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 Nations committee members include representatives of the Chiefs Committee on Health (CCOH), the National First Nations Health Technicians Network (NFNHTN), and regional NIHB Navigators.
Many positive changes have been made by the NIHB program throughout the joint review to date and this work continues. Highlights of changes and improvements that have been made during the 10 year period from 2015 through 2025, responding to recommendations from the NIHB-AFN joint review, are listed below.
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
All benefits
- To allow time for parents to register their children for First Nations status or with their Inuit land claim organization, NIHB now covers unregistered children less than two years old if they have a parent or guardian who is NIHB eligible
- NIHB created a publicly accessible email address so clients and other stakeholders can email the Program with questions or concerns. Note: email should not be used for submission of claims or appeals, and should not include personal information such as your client identification number
- NIHB developed new communications products, including regional pamphlets that provide key information on client eligibility, benefit coverage, program services and contact information. Client quick reference sheets are now available for dental and MS&E benefits, as well as the client reimbursement process
- NIHB clients and providers now have the option to submit benefit claims online and view their claims history through secure web accounts. NIHB's claims processor, Express Scripts Canada, provides this service for all benefits except medical transportation. Video tutorials are available to help clients and providers learn about different features of their web accounts
- To help clients find providers that can bill the program directly, NIHB produces lists of enrolled benefit providers for dental, pharmacy, MS&E, vision care and mental health counselling. These are updated regularly and shared with AFN, NIHB Navigators and regional call centres
- ISC implemented an Indigenous cultural competency learning policy. Under this policy, all ISC employees, including NIHB employees, are required to complete at least two days of cultural competency training every year
Pharmacy
- NIHB launched a new online searchable Drug Benefit List (DBL) in 2020. It allows clients and prescribers to easily search NIHB drug benefits and coverage criteria. A PDF version of the DBL remains available and both versions are updated daily
- Since 2015, NIHB has added over 5,000 new products to the Drug Benefit List. This includes close to 2,000 new medications for treating a wide variety of health conditions such as arthritis, asthma, ADHD, allergies, chronic obstructive pulmonary disease, cancers, cystic fibrosis, diabetes, eczema, epilepsy, heart disease, hepatitis C, HIV, hypertension, migraine, multiple sclerosis, opioid use disorder, osteoporosis, Parkinson's disease, psoriasis, seizures and many more
- NIHB established the nutrition products formulary for clients with a medical need for products like infant formulas and nutritional supplements. These are limited use benefits and include products for infants, children and adults
- NIHB listed Shingrix, a vaccine to prevent shingles. It is now covered as an open benefit for clients 60 years and older and included in the formulary for adjunct medications used during active cancer treatment. Coverage may be considered case-by-case for clients with other serious health conditions that weaken their immune system
- NIHB now covers numerous continuous glucose monitoring systems for clients of any age who manage their diabetes with insulin. Systems covered include Dexcom, Freestyle Libre, and Guardian Connect
- NIHB increased coverage for blood glucose test strips and lancets for clients who manage their diabetes with insulin to eight per day of each item
- NIHB changed the listing status of many medications to open benefit, prior approval not required , including most oral diabetes medications
- NIHB now provides coverage on a case-by-case basis for medications used for assisted fertility treatments
- NIHB increased coverage for smoking cessation medications Champix (330 tablets per year) and Zyban (360 tablets per year). NIHB also covers nicotine patches, gum, lozenges and inhalers
- NIHB made numerous changes to streamline the prior approval process for limited use benefits where possible, such as enabling automatic system adjudication for certain benefits and creating a special authorization process to allow for approvals of longer duration, or even for life, for some medications
- To facilitate coverage for over-the-counter medications and products, NIHB now accepts prescriptions or written recommendations from pharmacists for eligible items that are within a pharmacist's scope of practice
Dental
- NIHB expanded coverage for preventive dental services. Topical antimicrobial treatments such as silver diamine fluoride are now covered and coverage for sealants, preventive resin restorations and fluoride treatment was increased
- To increase access to preventive oral health care, dental hygienists can now submit claims to NIHB as independent providers, where allowed by provincial or territorial scope of practice
- NIHB increased coverage for crowns to four in 10 years, added coverage for all-ceramic crowns and no longer requires the first molar to be present for coverage of a crown on the second molar. NIHB also increased frequency for replacement of acrylic partial dentures to five years, from eight previously
- Standard root canal treatments are now covered without predetermination, excluding for wisdom teeth, and the frequency guideline has been lifted
- NIHB increased frequency guidelines for examinations provided by dental specialists
- The predetermination requirement was lifted for coverage of numerous dental services, including mild sedation, surgical tooth extractions, prefabricated posts, certain complete dentures, replacement of acrylic or cast partial dentures and prefabricated metal crowns for permanent teeth
- NIHB worked with dental provider associations to develop communications products and activities to increase provider understanding and familiarity with NIHB program policies and processes
- NIHB completed enhancements to the claims processing system that allows dental providers to submit predetermination requests online
- NIHB increased reimbursement rates for medically necessary orthodontic services and created a new tool that makes it easier for providers to submit cases for predetermination of coverage. In 2023, NIHB adjusted the threshold for coverage eligibility to allow more cases to be covered
Medical supplies and equipment (MS&E)
- NIHB established an advisory body of health professionals and academic specialists to provide independent, expert advice and recommendations on MS&E and vision care benefits. The committee includes health professionals who are Indigenous or have clinical experience working with First Nations and Inuit. AFN nominated a registered nurse who is a core member of the committee
- NIHB added new listings to the mobility equipment and supplies benefits list, including medical strollers, standing frames, positioning seats, bariatric crutches, walker accessories (such as forearm attachment, slow-down brakes, rubber tips), oxygen cylinder holders for walkers and wheelchairs, pediatric walking frames and coverage for a back-up manual wheelchair for clients using a power wheelchair
- Diabetic walking boots, orthoses for club feet and heel off-loading splints were added as new listings on the limb and body orthotics benefits list
- NIHB added new listings to the self-care equipment and supplies benefits list, including items to support gender identity, electronic blood pressure monitors, oral digital thermometers, nipple shields, specialized feeding bottles and teats, hip kit, expanded coverage of feeding syringes, portable ceiling lifts and portable tracks, bariatric floor- to-ceiling poles, hospital beds with related accessories and pressure relief mattresses
- NIHB added new hearing devices, including hearing aids, remote microphone systems, cochlear implant processors, and bone-anchored hearing systems, to the audiology benefits list, and expanded eligibility for hearing aids to cover adults with a wider range of hearing loss
- NIHB added new sizes of wound care dressings to meet client needs and coverage for single-use negative pressure wound therapy devices is now available for clients who have not responded to traditional treatments
- NIHB created the communication equipment and supplies benefits list, and added numerous new listings for voice restoration equipment, and augmentative and alternative communication equipment
- NIHB expanded coverage for low vision equipment and services, with over 30 new listings for low vision aids, orientation and mobility aids, assistive technology, independent living aids, low vision functional assessments and training programs
- NIHB added new listings for oxygen equipment and supplies, including M9 oxygen cylinders and moustache or pendant style oxygen conserving devices. To facilitate access, NIHB also streamlined testing requirements for coverage of oxygen and CPAP therapy
- NIHB increased coverage (quantity, frequency) for numerous benefits including urinary catheters, feeding pump bags and syringes, extension sets for enteral feeding, washable and disposable underpads, now also covered for wound and ostomy care , mattress covers, silver alginate wound dressing, mastectomy and gender affirming bras, floor-to-ceiling poles, diagnostic prosthetic sockets, canes and quad canes
- NIHB removed the prior approval requirement for many limited use benefits, within price and frequency guidelines, including adhesive suture strips and gauze packing strips, urinary catheters, complete hearing assessments and hearing aid accessories, adaptive feeding cups, numerous off-the-shelf limb and body orthotics (for example, splints, braces), specialized crutches, tub transfer boards, toilet tissue aids and positioning wedges and offloading walking boots
- To facilitate client access to benefits, NIHB added new types of health professionals recognized to prescribe or recommend eligible benefits within their scope of practice, including registered nurses, licensed or registered practical nurses, chiropodists, dietitians, speech-language pathologists, physiotherapists, occupational therapists, registered respiratory therapists, certified vision rehabilitation therapists, certified orientation and mobility specialist, assistive technology specialists and certified low vision therapists
- NIHB created a new delivery policy to clarify coverage that is available on a case-by-case basis for local or out-of-town delivery of eligible MS&E benefits. Additionally, NIHB implemented new coverage for installation costs when required for select self-care equipment
Vision care
- NIHB added coverage of progressive lenses for close and distance vision correction
- NIHB adjusted vision care exam rates to ensure they align with other publicly funded vision care programs, and will ensure that rates remain comparable
- NIHB implemented new standard coverage amounts for corrective eyewear, based on prescription strength. Coverage amounts can be used toward the purchase of any type of prescription eyewear, including contact lenses
- Coverage for an annual eye exam for clients aged 65 and over is now a benefit, with no additional criteria, when not covered by the provincial or territorial health plan
- Vision care benefit frequency guidelines were changed to align with the calendar year, instead of last date of service. This means that clients can access their eligible coverage for the year as early as January 1, or any date thereafter
- Vision care providers can now submit prior approvals and claims online through the Express Scripts Canada website
- General eye exams are now a frequency-based open benefit and no longer require prior approval
- Clients and providers can confirm eligibility for general eye exams and corrective eyewear through their web accounts or by calling Express Scripts Canada
Mental health counselling
- In 2017, NIHB expanded coverage for mental health counselling by removing the short-term crisis requirement to access the benefit. Coverage is now available for up to two hours for an initial assessment, 20 hours every calendar year. Additional hours may be covered on exception
- NIHB introduced coverage for mental health services provided by traditional healers through projects developed and delivered by First Nations and Inuit organizations
- NIHB created guidelines for coverage of group counselling, such as for families, and telecounselling to facilitate coverage for a greater range of counselling needs
- Mental health counselling frequency guidelines were changed to align with the calendar year. This makes it easier for clients and providers to know and track the client's eligibility for coverage each year
- Mental health providers may now self-identify as Indigenous and provide information on areas of specialization, cultural competency training and/or experience working with First Nations and Inuit clients. This information is available to NIHB staff and navigators when they help clients find enrolled providers in their area
- Mental health counselling providers can now submit prior approvals and claims online through the Express Scripts Canada website
Medical transportation
- NIHB expanded coverage so all pregnant clients who require transportation outside their community to deliver their babies are eligible for an escort
- NIHB revised the policy framework to clarify that when there is an ongoing need for escort coverage, for example if a client has a permanent disability or need for translation, repeated documentation for approval is not required
- NIHB clarified within the policy framework that the cost of paid parking may be reimbursed when coverage for private vehicle allowance is provided
- In 2021, NIHB increased commercial meal allowance rates by approximately 25%. Now, meal rates are reviewed annually