Appealing a decision under the NIHB Program – 5. Submit an appeal for other eligible benefits

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5. Submit an appeal for other eligible benefits

Other eligible benefits for appeal include:

  • vision care
  • medical transportation
  • medical supplies and equipment
  • mental health counselling

When you appeal any of these benefits, the documents you provide must include the:

  • condition for which the benefit is being requested
  • diagnosis and prognosis (including what other options have been tried)
  • relevant test results
  • reason for the proposed treatment
  • any additional supporting information, such as case notes from your health provider

Where to send your appeal

You must mail all documents to the Non-Insured Health Benefits (NIHB) Program (see below level of appeal for mailing instructions)
in a double-envelope:

  • The inner envelope should contain the appeal letter and supporting documents. It should be sealed and have "APPEAL-CONFIDENTIAL" clearly written on the outside. It should then be placed inside a second envelope.
  • The outer envelope should be addressed to the appropriate regional office.

Email requests will not be accepted, to ensure client confidentiality.

Your letter of appeal and supporting documents are to be addressed to a different program official at each appeal level. The information will be reviewed at each level by a different health professional that will provide recommendations to the Program.

Services that are identified as exclusions under the NIHB Program will not be considered for appeal.

Level 1 appeal

To begin the appeal process, you must address all documents to the Regional Manager, NIHB Program.

Level 2 appeal

You may choose to have the appeal reviewed at the level 2 stage if:

  • you do not agree with the level 1 appeal decision
  • there is new information available for review since the last appeal

The submission should include any additional or new supporting information from your health service provider or prescriber. You must address all documents to the Regional Executive, First Nations and Inuit Health Branch.

Level 3 appeal

You may choose to have the appeal reviewed at the final level 3 stage if:

  • you do not agree with the level 2 appeal decision
  • there is new information available for review since the last appeal

The submission should include any additional or new supporting information from your health service provider or prescriber. You must address all documents to the Director General, NIHB Program headquarters.

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