The Government of the Northwest Territories (GNWT) offers Extended Health Benefits (EHB), a public benefits plan, which helps eligible residents with the cost of non-insured medical needs not covered by the NWT Health Care Plan.
On this page:
Coverage for Low-Income Families:
If your family income is below the low-income threshold, your no-cost coverage includes:
- Drugs Benefits
- Dental Benefits
- Vision Care Benefits
- Medical Supplies and Equipment Benefits
- Extended Health Travel Benefits
Note: To reduce the impact of changes in the first benefit year (2024-2025), we have adjusted the cost sharing arrangements for income band levels from two to ten. If you fall within these income band levels, you will have access to eligible prescription drugs and medical supplies and equipment benefits at no cost to you.
Coverage for Seniors (aged 60 and over):
If you are 60 or older, your no-cost coverage includes:
- Drugs Benefits
- Dental Benefits
- Vision Care Benefits
- Medical Supplies and Equipment Benefits
- Extended Health Travel Benefits
Coverage for Higher-Income Families:
If your family income is above the low-income threshold, you may still be covered for some:
- Drugs Benefits
- Medical Supplies and Equipment Benefits
- Extended Health Travel Benefits
However, you may need to pay a portion of the costs based on your income level.
To apply for Extended Health Benefits, see:
Please note that comparable coverage for EHB 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 Indigenous Services Canada’s Non-Insured Health Benefits (NIHB) program.
Benefits
Alberta Blue Cross administers EHB benefits on behalf of the GNWT.
Drug Benefits
EHB covers eligible prescription drugs listed on the NWT Pharmacare Formulary. Coverage for drugs not listed on the formulary may be considered on an exception basis, with prior approval, if they meet the following requirements:
- A Health Care Prescriber provides clinical reasons for the request including that all other similar drugs on the Formulary have been tried.
- The NWT’s clinical consultant recommends approval for the drug.
- The drug has received a positive recommendation from the Canadian Agency for Drugs and Technologies (CADTH)
Cost Sharing Arrangement:
Depending on your income level:
- Below Low-Income Threshold (Income Band 1): Eligible prescription drugs are covered at no cost-share for residents
- Seniors (60+): Eligible prescription drugs are covered at no cost-share for residents
- Income Band 1-10: Eligible prescription drugs are covered at no cost-share for residents
- Above Income Band 10: Eligible prescription drugs are covered, with residents required to cost-share through a three-part arrangement:
- Deductible: This is the amount you or your family need to pay out of pocket before the drug plan starts covering costs. Your deductible amount is based on your income assessment. You will pay 100% of your family’s prescription drug costs up to the deductible amount.
- Co-payment: Once your family reaches the family deductible amount, the drug plan will cover 70% of your eligible prescription drug costs and you will pay the remaining 30% until you reach your family maximum amount.
- Drug Benefit Family Maximum: This is the maximum amount your family will pay for eligible prescriptions during the benefit year. Once you reach this family maximum, the drug plan will cover 100% of your eligible prescription drug costs for the rest of the benefit year.
Medical Supplies and Equipment Benefits
EHB covers prescribed medical supplies and equipment listed in the NIHB Medical Supplies and Equipment Guide and Benefit List.
Cost Sharing Arrangement:
Depending on your income level:
- Below Low-Income Threshold (Income Band 1): Medical supplies and equipment are covered at no cost-share for residents
- Seniors (60+): Medical supplies and equipment are covered at no cost-share for residents.
- Income Band 2-10: Medical supplies and equipment are covered at no cost-share for residents
- Above Band 10: Medical supplies and equipment are covered, with residents required to cost-share through a two-part arrangement:
- Co-payment: EHB will cover 75% of the eligible medical supplies and equipment costs and you will pay the remaining 25% until you reach your family maximum amount.
- MSE Family Maximum. This is the maximum amount your family will pay for eligible medical supplies and equipment during the benefit year. Family maximums range from $500 to $1500, based on your net income level. Once you reach this family maximum, EHB will cover 100% of your eligible medical supplies and equipment costs for the rest of the benefit year.
Vision Care Benefits
EHB covers products listed in the NIHB Guide to Vision Care Benefits and NIHB Regional Vision Care Fee Grid NWT if your family income is below the low-income threshold (Band 1) for your region, or if you are a senior aged 60 or over.
Dental Benefits
EHB covers a range of dental services listed in the NIHB Dental Benefits Guide and the NIHB Regional Dental Benefit Grid NWT if your family income is below the low-income threshold for your region, or if you are a senior aged 60 or over. Prior approval is required for certain treatments.
Extended Health Travel Benefits
EHB provides some travel benefits if you meet the following criteria:
- Seniors (aged 60 and over): Receive 100% coverage for prior-approved travel needed to access insured health services, medical supplies, equipment, and dental benefits.
- Residents below the low-income threshold: Receive 100% coverage of prior-approved travel needed to access medical supplies, equipment, and dental benefits.
- Residents above the low-income threshold: Receive 100% coverage for prior-approved travel needed to access medical supplies and equipment benefits only.
If you don’t meet these criteria, you can access medical travel benefits through the NWT Medical Travel Policy 49.06 and corresponding Ministerial Policies.
Regardless of which policy you access, medical travel benefits include:
- Coverage for travel to and from the nearest centre, plus stay at a boarding home, organized by the Medical Travel Office, including meals, accommodation, and transportation.
- In communities without a boarding home, the Medical Travel Office will arrange hotel stays, meals, and local transportation.
- If you choose not to stay at the boarding home, you must arrange your own meals, accommodation, and local transportation. We reimburse up to $50 per approved person per night for accommodation and $18 per approved person per day for meals. Reasonable local transportation costs to airport, accommodation, pharmacy, and appointments may also be approved.
Calculating Your Benefits
Use the Extended Health Benefits Calculator to estimate your eligibility for benefits and potential contribution based on your region, household income and family composition.
Claiming an EHB Expense
As a registered member of the EHB plan, you will receive an Alberta Blue Cross (ABC) card. Always carry this card with you to access services.
Prescription Drugs
- At the Pharmacy: Show your ABC card when you pay for your prescription. The pharmacist will bill ABC directly for any amounts covered by EHB, so you won’t need to submit claim forms or wait for reimbursement.
- If Direct Billing is Not Available: Pay upfront and submit a completed ABC Health Services Claim Form with your original receipts to ABC for reimbursement. You can find the form online at www.ab.bluecross.ca/forms.php. Your reimbursement will be mailed to your home address.
Dental Services
- At the Dentist: Most dental offices bill ABC directly. Show your card, and you’ll only need to pay amounts not covered by your plan.
- If Direct Billing is Not Available: Pay upfront and submit a completed ABC Health Services Claim Form, which your dentist must partially complete, along with your original receipts to ABC for reimbursement. This form is available from your dentist or online at www.ab.bluecross.ca/forms.php. Your reimbursement will be mailed to your home address.
Other Services
- Vision Care, Medical Supplies and Equipment: For most eligible expenses, you won’t need to pay upfront. If you do, get an official receipt and submit it with a completed ABC Health Services Claim Form for reimbursement.
For more information, see:
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 also might have coverage for prescription drugs, dental services, 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 you have coverage through the Workers Safety and Compensation Commission or a private insurance plan.
In such cases, Extended Health Benefits is considered payor of last resort.
Therefore, you must:
- Claim through your other plan first.
- If the full cost is not covered by your other plan, complete the relevant Alberta Blue Cross 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 insurance plan. You will then be reimbursed for eligible amounts up to the limits of the Extended Health Benefits Program.
Program Information
For information regarding eligibility for Extended Health Benefits, please contact:
Health Benefits Program
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, ext. 49462
Phone: 867-777-7400
Fax: 867-777-3197
Email: healthcarecard@gov.nt.ca