CLIENT TRAVEL POLICY GUIDELINES Page 1 of 8

Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

1.00 INTRODUCTION

The Nunavut Health Care Plan offers similar coverage and benefits to health care plans in
other provinces and territories (OHIP, Manitoba Health, etc). There are various
supplemental plans that provide additional coverage where necessary.

2.0 ELIGIBILITY

Any legal resident of Canada living in Nunavut can register for a Nunavut Health Care
Card, with the following exceptions:

The following individuals cannot register for Nunavut Health Care Cards:
Tourists, transients and visitors to Nunavut.
Students whose permanent residence is in another province or territory.
Temporary workers (365 days or less).
Members of the RCMP and Armed Forces (although their family members can
register while living in Nunavut).
Certified Refugees or Refugee Claimants

3.00 ADMINISTRATION

The Department of Health & Social Services is responsible for registering all permanent
residents of Nunavut for territorial health care coverage through the Health Insurance
Programs (HIP) office which is located in Rankin Inlet. Clients registered with the
Nunavut Health Care Plan are eligible for insured services and may also be eligible for
supplementary health benefits under other programs.

3.01 Registration
The role of the Registration section is to:

Determine a client’s eligibility.

Maintain an accurate Nunavut-wide registration database.
Encourage Nunavut residents to register for health care benefits.
Inform registrants of their eligibility for benefits.
Provide information to approved recipients on various aspects of
registration.

Department of Health and Social Services

 CLIENT TRAVEL POLICY GUIDELINES Page 2 of 8

Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

3.02 Application Forms

There are three kinds of application forms for Nunavut Health Care Coverage. All of
the forms are straightforward and include instructions on the back. When assisting
an applicant to complete one of these forms the following guidelines should be
followed:

All answers should be legible.

If a contact phone number is available it should be provided.
(a) Health Care Applications for Newborns (Yellow Form)
It is vitally important that the full legal name is spelt correctly as this is
how it will be entered into all government systems (HIP transfers this
information to Health Canada for their national registry).
If the parents are living in a common-law relationship and the child is
being registered in the surname of the biological father, he must also sign
the application.
In the case of custom adoption, the child will be registered in the birth
mother’s name until the adoption process has been completed and a copy
of the birth certificate is provided.
A child is always registered with the birth mother’s ethnicity until
documentation supporting a change is provided.
(b) Application for Health Care Coverage (Blue Form)

This form is used by people who have moved to Nunavut.

Applicants moving to Nunavut from within Canada must attach clear
copies of both their birth certificate and their current Health Care Card.
They may also have to provide a Canadian passport, Immigration
Documents and/or a Land Claims Beneficiary Card.
Applicants moving to Nunavut from outside Canada must attach a copy
of their official Immigration Documents (legible photocopies of originals
are accepted).
(b) Request for Change (Green Form)
This form is used when someone’s basic information has changed (for
example an address change or legal name change through marriage).
Any changes to a name must have supporting documentation, for example
a marriage license or birth certificate.
Changes to ethnicity must be accompanied by supporting documentation,
for example a beneficiary enrolment card or letter.

Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

4.00 Coverage and Benefits

a) Hospital Costs

The Nunavut Health Care Plan pays for inpatient and outpatient services
in approved public facilities for residents of Nunavut who hold valid
Health Care Cards.

When a resident from another province or territory obtains services in

Nunavut, the following information is transcribed on either a Hospital
Admission and Separation Form or an Outpatient’s Services Report
(depending upon the service):

 Full name and address including the postal code

 Date of birth
 Provincial/Territorial health care card number
 Expiry date of card
 Date of service
 Procedure
 Diagnosis

This information is then submitted to Health Insurance Programs for

review and reciprocal invoicing. If the individual does not have a valid
health care card, it is important to still collect an address, date of birth and
if possible a phone # so that he/she can be invoiced. The same
information should be collected if the individual is from another country.

b) Physician Service Fees

The Nunavut Health Care Plan covers physician service fees for those
residents holding valid Nunavut Health Care Cards.

When a resident from another province or territory obtains services in

Nunavut, the following information must be collected in order to bill their
respective province or territory:

 Full name and address including the postal code

 Date of birth
 Provincial/Territorial health care card number


Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

 Date of service
 Fee for service code
 Diagnosis

This information is then submitted to Health Insurance Programs for

review and reciprocal invoicing. If the individual does not have a valid
health care card, it is important to still collect an address, date of birth and
if possible a phone # so that he/she can be invoiced. The same
information would be collected if the individual were from another
country.

For individuals travelling outside of Nunavut but within Canada, coverage

applies for physician and hospital services. The majority of these services
are reciprocally billed. Outside Canada, limitations may apply. For
example: reimbursement of physician and hospital services is based on the
Nunavut Fee Schedule (i.e. a physician visit in the USA may cost $100.00
USD but Nunavut will only reimburse approximately $65.00 CD).
Therefore it is recommended that residents of Nunavut purchase extra
insurance when travelling. Reimbursement is based on submission of
substantiating documentation.

c) Physician Claim Cards

All physicians, whether on contract or fee for service, are required to fill
out fee for service documentation for each patient encounter. Currently
the information is collected on a physician’s claim card, which is then
submitted to a billing clerk for processing.

d) Dental Treatment

In general the Health Care Plan does not provide assistance with dental
treatment unless it is related to a jaw injury, TMJ problem or disease.
There is a limited amount of assistance available to EHB, IHB and NIHB
recipients.

Approval Number’s are required prior to travel for all Orthodontic and
GA travel.

Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

5.00 Exception Approvals

a) Procedures or Treatments
The Nunavut Health Care Plan will only consider coverage of certain
procedures or treatments, based on the mandatory prior approval process
having been completed (i.e. procedures by an oral or plastic surgeon). To
obtain prior approval, a letter must be written by the requesting physician
justifying the requirement for the specific treatment or procedure. This
letter should contain as much information as possible including a general
estimate of costs. Once the letter is received, the request is sent to a
medical advisor for consideration. If you are unsure as to whether or not a
procedure will be covered by the HCP, please contact Health Insurance
Programs.

b) Private Facilities
A number of southern jurisdictions have begun to out-source certain
patient services to private clinics. Therefore, the HCP will consider
coverage of private facility charges in special circumstances, based on the
mandatory prior approval process having been completed.

Service providers should always confirm with the Health Insurance

Program office that that the facility the client is being referred to is
approved prior to arranging appointments. The information is reviewed
and written notification of the decision is issued. If an invoice is received
without an approval letter attached and there is no approval letter on file
with the Department, HIP will not be responsible for payment.

c) Reimbursements
Personal reimbursements will be reviewed upon submission of
substantiating original documentation to the HIP office.

Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

d) Allowable Benefits
The following are benefits under the Nunavut Health Care Plan:

Specialist / Service Health Care Plan (HCP) Coverage NIHB EHB

Audiologist Yes, if done in a No, if done in a No No
Hospital Private Clinic *
Day Surgery Services Yes No No

Laser Eye Surgery Yes, if medically No, for cosmetic No No

required purposes
Hospital Stay at Standard Yes No No
Ward Rate

Occupational Therapist Yes, if done in a No, if done in a No No

Hospital Private Clinic *
Ophthalmologist Yes No No

Outpatient Services Yes No No

Physiotherapist Yes, if done in a No, if done in a No No

Hospital Private Clinic *
Psychologist Yes, if done in a No, if done in a No No
Hospital Private Clinic *
Speech Therapist Yes, if done in a No, if done in a No No
Hospital Private Clinic *
Yearly Physicals Yes, for children No No
under 10 and adults
over 65

* A private clinic may be used if prior approval has already been granted by the DH&SS

** Limited coverage or prior approval required

Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

e) Non Benefits

The following are not benefits of the Nunavut Health Care Plan:

Specialist or Service Health Care Plan (HCP) Coverage NIHB EHB

Acupuncturist No No No

Alcohol & Drug Rehabilitation No, regional responsibility No Yes**

Ambulance Services No, (Hospital to Hospital transfers are Yes** Yes**

covered)
Chiropractor No No No

Cosmetic Surgery No, unless prior approval has been No No

granted
Dentist / Denturist / Periodontist No Yes** Yes**

Experimental Procedures/Surgery No No No

Glasses / Contacts No Yes** Yes**

Medical Supplies or Equipment No Yes** Yes**

Massage Therapist No No No

Naturopath No No No

Optometrist No Yes No

Orthodontist No Yes** No

Osteopath No No No

Physicals at the request of a 3rd No No No

party (Driver's License, Pre-
employment etc.

Podiatrist No No No

Department of Health and Social Services

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Nunavut Health Care Plan

Revised Date: May 28, 2007 Section

No: 6

Prescription Drugs No Yes** Yes**

Semi Private Hospital Rooms No No No

Yearly Physicals No for individuals between the ages of 10 No No

– 65

** Limited coverage or prior approval required

This is only a general list of what the Nunavut Health Insurance Plan does and does not
cover.

6.00 New Residents

Once an individual moves to a new province or territory they should apply for
health care coverage within the first 3 months of residence.

For additional information about the Nunavut Health Care Plan contact the Department of
Health and Social Services at:

Department of Health and Social Services

Health Insurance Programs
P.O. Bag 003 Rankin Inlet

Toll Free Line 1-800-661-0833

Fax Line 1-800-645-8092
Email nhip@gov.nu.ca

Department of Health and Social Services