Information for Audiology Prescribers

Questions and Answers

What is the Non-Insured Health Benefits Program?

The Non-Insured Health Benefits (NIHB) Program is a national program that provides coverage to registered First Nations and recognized Inuit for a limited range of medically necessary goods and services to which these clients are not entitled through other plans and programs.

The benefit areas covered by the NIHB Program are:

• Dental Care Benefits;
• Eye and Vision Care Benefits;
• Medical Supplies and Equipment Benefits;
• Pharmacy Benefits (including prescription and over-the-counter drugs);
• Mental Health Counselling Benefits; and
• Medical Transportation Benefits to access medically necessary services.

What changes were made to the audiology prescribing requirements?

Audiologists are now recognized as prescribers under the NIHB Program and a referral prescription from a physician or nurse practitioner is no longer required.  Clients must access audiology services covered by the provincial/territorial governments, private plans, or other third-party payors, before seeking coverage through the NIHB Program.

Please note that hearing aid specialists such as hearing aid practitioners, hearing instrument practitioners and audio-prosthetists continue to require a referral prescription from a physician, audiologist or nurse practitioner.  Prior approval processes and frequency limitations still remain in place.

When will this change become effective?

This change took effect January 1, 2012.

Who can prescribe audiology benefits under the Non-Insured Health Benefits Program?

• An audiologist
• A physician
• A nurse practitioner

Please note: In order to be a prescriber under the NIHB Program, audiologists from the provinces/territories that are not regulated (NS, PEI, NL, YK, NU, NT), must be a member in good standing with the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA), the Canadian Academy of Audiology (CAA) or their provincial association or licensing body.

Can an audiologist prescribe and dispense under the NIHB Program?

Yes, an audiologist can prescribe and dispense under the NIHB Program, if this is permitted in their province/territory.  In order to dispense, audiologists are encouraged to register with Express Scripts Canada to become a provider with the NIHB Program. 

Audiologists must be prior approved for all audiology benefits by the regional office before any services are provided.

For information on how to register with Express Scripts Canada, including the enrolment forms, on the Express Scripts Canada website: http://www.provider.express-scripts.ca/mse.html or can contact the Express Scripts Canada Provider Registration Call Centre at 1-888-830-8009.

How will an audiologist be identified as a provider with the NIHB Program?

Once an audiologist has registered as a provider with the Program, he will be given a unique provider number. This number must be used for all prior approval and billing purposes when dealing with Express Scripts Canada.

Where can I find information on the policies and audiology items covered by the NIHB Program?

The Medical Supplies and Equipment Benefit List contains the products and services covered as eligible benefits by the NIHB Program, along with information pertaining to benefit codes, requirements for prior approval, and applicable frequency limitations.

The Medical Supplies and Equipment Provider Guide provides information on the NIHB Program and policies relevant to medical supplies and equipment (MS&E) providers.   It explains the extent and limitations of the NIHB Program’s MS&E benefits by describing the important elements of each associated policy.

The Medical Supplies and Equipment List is publicly available on Health Canada’s NIHB website at:  http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/provide-fournier/med-equip/criter/index-eng.php   The Medical Supplies and Equipment Provider Guide is publicly available on Health Canada’s NIHB website at:  http://www.hc-sc.gc.ca/fniah-spnia/pubs/nihb-ssna/_medequip/2009-prov-fourn-guide/index-eng.php

Where can I obtain more information about the NIHB Program?

For more information regarding the NIHB Program, visit the NIHB Program website:  www.healthcanada.gc.ca/nihb or contact the Health Canada regional office.