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Frequently Asked Health Benefits Questions

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​The most frequently asked questions have been divided into the following subcategories.

  • General Health Benefits
  • Eligibility
  • Pharmacy
  • Dental
  • BC Medical Service Plan (MSP)
  • Generic Drug
  • Ambulance Service
  • Buy Back

 

If you have a question that are not listed here, please contact HealthBenefits@fnha.ca​ or call: ​1-800-317-7878

General Health Benefits

When did the First Nations Health Authority (FNHA) take over Non Insured Health Benefits (NIHB)?

On July 2, 2013 the FNHA began receiving transfer payments from Health Canada for the NIHB program. The FNHA is purchasing existing services back from Health Canada through what is called 'buy-back'.

For those clients who premiums are paid for by FNHA and live in BC, they will automatically be added to FNHA Eligibility List. First Nation clients that have their Medical Service Plan (MSP) premiums paid by their employer or through another source are encouraged to contact the Regional office (1.800.317.7878) to ensure they are on or added to the FNHA Eligibility List. If a non-resident First Nations person uses health services in BC they will continue to be covered by Health Canada.

How has the health benefits program for First Nations in BC changed since FNHA began administering the program instead of Non-Insured Health Benefits (NIHB)?

Check out our HB Annual Report to check out what benefits and services we are providing and the efforts we are making to transform. Since transfer of responsibilities, we have put in place operational standards that we consistently meet or beat, and have recently added data analytics capacity to our team – with the aim of supporting communities make informed decisions and to better understand the needs of our communities and clients. 

How can I participate in improving the Health Benefits program?

The best way to participate in improving Health Benefits Program is by sharing your ideas with your Health Director. The First Nations Health Directors Association is leading engagement on the program.​

Do I have to pay upfront for FNHA Health Benefits?

Your benefit provider (e.g. your pharmacist or dentist) must inform you if you are expected to pay directly for any services or items. FNHA Health Benefits strongly encourages providers to bill FNHA Health Benefit directly; however, some do not.

Can I continue to use my current provider (e.g. my pharmacist or dentist) if they do not bill FNHA Health Benefits directly?

Yes, that is your choice. However, it is recommended that you contact the FNHA Health Benefits office (604.666.3331; or toll free 1.800.317.7878) before purchasing any item or receiving any service to ensure that the requested item or service is eligible for coverage under FNHA Health Benefits. Remember that in such cases, you must pay your provider first and then forward the proper information to FNHA Health Benefits in order to be considered for reimbursement. You should also note that your provider may charge more than the rate covered by FNHA Health Benefits, which means that you would not be reimbursed the full amount that you paid.

Why should I keep my private insurance if I am eligible for FNHA Health Benefits?

It is important to note that as a registered FNHA client, you should maintain any private, employer-sponsored, or other public health care coverage you may have, as some of the benefits you may currently be receiving may not be eligible benefits under FNHA Health Benefits (e.g. physiotherapy and chiropractic treatment). For benefits that are available under both your private plan and FNHA Health Benefits, your claims must first be forwarded to your current plan or program before forwarding them to FNHA Health Benefits. For FNHA eligible benefits, the remaining amount of your claim not paid for by your private plan can then be forwarded to FNHA Health Benefits in order to be considered for reimbursement.

Does FNHA Health Benefits provide out-of-country coverage?

FNHA Health Benefits may cover the cost of privately acquired supplemental health insurance premiums for approved clients who may be students or migrant workers. Supplementary health insurance coverage for all other outside of country travel (e.g. vacation travel) is not a benefit under FNHA Health Benefits. When travelling outside of Canada, it is recommended that you buy travel health insurance in case of an emergency.

What is the difference between an exception and exclusion?

FNHA Health Benefits may provide coverage as an exception for goods and services that are not included in the NIHB benefit lists and that are not an exclusion of the Program. Exception requests will be considered on a case-by-case basis upon receipt of written medical justification from the provider.

Exclusion items are goods and services which are not listed as benefits on FNHA Health Benefits benefit lists and are not available through the exception process or subject to appeal. Therefore, excluded items will not be covered by FNHA Health Benefits under any circumstance. These may include, but are not limited to, items used exclusively for sports, work, education, cosmetic reasons, are experimental, or are part of a surgical procedure.

Can I appeal a decision? How would I go about it?

When coverage for a benefit through FNHA Health Benefits has been denied, the recipient or parent/ guardian of the recipient, has the right to appeal the decision. Appeals must be forwarded in writing and can be initiated by the client or legal guardian. An interpreter, advocate, CHR, or support liaison may assist the client in compiling the appeal, but the client must request the appeal by giving input and signing the letter to initiate the appeal process. There are three levels of appeal available. At each stage, the appeal must be accompanied by supporting information from the provider or prescriber to justify the exceptional need.

At each level of appeal, the information will be reviewed by an independent appeal structure that will provide recommendations to the program based on the client's needs, availability of alternatives, and FNHA Health Benefits. At all levels of the appeal process, the client will be provided with a written explanation of the decision made. Please note that exclusions of the program are not subject to appeal.

Are removable air casts a benefit?

Air casts for the treatment of injuries such as sprains or broken bones are not a benefit under FNHA Health Benefits. Treatment of these conditions is usually provided by a hospital as a provincially insured service (i.e. plaster casts). Removable air casts may be considered as an exception with appropriate justification, such as diagnosis and treatment of Diabetic Plantar Neuropathic / Ischaemic foot ulcers.

Eligibility

Who is eligible for the FNHA Health Benefits Program?

Eligibility ​for the FNHA Health Benefits Program extends to all First Nations people that are resident of British Columbia and have a status number (excluding persons who receive health benefits by way of a First Nations organization pursuant to self-government agreements with Canada). Residency is defined as having an active BC Health Care card and living in BC.​

How can I apply for or replace my BC Care Card (or its replacement: the new BC Services Card)?

On February 15, 2013 the provincial government introduced  the BC Services Card, which will be phased in over a five-year period. The new card replaces the CareCard and can be combined with the driver's licence. It is secure government issued identification that British Columbians can use to prove their identity and access provincially-funded health services. In the future, the BC Services Card will provide in-person and online access to other government services. Residents of BC can acquire, change or replace BC Care Cards, or BC Services Cards on the Ministry of Health website . Find the BC Medical Plan enrollment form here

 

Pharmacy

Pharmacy Benefits

I have been prescribed a drug by my physician and the pharmacy has told me that it is not covered through FNHA Health Benefits. Why?

FNHA Health Benefits has a comprehensive Drug Benefit List to which the pharmacy has access. In most cases the drugs prescribed are on the list and the pharmacist can dispense them immediately; however, some drugs prescribed need prior approval and must go through the Drug Exception Centre (DEC). These are considered exceptions. Once the pharmacist initiates an exception and it has been denied by the Drug Exception Center, then the FNHA client may appeal the decision. Some drugs are excluded from the drug benefit list and are not subject to the appeal process.​


Dental

Dental Benefits

My dentist is charging me for treatment. Why?

FNHA Health Benefits Dental program has its own fee schedule, which may not cover all the fees charged by the provider. Any charges exceeding FNHA Health Benefits fees are not eligible for reimbursement. Please confirm with your provider what, if any, your financial responsibility is prior to receiving treatment.

Why does my dental provider have to send in a request before performing some services?

Predetermination, or prior approval, is common to most public and private dental plans. The predetermination process ensures that both the dental provider and FNHA client are informed of the policies and understand the coverage commitments. Clients must meet all of the clinical criteria and guidelines established by FNHA Health Benefits for the dental treatment to be considered for coverage.

 

My dentist informed me that treatment was not approved. Why?

FNHA Health Benefits evaluates all dental predeterminations against its Dental Framework which outlines the types of benefits available to clients and their coverage criteria. To provide coverage, all established policies, guidelines and criteria must be met.

MSP

BC Medical Services Plan (MSP)

I filed my income tax return and the Canada Revenue Agency is indicating that I owe for unpaid MSP premiums.

The Medical Services Plan premiums are being billed directly to the FNHA client rather than to FNHA Health Benefits. This may occur when a FNHA client is registered under another plan (i.e. through their employer) and is not registered through FNHA Health Benefits. Once they leave their job, the employer has taken them off their list and MSP automatically begins invoicing the client. It is important for clients who are receiving MSP benefits through another plan to notify the FNHA Health Benefits office. The FNHA client needs to complete an MSP application form and forward it to the Health Benefits office, with the attached bill and a photocopy of the individual's birth certificate so they can be registered on the FNHA Health Benefits group number. If the FNHA client is having difficulties with their income taxes because of unpaid premiums they may contact the FNHA Health Benefits office.

Can you tell me which services the BC Services Card does not cover?

Some exclusion for Medical Service Plan include: surgery for alteration of appearance (cosmetic surgery), reversal of sterilization, in-vitro fertilization, artificial insemination, genetic screening and other genetic investigations including DNA probes, acupuncture, hypnotherapy, acupressure, and procedures still in the experimental or developmental phase. Clients should contact MSP for a complete list of what is covered and what is not.

Do I have to replace my MSP card?

Having FNHA coverage for the MSP premiums does not change the Personal Health Number (PHN). However, the new BC Services Card is now being issued with the goal of eventually replacing all existing CareCards by 2018. The new cards have enhanced security features to help protect personal information. The new cards can be processed by an ICBC driver licensing office or ServiceBC can be contacted toll free at: 1.800.663.7867 for an alternate approach. For more information about the BC Services Card, please visit www.gov.bc.ca/bcservicescard

I received an ambulance and hospital bill for medical care incurred in the United States and, unfortunately, I did not buy the supplemental coverage for travel outside of Canada. Can FNHA Health Benefits assist in paying?

No, FNHA Health Benefits will not cover supplemental coverage. You may want to contact the Ministry of Health Services out-of-country claims department to discuss any other coverage you may have through the BC medical plan.

Are chiropractic, massage therapy, naturopathy, physical therapy and podiatry services covered through MSP or FNHA Health Benefits?

These services are not generally covered through MSP. There is an exception for clients whose premiums are being paid by FNHA. MSP pays a set amount per visit for a combined annual limit of 10 visits each calendar year for the following services: chiropractic, massage therapy, naturopathy, physical therapy, and non-surgical podiatry. Clients should contact MSP to determine eligibility and the amount they will cover.​

Are there any exceptions for additional physical therapy, chiropractic or massage therapy, and can the user fees be reimbursed by FNHA Health Benefits?

No, FNHA Health Benefits does not pay for these services and does not reimburse any user fees.

Generic Drugs

What is a brand name drug?

A brand name drug is the first version of a drug to be sold within a country. A brand name drug is sold by the drug manufacturer that first researched and developed the drug.

What is a generic drug?

A generic drug is a legal copy of a brand name drug.

How are generic and brand name drugs the same?

• They both have the same active ingredient (the compound that makes the drug work).

• They both have the same amount of the active ingredient.

• They both work the same way in the body.

• They are both absorbed by the body at the same rate.

How are generic and brand name drugs different?

• They may have different inactive ingredients (such as flavours or preservatives).

• They may have slightly different colours, shapes, or markings.

• Brand name drugs are more expensive.

Why are brand name drugs more expensive than generic drugs?

• Brand name drugs are more expensive because of the large investments brand name manufacturers make in marketing, branding, research and development (R&D). These investments increase prices by 30 to 40 percent.

• Generic drug manufacturers do not invest in R&D, marketing or branding the same way brand name manufacturers do. With minimal marketing and R&D expenses, the generic drug price is 30 to 40 per cent lower.

Are brand name drugs safer? How do I know if a generic drug is safe?

• Generics are just as safe as brand name drugs. Both generic and brand name drugs are rigorously tested by Health Canada for quality, safety and effectiveness.

• Health Canada also has regulations for generic drug manufacturing. All drug manufacturers in Canada must follow the same regulations for their manufacturing processes and for ensuring the quality of their ingredients. 

Are generic drugs as effective as brand name drugs?

Yes. Health Canada reviews and approves all drugs before they can be sold in Canada. For generic drugs, studies must show that generic drug formulations have been thoroughly tested to ensure the same rate and extent of absorption by the body as brand name drugs. Testing also proves that the active ingredient reaches the same concentration in the blood in the same amount of time as the brand name drug.

Are generic drugs as good as brand name drugs?

Yes. Generic drugs are high-quality medicine. A generic drug is a legal copy of the brand name drug.

Do generic drugs contain the same medicine as brand name drugs?

Yes. Both generic and brand name drugs contain the same active medicinal ingredients.

How are drugs researched and approved for sale in Canada?

A brand name drug manufacturer spends many years researching and developing a new drug before it can be approved for sale in Canada. The drug manufacturer applies for a patent on the drug so that no other company can manufacture or sell it.

Once it has a patent, the brand name manufacturer makes large investments in marketing and branding campaigns to sell its new drug. When the patent expires (usually after ten years), all other drug manufacturers are legally allowed to make copies of the brand name drug and sell it as a 'generic drug'.

Are generic drugs given to BC First Nations more often?

No.

• The same generic and brand name drugs are prescribed for the same conditions to both First Nations and non-First Nations individuals.

• The FNHA prescription drug list is similar to the BC Pharmacare prescription drug list that is mandated for all citizens of BC.

• Generic drugs are commonly used by all Canadians. Prescriptions in Canada are usually filled with generic drugs if they are available.

Since transfer, has FNHA made changes to generic or brand name coverage?

No. BC First Nations receive the same proportion of generic and brand names drugs as before transfer. Most drug plans – including Pharmacare, Veterans and NIHB – switch coverage to the generic version of a drug once the patent on the brand name drug has expired.

Why are there changes in generic brand coverage?

Each year in April, BC Pharmacare selects which generic brands it will cover based on price and the ability to supply all BC residents (and prevent drug shortages). Pharmacies often switch the generic brands they carry in the spring because of this change in BC Pharmacare coverage.

When might it be unsafe to switch to a generic brand?

Rarely someone might be allergic to an in-active ingredient in a drug. If you are allergic to ingredients such as lactose, gluten, sulfites, or tartrazine, check with your pharmacist before you take any drug (both brand name and generic) for the first time.

Why do prescription drugs have more than one name?

Whether your prescription drug is a brand name version or a generic version, it will always have more than one name: a brand name and a generic name. The brand name is chosen by the manufacturer selling the brand name drug. The generic name is the name of the active ingredient and is always the same no matter which version of the drug you use.

Sometimes brand names can be confusing. It's a bit like brand names for other products. For example, you may buy Kleenex, Scotties, or Royale (brand names) but they are all facial tissue (generic name). Kleenex is a popular brand and some people may say 'Kleenex' (brand name) when they really mean 'facial tissue' (generic name).

Ambulance Services

Why have I received a bill for ambulance services?

Ambulance services are not covered through the BC Medical Services Plan; however, they can be covered through FNHA Health Benefits. The service provider (BC Ambulance) may not have been provided with your 10 digit status number at the time of the service. Clients must provide their status number to the service provider in order for them to invoice FNHA Health Benefits. Call the provider or send back the bill with your 10 digit status number, date of birth and registered status name. Once the provider has the status number and date of birth the invoice will be sent to the FNHA Health Benefits office for review.

Ambulance Services Billings Department: 1.800.665.7199

Buy Back

What is Buy-back?

Buy-back is a​n arrangement between the First Nations Health Authority and Health Canada where the FNHA "buys-back" the administration of claims processing and benefits review services from Health Canada. It will take some time for the First Nations Health Authority to build the appropriate systems to process the tens of thousands of daily claims. The buy-back arrangement will ensure continuity of service as the FNHA builds these systems.

How long will the FNHA buy-back services?

The FNHA currently has a buy-back agreement for a term of two years in place. This agreement may be extended for an additional two years. 

Will the Health Benefits Program change during the Buy-Back phase?

There will be minor changes to the Health Benefits Program during the buy-back phase. An Improvements Working Group has been struck including leadership from the FNHA, FNHC, and FNHDA to make some early improvements to the program. The committee meets regularly and has developed a draft work plan. Issues identified by the Health Directors Association will be analyzed and prioritized taking into account the phases of Health Benefits transfer and the associated restrictions.

 Do you have questions?

​Contact us at 

HealthBenefits@fnha.ca 

or call 

1.800.317.7878 (Toll Free)

 How was your experience?

We want to hear from you about your experience with FNHA Health Benefits. Please take 5-10 minutes to fill out our survey here:

​Feedback ​

​This client satisfaction survey will help us understand BC First Nations experiences accessing FNHA Health Benefits. We will use this information to improve the quality of our services.​

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