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First, you must be an eligible client under the Non-Insured Health Benefits Program. Then, you must be examined by a dental provider who will establish a treatment plan and discuss with you the services that you will require.
The dental provider should tell you what is covered by the NIHB Program, because certain services may need to be pre-approved by the NIHB Program.
If your provider doesn't know whether the service is covered by the NIHB Program, you can obtain that information by contacting the Health Canada regional office, or the National Dental Predetermination Centre (NDPC) for those regions which have been centralized, and asking the dental benefits staff what is and is not covered.
Dental services must be provided by a licensed dental professional, such as a dentist, dental specialist, or denturist.
The NIHB Program strongly encourages dental providers to bill the NIHB Program directly. The dental provider has an obligation to tell you, as the client, if you will have to pay for services before treatment is started.
Yes, that is your choice. However, it is recommended you contact the Health Canada regional office or NDPC before receiving any dental service to ensure that this particular dental service is eligible for coverage under the NIHB Program.
In such cases, you must pay your provider yourself, and then submit a request with all necessary documentation to the NIHB Program in order to be considered for reimbursement.
Remember that your provider may charge more than the amount that is covered by the NIHB Program, which means that you would not be reimbursed the full amount that you paid.
The request for reimbursement can be submitted to NIHB up to one year from the date on which the services were received.
No. Emergency dental services do not require predetermination.
Emergency services include treatment for acute dental problems and associated examinations, radiographs, procedures for the immediate relief of pain and infection, arresting bleeding, and preliminary care of trauma to the mouth.
For more information about NIHB orthodontic services you can call the Orthodontic Review Centre at:
Information on orthodontic services can also be found on Health Canada's Dental Benefits Guide.
A client, parent, legal guardian or representative may initiate an appeal when a benefit has been denied by the NIHB Program.
For a case to be reviewed as an appeal, a signed note or letter from the client, parent or legal guardian, accompanied by supporting information from the dental provider (e.g. dentist) must be submitted to the NIHB Program. There are three levels of appeal available.
Some dental procedures are exclusions of the NIHB Program and are not eligible for appeal (e.g. implants).
For more information about Dental Benefits you can call the nearest Health Canada regional office, NDPC, or under the Benefit Information section of Health Canada's NIHB website at: www.healthcanada.gc.ca/nihb