Benefits Information

Health Canada provides eligible First Nations people and Inuit with a specified range of medically necessary health-related goods and services when they are not covered through private insurance plans or provincial/territorial health and social programs.

Non-Insured Health Benefits (NIHB) include prescription drugs, over-the-counter medication, medical supplies and equipment, short-term crisis counselling, dental care, vision care, and medical transportation.

On this page:

• Benefit Criteria
• Who is an Eligible Recipient?
• Recipient Reimbursement
• Appeal Process
• More Information and NIHB Program updates

Benefit Criteria

A benefit will be considered for coverage when:

• The item or service is on a NIHB Program benefit list or NIHB schedule;
• It is intended for use in a home or other ambulatory care settings;
• Prior approval or predetermination is obtained (if required);
• It is not available through any other federal, provincial, territorial, or private health or social program;
• The item is prescribed by a physician, dental care provider, or other health professional licensed to prescribe; and
• The item is provided by a recognized provider.

Who is an Eligible Recipient?

An eligible recipient is someone who is entitled to receive benefits such as vision care, prescription drugs or other benefits or services from the NIHB Program.

An eligible recipient must be identified as a resident of Canada and one of the following:

• A registered Indian according to the Indian Act;
• An Inuk recognized by one of the Inuit Land Claim organizations; or
• An infant less than one year of age, whose parent is an eligible recipient.

When recipients are eligible for benefits under a private health care plan, or public health or social program, claims must be submitted to these plans and programs first before submitting them to the Non-Insured Health Benefits Program.

Eligible Client Population by Region - March 2012

Source: Status Verification System (SVS) adapted by Program Analysis Division

Recipient Reimbursement

Service providers are encouraged to bill the Program directly so that recipients do not face charges at the point of service when receiving health care goods or services.

When a recipient does pay directly for goods or services, he or she may seek reimbursement from the NIHB Program. Requests for reimbursement must be received on a NIHB Client Reimbursement Request Form, within one year from the date of service or date of purchase.

The form information is available in HTML and Portable Document Format (PDF). The HTML version of the NIHB Client Reimbursement Request Form is not an actual form. It displays the information found on the form for viewing purposes only and will not be accepted if used to request reimbursement.

If you wish to submit a request, you must use only the PDF version of the NIHB Client Reimbursement Request Form.

For more information, consult the NIHB Client Reimbursement Question and Answer page.

To obtain a print version of the NIHB Client Reimbursement Request Form, contact the nearest Regional Office, or a local First Nations and Inuit Health Authority.

Appeal Process

Recipients may initiate an appeal when a benefit has been denied by the NIHB Program. Appeals must be initiated by recipients or their representative at each level of appeal. There must also be supporting information from a health care provider(s) as required.

A written explanation of the decision taken will be provided to the recipient, or representative, at each level of the appeal process.

Refer to the Non-Insured Health Benefits Appeal Procedures or contact the nearest Regional Office for more information.

More Information and NIHB Program updates

Audiology

• (2013) Prior Approval Process Information for Audiology Providers - Questions and Answers
• (2012) Information for Audiology Prescribers
  

Dental

• Dental Benefit Information - Questions and Answers
• Orthodontic Services Information - Questions and Answers

Drug

• Fact Sheet for Health Professionals - The Non-Insured Health Benefits Prescription Monitoring Program (NIHB-PMP)
• Pharmacy Benefit Information - Questions and Answers

Eye and Vision

• Vision Care Benefit - Policy Framework
• Vision Care Benefit List
• Eye and Vision Care Benefit Information - Questions and Answers
• New Vision Care Framework and Vision Care Benefit List - Questions and Answers

Medical Supplies and Equipment

• Information for Audiology Prescribers
• Information for Clients Who Require Incontinence Supplies
• Information for Providers of Incontinence Supplies
• Medical Supplies and Equipment Benefit Information - Questions and Answers

Medical Transportation

• Medical Transportation Benefit Information - Questions and Answers

NIHB Program Information

• Non-Insured Health Benefits Program Annual Report 2011/2012
• Bill C-3 (McIvor) Questions and Answers
• Coordination of Benefits
• General Questions and Answers
• Your Health Benefits - A Guide for First Nations to Access Non-Insured Health Benefits
• Report on Client Safety
• Qalipu Mi'kmaq First Nation Band Members
• Short-Term Crisis Intervention Mental Health Counselling Benefit Information

Non-Insured Health Benefits Forms

Non-Insured Health Benefits Program Updates