FAQ: COVID-19 Preparedness and Non-Insured Health Benefits (NIHB) Coverage

Updated: Apr 3

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:


FAQ:


Individuals can request up to 3 months of their prescriptions for chronic medications


(Under section 3.3, “Prescription Quantities”, pharmacies may dispense a 100-day supply of chronic medications. Pharmacies also have access to NIHB policy information through the claims processing contractor, Express Scripts, by way of the website and telephone support.)

For more information regarding the NIHB policy or Guide for Pharamcy Benefits, visit: www.sac.isc.gc.ca


Frequently Asked Questions (FAQs) for Pharmacy Providers


Q1: As part of COVID-19 preparedness, will NIHB cover an early refill of medication?


A1: For chronic medications, the NIHB Program reimburses up to a 100-day supply (unless otherwise indicated by the prescriber).


If a client is seeking a refill before 2/3 of their medications are used up (e.g. more than 33 days left of last fill), providers may require an intervention code to refill medications for NIHB clients.


Medications which fall under NIHB’s 30-day dispense policy may be submitted to NIHB for a longer duration at the professional discretion of the pharmacist. A call to the Drug Exception Centre at 1-800-580-0950 may be required to override system limits.


Providers must complete and retain the appropriate documentation on the nature of the intervention (e.g. COVID-19 preparedness) directly on the prescription or on any hard or electronic version of the client file.


Q2: Does NIHB cover over-the-counter fever reducing/pain relief medications when recommended by a pharmacist?


A2: NIHB covers a wide range of fever reducing/pain relief medications for both adults and children. Under NIHB’s Non-prescription Treatment Recommendation Policy, the NIHB Program will reimburse claims for non-prescription medications (Schedule II, III and unscheduled drugs) for selected conditions when recommended by a pharmacist (please see section 3.13 of Pharmacy Guide for complete policy details).

If you need help accessing a Non-Insured Health Benefit, Please contact the Chiefs of Ontario Northern and Southern NIHB Navigators at:

  1. Toll Free: 1. 877. 517. 6527

  2. Fax: 416.597.8365


Contact your NIHB Southern and Northern Navigators here

Northern Ontario NIHB Navigators:

Jennifer Shisheesh Phone: (807) 626-9339 from 9:00 am. – 5:00 pm

Email: jennifer.shisheesh@coo.org Secretariat Office: (416) 597-1266 Toll-Free number: 1-877-517-6527


Emily King Cell: (416) 573-7611

Fax: (416) 597-8365

Email: emily.king@coo.org Secretariat office (416) 597-1266 Toll Free number 1-877-517-6527


Southern Ontario NIHB Navigator:

Miryan Rutledge

Cell: (416) 522-7459

Fax: (416) 597-8365

Email: miryan.rutledge@coo.org

Secretariat Office (416) 597-1266

Toll-Free number 1-877-517-6527


Benefits Outside of Canada


You must purchase travel health insurance if you travel outside of Canada. NIHB will reimburse the cost of the premium if you are a migrant worker or a full time student working or studying outside of Canada. However you must contact them before leaving the country at: 1.800.640.0642


Reimbursements


For reimbursements, please mail your completed form(s), original receipt and a copy of your prescription to the applicable Regional Office, the NIHB Drug Exception Centre, or the NIHB Dental Predetermination Centre (for dental and orthodontic services).


Reimbursement Form: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/fniah-spnia/alt_formats/pdf/nihb-ssna/benefit-prestation/form-reimburse-rembourse2-eng.pdf

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