Extended Health Benefits for Specified Disease Conditions Program
The Government of the Northwest Territories (GNWT) sponsors the Extended Health Benefits program to provide non-Aboriginal 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, and accommodations.
You must apply for the Extended Health Benefits program. To apply, see:
Applying for Extended Health Benefits for Specified Disease Conditions Program
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 Indigenous Services Canada’s Non-Insured Health Benefits (NIHB) program.
Alberta Blue Cross administers benefits for the Specified Disease Conditions program on behalf of the GNWT.
This program provides you with 100 percent coverage for eligible prescription drug products, as defined in Indigenous Services Canada’s NIHB Drug Benefit List, when the drug is prescribed by a recognized health care professional and dispensed by a licensed pharmacist.
If a drug that has been prescribed for you is not on Indigenous Services 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:
- 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
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.
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
- 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
Claims will be paid according to the current Indigenous Services Canada NIHB schedule of prices.
How to claim for benefits
Each person registered in this program is provided with an Alberta Blue Cross identification card. Please carry this card with you at all times to access services.
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 identification 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.php).
Submit your form with original receipts to Alberta Blue Cross for reimbursement. Reimbursement will be mailed to you at your home address.
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, 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.
Claiming an EHB Expense
Coordination of Benefits
In addition to your Specified Disease Conditions program 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, the Specified Disease Conditions program 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 Specified Disease Conditions program.
For information regarding eligibility for the Specified Disease Conditions Extended Health Benefits program, 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