CLIENT TRAVEL POLICY GUIDELINES Page 1 of 5

Extended Health Benefits Program

Revised Date: May 28, 2007 Section

No: 8

1.00 INTRODUCTION

The Extended Heath Benefits Program provides assistance to eligible persons in Nunavut
who require health care services beyond those covered by the Nunavut Health Care Plan.
The Program is indented to provide eligible non-aboriginal residents that hold a valid
Nunavut Health Care Card with benefits that are similar to the benefits provided to
registered First Nations and recognized Inuit individuals under the NIHB Program. In
addition, the Program provides limited benefits to any individual who has exhausted or
does not have employer or other third-party health care benefits.

2.00 ELIBILITY
Eligibility is restricted to Métis or Non-Native senior citizens (65 and over); Métis or
Non-Native residents with a debilitating long-term disease condition; or any individual
who has exhausted or does not have third-party health care benefits.
3.0 BENEFITS
Benefits under the EHB Program are defined in the Extended Health Benefits Policy.
Under the terms of the Policy the following drug plan benefits are available for eligible
Métis or Non-Native residents with a debilitating long-term disease condition:

Full Coverage Plan – for patients who do not have other insurance coverage
through their employer or their spouse’s employer. Patients who qualify for this
plan receive a pharmacy card. Upon presentation of this card to any pharmacist in
Nunavut (or selected pharmacies in Yellowknife), and provided the prescription is
related to the program the individual is enrolled in, the pharmacist will direct
invoice the Department. Outside Nunavut patients must pay for their medications
and seek reimbursement later by submitting the original pharmacy receipts to the
EHB Department for consideration.

Additional Assistance Plan (ADA) – for patients who have other insurance
coverage. Patients who qualify for this plan must purchase their prescriptions up
front and submit the receipts to their employer insurance plan. Most employer
plans do not cover the full cost of the medication but rather a percentage (i.e.
80%). The ADA plan will pick up the remaining cost (i.e. 20%). Once the
patient receives their statement from their insurance plan, they may then forward
it, along with the prescription receipts (or copies if the employer plan retained the
originals), to the EHB Department for further reimbursement consideration under
the ADA program. The EHB program is the payer of last resort; therefore
patients must access their employer plan first prior to seeking assistance through
the EHB program.

Department of Health and Social Services

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Extended Health Benefits Program

Revised Date: May 28, 2007 Section

No: 8

Note: Full Coverage Plans cover 100% of health related expenses associated with a
patient’s chronic condition within the guidelines set in the Policy. Additional
Assistance Plans cover the difference that the other insurance plan may not.

Under the terms of the Policy the following drug plan benefits are available for eligible
Senior Citizens (65 or older):

Seniors’ Full Coverage Plan – for patients over the age of sixty five, who do not
have other insurance coverage through their employer or their spouse’s employer.
The seniors’ Full Coverage Plan is similar to the above two plans.

Seniors’ Additional Assistance Plan – for patients over the age of sixty five, who
have other insurance coverage. Seniors with an employer insurance plan must
access that plan first.

Accommodation and Meal Benefits

When patients make their own accommodation arrangements they are responsible for
paying their accommodation and meals up front. They must keep all receipts and submit
them on an expense claim. Reimbursement rates are at the latest long-stay rates
published by the GN. As of May 2007 these rates were:

stays with family or friends (Private Residence Home) – rate of $50.00 per night
and $20.00 for meals per day
stays in commercial accommodations (hotels) – the cost of the first nights stay
and meals will be reimbursed at the current government travel rate
more than 1 nights stay – room costs will be reimbursed at a maximum of $20.00
per night and $20.00 for meals per day

Medical Supplies and/or Equipment

Medical supplies and/or equipment – related to the condition. The patient must
submit the request to the Department, including the prescription. Requests are
reviewed and if approved, a vendor is pre-authorized payment by the Department.
NOTE: all medical supplies and equipment requests must be pre-authorized by
the Department to determine if the request is a program benefit.

Department of Health and Social Services

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Extended Health Benefits Program

Revised Date: May 28, 2007 Section

No: 8

Items Not Covered

The following expenses are not covered:

vehicle rental
parking fees
car insurance
taxi costs to and from the airport within home communities
phone calls
dry cleaning
laundry or valet services
movie rentals
liquor
entertainment charges
gift shop purchases, etc

Eligible Dental Benefits

This benefit is only available to those individuals registered in the seniors’ program.
Seniors wishing to access dental benefits may do so in two ways:
Program #70 (Full Coverage) – patients must advise their dentist to submit the
dental claim form to the HIP office for prior approval of services or they may pay
for the dental services up front and submit their receipts along with the detailed
dental form from the dentist explaining the services provided
Program # 95 (ADA Coverage) – patients pay for their dental services up front
and then submit receipts to their employer benefit program. After receiving a
statement from their employer benefit program, they may submit receipts and a
dental form with an explanation of the service provided to the HIP office for
further reimbursement consideration.

Eyeglasses Benefit

Hearing Aid and Eyeglasses Benefits are defined in the Extended Health Benefits Policy.
The maximum benefit for eyeglasses frames under the terms of the Policy is $1,000.00
every 24 months.

Department of Health and Social Services

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Extended Health Benefits Program

Revised Date: May 28, 2007 Section

No: 8

SPECIFIED DISEASE CONDITIONS

** Alcohol Dependency
Alzheirmer’s Disease
Asthma
Cancer
* Celiac Disease
Cerebral Palsy
Certain Disorders of Blood & Immune System
Chronic Obstructive Lung Disease
Chronic Psychosis
Cleft Lip / Palate
Congenital Anomalies & Chronic Disease of the Urinary System
Congenital Cytomegalovirus Infection
Congenital Heart Disease
Crohn’s Disease
Cystic Fibrosis
Dermatomyositis
Diabetes Insipidus
Diabetes Mellitus
** Drug Dependency
* Epilepsy
Head Injury
HIV Infection
All other HIV Related Diseases
Hypertension (Subject to certain BP levels)
Ischemic Heart Disease
Lupus Erythematosus
Multiple Sclerosis
Muscular Dystrophy
* Osteoarthritis
* Pernicious Anemia
* Phenylketonuria
Psoriasis
Rheumatic Fever
Rheumatoid Arthritis
* Rickets
Scleroderma
Scoliosis
Spina Bifida
Spinal Cord Injury
Tuberculosis
Ulcerative Colitis
Wegeners Granulomatosis
Senior Citizen
Special Approval Case – Prior Approval Required

* Indicates eligible for drug benefits only.

** Indicates restricted benefits.

Department of Health and Social Services

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Extended Health Benefits Program

Revised Date: May 28, 2007 Section

No: 8

The list of Specified Disease Conditions will be reviewed annually. Any changes to the
list will be reflected in the Guidelines.

Note: The Extended Health Benefits Program should not be confused with the
Government of Nunavut’s employee insurance plan (PSHCP) or other third-party
insurance plans. The Extended Health Benefits Program is provided by the
Government of Nunavut for qualifying individuals only.

A patient who has access to benefits under an employer or other third-party

health insurance plan must seek reimbursement form their employer or
third-party health insurance plan first.

For additional information about EHB benefits individuals can 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