UNSMIS’s Internal Rules serve as the cornerstone of our health insurance framework, ensuring clarity, fairness, and consistency in the administration of benefits. These rules are meticulously designed to address the evolving needs of our insured members while maintaining the financial stability of the insurance scheme.

The primary purpose of the Internal Rules is to outline the rights and responsibilities of both the insured members and the Society. This document provides a comprehensive guide on the procedures for claiming benefits, the types of medical treatments and services covered, and the conditions under which these benefits are granted. By adhering to these rules, members can ensure that their claims are processed efficiently and that they receive the maximum benefits to which they are entitled.

The Internal Rules encompass a wide range of topics, including but not limited to:

• Eligibility and enrolment: criteria for joining the insurance plan and maintaining coverage.
• Benefits: detailed descriptions of covered medical treatments and products.

• Prior authorization: Procedures for obtaining approval for certain treatments and services.

   

For detailed information, please refer to the full text of the Internal Rules available in English and French.