Non-Insured Health Benefits (NIHB) Program - General Questions and Answers
What is the Non-Insured Health Benefits Program?
The Non-Insured Health Benefits (NIHB) Program is a national program that provides coverage to registered First Nations and recognized Inuit for a specified range of medically necessary items and services that are not covered by other plans and programs.
What is covered by the NIHB Program?
The benefit categories for the NIHB Program are:
How do I obtain NIHB benefits?
Do I have to pay upfront for NIHB benefits?
The NIHB Program encourages enrolled providers to bill the NIHB Program directly; however, in some cases providers will request that clients pay up front for their health benefits and services. To avoid an unexpected bill, it's best to confirm with your provider that they are registered with NIHB and will bill the Program directly.
Can I continue to use my current provider (e.g. my pharmacist or dentist) if they do not bill the NIHB Program directly?
In most cases, yes. If you work with a provider who does not bill the NIHB Program, you will need to pay your provider first and then submit the proper information to the NIHB Program in order to be considered for reimbursement. Your request for reimbursement can be submitted to NIHB up to one year from the date on which the services were received.
You should contact the Health Canada regional office before purchasing items or receiving services to make sure that the provider is recognized by NIHB, and that requested item/service is eligible for coverage under the NIHB Program. Prior approval may be required. You should also be aware that your provider may charge more than the rate covered by NIHB, which means that you would not be reimbursed the full amount that you paid.
Visit Client Reimbursement Question and Answer for more information.
What if I have other health benefit coverage?
You may have other coverage through a provincial/territorial program or private health care plan. Having health coverage under more than one benefit plan enables you to use both plans when claiming expenses for eligible benefits. In some cases, private or employer-sponsored benefits may include benefit coverage that is not provided under NIHB (e.g. allied health services such as massage therapy or physiotherapy, or the services of paramedical practitioners).
Does the NIHB Program provide out-of-country coverage?
No. Supplementary health insurance coverage for outside of country travel (e.g. vacation travel) is not a benefit under the NIHB Program. When travelling outside of Canada, it is recommended that you buy travel health insurance in case of an emergency.
In certain cases, the NIHB Program may cover the cost of privately acquired supplemental health insurance premiums for approved students and migrant workers. Prior approval from your regional office is required.
Are eligible NIHB clients who relocate back to Canada eligible for benefits?
Is a United States citizen with Indian Status in Canada eligible for NIHB benefits?
A U.S. citizen can receive NIHB benefits provided in Canada if that person meets the NIHB eligibility requirements, and if he or she is a Canadian resident.
What is an exception as defined by NIHB?
An exception is an item falling into an eligible category (e.g. prescription medication) that is not specifically listed as a benefit, but is not an exclusion. Exception requests will be considered on a case-by-case basis upon receipt of written medical justification from the provider.
What is an exclusion?
For each benefit area, exclusions are those items specifically listed as being not eligible for coverage. In addition, any item that is not part of a category covered by the NIHB Program is an exclusion because it is a non-benefit.
Exclusions will not be covered by the NIHB Program under any circumstance, are not available through the exception process and may not be appealed. Examples of items that are excluded are those used exclusively for sports or work, are for cosmetic reasons or are experimental.
Is there an appeal process when a benefit has been denied?
Yes. An NIHB client, parent, legal guardian or representative may initiate an appeal when a benefit has been denied by the NIHB Program. There are three levels of appeal available. Visit appeal process for details.
How does NIHB respect my privacy?
Health Canada's Non-Insured Health Benefits Program is committed to protecting clients' privacy and safeguarding the personal information in its possession. When a benefit request is received, the NIHB Program collects, uses, discloses and retains an individual's personal information according to the applicable federal privacy legislation.
Where can I obtain further information about the NIHB Program?
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