Non-Insured Health Benefits program updates

COVID-19: NIHB services continue

During the coronavirus outbreak, wait times at some call centres and for some services may take longer than usual. Details on temporary changes related to COVID-19, as well as regular program updates, can be found below.

Quick Links:

These updates give First Nations and Inuit clients the latest news on NIHB policies and benefit coverage.

October 2020

Pharmacy benefit information

Update on coverage of rituximab

  • Rituximab is a type of medication used to treat some autoimmune conditions. Previously, the only rituximab product reimbursed by NIHB was Rituxan
  • NIHB has recently listed a second rituximab product, Truxima
  • Truxima was approved by Health Canada as 'biosimilar' to Rituxan, which means that these medications work in the same way and have similar effectiveness
  • Adult clients with new prescriptions for a rituximab medication who meet NIHB's coverage criteria will be covered for Truxima (instead of Rituxan) for treatment of rheumatoid arthritis, granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)
  • Clients who are already taking Rituxan will continue to be covered for their current medication

Medical supplies and equipment (MS&E) information

  • The MS&E policy guide and benefits lists have been combined so that information about eligible benefits and coverage policies can be found together
  • The following MS&E coverage changes came into effect on October 7, 2020:

Dental benefit information

New coverage for preventive dental services

  • NIHB added new coverage for preventive dental services
  • Topical treatments such as silver diamine fluoride are applied to damaged areas on the surface of the teeth to prevent the progression of cavities
  • These are called remineralization or antimicrobial treatments, and are now covered by NIHB without predetermination:
    • 3 times per 12 months for clients under 17 years of age
    • once per 12 months for clients 17 and older

August 2020

Pharmacy benefit information

New pharmacy benefit listings

  • NIHB now covers 3 Voltaren Emulgel products for treatment of back, muscle or joint pain. Eligible products listed in the NIHB drug benefit list are covered without prior approval, up to 100 grams per month
  • NIHB recently listed triamcinolone hexacetonide, a steroid used to reduce swelling caused by a variety of health conditions including allergies, asthma or rheumatoid arthritis
    • The program now covers both injectable forms of the medication, triamcinolone hexacetonide and triamcinolone acetonide, as open benefits

Coverage of non-prescription pharmacy benefits recommended by pharmacists

  • NIHB now accepts a pharmacist's recommendation for coverage of any eligible non-prescription 'over-the-counter' pharmacy benefit
  • To be eligible for coverage, the item must be listed on the NIHB drug benefit list and within the pharmacist's scope of practice to recommend or prescribe
  • Previously, NIHB had a selected list of non-prescription items that could be recommended by a pharmacist. That list is no longer in effect, and is replaced by this new policy

New dose limit for gabapentin

  • For client safety, NIHB has changed the dose limit for coverage of gabapentin to 3600 milligrams per day, to a maximum of 30 days
  • Pharmacists should call the Drug Exception Centre if a client reaches the dose limit

Medical supplies and equipment information

New coverage for oral digital thermometers

  • During the COVID-19 pandemic, oral digital thermometers are listed as an open benefit with a price limit of $25 and a replacement guideline of 1 per 5 years
  • Thermometers are covered with a prescription from a physician or a nurse practitioner, or a written recommendation from a registered nurse or a pharmacist

Reminder: coverage of electric breast pumps

  • Electric breast pumps are a limited use benefit and prior approval is required for coverage. Criteria for coverage can be found in the MS&E guide and benefit lists
  • During the COVID-19 pandemic, electric breast pumps may be covered for purchase (instead of rental), once every 3 years at a maximum price of $275.00

Increased coverage for some communication and respiratory benefits

  • NIHB recently changed frequency guidelines for selected voice restoration products and supplies. Prior approval is required and the new frequency guidelines are:
    • puncture dilator: 1 per year
    • gel cap insertion system: 1 per year
    • plug insert: 2 per year
    • flushing device: 1 box per year
    • cleaning brush: 2 boxes per year
    • gel cap: 1 box per year
  • The replacement guideline for inlet filters has increased to 14 filters per year
    • Inlet filters are used with home positive airway pressure (PAP) devices and are covered as open benefits

July 2020

NIHB launches new claims processing system and services via Express Scripts Canada

NIHB is pleased to announce that new and improved claims processing services for clients and providers are now available through Express Scripts Canada.

About Express Scripts Canada

  • Express Scripts Canada is a private sector company that provides electronic claims processing services through a system that is tailor-made for NIHB
  • Express Scripts Canada has processed NIHB dental, pharmacy and medical supplies and equipment benefit claims since 2009
  • Express Scripts Canada now also provides claims processing services for vision care and mental health counselling benefits
  • Express Scripts Canada does not process any aspects of NIHB medical transportation benefits, which continue to be administered by NIHB through Indigenous Services Canada's regional offices, First Nations communities, or territorial governments (NWT and Nunavut)
  • NIHB maintains full responsibility for benefit coverage policies and decisions on client claims, and continues to review requests for benefits that require prior approval or predetermination
  • If you need assistance or more information about any services provided by Express Scripts Canada, contact the NIHB Client Call Centre at Express Scripts Canada from Monday to Friday between 6:30 a.m. and 8:30 p.m., Eastern Time, excluding statutory holidays

NIHB client web accounts

  • NIHB clients now have the option of creating a secure, web-based personal client account through the Express Scripts Canada NIHB website
  • By creating a secure NIHB client web account, clients can:
    • view their benefit claims history and status of pending requests
    • submit client reimbursement requests online
    • submit appeal requests online
    • receive NIHB communication directly by email
  • To create a web account:
  • If you need help with this process, you can contact the NIHB Client Call Centre at Express Scripts Canada
  • The creation of a web-based account is not mandatory
  • You can still correspond with NIHB or Express Scripts Canada by mail, fax or telephone

New client reimbursement process

  • Client reimbursement requests for the following will now be processed by Express Scripts Canada:
    • pharmacy
    • dental
    • medical supplies and equipment
    • vision care
    • mental health counselling benefits
  • The NIHB Client reimbursement page of the Express Scripts Canada NIHB website provides the form and instructions to submit client reimbursement requests, including what supporting documents are required for each benefit type
  • There are 3 ways to submit a client reimbursement request to Express Scripts Canada:
    • by mail
    • by fax
    • online through your new NIHB client web account
  • If you are submitting your client reimbursement request online through your NIHB client web account, you can send all documents electronically
  • A scanned copy or photo of supporting documents, such as receipts, can be accepted

New online drug benefit list

  • The NIHB drug benefit list is a listing of prescription and over-the-counter medications and products that are covered by NIHB
  • A new and improved online drug benefit list is now available on the Express Scripts Canada NIHB website. It is easier to search, and new listings are added right away
  • For best results, search medications or products by chemical name, for example, 'ibuprofen', not 'Advil'. You will get a list of results, with an option to View details to see listing status and criteria, if applicable, for each product
  • Please continue to contact the NIHB Drug Exception Centre for questions about pharmacy benefits

Please visit the Express Scripts Canada NIHB website for more information and to access these new features and services.

June 2020

NIHB to launch new claims processing system and services via Express Scripts Canada on June 29, 2020

  • NIHB is pleased to inform you that it will be launching a new claims processing system on June 29, 2020, through a contract with Express Scripts Canada
  • Express Scripts Canada has been providing claims processing services to the program for dental, pharmacy and medical supplies and equipment benefits since 2009
  • Vision care and mental health counselling benefit claims will also begin to be processed by Express Scripts' new system
  • Express Scripts Canada will not process medical transportation benefits, which continue to be administered by NIHB
  • Client reimbursement requests for pharmacy, dental, MS&E, vision care and mental health counselling benefits should be sent to Express Scripts, once the new system is launched
  • Express Scripts will provide the NIHB program and clients with a number of new tools and features, including:
    • online services, such as claims history and submission, through secure, web-based client and provider accounts
    • call centre support
    • an improved and accessible on-line drug benefit list, updated daily
  • Detailed information will be available on this page after the launch of the new system
  • Contact NIHB with any questions

May 2020

COVID-19 update #4

Medical transportation

  • NIHB continues to support clients who need transportation to access medically necessary appointments and services not available in their community
  • Health and benefit providers may resume some services that were cancelled or postponed, however re-opening plans are determined by provincial or territorial authorities
  • Contact your provider to find out what services are offered, and if appointments can be made or re-scheduled
  • Some First Nations and Inuit communities have restrictions on re-entry into the community after travelling, so you should check with your community health centre or health manager about any restrictions
  • If you are vulnerable due to age or health condition, talk to your health care provider for advice on travel to medical services. NIHB can cover private modes of transportation and accommodation, such as hotel, where necessary, and may be able to assist with temporary relocation to an urban centre for clients who have an ongoing need to attend essential medical appointments
  • Communities that deliver medical transportation services, such as medical vans, have been advised that expenses for increased cleaning and sanitization are eligible under their funding agreements with NIHB. This includes the costs associated with installation of plexi-glass shields between the drivers and passengers seats
  • Boarding homes have also been advised to take measures to support social distancing and increased infection-control practices
  • If you are staying in a hotel while on medical travel and food services are not available, NIHB will provide additional coverage for meal delivery charges of $7.00 per meal or $21.00 per day, per family or group of travellers

Pharmacy Benefit information

New pharmacy benefit listings

  • NIHB now covers the Trelegy Ellipta inhaler (fluticasone furoate/umeclidinium/vilanterol) as a limited use benefit for the treatment of chronic obstructive pulmonary disease (COPD). This is the first triple drug inhaler for treatment of COPD available in Canada
  • NIHB added open benefit coverage for Soliqua (lixisenatide + insulin glargine) and Adlyxine (lixisenatide) for treatment of type 2 diabetes. These injectable medications come in a pre-filled pen
  • Internalized Normalized Ratio (INR) monitors and supplies are now listed as limited use pharmacy benefits. INR monitors are used by patients who take warfarin (a medication used to thin the blood), to measure how quickly blood clots in their circulatory system

Medical Supplies and Equipment (MS&E) information

Increased coverage for feeding supplies

NIHB has increased coverage for the following items to 1 per day:

  • disposable feeding syringes
  • feeding pumps bag
  • gravity feeding bag
  • feeding delivery set

Changes to audiology benefit coverage

  • Invisible-in-canal hearing aids are now listed as limited use benefits (prior approval is required).
  • NIHB has expanded coverage of FM systems (a type of assistive hearing device) to include the following conditions:
    • permanent hearing loss in one ear
    • auditory neuropathy (where the ear does not transmit sound to the brain)
    • difficulty processing auditory information
  • Coverage for disposable batteries used in certain hearing devices has increased:
    • cochlear implant processors: 7 batteries per week
    • bone anchored hearing system processors: 3 batteries per week
  • NIHB now covers rechargeable batteries and chargers for hearing aids:
    • rechargeable batteries for hearing aids are covered once every 3 years
    • rechargeable batteries for cochlear implant processors are covered once per year
    • battery chargers are covered every 5 years

Coverage for laryngectomy and voice restoration products

  • Coverage for speaking valves (post-tracheostomy) has increased to 4 valves per year
  • Hands-free speaking valves (post-laryngectomy) are now listed as limited use benefits, with coverage for 1 box (set of 3 valves) per year
  • Cleaning supplies for these items are also covered

Please check the MS&E guide and benefit lists for more information and coverage criteria.

Reminder of prescription requirements for custom-made foot orthotics

  • A prescription from a health care provider is needed for coverage of custom-made foot orthotics. You should have the prescription before you visit an enrolled provider to be fitted for the item
  • A prescriber of custom-made foot orthotics could be a doctor, nurse practitioner or podiatrist
  • NIHB now accepts prescriptions from chiropodists for custom-made foot orthotics in provinces where this profession is regulated:
    • Ontario
    • Saskatchewan
    • New Brunswick

April 2020

COVID-19 update #3

Virtual dental consultation services

  • Due to the COVID-19 pandemic, dental providers have postponed non-emergency services
  • NIHB will temporarily cover fees for consultation services by phone or other virtual methods offered by dental providers to help them assess clients' needs and facilitate access to emergency dental care
  • Please contact your dental provider's office if you require emergency dental services

Virtual services and shipping for hearing devices

  • During the COVID-19 pandemic, NIHB will cover some services that can be provided through tele-audiology, if offered by the provider. This includes:
    • fitting and dispensing
    • hearing aid performance check and readjustment
  • If providers offer fitting and support services through tele-audiology, they can temporarily ship hearing devices directly to you, so you don't have to go to their office in person to pick up the item. This includes:
    • hearing aids
    • bone-anchored hearing system processors
    • replacement of cochlear implant processors
    • FM systems
  • Providers will program the hearing device according to client-specific needs before shipping, and contact you by telephone to provide the first fitting remotely
  • When providers begin offering in-person services again, they will contact you to schedule a follow-up visit to their office

Temporary coverage for electric breast pump purchase

  • Until further notice, the purchase of a double electric breast pump will be covered instead of a rental

Positive Airway Pressure (PAP) therapy

  • If a client infected with COVID-19 uses PAP therapy, this may increase the risk of transmission to others in the home
  • If you are in this situation, talk to your health care provider about the risks and benefits of continuing PAP therapy
  • Clients who have COVID-19 and continue PAP therapy can request additional supplies such as tubing, filters, and masks from the NIHB program

Information for parents and guardians of NIHB-eligible infant children

  • During the COVID-19 pandemic, there may be delays in registering an infant for First Nation status
  • In order to allow additional time for parents to register their infant children, NIHB has extended coverage of unregistered infants up to 24 months of age, until further notice
  • Infants up to 12 months of age can access most types of NIHB benefits under the identification number of their eligible parent or guardian. Contact the NIHB Dental Predetermination Centre if dental services are required
  • If your child has reached 12 months of age and is not registered, please call the NIHB Drug Exception Centre if pharmacy services are required. For all other benefits, call your NIHB regional office. You will be provided with a temporary NIHB client number that is valid until your child reaches 24 months of age

Reminder: changes in other coverage

  • Let NIHB know as soon as possible if you no longer have other health benefit coverage (for example, through an employer sponsored plan)
  • Contact your NIHB regional office, the Drug Exception Centre (for pharmacy benefits), or the Dental Predetermination Centre (for dental benefits)
  • NIHB will update your file right away to avoid delays in processing future claims

COVID-19 update #2

Pharmacy benefit information

Change to prior approval for certain medications
  • Prior approval for many limited use medications has been temporarily lifted
  • Pharmacists have been advised of this change and are asked to submit all NIHB client prescriptions electronically to see if the medication is covered as open benefit
  • The NIHB Drug Exception Centre (DEC) continues to process requests for prior approval, and can be reached at 1-800-580-0950
Pharmacist recommendation for fever and pain medications

NIHB covers a range of over-the-counter fever and pain medications with just a pharmacist's recommendation, so a prescription from a doctor is not needed:

  • Up to 100 tablets for adults and youth
  • One package of a chewable or liquid children's product

Medical supplies and equipment (MS&E) information

  • Health care providers are not NIHB employees. They determine how to prioritize services to their patients
  • Health services may cancel assessments to protect their staff, or because health professionals are urgently required in other areas
  • Clients are encouraged to contact their MS&E provider to confirm store hours, benefit availability and make arrangements for delivery
Temporary changes for replacement of select medical equipment or supplies
  • If you are unable to see your prescriber to get a new prescription for the replacement of equipment or supplies, your MS&E provider may use the existing prescription on file for the replacement of:
    • limb and body orthotics
    • custom made shoes and orthotics
    • medical grade compression stocking
    • mobility equipment
    • incontinence and ostomy supplies
    • self-care benefits (such as lift, transfer equipment, urinal)
  • Quantities above the current recommended replacement guidelines may be requested without medical justification, if required due to circumstances caused by the COVID-19 outbreak
Oxygen benefits
  • The requirement for testing (ABG and oximetry) is not required for clients applying for 9 month, 1 year or yearly renewal for coverage of home supplemental oxygen such as:
    • concentrators
    • portable cylinders
    • homefill systems
    • portable oxygen concentrators
  • Your provider may contact you by telephone to obtain an update of your condition and the respiratory equipment in the home
  • Initial requests for supplemental home oxygen continue to require testing results. The requirement for an ABG test is waived. Either oximetry or ABG testing is acceptable
Respiratory benefits
  • For CPAP and BPAP benefits, purchase will be approved without a trial in situations where a prescription and diagnostic testing with physician interpretation are provided.
  • Your provider will inform you if you are eligible
Communication benefits
  • Communication benefits include items such as:
    • voice prosthesis
    • speaking valve
    • laryngectomy supplies
  • No prescription will be required for renewal requests if the provider has a prescription on file
  • Additional items can be approved without medical justification if you require greater access to these supplies due to a change in your condition, such as, due to respiratory infection
  • Orders can be made at:

Please contact your NIHB regional office if you have questions about MS&E benefits.

Renewal of Indian status card and NIHB client eligibility

  • Service providers require your NIHB client identification number to submit a claim. If you are a registered First Nations person, providers may ask to see your Indian status card because your Indian status registration number is also your NIHB client identification number
  • Due to the COVID-19 outbreak, you may experience challenges or delays in renewing your status card as band offices may be closed. You can still apply for a Secure Certificate of Indian Status by mail. Consult Indian Status
  • Eligible NIHB clients should not be denied services because their status card has expired
  • Service providers can still use your status number to verify your eligibility when submitting NIHB claims
  • To verify client eligibility, providers can call Express Scripts Canada for dental, pharmacy and MS&E benefits. For all other benefits, contact the NIHB regional office

Service standards and processing times

  • Until further notice, usual program service standards no longer apply for processing of dental predetermination and appeals. Adjudication of prior approval requests for other benefits may take longer than usual
  • Wait times at the NIHB Drug Exception Centre, Dental Predetermination Centre and NIHB regional call centres may be longer than usual

March 2020

COVID-19 pandemic updates

The NIHB program is continuing to provide benefits and services while following public health guidance and recommendations from health professionals as the situation evolves.

The NIHB Drug Exception Centre, Dental Predetermination Centre and regional call centres continue to operate and receive calls from providers and clients. Please note that wait times may be longer than usual, and we appreciate your patience.

The NIHB program normally covers up to a 100-day supply of chronic medications. In determining the quantity to refill for clients, pharmacists will consider advice from professional associations and regulatory bodies, as well as patient-specific factors. If a client is seeking an early refill (before 2/3 of their medications are used), the pharmacist may submit the claim with an over-ride code, and NIHB will reimburse. However, it is the pharmacist's decision to provide early or longer refills.

NIHB clients are encouraged to consult with their health or benefit service provider to confirm whether routine, non-urgent appointments should be postponed.

Dental professional organizations across Canada have advised that non-emergency services should be postponed. Call your dental provider's office to see if any scheduled dental appointments have been cancelled.

You may contact your mental health service provider to confirm whether they can provide counselling services via telephone (tele-mental health services by eligible providers are covered by the NIHB program).

NIHB is continuing to support clients who need medical transportation benefits to access urgent or essential medical services. Vulnerable clients will be supported by prioritizing private modes of transport. Additional guidance has also been provided to support external service providers (such as boarding homes and airlines) for infection prevention/control.

As the situation evolves, information will be provided through NIHB call centres and posted online.

For the latest information on COVID-19 guidance:

February 2020

Pharmacy benefit information

Updated Drug Benefit List

The January 2020 Drug Benefit List (DBL) is now available. The DBL is a listing of drugs and products covered by the NIHB program and is updated several times during the year. Please refer to Appendix H, 'New listings' to see medications and products added since the last publication of the DBL in October 2019.

New listing for BuTrans patches

BuTrans (buprenorphine) patches are now listed as limited use benefits for the following:

  • chronic non-cancer pain, when pain is limiting daily activities
  • pain due to cancer
  • end-of-life care

BuTrans patches were also added to the formularies for palliative care and adjunct medications used during active cancer treatment. Once a client has received prior approval for a medication listed on one of these formularies, they will be automatically approved for all other medications on the list.

Coverage of buprenorphine implant (Probuphine)

NIHB now covers Probuphine (buprenorphine implant) as a limited use benefit for the management of opioid use disorder. Criteria for coverage can be found in Appendix A of the DBL.

Change of listing status for selected diabetes medications

NIHB has changed the listing status of some oral diabetes medications to open benefits. Prior approval is no longer required for coverage of these medications:

Brand name Active ingredient
Onglyza saxagliptin
Komboglyze saxagliptin and metformin
Trajenta linagliptin
Jentadueto Linagliptin and metformin
Forxiga dapagliflozin
Xigduo dapagliflozin and metformin

Change in coverage of non-medicated emollient cream for eczema

Coverage of non-medicated emollient cream (Glaxal Base and similar products) for the treatment of eczema is now provided for clients of all ages. Emollients are non-cosmetic moisturisers that can help reduce the severity of eczema and reduce the amount of medicated cream that is needed. Previously, these products were covered only for children. They are limited use benefits and NIHB covers up to 454 grams per month.

New coverage of antipruritic cream for renal patients

An antipruritic cream (menthol and camphor in non-medicated emollient) has been added to the formulary for chronic renal failure patients. Dry, itchy skin (pruritus) is a common complication of kidney disease, and this cream is used to moisturize and relieve skin irritation.

Coverage of iron preparations

A wide selection of iron preparations for the treatment of iron deficiency anemia are listed as open benefits, including many pediatric preparations. Some specialized formulations such as Feramax powder are covered without prior approval for children. Injectable therapies, including Monoferric, are also included as open benefits for patients who do not respond to oral iron therapy.

December 2019

Pharmacy benefit information

New coverage of anti-inflammatory creams

The NIHB program now covers anti-inflammatory creams or gels prepared ('compounded') by a pharmacist. This coverage is for cream or gel mixtures that contain the medications diclofenac or ketoprofen in concentrations of 3-10%, sometimes combined with lidocaine powder. These products may be prescribed for joint or muscle pain due to an injury or chronic condition. NIHB will cover up to 100 grams per month.

Reminder: coverage for smoking cessation treatments

Smoking cessation therapies are used to help people quit smoking. NIHB clients are eligible in a 12-month period for coverage of:

  • up to 36 boxes of patches (7 patches per box)
  • one 12-week course of as-needed treatment, like:
    • gums
    • lozenges
    • inhalers
    • spray
  • one 3-month course of Zyban
  • one 3-month course of Champix

Some people need more than one form of treatment at a time to control cravings. NIHB will cover these products when used together, or separately. Please talk to your health care provider about the right product, or combination of products that is best for you.

November 2019

Pharmacy benefit information

New formulary for nutrition products

On October 1, 2019, the NIHB program added a special formulary for clients with a medical need for nutrition products such as thickening agents, infant formulas and nutritional supplements. Products are listed for infants, children and adults.

The Nutrition Products Formulary is available in Appendix I of the Drug Benefit List. These products are listed as limited use (prior approval required). If you have a prescription for a medically necessary nutrition product, your pharmacist can contact the NIHB Drug Exception Centre at 1-800-580-0950 to request approval for coverage.

Increased coverage of test strips and lancets for clients using insulin

On October 1, 2019, coverage for blood glucose test strips and lancets increased to 8 per day of each item for clients who manage their diabetes with insulin.

New coverage for Ozempic

NIHB has listed Ozempic as an open benefit. Ozempic is covered in combination with metformin for the treatment of type 2 diabetes.

New coverage for lidocaine ointment

Lidocaine 5% ointment is now covered as an open benefit. NIHB covers up to 35 grams per month with a prescription. Lidocaine ointment is used to reduce pain or itching caused by skin irritations such as insect bites, poison ivy, minor cuts or burns.

Coverage status change for zinc

Elemental zinc is now covered as an open benefit. It may be prescribed to patients to support wound care related to a chronic condition, such as type 2 diabetes.

Medical Supplies and Equipment (MS&E) information

New MS&E benefit coverage

The NIHB program has added the following new MS&E benefits. These are limited use benefits (prior approval required):

  • standing frames, positioning seats and portable ceiling lifts and tracks
  • FM systems (a type of assistive hearing device)
  • voice restoration equipment and accessories
  • electric breast pumps when required for certain medical conditions, to a maximum price of $275

Change in coverage for select MS&E items

On September 9, 2019, the NIHB program increased coverage for mastectomy bras and gender-affirming bras to 3 per year.

On November 18, 2019, laryngectomy products were added as open benefits. Also, coverage for Heat Moisture Exchangers (HMEs) increased to 1 per day (open benefit). HME devices are used to make breathing easier following a laryngectomy or a tracheostomy.

New recognized prescribers for MS&E benefits

Nurse practitioners are now recognized by the NIHB program as prescribers of limb and body orthotics and prosthetic devices.

Speech-language pathologists have been added as recognized prescribers for laryngectomy supplies and for certain voice restoration equipment and accessories.

Hearing reassessment for children and youth with hearing devices

On November 18, 2019, the NIHB program increased coverage to allow for more frequent hearing reassessments for children and youth under 18 years of age with hearing devices:

  • The first year a client under 18 has a hearing device, they are entitled to 4 reassessments.
  • The second year a client under 18 has a hearing device, they are entitled to 2 reassessments.
  • After 2 years, clients under 18 with hearing devices are entitled to one hearing reassessment per year.

For more information on all MS&E benefit and policy changes, please refer to the Guide for Medical Supplies and Equipment Benefits and the Medical Supplies and Equipment Benefit Lists.

General program information

Reminders: provider billing and client reimbursement

Many providers are enrolled with NIHB and paid directly by the program, so clients do not have to pay out of pocket for eligible benefits. NIHB recommends that before you receive any item or service, you should speak with your provider's office to confirm that:

  • the provider is enrolled with NIHB and will bill the program directly
  • the item or service is fully covered by NIHB
  • the provider will not charge you any additional fees

If you are planning to pay up front for benefits and then seek client reimbursement from NIHB, you should contact the NIHB program before purchasing items or receiving services to confirm that:

  • the provider is recognized by NIHB as eligible to provide the product or service
  • the requested item or service is eligible for coverage under the NIHB program
  • the provider's rate for the product or service is fully covered by NIHB
Date modified: