Coverage
NWT Extended Health Benefits for specified disease conditions covers several diseases and conditions. However, some NWT residents may have other plans that cover these diseases/conditions. Therefore, you should first claim from the other insurance company, before claiming from the Department of Health and Social Services.
Diseases/Conditions Covered
| ** |
Alcohol Dependency |
Hepatitis | |
| Alzheimer’s Disease | HIV Infection | ||
| Asthma | All Other HIV Related Diseases | ||
| Bilateral Congenital Microphthalmos | * | Hypertension (Pressure greater than 150/90 mm/hg; under 45 years – pressure equal to or greater than 130/90 mm/hg) | |
| Budd-Chiari Syndrome | Ischemic Heart Disease | ||
|
Cancer |
Lupus Erythematosus |
||
| * | Celiac Disease | Multiple Sclerosis | |
| Cerebral Palsy | Muscular Dystrophy | ||
| Certain Disorders of the Blood and Immune System | * | Osteoarthritis | |
| Charcot-Marie-Tooth | * |
Pernicious Anemia |
|
| Chronic Obstructive Lung Disease | * |
Phenylketonuria (PUK) |
|
| Chronic Pancreatitis | Primary Pulmonary Hypertension | ||
| Chronic Psychosis | Psoriasis | ||
| Cirrhosis of the Liver | Rheumatic Fever | ||
|
Cleft Lip and Cleft Plate |
Rheumatoid Arthritis | ||
| Congenital Anomalies of the Urinary System | * |
Rickets |
|
| Congenital Cytomegalovirus Infection | Scleroderma | ||
| Congenital Heart Disease | Scoliosis | ||
|
Crohn’s Disease |
Sickle Cell Anemia |
||
| Cystic Fibrosis | Spina Bifida | ||
| Dermatomyositis |
Spinal Cord Injury:
|
||
| Diabetes Insipidus | Tuberculosis | ||
|
Diabetes Mellitus |
Ulcerative Colitis |
||
| ** | Drug Dependency |
Wegener’s Granulomatosis |
|
| * | Epilepsy | ||
|
Gastoparesis |
|||
| Head Injury | |||
| Hemophilia |
* Indicates Specified Disease Conditions that are eligible for drug benefits only.
** Indicates restricted benefits.
Benefits/Conditions Not Covered
The following benefits/services are NOT covered by Extended Health Benefits:
- third party physicals such as insurance medicals, or physicals required for food handlers, passport or employment
- optometrists examination
- chiropractors
- naturopaths
- podiatrists
- osteopaths
- acupuncture treatments
- physiotherapy and/or psychology services received outside an approved hospital facility.
- any service to which a resident is entitled under legislation, such as Workers’ Compensation Act, Public Health Act, or other territorial or federal legislation, including treatment of veterans who are entitled to such treatments as a result of service in the Armed Forces
Other Plans
Some NWT residents may be covered for benefits that are listed on the Diseases/Conditions Covered section of this site. For example, you may qualify under a plan because you or your spouse or guardian work for an employer that provides these benefits. In a few cases, Workers Compensation or private insurance plans may provide coverage. If you qualify for these benefits under any other insurance plan, you must:
- claim from the other plan first. You will usually need to pay the bill and submit it to the plan.
- if the full cost is not covered by the other plan, complete and submit an EHB claim form for reimbursement to the Health Services Administration Office. Be sure to attach original receipts and the statement of payment from the other plan. The Department of Health and Social Services will reimburse you for the remaining expenses up to the limits of the Program.