GNWT HSS

Extended Health Benefits for Specified Disease Conditions

Extended Health Benefits for Specified Disease Conditions

 

The Government of the Northwest Territories (GNWT) sponsors the Extended Health Benefits program to provide non-Native and Métis residents of the Northwest Territories who have specified disease conditions with certain benefits not covered by hospital and medical care insurance.

Through this program, you receive coverage for eligible prescription drugs, medical supplies and equipment. You may also receive benefits related to medical travel such as meals, accommodation and ambulance services.

 

Eligibility

In order to qualify for this program, you must be:

  • non-Native or Métis
  • a permanent resident of the NWT
  • registered with the NWT Health Care Plan
  • under the care of a physician or nurse practitioner for one of the following disease conditions.
Alcohol Dependency**Cystic FibrosisPhenylketonuria (PKU)*
Alzheimer’s DiseaseDermatomyositisPrimary Pulmonary Hypertension
AsthmaDiabetes InsipidusPsoriasis

Bilateral Congenital Microphthalmos Budd-Chiari Syndrome 

Diabetes Mellitus

Cancer

Drug Dependency**Rheumatic Fever
Celiac Disease*Epilepsy*Rheumatoid Arthritis
Cerebral PalsyGastroparesisRickets*
Certain disorders of the blood and immune systemHead InjuryScleroderma
Charcot-Marie toothHemophilia
Chronic Obstructive Lung DiseaseHepatitisScoliosis
Chronic PancreatitisHIV Infection and other HIV related diseasesSickle Cell Anemia
Chronic PsychosisHypertension (subject to certain BP levels)*Spina Bifida
Cirrhosis of the liverIschemic Heart DiseaseSpinal Cord Injury - Paraplegia and Quadriplegia
Cleft Lip & Cleft PalateLupus ErythematosusTuberculosis
Congenital Cytomegalovirus InfectionMultiple SclerosisUlcerative Colitis
Congenital Anomalies of the Urinary SystemMuscular DystrophyWegener’s Granulomatosis
Congenital Heart DiseaseOsteoarthritis* 
Crohn’s DiseasePernicious Anemia* 

*Indicates Specified Disease Conditions that are eligible for drug benefit only
** Indicates restricted benefits

 

You must apply for the Extended Health Benefits program. An Extended Health Benefits application form may be obtained from your local health centre, public health unit or medical clinic, or from the Health Services Administration office of the Department of Health and Social Services.

 

Please note that comparable coverage for Specified Disease Conditions is provided to Indigenous Métis residents of the NWT through the Métis Health Benefits Program and provided to First Nations and Inuit residents of the NWT through Health Canada’s Non-Insured Health Benefits (NIHB) program.

 

Benefits

Alberta Blue Cross administers benefits for the Specified Disease Conditions program on behalf of the GNWT.

 

Prescription Drugs

This program provides you with 100 per cent coverage for eligible prescription drug products, as defined in Health Canada’s NIHB Drug Benefit List, when the drug is prescribed by a health care professional and dispensed by a licensed pharmacist.

 

If a drug that has been prescribed for you is not on Health Canada’s NIHB Drug Benefit List, your health care professional or pharmacist may submit a request to Alberta Blue Cross on your behalf for prior authorization.

 

Medical Supplies and Equipment

The program will pay reasonable and customary charges for medically necessary supplies and equipment provided in Canada as follows:

  • Audiology equipment (e.g. hearing aids)
  • Diabetic supplies and equipment (e.g. blood testing strips and injection supplies)
  • Incontinence products for adults and disabled children only
  • Medical equipment (e.g. wheelchairs and walkers)
  • Medical supplies (e.g. bandages and dressings)
  • Orthotics and custom-made footwear
  • Oxygen and respiratory supplies and equipment
  • Pressure garments and
  • Prosthetics

To make a claim for these supplies, you will need a prescription or written order from a recognized health care professional.

 

Many of the medical supplies and equipment items require prior approval in order for the product to be covered by the program.

 

Medical Travel

This program may reimburse accommodations, meals and transportation expenses incurred when you travel to access medical treatment not available in your home community.

 

Expenses eligible for reimbursement may include the following, subject to prior approval:

  • Private Accommodations
  • Commercial Accommodations
  • Boarding Facilities
  • Meals
  • Escorts and/or interpreter services
  • Travel (air and ground) to the nearest health clinic or hospital to receive health services not available in your home community or not covered by provincial or territorial travel assistance programs
  • Emergency Ambulance Services that originate in the Northwest Territories may be considered in some circumstances

Claims will be paid according to the current Health Canada NIHB schedule of prices.

 

How to claim for benefits

Each person registered on this program is provided with an Alberta Blue Cross identification card. Please carry this card with you at all times to access services.

 

Prescription drugs

 

Show your Alberta Blue Cross identification card when you pay for your prescription at a pharmacy, and the pharmacist will bill Alberta Blue Cross directly for the amount owing.

 

The direct-bill drug card eliminates the need for submitting claim forms and the time you would otherwise have to wait for reimbursement of your claim.

 

If your pharmacist does not accept direct billing, you will have to pay your pharmacist and claim reimbursement by submitting a completed Alberta Blue Cross Health Services Claim Form (available from your pharmacist or online at www.ab.bluecross.ca/forms.html).

  

Submit your form with original receipts to Alberta Blue Cross for reimbursement. Reimbursement will be mailed to you at your home address.

 

Other services

 

In most cases, you will not have to pay for eligible benefits through your plan. However, in cases where you pay the total cost of medical supplies/equipment or ambulance services, ask for an official receipt and send this to Alberta Blue Cross along with a fully completed Alberta Blue Cross Health Services Claim Form.

 

*Please note that all claims for reimbursement must be submitted within 12 months of the date on the receipt.

 

Coordination of benefits

In addition to your Extended Health Benefits sponsored by the GNWT, you might also have coverage for prescription drugs or other benefits through another supplementary health benefit plan. For example, you might qualify under another plan because you or your spouse work for an employer that provides such benefits or have coverage through Workers Compensation or a private insurance plan.

 

In such cases, the Extended Health Benefits program is considered payor of last resort. Therefore, you must:

  1. Claim through your other plan first.
  2. If the full cost is not covered by your other plan, complete an Alberta Blue Cross Health Services Claim Form and submit it for reimbursement after you have claimed through your other plan. Be sure to attach your confirmation of payment from the other plan carrier. You will then be reimbursed for eligible amounts up to the limits of this program.

Claiming and Benefit Inquiries...

If you have questions about your benefits or require any assistance with claiming,

Please contact Alberta Blue Cross toll free at 1-800-661-6995.


Please have your Alberta Blue Cross identification card on hand when you call.


Program Information...

For an application for this progam or information regarding the Specified Disease Conditions Extended Health Benefits program, please contact:

Health Services Administration
Department of Health and Social Services
Government of the Northwest Territories
Bag #9, Inuvik, NWT X0E 0T0
Toll-free: 1-800-661-0830
Phone: (867) 777-7400
Fax: (867) 777-3197
Email: hsa@gov.nt.ca

 

Resources

Medical Travel

 

Application Forms and Publications