If you are a First Nations or Inuit patient with NIHB coverage, you can receive dental care at Downtown Toronto Dentistry without paying out of pocket for eligible services. Our downtown clinic treats NIHB clients and handles the claim process for you.
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The Non-Insured Health Benefits (NIHB) program is a federal health program administered by Indigenous Services Canada. It covers dental services that are not covered by a provincial plan or private insurance. Claims are processed by Express Scripts Canada, the program’s third-party claims processor.
Patients’ Note: Because NIHB is a payer of last resort, patients who also have a provincial or private plan use that coverage first, and NIHB then helps with eligible costs it does not pay.
You may be eligible for NIHB dental coverage if you belong to one of the following groups:
There is no application process. If you meet one of these criteria, you can access NIHB dental benefits.
NIHB covers a wide range of routine and medically necessary dental care, including:
Certain dental services need predetermination, which is prior approval from the program before treatment starts. When your treatment requires it, we prepare and submit the predetermination request to Express Scripts Canada for you. When approval comes back, we schedule your care.
| Dental Service | NIHB Coverage | Notes |
|---|---|---|
| Covered | ||
| Exams and X-rays | Covered | Frequency limits apply by age |
| Cleanings, scaling, polishing | Covered | Frequency limits apply |
| Fluoride | Covered | — |
| Sealants | Covered | Up to age 18 |
| Fillings | Covered | — |
| Extractions (simple and surgical) | Covered | — |
| Root canals (most teeth) | Covered | Wisdom teeth need pre-approval |
| Complete dentures | Covered | Typically once in any 8 years per arch |
| Denture repairs | Covered | — |
| Covered with Pre-Approval | ||
| Crowns | Covered with pre-approval | Typically once in any 3 years |
| Initial partial dentures | Covered with pre-approval | — |
| Root canals on wisdom teeth | Covered with pre-approval | — |
| Braces | Covered with pre-approval | Strict criteria, ages 0 to 17 |
| General anaesthesia | Covered with pre-approval | — |
| Not Covered | ||
| Veneers | Not covered | — |
| Mouth guards and night guards | Not covered | — |
| Bone grafts | Not covered | — |
| Teeth whitening and cosmetic work | Not covered | — |
NIHB dental fees in Ontario follow the NIHB Regional Dental Benefit Grid for the province. When you are eligible, and we bill the program directly, you pay no deductible or co-payment for covered services. Current fee details for each procedure are published by Express Scripts Canada.
We submit your claim to Express Scripts Canada, so you are not billed for eligible services.
