Dental care benefits for First Nations and Inuit falling behind Canadian standards, say dentists

Dentists and program users say the federal Non-Insured Health Benefits (NIHB) program often does not cover modern dental costs and that administrative delays and payment issues are causing some providers to stop billing the program.

Several First Nations and Inuit patients and dental professionals report that the federal Non-Insured Health Benefits program (NIHB) is not keeping pace with current dental costs and care practices. The program, which is intended to cover services not insured by medicare, requires predeterminations and often acts as a payer of last resort. People who use NIHB say long paperwork cycles, delayed decisions and payment problems have led to out-of-pocket costs and longer waits for treatment. Dentists and health leaders say some providers have stopped accepting direct billing to NIHB because of these administrative burdens. Key developments: - NIHB covered dental benefits for about 344,898 clients in 2023–24, with dental as the program's third largest expenditure at over $379 million that year. - Patients reported partial approvals, lengthy predetermination processes and appeals that were denied after weeks, leaving some with significant out-of-pocket costs. - Dentists and dental associations say administrative complexity and delayed payments are prompting some providers to opt out of direct billing to NIHB, reducing local access for eligible clients. - The new Canadian Dental Care Plan (CDCP) applies to eligible First Nations and Inuit but NIHB must be billed first; the federal government did not confirm whether 2022 parliamentary recommendations to modernize NIHB have been acted on. Summary: Access to dental services for many NIHB clients is reported to be constrained by administrative processes, coverage limits and payment issues, which can lead to out-of-pocket costs and travel for care. It is unclear what steps have been taken in response to parliamentary recommendations aimed at modernizing the program. Undetermined at this time.