Group Medical Services (GMS)

Immigrants & Visitors to Canada Insurance

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Summary of Benefits

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GMS provides emergency medical insurance for visitors to Canada, newly landed immigrants, or returning Canadian citizens.

Eligibility

• To be eligible for coverage you must, as of the effective date:
  a) be under the age of 80
  b) be in good health at the time you purchase your policy and on the effective date, and know of no reason why you would attend any medical consultation during the period of coverage; and
  c) not be insured or eligible for benefits under a Canadian government health insurance plan.
  d) if you are currently in Canada, not have been denied similar coverage by another Canadian insurer.
  e) if you are currently in Canada, not have had more than $5,000 in medical treatment in the last 12 months while in Canada.

Coverage During Flight to/from Canada

Not Covered

Sum Insured

$25,000 – $50,000 – $100,000 – $150,000

Deductible

Deductible applies: Per person, Per claim
Options available: $0 – $100 – $500 – $1,000
Note: Deductible after 30 days will be $1,000

Emergency Hospital

Semi-private hospital room

Emergency Medical

• Services of physician or surgeon
• Diagnostics, lab test and/or x-ray
• Licensed local road or air ambulance to the nearest hospital
• Out-patient medical emergency room expenses

Drugs or Medications

Not exceeding a 30-day supply

Professional Services

Up to an aggregate maximum of $300 per person, for the emergency services of an osteopath, physiotherapist, chiropractor, chiropodist and/or podiatrist

Follow-up Visits

When deemed medically necessary, visit must be no later than 14 days after the initial medical emergency

Accidental Dental

Up to $2,000 for emergency treatment for accidental blow to the face (excludes implants)

Dental Emergencies

Up to $250 for the medical treatment of dental pain (excludes implants)

Out-of-Pocket Expenses for Family

Emergency Return Home

Up to $5,000 for the additional cost of a one-way economy transportation to your country of origin for further medical treatment

Return of Deceased

Up to $10,000 per person for return of remains or up to $4,000 for cremation or burial at place of death

24 Hour Travel Assistance Services

a. coordination of all medical care, transportation and repatriation;
b. telephone interpretation services in most languages;
c. monitoring progress during medical treatment and recovery by managed care

Pre-existing conditions

A pre-existing medical exclusion applies to medical conditions and/or symptoms that existed prior to your trip. Applicants must be able to truthfully answer “ no ” to all the following questions:

Age 0 to 54
1. Do you have any reason to see a physician; visit a hospital or clinic; or obtain medical treatment ?
2. If you are currently in Canada, have you ever been denied similar coverage offered by another Canadian insurer?
3. If you are currently in Canada, have you had more than $5,000 in medical treatment in the last 12 months while in Canada?

Age 55 to 69
1. Do you have any reason to see a physician; visit a hospital or clinic; or obtain medical treatment ?
2. If you are currently in Canada, have you ever been denied similar coverage offered by another Canadian insurer?
3. If you are currently in Canada, have you had more than $5,000 in medical treatment in the last 12 months while in Canada?
4. Are you:
. a. expecting medical treatment for heart disease ;
. b. waiting for a test(s) for a suspected heart condition; and/or
. c. taking prescription drugs for heart disease while taking insulin to treat diabetes?
5. Do you have an Implantable Cardioverter Defibrillator (ICD)?
6. Have you fainted or fallen more than once without medical diagnosis (syncope)?
7. Do you use home oxygen for a medical condition?
8. Do you take oral steroids to treat a lung condition?
9. Are you being treated for cancer or have Metastatic Cancer?
10. Do you have a vascular aneurysm that is surgically untreated?
11. Have you ever had
. a. a valve replacement,
. b. kidney (renal) dialysis, or
. c. an organ transplant?
12. Do you have a medical condition from the list below that has not been stable for 12 months before you apply?
. a. Congestive Heart Failure
. b. Atrial flutter
. c. Atrial/ventricular fibrillation
. d. Peripheral vascular disease
. e. Stroke/transient ischemic attack (TIA)
. f. Acquired Immune Deficiency Syndrome (AIDS)
. g. Terminal Illness
. h. Blood Clot(s)
. i. Gastrointestinal Bleeding

Age 70 to 79
You must answer “ no ” to all questions above for applicants between 55 and 69 years of age, PLUS the following question:
Do you need help from another person(s) with activities of daily living (ADL), including but not limited to: personal hygiene and grooming; dressing and undressing; feeding yourself; getting into and out of bed, a chair, a wheelchair, the toilet, etc; bowel and bladder management; and/or managing your medication?

Some words above have very specific meanings. Those words are underlined and have a definition. Please see the definitions below…

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Alteration
An alteration to an existing prescription drug includes any of the following:

• a new medication
• a change in medication type
• an increase or decrease in medication dose
• the discontinuation of a medication; or
• an adjustment (stop and start) in an anticoagulation medication dosage due to surgery within ten (10) days before your application date.
  The following alterations resulting from the regular maintenance of a condition where there is no change in the condition are not considered an alteration:
• a dosage adjustment for an anti-hypertensive or cholesterol lowering medication;
• a change from a brand name medication to a generic brand medication of the same dosage;
• if you are taking Coumadin/Warfarin for anticoagulation therapy and are required to have your blood levels tested on a regular basis (INR) and you are adjusting the dosage of your anticoagulation medication to ensure your INR is maintained within therapeutic range as directed by your physician(s); or
• if you are taking insulin or oral anti-diabetic medication for diabetes and are required to have your blood levels tested on a regular basis and you are adjusting the dosage of your medication to ensure your blood glucose level is maintained within therapeutic range as directed by your physician(s).

Medical Consultation
A meeting with a physician to discuss and evaluate symptoms to diagnose a medical condition, illness or injury. It also includes meeting with a physician to evaluate your progress and medical treatment of a medical condition, illness or injury.

Medical Treatment
Any medical, therapeutic or diagnostic measure prescribed or recommended by a physician in any form, including; prescription medication; investigative testing; in-hospital care; surgery; or other prescribed or recommended action directly referable to the applicable condition, symptom or problem.

Oral Steroids
Oral steroids are steroids that are swallowed to treat a lung condition. They do not include steroids that are inhaled to prevent asthma attacks or to temporarily treat and relieve inflammation of the airway.

Heart Disease
Any disease of the heart including, but not limited to: angina, irregular heartbeat, heart attack, congestive heart failure, ischemic heart disease, valvular heart disease, and myocardiopathy.

Terminal Illness
A disease that cannot be cured and is reasonably expected to result in death.

Stable
When applying, a medical condition is stable if:

1. you have no reason to expect medical treatment for the medical condition or any symptoms after your effective date;
2. in the 12 months before your application date, you have not received new or different medical treatment for the medical condition;
3. in the 12 months before your application date, you have not had an alteration to an existing prescription drug or were prescribed a new prescription drug for the medical condition;
4. in the 12 months before your application date, your medical condition has not become worse;
5. in the 12 months before your application date, you have not experienced new, more frequent or more severe symptoms;
6. in the 12 months before your application date, you have not had or needed medical consultation for undiagnosed symptoms;
   7.      in the 12 months before your application date, you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and
7. in the 12 months before your application date, you have not had tests or an investigation, whether you know the results or not, related to the medical condition.

Limitations & Exclusions

Refer to policy wording for a complete list of the limitations and exclusions

Waiting Period for Sickness-related Benefits

No waiting period if the insurance is purchased prior to arrival in Canada or if you are replacing an existing health plan issued by a Canadian insurer.
Without existing Canadian Health Coverage the following waiting periods apply:

• If you apply within 30 days of your arrival – 48 Hour waiting period
• If you apply more than 30 days after your arrival – 7 Day waiting period

Claims Procedures

Note: You, or someone on your behalf, must contact GMS prior to medical treatment whenever possible. Failure to contact GMS within twenty-four (24) hours of receiving medical treatment or admission to hospital will limit benefits otherwise payable to 70% of eligible charges up to your policy dollar limit.
A completed claim form must be submitted within ninety (90) days of the illness or injury.

All documents for payment of eligible expenses must be received by GMS within thirty (30) days of your return home and no more than twelve (12) months from the date the last eligible expense was incurred.

Group Medical Services (GMS) Claims Department:
Call Toll Free Canada/USA: 1-800-459-6604
Call Collect from all other locations: 905-762-5196

SEND YOUR CLAIMS TO:
Group Medical Services Claims Department
2055 Albert Street, P.O.Box 1949
Regina, Saskatchewan, Canada S4P 0E3

IMPORTANT: Please see the Claims Procedures section of your policy for full requirements and terms.

Download the GMS Claim Form

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GMS Visitors to Canada Emergency Medical Insurance

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Group Medical Services is the operating name for GMS Insurance Inc. outside of Saskatchewan.

Products not offered in Quebec or New Brunswick

Underwritten by:

Group Medical Services

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