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 100 percent coverage for eligible prescription drug products as defined in Indigenous Services Canada’s 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.

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.

Dental Services

You are eligible for 100 per cent coverage of the cost of eligible dental services, as defined by Indigenous Services Canada’s 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. Some dental services may require a prior approval.

Services not covered include:

  • dental expenses incurred prior to the effective date of coverage
  • claims for dental expenses received by Alberta Blue Cross more than 12 months after the date of service
  • dental services not listed in Indigenous Services Canada’s NIHB Schedule of Dental Benefits.

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 a 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.

Claiming an EHB Expense

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 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.

Dental services

Alberta Blue Cross allows all dental offices to bill Alberta Blue Cross directly for services provided to you. Show your card and you will only be required to pay amounts not covered by your plan.

If your dentist does not accept direct billing, you will have to pay your dentist directly and claim reimbursement by submitting a completed Alberta Blue Cross Dental Services Claim Form (available from your dentist or online at www.ab.bluecross.ca/forms.php). Your dentist must also complete a section of this form. Mail 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. However, in cases where you are required to pay the total cost of vision care, 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.

For more information, see:

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

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