Orthodontic Request

(Currently, Orthodontic requests are escalated to our National Office for adjudication)

If the child is registered:  The request for Braces must be reviewed by the NIHB Predetermination Centre prior to submitting to Jordan’s Principle.  If denied, Jordan’s Principle can consider funding orthodontic services and products for First Nations children for services that are not available to other children, if those services or products would achieve substantive equality or be in the best interest of the child. If the request does not meet NIHB criteria it is considered above the normative standard and therefore requires additional information for review.  This means we look at the “Substantive Equality” which seeks to address the inequalities that stem from an individual’s particular circumstance, to help put them in the same position as others.

If the child is NOT Registered: (VERY important to include the both parent’s names, dates of birth and treaty numbers in the application form so that we can determine eligibility for status; It is also important to include the location the child resides)

Jordan’s Principle can consider funding orthodontic services and products for First Nations children for services that are not available to other children if those services or products would achieve substantive equality or be in the best interest of the child.  This means we look at the “Substantive Equality” which seeks to address the inequalities that stem from an individual’s particular circumstance, to help put them in the same position as others.

In order to review the request under Jordan’s Principle we need the following documentation:

  1. Jordan’s Principle application with as much information about the child’s situation and the impact of not having this service or support (see attached)
  2. Letter of recommendation from mental health, social or educational professional describing the significant impacts on the child/youth explaining how the braces would promote the health and well-being of the child. The letter should be written on the professional’s business letterhead and indicate the significant challenges that the child is experiencing as a result of not having braces. This may include psychological, social or functional aspects such as:
    • Details regarding significant mental health challenges due to the appearance of the child’s teeth
    • Details of low attendance at school as a result of low self-esteem issues due to the appearance of the child’s teeth
    • Details of bullying behaviors targeted the child because of the appearance of their teeth
    • Details regarding speech impediments
    • Details regarding pain or inability to eat
  3. The letter of recommendation must come from someone other than the orthodontist or dentist.
  4. Copy of the NIHB denial letter (if available) or include date(s) of NIHB denial/appeal
  5. Copy of the dental treatment plan (quote) which will include dental codes and costs using NIHB current rates. Face on and profile radiographs may also be submitted.
  6. If approved, a copy of the Oral Health Status report from the dentist is required indicating that the youth has maintained good oral hygiene for a period of six months prior to this request. (This report is not required if the request is for reimbursement)
  7. If you are requesting reimbursement costs (after the fact), please include the cost you want Jordan’s Principle to cover. You will need the original receipts. Also indicate if portions were paid for by an insurance company, the band, NIHB, etc.

 

If the request is approved, we will be sending the requestor and provider an email approval and the work can proceed.  If the Orthodontic Office is not already a Vendor with Jordan’s Principle, we will send them forms to fill out so that they can bill us directly for services (rather than the client needing to pay for them first). Once the work has been completed, an invoice can be sent to Jordan’s Principle to pay directly. 

If the request is for reimbursement to a guardian/parent and it is approved, we need the items in number 7 and then we can set the requestor up as a vendor with Jordan’s Principle and pay them directly for the reimbursement.

For Non-Insured Health Benefits Codes and Rates, please visit:

https://provider.express-scripts.ca/dental/benefit-grids

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