Non-Insured Health Benefits (NIHB)

About the program

The Non-Insured Health Benefits (NIHB) program provides registered First Nations and recognized Inuit with coverage for a specified, nationally consistent range of health benefits not otherwise covered through:

provincial or territorial health insurance private insurance plans other publicly-funded plans or programs The NIHB program is part of a broader system of federal, provincial and territorial health programs and services contributing to the health of Indigenous people in Canada. For more information on the health system, see Indigenous Health Care in Canada.

What the program covers

Indigenous Services Canada’s NIHB program provides eligible clients with coverage for medically necessary goods and services, in the following benefit areas:

pharmacy vision care dental care mental health counselling medical supplies and equipment medical transportation to access medically required health services not available: on reserve in the community of residence Health benefits and services are listed as eligible based on medical evidence for their effectiveness. Health services outside of the benefit areas listed above are not covered by the NIHB program.

Benefit claims

Eligible clients need to show client identification to access their coverage. Prior approval may be required.

Health benefit providers are encouraged to enrol with the NIHB program so they can submit claims directly for eligible benefits provided to clients. This avoids clients having to cover costs upfront. Health benefit providers can visit Express Scripts Canada for information on enrolment, claims submission and payment.

Contact the NIHB regional office or your community for information on medical transportation benefits.

Clients who pay providers directly for eligible benefits may submit claims to NIHB using the client reimbursement process.

Working with partners

The NIHB program works with First Nations and Inuit partner organizations at the national and regional levels to share program and benefit information, identify areas for improvement and obtain input and guidance.

Indigenous Services Canada is working with the Assembly of First Nations on a joint review of the NIHB program.

The department also facilitates First Nations and Inuit control of the program at a time and pace of their choosing, by working with Indigenous partners to fund the provision of benefits through contribution agreements, as well as through broader health transformation projects and as part of self-government agreements.

Who is eligible

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

• a First Nations person who is registered under the Indian Act (commonly referred to as a "Status Indian")
• an Inuk recognized by an Inuit land claim organization as outlined in Inuit client eligibility for the NIHB program
• a child less than 2 years old whose parent is an NIHB-eligible client

To make sure that your child continues to be eligible for the program, you should apply as soon as possible for your child's:

• Indian status

OR;

• recognition from your Inuit land claim organization

Providers who have enrolled with NIHB (through the program's third party claims processor, Express Scripts Canada) are encouraged to submit claims directly, for services provided to NIHB clients, so that clients do not pay for eligible benefits at the point of service.

For clients to access benefit coverage, show your health care provider your client identification to confirm your eligibility with the program. Be sure to ask if the provider will be able to submit the claim for payment directly to Express Scripts Canada.

Coverage is available only for eligible goods and services obtained in Canada.

Some clients receive their health benefit coverage directly from a First Nations or Inuit government, community or health authority. This applies to:

• those served under self-government agreements or other arrangements, including Nisga'a (BC), Nunatsiavut (NL), Nunavik Inuit or James Bay Cree (beneficiaries living in the land claims region), and First Nations residents of BC who are clients of the First Nations Health Authority
• Bigstone Cree Nation (AB), which manages all NIHB benefits for their members
• Akwesasne (ON), which manages most NIHB benefits for their members
• clients served by other First Nations and Inuit communities or organizations that deliver some or all NIHB benefits directly to community members under a contribution agreement