Nunavut Extended Health Benefits has three streams: medical travel support, specified conditions for non-Indigenous residents under 65, and seniors coverage at 65 or older. It is the payer of last resort, after any other plan.
Applies in: Nunavut
Nunavut Extended Health Benefits (EHB) is the territorial top-up program for health costs the Nunavut Health Care Plan does not cover, and you register for it with an application form sent to the Director of Medical Insurance. The Government of Nunavut Extended Health Benefits Policy states that the Department of Health provides assistance to eligible persons who require health care products and services and medical travel support beyond the coverage conferred by the Nunavut Health Care Plan and a third-party plan.
The program runs in three streams, and the stream decides both who registers and what is covered. It is a payer of last resort in every stream: other coverage pays first. This guide walks through the registration process only and gives no advice on eligibility in an individual case.
The policy defines its terms carefully, and one distinction shapes the whole program. A third-party plan includes Health Canada's Non-Insured Health Benefits (NIHB) program, along with group health insurance and health benefits plans. Both the specified conditions stream and the seniors stream are for people who are not Indigenous under the policy definition: not a registered Indian according to the Indian Act, and not an Inuk recognized by one of the Inuit land claim organizations. Recognized Inuit residents receive the comparable drug, dental and vision benefits through federal NIHB instead of through EHB. That is the only point this guide makes about NIHB, and it is the point the policy itself makes by building NIHB into its definitions.
The benefit categories across the program are dental care, audiology services and products, vision care, medical supplies and appliances, prescription drugs and medical travel support. The formulary EHB uses is Health Canada's NIHB Drug Benefit List, together with the Chronic Renal Failure Formulary and the Palliative Care Formulary.
Two third-party rules apply before any stream does. You are not eligible for a category of benefits if you are eligible for a third-party plan that covers that category and you choose not to participate in the plan, or in that category under it. And the amounts you can claim under EHB are reduced by the amounts your third-party plan pays.
For prescription drugs, when both a generic and a brand-name version of a covered drug exist, the policy covers only the least expensive version, unless a medical practitioner or nurse practitioner applies for an exception documenting an adverse reaction to the least expensive drug, the Director of Medical Insurance approves it after consulting a pharmacist, and the prescriber writes no substitution on the prescription. You can choose the more expensive version yourself and pay the difference.
This stream is not a registration stream in the same way. It covers client and escort costs on a medical trip for the days when you have no third-party plan covering flight co-payments, ground transportation, meals or accommodation for the trip, or that coverage is exhausted, or it pays at lower rates than the policy sets. Covered items include the flight co-payment under the Medical Travel Policy, taxi fare between home or the local health centre and the airport in Coral Harbour, Whale Cove, Resolute Bay and Arctic Bay, ground transportation in the referral city between the health facility, the airport and accommodation, and ambulance charges to transfer a client between health facilities. A stay in private accommodation carries a $50 nightly accommodation allowance, documented on a billet form, with $50 per day meal allowances in the situations the policy sets out. A short stay in commercial accommodation outside a northern area is reimbursed up to a nightly maximum of $175. Trips expected to last more than 90 days move to a long-term set of allowances instead.
Who registers. You are eligible if you are not Indigenous, are under the age of 65, are enrolled in the Nunavut Health Care Plan, and have a condition listed on Schedule A of the policy, or a condition accepted for special coverage. Schedule A includes, among others, alcohol dependency, Alzheimer's disease, asthma, cancer, celiac disease, cerebral palsy, Crohn's disease, cystic fibrosis, diabetes insipidus, diabetes mellitus, epilepsy, HIV infection, ischemic heart disease, lupus, multiple sclerosis, muscular dystrophy, osteoarthritis, psoriasis, rheumatoid arthritis, spina bifida, spinal cord injury, tuberculosis and ulcerative colitis.
What registration covers. The full cost of formulary prescription drugs prescribed for a condition you are diagnosed and registered for, the full cost of pre-approved exception drugs for that condition, and the full cost of medical supplies and appliances, including fitting and shipping, where they are on the NIHB Medical Supplies and Equipment General Benefits list and prescribed for that condition. Where treatment of a drug's side effects makes it necessary, the stream also reaches dental care, audiology, vision care and further listed supplies on the terms the policy sets.
How to register.
If your condition is not listed. You can request special coverage. The form is signed by your nurse practitioner or medical practitioner and carries your name, date of birth, Nunavut Health Care Plan card number and contact information, the condition, an evaluation of whether it is life threatening or will become life threatening if untreated, an assessment of its chronicity, and the practitioner's name and contact information. The Director decides after considering chronicity, the life-threatening nature of the condition, and any other relevant factor, and communicates the decision to you and your practitioner. Approved conditions are published on a department web page as eligible for the stream. A retroactive diagnosis counts from the later of your Nunavut Health Care Plan enrolment date and the condition's onset date as first established by a practitioner.
Who registers. You are eligible if you are not Indigenous, are 65 years of age or older, and are enrolled in the Nunavut Health Care Plan.
How to register. Give the Director of Medical Insurance a completed application form, including an employer-signed statement of third-party plan coverage if required. The Director may require clients in the seniors and specified conditions streams to renew their registration from time to time.
What registration covers.
You can appeal a decision under the policy by submitting the appeal form to the Deputy Minister of Health, with your name, Nunavut Health Care Plan number, contact information, the decision being appealed, your reasons, and any evidence you want considered. The Deputy Minister acknowledges the appeal, gathers information, and decides within 30 calendar days to maintain, annul or vary the decision, or make another decision the circumstances need. That appeal decision is final and binding.
The policy document opened for this guide states the three streams, the eligibility tests, the registration forms and their required statements, and the seniors benefit amounts above, including the $1,000 dental maximum and the $100 frame maximum. It does not state where to obtain the application form in a community, a mailing address for the form on the pages read here, or a processing time for registration, so this guide gives none of those. It also does not state a registration fee, so this guide does not describe registering as free or as paid.
| Stream 1, Medical Travel Support | Help with flight co-payments, ground transportation, meals and accommodation on a medical trip, where no third-party plan covers them or that plan is exhausted |
|---|---|
| Stream 2, Specified Conditions | Not Indigenous, under 65, enrolled in the Nunavut Health Care Plan, with a condition on Schedule A or approved for special coverage |
| Stream 3, Seniors | Not Indigenous, 65 or older, enrolled in the Nunavut Health Care Plan |
| Seniors dental care | A combined maximum of $1,000 per calendar year for dental care by dental professionals |
| Seniors vision care | A vision examination once in any year, lenses in full once in any 2 years, and a maximum of $100 for a frame once in any 2 years |
Extended Health Benefits is a payer of last resort. Amounts you can claim are reduced by amounts your third-party plan pays, and the formulary is the Non-Insured Health Benefits Drug Benefit List.
It is a Government of Nunavut Department of Health program that helps eligible people with health care products and services and medical travel support beyond the coverage of the Nunavut Health Care Plan and any third-party plan. It is divided into three streams: medical travel support, specified conditions, and seniors.
A person is eligible for the seniors stream if they are not Indigenous, are 65 years of age or older, and are enrolled in the Nunavut Health Care Plan. The policy uses the term not Aboriginal, meaning not a registered Indian under the Indian Act and not an Inuk recognized by an Inuit land claim organization.
Because recognized Inuit and registered First Nations residents receive drug, dental and vision benefits through the federal Non-Insured Health Benefits (NIHB) program instead. Extended Health Benefits is the territorial program for residents who do not have that federal coverage, and NIHB itself counts as a third-party plan under the policy.
For the seniors stream, give the Director of Medical Insurance a completed application form, including an employer-signed statement of third-party plan coverage if required. For the specified conditions stream, the form must also include a statement from a nurse practitioner or medical practitioner naming your Schedule A or specially approved condition and the drugs currently prescribed for it.
The full cost of prescription drugs on the formulary, pre-approved exception drugs, ambulance charges for transportation within Nunavut, dental care up to a combined $1,000 per calendar year, medically required audiology services and products, the full cost of listed medical supplies and appliances including fitting and shipping, and vision care at set rates, including an examination once a year and lenses once in any 2 years.
You can ask the Director of Medical Insurance to approve special coverage for the condition. Your nurse practitioner or medical practitioner signs the form, which sets out your name, date of birth, Nunavut Health Care Plan card number and contact information, the condition, whether it is life threatening or will become life threatening if untreated, and an assessment of how chronic it is. The Director decides after considering chronicity, how life threatening it is, and any other relevant factor, and tells you and your practitioner.