Guide to mental health counselling benefits for First Nations and Inuit

1.1 Purpose of the guide

This guide outlines the terms and conditions, criteria, guidelines and policies for the NIHB program's professional mental health counselling benefit, including:

• client eligibility
• provider eligibility
• benefit coverage
• prior approval process
• claims submission process

Administrative information for NIHB providers on how to submit prior approval requests and make claims can be found in the Mental Health Counselling Claims Submission Kit, available on the Express Scripts Canada NIHB provider and client website.

For more information, clients and providers may contact the NIHB regional office.

1.2 NIHB program - overview

Indigenous Services Canada's (ISC) Non-Insured Health Benefits program is a national program that provides eligible First Nations and Inuit clients, residing in Canada, with coverage for a range of medically necessary health benefits when these benefits are not otherwise covered through private or provincial or territorial health insurance plans or social programs.

NIHB program benefits include prescription drugs and over-the-counter medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access medically required health services that are not available on the reserve or in the community of residence.

For some First Nations and Inuit clients, mental health counselling benefits coverage is managed and delivered by a First Nations or Inuit community, organization, regional health authority or other government (for additional information, see Appendix D: Self-government agreements and other community-managed benefit coverage). Please note that these requests are not processed by Express Scripts Canada or the NIHB program. Clients and service providers can contact the responsible community health services or regional health authority for information about their process for accessing benefits.

1.3 NIHB mental health counselling benefit - overview

The mental health counselling benefit is based on supporting a planned and scheduled therapeutic approach to mental health intervention and operates as part of a continuum of mental wellness programs provided by Indigenous Services Canada, which complement other mental wellness services that are provided in/by communities, and by/through provinces and territories. Providers are expected to make themselves aware of the mental wellness services available in the community, and locally from the province or territory and ensure the client is aware of the availability of such services. An overview of other Indigenous Services Canada's mental health counselling programming can be found in section 6.2 Mental health counselling programming and at Indigenous mental health webpage.

For more information on assistance for clients seeking a provider, see section 3.2.1 Finding a provider and accessing services in the guide.

The provision of this benefit is part of Indigenous Services Canada's commitment to work towards the development of a coordinated and comprehensive approach to mental health and addiction programming. Mental health counselling coverage is offered in a way that:

• recognizes NIHB mental health counselling benefit as a component of a mental wellness continuum that includes other Indigenous Services Canada, community-based and provincial or territorial mental health programming and services
• supports culturally competent mental health counselling

2.1 Provider eligibility

Health professional regulation and licensing is a provincial and territorial jurisdiction. To be eligible under the NIHB program, a provider must meet ALL of the following conditions:

• registered in good standing by a Provincial/Territorial legislated regulatory body responsible for the licensing of mental health counselling professionals in the province or territory in which the client receives services
• practising in accordance with the Provincial/Territorial legislation governing the licensing of such professionals
• where a clinical designation exists (example, Clinical Social Worker), that designation is required
• eligible for independent, unsupervised practice

Based on these requirements, only the types of regulated professionals listed in Appendix A: Eligible provider types by province and territory are considered eligible under the NIHB program. The process for limited consideration of exception providers, certified by a non-legislated entity functioning as a self-regulatory body, is also included in this appendix. Providers not meeting the regular or exception criteria outlined in Appendix A will not be considered eligible under any circumstances. Membership in a professional association is not equivalent to being licensed by a provincial or territorial regulatory body.

A provider's disciplinary or criminal record history will be considered as part of NIHB's review of the billing agreement application.

When providers enrol with Express Scripts Canada, the provider billing numbers issued are region-specific. The provider must be both licensed and enrolled with Express Scripts Canada in the region where the client is located or receiving services and must bill using a provider number and fee guide which corresponds to the province or territory in which the client is located or is receiving services or claims. Prior approval requests will not be processed and are subject to recovery.

Providers must be operating physically in Canada in order to be eligible as an NIHB mental health counselling provider.

Regarding providers of interprovincial mental health telecounselling services in exceptional circumstances, please refer to Appendix C: Interprovincial mental health telecounselling.

2.2 Provider enrolment process

Providers wishing to deliver services reimbursed by NIHB must complete a Mental Health Counselling Billing Agreement found in the Mental Health Counselling Professional Provider Enrolment Package, available on the Express Scripts Canada NIHB provider and client website, and submit it to Express Scripts Canada.

See Appendix D: Self-government and other community-managed benefit coverage for clients whose NIHB coverage is managed through an alternate arrangement such as self-government. Express Scripts Canada cannot process claims for such clients.

To avoid the appearance or existence of a conflict of interest, providers must disclose any work that they do with other mental health/wellness programs or organizations that provide services to members of First Nations or Inuit communities. A provider offering professional services to a First Nation or Inuit community organization, whether as an employee or an independent contractor, shall disclose in writing to the NIHB regional office within 10 days of starting such arrangements. Failing to disclose this information may lead to the suspension or termination of the aforementioned agreement.

For greater clarity, should the provider offer employment or professional services to a community organization funded through a contribution agreement with Indigenous Services Canada, the provider may not refer the clients receiving services in the community to their independent/private practice and submit any claims under the NIHB Provider number issued by Express Scripts Canada.

2.3 Provider roles and responsibilities

Before initiating counselling, providers must confirm that the client and any services they propose to provide to the client are eligible for coverage, as ineligible services will not be reimbursed. Regarding exceptional circumstances, where the client and the provider are not physically located in the same province, refer to Appendix C: Interprovincial mental health telecounselling. By submitting a payment request to Express Scripts Canada, a provider indicates understanding and acceptance of the terms and conditions for receiving payment for services.

Providers must:

• be aware of the current continuum of mental wellness services available to clients in their community, and locally from the province or territory
• confirm that the client is eligible for NIHB
• submit ONLY claims for services they have provided directly. Each eligible provider must enrol and submit claims under their distinct number. Distinct provider numbers are not interchangeable. No claims may be submitted for services by ineligible providers
• follow requirements for prior approval to ensure services are eligible for coverage (if prior approval is not obtained before continuing counselling beyond the initial assessment, there remains a risk to the provider as ineligible services will not be paid)
• ensure that the client understands the coverage that is available
• complete a client assessment and discuss the recommended number of counselling hours and frequency of counselling with the client
• complete a treatment plan to be kept on the client's file. A copy of the treatment plan may be requested as part of the exceptions process outlined in section 3.5 Exceptions
• keep all client records (including date, location, and start/end time)
• ensure that they do not knowingly submit a claim for payment for services that are funded by or will be paid by another plan or program (where there is coordination of benefits, this must be clearly marked)
• comply with professional regulatory body requirements for security, police record checks, and client file management
• maintain active licensure and notify the NIHB regional office and Express Scripts Canada (1-888-511-4666) immediately upon a change of standing with their regulatory body (this includes, but is not limited to, the introduction of a remediation plan or any restrictions in practice put in place, as well as any change in their criminal record. See section 2.1 Provider eligibility)
• bill at their usual and customary rate, but no higher than the current Mental Health Counselling Regional Fee Grids, available on the Express Scripts Canada NIHB provider and client website
• use their provider ID/billing number only to bill for eligible services provided to clients located in the province or territory where the provider is licensed and enrolled
• inform clients of their office policies, including for no-shows and cancelled appointments
• avoid conflicts of interest

As part of the treatment plan, the provider is encouraged to link the client to community-based mental health counselling services or other culturally appropriate services, where available.

As part of their ongoing professional development, providers are encouraged to continue to enhance their knowledge of First Nations and Inuit cultures. This can include opportunities provided by their professional associations, through First Nations or Inuit communities or organizations, or other related training.

The Mental Health Counselling Services Information Form in the Mental Health Counselling Professional Provider Enrolment Package, available on the Express Scripts Canada NIHB provider and client website, provides an opportunity for providers to indicate their areas of expertise or specialization, and to say that they have experience in supporting First Nations and Inuit (cultural competence). Please note, this information is not reviewed by the NIHB program for completeness or accuracy. To be sure to have the most up-to-date information in choosing a provider who meets their needs, clients are encouraged to contact the provider's office directly.

Clients seeking a list of providers with particular areas of expertise or specialization can contact their regional office.

Providers are encouraged to update their record by contacting the NIHB Call Centre at Express Scripts Canada to maintain an up-to-date record of their areas of expertise or specialization. Clients may contact the appropriate regional office to request the names and contact information of providers who have reported that they have particular areas of expertise or specialization.

Mental health counselling providers must follow applicable privacy legislation, regulations and professional regulatory body requirements applicable to maintaining their records. Client files are in the control of the provider and not Indigenous Services Canada.

2.4 Provider Claim Verification Program (PCVP)

As part of the NIHB program's risk management activities, Indigenous Services Canada has mandated its claims processor to maintain a set of pre-payment and post-payment processes, including claim verification activities.

This function incorporates the review of claims against records to confirm compliance with the terms and conditions of the NIHB program. If under any circumstances it is found that a provider has inappropriately billed the program, claim payments will be recovered; either by direct payment from the provider or withheld from future provider claim statements.

Detailed information about the Provider Claim Verification Program and procedures can be found in section 6 of the Mental Health Counselling Claims Submission Kit available on the Express Scripts Canada NIHB provider and client website.

2.5 Privacy statement

Indigenous Services Canada's NIHB program has the responsibility to protect personal information under its control in accordance with the Privacy Act and its related Treasury Board policy and directives, and is responsible for ensuring that the personal information collected is limited to that which is necessary to administer the program.

For more information, please contact Indigenous Services Canada's Access to Information and Privacy (ATIP) Coordinator at 819-997-8277 or atiprequest-aiprpdemande@rcaanc-cirnac.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

3.1 Client eligibility

The provider must verify that the individual is eligible for benefits under Indigenous Services Canada's NIHB program. Providers are asked to identify any other benefit coverage available to the client, if applicable.

To be eligible, a client must be a resident of Canada, and one of the following:

• a First Nations individual who is registered according to the Indian Act (commonly referred to as a "Status Indian")
• an Inuk recognized by one of the Inuit land claim organizations as outlined in Inuit client eligibility for NIHB
• a child less than 2 years old, whose parent is an NIHB-eligible client

Refer to the NIHB program webpage Who is eligible for the NIHB program.

In order to confirm client eligibility prior to service provision, clients or providers may contact their local NIHB regional office.

Please note that NIHB coverage is provided for the individual eligible client only and is not family coverage. Services to eligible clients must be billed using each eligible client's individual identification number. Providers may not use a client's identification number to bill the NIHB program for services provided to dependants or individuals other than the individual client.

More detailed information about Client Identification and Eligibility is included in section 4 of the Mental Health Counselling Claims Submission Kit, available on the Express Scripts Canada NIHB provider and client website.

See Appendix D: Self-government and other community-managed benefit coverage for information on health benefit coverage provided by First Nations and Inuit governments and community-based organizations directly to their members.

3.2 Information for clients

Call 9-1-1 or the number for emergency services for your area if you are experiencing a mental health crisis. Providers do not offer after-hours or on-call emergency services.

3.3 Eligible services: Coverage and frequency guidelines

Every calendar year, NIHB clients are eligible for coverage of up to 22 hours of counselling performed by an NIHB-eligible provider consisting of:

• initial assessment (actual hours, up to a maximum of 2 hours). In order to facilitate timely access to services, these sessions are post approved^{Footnote 1}
• up to 20 hours of counselling, not including the initial 2 hours/assessment. Prior approval is required (see section 3.7 Prior approval process)

Additional hours in the same calendar year may be covered on an exception basis. See section 3.5 Exceptions.

Services submitted for coverage must not be eligible for payment by another provincial/territorial, federal, or private plan or program, except in the case of coordination of benefits (see section 3.8.3 Coordination of benefits).

Mental health counselling providers should note that:

• only active counselling time is eligible for reimbursement
• note taking that is part of, or immediately follows, a client's session is considered active counselling time and forms part of the client's eligible hours (common practice is that a client is seen for 50 minutes and note taking is 10 minutes. This is billed as 1 hour of counselling). Note taking is not to be billed as a separate activity
• claims must be submitted for the actual active counselling time (including the note taking) and not rounded up to the nearest hour. For example, if a client has a 30-minute session that includes the note taking, that is billed as 0.5 hours, or a 90-minute session is 1.5 hours
• billing by a provider may not exceed 8 hours of counselling services in one day (regardless of the number of clients served)
• mental health counselling providers may not bill the program for non-counselling hours spent with clients including for meals, transportation or social time, as this is not considered to be active counselling time

3.4 Types of eligible mental health counselling

All types of counselling (for example, group or individual counselling) count equally towards the client's 22 hours of total counselling eligible in a calendar year.

The modality of treatment is to be determined by the provider, in accordance with practice standards and governing regulations set out by the applicable regulatory body. However, the NIHB program will not provide coverage for any items listed as exclusions in section 3.6 Exclusions.

Only services provided by an eligible provider directly to and for an eligible client will be eligible for coverage/reimbursement.

A provider may only bill for one client per session hour, with the exception of group counselling (refer to section 3.4.3 Couples/group of 2 counselling and section 3.4.4 Group counselling).

Services eligible for reimbursement are as follows:

3.5 Exceptions

Requests for counselling beyond the noted frequency or additional requests within the same calendar year may be considered on an exception basis.

In cases where providers/clients are seeking such exceptional coverage, the provider is required to submit a rationale for the additional hours, along with the completed Mental Health Counselling Prior Approval and Claim Form via fax or email to their regional office, or through the PA submission field within their online web account on the Express Scripts Canada NIHB provider and client website. The rationale must detail the frequency and duration of counselling required by the client, and the anticipated date of completion of the treatment plan in place for the client. Additional information may be sought on a case-by-case basis.

3.6 Exclusions

The following goods and services are exclusions which will not be covered by the NIHB program and are not subject to the NIHB program's appeal process:

• services to non-eligible individuals
• claims submitted on behalf of another provider, whether the provider and client are eligible or not. Providers may only submit claims under their own provider number
• claims submitted for missed/no-show or cancelled appointments
• other non-counselling time, such as "on-call" after-hour availability, waiting/travel time or administration (filing reports, making notes - other than note taking that is billed as part of a session, as noted in section 3.3 Eligible services: Coverage and frequency guidelines), or other non-counselling hours spent with clients such as meal(s), transportation, or social time
• any service by a non-eligible provider, regardless of its purpose (see section 2.1 Provider eligibility)
• professional or other fees for ceremony or other traditional practices carried out by the provider or another person (see section 1.1 Purpose of the guide for additional information on traditional healing in support of mental health counselling OR contact your local community for information on Elder and Traditional Healer services they may offer)
• services that are not mental health counselling/psychotherapy (including, but not limited to general social work, assistance with applications for programming, psychoeducational testing assessments, educational and vocational counselling, life skills training, life coaching/mentoring, early intervention/enrichment programs, sexual surrogacy/surrogate partner therapy, neuromodulation or other medical treatment such as psychedelic assisted psychotherapy)
• conversion therapy (any practice, treatment or service designed to change or repress a person's sexual orientation, gender identity/expression)
• accommodations and treatment fees for facility-based addictions treatment (publicly funded addictions treatment is available to eligible clients through the Indigenous Services Canada's Mental Wellness program or through programs funded by provincial or territorial governments. Contact the FNIHB regional office for more information on accessing these programs)
• services that have been submitted to or paid by the Indian Residential Schools Resolution Health Support Program. Claims are to be made either to the NIHB program or the Indian Residential Schools Resolution Health Support Program, but not both. See the Indigenous Services Canada website for more information on Indian Residential Schools Resolution Health Support Program
• services that are funded by another program or agency (such as counselling provided to incarcerated clients)
• psychiatric and family physician services insured through the provincial or territorial health plan
• services for the purpose of a third party (for example, school application, employment assessment, to support a legal action, child custody)
• costs to administer tests, such as license fee (only the professional time may be billed)
• community workshops, seminars or training
• any event that is a full-day in length, such as a day or weekend retreat, camps of any type, and workshops
• consultation or management advisory services (for example, policy, procedure review)
• telehealth through instant messaging, emails or text-based apps
• the cost of cellular phones or cellular data
• subscription-based services (example, a monthly/annual fee for access to a therapist service on demand)
• claims for services funded by NIHB outside of Express Scripts Canada, for example, for services offered directly in the community (community managed services, or Indigenous Services Canada contracted visiting providers). Express Scripts Canada cannot process these claims. Contact the client's community health organization to find out how to make a claim.

3.7 Prior approval (PA) process

3.8 Claim submission

6.1 Contact information

For additional information on NIHB mental health counselling benefits, or assistance finding an enrolled mental health counselling provider, contact your local NIHB regional office.

If the client receives health benefits coverage under a separate agreement, please refer to Appendix D: Self-government and other community-managed benefit coverage for contact information.

6.2 Mental health counselling programming

Many municipalities or other local governments, and provincial or territorial governments offer mental health counselling programming, for example, through non-profit organizations such as the Canadian Mental Health Association or local Friendship Centres for urban Indigenous communities.

Through its Mental Wellness programming, Indigenous Services Canada administers contribution agreements and transfers direct departmental spending to support culturally appropriate community-based programs, services, initiatives and strategies related to the mental wellness of First Nations and Inuit clients. The range of services includes prevention, early intervention, treatment, and aftercare. Key services supporting program delivery include: substance abuse prevention and treatment (part of the Canada Drugs and Substances Strategy), mental health promotion, and suicide prevention. The Mental Wellness program objective is to address the greater risks and the lower health outcomes associated with the mental wellness of First Nations and Inuit individuals, families and communities.

Appendix A: Eligible providers by province and territory

Please note that health professionals are regulated at the provincial or territorial level; there are no national legislated regulatory bodies for mental health counselling providers. As a result, not all professions are recognized in all provincial/territorial jurisdictions.

Mental health professional licensing varies between jurisdictions, and in order to enrol with NIHB, providers must be a legally regulated health professional, licensed under provincial or territorial law to practice mental health counselling (psychotherapy) in the province or territory where the client is located.

The following tables outline which professionals are recognized, by province/territory:

On an exception basis only, other types of providers may be enrolled at the discretion of Indigenous Services Canada when ALL of the following conditions apply:

• The provider has been certified by a non-legislated entity that functions as a self-regulatory body^{Footnote 2}
  
  And;
  
  

• In the opinion of Indigenous Services Canada (ISC), there are an insufficient number of legislated providers enrolled with the NIHB program in the vicinity, limiting access to services (the exception provider's practice is limited to serving such communities)

Such providers are enrolled only on an exceptional, case-by-case, time-limited basis at the determination of ISC.

Note to providers: if you are a regulated health professional such as a psychologist, do not enrol using your CCC or other exception credentials.

Appendix B: Coverage for mental health telecounselling (client and provider in same province or territory)

Mental health counselling services provided virtually (for example, the use of video-conferencing or telephone to deliver mental health counselling services) are eligible for coverage. Please note that asynchronous models such as instant messaging, email or subscription-based services are not eligible for reimbursement.

Mental health telecounselling is an evolving field, and policies surrounding its use and coverage are being reviewed on an ongoing basis.

Coverage for mental health telecounselling is only provided if the client receiving mental health counselling agrees to its use. The provider must return to face-to-face counselling at any time the client wishes to do so. Please note, the medical transportation (MT) benefit supports eligible clients in accessing medical services at the nearest appropriate location (available health professional or facility). Clients who need to travel beyond the nearest appropriate provider for face-to-face service provision will not be eligible for MT through NIHB and may need to be supported in transitioning to a new provider.

Interprovincial mental health telecounselling (where the provider and client are in different provinces) may be considered on an exception basis only (refer to Appendix C: Interprovincial mental health telecounselling).

In using mental health telecounselling, providers are responsible to ensure that its use:

• meets the standards and code of ethics of the respective legislated regulatory bodies and provincial or territorial regulations in the provision of mental health counselling services through telehealth, including client privacy and confidentiality
• in situations where the provider and the client are in different jurisdictions, the provider must:
  • ensure that their own regulatory body permits the provision of services to clients in another jurisdiction and must follow all associated requirements to do so
  • ensure they meet all the requirements of the regulatory body in the jurisdiction where the client will receive the service (for example, some jurisdictions may require that a provider from another province or territory register for approval to provide services in this way)
• follows the Model Standards for Telepsychology Service Delivery (PDF) (found on the ACPRO website) adopted by the Association of Canadian Psychology Regulatory Organizations (ACPRO) in provinces or territories where a provider's regulatory body does not have guidelines for the provision of telehealth

Providers must:

• determine, with the client, the suitability of telehealth services for delivering mental health counselling services for the client, taking into account potential privacy issues and client's technical capacity. This determination should be based on the provider's professional judgment and take into consideration such factors as client's needs, safety and the accomplishment of therapeutic goals
• ensure their ongoing competence with service delivery technologies for mental health telecounselling, and mitigate any potential negative impacts of the technology on the client
  
  And;
  
  
• the technology (for example, computer/video conferencing or telephone) and location (for example, nursing station, community health centre, or other) used to provide counselling services will be determined by the provider based on the client's case, and in accordance with the provider's regulation related to the delivery of telehealth services
• the provider must have a process in place to confirm the client's attendance such as a telephone log, attendance sheet or email confirmation (depending on the modality) and must maintain client attendance records for claim verification purposes (note that claims for mental health telecounselling services which are not supported by client attendance records may not be reimbursed or may be subject to reclaim)
• the cost of the equipment, data, etc. are the responsibility of the provider
• the cost of cellular phones or cellular data plans or packages are not an eligible benefit

Initial client assessments should generally be undertaken in-person. In exceptional circumstances, coverage for assessment via telehealth may be approved.

Please also refer to the terms and conditions as outlined in the Mental Health Counselling Billing Agreement found in the Mental Health Counselling Professional Provider Enrolment Package on the Express Scripts Canada NIHB provider and client website.

Appendix C: Interprovincial mental health telecounselling

Wherever possible, clients are served by providers located in their community of residence and licensed in the jurisdiction where the client is located, as this enables the client to see the provider in-person or virtually through telecounselling, as needed. Providers should be aware that if a client receives telecounselling and wishes to return to in-person counselling, the NIHB program will not provide medical transportation benefit coverage beyond the nearest appropriate provider.

The NIHB program may, in exceptional circumstances, allow enrolment of professionals on an exception basis to provide virtual telehealth services to a specific client or clients in another region when prior approval is obtained from the regional office.

Interprovincial telecounselling on an exception basis requires justification and agreement on the part of the client that such services will only be provided virtually, and that medical transportation support to attend in-person sessions will not be supported. For example, interprovincial telecounselling may be supported on a time-limited basis:

• to allow for continuity of care when a client relocates
• when a provider has an area of expertise not available in the client’s province or territory
• the client has contacted the program in support of this request

Providers enrolled for interprovincial telecounselling will receive a temporary ID, which will be end-dated (or terminated) once the approved counselling hours for the client(s) have been completed. Requests for telecounselling may be approved if the following requirements are met:

• the provider is registered in good standing with the regulatory body where they practice and the provider must be permitted to practice as a regulated health professional in the province where the client is located, by the body noted in Appendix A: Eligible providers by province and territory:
  • the regulatory body must permit the professional to practice virtually (the provider must either be licensed by this body or have specific written authorization from the regulator permitting them to practice in this manner), including any special licensing or practice requirements for virtual service providers
• the client confirms their preference is to access services virtually through the provider and understands that medical transportation support will not be available
• prior approval is obtained from the regional office
• reviewed on a case-by-case basis to serve specific clients
• the provider is insured to provide these services in this manner
  
• it is the provider's responsibility to ensure and to document that these requirements are met

Claims must be made using the provider number corresponding to the province or territory where the client is receiving services (for example, an Ontario provider uses their Ontario provider number to serve Ontario clients and a Nova Scotia number to serve clients located in Nova Scotia). Providers may not make claims for telecounselling services to clients in another province or territory using the provider number for the province they, the provider, are in. Providers must bill at their usual and customary rate, up to the maximum published in the regional fee grid where the client is receiving services. Services that are billed in a manner that is contrary to NIHB policy are subject to recovery.

Requests for counselling beyond the hours supported in the initial prior approval and/or the client’s noted frequency within the same calendar year may be considered on an exception basis.

If a provider carries out interprovincial telecounselling without prior approval, there is a risk that the service will not be reimbursed.

Appendix D: Self-government agreements and other community-managed benefit coverage

Some First Nations and Inuit clients receive their health benefits through other agreements (for example, self-government agreements, other funding agreements). For these clients, their mental health counselling benefits coverage is managed and delivered by a First Nations or Inuit community, organization, regional health authority or other government. Please note that these requests are not processed by Express Scripts Canada or the NIHB program. Clients and service providers can contact the responsible organization listed here for information about coverage and claims payment/ reimbursement of benefits for these clients.

Services to clients of the following First Nations, Inuit Land Claim Organizations, Health Authorities and/or Self-Governing entities are not managed by the NIHB program and cannot be processed by Express Scripts Canada. Please note that this list is not exhaustive and continues to evolve. Please contact the NIHB regional office if you have questions about a particular client case:

For NIHB clients living in Nunavut or the Northwest Territories, mental health counselling services are managed by the territorial governments, and the NIHB program does not process claims for in-territory services, whether provided in person or via telecounselling from elsewhere. However, clients living in these territories who access mental health counselling services when out of territory should contact the NIHB office in the region where they obtained services for assistance in submitting a claim.