Contributions for Supplementary Health Benefits (Non-Insured Health Benefits Program)
Table of contents
- Summary
- Policy and legal authority
- Objectives and results
- Eligible recipients and annual maximum amount payable
- Eligible expenditures
- Stacking provisions
- Basis and timing of payment
- Method for determining the amount of funding
- Application requirements
- Due diligence in managing and administering the Transfer Payment Guidelines
- Audit framework
- Official languages
- Other terms and conditions
- Non-monetary contributions
- Funding approaches
- Terms and conditions effective date
1. Summary
1.1 General context
Indigenous Services Canada (ISC) aims to provide effective, sustainable and culturally appropriate health programs and services that contribute to the reduction of gaps in health status between First Nations and Inuit and other Canadians.
Improving the health of Indigenous people is a shared responsibility between federal, provincial or territorial and Indigenous partners. The Canadian health system is a complex patchwork of policies, legislation and relationships. Indigenous peoples are included in the per capita allocations of funding from the federal fiscal transfer and are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories, including primary health care, health promotion and supplementary health benefits.
Indigenous Services Canada also funds or directly provides certain health care services to First Nations communities and funds the provision of certain community health programs for Inuit living in Inuit Nunangat. This is in addition to federal funding provided to territorial governments. Indigenous Services Canada also funds non-insured health care benefits for eligible First Nations and recognized Inuit regardless of where they live in Canada.
Federal funding for First Nations and Inuit health services is provided through annual appropriations and is subject to discretionary increases or reductions by the federal government. This is in contrast with the main federal transfer to provinces and territories for health, (that is, the Canada Health Transfer), which is protected in legislation.
ISC also supports the improved capacity of First Nations and Inuit communities to address their own unique health needs by increasing their control over health program design and delivery.
2. Policy and legal authority
- Department of Indigenous Services Act, S.C. 2019, c. 29, s. 336
3. Objectives and results
The Canada Health Act requires that provinces and territories provide coverage for insured services medically necessary hospital and physician services to all eligible residents including First Nations and Inuit. Individuals may have access to other health-related goods and services through other publicly-funded programs or through private insurance plans. ISC through its Non-Insured Health Benefits (NIHB) program is a national program that provides registered First Nations and Inuit with coverage for a range of medically necessary health-related goods and services not provided through other private or provincial or territorial programs.
The benefits covered by the NIHB program include pharmacy benefits, for example, prescription drugs and some over-the-counter medication, medical supplies and equipment, dental care, vision care, mental health counselling and medical transportation benefits to access medically required health services not available on reserve or in the community of residence.
The objectives of the NIHB program are to provide non-insured health benefits to First Nations and Inuit people in a manner that:
- is appropriate to their unique health needs
- contributes to the achievement of an overall health status for First Nations and Inuit people that is comparable to that of the Canadian population as a whole
- is sustainable from a fiscal and benefit management perspective
- facilitates First Nations and Inuit control at a time and pace of their choosing
4. Eligible recipients and annual maximum amount payable
The following classes of recipients are eligible for funding under the Supplementary Health Benefits Authority categories of contribution. The following table lists the different classes of eligible recipients and the annual maximum amount payable for this authorityFootnote 1.
The amount for the Supplementary Health Benefits Authority per recipient per year will not exceed the following dollar values listed in table 1 of this document.
| Eligible recipients | Supplementary health benefits |
|---|---|
| First Nations in Canada,* that is, communities, bands, district, tribal councils and associations | $15,000 |
| Inuit associations, councils and hamletsTable note 1 | $15,000 |
| Canadian national Indigenous organizations | $1,250 |
| Non-governmental and voluntary associations and organizations, including non-profit corporations | $22,000 |
| Educational institutions, hospitals and treatment centres | $9,000 |
| Municipal, provincial and territorial governments | negotiated amounts |
| Health authorities and health agenciesTable note 1 | $8,000 |
|
|
5. Eligible expenditures
A list of specific eligible key activities which fall under the Supplementary Health Benefits Authority is included in Appendix C. Generally, eligible expenditures will include administration of the program, staff salaries and benefits, contracts related to program planning, delivery and evaluation, staff travel, office supplies, accommodation, printing, staff training, operation and maintenance of health facilities, utilities such as broadband connectivity and telecommunications, minor equipment and furniture for eligible program activities. Other expenditures may be considered eligible based on program plans provided. These are subject to ISC review and approval.
6. Stacking provisions
The maximum level, stacking limits, of total Canadian government funding, federal, provincial, territorial and municipal assistance for any one activity, initiative or project, for recipients will not exceed 100% of eligible expenditures. The stacking limits must be respected when assistance is provided.
Recipients of contribution agreements are required to disclose any other government funding received for the same activity, initiative or project. Based on the provision of financial statements, financial reports and contribution audits, Indigenous Services Canada establishes whether stacking has occurred and if funds provided need to be recovered.
7. Basis and timing of payment
Payments are based on the achievement of predetermined performance expectations or milestones and a risk based approach. In ISC specific context and in order to provide cash flow to the recipient for delivering ongoing health programs and services, advance payments will be issued following a cash flow requirement forecast established in the contribution agreement. This may include, but is not limited to historical funding levels, per capita, population and geographic indices and the cost to deliver programs.
Pre-fiscal year expenditures may be reimbursed for eligible expenditures incurred in a previous fiscal year for funding agreements in place. Canada's reimbursement of eligible pre-fiscal year expenses will be subject to the parameters specified in the program terms and conditions or the contribution agreement.
8. Method for determining the amount of funding
The method to be used to determine the amount of a contribution is based on a review of historical funding levels and/or utilization data, recipient reporting as well as the Program Plan (or the Multi-Year Work Plan or Health Plan submitted, where applicable).
9. Application requirements
ISC offers a variety of consolidated contribution agreements to First Nations and Inuit recipients that vary in the level of control, flexibility, authority, reporting requirements and accountability. At a minimum, recipients have a set funding agreement which offers no flexibility, recipients deliver NIHB program eligible benefits and services as set out in NIHB program policies, these terms and conditions and the funding agreement. First Nations and Inuit communities interested in having more control of their health programs and services can decide among different approaches based on their eligibility, interests, needs and capacity. It is at this time that a recipient undergoes a recipient readiness assessment for a more flexible funding approach.
Where it is advantageous to the success of the activities, ISC would offer set, fixed, flexible or block funding approaches for contributions to Indigenous recipients, in accordance with Appendix K: Transfer Payments to Indigenous Recipients of the Directive on Transfer Payments. The funding approach relevant to programs and services is defined in the program framework and is dependent on the capacity of the recipient to manage and deliver programs, the class of eligible recipient and the nature of the program. Fixed, flexible or block contribution agreements under the Supplementary Health Benefits Authority require the explicit approval of the Assistant Deputy Minister, Services to Individuals Sector. The funding approaches are further described in appendix B.
Redistribution of Funding
Where a recipient delegates authority or further distributes contribution funding to an agency or a third party (such as an authority, board, committee or other entity authorized to act on behalf of the recipient), the recipient shall remain liable to the department for the performance of its obligations under the funding agreement. Neither the objectives of the programs and services nor the expectations of transparent, fair and equitable services shall be compromised by any delegation or redistribution of contribution funding.
Recipients have full independence in the selection of such third parties and will not be acting as an agent of the government in making further distributions.
For initial contribution agreements, the recipient must provide:
- For First Nations bands and/or Inuit organizations, or a group formally mandated by Band Council Resolution or other formal mandate: legal entity address and telephone number, band contract person and title, legal quorum to sign an agreement and number of councilors.
- For corporations: incorporating documents (articles of incorporation or letters patents), by-laws.
- Disclosure of any involvement of former public servants who are subject to the Conflict of interest and post-employment code for public office holders or the Conflict of interest and post-employment code for the public service.
- For municipal, provincial and territorial governments, agencies and health authorities: legal Act or letter of registration.
The following requirements will apply to all community-based contribution agreements:
- A mandate, as evidenced by a Band Council Resolution (BCR) or other formal mandate for initial agreements, upon renewal of agreements or for the addition of any new initiatives, as required by the program.
- A plan: The health plan, multi-year work plan or multi-year program plan is the recipient's primary document that identifies the community's health needs, defines its capacity to respond and outlines its programs and services to address health priorities. The health plan has the additional requirements of identifying all available resources, describing how various services will be integrated and indicating how success will be measured. The plan becomes the focus for establishing priorities, building capacity and enhancing accountability for program delivery. Additional details on the planning process are included in Appendix B
- Evidence of demonstrated capacity in areas such as financial and administrative experience to deliver the programs and services. Successful experience in the management of programs and finances does not necessarily have to be in the area of health; it can also be in such areas as education, social services and economic development.
In the interests of promoting program coordination and avoiding reporting burden, ISC will support consolidation of the contribution agreement planning and reporting requirements among programs that are delivered under the same contribution agreement with different funding approaches. The consolidation of the contribution agreement planning and reporting requirements will be established based on the most flexible funding approach used by the recipient.
Renewal of contribution agreements
The decision to enter into subsequent contribution agreements will be based on:
- evidence that a plan has been implemented and updated
- discussions between the ISC and the recipient to determine if the agreement will be renewed
- all required reports and audits
- risk assessment
ISC may sign agreements with eligible recipients in partnership with other branches or sectors of Indigenous Services Canada or other federal departments for the provision of health services, specific programs and block-funded services. All other aspects of the terms and conditions will remain applicable under these agreements while trying to ensure seamless requirements between funders.
10. Due diligence in managing and administering the Transfer Payment Guidelines
Indigenous Services Canada ensures that NIHB program has financial resources for the effective, management, administration and contribution audit activities related to programs under these terms and conditions.
10.1 Performance Measurement Strategy
The Performance Measurement Strategy developed for this authority demonstrates the department's intention and capacity to measure performance against key results commitments on an ongoing basis, ongoing performance measurement and periodically through program specific research projects. The performance measurement strategy covers:
- main activities of the program, and its clients or target populations
- expected results
- performance indicators
- data collection sources and methods
- responsibility and frequency for collection
- reporting method
Departmental systems, procedures and resources are in place to ensure due diligence in approving transfer payments, verifying eligibility and entitlement, and managing and administering the contributions program. As the manager responsible for the Supplementary Health Benefits Authority, the Assistant Deputy Minister or designated representative will ensure:
- recipients are provided with appropriate assistance, advice or expertise
- progress of approved projects is monitored
- public funds are being managed appropriately
Indigenous Services Canada has established a Transfer Payment Management Control Framework that ensures due diligence in the establishment and administration of contribution agreements. In addition, ISC has policies, procedures, a contribution management system and training tools to support the management of all contribution agreements.
ISC uses standard agreements to serve as vehicles for the administration and management of First Nations and Inuit community health programs and resources. These agreements vary in terms of level of control, flexibility, authority and reporting requirements as described in the applicable Performance Measurement Strategy. These agreements define the funding mechanisms in order to meet the needs of the recipient while taking capacity into account.
| Expected results | Performance indicators |
|---|---|
| Access to non-insured health benefits appropriate to the unique health needs of First Nations people and Inuit | Percentage of First Nations and Inuit population who accessed NIHB by type of benefit:
|
| Efficient management of access to non-insured health benefits | Administrative cost ratio, ratio of administration costs to benefit expenditures |
10.2 Intervention policy
As a result of the unique relationship developed with the recipients receiving funding to deliver health programs and services, an intervention policy has been developed to provide a framework for responding to the difficulties encountered by recipients with the management or delivery of programs. The intervention policy provides a list of potential triggers or indicators of the need for intervention, including default of the terms of the funding agreement, health emergencies, failure to deliver health programs and services and administrative and managerial difficulties. When intervention is required, the policy stipulates that the level of intervention must be appropriate to the situation, as determined through discussion with the recipient. Intervention may lead to third party management or other remedial management activities. Indigenous Services Canada may sign agreements, either alone or jointly with other departments, in support of remedial management activities, including third party management agreements.
10.3 Reporting requirements
The contribution agreement contains provisions that outline the financial and non-financial reporting required from recipients. The level and frequency of reporting will vary depending on the mode of delivery. For targeted programs, reporting and accountability requirements specified in the contribution agreement will be at a level and frequency that is appropriate to determine whether program specific delivery requirements have been met and if expenditures were made by the recipient in accordance with the terms of the agreement.
Where special, time-limited funding is made available for programs or services aimed at specific health issues, the contribution agreement will stipulate any additional conditions associated with the funding. Unless otherwise specified, special, time-limited funding must be spent only for the purpose for which such funding is provided.
Existing mechanisms will be utilized to ensure that adequate reporting relationships, policy directions and administrative processes are in place to support the implementation, monitoring and risk management of the transfer payments to meet the accountability of the recipient, the department and of the minister.
Contribution agreements with municipal, provincial and territorial governments, health agencies and health authorities as well as international organizations, require adjustments to accountability requirements, in order to align with existing accountability structures and legal obligations of these organizations. These adjustments are intended to avoid duplication and facilitate integration. A summary table of the requirements for due diligence is presented in appendix D.
11. Audit framework
11.1 Contribution audits
Risk-based contribution audits are conducted in accordance with the ISC Audit and Quality Assurance Framework. This framework presents the kind of audit activities that the department may conduct, the related roles and responsibilities and the approval process. Contribution audits are carried out in accordance with an annual audit risk-based audit plan that covers audits to be conducted based on an evaluation of risks.
The operational risks considered are the probability that:
- First Nations and Inuit communities do not receive health programs and services for which they are entitled
- Program funds are not used for intended purposes or in non-conformance with the terms and conditions of the contribution agreement or that First Nations and Inuit internal control practices are inappropriate, and/or
- Program funds being used for personal profit
Indigenous Services Canada is responsible for determining whether recipients have complied with the terms and conditions applicable to the contributions. ISC can look at individual contribution agreements based on systematic risk assessment and intuitive risk assessment of program management when a problem is suspected or when program internal controls have failed, in other words, financial and operational monitoring.
11.2 Program audits
The internal audit function is a professional, independent and objective assurance and consulting activity designed to add value and improve the department's operations through a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control and governance processes. Internal audits are selected using a risk-based audit planning process that spans multiple years, focuses primarily on departmental areas of high risk and significance and also considers departmental priorities.
A risk management strategy to support the Supplementary Health Benefits Authority was developed which details the risk profile for each main component of this authority. A risk assessment tool was also developed to standardize the risk. Audit plans include provision for the review of internal management policies, practices and controls over transfer payment programs, and determination of the adequacy of the departmental processes to track whether recipients have complied with the requirements of applicable contribution agreements.
12. Official languages
Where a program supports activities that may be delivered to members of either official language community, access to services from the recipient will be provided in both official languages where there is sufficient demand. In addition, ISC will ensure that the design and the delivery of programs respect the obligations of the Government of Canada as set out in part VII of the Official Languages Act by ensuring that these projects provide benefits to all Indigenous Canadians, including French and English minority communities. ISC will ensure that it has the capacity to communicate with, and provide services to, members of the public in the official language of their choice. All communication with the public from ISC, in other words press releases, announcements, will be in accordance with the Official Languages Act. Part roman numeral 4 of the Official Languages Act does not apply when funding is further distributed.
13. Other terms and conditions
13.1 Intellectual property
Copyright in any material created by the funded recipient as the result of a contribution agreement related to the delivery of health programs and services in First Nations or Inuit communities will vest in the recipient. The minister will be entitled to use, reproduce and translate any such copyright material for any government purpose and may share such materials with provincial or territorial governments for internal use only, subject to deletion of any personal or confidential information where required by law. The minister will not otherwise distribute or disclose any material outside of the federal government unless authorized by law or the recipient.
Where a funded project or activity involves or additionally includes the creation of studies, research, reports, communications or other media relating to Indigenous health or the development of knowledge relating to Indigenous health, copyright will again vest in the recipient. The minister will be entitled to use, reproduce and translate any such copyright material for any government purpose and may share such materials with provincial or territorial governments for internal use only, subject to deletion of any personal or confidential information where required by law. The minister will also be entitled, by way of cost-free and royalty-free license, to distribute or disclose such materials outside of the federal government to any party if the materials are non-confidential information under the agreement and where the distribution is for non-commercial purposes only. For confidential studies or reports, external distribution should only be in accordance with the consent of those whose rights are affected or in accordance with law.
13.2 Termination
Either party may terminate a contribution agreement without cause by giving the other party notice in writing in accordance with processes defined in the contribution agreement. A termination clause is included in each agreement. The minister may terminate at any time within the course pursuant to the remedies on default section of the contribution agreement or for reasons of appropriation.
14. Non-monetary contributions
The minister may contribute goods, assets or services, rather than funding, to the recipient for health purposes. Non-monetary contributions may be employed in cases where the process would be of greater advantage to both parties and will not undermine long term objectives to increase First Nations and Inuit control of the delivery of health programs and services. Non-monetary contributions may consist of any good, asset or service that is required for, or can be used by, the recipient for health purposes and may include, for the purposes of supplementary health benefits:
- any medical equipment or assets and repairs thereto for use by a recipient or that supports other health programs funded or delivered by the minister
- goods or services required by the recipient to implement programs supporting Jordan's Principle
The minister will use vote 10 funds for all non-monetary contributions, including the contracting for and delivery of such contributions to the recipient's community or the location where the recipient delivers health programs and services. The minister will follow all federal contracting laws and policies for the purchase of non-monetary contributions. The minister will ensure that the recipient receives non-monetary contributions on the condition that they be used for health purposes and may require reporting and may audit for this purpose.
15. Funding approaches
The diversity of interests, needs and capacities of the recipients leads to the requirement for divergent methods of delivering health programs and services. This requires adaptable vehicles for the administration and management of health programs and services, which vary in terms of level of control, flexibility, reporting requirements and accountability. Where it is advantageous to the success of the activities, ISC would offer set, fixed, flexible or block funding approaches for contributions to Indigenous recipients, in accordance with Appendix K: Transfer Payments to Indigenous Recipients of the Directive on Transfer Payments. The funding approach relevant to programs and services is defined in the program framework and is dependent on the capacity of the recipient to manage and deliver programs, the class of eligible recipient and the nature of the program. Fixed, flexible or block contribution agreements under the Supplementary Health Benefits Authority require the explicit approval of the Assistant Deputy Minister, Services to Individuals Sector. The funding approaches are further described in Appendix B.
16. Terms and conditions effective date
These terms and conditions came into effect on March 2026.
Appendix B: Funding approaches
The following table provides an overview of the funding approaches that ISC's Supplementary Health Benefits Authority will be using as well as the distinct differences and reporting requirements.
| Requirements | Set | Fixed | Flexible | Block |
|---|---|---|---|---|
| Planning | Recipient follows multi-year program plan. This plan will include objectives and activities that will be delivered. | Recipient follows multi-year program plan. This plan will include objectives and activities that will be delivered. | Recipient establishes multi-year work plan including a health management structure. This plan will include a budgetary plan, key priorities, objectives and activities that will be delivered. | Recipient establishes a health plan including a health management structure. The health plan will include key priorities, objectives, activities, mandatory health programs and other programs and services, annual reporting requirements, as well as information on the provisions of the professional or program advisory functions where applicable. Ability to redesign non-mandatory programs. Ability to foster integration initiatives with flexible approaches and intergovernmental arrangements. |
| Reallocation of funds | Recipients able to reallocate funds within the same budget activity , on written approval by the minister within the fiscal year reporting period. | Recipients able to reallocate funds within the same budget activity. | Recipients able to reallocate funds in the same program authority. | Note: Supplementary Health Benefits Program funding cannot be reallocated to other program authorities or activities. |
| Financial reporting | Final year-end financial reports. | Annual year-end audit report. | Annual year-end audit report. | Annual year-end audit report. |
| Annual program reporting | Annual Report to the minister based on annual reporting guide. | Annual Report to the minister based on annual reporting guide. | Annual Report to the minister based on annual reporting guide. | Annual Report to the minister based on annual reporting guide. |
| Unexpended funds | No retention of surplus and no carry over of funds into the next fiscal year. | Recipients are able to retain any unexpended funding remaining at the expiry of the agreement provided that the obligations and objectives set out in the agreement are met and the recipient agrees to use the unexpended funding for purposes consistent with the program objectives or any other purpose accepted by the minister. | Recipients are able to carry over program funding annually for the duration of their agreement. Upon termination the recipient must reimburse the government any unspent funds. | Recipients are able to retain surpluses to reinvest in health priorities within the Supplementary Health Benefits authority |
| Must ensure the provision of all mandatory programs | ||||
Appendix C: Eligible activities
Per section 5, the following table lists the eligible key activities that fall under the Supplementary Health Benefits Authority:
| Health benefits within the program activity | Eligible key activities |
|---|---|
| Pharmacy | Cost of drug items listed on the NIHB Drug benefit list or approved as an exception in accordance with NIHB policy provisions. Dispensing, professional or markup fees up to but not to exceed that provided by ISC. Shipping and delivery charges for benefit items approved as per NIHB policy provisions when it is determined to be the most appropriate, economic and efficient method of transporting the benefit item to the client. Health professional consultative services when it is determined to be the most efficient and economical method of supporting the provision of benefits and approved by ISC. |
| Medical supplies and equipment | Cost of purchase, client reimbursement, co-pay or rental of medical supplies and equipment benefit item listed in NIHB medical supplies and equipment benefit list or approved as an exception in accordance with NIHB policy provisions. Shipping and delivery charges for benefit items approved as per NIHB policy provisions when it is determined to be the most appropriate, economic and efficient method of transporting the benefit item to the client. Professional assessment and fitting or dispensing fee, where eligible as per NIHB medical supplies and equipment policy, not to exceed that provided by ISC. Costs of repair or maintenance of equipment, where eligible as per NIHB medical supplies and equipment policy or benefit list, up to, but not to exceed the cost of a new item and not to exceed that provided by ISC. The costs of restocking fees and shipping costs for the provider to dissemble and ship to the manufacture any parts of a custom made or off the shelf product unused by the client. Health professional consultative services when it is determined to be the most efficient and economical method of supporting the provision of benefits and approved by ISC. |
| Dental care | Cost of dental services as outlined in the NIHB Dental benefits guide and approved in accordance with published policies, guidelines and criteria. Costs of eligible dental services cannot exceed those outlined in the NIHB dental benefits grid. Transportation and meal costs not to exceed rates provided by ISC for contracted dentists brought into the community when it is determined to be the most appropriate, economic and efficient method for arranging for access to dental treatment for eligible clients. Material costs, such as dental consumables or sundries, required for the provision of dental services when services are delivered in community by qualified dentist and not reimbursed on a fee for service basis. Dental equipment, for example, x-ray machines, dental chairs, sterilizers, is not an eligible expenditure under the NIHB program. Per diem models may be considered when it is determined to be the most efficient and economical method of supporting the provision of access to dental services. If a per diem agreement is in place, providers cannot be reimbursed on a fee for service basis. Cost of dental support staff when it is determined to be the most efficient and economical method of supporting the provision of service, not covered under fee for service or alternate payment arrangement and approved by ISC. |
| Vision care | Eligible costs for benefits covered or approved as an exception in accordance with NIHB Guide to vision care benefits and policy provisions. Transportation and meal costs not to exceed rates provided by ISC for eligible vision care professionals brought into the community when it is determined to be the most appropriate, economic and efficient method for arranging for access to vision treatment for eligible clients. Professional dispensing or service fees where applicable up to but not to exceed the rates outlined in the applicable NIHB vision care benefit grid. Per diem models may be considered when it is determined to be the most efficient and economical method of supporting the provision of access to vision care services. If a per diem agreement is in place, providers cannot be reimbursed on a fee-for-service basis. Cost of vision care support staff when it is determined to be the most efficient and economical method of supporting the provision of service, not covered under fee for service or alternate payment arrangement and approved by ISC. Vision care professional consultative services when it is determined to be the most efficient and economical method of supporting the provision of benefits and approved by ISC. |
| Mental health counselling | Professional fees for approved mental health services listed in the NIHB Guide to mental health counselling benefits or approved as an exception in accordance with NIHB policy provisions, up to but not to exceed the rates outlined in the NIHB mental health benefit grid. Transportation and meal costs for contracted visiting mental health counsellors brought into the community when it is determined to be the most appropriate, economical and efficient method for arranging for access to mental health counselling for eligible clients not to exceed ISC negotiated rates. In cases where recipients have funding agreements specific to the provision of traditional healing services in support of mental health service fees, honoraria or salaries as well as associated costs for traditional healer services provided in the community, whichever is determined to be the most appropriate method for arranging traditional cultural counselling for eligible clients. Health professional consultative services when it is determined to be the most efficient and economical method of supporting the provision of benefits and approved by ISC. |
| Medical transportation | Payment, or reimbursement of the cost or co-payment of transportation, meals and accommodation, including hotels, apartment hotels, boarding homes, for eligible clients and approved escorts in accordance with the NIHB medical transportation policy, up to but not to exceed the rates provided by NIHB. May include coverage of the portion of ambulance charges that would normally be billed to any other provincial or territorial resident. The purchase or lease, operating and maintenance of vehicles and other motorized conveyances for the delivery of medical transportation services when it is determined to be the most appropriate long term, efficient and economical method of transportation for the provision of medical transportation benefits to eligible clients. NIHB does not purchase, nor pay for the cost to operate emergency medical services (EMS), including air or ground ambulance services or medevacs. EMS operating costs, including basing fees, the purchase of emergency medical vehicles or medical personnel required to operate such services are not eligible under the program. Transportation, accommodation and meal costs for contracted visiting health professionals brought into the community when it is determined to be the most appropriate, economic and efficient method arranging for access to health services to eligible clients not to exceed rates provided by ISC. Health professional consultative services when it is determined to be the most efficient and economical method of supporting the provision of access to medically required health services, not covered under provincial and territorial health plan and approved by ISC. |
| Benefit administration and coordination | General administrative costs specifically related to benefit management including management oversight, janitorial services, general maintenance and repairs, legal, accounting and book keeping, heating, lighting, property rental or leasing, office supplies, photocopying, fax and telephone, staff training, bank fees, postage, shipping, human resources and pay services. Salaries and contract costs for employees of the recipient to manage and coordinate the delivery of benefits outlined in the funding agreement, such as support clerks and coordinators to arrange medical transportation benefits for eligible clients and approved escorts. Salaries and contract costs for IT support software and computers systems used in the provision and coordination of medical transportation benefits. Salaries and contract costs for employees of the recipient such as NIHB navigator positions to provide support and assistance to clients in accessing NIHB benefits and related health services. Purchase or rental of office equipment such as computers, photocopiers, etcetera, to support the cost-effective and efficient administration and management of the NIHB program. |
Appendix D: Summary of requirements for due diligence
| Planning requirements at the beginning of each year of agreement | Set | Fixed | Flexible | Block |
|---|---|---|---|---|
| Program planFootnote 2 | Yes | Yes | No | No |
| Multi-year work plan | No | No | Yes | No |
| Health plan | No | No | No | Yes |
| Reporting requirements | ||||
| Auditor's report | No | Yes, annual | Yes, annual | Yes, annual |
| Balance sheet | ||||
| Combined statement of revenue, expenditures and accumulated surplus | ||||
| Financial Report on health program expenditures | Yes, year-end only | No | No | No |
| Report on the provision of mandatory programs | Yes, as required by authorities | Yes, as required by authorities | Yes, as required by authorities | Yes, as required by authorities |
| Annual report to the minister | No | No | No | Yes |
| Report on program activities other than mandatory | Yes | Yes | Yes | No |