Prescribed Minimum Benefits

According to the Prescribed Minimum Benefits, you have the right to a guaranteed level of cover for a list of medical conditions and treatments even if your Plan benefits have run out.

In an emergency, we will cover you in full at any provider until your condition is stable. You may have a co-payment once your condition is stable and you receive treatment from a non-designated service provider who charges more than the Society Rate. Please remember that even though you or your doctor may consider this to be an emergency, it may not be classified as an emergency under the Prescribed Minimum Benefits.

Cover for Prescribed Minimum Benefits

In most cases, the Society offers benefits which cover greater than the Prescribed Minimum Benefits. To access Prescribed Minimum Benefits, there are rules that apply:

  1. The condition must be part of the list of defined PMB conditions
  2. The treatment needed must match the treatments in the defined benefits
  3. Members must use the Society’s designated healthcare service providers

However, even in these cases, where appropriate and according to the rules of the Society, you may be transferred to a Designated Service Provider, or you will be responsible for a co-payment. You will be responsible for the difference between what we pay and the actual cost of your treatment.

For more information on Prescribed Minimum Benefits, please click here.