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Dental Benefits
NOTICE
- NIHB is centralizing the processing of dental predetermination submissions and related requests at NIHB Heaquarters in Ottawa. (Effective dates)
Coverage for dental services is determined on an individual basis, taking into consideration the current oral health status, recipient history, accumulated scientific research, and availability of treatment alternatives.
What is covered?Footnote 1
- Diagnostic services like examinations or x-rays;
- Preventive services like cleanings;
- Restorative services like fillings;
- Endodontics such as root canal treatments;
- Periodontics or the treatment of gums;
- Prosthodontics including removable dentures;
- Oral surgery including the removal of teeth;
- Orthodontics to correct irregularities in teeth and jaws; and
- Adjunctive services, which include additional services like sedation.
Who can provide dental benefits?
Dental services must be provided by a licensed dental professional such as a dentist, dental specialist, or denturist.
See the Dental Benefits Guide section for details on the benefit policies, procedures and resources for health providers.
How do eligible recipients access dental benefits?
- Recipients must make an appointment with a dental provider who will complete an examination, establish a treatment plan, and discuss the services required with the recipient;
- The dental provider will indicate what is covered by the Non-Insured Health Benefits (NIHB) Program (certain services may need predetermination which is prior approval). If the provider is not aware, the recipient should contact the Regional Office and speak to dental benefit staff to determine what is covered.
Is there an appeal process when a benefit is not covered?
Eligible recipients can appeal a decision to decline coverage for a benefit. Please refer to the Appeal Procedures section.
Resources
Distribution of NIHB Dental Expenditures ($ millions) - 2011/12
For more information on NIHB dental benefits provided, see the Non-Insured Health Benefits Program Annual Report 2011/2012.
Questions and Answers - July 2011 Dental Benefits
Dental Policies
The Non-Insured Health Benefits Dental Policies clearly define the clinical criteria and guidelines under which the NIHB Program will cover dental services for eligible registered First Nations and recognized Inuit.
Orthodontic Benefits - Questions and Answers
The Non-Insured Health Benefits Program has developed a series of frequently asked questions for recipients.
Visit the Reports and Publications section to access a wide variety of Non-Insured Health Benefits documents.
Footnotes
- Footnote
-
Predetermination applies for some dental services.
