The Non-Insured Health Benefits (NIHB) Program

Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section.

Orthodontic Policy July 2011

The NIHB Program covers a limited range of orthodontic services for eligible First Nations and Inuit clients when there is a severe and functionally handicapping malocclusion.

Predetermination is required for all orthodontic services.

The NIHB Program covers orthodontic services for cases characterized by the following clinical criteria:

• Dento-facial anomalies, such as cleft lip and palate - No age restriction
• Combination of marked skeletal discrepancy and a marked dental discrepancy (anteroposterior, transverse, and/or vertical) - Under 18 years of age

The purpose of the orthodontic treatment must be to resolve the identified discrepancies.

The NIHB Program covers three (3) types of orthodontic treatment modalities:

1. Comprehensive treatment for severe and functionally handicapping malocclusion;
2. Limited treatment for severe and functionally handicapping malocclusion;
3. Interceptive and/or Preventive treatment for severe and functionally handicapping malocclusion.

The overall cost for multiple phases of treatment cannot exceed the total fee of what would be charged for malocclusion of similar severity treated in one phase. For limited and interceptive/preventive treatment, the NIHB orthodontist fee is calculated by using the respective general practitioner provincial/territorial NIHB grid. Laboratory fees and adjustments costs are added to the approved professional fee. The final amount approved for an orthodontist is then adjusted with an increase of 20%.

The NIHB Program does not cover orthodontic treatment to address the following:

• Facial esthetics (e.g. significant crowding associated with a functional buccal segment)
• Psychological purposes (e.g. self-esteem cases)
• Temporomandibular disorders
• Non-handicapping malocclusion (e.g. crossbite relationships without an associated significant functional shift)
• Skeletal discrepancies with a functional pattern