Non-Insured Health Benefits Directorate

The Non-Insured Health Benefits (NIHB) Directorate is responsible for managing the Non-Insured Health Benefits (NIHB) Program which provide, to registered Indians and recognized Inuit, a limited range of medically necessary health-related goods and services which supplement benefits provided through private insurance plans, provincial/territorial health and social programs. The non-insured health benefits include:

• Mental Crisis Counseling (short term mental health crisis intervention)
• Dental Benefits;
• Drug Benefits;
• Vision Care Benefits;
• Medical Supplies and Equipment Benefits;
• Medical Transportation; and
• Provincial health premiums (Alberta and British Columbia).

Offices and Divisions

The NIHB Directorate consists of:

• Benefit Management Division
• Benefit Review Services Division
• Director General's Office
• Operational Services and Systems Division
• Program Analysis and Risk Management Division
• Program Policy and Planning Division

Benefit Management Division

The Benefit Management Division is responsible for the development and management of benefits to support First Nations and Inuit clients with access to benefits that will contribute to optimal health outcomes in a fair, equitable and cost-effective manner.

The Division consists of the following five units:

• Benefit Policy
• Pharmacy
• Dental
• Negotiations Secretariat
• Quality Assurance (September 2006)

Benefit Review Services Division

The Benefit Review Services Division is a national centre responsible for the review and adjudication of Non-Insured Health Benefits (NIHB) requests for pharmacy and orthodontic benefits, and providing recommendations to First Nations and Inuit Health Branch regions on requests for medical supplies and equipment.

The Division consists of the following three units:

• Medical Supplies and Equipment Review Centre
• National Drug Exception Centre
• Orthodontic Review Centre

Director General's Office

The Director General's Office is responsible for the overall coordination and development of the Non-Insured Health Benefits (NIHB) Program policy in order to ensure that non-insured health benefits are provided to First Nations and Inuit in a manner that:

• is appropriate to their unique health needs;
• contributes to the achievement of an overall health status for First Nations and Inuit that is comparable to that of the Canadian population as a whole;
• is sustainable from a fiscal and benefit management perspective; and
• facilitates First Nations and Inuit control at a time and pace of their choosing.

Operational Services and Systems Division

The Operational Services and Systems Division is responsible for development, maintenance and management of the key business processes, systems and services required to operate the Non-Insured Health Benefits (NIHB) Program. This includes the management of the Health Information and Claims Processing System (HICPS) contract and supplier relations including financial controls and accountability, systems, provider communications and governance issues.

The Division consists of the following three units:

• Systems Maintenance and Program Coordination
• National Claims Processing System & Services
• NIHB Applications Support

Program Analysis and Risk Management Division

The Program Analysis and Risk Management Division is responsible for:

• Disseminating Non-Insured Health Benefits (NIHB) Program data on population, expenditure, and benefit utilization trends;
• Conducting research and data analysis in support of policy recommendations; and
• Coordinating the NIHB Program's risk management activities including provider audit activities in the pharmacy, dental, and medical supplies and equipment benefit areas.

Program Policy and Planning Division

The Program Policy and Planning Division is responsible for:

• Liaison with national organizations representing First Nations and Inuit and providing support and information to First Nations and Inuit in Non-Insured Health Benefits (NIHB) Program policies;
• Addressing program strategic policy issues, including privacy, which may apply to the information and data holdings of the NIHB Program, other benefit providers and clients;
• Development, implementation and monitoring of performance measures related to the efficiency and effectiveness of the NIHB Program;
• Coordinating NIHB Directorate's annual strategic planning cycle and contributing NIHB planning and performance information to the departmental reporting process.

For general information about non-insured health benefits for First Nations and Inuit, visit our Non-Insured Health Benefits section.

Specific information for health providers on non-insured health benefits is available in our First Nations and Inuit Health section.