NIHB Handbook (PDF) - First Nations Health Directors Association

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Addictions Treatment Other medically necessary health services • y Travel for the treatment of alcohol, drug, and solvent abuse. • y Travel will be covered to the closest appropriate National Native Alcohol and Drug Abuse Program (NNADAP) funded/referred facility in the home province/territory (some exceptions for out-of-province). • y Clients are to meet all treatment centre entry requirements prior to medical transportation being authorized. • y Travel by the most economical and practical means. • y Transportation for family members when their participation is an integral and scheduled portion of the treatment program and approved prior to treatment. • y Transportation will not be provided if the client discharges themselves from treatment against advice from the treatment centre counsellor, before completing the program. An exception may be considered with proper justification in some circumstances and approval by the Health Canada regional office. • y Travel to medical services defined as insured services by provincial/ territorial health plans (e.g., appointments with physician, hospital care). • y Diagnostic tests and medical treatments covered by provincial/ territorial health plans. • y To access other NIHB approved benefits (vision, dental and mental health). Remember 1. The rules about what is covered may vary by region depending upon provincial/territorial insured services. 2. Prior approval is needed to access any medical transportation benefit under the NIHB Program. General Principles 1. Clients must have prior approval to access medical transportation benefits. 2. In emergency situations, when prior approval has not been obtained, expenses may be reimbursed (Required: appropriate medical justification and approval after the fact). 3. Clients must provide proof or confirmation from the health care provider or representative that they have attended the appointment. 18 Your Health Benefits n A GUIDE FOR FIRST NATIONS TO ACCESS NON-INSURED HEALTH BENEFITS
4. When a client does not attend a scheduled appointment and medical transportation benefits have been provided, the client may be required to assume the cost of the return trip or of the next trip to access medically necessary health services unless justification is provided to explain why the client was unable to attend or notify the appropriate public carrier of the cancellation. 5. This benefit may be provided when the client is referred by the provincial/territorial health care authority for medically necessary health services to a facility outside of Canada when such services are covered by a provincial/territorial health plan. See Approved Health Benefits Outside of Canada, Section 7. Exceptions (May be considered on an exceptional basis with justification.) ■■ ■■ ■■ ■■ ■■ Diagnostic tests for educational purposes (e.g., hearing tests for children required by the school). Speech assessment and therapy, when coordinated with other approved NIHB medical travel to a provincially/territorially insured service. Medical supplies and equipment benefits where a fitting is required and cannot be made on the reserve or in the community of residence. Transportation for methadone ingestion may be covered for up to four (4) months. Extension with medical justification may be considered. Provincially/territorially supported preventative screening programs when coordinated with other medical travel and the cost of testing is covered under the provincial/territorial health plan. What is not covered / Exclusions Certain types of travel, benefits and services will not be covered under the NIHB Program under any circumstances and are not subject to the NIHB appeal process. These include: ■■ ■■ ■■ ■■ Travel and related benefits (e.g., meals and accommodation, ambulance) where they are the responsibility of another party or provided as an insured service. Compassionate travel (e.g., family visits unless prior approval has been obtained as a part of the treatment plan at a drug and alcohol rehabilitation facility). Travel for clients in the care of a federal, provincial or territorial institution (e.g., incarcerated clients). Court-ordered treatment/assessment, or as a condition of parole, coordinated by the justice system. Your Health Benefits n A GUIDE FOR FIRST NATIONS TO ACCESS NON-INSURED HEALTH BENEFITS 19
Page 1 and 2: Your Health Benefits A Guide for Fi
Page 3 and 4: NON-INSURED HEALTH BENEFITS (NIHB)
Page 5 and 6: THE ASSEMBLY OF FIRST NATIONS HEALT
Page 7 and 8: Replacement eyeglasses/ lenses Eyeg
Page 9 and 10: What is not covered / Exclusions
Page 11 and 12: Preventive services Scaling (cleani
Page 13 and 14: Orthodontic services (braces) Oral
Page 15 and 16: ■■ Predetermination requests re
Page 17 and 18: 3. MEDICAL TRANSPORTATION BENEFITS
Page 19: Escorts (General) Criteria for Esco
Page 23 and 24: 4. DRUG BENEFITS What is covered? W
Page 25 and 26: Who can prescribe drugs? ■■ ■
Page 27 and 28: General Principles 1. Eligible bene
Page 29 and 30: 6. SHORT-TERM CRISIS INTERVENTION M
Page 31 and 32: 7. APPROVED HEALTH BENEFITS OUTSIDE
Page 33 and 34: 8. PROCEDURE FOR APPEALS An eligibl
Page 35 and 36: Appeal for Dental, Medical Supplies
Page 37 and 38: 9. PROTECTING YOUR INFORMATION The
Page 39 and 40: 10. REGIONAL NAVIGATORS ARE HERE TO
Page 41 and 42: Northern Region Non-Insured Health

NIHB Handbook (PDF) - First Nations Health Directors Association

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