GMS: Health & Dental Insurance for Canadians
In addition to base benefit listed above, you can select optional coverage upgrades that include travel medical insurance, hospital cash as well as dental and prescriptions drugs coverage.
– Basic Prescription Drugs: Up to $3,500 for prescription drugs.
– Enhanced Prescription Drugs: Up to an overall maximum of $5,000 for prescription medications and oral contraceptives. Includes $800 for pre-existing medications.
– Dental Care: Includes Preventative Care, Basic and Major Services. Year 1 – $500, Year 2 – $750, Year 3+ – $1,000.
– Hospital Allowance: $100 a day up to $3,000 per policy year.
– Annual Medical Travel Insurance: Includes out-of-country and out-of-province coverage of $2,000,000 for 15, 30 or 48 days per trips within a year.
Click to view – GMS Personal Health | Policy Wording
– Be a resident of Canada.
– Be eligible and insured under a Provincial Insurance Plan from your province of residence in Canada.
Please note that you will need to meet other eligibility requirements outlined below if you enroll your family members.
In order to be eligible for a health plan on a Couple or Family basis, each person to be insured must:
– Have a valid government medical insurance plan from their province of residence.
– Be present in their province of residence for at least 180 days in each calendar year while insured.
Family packages are available for applicants with:
a) 2 parents and with up to 4 eligible dependents.
b) 1 parent and up to 5 eligible dependents.
Each dependent is considered eligible when the following criteria is met:
a) Dependent is under 21 years old
b) Dependent is under 25 y.o. when the child is enrolled in at least three (3) classes per semester or sixty percent (60%) of a full course load in a full-time student educational facility.
c) Dependent, regardless of age, is a developmentally or physically disabled child (if satisfactory proof of disability is received
within 31 days of the child attaining the ages indicated above to ensure continuing eligibility).
Please take a look below at a list of what is generally excluded from Personal Health Plans from GMS.
– Risky Activities: Your insurance will not cover medical expenses related to your participation in:
a) Professional sport activities;
b) Speed contests or racing of motorized land, water or air vehicle;
c) An extreme sport, including but not limited to, scuba diving (except when you are NAUI, PADI, ACUC or SSI certified), bungee jumping, parachuting, mountaineering, skydiving, participation in a rodeo, hang gliding, acrobatic or stunt flying or participating in a horse race as a jockey.
– Self-harm: Your policy will not cover any medical expenses resulting from self-inflicted injuries or suicide.
– Illegal Activity: Your insurance will not cover any medical expenses directly or indirectly related to criminal or otherwise illegal acts.
– Drugs and Alcohol: This insurance does not cover any medical
expenses resulting from your sickness, injury, or death if at the time of the incident evidence supports that it was related to the use or abuse of prohibited drugs, alcohol, or any other intoxicant or the misuse of a drug, whether prescribed or not.
– Motor Vehicle Accident: GMS does not cover any medical expenses resulting from a motor vehicle accident, unless not covered by any other policy.
– Not Medically Necessary Services: Your policy will not cover any medical costs that are considered not medically necessary or which are considered by GMS to be experimental.
– Unapproved Treatment: This insurance will not cover any medical costs that a)contravene or are prohibited by the provincial laws of your
province of residence or the federal laws of Canada; and b) are experimental in nature or that are not considered to be effective.
– Result of Conflict: No medical expenses are covered when resulting from war, terrorism, or acts of foreign rebellion.
– Cosmetic Services: GMS will not cover or otherwise pay for any charges for cosmetic treatments, except when associated with reconstructive surgery.
– Government Health Plan: Your policy will not cover any costs for medical expenses which are payable under any government medical insurance plan.
Click to view – GMS Personal Health | Policy Wording
In order to have your insurance cancelled and paid premium refunded, you will need to submit your formal cancellation request for approval.
In order to request a refund, please contact one of our Insurance Advisors.
In order to use your insurance, you should do the following depending on the type of medical service:
Regular Mail: – You are also welcome to download Claim Forms at gms.ca. You will need to complete the form, attach your receipts and mail to GMS.
Mail to: Group Medical Services
2055 Albert Street, PO Box 1949
Regina, SK S4P 0E3
Direct-pay-card will be mailed to you right after you purchase one of Personal Health Plans from GMS.
On the other hand, not all pharmacies participate in the network and you may need to cover the cost of prescribed medications yourself before submitting a claim using either your online GMS profile or via a regular mail, fax.
- 1-800-459-6604 – Toll-free (Canada & USA)
- 905-762-5196 – Collect (All other locations)
Once you’ve reported your claim, you will be required to submit the following documents for review within 90 days of emergency occurrence:
– Original itemized receipts for the treatment you received.
– Proof of payment.
– Complete medical records including final diagnosis by an attending physician.
– Proof of travel (showing the dates you’ve departed and returned to your home province).
– Your historical medical records, if requested by GMS.
– Any other documentation requested by GMS that deemed necessary.
Please note that costs to obtain documents will not be covered by GMS.
People without any Extended Health Insurance:
While your provincial insurance does cover most of the medical procedures you may need, it does not include coverage for certain services and supplies such as dental treatment, prescription drugs, hospital allowance and travel insurance to name a few. These benefits could help you secure your financial stability in case you ever happen to find yourself in a situation where you provincial insurance will not be able to mitigate the costs you incur.
People who are leaving a Group Plan:
You can effortlessly transition to GMS individual plan from any insurer’s group plan and stay covered for what you need the most. Replacement Health Plans from GMS offer comprehensive coverage of the most important healthcare needs you may have including Dental, Prescription Drugs and Travel coverage.
Retirees:
If you are retired or are planning to retire soon, you are most lively not covered by any group insurance. Make sure you get coverage from GMS for unexpected health problems and emergencies, and for many health expenses that are not covered by provincial and territorial plans.
