GMS: Health & Dental Insurance for Canadians

Explore available plan options and choose the one you believe is right for you!

 
 
 
 

Summary of Benefits
Eligibility Requirements
How to Get a Refund
How to Make a Claim

Summary of Benefits – Personal Health Insurance
Benefit
Basic Plan
ExtendaPlan
OmniPlan
Health Practitioners
$250 combined
$300 per specialty
Eye Exams
$120 / 2 years
$90 / 2 years
Glasses and Contacts
Included in Eye Exam
$300 / 2 years
Hearing Aids
$500 / 5 years
$800 / 5 years
Diabetic Supplies
$300
$300
Health Equipment
$500
$500
Oxygen Equipment
$500/year; $1,500 Max
$500/year; $2,500 Max
Blood Pressure Monitors
1 per policy / 5 years
1 per policy / 5 years
Orthopedic Shoes
$225
$225
Custom Made Foot Orthotics
80% / 5 years
80% / 3 years
Mobility Aids
$300
$300
Ostomy Supplies
$300
$300
Funeral Expenses
$4,000
Out-of-Province Referral
$50,000 max / person
$50,000 max / person
Ambulance Transportation
$2,000
Unlimited
Unlimited
Air Ambulance
Unlimited
Unlimited
Unlimited
Hospital Room Upgrade
$500
$1,000
45 days to $3,500
Private Duty Nursing
80% to $1,500 (in-patient)
80% to $3,000
80% to $5,000
In-Hospital Medications
$1,000
$1,000
$2,000
Accidental Dental
$500 / injury
$2,000 / injury
$5,000 / injury
Medical Supply Rental
$500 per person / 5 years
$750 per person / 5 years
$1,000 per person / 5 years
Artificial Limbs, Eyes & Larynx
$5,000
$5,000
$5,000
Patient Walkers
80% to $300 / person / 5 years
80% to $300 / person / 5 years
80% to $300 / person / 5 years
Breast Prosthesis
$175 single; $350 bi-lateral / 2 years
$325 single; $650 bi-lateral / 2 years
$325 single; $650 bi-lateral / 2 years
Casts & Crutches
Unlimited
Unlimited
Unlimited
Optional Coverage Benefits:

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.

Policy Wording:
Policy Wording is an official document that describes all payable benefits, eligibility requirements, exclusions and limitations as well as claims and refund procedures.

Click to view – GMS Personal Health | Policy Wording

Eligibility & Exclusions
As of the application date, in order to be eligible for any Personal Health plans with GMS, you as an applicant MUST:

– 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.

Requirements for Couples & Families:

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.

*Dependent is your spouse and any unmarried child i.e. step-child, adopted child, legal custodianship (of you or your spouse) that is chiefly dependent on you or your spouse for support and maintenance.

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).

General Policy Exclusions:
As with any insurance policy, there are certain exclusions from the coverage provided.

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

Cancellations & Refunds
You can cancel your health & dental insurance policy if you decide that you no longer need the coverage.

In order to have your insurance cancelled and paid premium refunded, you will need to submit your formal cancellation request for approval.

Policy Evaluation Period:
You can cancel your insurance within 10 days following your application and receive a refund equal to all premium paid up to that date.

  • Please note that you must have no claims on your file to receive a refund. If a claim has been paid, the total amount must be repaid to GMS before policy can be cancelled.
  • Termination by the insured person:
    As an insured person you have the right to end your contract with GMS and receive a refund for the unused coverage period.

  • Please note that annual premiums will be refunded on a pro-rated basis for the unused number of covered days you have paid for.
  • Termination by insurer:
    GMS reserves the right to terminate an insurance contract if deemed necessary.

  • A written notice will be provided to you outlining an amount of refund for the unused remainder of your coverage period paid for.
  •  
    In order to request a refund, please contact one of our Insurance Advisors.

    How to make a Claim
    Health & Dental Insurance is a fantastic tool to cover the costs for your medical needs where you provincial medical plan falls short.

    In order to use your insurance, you should do the following depending on the type of medical service:

    Health, Dental & Hospital Cash Claim:
    Online Claims: – Simply register for a MyGMS account at gms.ca. It will allow you to access to a claim form and attach copies of your receipts. You can also sign up for a direct deposit to have GMS reimburse the money into your bank account.

    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

    Please note that you can choose to have your Dental Claim to be paid directly using a pay-direct-card when you receive medical service. Pay-direct-card will be mailed to you shortly after you purchase GMS Personal Health Plan, provided you include dental coverage.
    Prescription Drugs Claim:
    When purchasing prescription medications at a pharmacy store, your pharmacist may choose to ask for your direct-pay-card to have GMS cover the expense directly, so you won’t need to pay out of pocket.

    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.

    Please remember that when submitting claims by mail, you will need to provide original itemized receipts along with your unique GMS ID as well as fully completed Claim Form.
    Travel Claim:
    If an emergency strikes while you are outside your province of residence, you need to notify GMS before receiving medical treatment, when possible, by calling them at one of the following numbers:

    • 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.

    *Failure to notify GMS Emergency Assistance Center within the first 24 hours in the event of treatment or hospitalization will limit insurance benefits otherwise payable to 70% of eligible expenses up to the sum insured or $50,000.

     

    Who needs Personal Health & Dental Insurance?
    If you don’t have an extended group benefits from work or if you are self employed GMS Individual Health Plan is a great way to supplement your provincial coverage.

    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.

    Need help deciding?
    Select the best way to get in touch with our Insurance Advisors and let’s discuss your insurance options today!
    Available Weekdays | 10am-11pm EST, Weekends | 12pm-8pm EST
    Testimonials
    I like how quick and helpful Arbetov’s adviser are! They will ask you a few questions to see what kind of insurance you need and then give you the options, while explaining how things work. It literally took me less than an hour to get up to speed with what’s on the market and what would be my go-to options. And just like that I got from having no insurance aside from the government plan to being able to see my dentists without worries whether it is going to be an expensive procedure.
    Jannet P.
    VERIFIED CLIENT
    Please note that the above information is only a summarized version of covered benefits and conditions detailed in the official Policy Wording issued by GMS.
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