NIHB dental coverage
We welcome NIHB patients and can help you understand how your dental coverage works and what services are covered before your appointment.
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What is the Non-Insured Health Benefits (NIHB) Program?
The Non-Insured Health Benefits (NIHB) Program is a federal program that provides coverage for eligible First Nations and Inuit for a variety of medically necessary health services that are not covered by provincial or territorial health insurance or other insurance plans.
The Non-Insured Health Benefits (NIHB) Program provides coverage for a range of medically necessary dental services for eligible First Nations and Inuit. Coverage is provided according to NIHB policies, clinical criteria, frequency limitations, and predetermination requirements.
What dental services are covered by the Non-Insured Health Benefits program?
The NIHB program covers a broad range of medically necessary dental services. Coverage depends on program guidelines, eligibility, clinical criteria, and whether predetermination (prior approval) is required. The NIHB dental coverage covers a broad range of dental services for eligible patients, including:
Diagnostic services
– Comprehensive dental examinations
– Recall checkups
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- Digital dental X-rays
Preventive services
Regular preventive care helps reduce the risk of cavities and gum disease and may include:
– Teeth cleaning (scaling)
– Polishing
– Fluoride treatments
– Dental sealants
Restorative services
Coverage may include treatments that restore damaged teeth, such as:
– Tooth-coloured fillings
– Dental crowns (when eligible)
Cosmetic services
– Dentures (when eligible)
– Orthodontic treatment (when eligible)
Dental surgery
– Root canal therapy (when eligible)
– Gum disease treatment
– Gum surgery
– Tooth extractions
Sedation
The NIHB program may cover eligible sedation and general anesthesia services when medically necessary and clinical criteria are met. Some forms of sedation require predetermination before treatment.
Book an appointment using your NIHB dental coverage
If you’ve been approved for the Non-Insured Health Benefits (NIHB) Program, Westmount Dental is here to help you make the most of your coverage.
How to apply for the Non-Insured Health Benefits (NIHB) Program
You must be eligible for the Non-Insured Health Benefits (NIHB) Program before you can receive covered dental benefits. Unlike private dental insurance, there is no separate application for dental coverage. Once you are registered and eligible for NIHB, you can access covered dental services through participating providers.
In general, you may be eligible if you are:
– A registered First Nations person under the Indian Act
– An Inuk recognized by an Inuit land claim organization
– An infant under two years of age whose parent is an eligible NIHB client
Before your appointment, make sure you have your NIHB identification information available. Our team can verify your eligibility and explain your available dental benefits.
How to access your NIHB dental coverage
1. Book your appointment.
Contact us to schedule an appointment with our dental team. We are open Monday to Sunday, with weekday availability until 7:00PM.
2. Dental examination to create a treatment plan.
We will perform a dental examination and develop a personalized treatment plan.
3. Review NIHB dental coverage.
We will review which dental services are covered under the NIHB program.
4. If needed, submit documents for predetermination.
If prior approval (predetermination) is required, we will help submit the necessary documentation before treatment begins.
Need help understanding your NIHB dental coverage?
Our experienced team can help verify your eligibility, explain your coverage, submit eligible claims directly, and assist with any required predetermination requests before treatment begins.
Frequently asked questions
Find answers to our most commonly asked questions about the Non-Insured Health Benefits (NIHB) Program.
The NIHB Program provides dental coverage for eligible First Nations and Inuit clients. If you’re unsure about your eligibility, our team can help guide you through the process.
Westmount Dental can submit eligible NIHB claims directly whenever possible. The NIHB program encourages enrolled providers to bill directly so eligible patients generally do not have to pay deductibles or co-payments for covered services at the time of treatment.
Some services require predetermination before claims can be approved.
No. Many routine services are covered without prior approval. Some procedures, such as certain crowns, orthodontic treatments, or more complex services, require predetermination before treatment begins.
The NIHB program coordinates benefits with other available insurance plans. Our team can help determine how your coverage applies.
Certain dental services require predetermination, which is similar to prior approval. Before these treatments are performed, the NIHB program reviews the proposed treatment to determine whether it meets program guidelines and coverage criteria.
If your treatment requires predetermination, our team will prepare and submit the required documentation on your behalf and explain the coverage decision before treatment begins.