NIHB | 2SQTP-NB

Non-Insured Health Benefits for First Nations and Inuit Peoples

While some patients who are Indigenous have access to NIHB coverage, others do not, and this is a conversation that needs to be navigated with care. Many patients will already know whether they are covered, however for those who are unsure, please see Patient Eligibility.

NIHB covers a variety of costs, not only with general health, but also costs associated with things such as gender-affirming garments, hormone prescriptions, travel for appointments, and most mental health services. In all cases, while prior approval may not be necessary, it is recommended for direct billing and to ensure coverage for the client.

We have broken down specific items and coverage that clients may benefit from below, however for those who are looking for more information about the program:
General Information

NIHB Drug Benefit List

Contact Information

Medical Supplies and Equipment Guide and Benefits List

Express Scripts Billing

Prior Approval Forms (Express Scripts)

NIHB Client Reimbursement and Escript Submission for Clients

Patient Eligibility

Many government forms and prior approvals are not user-friendly, and patients may appreciate support in navigating forms. It should be noted that status cards have an expiry date, and patients will not be covered through NIHB after this date unless they reapply.

To be eligible, a client must be a resident of Canada, and identify as one of the following:

Registered First Nations must be registered Indian according to the Indian Act.
An Inuk recognized by one of the Inuit Land Claim Organizations.
A child that is less than two (2) years old, whose parent is an eligible client (Special Provision for First Nations and Inuit Children under Two Years Old).

To facilitate claim verification, patients will need the following information:

Surname (under which the Client is registered).
Given names (under which the client is registered).
Date of birth (date format YYYY-MM-DD).
Client identification number

One of the following identifiers is required for recognized Inuit Clients:

Government of the Northwest Territories (GNWT) Health Plan Number: Inuit Clients from the Northwest Territories may present a health plan number issued by the GNWT. This number is valid in any region of Canada and is cross-referenced to the NIHB client identification number. This number begins with the letter T and is followed by seven (7) digits.

Government of Nunavut (GNU) Health Plan Number: Inuit Clients from Nunavut may present a health plan number issued by the GNU. This number is valid in any region of Canada and is cross-referenced to the NIHB client identification number. This is a nine (9) digit number starting with a one (1) and ending with a five (5).
NIHB Client Identification Number (N-Number): This is a client identification number issued by NIHB to recognized Inuit clients. This number begins with the letter N and is followed by eight (8) digits.
The NWT/NU Health Care card or Government of Canada NIHB N-number letter (ISC or Government of Canada letterhead) identifying the individual and accompanied by picture identification is sufficient identification for clients.

One of the following identifiers is required for registered First Nations Clients:

Registration number: This is a 10-digit number, issued by the Government of Canada (issued by the Indian Registrar of ISC) to clients registered under the Indian Act. It is commonly called a status card. The registration number is the preferred method of identifying First Nations Clients.

NIHB Client identification number (B-number): In specific and exceptional cases, some First Nations Clients may have numbers issued by NIHB. This number begins with the letter B and is followed by eight (8) digits.

Transition-Related Coverage

Non-Medical Transition (Self-Care)

Note that prescriptions or recommendations for gender identity items require an indication of diagnosis of gender dysphoria, and prescriptions or recommendations are required for the initial benefit request only.

Gender-Affirming Hormone Therapy (Hormones and Synthetic Substitutes)

All testosterone-based GAHT recommendations in the education package are covered by NIHB. All estrogen-based and progestin GAHT recommendations in the education package are covered by NIHB.

Post-Surgery (Self-Care and Medical Surgical Equipment and Supplies)

The following items may be helpful for patients recovering from surgery.

There may also be a number of items available for coverage that can help post-surgery under the category 13.4 Wound Care. It should be noted that this has not been confirmed to be successful for patients, and needs to be further researched. Furthermore, it would require coordination with the surgeon to know their after-care recommendations. That said, if successful, it can cover adhesives, dressings, bandages, compression bandages, adhesive remover, and gloves. See Prior Approval Requirements. See also Wound Care Assessment Form.

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Other Coverage

Medical Transportation

Transportation (as well as lodging and food) may be covered for eligible patients when they are accessing “medically necessary health services” which are unavailable on reserve or in their community of residence.

Medically necessary health services” include:

Medical services (defined as insured services by provincial or territorial health plans, such as appointments with physicians or hospital care
Services covered by provincial or territorial health plans such as diagnostic tests or medical treatments
Alcohol, sovent, drug abuse, and detox treatments
Traditional healers
Non-insured health benefits such as vision, dental, and mental health counselling

Medical transportation benefits may include:

Travel costs, such as bus, airline, or private vehicle
Living expenses, such as meals and accommodations
Emergency transportation, such as ambulance by air or ground
May also include coverage for an aide or escort to travel with you under certain conditions
In some cases the program may cover travel costs to bring health professionals into isolated communities to deliver health services

These costs may be covered for eligible clients when coverage is not available under other federal, provincial, territorial, or private health insurance. General information above was found here, while more specific stipulations are found here. It should be noted that there are many details involved to be sure that the patient will be covered, as such, we strongly recommend that coverage is thoroughly verified before patients make arrangements for travel to ensure they will have coverage.

Mental Health Counselling

Mental health counselling does not require a prescription from a primary care provider, however it is helpful for PCPs to understand the coverage that their patients are entitled to, especially for those who require a WPATH letter from a mental health provider.

Counselling can be covered for eligible patients when they are seeing an eligible provider who is already registered with NIHB, and claims are often submitted directly to NIHB. Every 12 months patients are eligible for up to 20 hours of counselling, with the first two assessment hours not requiring prior approval, to a maximum of $150 per hour. Providers can apply for more coverage after the 22 hours which is at the discretion of NIHB. While we are unaware of an extension being rejected, it is a possibility that should be kept in mind.

It should also be noted that Indigenous patients within the Atlantic provinces who are not eligible for NIHB coverage may be able to apply for mental health services through the MW directorate, which covers IRS, MMIWG, and IDS survivors and family members, if they are seeing a therapist registered through the MW directorate. As there is a lot of trauma associated with whether patients would qualify under these circumstances, conversations letting patients know it may be a possibility should be conducted with care. If eligible, this covers up to 60 hours of mental health counselling per year (at a maximum of $150/hour), with the first two assessment hours not requiring prior approval, and does not require the patient to have a status number. Similar to coverage mentioned above, providers can apply for an extension of coverage past the 60 hours if needed within a given year. While we are unaware of an extension being rejected, it is a possibility that should be kept in mind.

Reimbursement

Where patients will need to pay up front, it is recommended that:

Patients receive a prescription for the item/service from their PCP
Patients confirm coverage
1. Whether coverage is available
2. Whether prior approval is required
3. The maximum amount covered within a given time frame
For medical transportation benefits
1. Fill out the Medical Transportation form
2. Submit to regional office (determined by where the patient is from)
For all other benefits
1. Create an account and submit online through Express Scripts, or fill out the NIHB Client Reimbursement Form which can be submitted online or by mail.

We are excited to announce that we will be partnering with TransCare+ in 2024! Once our resources are integrated there, this website will direct route you to our space on their website, where you will continue to be able to access our content.