NIHB Handbook - First Nations Health Council

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Prosthodontics(removable dentures)Maryland BridgePolicy (MB)Prosthodontics –fixed (bridges)Orthodontics (braces)Adjunctive services(sedation)Oral surgeryOther servicesIncludes three months post-insertion care including adjustments andmodifications. For immediate dentures an additional reline is permitted.Predetermination is required.Dentures are eligible once every 8 years.Replacement dentures within an 8 year period require supporting rationale.– When an individual has 1 or more implants and requires a completeover- denture, the program may fund the over-denture.– Maryland Bridge will be considered on an exceptional basis whenthe individual’s needs meet the following criteria:– No more than three units per bridge.– Limited to anterior (front) sextants.– Proposed permanent tooth abutments must have nil to minimumrestoration.Appliances for a single space in a posterior (back) situation are not covered.Fixed prostheses are not eligible benefits.Removable prosthetics (dentures complete or partial) are covered asa defined benefit once in an 8-year period.The NIHB Program covers a limited range of orthodontic benefits andindividuals must meet the clinical criteria and guidelines established bythe NIHB Program for orthodontic treatment to be funded. This meansthat the child must have a severe and functionally handicapping malocclusionwhich is characterized as: a combination of marked skeletal discrepancies– such as an over bite problem that is associated with severe functionallimitations. i.e. such as an inability to properly chew your food.Dento-facial anomalies such as cleft lip and palate; (no age restriction)For further information, see the NIHB Orthodontic bulletin at the websiteaddress below: http://www.hc-sc.gc.ca/fnih-spni/alt_formats/fnihbdgspni/pdf/pubs/dent/2004-08-ortho_e.pdfor contact your regional office.General anaesthetic services are normally limited to children under12 years of age. Predetermination is required for this service.There are regional variations in eligibility depending on provincial andterritorial services and rules.Implants and ridge augmentation are not funded benefits under the NIHBprogram. Uncomplicated extractions are part of basic treatment and donot require predetermination.Complicated or “surgical” extractions require predetermination.Periodontics (treatment of inflamed or diseased gums) surgical casesrequire predetermination.Paediatric dentistry is an available benefit to children.7
Remember1. Prior approval or predetermination is required on certain benefits. For example:Crowns, and dentures, root canal treatment on bicuspids and molars must meetpolicy criteria.Who may be involved in providing dental care?DentistDental HygienistsDental Specialist (Endodontist, Periodontist, Prosthodontist and Orthodontists)DenturistDental Therapist (in some provinces)ExceptionOrthodontics – There is no age restriction for dento-facial anomalies such as cleft lip and palate.What is not covered/ExclusionsExtensive rehabilitationImplantsPrefabricated/composite veneers and bleaching (whitening of the surface of the tooth)Other cosmetic/aesthetic treatmentRidge augmentation (for denture fitting)About the Process1. There is no longer an annual $800 threshold; previously there was only a certain amountof basic dental work that could be done in a 12-month period before prior approval orpredetermination was needed. Your dentist has a complete list of eligible services. If yourdentist refuses to provide you with eligible services unless you pay up-front or requestsco-payment, you should contact your FNIHB-NIHB Regional Office or the AFN as thiscontravenes the NIHB Program policies. The FNIHB-NIHB Regional Office may also provideyou with a list of alternative providers in your area.8
Page 1 and 2: This handbook was developed by the
Page 3 and 4: AFN Health & Social Secretariat Man
Page 5 and 6: 1. EYE AND VISION CARE BENEFITSWhat
Page 7 and 8: Trial of BifocalsTints and Coatingf
Page 9: 2. DENTAL BENEFITSWhat is covered?P
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Page 15 and 16: Non-MedicalAddictions TreatmentOthe
Page 17 and 18: 4. DRUG BENEFITSWhat is covered?Pay
Page 19 and 20: What is not covered/ExclusionsAnti-
Page 21: Remember1. The rules about what is
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Page 28 and 29: Where to Submit an Appeal for Denta
Page 30 and 31: CONSUMER RIGHTS IN HEALTH CARE1. Yo
Page 32 and 33: Health Canada’s NIHB Privacy Code
Page 34 and 35: NOTES31
Page 36: Having Difficulty QUITTING Smoking?

NIHB Handbook - First Nations Health Council

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