NIHB Handbook - First Nations Health Council
NIHB Handbook - First Nations Health Council NIHB Handbook - First Nations Health Council
Implants (e.g. punctual occlusion procedure)Refractive laser surgeryTreatments with investigational/experimental statusVision trainingFor additional informationReview the Vision Care Framework at the website address below.http://www.hc-sc.gc.ca/fnih-spni/pubs/eye-yeux/2005_vision-vue_frame-cadre/index_e.htmlCall your First Nations & Inuit Health Branch (FNIHB) regional office or a designatedFirst Nations health authority. Please refer to the contact list included on the page 32of this handbook.5
2. DENTAL BENEFITSWhat is covered?Payment for treatment is made to the provider for the services listed below.DiagnosticUp to four examinations per 12 month period for a person underservices:17 years old.Exams andUp to three examinations (complete, recall, specific, emergency) perradiographsyear for a person 17 years old and over and provided they are within( x-rays) NIHB Program guidelines.Radiographs (x-ray):6 Intraoral x-rays in a 12 month period.Temporo Mandibular Joint (TMJ) requires predetermination.Panoramic x-ray, 1 every 120 months without predetermination andthe 2 nd one after 120 months without predetermination. More than 2in a lifetime require predetermination.Cephalometric (side shot) requires predetermination.Preventative services Scaling (cleaning) in combination with root planing (scraping/cleaning(cleanings)below the gum line) to a maximum of 4 units per year for people 12 yearsof age and older, and only 1 unit per year for people under 12 years of age.Topical fluoride: under 17 years of age, twice per year. 2 per 12 monthperiod.Sealants or preventive resins for eligible people under 14 years of ageon permanent molars and maxillary anterior incisors.Polishing: 17 and older, 1 per 12 month period. Under 17, 2 per12 month period.Restorative services The maximum allowable for amalgam and tooth coloured fillings is(fillings)five surfaces per tooth.The maximum allowable on primary/baby teeth is up to the cost ofa stainless steel crown.Bonded amalgam fillings are funded at a rate of a non-bonded equivalent.Replacement fillings within a two year period are subject to question.Retentive Pins: cores and posts, 1 every 36 months, predeterminationis required.EndodonticsRoot canals may be completed on the front or anterior teeth without(root canal treatment) predetermination.Predetermination is required for all other teeth (bicuspids and molars)and must meet FNIHB’s Endodontic policy criteria.Pulpotomies and pulpectomies (open and drain) are not eligible onprimary or baby incisor teeth (four front teeth, top and bottom).6
- 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: Trial of BifocalsTints and Coatingf
- Page 11 and 12: Remember1. Prior approval or predet
- Page 13 and 14: 3. MEDICAL TRANSPORTATION BENEFITSW
- 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
- Page 24 and 25: What is not covered/ExclusionsPsych
- Page 26 and 27: What is not covered/ExclusionsAny b
- 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?
2. DENTAL BENEFITSWhat is covered?Payment for treatment is made to the provider for the services listed below.DiagnosticUp to four examinations per 12 month period for a person underservices:17 years old.Exams andUp to three examinations (complete, recall, specific, emergency) perradiographsyear for a person 17 years old and over and provided they are within( x-rays) <strong>NIHB</strong> Program guidelines.Radiographs (x-ray):6 Intraoral x-rays in a 12 month period.Temporo Mandibular Joint (TMJ) requires predetermination.Panoramic x-ray, 1 every 120 months without predetermination andthe 2 nd one after 120 months without predetermination. More than 2in a lifetime require predetermination.Cephalometric (side shot) requires predetermination.Preventative services Scaling (cleaning) in combination with root planing (scraping/cleaning(cleanings)below the gum line) to a maximum of 4 units per year for people 12 yearsof age and older, and only 1 unit per year for people under 12 years of age.Topical fluoride: under 17 years of age, twice per year. 2 per 12 monthperiod.Sealants or preventive resins for eligible people under 14 years of ageon permanent molars and maxillary anterior incisors.Polishing: 17 and older, 1 per 12 month period. Under 17, 2 per12 month period.Restorative services The maximum allowable for amalgam and tooth coloured fillings is(fillings)five surfaces per tooth.The maximum allowable on primary/baby teeth is up to the cost ofa stainless steel crown.Bonded amalgam fillings are funded at a rate of a non-bonded equivalent.Replacement fillings within a two year period are subject to question.Retentive Pins: cores and posts, 1 every 36 months, predeterminationis required.EndodonticsRoot canals may be completed on the front or anterior teeth without(root canal treatment) predetermination.Predetermination is required for all other teeth (bicuspids and molars)and must meet F<strong>NIHB</strong>’s Endodontic policy criteria.Pulpotomies and pulpectomies (open and drain) are not eligible onprimary or baby incisor teeth (four front teeth, top and bottom).6
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