Implementing the 2024 Extended Health Benefits Policy

In June 2023, the Executive Council approved the new Extended Health Benefits Policy. Until the new Policy comes into effect, the existing Extended Health Benefits Policy remains in place.

Extended Health Benefits Policy (new)

Why is there a need for a new Extended Health Benefit Policy?

The existing Extended Health Benefits Policy has seen little change in the past 34 years. As a publicly funded program, the current Policy does not meet the objectives of fairness and equity because there are financial barriers for some residents that limit their access to important drug therapies and preventive services that help to maintain good health.

To address these gaps in coverage, significant changes have been made in the new Extended Health Benefits Policy. The updated policy aims to ensure fair access to extended health benefits for all NWT residents, with a focus on those with low income who are not currently covered under the existing policy.

Key elements of the new policy include:

  • Introduction of income assessment: The new policy implements an income assessment process to determine eligibility for all benefits, except for benefits accessed by seniors. This ensures that benefits are allocated based on individual income levels, promoting fairness and equitable access.
  • Removal of specified disease condition: The new policy eliminates the requirement of having a specified disease condition to access benefits.
  • A suite of benefits for all residents: The new policy offers a range of benefits, each with its own eligibility criteria and levels of coverage. This approach provides flexibility and accommodates diverse healthcare needs, allowing individuals to access the specific benefits that are most relevant to their circumstances.

Changes implemented from public engagement include:

  • Removal of the requirement for residents to purchase third-party insurance and exhaust its drug benefits before being eligible for the EHB Drug Benefits. The EHB program continues to be the payor of last resort.
  • Incorporation of support for residents above the low-income threshold to access medical supplies and equipment benefits through a cost-sharing model, along with reasonable family maximums.
  • Revisions to the presentation of benefits in the policy. The benefits are now described in Schedules, which outline each benefit and its specific eligibility criteria, replacing the previous presentation of benefits as packaged programs based on eligibility.

Preparing for the new policy

A lot of work needs to be done prior to implementing the new policy. This includes:

  • Setting up systems to manage information effectively.
  • Reviewing and updating administrative processes to make sure everything runs smoothly and efficiently.
  • Developing guidelines and documents to help everyone understand how the new policy will work.
  • Training staff members so they can support the new policy and answer questions from residents.

Our goal is to improve access to healthcare services and ensure a seamless transition for everyone. We're committed to making this process as easy as possible.