ho needs assistance. N IH B w ill provide coverage for an escort for all minors. For more information or to arrange medical transportation, contact the NIHB office in your region. WHAT IF A CHILD IN MY CARE NEEDS A SERVICE THAT IS NOT COVERED BY NIHB? Items or services that are not eligible benefits under the N IH B Program may be covered under the Jordan s Principle-A Child-First Initiative. The Jordan's Principle-A Child-First Initiative helps to ensure that all First Nations children living on and off reserve have can access the government services they need, w hen they need them. This includes health, education, mental health, medical equipment, speech therapy, and more. There are regional Jordan's Principle Focal Points across Canada to help families and children get started. These contacts are Government of Canada employees dedicated to evaluating requests under Jordan's Principle - A Child-First Initiative. They work closely with local Service Coordinators across Canada to ensure First N ations children have access to the services they need w ithout delay. If you know a child who needs help accessing a health, social or education service, call JP-CH ILD ( ) or visit for more information. WHERE CAN I GET MORE INFORMATION ABOUT THE NIHB PROGRAM? Please visit the NIHB section of the Government of Canada website at canada.ca/nihb. You can also contact the N IHB Program directly via at NIHB-SSN or at the telephone numbers listed below.

5 NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM 5 NIHB CLIENT INQUIRIES Alberta (M ain reception) Toll-free: Atlantic Toll-free: British Columbia First Nations Health Authority (FN H A ) Toll free: Northwest Territories/Nunavut Toll-free: Ontario Toll-free: Quebec Toll-free: Saskatchewan Toll free: Yukon Toll-free: DENTAL AND ORTHODONTIC SERVICES NIHB Dental Predetermination Centre Toll-Free: (Dental Services) Toll-Free: (Orthodontic Services) PHARMACY BENEFITS NIHB Drug Exception Centre Toll-Free English: Toll-Free French: JORDAN S PRINCIPLE / CHILD FIRST INITIATIVE Toll-free English: JP-CHILD ( ) Toll free French: PJ-ENFAN ( ) January 2018