Non-Insured Health Benefit (NIHB) Program

What is it?

Provinces and territories are responsible for delivering health care services. First Nations people and Inuit access these insured services through provincial and territorial governments, like any other resident.

However, there are a number of health-related goods and services that are not insured by provinces and territories or other private insurance plans. To support First Nations people and Inuit in reaching an overall health status that is comparable with other Canadians, Health Canada Non-Insured Health Benefits for First Nations and Inuit Program (NIHB) provides coverage for a limited range of these goods and services when they are not insured elsewhere. Please note that for First Nations in British Columbia, healthcare benefits coverage is provided by the First Nations Health Authority (FHNA).

Who is eligible?

An eligible recipient must be a resident of Canada and be one of the following:

  • A registered Indian according to the Indian Act
  • An Inuk recognized by one of the Inuit Land Claim organizations
  • An infant less than one year of age, whose parent is an eligible recipient

How does it work?

Service providers are encouraged to bill the program directly so that recipients are not expected to pay when receiving health care goods or services.

When a recipient does pay, he/she may seek reimbursement from the NIHB Program. Requests for reimbursement must be received on a NIHB Client Reimbursement Request Form, within one year from the date of service or date of purchase.

To obtain the NIHB Client Reimbursement Request Form, contact the nearest NIHB Regional Office or a local First Nations and Inuit Health Authority.

What is covered?

The NIHB Program funds prescription and over-the-counter medications that are not covered by other private or provincial/territorial health insurance plans. Eligible drugs are listed in the Non-Insured Health Benefits Drug Benefit List.

The NIHB Program covers the ‘lowest cost alternative drug’, which is commonly known as a generic drug.

How do you access drug benefits?

You must obtain a prescription from a physician or other licensed prescriber. The prescription should be taken to a pharmacy to be filled. Or, it can be taken to a nursing station, which may arrange to have the prescription filled at a local pharmacy on behalf of the recipient.

For more information, check out the Health Canada Non-Insured Health Benefits, Benefits Information Web site.

Is prior approval required before billing the NIHB Program for a prescription?

The NIHB Program maintains a comprehensive NIHB Drug Benefit List. In most cases, the drugs that are prescribed are on the list and the pharmacist can dispense them immediately.

However, the pharmacist must obtain approval in any of the following cases:

  • a drug is not on the NIHB Drug Benefit List
  • a physician has written 'no substitution' on the prescription
  • a drug is listed as a 'limited use drug' requiring prior approval
  • a drug is a 'maximum allowable' drug

How is prior approval obtained for prescription drugs?

The pharmacist will call the national NIHB Drug Exception Centre and will give details about the prescription, the prescriber and the pharmacist.

If required, the Drug Exception Centre analyst will fax a copy of the Exception or Limited Use Drug Request Form to the doctor. The doctor or licensed prescriber will complete the form stating the exceptional medical need for the drug.

The response will be reviewed and a decision will be made. The decision is communicated to the pharmacist. The decision process may take a few days. The time for approval is dependent on the doctor or licensed prescriber providing the information.

SourceHealth Canada Non-Insured Health Benefits Web site.