Summary of Benefits:
|Overall Maximum Limit||$25,000, $50,000, $100,000, $150,000|
|Deductible Options||No deductible, $100, $500, $1,000|
|Pre-Existing Medical Condition Stability Period||180 days prior to policy effective date|
|Side Trips||Covered in the United States and Mexico as long as the majority of the policy duration is spent in Canada. No coverage while in country of origin|
|Maternity||No coverage for maternity expenses|
|Excluded Sports||Professional sports, speed contests or racing of motorized land, water or air vehicle(s), 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, rodeo, hang gliding, acrobatic or stunt flying or jockeying|
|Recommended for Super Visa Travellers||Yes - ages 79 and younger|
|Hospital Accommodation/Physician||Reasonable and customary costs|
|Ambulance||Reasonable and customary costs|
|Prescription Drugs||30-day supply|
|Emergency Transportation||Only when on a covered side trip to the United States or Mexico: air ambulance or economy airfare to destination in Canada or country of origin, including medical attendant, if medically necessary|
|Specialists and Therapists||$300 combined for osteopath, physiotherapist, chiropractor, chiropodist, podiatrist|
|Accidental Death and Dismemberment||N/A|
- You are eligible to purchase GMS insurance if you are an immigrant or visitor to Canada who is not covered under a provincial or territorial government plan.
- You are not eligible to purchase this plan if any of the following apply to you:
- You are eighty (80) years of age or older as of the application date;
- You have had a medical consultation with a physician since you arrived in Canada;
- You have been in Canada for more than thirty (30) days at the time of application, unless you have an existing GMS immigrants & Visitors to Canada plan;
- You have reason to seek medical attention when you apply;
- You are not eligible for coverage if, on your effective date; you are an immigrant or a visitor to Canada over the age of fifty – five (55) and in the past twelve (12) months
- You have suffered from, been diagnosed with, received new treatment for, or had a recurrence of, or complications relating to any of the following: stoke/ TIA, blood clots, congestive heart failure, atrial/ ventricular fibrillation, AIDS, any terminal illness, renal failure, gastrointestinal bleeding:
- You have undergone the following procedures renal dialysis, valve replacement or organ transplant;
- You are awaiting further tests or treatment for heart disease;
- You have both heart disease and insulin dependent diabetes and are taking prescription medication for both;
- You use home oxygen for a heart and/or lung disease;
- You take oral steroids for a lung condition;
- Any of the following apply to you; under active treatment for cancer, have an aortic aneurysm that remains surgically untreated, have experienced undiagnosed episodes of syncope/fainting or falling;
- You have an ICD (Implantable Cardioverter Defibrillator)
Note that NO refunds are issued if there were any claims made during the period of coverage or you have an Annual Plan with GMS.
You are eligible to receive a Full Refund in case:
1) Your Super Visa application has been refused.
2) You decided / unfit to travel to Canada and request a refund:
– A) Before the effective date set on your GMS medical insurance policy.
– B) Past the effective date, if GMS is notified within the first 30 days once the policy start date has commenced. There will be an administration fee of $40.
Request a Partial Refund, which may require you to pay an administration fee of $40, when:
– a) You send a request for a Partial Refund after the first 30 days after your GMS insurance policy becomes effective in case no travel to Canada has taken place.
– b) Early Departure – return to your country of origin before the expiry date on your insurance policy, which has to be a Daily Immigrants & Visitors to Canada Plan. Such refund will be calculated starting from a day you left Canada.
– c) You become eligible for a Provincial Healthcare Plan, while your insurance policy is still in effect. The refund will be calculated starting from the day GMS was notified.
– d) Death occurs while the insurance coverage is ongoing. The refund will be calculated from the date of death.
For a list of complete details on Refund availability refer to the GMS | Policy Wording section on Refunds.
In order to apply for a refund please contact one of our Insurance Advisors.
MAKING A CLAIM
- You, or someone on your behalf, must contact GMS prior to treatment whenever possible, failure to contact GMS within twenty-our (24) hours of receiving medical treatment or admission to hospital will limit benefits otherwise payable to 70% of eligible charges to a maximum of the sum insured.
- A completed claim form must be submitted within ninety (90) days of the illness or injury.
- In order to pay a claim, GMS will require the following documentation
- Original itemized receipts for all bills and invoices;
- Proof of payment by your or any other benefit plan;
- Medical records, including a completed diagnosis by the attending physician’
- For dental claims, proof o the accident;
- Proof of the travel dates including a completed diagnosis by the attending physician;
- Your historical records, I requested by GMS.
- 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.
- You shall afford to GMS the opportunity to examine you when and as often as it reasonably requires while the claim hereunder is pending.
- In the case of death, GMS may require an autopsy subject to any law o the applicable jurisdiction relating to autopsies.
- The costs associated with the administration and consultation with GMS assistance firm which necessitate the need to set up a case file will be considered a claim occurrence, regardless of whether payment is made by GMS for any emergency medical expenses.
- If you apply for coverage prior to your arrival in Canada, there is no waiting period to obtain emergency medical treatment.
- if you apply for coverage within thirty (30) days of your arrival in Canada, no benefits will be paid for expenses incurred within forty eight (48) hours o your effective date.
- If you apply for coverage after being in Canada for more than (30) days;
- you must have an existing plan with GMS;
- you must apply before the expiry of the existing plan with GMS;
- there is no waiting period to obtain emergency medical treatment; and
- you will not be subject to condition 2.b. above, but you not have incurred medical services in excess of $5,000 in the last 12 months.
- The maximum number o days coverage may be purchased for is three hundred sixty-five (365) days per trip;
- Only a person who is named on the application, who meets the eligibility requirements on the effective
- Coverage is to the sum insured purchased for, paid for and verified on your application.
- All eligible expenses are reimbursed less the deductible specified on the
- Foreign workers are required to provide valid proof of active work from their employer for the period of coverage.
- Coverage is not applicable in your country of origin. Travel to the U.S.A. or Mexico during the period of coverage the period of coverage is spent in Canada. Travel to the U.S.A. or Mexico does not apply to residents of the U.S.A. returning to the U.S.A. or to Mexican residents returning to Mexico.
- There is a $1,000 Canadian deductible applied to each claim made within the policy period, unless a lower deductible was indicated on the application and premium was paid at the time of application.
- GMS, in consultation with the attending physician, reserves the right to transfer you to another hospital or medical facility capable of providing the necessary medical services, or to return you to Canada or your country of origin refusal to do so will absolve GMS of further liability.
- GMS is not responsible for the availability, quality, results from any medical treatment or transportation or your failure to obtain medical treatment.
- GMS is authorized to receive reports indicating diagnosis and services rendered to you from any physician, health care provider, other person, hospital or institution.
- Any material misrepresentation, provision of incorrect information or non – disclosure of information, related to medical conditions, will result in non –payment of any related claims.
- GMS reserves the right to negotiate amounts payable on your behalf with any service provider who renders services under your policy. Payments will be provided directly to the service provider. You may not claim or receive more than 100% of covered incurred expenses. Payment under this condition is subject to all other policy conditions and limitations.
Immigrants & Visitors to Canada
- Payment of any amount by GMS on your behalf does not constitute a guarantee that GMS will cover your expenses if GMS determines you have no coverage under this policy. You must repay, on demand, any amount paid or authorized by GMS on your behalf if GMS determines that the amount was not payable under the terms and conditions of your policy.
- Benefits are payable only for amounts in excess of what would normally be payable under government plans as they exist as of the effective date of this policy. There is no coverage for any benefits of any nature which were provided by a government plan on the effective date of this policy regardless of whether such benefits continue to be provided by a government plan at the time the claim is made.
- Coverage is not effective until GMS approves the application, and the appropriate premium has been paid.
14.All amounts stated in this policy are in Canadian funds.
- Benefits payable do not include interest charges.
- This policy shall be interpreted and construed in accordance with the laws of the provision Saskatchewan (Canada) and the federal laws of Canada applicable there in, and the parties hereby at torn to the non-exclusive jurisdiction of the Courts of the Province of Saskatchewan.
- If eligible expenses are paid due to the fault of a third party, GMS may take legal action against the person(s) at fault, in your name to recover these expenses you agree to fully cooperate with GMS in any action that might be taken.
- This policy is in excess only of all other insurance plans or amounts recoverable by any other party. If GMS pays eligible expenses to you and a third party makes payment for those same benefits, you are responsible for reimbursing GMS the amount previously paid by GMS.
- In the event that you have concurrent insurance from another source(s) for benefits provided under this policy, benefits shall be coordinated as follows:
- All benefits from any government plan shall be determined and recovered first;
- GMS will pay eligible expenses only in excess of amounts covered by that of
the other insurer(s) including but not limited to any employment related plan, extended health care plan, private or provincial vehicle insurance, credit card policy, or any other insurance, whether collectible or not;
- However, if the other source(s) of coverage is also “excess only”, all benefits shall be determined and recovered from benefit plans based on the following
- any plan not containing a coordination of benefits statement;
- Any employment/retirement related plan; then
iii. Any other plan, including GMS. In this case, the benefits shall be prorated
According to the maximum amounts that would have been payable as the Result of the benefit contained under the respective plans. You agree that
Prorated sharing is what was intended when this policy was entered into
And that sharing on any other basis including on the basis of independent
Liability and/or equal sharing is not what was intended or agreed to.
- If a covered person is entitled to similar benefits under any other individual or group contract, the benefits payable under this policy shall be coordinated so that the total payment from all coverage’s shall not exceed the amount for which the claim is made.
- Insurance is in effect only for those coverage’s and for the sum insured indicated on your application for which the premium has been paid. Benefits are payable in accordance with the classification of coverage and are limited to the sum insured.
- As provided for under Section 102 of the Insurance Act you may, by contract or declaration, designate the insured, the insured’s personal representative or a beneficiary as a person to whom insurance money is to be payable by providing written notice to GMS of such designation. Designations made through the insurance contract shall be deemed to be revocable and shall be in effect until you alter or revoke the designation in writing. GMS reserves the right to restrict or exclude your right to designate persons to whom insurance money is payable.
- If GMS determines that there is no coverage for a claim(s) under this policy all amounts advanced to you or on your behalf must be repaid by you to GMS on demand. In such circumstances any payment(s) made GMS will not constitute an acceptance of coverage.
- It is your responsibility to provide proof that the dates of travel are consistent with the terms of this policy.
- GMS reserves the right to investigate or obtain a private opinion on any claim and to obtain any and all information relating to a claim.
- This contract is void in the case of fraud or attempted fraud by you, or if you conceal or misrepresent any material fact or circumstance concerning this insurance.
- By purchasing this policy you are authorizing:
- any physician, health care provider, other person, hospital or institution to release to Group Medical Services and/or its authorized agents, represents, affiliates or other service providers (collectively “GMS”) any information covering your medical history, symptoms, treatment, examination, diagnosis and/or services rendered to you;
- GMS to collect store and use any information which is provided or information obtained pursuant to clause(c)
- GMS to obtain information from, or disclose information to: any government plan; the operator of any hospital, clinic or other health facility; a physician or other health care provider; any insurance company; or any other service provider or third party as may be reasonably required. This information is intended for the purpose of administering the plan and communicating with you.
- You agree to fully cooperate with GMS to provide the documentation and authorization required by GMS to administer your plan, including the assessment of your claim(s). Failure to provide the documentation and authorization, with the time periods specified in this policy will result in the non - payment of the claim(s)
- GMS reserves the right to suspend claims reimbursement until such time as payment of premium in full is received. In the event of non - payment of premium, GMS reserves the right to terminate the policy, with notice.
- You have ten (10) days from the day you apply for your policy to return it to GMS for cancellation, provided the coverage has not started during your examination period. Refer to "Coverage Begins and Ends" to established when coverage starts. The policy will be considered null and void and any premium paid up to the end of the 10-day examination period will be refunded. This period of examination expires ten (10) days after you apply for your policy and have received a copy of the policy contract. Failure to return the policy will be considered an acceptance of all of its terms, conditions and limitations. All other requests for termination are subject to the conditions provided for in the policy statutory conditions
- Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act (BC, AB,NS, PE -title of act may vary jurisdiction), Limitations Act (SK, NF), Limitations Act 2002 (ON) or other applicable legislation.
- Despite any other provision of this contract, the contract is subject to the statutory conditions in the insurance act respecting contracts of accident and sickness insurance of the Canadian province or territory where the policy was issued.