Ostomy Supply Reimbursement In Northwest Territories

Northwest Territories Extended Health Benefits Program (EHB)

The Government of the Northwest Territories (GNWT) sponsors the Extended Health Benefits for Seniors Program and Extended Health Benefits for Specified Disease Conditions Program. These programs provide eligible residents of the Northwest Territories access to various benefits, including ostomy supplies.

Am I Eligible?

You may be eligible for the EHB for Seniors Program or for Specified Disease Conditions Program if you are:

SENIORS PROGRAM:

ou must be 60 years of age or older.

SPECIFIED DISEASE CONDITIONS PROGRAM:

diseases that are accepted include cancer, Crohn’s disease, and ulcerative colitis. If you have an ostomy for an uncommon reason, please consult with an NSWOC nurse who can apply for an exception.

https://www.hss.gov.nt.ca/en/services/applying-extended-health-benefits-specified-disease-conditions-program

NOTE: First Nations persons have ostomy coverage through NIHB. Learn more about NIHB here.

Benefit Coverage

EHB bases its benefits plan on NIHB, which provides 100% coverage for a certain allotment of ostomy supplies. (For example, 30 drainable ostomy bags per month.) An NSWOC can provide a letter of exemption and prescription if you require extra ostomy supplies for medical reasons.

EHB is considered the payor of last resort, which means they will only pay for ostomy supplies if you do not have third-party coverage or have a plan that doesn’t cover the full amount. For instance, your employer benefits only cover 80%, you can get reimbursed for the other 20% from EHB.

Medical travel expenses are also covered.

https://www.hss.gov.nt.ca/en/services/medical-travel

Applying for Extended Health Benefits

Application forms are available at hospitals, health clinics, health centres and the Health Services Administration Office or via the following links:

SENIORS PROGRAM:

SPECIFIED DISEASE CONDITIONS PROGRAM:

You will be issued an Alberta Blue Cross identification card upon approval.

Authorization:

Clients must be assessed by an NSWOC, nurse practitioner or physician.
To claim these supplies, you will need a prescription or written order from a recognized health care professional.
Many medical supplies and equipment items require prior approval for the product to be covered by the program.

Purchasing Ostomy Supplies

Clients may purchase ostomy supplies through any third-party ostomy suppliers such as home health care stores and pharmacies of their choice.

Reimbursement Procedure

It may be possible to have your ostomy vendor bill Alberta Blue Cross directly.
Should you have to pay for your supplies out of pocket, please coordinate with other benefits you have first (third-party benefit plan, i.e. employer) before submitting a claim to Alberta Blue Cross.
If the full cost is not covered by your third-party coverage, complete and submit the Alberta Blue Cross Health Services Claim Form after you have claimed through your other plan. You need to attach your payment confirmation from the other plan carrier otherwise, your claim will not be processed.
Claims must be submitted within 12 months of the date of the receipt.
Please visit the Government of NWT website for more info: https://www.hss.gov.nt.ca/en/services/claiming-extended-health-benefits-expense

Contact Information:

HEALTH BENEFITS PROGRAM
Health Services Administration Department of Health and
Social ServicesGovernment of the Northwest Territories

Bag #9
Inuvik NWT X0E 0T0

Toll-free: 1-800-661-0830
Phone: 867-777-7400
Fax: 867-777-3197
Email: hsa@gov.nt.ca

Disclaimer: The information contained in this page have been researched and sourced from a variety of provincial and federal sites. However information may change and we encourage individuals to check for updates of policies, plans and forms.

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