Vision Care Provider Agreement Health Canada Non-Insured Health Benefits (NIHB) Program

This Agreement sets the terms and conditions for submitting invoices to Health Canada for vision services to clients who are eligible for NIHB coverage. NIHB vision care services shall only be provided by a professional who is licensed/certified, authorized, and in good standing with the regulatory body of the province/territory in which they practice and who has entered into an Agreement with NIHB.

  • New Provider Agreement
  • Update Existing Provider Information

Business Information

Name of Provider (Company, Organization or Sole Proprietor):

Provider Operating Address

  • Street number and name:
  • City:
  • Province/Territory:
  • Postal Code:
  • Phone Number:
  • Fax Number:
  • Email:

Preferred means of communication

  • Mail
  • Fax
  • E-mail

At times, Health Canada may enter into contracts with a vision care provider for the purpose of providing on-site vision clinics in First Nations or Inuit communities in accordance with prevailing Health Canada fee schedules, travel reimbursement rates and policies. Would you be interested in being considered for such an arrangement? If you check this box, you may be contacted to discuss this further.

Professional Information (add another sheet for additional professionals billing under this Provider)

Attach evidence of current registration with regulatory body.

Type of Professional

  • Optician
  • Optometrist
  • Ophthalmologist

Name:

Professional Registration Number:

Type of Professional

  • Optician
  • Optometrist
  • Ophthalmologist

Name:

Professional Registration Number:

Terms and Conditions

  1. The provider shall adhere to the terms and conditions in the NIHB Vision Care Policy Framework and Vision Care Benefit List as updated from time to time and posted on Health Canada's website when submitting invoices to Health Canada.
  2. The provider agrees that, in cases when a client has any alternate health plan (public or private) for which a benefit is payable, the claim should be submitted to the other plan prior to submitting it to the NIHB Program. NIHB will not pay for services that are insured under any provincial or territorial health plan.
  3. Vision care benefits shall only be provided by a professional as noted in the NIHB Vision Care Policy Framework in compliance with all applicable laws and regulations governing their profession, including the possession of all required licenses, certificates, permits, clinical record keeping and liability insurance that are necessary to allow them to lawfully provide vision exams and/or dispensing of eyewear.
  4. The provider shall ensure that the information in this agreement, including any attachments, is accurate, complete and up-to-date. The provider agrees that Health Canada may validate registration with the applicable regulatory body at any time. The provider will immediately notify Health Canada if its professional registration status is suspended or terminated.
  5. The provider agrees that Health Canada may request supporting documentation to audit or review any invoices submitted to Health Canada for payment to ensure compliance with the terms and conditions of the NIHB Program. The provider agrees to cooperate with Health Canada in any such audit or review and to provide information as required, in accordance with applicable laws, regulations and professional standards.
  6. The provider understands that Health Canada may take action to recover amounts determined to have been inappropriately paid and/or overpaid.
  7. The provider is not providing services to Health Canada and it is not a service contractor to Heath Canada. The provider shall not represent itself as an agent or representative of Health Canada in any publicity or marketing.
  8. Either the provider or Health Canada may terminate this agreement at any time without cause.

Provider signature (NO STAMPS)

Name of person signing (please print):

Title or Position:

Phone Number:

Date (YYYY-MM-DD):

Privacy Notice

The personal information you provide to Health Canada is governed in accordance with the Privacy Act. We only collect the information we need to administer the Vision Care benefits under the Non-Insured Health Benefits (NIHB) Program. Collection of information for this purpose is authorized under the Department of Health Act. We require your personal information to consider you for enrollment as a provider of these services. Your personal information may be disclosed without your consent, but only in accordance with subsection 8(2) of the Privacy Act. For more information: This personal information collection is described in Info Source, available online at infosource.gc.ca. The Personal Information Bank (PIB) is under development. In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. For more information about these rights, or about our privacy practices, please contact the Health Canada/Public Health Agency of Canada's Access to Information and Privacy (ATIP)  Coordinator at 613-954-9165 or atip-aiprp@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

For inquiries and/or mailing address, please refer to the Contact Information page.

Every entity that will be billing Health Canada in its own name as a provider must complete this form. For providers with more than one branch location, please complete one agreement per location.

Please complete this agreement in its entirety and return it to the Health Canada regional office serving your region, as noted below. Incomplete or unsigned forms will be returned unprocessed.

Please complete the enclosed form to provide payment information.

Contact Information

Alberta Region
Non-Insured Health Benefits, Health Canada
9700 Jasper Avenue, Suite 730
Edmonton, Alberta  T5J 4C3
Telephone: (780) 495-3302
Telephone (toll-free): 1-800-232-7301
Fax: (780) 420-1219

Saskatchewan Region
Non-Insured Health Benefits, Health Canada
2045 Broad Street, 1st Floor
Regina, Saskatchewan  S4P 3T7
Telephone (toll-free): 1-866-885-3933
Fax: (306) 780-7092

Manitoba Region
Non-Insured Health Benefits, Health Canada
391 York Avenue, Suite 300
Winnipeg, Manitoba  R3C 4W1
Telephone (toll-free): 1-800-665-8507
Fax: (toll-free): 1-800-289-5899

Ontario Region
Non-Insured Health Benefits, Health Canada
2720 Riverside Drive, AL 6604E
Ottawa, Ontario  K1A 0K9
Telephone (toll-free): 1-800-881-3921
Fax: (toll-free): 1-800-806-6662

Quebec Region
Non-Insured Health Benefits, Health Canada
202 - 200 René-Lévesque Blvd W, East Tower
Montreal, Quebec  H2Z 1X4
Telephone: (514) 283-1575
Telephone (toll-free): 1-877-483-1575
Fax: (toll-free): 1-855-244-4470

Atlantic Region (PEI, NS, NB, NL)
Non-Insured Health Benefits, Health Canada
1505 Barrington Street, Suite 1525
Halifax, Nova Scotia  B3J 3Y6
Telephone: (902) 426-2656
Telephone (toll-free): 1-800-565-3294
Fax: (toll-free): 1-800-377-9288

Northern Region (Northwest Territories and Nunavut)
Non-Insured Health Benefits, Health Canada
2720 Riverside Drive, AL 6604C
Ottawa, Ontario  K1A 0K9
Telephone (toll-free): 1-888-332-9222
Fax: (toll-free): 1-800-949-2718

Northern Region (Yukon Office)
Non-Insured Health Benefits, Health Canada
300 Main Street, Suite 100
Whitehorse, Yukon  Y1A 2B5
Telephone: (867) 393-3800
Telephone (toll-free): 1-866-362-6717
Fax: 1-867-667-3999

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