News from the Non-Insured Health Benefits Program (NIHB)
2025 NIHB dental fee updates
On April 1, 2025, the release of the 2025 Non- Insured Health Benefits (NIHB) Program regional dental fee updates were synchronized across provinces/territories.
The updated fees appear in the NIHB Regional Dental Benefit Grids, organized by general practitioners (GP), specialists (SP), oral surgeons (OS), denturists (DN) and dental hygienists (HY). The grids contain maximum NIHB fees for eligible procedure codes.
The current NIHB Regional Dental Benefit Grids, as well as the latest updates, errata and amendments, are available on the Express Scripts Canada NIHB Provider and Client Website at nihb-ssna.express- scripts.ca/en > Provider > Dental. The Dental Benefit Grids can be found at nihb-ssna.express-scripts. ca/en > Provider > Dental > Dental benefit grids.
Upon entering the Dental Benefit Grids, choose the current year and the desired province/territory to view the grid corresponding to the applicable provider specialty (e.g., GP/SP, HY, DN and OS).
Claims submission period increased to 365 calendar days from date of service
Effective June 7, 2024, the claims submission period for dental providers increased from 30 calendar days to 365 calendar days from the date of service. This period applies to claims submitted by dental providers in real-time through Electronic Data Interchange (EDI) or through the Express Scripts Canada NIHB Provider and Client Website.
Please note that if a claim is submitted to Express Scripts Canada more than 365 calendar days from the date of service, the claim will be rejected. Also note that there has been no change to the process for submitting manual claims. Providers continue to have 365 calendar days from the date of service to submit their claim.
If you have any questions about the increased claims submission period or the eligibility of a claim, you may contact the NIHB Call Centre at Express Scripts Canada at 1 888 511-4666 Monday to Friday: 6:30 a.m. to 8:30 p.m., Eastern Time.
For more information on this change to the claims submission period, you may access the associated bulletin Claims Submission Period Increased from 30 Calendar Days to 365 Calendar Days on the Express Scripts Canada NIHB Provider and Client Website dental bulletins page (nihb-ssna.express- scripts.ca/en > Provider > Dental > Bulletins).