Orthodontic Benefits - Questions and Answers for Patients

August 2004

1. What is the Non-Insured Health Benefits (NIHB) Program?
   
   The Non-Insured Health Benefits (NIHB) Program is a public health program funded by Health Canada. The Program covers a limited range of orthodontic benefits for approximately 749,000 eligible First Nations and Inuit when these benefits are not available through other public or private programs and when Program criteria are met.
   
   
2. Is all orthodontic treatment covered under NIHB?
   
   No it is not. Orthodontic treatment provided under NIHB is health-based. Clients must meet the clinical criteria and guidelines established by the NIHB Program for their orthodontic treatment to be funded. Funding for orthodontic treatment is determined based on the severity of the patient's condition. The orthodontic treatment funded by the NIHB Program is targeted at conditions that directly impact health.
   
   
3. How do I know if the orthodontic treatment my dental provider recommends will be covered?
   
   The NIHB Program can only determine if a client's treatment request meets our funding criteria by reviewing the client's records and treatment plan. We ask orthodontists to help individuals submit the required information. Unfortunately, the NIHB Program cannot provide orthodontic treatment funding if the required records and treatment plans are not submitted for review.
   
   
4. My treatment plan has been accepted by NIHB for coverage. Who pays for these services?
   
   Health Canada prefers dental providers bill NIHB directly for services so there are no upfront charges to patients. However, providers have the choice to request the patient pay and seek reimbursement from our Program. Therefore NIHB asks providers to explain their office policies to potential patients up front, as they do with other patients.
   
   
5. What are the orthodontist's responsibilities?
   
   Your orthodontist will give you information on available treatment options appropriate to your dental care needs, regardless of the nature and extent of your dental plan coverage. It is important to understand that not all treatment recommended by your orthodontist may be covered by NIHB. Your orthodontist will assist you by supplying information required for NIHB to determine funding.
   
   Your orthodontist should also clearly explain any financial responsibilities for the orthodontic treatment, and whether he or she is prepared to assist you in obtaining reimbursement.
   
   
6. My treatment plan has been accepted by NIHB for coverage. How do I seek reimbursement from NIHB for the cost of these services if my provider does not bill the Program directly?
   
   Health Canada prefers that providers bill NIHB directly for services so there are no upfront charges to patients. However, if you must pay and seek reimbursement from the NIHB Program, the following information is required:
   • a completed and signed Dent-29 form
   • the original receipt (as proof of payment for the service)

   This information should be submitted to the Health Canada's Orthodontic Review Centre:
   
   Orthodontic Review Centre
   Non-Insured Health Benefits
   First Nations and Inuit Health Branch
   Health Canada
   55 Metcalfe Street, 5th Floor
   Postal Locator 4005A
   Ottawa, Ontario
   K1A 0K9

Need help?

NIHB clients are encouraged to contact Health Canada's Orthodontic Review Centre:

Toll-free phone: 1-866-227-0943
Toll-free fax: 1-866-227-0957