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Non-Insured Health Benefits: COVID-19 Pandemic Update #2

Important Notice: 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 other temporary changes can be found in the updates below.

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

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:

  • Atos Medical or 833-514-2867

  • Auto Control Medical or 800-461-0991

Please contact your 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.

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