Orthodontic Bulletin

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June 2002

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The NIHB Program provides supplementary health benefits, including dental treatment, for registered Indian, recognized Inuit and Innu throughout Canada.

The Non-Insured Health Benefits (NIHB) Program is pleased to announce the establishment of a national Orthodontic Review Centre (ORC) effective July 1^st , 2002. All requests for funding of orthodontic treatment are now to be sent to the Orthodontic Review Centre in Ottawa at the following address:

Orthodontic Review Centre
Non-Insured Health Benefits, Health Canada
First Nations and Inuit Health Branch
Graham Spry Building
250 Lanark Avenue, 6th Floor
Address Locator 2006C
Ottawa, Ontario K1A 0K9

See new address

Toll-free Phone: 1-866-227-0943
Toll-free Fax: 1-866-227-0957

In the Ottawa area: (613) 946-2546

NIHB Guidelines for Comprehensive Orthodontic Treatment

NIHB will consider funding the orthodontic treatment for eligible First Nations, Inuit and Innu clients when ALL eight of the following conditions apply:

1. The malocclusion is significantly severe and functionally handicapping.
2. All preliminary dental treatment (periodontal and restorative) has been completed.
3. The patient is caries-free and has demonstrated consistently good oral hygiene.
4. This is the appropriate time for the proposed treatment to be provided.
5. The client is less than 18 years of age at the time of the case being submitted for assessment.
6. The patient and the parent/ guardian have attended the treatmen conference appointment, provided the consent and demonstrated a commitment to the Orthodontic treatment plan.
7. Records must be accompanied by a NIHB completed Orthodontic Summary Sheet, CAO Standard Orthodontic Information Form or letter with all the required information on the orthodontist's letterhead, and a completed NIHB Dent-29 Form.
8. The overall cost of multiple phases of treatment will not exceed the total fee of what would be charged for a malocclusion of similar severity treated in one phase.

If in the provider's judgment, oral health is being compromised, or if there are non-compliance issues, the provider will discontinue treatment and advise NIHB in writing.

All requests for funding of orthodontic treatment will be reviewed the third week of each month.

If all required information has not been submitted, providers will be immediately informed by fax of the missing information. In the event that the information has not been received after 30 days, all records will be returned to the provider.

Payment Structure for Comprehensive Treatment

Initial Payment	(P1200 or specific wording)	30%
Payment at 9 months	(P1300 or specific wording)	25%
Payment at 15 months	(P1300 or specific wording)	25%
Final Payment	(P1400 or specific wording)	20%

Note: Final records may differ based on regional provider customary practices.

Coordination of Benefits for Orthodontic Care

Coordination of Benefits (COB) with third party carriers is coordinated at the time of review. Either the dental provider or the client is required to attach the Explanation of Benefits (EOB) from the third party carrier when submitting for orthodontic treatment.

Appeal Process

The NIHB Program has three levels of appeal which must be initiated by the parent or guardian on behalf of the child when funding for orthodontic treatment has been denied.

The first level is the NIHB Orthodontic Consultant, the second is the Director, Benefit Management and the third and final level is the Director General NIHB. At all levels, the case will be reviewed by an independent orthodontic consultant. For more information on the appeals process please contact the Orthodontic Review Centre toll-free at 1-866-227-0943 or in the Ottawa area at (613) 946-2546.