The First Nations Health Authority (FNHA) Dental Benefit is designed to provide First Nations people in British Columbia (BC) with regular access to essential preventative dental services, such as exams and dental cleanings.
As of September 16, 2019, Pacific Blue Cross (PBC) administers dental care coverage under the First Nations Health Authority (FNHA) Dental Benefit.
Dental coverage includes:
- Exams & X-rays
- Fillings
- Bridges
- Crowns, inlays, onlays, veneers
- Dental surgery
- Dentures
- Night guards
- Orthodontic services
- Periodontal services
- Preventive services
- Root canals
These services can be accessed through any dental provider. If the provider is registered with PBC, they can bill directly to the program. If they are not registered with PBC, the patient must pay out of pocket and request reimbursement.
Services not covered include cosmetic treatments, implants, and ridge augmentation.
Eligibility
To be eligible for FNHA coverage, patients must have Indian Status, live in BC, and be enrolled in the Medical Services Plan (MSP).
For First Nations people in BC, MSP is managed by the Health Benefits Program. The Health Benefits Program is available to First Nations people with Indian status living in BC, and to infants (up to 24 months) awaiting status if at least one parent is eligible for the program.
Individuals are not eligible for Health Benefits if they have health insurance provided by the federal government or by a First Nations organization as part of a self-government agreement with Canada.
If already registered for Health Benefits, then eligible individuals are automatically covered under FNHA coverage – no application is needed. Patients registering for Health Benefits for the first time can apply for MSP in one of three ways:
Key FNHA Dental Benefit Details
There are a few steps to follow when seeking dental care under the FNHA Dental Benefit. Patients should:
- Check with their dental provider if they're registered with PBC for direct billing.
- Discuss with the dentist which services are covered by the plan.
- Ensure the dental provider has received pre-approval for services.
Once these steps are completed, the dental service can be performed.
Patients can use the online PBC Member Portal to manage their coverage, including the following:
- Look up detailed coverage information
- Submit receipts for reimbursement
- Check your balance for each benefit
- Get reimbursed via direct deposit in as little as 48 hours
Reimbursement documents must be submitted within one year of the service being provided. They can be submitted online through the PBC Member Profile or by mail using the Reimbursement form.
Pre-determination is required prior to certain services. The dental care provider must submit documentation to PBC for pre-determination for services that require preapproval. These services generally fall under the scope of:
- Major restorative services
- Orthodontic treatment
- Surgical procedures
- Endodontic services
- Periodontal services
- Dental sedation (minimal sedation does not require pre-determination)
- Certain diagnostic services
Patients should speak with their dental care provider prior to treatment to ensure that all services requiring pre-determination have been approved.
FAQs
What happens if I miss the one-year deadline for submitting reimbursement documents?
If more than one year has passed since you received a service, you can no longer submit the receipt for reimbursement.
How can I check if my dental treatment is covered by the FNHA Dental Benefit plan?
Detailed information about your dental benefits can be found within the PBC Member Profile, accessible either online or via the PBC App.
Can I access the FNHA Dental Benefit if I’m temporarily living outside of BC?
In order to qualify for coverage under the FNHA Dental Benefits Program, you must be physically present in BC for at least six months in a calendar year.
In certain situations, while temporarily outside the province for work or vacation, patients may maintain eligibility for coverage during an extended absence of up to 24 consecutive months, one time within a 60-month (five-year) period.
References
- FNHA, First Nations Health Benefits Blue Cross Fact Sheet
- FNHA, Dental Benefits
- FNHA, Dental Benefit
- FNHA, BC Medical Services Plan
- FNHA, Eligibility for Health Benefits
- Government of British Columbia, Information for Health Professionals
- FNHA, Reimbursements
- Government of British Columbia, Eligibility for MSP
*The content provided in this article, including text, graphics, and referenced material, is intended for informational purposes only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult with your dentist or another qualified oral health professional for questions regarding your dental condition. Never disregard professional dental advice or delay seeking it based on information from this article. If you believe you have a dental emergency, contact your dentist, or seek immediate assistance from an oral healthcare professional.
