Extended Health Benefits Survey

Overview of Discussion Paper

Current Policy
The current Extended Health Benefits Policy gives eligible NWT residents access to products and services (supplementary health benefits) not covered under the NWT Health Care Plan.

The Department of Health and Social Services administers two programs under the Policy. The Specified Disease Conditions Program provides prescription drug benefits, and in some cases medical travel benefits, for eligible residents with a disease listed in the policy. The Seniors’ Program provides full coverage for eligible prescription drugs, eyewear, dental treatment services, medical supplies and equipment, and medical travel to residents 60 years and older.

Why it needs to change
The Extended Health Benefits Policy has seen little change in the last 34 years and no longer meets the objectives of fairness and equity as a publicly funded benefit program. An estimated 2,200 NWT residents do not have access to any benefits like the ones available to most residents through employer or government insurance plans. The Department of Health and Social Services is proposing policy changes that will ensure all residents in need of health benefits can get them.

These proposed changes are a starting point for public discussion about how the territorial government can improve on its existing health benefits programs.

At this time, the review does NOT include benefits directed towards NWT Seniors. Those remain the same.

Existing benefits for Indigenous residents under the federal Non-Insured Health Benefits programs and the GNWT Métis Health Benefits program also remain in place and are NOT part of this discussion.

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Proposed Elements of a new Supplementary Health Benefit Policy Framework
A big change being proposed is to move to an income-tested model to determine who is eligible for supplementary health benefits. That means individuals or families who earn below a set amount of income, and who have no other insurance, would qualify automatically for health benefits and drug benefits.

The Department of Health and Social Services researched other provincial and territorial policies in Canada then drafted a framework for a new Supplementary Health Benefits Policy for the NWT. Under which, two new program streams are being proposed: a Supplementary Health Benefits Program and a Drug Benefit Program.

Supplementary Health Benefits Program
Low-income residents without insurance would receive coverage for basic dental services and treatment, medical supplies, and equipment such as hearing aids and walkers, and prescription eyewear.

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Drug Benefit Program
Low-income residents eligible for the Supplementary Health Benefits Program would be eligible for the drug benefits program, which covers the cost of their prescription drugs. As well, residents who have drug coverage under their employer-sponsored or third-party insurance plans may also benefit. Once their insurance coverage has been exhausted, those residents can apply to the Drug Benefit Program to receive assistance for the high cost of drugs. Cost sharing and coverage levels will be determined by how much income they earn.

The advantage of having a separate drug benefit program is that drug benefits would be available to all residents, reducing potentially catastrophic drug costs for individuals and families.

Providing both streams of benefits for residents who currently do not have any access will help support better health outcomes and ultimately reduce the financial demands on the acute care services within the health system.

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How income testing would work
Residents who wish to access either program would apply annually. Income-testing would be based on Canada Revenue Agency’s Income Statement, issued after your personal income tax has been assessed. Everyone in a family household would have to provide their Income Statements.

Residents applying to the drug benefit program would need to show evidence that the drug benefits under their insurance plan have been, or will be, exhausted within the year cycle. Income-testing considers drug costs, insurance coverage and ability to pay.

Low-income thresholds in the NWT would be based on Canada’s Official Poverty Line, as set out by Statistics Canada. It is called the Market Basket Measure. Below is the distinct Northern Market Basket Measure which recognizes the high cost of living and other factors in the NWT.

$32,601 represents the annual income needed to meet a basic standard of living averaged across all NWT regions; or

$36,925 represents the annual income needed to meet a basic standard of living in the most expensive region to live in the NWT (Sahtu).

$9,451 per dependent (a child under 19) is added to the base low-income threshold.

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