Bigstone Health Benefits

Bigstone health benefits are an inherent right for registered treaty status indians as defined by the indian act and are constitutionally protected. The benefits are to be comprehensive, accessible and provided as needed in a timely manner to all registered treaty status Bigstone Cree nation members and clients living on reserve and off reserve and who are ordinarily resident in Canada. Bigstone Health Benefits (BHB) does not cover items or services outside of Canada.

The Bigstone Health Benefits program draws its authority from the Federal Government, the 1979 Indian Health Policy and the renewed mandate of 1997. BHB follows the national guidelines, policy, procedure and mandate. The program is needs-based which covers some of the cost for medically justified products and services that are not covered by Provincial, Territorial or any other third-party Health Plans.

The Goals and Objectives of Bigstone Health Benefits are to provide benefits to registered Bigstone Cree Nation membership in a manner that:

Is appropriate to unique health needs
Contributes to the achievement of an overall health status that is comparable to that of the Canadian population as a whole
Is sustainable from a fiscal and benefit management perspective
Will maintain health, prevent disease, facilitate early detection of disease, and management of illness, injury or disability.

The purpose of this web page is to provide Bigstone Cree Nation members and clients with Bigstone Health Benefits coverage information.

For coverage, criteria and/or frequency, guidelines must be met. The benefit information below is a general overview; please contact our office for specific information.

Bigstone Health Commission will not tolerate abusive behaviour of any kind. Any abusive behaviour directed towards employees will result in discontinued access to the Bigstone Health Benefits program.

Bigstone Health Benefits Contact Information

ADDRESS: 16310 100 Ave Edmonton, Alberta, Canada T5P 4X5
PHONE: (780)341-2777
FAX: (780)444-6521
TOLL FREE: 1(866) 891-9719

VISION CARE OPTICAL
EXTENSION 4001
DIRECT LINE: (780)341-2780
Monday – Friday 9:00 AM to 5:00 PM

DENTAL
EXTENSION 4000
DIRECT LINE: (780)481-4261
Monday – Friday 8:30 AM to 5:00 PM

PHARMACY AND MEDICAL SUPPLIES
EXTENSION 4023
DIRECT LINE: (780)341-2776
Monday – Friday 8:30 AM to 5:00 PM

MENTAL HEALTH
EXTENSION 4024
DIRECT LINE: (780)341-2784
Monday – Friday 8:30 AM to 4:30 PM

Eye examinations

Children 0-17 years eligible once a year
Adults 18 to 64 years eligible every 2 years
Elders 65 and older eligible every 1 year
Individuals diagnosed with diabetes are eligible for an eye examination once a year

Eye wear

Eligible eyewear coverage amount depends on prescription. Amount can be used towards either glasses and/or contact lenses.

Children 0-17 years eligible once a year
Adults 18 years and older eligible every two years

Replacement lenses due to change in the prescription.

Eligible lens replacement coverage amounts depends on the prescription.

If prescription changes by + or—0.50 diopters or more
- Children 0-17 years eligible once a year
- Adults 18 to 64 years eligible every 2 years
- Individuals diagnosed with diabetes are eligible for replacement lenses if prescription has changed by + or—0.50 diopters or more.

Repairs

One major and one minor within the applicable replacement time frame (1 or 2 years).

Includes coverage for a range of dental services and procedures in the following categories:

Diagnostic (exams & x-rays)
Preventive (cleanings)
Restorative (fillings)
Endodontic (root canals)
Periodontal (deep cleanings)
Prosthodontic (removable dentures)
Oral surgery (extractions)
Adjunctive (general anesthetic, sedation)
Orthodontic (braces)

Dental services and procedures are divided into 2 schedules:

Schedule A – these are categories of dental procedures that do not require prior approval but have frequency limitations.
Schedule B – these are categories of dental procedures that require prior approval.

Basic Frequency Guidelines:

Children are up to the age of 16 years old and Adults are ages 17 years old and up.

Examinations

Complete

1 in any 5 years (replaces the recall and new patient limited exams for the respective eligible period)

New patient limited

1 in a lifetime with same provider or different provider in the same office
1 in any 12 months with a different provider in a different office

Recall

Children—once per 6 months
Adults—once per 12 months

Emergency

Children and Adult—once per 12 months

Specific

Children and Adult—once per 12 months

Cleaning

Scaling

Age 0-11 1 unit in any 12 months
Age 12 to 16 2 units in any 12 months
Age 17+ 4 units in any 12 months

Polish and Fluoride

Children—once per 6 months

Adults—once per 12 months

Fillings

Up to 5 surfaces, once per tooth, every 12 months

Nitrous oxide and oral sedation

All ages 4 in any 12 month period

Sedation & General Anesthetic

Ages 0 to 11 years are covered once per 12 months
Ages 12+ prior approval is required

Standard Root Canals

Every tooth is eligible once except for wisdom teeth which require prior approval

Crowns

Prior approval is required
4 in any 10 year period
1 crown on the same tooth, once every 8 year period

Dentures/Partial Dentures (Prior approval may be required)

Standard complete dentures: 1 per arch in any 8 year period
Partial Cast/Immediate Dentures: 1 per arch in any 8 year period
Partial Acrylic Dentures: 1 per arch in any 5 year period
Denture adjustments are a covered benefit
Repairs and additions: 1 per prothesis in any 12 months
Reline or Rebase: 1 per prothesis in any 24 months
Tissue conditioning: 1 per prothesis in any 24 months

Orthodontics

Prior approval is required for orthodontic treatment
Exam and records are covered once in a lifetime for ages 17 and under

Dentist Fees

Clients are encouraged to discuss costs and coverage with their provider before proceeding with treatment. The provider should contact our office prior to your appointment to check what treatments you are eligible for. If you are not eligible for a treatment, you have the option to decide if you want to receive that treatment.

Each Province and Territory in Canada has a Dental Association. One of the functions of each of these Dental Associations is to give guidance to dentists about dentist prices by publishing Dental Fee Guides. The fee guides are updated annually by each provincial dental association. The fee guides are only suggestions, and ultimately the Dentists set their own fees.

To avoid out-of-pocket expenses, choose a dentist that sets their fees in alignment with the NIHB fees.

Includes coverage for a range of items in the following categories:

Prescription medications;
Over-the-counter medications;
Diabetic supplies;
Injectable medications;
Extemporaneous (compounded) mixtures;
Medication delivery devices;
Recognized non-oral contraceptive devices;
Therapeutic vitamins and minerals;
Medically necessary nutrition products;
Opioid dependency treatment; and
Special formularies for; chronic renal failure, palliative, and clients in active cancer treatment.

Items covered are divided into the following categories;

Open benefit – these items do not require a prior approval.
Limited use benefits – these items have established criteria and require prior approval. Information will be requested from the prescriber to determine if criteria is met.

Medical supplies and equipment benefits include:

Audiology
- hearing assessment,
- hearing aids/devices,
- batteries,
- repairs
Limb and body orthotics (braces for all areas of body)
Custom-made footwear and custom-made foot orthotics
Oxygen equipment and supplies
Pressure garments and devices
Prosthetics
Respiratory equipment and supplies (CPAP, BiPAP)
Self-care equipment
- Bathing and toileting aids
- Cushions and protective aids
- Dressing aids
- Feeding aids
- Lifting and transfer aids
- Gender identity
- Lifting and transfer aids
Low vision equipment
Mobility equipment
- Seating devices
- Standing devices
- Walking aids
- Medical strollers
- Wheelchairs (manual, power)
Communication equipment
- Voice restoration
- Augmentative and alternative communication
- Laryngectomy supplies
Medical surgical equipment
- Incontinence
- Ostomy
- Wound care

Every 12 months, clients can receive up to 22 hours of counselling performed by one enrolled provider, at a time, on a fee-for-service basis. If required, additional hours may be approved.

Counselling sessions may include: Individual, Family, or Group

The Indian Residential Schools Resolution Health Support Program provides mental health coverage to eligible former Indian Residential School students and their families (including Bigstone Cree Nation clients). For more information please call Indigenous Services Canada 1-800-232-7301.

For addictions treatment centre inquires contact the Alberta Regional Referral Coordinator at (780) 495-2345 or toll free 1-866-495-2345.

Clients
Providers

How To Register for Health Benefits

Once you receive your Bigstone Cree Nation status number, you must register with the Bigstone Health Benefits program. Registration for the Bigstone Health Benefits Program is not automatic once you are accepted.

To register, submit the two required items to our office by mail.

completed Bigstone Health Benefits Program Consent Form [CLICK HERE] which can be printed here on the website or contact our office to have one mailed; and

provide one form of status number confirmation

Acceptable forms of status number confirmation (only one required).

Copy of letter of acceptance from Indigenous Services Canada or;
Copy of letter of confirmation from Bigstone Cree Nation Membership or;
Copy of the front and back of status card

Mail or drop off at: Bigstone Health Benefits 16310 100 Avenue Edmonton, AB T5P 4X5. You may also drop off at the Bigstone Health Commission office in Wabasca, AB.

Clients who have recently turned 18 years old are required to complete their own consent form, as the one previously completed by their parent or guardian will no longer be valid.

If you have legally changed your name or gender, mail a completed consent form and a copy of your updated status card to our office.

If your contact information has changed, call our office to update your information.

Health Benefits Coverage for Unregistered Children

To allow parents additional time to register their child(ren), health benefits can be billed using the parent’s status number until the age of 24 months. The provider must submit these claims manually. After the age of 24 months, the child needs their own status number.

Bigstone Health Benefits Providers

Bigstone Health Benefits encourages you to visit providers who bill Bigstone Health Benefits directly. However, if you choose a provider not enrolled with Bigstone Health Benefits you must pay for the item/service and then submit a reimbursement request. Please note: the item/service you require may not be a covered benefit. The provider may charge more than the amount Bigstone Health Benefits covers.

How To Access Benefits

Let the provider know you are registered with Bigstone Cree Nation and provide them with your 10-digit status number. Clients are encouraged to discuss costs and coverage with their provider before booking an appointment or purchasing items and/or services.

For vision, dental, and mental health counselling benefits:

Select a health benefits provider enrolled with Bigstone Health Benefits. Providers enrolled with Bigstone Health Benefits can be viewed on the interactive providers map below. You may also call our office for a list of providers in your area.
Client arranges appointment.
Client attends appointment. Provider will deliver item or service and may determine future health need(s).
Provider submits payment and/or future requests for item and/or service to our office.
Bigstone Health Benefits reviews request and responds to provider.
Provider will notify you if item and/or service has been approved or denied.

For pharmacy and medical supplies (A prescription may be needed for medications or certain medical items):

Select a health benefits provider enrolled with Bigstone Health Benefits. Providers enrolled with Bigstone Health Benefits can be viewed on the interactive providers map below. You may also call our office for a list of providers in your area.
Client takes prescription to provider.
Provider will deliver item or service and may determine future health need(s).
Provider submits payment and/or future requests for item and/or service to our office.
Bigstone Health Benefits reviews request and responds to provider.
Provider will notify you if item and/or service has been approved or denied.

Client Reimbursement [CLICK HERE]

The Client Reimbursement form can be printed here on the website or contact our office to have one mailed.

Appeal Procedure [CLICK HERE]

The Appeal Procedure form can be printed here on the website or contact our office to have one mailed.

Consent Form [CLICK HERE]

Privacy Commitment

In light of protecting your personal health information, do not send any submissions containing personal information via email unless protected with a password. If you are unable to password protect your health information, send by mail or fax.

Since 2004, Bigstone Cree Nation has managed their own non-insured health benefits separately from Indigenous Service Canada, Non-Insured Health Benefits. Bigstone Health Commission is the payer of health benefits for all individuals registered with Bigstone Cree Nation. The Bigstone Cree Nation registration number (also known as status number), first three digits begins with 458. Bigstone Health Benefits follows Indigenous Service Canada, Non-Insured Health Benefits Policy and reimburses according to NIHB Benefit Grids, Drug Benefit List, and Price Files.

Currently, the claim submission process is manual for most benefits areas. Therefore, claim processing times are longer than most insurance companies. Providers can expect payment within 60-90 days from the date the claim is received by our office.

Provider Eligibility

Bigstone Health Benefits values good quality, ethical providers. Our office maintains close working relationships with all providers as they have direct contact with our clients across Canada. To achieve this, our office spends additional time communicating with each provider. Bigstone Health Benefits expects our clients be provided with top quality care and service.

Providers must apply to be enrolled in the Bigstone Health Benefits program to direct bill. Criteria must be met to be eligible to apply to be a Bigstone Health Benefits Provider. One criterion is the provider must be an existing approved NIHB provider. Please contact our office to inquire if you are eligible to enroll as a provider.

Provider Responsibility

It is the provider’s responsibility and obligation to perform their duties to the client and Bigstone Health Benefits in a manner acceptable to their professional provincial regulatory body.

It is the expectation that the provider will adjudicate claims to Bigstone Health Benefits and not bill the client.

The provider must submit claims for Bigstone Cree Nation clients to Bigstone Health Benefits and not to Indigenous Service Canada, Non-Insured Health Benefits. If claims are adjudicated to the Express Scripts Canada portal (Indigenous Services Canada, Non-Insured Health Benefits) it will reject with the error message “This patient has other coverage”.

The provider should act on behalf of the client to achieve access to health benefits. The provider is encouraged to contact our office with any questions.

Privacy Commitment

In light of protecting client personal health information, do not send any submissions containing personal information via email unless protected with a password. If you are unable to password protect your health information, send by mail or fax. We both hold the important responsibility of protecting personal health information.

Provider Delist Information

Bigstone Health Benefits holds the right and authority to delist a health benefits provider at any time if:

the providers’ responsibility is not being fulfilled; and/or
the provider is demonstrating unethical or illegal activity within their practice.

Bigstone Health Benefits will end the relationship immediately and report the activity to the applicable professional provincial regulatory body.

Provider Forms

Printable forms are for approved providers only. Do not utilize the forms unless you are an approved provider. If you are unsure if you are an approved provider, call our office 1-866-891-9719.

Click on the names to download the forms

Common Pseudo PINS

MSE Audiology prior approval form

MSE Custom Footwear and Orthotics prior approval form

MSE General prior approval form

MSE Limb and Body Orthotics prior approval form

MSE Oxygen and Equipment prior approval form

MSE Respiratory prior approval form

Pharmacy Manual Claim

Pharmacy Manual Reversal

BHB PAMPHLET August 2023 Download