AISH Program Policy

Published Date: March 01, 2014
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Benefits

Health Benefits

Requesting Additional Health Benefits and Health Benefits Exception Committee (HBEC)

AUTHORITY

Assured Income for the Severely Handicapped Act, section 3
Assured Income for the Severely Handicapped General Regulation, section 7

INTENT

To meet the unique, medically essential needs and circumstances of clients, cohabiting partners, or dependent children for health benefits outside what is normally available through the AISH Health Benefits Card

POLICY

The AISH program provides clients, their cohabiting partners and their dependant children with coverage for prescription drugs, essential diabetic supplies, dental and optical services, and ambulance services through the AISH Health Benefits Card.

The Health Benefits Exception Committee (HBEC) reviews requests for additional health benefits for clients, cohabiting partners, and dependent children. The HBEC provides an arms-length review to ensure decisions are fair, equitable, and within established parameters.

The HBEC reviews health benefits decisions if:

  • The requested good or service is something that could reasonably be considered as a drug, dental procedure, optical service, ambulance service, or diabetic supply; and
  • All other potential methods of authorization have been tried unsuccessfully.

The requested health benefits will not be issued or reimbursed while waiting for the HBEC decision.

Exceptional Health Benefit Decision

Decisions for exceptional health benefits are final and are not appealable to an appeal panel. However, the HBEC may review and alter their decision if significant new information is submitted. After the review, the AISH Program provides a written decision that explains the reasons for their decision. The decision is normally sent to clients within 10 business days of the review.