Non-Insured Health Benefits (NIHB) Program - General Questions and Answers

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What is the Non-Insured Health Benefits Program?

The Non-Insured Health Benefits (NIHB) Program is a national program that provides coverage to registered First Nations and recognized Inuit for a limited range of medically necessary items and services that are not covered by other plans and programs.

What is covered by the NIHB Program?

The different benefit areas for the NIHB Program are:

• Dental Care;
• Eye and Vision Care;
• Medical Supplies and Equipment;
• Pharmacy Benefits (including prescription and over-the-counter drugs);
• Short-Term Crisis Intervention Mental Health Counseling; and
• Assistance with medical transportation to access medically necessary services.

How do I obtain NIHB benefits?

The procedure varies by benefit. For more specific information please consult the Health Canada Website on benefits, or contact the Health Canada regional office.

Do I have to pay upfront for NIHB benefits?

Your benefit provider (e.g. your pharmacist or dentist) must inform you if you are expected to pay directly for any services or items.

The NIHB Program strongly encourages providers to bill the NIHB Program directly; however, some do not. The Health Canada regional office may be able to provide you with a list of providers in your area that bill the NIHB Program directly.

Can I continue to use my current provider (e.g. my pharmacist or dentist) if they do not bill the NIHB Program directly?

Yes, that is your choice. However, it is recommended you contact the Health Canada regional office before purchasing any item or receiving any service to ensure that the requested item/service is eligible for coverage under the NIHB Program.

Remember that in such cases, you must pay your provider first and then submit the proper information to the NIHB Program in order to be considered for reimbursement.

You should also note that your provider may charge more than the rate covered by NIHB, which means that you would not be reimbursed the full amount that you paid.

Your request for reimbursement can be submitted to NIHB up to one year from the date on which the services were received.

For more information on the client reimbursement process.

For more information on which benefits are covered under the NIHB Program.

Why should I keep my private insurance if I am eligible for NIHB benefits?

It is important to note that as a registered First Nations or recognized Inuit you should maintain any private, employer-sponsored, or other public health care coverage you may have, as some of the benefits you may currently be receiving may not be eligible benefits under the NIHB Program (e.g. physiotherapy and chiropractic treatment).

For benefits that are available under both your private plan and NIHB, your claims must first be submitted to your current plans/programs before submitting them to the NIHB Program. For NIHB eligible benefits, the remaining amount of your claim not paid for by your private plan can then be submitted to NIHB in order to be considered for reimbursement.

Does the NIHB Program provide out-of-country coverage?

The NIHB Program may cover the cost of privately acquired supplemental health insurance premiums for approved students and migrant workers. Supplementary health insurance coverage for all other outside of country travel (e.g. vacation travel) is not a benefit under the NIHB Program.

When travelling outside of Canada, it is recommended that you buy travel health insurance in case of an emergency.

I was injured while on vacation. Will NIHB arrange medical transportation to transfer me back to my home?

No, the NIHB Program does not cover transportation to a home community when an injury has caused the cancellation of a trip. It also does not cover the costs of transferring clients between hospitals, within a province/territory, or from one province/territory to another.

Are eligible NIHB clients who relocate back to Canada when they reach retirement age eligible for benefits?

An NIHB eligible client can access NIHB benefits within Canada once they have re-established their Canadian residency. For more information regarding access to benefits, or contact the nearest Health Canada regional office.

Is a United States citizen with Indian Status in Canada eligible for NIHB benefits?

A U.S. citizen with Indian Status from Indian and Northern Affairs Canada (INAC) can receive NIHB benefits if that person meets the NIHB eligibility requirements.

In addition to having INAC Indian Status, they must also be a Canadian resident and be registered, or eligible for registration, under a provincial or territorial health care plan (for example, the Ontario Health Insurance Plan, New Brunswick Medicare, or Saskatchewan Health).

What is an exception as defined by NIHB?

NIHB may provide coverage as an exception for goods and services that are not included in the NIHB benefit lists and that are not an exclusion of the Program. Exception requests will be considered on a case-by-case basis upon receipt of written medical justification from the provider.

What is an exclusion?

Exclusion items are goods and services which are not listed as benefits on NIHB benefit lists and are not available through the exception process or subject to appeal. Therefore, excluded items will not be covered by the NIHB Program under any circumstance. These may include, but are not limited to, items used exclusively for sports, work, education, cosmetic reasons, are experimental, or are part of a surgical procedure.

Is there an appeal process when a benefit has been denied?

Yes. An NIHB 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 appealed, a signed note or letter from the client, parent or legal guardian, accompanied by supporting information from the service provider or prescriber (e.g. a doctor) must be submitted to the NIHB Program.

There are three levels of appeal available.

For more information on the appeal process, or contact the Health Canada regional office.

How does NIHB respect my privacy?

Health Canada's Non-Insured Health Benefits Program is committed to protecting clients' privacy and safeguarding the personal information in its possession. When a benefit request is received, the NIHB Program collects, uses, discloses and retains an individual's personal information according to the applicable federal privacy legislation.

Where can I obtain further information about the NIHB Program?

Information can be found on this website or you can contact the nearest Health Canada regional office or consult a Navigator, if there is one in your area.

How do I contact the Health Canada regional office in my area?

For a complete list of Health Canada regional offices.