Non-insured Health Benefits program joint review
The Government of Canada is engaged in a multi-year joint review of the NIHB program, in partnership with the Assembly of First Nations (AFN). The objectives of the review are to identify and implement actions that enhance client access to benefits, identify gaps in benefits, and streamline service delivery to be more responsive to client needs. This work is ongoing and NIHB is committed to working with partners to continuously improve the program for clients.
The joint review is overseen by a steering committee comprised equally of First Nations and Indigenous Service Canada (ISC) representatives, and guided by an Elder. First Nations representatives are nominated through an AFN led process and selected based on their expertise on NIHB and client experiences. First Nation committee members include representatives of the Chiefs Committee on Health (CCOH), the National First Nations Health Technicians Network (NFNHTN), and regional NIHB Navigators.
Many changes and improvements have been made by the NIHB program throughout the joint review to date, including those listed below, and this work continues.
If you have additional feedback on the NIHB program, please contact us. For the most recent updates on NIHB coverage, visit the program updates page or subscribe to receive NIHB program updates directly, via email.
On this page
2023
Pharmacy benefit changes
- NIHB added 477 items (DINs) including 34 new medications for treatment of conditions such as arthritis, allergies, ADHD, cancer, cardiac disease, eczema, migraines and seizures
- NIHB listed Rybelsus, an oral diabetes medication, as a limited use benefit on December 22
- Clients 60 years of age and older are now covered for the Shingrix vaccine without prior approval
Medical supplies and equipment benefit changes
- NIHB now lists hospital beds and accessories as limited use benefits. Prior approval is required. Examples of benefits covered include electric hospital beds, bariatric bed mattresses and pressure relief mattresses
- NIHB added new coverage for oxygen supplies. Rental of a low flow oxygen meter is now covered with prior approval. Oxygen connectors and adapters are covered without prior approval, within program frequency guidelines
- NIHB expanded low vision benefits to include low vision aids, orientation and mobility aids, assistive technology, functional assessments and training programs
- NIHB now accepts recommendations from Registered Respiratory Therapists (RRT) for coverage of certain equipment and supplies
- NIHB removed the prior approval requirement for coverage of specialized crutches, tub transfer boards, toilet tissue aids and positioning wedges (within program frequency guidelines)
Dental benefit changes
- NIHB removed the predetermination requirement for coverage of surgical tooth extractions, prefabricated posts and initial placement of standard complete dentures (replacement dentures were already covered without predetermination)
- NIHB lifted program frequency guidelines for coverage of standard root canal treatments (no predetermination required)
- NIHB-enrolled providers can now submit predetermination requests for dental and orthodontic services online through secure web accounts
Vision care benefit changes
- NIHB increased covered of general eye exams for clients 65 years and older. These are now covered every year (previously every 2 years) when not covered by a provincial or territorial plan
2022
Pharmacy benefit changes
- NIHB added 656 items (DINs) including 40 new medications for treatment of conditions such as asthma, migraine, osteoporosis, psoriasis, diabetes, cystic fibrosis, HIV, cancer, heart disease and Parkinson's disease
- NIHB increased coverage for Champix (330 tablets per year, increased from 165) and Zyban (360 tablets per year, increased from 180) for smoking cessation
- NIHB now provides coverage on a case-by-case basis for medications used for assisted fertility treatments
Medical supplies and equipment benefit changes
- NIHB expanded eligibility for hearing aids to cover adults with a wider range of hearing loss
- NIHB streamlined the process for replacement of hearing aids for adult clients
- NIHB added new recognized prescribers for low vision aids and eye prosthesis and added coverage for eye conformers
- NIHB added coverage for specialized feeding bottles and teats for children with complex feeding needs
- Some temporary changes made by NIHB during the COVID-19 pandemic became permanent, including coverage for oral digital thermometers (up to $16, every 5 years) and for virtual audiology services (if offered by the provider)
Communications and Client Support
- To allow time for parents to register their children for First Nation status or with their Inuit land claim organization, NIHB now covers unregistered children up to 2 years of age if they have a parent or guardian who is NIHB eligible
2021
Pharmacy benefit changes
- NIHB added 63 new medications and products for treatment of conditions such as:
- arthritis
- dermatitis
- deep vein thrombosis
- prostate cancer
- opioid use disorder
- New listings include 18 medications for rare diseases as limited use benefits (prior approval required). Previously covered on an exception basis, these are now listed benefits with coverage criteria
- NIHB listed Shingrix, a vaccine to prevent shingles, as a limited use benefit. Prior approval is not required for clients between 65 to 70 years of age
- Shingrix is also covered for clients in cancer treatment, and may be covered on exception for clients with other serious health conditions that weaken their immune system
- NIHB listed the Dexcom G6 continuous glucose monitoring system as a limited use benefit for children 2 to 19 years of age on intensive insulin
Dental benefit changes
- NIHB expanded coverage for crowns to include second molars, whether the first molar is present or not, if all other coverage criteria are met
Medical supplies and equipment benefit changes
- NIHB now accepts recommendations from Licensed Practical Nurses and Registered Practical Nurses for certain MS&E items on the respiratory, self-care, medical surgical, and mobility equipment benefit lists
- NIHB launched the Medical Supplies and Equipment and Vision Care Advisory Committee to provide expert advice and recommendations to the Program regarding benefit coverage
- NIHB now covers adhesive suture strips as an open benefit. Prior approval is no longer required within program price and frequency guidelines
Medical transportation benefit changes
- NIHB implemented an increase of 25% for commercial meal allowance rates from:
- $48 to $60 per day for destinations south of 60
- $56 to $70 for destinations north of 60
- rates may differ where medical transportation is managed by the territorial government
2020
Pharmacy benefit changes
- NIHB added 21 new medications and products for treatment of conditions such as:
- rheumatoid arthritis
- chronic obstructive pulmonary disease
- type 2 diabetes
- eczema
- opioid use disorder
- NIHB changed the listing status of numerous oral diabetes medications to open benefit with no prior approval required
- NIHB launched a new and improved online drug benefit list. Updated daily, it allows clients and prescribers to easily search NIHB drug benefits and coverage criteria
Dental benefit changes
- NIHB added coverage for topical antimicrobial treatments such as silver diamine fluoride
- clients under 17 years are eligible for 3 applications in 12 months
- clients 17 and older are eligible for one application in 12 months
Medical supplies and equipment benefit changes
- NIHB added new coverage for augmentative and alternative communication face-to-face equipment and accessories, used to supplement or replace natural speech when clients have a significant speech impairment. These include:
- speech generating devices (SGD)
- communication display boards and software
- wheelchair mounting and access equipment
Communications and client support
- Express Scripts Canada now processes claims for NIHB pharmacy, dental, MS&E, vision and mental health benefits
- New services for NIHB clients provided by Express Scripts Canada include a national call centre and personal client web accounts for online claims submission and access to claims history
2019
Pharmacy benefit changes
- NIHB added 124 new medications and products for treatment of conditions such as:
- multiple sclerosis
- type 2 diabetes
- HIV
- eczema
- opioid use disorder
- chronic obstructive pulmonary disease
- Coverage for blood glucose test strips and lancets for clients who manage their diabetes with insulin was increased to 8 per day of each item
- NIHB established the Nutrition Products Formulary for clients with a medical need for products like:
- thickening agents
- infant formulas
- nutritional supplements
- These are limited use benefits, and include products for infants, children and adults
Dental benefit changes
- NIHB added coverage for all-porcelain/ceramic crowns
Medical supplies and equipment benefit changes
- NIHB added new types of health professionals to prescribe or recommend benefits within their scope of practice, including:
- chiropodists
- dietitians
- speech-language pathologists
- occupational therapists
- physiotherapists
- NIHB added new listings for limited use benefits including:
- medical strollers
- standing frames
- positioning seats
- ceiling lift and portable track
- FM systems
- cochlear implant and bone anchored hearing system processors
- voice restoration equipment
- 'back-up' manual wheelchair for clients using a power wheelchair
Vision care benefit changes
- NIHB implemented changes to coverage of corrective eyewear. New standard coverage amounts are based on prescription strength and can be used toward the purchase of any type of prescription eyewear
2018
Pharmacy benefit changes
- NIHB added 64 different medications for treatment of conditions such as:
- cancer
- diabetes
- hypertension
- psoriasis
- Naloxone nasal spray (Narcan) was listed as open benefit
Dental benefit changes
- NIHB increased coverage of fluoride treatment to include clients of all ages. Clients 17 years and older are eligible for one treatment in 12 months
- NIHB removed the predetermination requirement for mild sedation, such as nitrous oxide and oral sedation
- NIHB increased provider fees for orthodontic services, and created a new tool that makes it easier for providers to submit cases for predetermination of coverage
Medical supplies and equipment benefit changes
- NIHB added new benefit coverage for:
- electronic blood pressure monitors
- completely-in-canal hearing aids
- nipple shields for nursing mothers
- various items to support gender identity
- NIHB listed new limited use benefits including
- commodes
- offloading diabetic walking boots
- orthosis for club foot
- oxygen conserving devices
- NIHB removed prior approval requirements for many bathing, toileting, transfer and mobility aids, as well as numerous off-the-shelf limb and body orthotics (for example, splints, braces), within program price and quantity guidelines
Communications and client support
- NIHB extended coverage for unregistered infants up to 18 months of age to give parents more time to apply for their child's status number
- The NIHB Drug Exception Centre (DEC) now takes calls from clients related to medication benefits, and received over 7,000 client calls in 2018
2017
Pharmacy benefit changes
- NIHB added 35 different medications, for treatment of conditions such as:
- asthma
- ADHD
- type 2 diabetes
- various types of cancer
Dental benefit changes
- NIHB reviewed preventive dental benefits and increased coverage for sealants and preventive resin coatings. Coverage for these services now includes bicuspids and is provided for clients age 17 years and under
Medical supplies and equipment benefit changes
- NIHB added new types of hearing aids as eligible benefits
- NIHB increased coverage for intermittent disposable urinary catheters to 4 per day and removed the prior approval requirement
Mental health counselling benefit changes
- New funding was announced for the introduction of traditional healer services through projects to be developed and delivered by First Nations and Inuit organizations
- Access to mental health counselling was expanded by removing the 'crisis' requirement to access benefits
Medical transportation benefit changes
- NIHB expanded coverage so all pregnant women who require transportation outside their community to deliver their babies are eligible for an escort
2016
Pharmacy benefit changes
- NIHB added 32 different medications, for treatment of conditions such as:
- epilepsy
- type 2 diabetes
- osteoarthritis
- chronic obstructive pulmonary disease
- NIHB added coverage of Naloxone for treatment of opioid overdose, and simplified the process for coverage of Suboxone to treat opioid use disorder
Dental benefit changes
- NIHB increased coverage for partial plastic dentures to be eligible for replacement every 5 years (instead of 8)
- NIHB established an advisory body of oral health professionals to provide independent expert advice about dental benefits and oral health for NIHB clients. The committee includes First Nations and Inuit dental professionals, and the AFN has an observer seat
- To increase access to preventive oral health care, dental hygienists can now submit claims to NIHB as independent providers (within provincial/territorial scope of practice)
- NIHB removed the predetermination requirement for standard root canal treatments (except for wisdom teeth)
Mental health counselling benefit changes
- NIHB added guidelines for coverage of group counselling
Vision care benefit changes
- NIHB added coverage of progressive lenses for close and distance vision correction
Communications and client support
- NIHB created a 'client enquiries' email address to increase options for clients to contact the program with questions or concerns
2015
Pharmacy benefit changes
- NIHB added 19 different medications for treatment of conditions such as hypertension and hepatitis C
- NIHB began accepting prescriptions from pharmacists for some medications where allowed by provincial or territorial legislation, including:
- some prenatal and women's health products
- smoking cessation aids
- allergy medications
Mental health counselling benefit changes
- The first 2 counselling sessions no longer require prior approval. A treatment plan is no longer required and approval may be provided for up to 20 sessions
- Coverage can be provided for counselling provided through tele-health, when acceptable to client and provider
Communications and Client Support
- NIHB Navigators have been hired in most regions. AFN hosts the NIHB Navigators Network to provide a forum for sharing information and connecting Navigators to key NIHB staff to answer questions and assist with client cases
- NIHB began sharing information through the Healthy First Nations and Inuit Facebook page. Topics have included:
- client eligibility and registration of children
- preventive dental and vision care benefits
- coverage of smoking cessation products
- coverage of prenatal vitamins