Frequently Asked Questions (Continued)

9. Is travel to an Audiologist covered?

(No) It has to be sent to FNHA Office for approval as a benefit exception.

10.  Is travel for a Mammogram covered?

(No) It has to be sent off for benefit exception due to it  being set up in Hazelton every three months.

11.   What if I need to stay  longer than 5 days?

Prior approval is required from the  FNHA office for trips   requiring more than 5 consecutive days stay.   Requests for long-term or extended stays should be  submitted as a benefit exception and accompanied by the  appropriate documentation.  After 30 days, a benefit exception must be  submitted and approved and FNHA will be responsible for the accommodation portion.

12.   Is travel for laboratory/ blood work and other testing covered?

A benefit exception will submitted to FNHA office for prior approval or reimbursement.

 13.   Will I get an escort?

The use of an escort must be preauthorized by FNHA following the request of a doctor.   An escort form must be filled out by the physician with details on how and why the escort needs to assist the client.

14.   What are the meal rates for  medical over 5 days?

For trips that are up to seven (7) nights in duration:

 

$48 per night’s stay  

 

$25 per night’s stay for children under 9

 

For trips that are seven (7) or more nights in duration, a weekly rate will apply

 

A maximum weekly rate of $163 per week, inclusive of the escort.

15.   Will meals be covered for day trips?

The same-day travel rate of $10 for trips that are 6 hours or more in duration has not changed..

For the winter months of  November to March, there is lunch coverage for travel to Terrace.

 16.   What kind of medical  travel is excluded?

Compassionate travel (i.e. an escort for support; if they need a driver)

Appointments other than to the nearest appropriate health facility

Appointments for clients in the care of federal or provincial institutions

Return trips home in cases of illness while away from home for reasons other than for approved travel to access  medically required services

Travel only to pick up new or repeat prescriptions or vision-care products appointments/ treatments that are not a  provincially insured health service nor an NIHB benefit, such as private, non insured physiotherapy or counseling.

 17.   Do I get medical coverage if I was in a job related or  motor vehicle accident?

FNHA  does not provide or pay health services for registered First Nations clients if they are eligible for other available sources of  benefits under any provincial or social funded programs or private insurance plans i.e. ICBC, WCB, or Correctional services

18. How do I appeal FNHA’s  decision?   

Appeals must be submitted in   writing and can be initiated by the client, legal guardian, or            interpreter. Accompanied with   supporting documents to justify the exceptional need.

 Level 1 Appeal – The first level of appeal is the Manager, FNHA

Level 2 Appeal – the second level of appeal is the Regional Director, FNHA

Level 3 Appeal – The third and final level of appeal is the Director General, Non-Insured Health   Benefits, First Nations and Inuit Health Branch, Manulife Building, 55 Metcalfe Street, Postal Locator 4006A, Ottawa, Ontario K1A 0K9.

At all levels of the appeal process, the client will be provided with a written explanation of the decision taken.