Medical Supplies and Equipment Benefit Information
Questions and Answers
What Medical Supplies and Equipment Benefits are covered by the NIHB Program?
The NIHB Program offers coverage for a range of Medical Supplies and Equipment items.
What are the general Medical Supplies and Equipment categories?
- Audiology equipment (e.g. hearing aids);
- Medical equipment (e.g. wheelchairs and walkers);
- Medical supplies (e.g. bandages and dressings);
- Orthotics and custom-made footwear;
- Oxygen and respiratory supplies and equipment;
- Pressure garments; and
Who can prescribe Medical Supplies and Equipment Benefits?
Medical Supplies and Equipment Benefits must be prescribed by:
- A physician;
- A nurse practitioner for certain medical supplies and equipment items, such as bandages, ostomy supplies, wheelchairs; or
- A health professional licensed to prescribe by a province or territory and recognized by the Health Canada NIHB Program.
Please note that a nurse practitioner cannot prescribe continuous positive airway pressure (CPAP).
Why does NIHB require a prescription for Medical Supplies and Equipment?
A prescription from a physician, medical specialist, or nurse practitioner is required to demonstrate the item or service requested is medically necessary.
Who can provide Medical Supplies and Equipment Benefits?
Providers differ across the provinces and territories. Please contact the Health Canada regional office for information on eligible providers in your area.
Do I have to pay upfront for Medical Supplies and Equipment Benefits?
The NIHB Program strongly encourages medical supplies and equipment providers to bill the NIHB Program directly.
If your medical supplies and equipment provider chooses not to bill the NIHB Program directly, please contact the appropriate Health Canada regional office, which may provide you with a list of providers in your area that will bill the NIHB Program directly.
The medical supplies and equipment provider has an obligation to tell you, as the client, if you will have to pay for items upfront.
Can I continue to see my current medical supplies and equipment provider if they do not bill the NIHB Program directly?
Yes, that is your choice. However, it is recommended you contact the Health Canada regional office in advance to ensure that the item you need is eligible for coverage under the NIHB Program.
In such cases, you must pay the provider yourself, and then submit a request with all of the proper information to the NIHB Program in order to be considered for reimbursement.
Remember that your provider may charge more than the amount that is covered by the NIHB Program, which means that you would not be reimbursed the full amount that you paid.
The request for reimbursement can be submitted to NIHB up to one year from the date on which the services were received.
Are there any medical supplies and equipment items not covered by the NIHB Program? (Exclusions)
Yes, there are some items which are not covered as a medical supplies and equipment benefit under the NIHB Program and are not eligible for appeal.
Some examples include, but are not limited to, items used exclusively for sports, work or education; items for cosmetic purposes; or experimental equipment, treatment and therapies.
Is there an appeal process when a benefit has been denied?
A client, parent, legal guardian or representative may initiate an appeal when a benefit has been denied by the NIHB Program.
For a case to be appealed, a signed note or letter from the client, parent or legal guardian, accompanied by supporting information from the service provider or prescriber (e.g. doctor) must be submitted to the NIHB Program. There are three levels of appeal available.
Where can I find more information on the Medical Supplies and Equipment Benefit?
For more information you can call the Health Canada regional office.
For a complete list of eligible MS&E items please visit Health Canada's NIHB Website.
For the Medical Supplies and Equipment Criteria please visit Health Canada's NIHB Website.
How do I contact the Health Canada regional office in my area?
A complete list of Health Canada regional offices is available on the Health Canada Website.
For more information on NIHB medical supplies and equipment benefits provided, see the Non-Insured Health Benefits Program Annual Report 2012/2013.
The Pharmacy and Medical Supplies and Equipment Benefits - Policy Framework (2010) is intended to provide stakeholders, providers and clients with a broad overview of the parameters of the NIHB Program policies as they relate specifically to the pharmacy and medical supplies and equipment (MS&E) benefit area.
Visit the Reports and Publications section to access a wide variety of Non-Insured Health Benefits documents.
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