An Overview of Benefits
GMS will pay the reasonable and customary charges for eligible expenses resulting from an unexpected medical emergency occurring during your period of coVerage. Payment will be up to the policy dollar limit and reduced by any deductible as shown on your confirmation. Coverage is subject to all of the policy conditions and exclusions contained in this booklet.
In addition, coverage will be provided while you are in transit between Canada and your country of origin for a period of no more than 48 hours after your initial departure for no additional premium. See Automatic Extension on page 5 for more details.
Eligible expenses within Canada include:
1. In-Hospital Care – Hospital accommodations up to semi-private rooms and hospital services and supplies necessary for the care of a medical emergency during hospitalization. When deemed medically necessary, follow-up visits are covered until such time that the medical emergency has been deemed to have ended as advised by GMS. Where a follow-up visit is required, GMS requires it to occur no later than fourteen (14) days after the initial medical emergency, unless otherwise instructed and approved by GMS.
2. Medical Services – Medical treatment by a physician or surgeon.
3. Diagnostic Services – X-rays and other diagnostic tests. Magnetic resonance imaging, computerized axial tomography scans, sonograms, ultrasounds and biopsies are excluded, unless pre-authorized by GMS.
4. Out-Patient Treatment – Out-patient medical emergency room expenses.
5. Prescription Medication – Drugs and medication obtained on the prescription of the attending physician and supplied by a licensed pharmacist, to a maximum thirty (30) day prescription. Refills of prescriptions, and any associated physician’s expenses, are excluded from coverage.
6. Ambulance – Expenses for the use of a licensed road or air ambulance in a medical emergency situation that requires immediate transportation to the nearest hospital where adequate facilities are available. GMS will reimburse the expense for an air ambulance or regularly scheduled airline only when the transport is to a hospital for further in-hospital medical treatment that is not available at the facility attended and is upon written recommendation of the attending physician and with prior GMS approval. This benefit excludes helicopter transports.
7. Health Practitioners – Expenses, up to an aggregate maximum of $300 per person, for the emergency services of an osteopath, optometrist, physiotherapist, chiropractor, chiropodist and/or podiatrist.
8. Accidental Dental – Expenses for the repair or replacement of natural teeth or permanently attached artificial teeth necessitated by an accidental blow to the mouth, to a maximum of $2,000 per person. Expenses for medical treatment of the relief of dental pain, to a maximum of $250. This benefit excludes dental implants.
9. Return of Remains – When death results from a covered medical emergency, the expenses for either the preparation or transportation of the deceased to his/her destination in Canada or country of origin, to a maximum of $10,000 per person, or the expense of cremation or burial at the place of death, to a maximum of $4,000.
10. Child Care – Payment up to $500, with prior GMS approval, for licensed care of dependent children if they are travelling with you, should you be hospitalized due to a medical emergency
11. Out-of-Pocket Expenses – Payment for reasonable and customary expenses, 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 in hospital on your return date.
12. Repatriation to Country of Origin – Payment to a maximum of $5,000 to transport you by common carrier back to your country of origin for further medical treatment, if found medically fit to travel. The $5,000 limit includes expenses for one-way air transportation for one (1) accompanying family member insured under your policy. The cost of a medical escort or attendant is not covered. This benefit must be pre-approved by GMS.
If you are under fifty-five (55) years of age you are NOT eligible if you:
1. have any reason to seek medical treatment, excluding the regular care of a chronic condition or medical evaluation required to satisfy travel visa requirements;
2. are currently in Canada, and have ever been denied similar coverage offered by another Canadian insurer; and
3. are currently in Canada, and had more than $5,000 in medical treatment in the last twelve (12) months while in Canada.
If you are fifty-five (55) years of age and older you are NOT eligible if you:
1. are eighty (80) years of age or older on the policy effectiVE date;
2. have any reason to seek medical treatment, excluding the regular care of a chronic condition or medical evaluation required to satisfy travel visa requirements;
3. are currently in Canada, and have ever been denied similar coverage offered by another Canadian insurer;
4. are currently in Canada, and had more than $5,000 in medical treatment in the last twelve (12) months while in Canada;
5. are expecting medical treatment for heart disease;
6. are waiting for test(s) for a suspected heart condition;
7. are taking prescription drugs for heart disease while taking insulin to treat diabetes;
8. have an implantable cardioverter defibrillator (ICD);
9. fainted or fell more than once without medical diagnosis (syncope);
10. use home oxygen for a medical condition;
11. take oral steroids to treat a lung condition;
12. are being treated for cancer or have Metastatic Cancer;
13. have a vascular aneurysm that is surgically untreated
14. have ever had:
a. a valve replacement;
b. kidney (renal) dialysis; or
c. an organ transplant;
15. 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 conditions in the last twelve (12) months:
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 clots; or
i. gastrointestinal bleeding; and
16. require assistance from another person(s) with actiVities of daily liVing (ADL) if you are seventy (70) years of age or older.
Eligibility Expenses Outside of Canada:
Coverage for side trips up to 30 days or less in duration, outside of Canada that:
a. originate and terminate in Canada; and
b. are not greater than 50% of your period of coVerage. Expenses incurred in your country of origin are not covered. Coverage includes all of the benefits listed under the Eligible Expenses within Canada and the following additional benefits.
1. Air Ambulance – Expenses for the use of an air ambulance or common carrier to transport you back to your destination in Canada or your country of origin for further in-hospital medical treatment, upon the written recommendation of the attending physician and with prior GMS approval. This benefit excludes helicopter transports.
2. Special Attendant – One (1), round-trip, economy class airfare for a medical attendant, if medically necessary and pre-approved by GMS, to accompany you back to your destination in Canada or your country of origin. The attendant must not be a friend, relative, associate or other person who was travelling with you when the medical emergency occurred. This benefit must be pre-approved by GMS.
3. Escort of Insured Dependent – Payment for a one-way, economy class airfare by the most direct route to return an accompanying child/children (up to the age of (18) years) to the original point of departure. The cost of an escort, when necessary, will be covered. This benefit must be pre-approved by GMS.
You can also buy extra days to prolong your coverage of GMS, if:
a. You contact GMS 48 hours before your existing coverage expires
b. You did not require any medical attention during the coverage period, this excludes medical evaluation needed to satisfy travel visa requirements.
c. The entire period of coverage does not exceed one year
d. You won’t be eighty years of age or older as of the start of the date for policy extension.
SIDE TRIPS: Coverage for side trips up to 30 days or less in duration, outside of Canada that:
a. originates and terminates in Canada; and
b. are not greater than 50% of your period of coverage. Expenses incurred in your country of origin are not covered.
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. An 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 an 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 your government health plan takes effect.
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 document, 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 the 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 been reported when an insured person, or a family member, contacts GMS’ Travel Assistance. 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.
3. Once a refund has been issued, you will no longer be eligible for any claim payment regardless of when the expense or claim occurred.
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 cheque will be payable to you unless an alternative payee has been assigned;
c. all refunds requested after the effective date shown on your confirmation document are subject to an administration fee (currently $40, but subject to change without notice);
d. no refund will be issued by cheque for amounts under $5.
The following expenses are not covered by this policy.
1. GMS does not cover expenses incurred in your country of origin.
2. GMS does not cover expenses incurred where you act against medical advice or the advice of GMS.
3. GMS does not cover expenses resulting from the regular care of a chronic condition.
4. 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.
5. 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).
6. 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.
7. GMS does not cover any medical treatment, which is a continuation of or a recurrence of a medical condition.
8. 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’ opinion on the issue is final and binding.
9. 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.
10. 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.
11. GMS does not cover expenses for medical treatment at a diagnostic facility unless pre-approved by GMS.
12. 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.
13. 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.
14. GMS does not cover any expenses resulting from and/or incurred during trips undertaken for the purpose of receiving a diagnosis of medical treatment.
15. GMS does not cover any expenses when you travel against the advice of a physician.
16. GMS does not cover expenses related to your pregnancy, an abortion, miscarriage, childbirth or complications of any of these conditions.
17. 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 dependent on your coverage.
18. 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.
19. 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.
20. GMS does not cover expenses resulting from suicide or self-inflicted injuries.
21. GMS does not cover expenses resulting directly or indirectly from your criminal or illegal acts.
22. 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.
23. 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.
24. 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.
25. GMS does not cover expenses resulting from air travel unless riding as a passenger on a common carrier.
26. GMS does not cover medical treatment or services that contravene or are prohibited by provincial laws and/or the federal laws of Canada.
27. GMS does not cover expenses resulting from your service in the armed forces, willful exposure to peril, and/or relief work.
28. 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. Eligible expenses outside Canada.
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.
31. GMS does not cover any expenses resulting from COVID-19.
For medical emergencies and assistance, we are available 24-hours a day, 7 days a week.
toll-free 1.800.459.6604 (within Canada & US)
collect 905.762.5196 (from all other locations) For general inquiries.
toll-free 1.800.667.3699 or firstname.lastname@example.org