GMS medical insurance provides coverage for hospitalization, physician services, prescription medications, and paramedical services. The specific coverage and benefits may vary depending on the chosen plan. GMS aims to help individuals and groups manage their healthcare expenses and provide reliable access to essential healthcare services.
What is GMS Medical Insurance?
Group Medical Services (GMS) is a Canadian company that provides medical insurance and health coverage to individuals and groups. GMS offers a range of insurance products, including individual health and dental plans, as well as group health and dental plans for businesses and organizations.
GMS medical insurance provides coverage for a variety of healthcare services and expenses. This can include coverage for visits to doctors, specialists, and other healthcare professionals, hospital stays, prescription medications, paramedical services (such as physiotherapy, chiropractic, and massage therapy), dental care, and more, depending on the specific plan and coverage options chosen.
Group health insurance plans from GMS are typically designed to be offered by employers or organizations to their employees or members. These plans provide coverage for a group of individuals and can often offer more comprehensive benefits and cost savings compared to individual plans. Group plans can be customized to meet the specific needs of the group and may include options for different levels of coverage, deductibles, and additional benefits.
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GMS medical insurance aims to provide reliable and accessible health insurance options to Canadians, offering coverage for essential healthcare services and helping individuals and groups manage their healthcare expenses. It’s important to note that specific details of GMS medical insurance plans may vary, so it’s advisable to review the plan documents or contact GMS directly for accurate and up-to-date information about their offerings.
Benefits of GMS Medical Insurance
GMS medical insurance offers several benefits to individuals and groups. Here are some of the key advantages:
Comprehensive Coverage:
GMS provides coverage for a wide range of healthcare services, including hospitalization, physician services, prescription medications, and paramedical services. This comprehensive coverage ensures that individuals and groups have access to essential healthcare when they need it.
Cost Savings:
GMS medical insurance plans often provide cost savings compared to paying for healthcare services out of pocket. By having insurance coverage, individuals and groups can reduce their out-of-pocket expenses and potentially save on expensive medical bills.
Customization Options:
GMS offers flexibility and customization options for its medical insurance plans. This allows individuals and groups to tailor their coverage to meet their specific needs and preferences, ensuring that they have the right level of protection for their healthcare requirements.
Access to Network Providers:
GMS typically has a network of healthcare providers, including doctors, specialists, and pharmacies, which policyholders can access. This network can help individuals and groups find and receive care from reputable providers, enhancing convenience and ensuring quality healthcare services.
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Peace of Mind:
Having GMS medical insurance provides peace of mind, knowing that one is financially protected in case of unexpected medical expenses or health-related emergencies. This can alleviate stress and allow individuals and groups to focus on their well-being without worrying about the financial implications of healthcare costs.
Other benefits of GMS Medical Insurance includes:
Emergency Medical Expenses: maximum benefit: $5,000,000
Hospital Room: ward or semi-private.
Physician Services
Diagnostic Services: basic diagnostic tests ordered by a physician (advanced diagnostics require pre-approval)
Prescription drugs or medicines – 30-day supply per prescription
Medical Appliances: rental of essential medical appliances (wheelchair, crutches, canes etc.) when needed.
Accidental Dental:
Up to $2,000 for repair or replacement of natural teeth or permanently attached artificial teeth, damaged by an accidental blow to the mouth.
Dental Emergencies: Up to $250 for treatment or relief of acute dental pain.
Private Duty Nursing: up to $5,000.
Professional Medical Services – care received from a licensed physiotherapist, chiropractor, osteopath, chiropodist, or podiatrist, up to $300 per specialty.
Ambulance Transportation:
Licensed local road ambulance, when necessary, to the nearest hospital.
Air Ambulance & Remote Evacuation:
up to $20,000 for the use of a helicopter air ambulance in a medical emergency involving life threatening circumstances where you require immediate transport to the nearest hospital.
Repatriation
expenses to transport you by air ambulance (excluding helicopters) and Attendant (if necessary) or regularly scheduled common carrier back to your province of residence for further in-hospital medical treatment.
Return of Family Member:
up to $1,000 for one-way air transportation to return of one covered family member and/or insured dependent (including escort when required), if you are repatriated to your province of residence for further in-hospital medical treatment or in the event of your death.
Family/Friend to Bedside up to $3,000 to bring family member or a close friend, and reimbursement of up to $150 per day to a maximum of $750 for reasonable expenses incurred by the transported person, once they arrive if you have been hospitalized for more than 3 consecutive nights.
Return of Remains: In the event of death from covered condition, up to $7,000 for the preparation and transport of your remains, or up to $3,000 for cremation or burial at the place of death. (This benefit does not cover the cost of a burial casket or urn).
Return of Vehicle: up to $2,000, for returning your vehicle, to your province of residence if you have been transferred to Canada due to covered illness or injury.
Return of Cat or Dog: Reimbursement up to $300 to return your cat or dog to your province of residence if you have been transferred to Canada due to covered illness or injury.
Child Care: up to $500 for licensed care of dependent, should you be hospitalized due to a medical Emergency.
Out of pocket expenses: expenses up to a maximum of $1,000 incurred by insured travelling companion in the event you are in hospital receiving care on your return date. This benefit includes coverage for up to $150/day for accommodations, which shall form part of the $1,000 limit.
Eligibility Requirements for GMS Medical Insurance
You must buy GMS Medical Insurance plan before leaving your province of residence. Also, you must have valid provincial health insurance for the duration of your trip.
- However, you are NOT eligible for coverage if you:
are awaiting tests or medical treatment for a heart condition; - have a surgically untreated vascular aneurysm;
- have been diagnosed with Congestive Heart Failure (CHF);
- have an Implantable Cardioverter Defibrillator (ICD);
- were diagnosed; received new medical treatment (e.g. consultation, tests or prescription drugs); or had a change in your medical treatment (e.g. a stop, start or dosage change to a prescription drug, other than a dosage change of Coumadin or Warfarin) for, any of the following heart or vascular conditions in the last twelve (12) months:
heart transplant; - atrial flutter;
c. atrial/ventricular fibrillation; - peripheral vascular disease;
- stroke/TIA; or
- blood clots;
- were diagnosed; received new medical treatment (e.g. consultation, tests or prescription drugs); or had a change in your medical treatment (e.g. a stop, start or dosage change to a prescription drug, other than a dosage change of Coumadin or Warfarin) for, any of the following heart or vascular conditions in the last twelve (12) months:
- have diabetes that is treated with insulin AND take prescription medication for a heart condition (excluding medication to treat high cholesterol or high blood pressure);
- use home oxygen or take an oral steroid to treat a lung condition;
- are currently being treated for cancer, excluding breast or prostate cancer treated exclusively with hormone therapy;
- were diagnosed; received a new medical treatment (e.g. consultation, tests or prescription drugs); or had a change in your medical treatment (e.g. a stop, start or dosage change to a prescription drug) for, any of the following conditions in the last twelve (12) months:
- liver failure;
- GI bleed;
- AIDS; or
- terminal illness;
- have had any of the following procedures in the last twelve (12) months:
- valve surgery or replacement;
- kidney dialysis;
- organ, stem cell or bone marrow transplant;
- require assistance from another person(s) with activities of daily living (ADL) if you are seventy (70) years of age or older;
- are not a Canadian resident; and
- have not purchased prior to departing on your trip, unless purchased as a top-up to an existing GMS policy.
GMS Medical Insurance Coverage
GMS insurance coverage includes various types of healthcare services and expenses. Here is a summary of the common coverage areas provided by GMS:
Medical Services:
Coverage for visits to doctors, specialists, and other healthcare professionals. This typically includes consultations, examinations, diagnostic tests, and treatments.
Hospitalization:
Coverage for hospital stays, including room charges, nursing care, and related medical services.
Prescription Medications:
Coverage for prescribed medications, which can help offset the cost of necessary drugs.
Paramedical Services:
Coverage for paramedical services such as physiotherapy, chiropractic care, massage therapy, and other similar treatments.
Dental Services:
Coverage for dental care, including routine check-ups, cleanings, fillings, extractions, and other necessary dental treatments.
Vision Care:
Coverage for vision-related services, such as eye exams, prescription eyeglasses or contact lenses, and vision correction procedures.
Travel Insurance:
Coverage for emergency medical expenses and travel-related benefits while traveling outside of the insured person’s province or country of residence.
GMS Medical Insurance Plans
GMS offers a range of medical insurance plans to meet the needs of individuals and groups. While specific plan details may vary, here are some common types of medical insurance plans provided by GMS:
Individual Health Plans: These plans are designed for individuals and provide coverage for essential healthcare services. They typically include benefits such as coverage for physician services, hospitalization, prescription medications, paramedical services, and dental care.
Group Health Plans: GMS offers group health insurance plans for businesses, organizations, or associations to provide coverage to their employees or members. These plans often offer more comprehensive benefits and cost savings compared to individual plans. Group plans can be customized to meet the specific needs of the group and may include options for different levels of coverage, deductibles, and additional benefits.
Travel Medical Insurance: GMS offers travel medical insurance plans to provide coverage for emergency medical expenses while traveling outside of the insured person’s province or country of residence. These plans typically include benefits such as coverage for emergency medical treatment, hospitalization, and emergency medical evacuation.
Health and Dental Combination Plans: GMS also provides combined health and dental insurance plans that offer coverage for both medical and dental services. These plans often include benefits such as coverage for physician services, hospitalization, prescription medications, dental care, and other related services.
GMS medical insurance FAQs
Here are some frequently asked questions (FAQs) regarding GMS medical insurance:
What is the waiting period for coverage to become effective?
The waiting period for coverage to become effective may vary depending on the specific GMS insurance plan and its terms. It’s advisable to review the plan details or contact GMS directly to understand the waiting period for your chosen plan.
Can I choose my healthcare providers?
GMS typically has a network of healthcare providers, including doctors, specialists, and pharmacies. It’s recommended to check the provider network associated with your plan to determine if you have the freedom to choose your healthcare providers. In some cases, GMS plans may require you to use network providers to receive maximum coverage.
How do I submit a claim?
GMS provides instructions and forms for claim submission. Generally, you would need to complete a claim form, attach any necessary supporting documentation (such as receipts or medical reports), and submit the claim to GMS according to their specified procedures. Claims can usually be submitted online, by mail, or through the GMS mobile app.
Are pre-existing conditions covered?
Coverage for pre-existing conditions can vary depending on the specific GMS plan and its terms. Some plans may provide limited or no coverage for pre-existing conditions, while others may offer coverage after a waiting period. It’s important to review the plan details or contact GMS directly to understand how pre-existing conditions are addressed in your chosen plan.
Can I make changes to my coverage during the policy term?
Changes to coverage during the policy term may be possible, but it depends on the specific terms and conditions of your GMS insurance plan. Some changes, such as adding or removing dependents, may be allowed while others may have restrictions or require a qualifying event. It’s advisable to review the plan documents or contact GMS directly to understand the options for making changes to your coverage.