Non-Insured Health Benefits Directorate

The Non-Insured Health Benefits (NIHB) Directorate is responsible for managing the Non-Insured Health Benefits (NIHB) Program which provides, registered First Nations and recognized Inuit coverage for a range of medically necessary health related benefits to supplement benefits provided through private insurance plans, provincial/territorial health and social programs. Coverage under the NIHB Program includes:

  • prescription drugs and over-the-counter medications;
  • dental care;
  • vision care;
  • medical supplies and equipment;
  • mental health counselling; and
  • medical transportation.

Offices and Divisions

The NIHB Directorate consists of:

Director General's Office

The Director General's Office is responsible for the overall coordination and development of Non-Insured Health Benefits (NIHB) Program policy in order to ensure that benefits are provided to First Nations and Inuit in a manner that:

  • is appropriate to their unique health needs;
  • contributes to the achievement of an overall health status for First Nations and Inuit that is comparable to that of the Canadian population as a whole;
  • is sustainable from a fiscal and benefit management perspective; and
  • facilitates First Nations and Inuit control at a time and pace of their choosing.

Benefit Management and Review Services Division

The Benefit Management and Review Services Division (BMRSD) is responsible for the review and adjudication of requests for coverage of pharmacy, dental and orthodontic benefits under the NIHB Program. BMRSD also provides expert advice and recommendations on medical supplies and equipment to Health Canada Regional Offices and establishes and maintains the Program’s dental policies.

The Division consists of the following four units:

  • Dental Policy Unit
  • Dental Predetermination Centre
  • Medical Supplies and Equipment Review Centre
  • Drug Exception Centre

Operational Services and Systems Division

The Operational Services and Systems Division is responsible for the development, maintenance and management of the key business processes, systems and services required for Non-Insured Health Benefits (NIHB) Program operations. The division manages the management of the Health Information and Claims Processing Services (HICPS) contract and system, as well as supplier relations, financial controls and accountability, systems, provider communications and governance issues.

Business Support, Audit and Negotiations Division

The Business Support, Audit and Negotiations Division is responsible for:

  • conducting data analysis in support of policy and program development, program delivery, and financial management;
  • provider relations activities with registered service providers and their federal/provincial/territorial associations;
  • the NIHB Program's risk management activities;
  • developing NIHB compensation models and negotiating with professional associations.

Pharmacy Policy Development Division

The Pharmacy Policy Development Division is responsible for managing the NIHB Program’s pharmacy policy, including the maintenance of the Drug Benefit List, policies regarding safe use of listed medications, and product price negotiations through the pan-Canadian Pharmaceutical Alliance.

Program Policy and Planning Division

The Program Policy and Planning Division is responsible for:

  • liaising with national organizations representing First Nations and Inuit;
  • addressing strategic program policy issues ;
  • development, implementation and monitoring of performance measures related to the efficiency and effectiveness of the NIHB Program;
  • leading the development of program policy related to medical supplies and equipment benefits, vision care benefits, mental health counseling benefits and medical transportation benefits; and
  • coordinating NIHB Program's annual strategic planning cycle and contributing NIHB planning and performance information to the departmental reporting process.

For information on health coverage for First Nations and Inuit visit Non-Insured Health Benefits section.

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