Applying for Métis Health Benefits Program

Applying for Métis Health Benefits Program

NWT Métis Health Benefits Program

The Government of the Northwest Territories (GNWT) sponsors the Métis Health Benefits program to provide eligible Indigenous Métis residents of the Northwest Territories access to a range of benefits not covered by hospital and medical care insurance.

Through this program, NWT residents receive coverage for eligible prescription drugs, dental services, vision care, medical supplies and equipment. You also receive benefits related to medical travel such as meals, accommodation and ambulance services.

You must apply for the Métis Health Benefits program. To apply, see:

Please note that comparable coverage for Métis Health Benefits is 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 benefits for the Métis Health Benefits program on behalf of the GNWT.

Prescription Drugs

This program provides you with coverage for eligible prescription drug products as defined by Indigenous Services Canada Non-Insured Health Benefit (NIHB) Drug Benefit List, when the drug is prescribed by a recognized health care professional and dispensed by a licensed pharmacist. There are a few cases when the program will not cover the full cost of the claim and you may need to pay out of pocket:

  • If the drug that is prescribed is not listed on the NIHB Drug Benefit List, or
  • If you want a drug that is not the lowest cost equivalent (generic).

If a drug that has been prescribed for you is not on the NIHB Drug Benefit List, your health care professional or pharmacist may submit a Request for Exception Drug Form to Alberta Blue Cross on your behalf for prior authorization. The exception drug coverage is for a period not exceeding 12 months after which a request may be resubmitted for approval or you may pay the cost.

Dental Services

You are eligible for 100 per cent coverage of the cost of eligible dental services, as defined by Indigenous Services Canada NIHB Schedule of Dental Benefits, and subject to plan limitations and exclusions.

Covered services include check-ups, cleanings, fillings, extractions, root canals, crowns, dentures, and orthodontics.

Your dental office should have a copy of Indigenous Services Canada’s NIHB Schedule of Dental Benefits so they are able to confirm your coverage at the time of your appointment. Prior approval is recommended for all dental services. Speak with your dental provider regarding eligible benefits. If your dental provider is outside the Northwest Territories, contact Alberta Blue Cross or Health Services Administration.

Vision Care

This program provides a flat rate of up to $300 for a standard prescription or $440 for a high index prescription. Persons 18 years of age and older are eligible for vision care benefits every two years. Persons under 18 years of age are eligible for vision care benefits every year.

Covered services may include frames, lenses, and contact lenses. Prior approval is recommended for all vision care benefits.  Speak with your optical provider regarding eligible benefits.

Major repairs to frames or lenses may be considered up to $125, and minor repairs up to $25.

Payment of vision benefits is based on terms and rates as established through NIHB payment schedules.

Services not listed in the NIHB fee guide may be considered on an exception basis. Medical justification must be provided by an ophthalmologist.

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 are required to travel to access medical treatment not available in your home community. For travel related to dental services, expenses must be approved in advance by Alberta Blue Cross.

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 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.

Most providers directly bill Alberta Blue Cross, so you can avoid paying out of pocket for services. If your provider does not accept direct billing, you will
need to submit your claim with original receipts:

If you submit your claim online, you can sign up to receive your reimbursement through direct deposit; otherwise, your reimbursement will be mailed to your
home address.

For more information, see:

You are only able to claim eligible benefits in the Indigenous Services Canada NIHB schedule. All claims for reimbursement must be submitted within 12 months of the date on the receipt.

Coordination of Benefits

In addition to your Métis 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, the Métis 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 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 Métis Health Benefits program.

Program Information...

For information regarding eligibility for the NWT Métis 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
Toll-free: 1-800-661-0830
Phone: 867-777-7400
Fax: 867-777-3197
Email: healthcarecard@gov.nt.ca