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NIHB clients do not pay deductibles or co-payments.

Dental benefits are covered in accordance with the mandate of the NIHB program.

The NIHB Dental Benefits Guide applies to the coverage of dental benefits by the NIHB Dental Predetermination Centre or by First Nations or Inuit Health Authorities or organizations (including territorial governments) who, under a contribution agreement, have assumed responsibility for the administration and coverage of dental benefits to eligible clients.

In the event of a contradiction between document versions, the provisions of the Indigenous Services Canada web-posted guide, along with the latest NIHB dental publications and Regional Dental Benefit Grids, will prevail. The Dental Benefits Guide summarizes the terms and conditions, criteria, guidelines and policies under which the NIHB program covers dental services for eligible First Nations and Inuit clients.Īs policies and procedures evolve, the guide is updated accordingly and dental providers are advised of these changes through the program's newsletters and bulletins available on the Express Scripts Canada NIHB provider and client website and other communication tools.ĭental providers are advised to read and retain the most current version of the guide to ensure continued compliance with the terms and conditions of their NIHB Billing Agreement. Terms and conditions for coverage are detailed in section 3.0 Terms and conditions 1.2 Purpose of the Dental Benefit Guide

Canadian Dental Hygienists Association (CDHA) National List of Service Codes.

Denturist Association of Canada (DAC) Procedure Codes Master List.

Fédération des dentistes spécialistes du Québec (FDSQ) Fee Guide.

Association des chirurgiens dentistes du Québec (ACDQ) Fee Guide.

Canadian Dental Association (CDA) Uniform System of Coding & List of Services.

The individual services are listed in the NIHB Regional Dental Benefit Grids available on the Express Scripts Canada NIHB provider and client website and are based on: The NIHB program's dental benefit covers the following services:

medical transportation (to access medical services not available on-reserve or in the community of residence).

prescription drugs and over-the-counter medications.

The benefits provided under the NIHB program include:

provincial/territorial health insurance plans.

The NIHB program provides eligible First Nations and Inuit with coverage for a range of medically necessary health benefits when these benefits are not otherwise covered by:

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Appendix E: Provider Claim Verification Program (PCVP).Appendix B: NIHB Dental Predetermination Centre contact information.Appendix A: NIHB Regional Dental Benefit Grids.8.9.5 Documentation requirements for predetermination and post-determination.8.9.4 Deep sedation and general anesthesia.8.8.3.2 Step 2: Additional consideration.

8.8.3.1 Step 1: Application of the Modified Handicapping Labio-Lingual Deviation (HLD) Index.8.8.3 Orthodontic submissions review process and documentation requirements.8.6.5.2 Immediate partial and complete dentures.8.6.5.1 Standard partial and complete dentures.8.6.5 Non-inserted Removable Prosthodontic Policy.8.6.4.2 Predetermination documentation requirements for complete dentures.8.6.3.2 Predetermination documentation requirements for partial dentures.8.6 Prosthodontic services – removable prosthodontics.8.5.4 Predetermination documentation requirements for preventive and periodontal services.8.5.3.1 Scaling and root planing (additional units).8.5.2.2 Sealants and preventive resin restorations.

8.5.2.1 Frequency guidelines for polishing, topical fluoride treatment, topical application of an antimicrobial or remineralization agent, scaling and root planing.

8.4.4 Documentation requirements for predetermination and post-determination.

8.3.5.3 Documentation requirements for predetermination and post-determination.

8.2.1 Frequency guidelines for interproximal disking of teeth.

8.1.2.2 Cone beam computerized tomographies.8.1.2.1 Frequency guidelines for radiographs.1.2 Purpose of the Dental Benefit Guide.