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Friday, December 15th, 2017

GMS
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Administrated by: GMS Insurance Inc.
Underwritten by: GMS Insurance Inc.
24 hours Emergency Assistance Center: GMS Travel Assistance.

IMPORTANT NOTE: The product-related information on this website is for illustration purposes only. For complete benefits, terms, conditions, limitations and exclusions, please see the policy booklet at the download section below. Please read and understand your policy before you travel.

Note: This plan is NOT available for purchase in the provinces of Quebec and New Brunswick.

BENEFITS:
   - Maximum benefits: $25,000; $50,000; $100,000 and $150,000.
   - Hospital Care - semi-private room accommodation and emergency room expenses.
   - Physicians and surgeons services.
   - Ambulance Transportation: Licensed local air or land ambulance, when necessary, to the nearest hospital. *
   - Diagnostic Treatments: X-rays and other diagnostic tests. **
   - Prescription drugs or medicines, 30-day supply.
   - Professional Medical Services - up to $300 per insured for the emergency services of an osteopath, physiotherapist, chiropractor, chiropodist and/or podiatrist.
   - 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 face.
   - Dental Emergencies: Up to $250 for relief of dental pain. 
   - Return of Remains: In the event of death from covered condition, up to $10,000 is provided to return the body home, or up to $4,000 for cremation or burial at the place of death.
   - Follow-up visits are covered up to 14 days after the initial medical emergency when deemed medically necessary.
   - Child Care - up to $500 for licensed care of dependent children if they are travelling with you, should you be hospitalized due to a medical emergency.
   Meals and Accommodation - up to $150 per day to a maximum of $1,000 for accommodations, meals, necessary telephone calls and taxi or bus fares incurred by an accompanying family member in the event that you are hospitalized.  
   - Repatriation to Country of Origin: up to $5,000 for one-way air transportation for you and one accompanying family member insured under your policy to transport you back to your country of origin for further medical treatment. The cost of a medical escort or attendant is not covered. *
   - Coverage while in-transit between Canada and the country of origin - limited up to 48 hours after your initial departure.

 * This benefit must be pre-approved by GMS.
** Magnetic resonance imaging, computerized axial tomography scans, sonograms, ultrasounds and biopsies are excluded, unless pre-authorized by GMS. GMS does not cover expenses for coronary artery angioplasty, cardiac surgery or implantable cardioverter defibrillator (ICD) (including any associated diagnostic tests or charges), unless necessary in a medical emergency and approved by GMS prior to any actions.

ELIGIBILITY: 
Eligibility questions determine if an applicant can purchase a GMS Immigrants & Visitors to Canada Plan. Applicants must truthfully answer “no” to all questions. Questions are based on the age of the applicant.
Under 55 years of age:
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?
Between 55 and 69 years of age:
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; (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)
    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? (Oral steroids do not include steroids that are inhaled to prevent asthma attacks or to temporarily treat and relieve inflammation of the airway)
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 (A disease that cannot be cured and is reasonably expected to result in death)
    h. Blood Clot(s)
    i. Gastrointestinal Bleeding
Between 70 and 79 years of age:
You must answer “no” to all questions 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? 

Stable: a medical condition is stable if:
   a. you have no reason to expect medical treatment after your effective date for the medical condition or any symptoms;
   b. in the 180 days before your effective date, you have not received new or different medical treatment for the medical condition;
   c. in the 180 days before your effective date you have not had an alteration to an existing prescription drug or were prescribed a new prescription drug for the medical condition;
   d. in the 180 days before your effective date your medical condition has not become worse;
   e. in the 180 days before your effective date you have not experienced new, more frequent or more severe symptoms;
   f. in the 180 days before your effective date you have not had or needed medical consultation for undiagnosed symptoms;
   g. in the 180 days before your effective date you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and
   h. in the 180 days before your effective date you have not had tests or further investigation, whether you know the results or not, related to the medical condition.
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 effective 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. 

WAITING PERIOD:
1. If you apply before arriving in Canada, or purchase to continue coverage without a gap from another policy, that is providing similar coverage from a Canadian insurance company, coverage begins on the effective date with no wait period.
2. If uninsured and apply within the first 30 days of arriving in Canada, coverage for injury begins on the effective date and a 2 day (48 hour) waiting period is applied to coverage for medical conditions, other than injury.
3. If uninsured and apply more than 30 days of arriving in Canada, coverage for injury begins on the effective date and a 7 day (168 hour) waiting period is applied to coverage for medical conditions, other than injury.

EXTENSIONS:
You may extend your coverage subject to GMS's approval if:
  a) you contact GMS 48 hours prior to the expiry date of the existing coverage;
  b) you have not required medical treatment (whether a claim was submitted or not) during your period of coverage;
  c) your total period of coverage (including all extensions approved or requested) will not exceed 1 year; or
  d) you will not be 80 years of age or older as of the start date for the policy extension; 

SIDE TRIPS: Emergency medical coverage is included for side trips up to 30 days outside of Canada provided that:
   - Your trip originates and terminates in Canada;
   - You spend 50% or greater of your period of coverage in Canada; and
   - Your temporary visit is not to your country of origin.

REFUNDS:
1. Full refunds are available if no travel has taken place, when your request for a refund is received:
  a) prior to the effective date as shown on your confirmation document; or
  b) after the effective date as shown on your confirmation document if you have not travelled to Canada because your application for a visa to enter Canada was declined. A $40 administration fee applies and it will be deducted from the refund. A copy of the visa decline letter will be needed when requesting a refund.              
2. Partial refunds are available, with a $40 administration fee, in the following situations.
  a) Your request for a refund is received after the effective date shown on your confirmation document when no travel has taken place, except if your request is the result of a declined visa application. The refund will be calculated from the date GMS was notified;
  b) you return to your country of origin. The refund will be calculated from the date you departed Canada (proof of departure will be required);
  c) you become eligible and covered under a government health plan during the period of coverage. The refund will be calculated from the date GMS was notified, NOT the effective date of the government health plan; or
  d) your death occurs during the policy period. The refund will be calculated from the date of your death.
3. Refunds are NOT available when:
  a) a claim has been reported under this policy; or
  b) you request a refund after the expiry date of your policy. 
The following conditions apply to partial refunds issued under this policy:
1. When you apply for a refund after the date on which the coverage is to be effective as shown on your confirmation, the following must be provided:
 a) proof of travel showing the date you departed from Canada.
 b) proof of coverage under a government health plan including effective date of coverage;
 c) in case of a your death, a copy of the death certificate; or
 d) proof that you did not travel from your country of origin.
Depending on the documentation provided GMS reserves the right to limit or restrict the refund.
2. GMS considers a claim to have occurred when an insured person, or a family member, contacts GMS' Travel Assistance regarding the intent, or need to seek medical treatment regardless of whether a claim is actually filed with GMS for reimbursement. You may still be eligible for a partial refund if:
 a) GMS Travel Assistance was only contacted once during the period of coverage; and
 b) no payment for emergency medical treatment was issued or pending.
Refunds are subject to GMS' review and approval. A file handling fee of $300 will be deducted from the refund amount owned. Once a refund is issued, future expenses or additional claims will not be accepted, regardless of when the expense or claim occurred.
3. Once a refund has been issued, you will no longer be eligible for any claim reimbursement.
A refund is calculated and paid based on the following.
1. A refund is calculated using the number of unused days and the daily rate applied based on your original trip length. The number of unused days is calculated based on your departure date unless otherwise indicated in the Requesting a Refund section above under 2.a.,b.,c., and d.
2. Refunds will be processed as follows:
 a) payment made by credit card will be credited to the credit card on file;
 b) payment made by cash or cheques will be payable to you unless an alternative payee has been assigned;
 c) all refunds requested after the effective date shown on the confirmation document are subject to a $40 administration fee;
 d) no refund will be issued for amounts under $5. 

CLAIMS:
Emergency phone numbers: Toll free within Canada and the USA: 1-800-459-6604 and Collect call from all other locations: 905-726-5196.
Regardless of your plan deductible, in the event of a medical emergency, you are required to contact GMS within twenty-four (24) hours of receiving medical treatment or admission to hospital. Failure to do so may limit benefits to the lesser of 70% of reasonable and customary expenses or $50,000.
Claims Instructions:
   1. Complete a claim form and attach all original itemized medical bills and prescription receipts.
   2. Sign and date completed form and return package to:
Allianz Global Assistance
2100-250 Yonge Street
Toronto ON, Canada M5B 2L7
   - Notice of claim: In the event of a medical emergency you must provide written notice of claim within thirty (30) days after contacting GMS Travel Assistance.
   - Proof of claim must be submitted within 90 days of occurrence.
   - Keep a copy of all the submitted correspondence for your records.

EXCLUSIONS: 
The following expenses are not covered by this policy.
1. GMS does not cover expenses incurred where you act against medical advice or the advice of GMS.
2. GMS does not cover expenses resulting from the regular care of a chronic condition.
3. GMS does not cover any expenses that are the result of your failure, prior to arriving in Canada, to:
    a. adhere to medical treatment;
    b. obtain investigative or diagnostic tests recommended by a medical professional; and/or
    c. receive results from investigative or diagnostic tests.
4. GMS does not cover expenses resulting from medical condition(s) which have not been stable for one hundred and eighty (180) days immediately prior to your effective date, including:
     a. medical condition(s) for which you received medical treatment or medical consultation; and/or
     b. undiagnosed medical condition(s) related to symptoms which you received medical treatment or medical consultation.
You must be stable based on the definition of stable in this policy, regardless of the opinion of your physician or any other person who may provide an opinion on your medical condition(s).
5. GMS does not cover expenses when you travel outside Canada if a travel advisory has been issued by the Canadian government recommending that Canadians not travel to the country, or specific regions within the country.
6. GMS does not cover any medical treatment, which is a continuation of or a recurrence of a medical condition.
7. GMS does not cover any expenses resulting from medical treatment that is not a medical emergency, including but not limited to: routine or general physical examinations; medical check-ups; regular care of chronic conditions; elective surgery; dental or cosmetic surgery, even if recommended by a physician; and follow ups or continued services following emergency medical treatment. GMS’s opinion on the issue is final and binding.
8. GMS does not cover expenses that are a duplication of any service, allowance or repayment available by an existing government health plan or private plan.
9. GMS does not cover medical treatment, hospitalization or surgery (including elective, non-elective, personal comfort, dental or cosmetic) which is not considered to be an emergency, even if it is recommended by a physician.
10. GMS does not cover expenses for medical treatment at a diagnostic facility unless pre-approved by GMS.
11. GMS does not cover emergency air transportation or return to Canada or your country of origin, which is not arranged and pre-approved by GMS.
12. GMS does not cover drugs which are commonly available without a prescription, not legally registered or approved in Canada, experimental drugs or preventative medicines or vaccines.
13. GMS does not cover any expenses resulting from and/or incurred during trips undertaken for the purpose of receiving a diagnosis of medical treatment.
14. GMS does not cover any expenses when you travel against the advice of a physician.
15. GMS does not cover expenses related to your pregnancy, an abortion, miscarriage, childbirth or complications of any of these conditions.
16. GMS does not cover a newborn until it has been released from the hospital for forty-eight (48) hours and has been added as a dependant on your coverage.
17. GMS does not cover expenses for coronary artery angioplasty, cardiac surgery or implantable cardioverter defibrillator (ICD) (including any associated diagnostic tests or charges), unless necessary in a medical emergency and approved by GMS prior to any actions.
18. GMS does not cover any expenses for medical treatment or surgery which is considered by GMS to be experimental. GMS’ opinion on the issue is final and binding.
19. GMS does not cover expenses resulting from suicide or self-inflicted injuries.
20. GMS does not cover expenses resulting directly or indirectly from your criminal or illegal acts.
21. GMS does not cover expenses resulting from your sickness, injury, or death if at the time of the sickness, injury or death evidence supports that it was caused by, or in any way contributed to, by the use or abuse of prohibited drugs, alcohol, or any other intoxicant or the misuse of medication, whether prescribed or not.
22. GMS does not cover expenses incurred as a result of a motor vehicle accident, unless such services are not covered by any other private or public vehicle insurance.
23. GMS does not cover any expenses resulting from your participation in:
    a. professional sport;
    b. speed contests or racing of motorized land, water or air vehicle(s);
    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.
24. GMS does not cover expenses resulting from air travel unless riding as a passenger on a common carrier.
25. GMS does not cover medical treatment or services that contravene or are prohibited by provincial laws and/or the federal laws of Canada.
26. GMS does not cover expenses resulting from your service in the armed forces, willful exposure to peril, and/or relief work.
27. GMS does not cover expenses for medical treatment and services provided outside Canada except as provided under the following sections in this policy:
    a. Automatic Policy Extensions; or
    b. Travel Benefits Outside Canada.
28. GMS does not cover any expenses that result from your failure, prior to arriving in Canada to:
    a. adhere to medical treatment;
    b. obtain investigative or diagnostic testing recommended by a medical professional; or
    c. receive results from investigative or diagnostic tests.
29. GMS does not cover expenses resulting from any nuclear reaction, radiation or radioactive contamination or occurrence, where the risk of the exposure was present prior to your arrival in Canada, however caused.
30. GMS does not cover expenses resulting from war, terrorism or acts of foreign rebellion.

RATES:

Daily premium per person with a $1,000 DEDUCTIBLE.

Age/Sum

$25,000

$50,000

$100,000

$150,000

Under 18

$1.58

$1.81

$2.40 $3.05

18-34

$1.73

$1.99 $2.62 $3.31

35-54

$1.99

$2.26 $3.48 $4.08

55-59

$2.16

$2.40 $3.50 $4.22

60-64

$2.89

$3.24 $4.14 $4.86
65-69 $3.35 $3.85 $4.85 $5.92
70-74 $5.32 $6.32 $7.52 $9.09

75-79

$6.17

$7.14 $8.81 $10.70

The deductible is applied to each claim.

   - To determine rates for a $500 deductible, add 15% to the $1,000 deductible premium above.
   - To determine rates for a $100 deductible, add 30% to the $1,000 deductible premium above.
   - To determine rates for a $0 deductible, add 45% to the $1,000 deductible premium above.

Dependant: any unmarried child of you or your spouse (including step-child or adopted child) who is chiefly dependent upon you or your spouse for support and maintenance, and is 18 years of age or under.

IMPORTANT NOTE: The product-related information on this website is for illustration purposes only. For complete benefits, terms, conditions, limitations and exclusions, please see the policy booklet at the download section below. Please read and understand your policy before you travel.

 

DOWNLOADS:

GMS Visitors Insurance POLICY PDF

GMS Visitors Insurance CLAIM FORM PDF

GMS Visitors Insurance REFUND Policy Reference

 

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