Your contract of insurance is formed by your application for insurance, your confirmation document and this policy. The maximum number of days that may be purchased per policy is 365 days. For additional coverage you must reapply and meet all eligibility conditions.
If you are under fifty-five (55) years of age you are NOT eligible if you:
- have any reason to seek medical treatment, excluding the regular care of a chronic condition or medical evaluation required to satisfy travel visa requirements;
- are currently in Canada, and have ever been denied similar coverage offered by another Canadian insurer; and
- 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:
- are eighty (80) years of age or older on the policy effective date;
- have any reason to seek medical treatment, excluding the regular care of a chronic condition or medical evaluation required to satisfy travel visa requirements;
- are currently in Canada, and have ever been denied similar coverage offered by another Canadian insurer;
- are currently in Canada, and had more than $5,000 in medical treatment in the last twelve (12) months while in Canada;
- are expecting medical treatment for heart disease;
- are waiting for test(s) for a suspected heart condition;
- are taking prescription drugs for heart disease while taking insulin to treat diabetes;
- have an implantable cardioverter defibrillator (ICD);
- fainted or fell more than once without medical diagnosis (syncope);
- use home oxygen for a medical condition;
- take oral steroids to treat a lung condition;
- are being treated for cancer or have Metastic Cancer;
- have a vascular aneurysm that is surgically untreated;
- have ever had:
- a valve replacement;
- kidney (renal) dialysis; or
- an organ transplant;
- 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:
- congestive heart failure;
- atrial flutter;
- atrial / ventricular fibrillation;
- peripheral vascular disease;
- stroke / transient ischemic attack (TIA);
- acquired immune deficiency syndrome (AIDS);
- terminal illness;
- blood clots; or
- gastrointestinal bleeding; and
- require assistance from another person(s) with activities of daily living (ADL) if you are seventy (70) years of age or older.
If any of the medical conditions listed above do apply to you, contact GMS immediately as you are not covered.
Should any changes to your health occur after you applied for coverage, GMS must be notified.
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 deducible 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.
– 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.
Eligible expenses outside of Canada:
Coverage for side trips up to 30 days or less in duration, outside of Canada that:
- originates and terminates in Canada; and
- 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 Dependant
– 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.
EXCLUSIONS TO COVERAGE
The following expenses are not covered by this policy.
- GMS does not cover expenses incurred in your country of origin.
- GMS does not cover expenses incurred where you act against medical advice or the advice of GMS.
- GMS does not cover expenses resulting from the regular care of a chronic condition.
- GMS does not cover any expenses that are the result of your failure, prior to arriving in Canada, to:
- adhere to medical treatment;
- obtain investigative or diagnostic tests recommended by a medical professional; and/or
- receive results from investigative or diagnostic tests.
- 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:
- medical condition(s) for which you received medical treatment or medical consultation; and/or
- 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).
- 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.
- GMS does not cover any medical treatment, which is a continuation of or a recurrence of a medical condition. 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.
- 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.
- 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.
- GMS does not cover expenses for medical treatment at a diagnostic facility unless pre-approved by GMS.
- 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.
- 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.
- GMS does not cover any expenses resulting from and/or incurred during trips undertaken for the purpose of receiving a diagnosis of medical treatment.
- GMS does not cover any expenses when you travel against the advice of a physician.
- GMS does not cover expenses related to your pregnancy, an abortion, miscarriage, childbirth or complications of any of these conditions.
- 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.
- 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.
- 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.
- GMS does not cover expenses resulting from suicide or self-inflicted injuries.
- GMS does not cover expenses resulting directly or indirectly from your criminal or illegal acts.
- 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.
- 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.
- GMS does not cover any expenses resulting from your participation in:
- professional sport;
- 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, participation in a rodeo, hang gliding, acrobatic or stunt flying or participating in a horse race as a jockey.
- GMS does not cover expenses resulting from air travel unless riding as a passenger on a common carrier.
- GMS does not cover medical treatment or services that contravene or are prohibited by provincial laws and/or the federal laws of Canada.
- GMS does not cover expenses resulting from your service in the armed forces, willful exposure to peril, and/or relief work.
- GMS does not cover expenses for medical treatment and services provided outside Canada except as provided under the following sections in this policy:
- Automatic Policy Extensions; or
- Travel Benefits Outside Canada.
- GMS does not cover any expenses that result from your failure, prior to arriving in Canada to:
- adhere to medical treatment;
- obtain investigative or diagnostic testing recommended by a medical professional; or
- receive results from investigative or diagnostic tests.
- 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.
- GMS does not cover expenses resulting from war, terrorism or acts of foreign rebellion.
COVERAGE BEGINS AND ENDS
- 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.
- 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 waiting period is applied to coverage for medical conditions, other than injury.
- If uninsured and apply more than 30 days of arriving in Canada, coverage for injury begins on the effective date and a 7 day waiting period is applied to coverage for medical conditions, other than injury.
An Immigrants & Visitors plan ends on the earliest of:
- the date you depart from Canada except as provided under the Automatic Policy Extensions section and Travel Benefits Outside Canada section;
- the date your period of coverage ends as shown on your application;
- the date GMS returns you to your country of origin; or
- the date you notify GMS that you are eligible and covered under a government health plan.
- GMS will provide payment for eligible expenses incurred by you, less any applicable deductibles, during the period of coverage up to your policy dollar limit as shown on your confirmation document. The deductible applicable will be specified on your confirmation document. The deductible is applied to each claim.
- Foreign workers are required to provide valid proof of active work from their employer for the period of coverage.
- 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 of medical treatment or transportation.
- GMS is not responsible for the quality or results of any medical treatment.
- GMS is not responsible for 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, institution or insurance companies.
- 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.
- 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 for amounts in excess of what would normally be payable under government health 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 health plan on the effective date of this policy regardless of whether such benefits continue to be provided by a government health plan at the time the claim is made.
- Coverage is not effective until GMS approves the application, and the appropriate premium has been paid.
- 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 Province of Saskatchewan (Canada) and the federal laws of Canada applicable therein, and the parties hereby agree to concede 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 of all other insurance plans and/or amounts recoverable from 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 health 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 priority:
- any plan not containing a coordination of benefits statement;
- any employment/retirement related plan; then
- 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.
- GMS reserves the right to restrict or deny your right to designate persons 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 by 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 GMS and/or its authorized agents, representatives, affiliates or other service providers (collectively “GMS”) any information covering your medical history, symptoms, medical 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 health 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, within the time periods specified in this policy will result in the non-payment of the claim(s).
- GMS reserves the right to suspend claims payment 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 the Coverage Begins and Ends section to establish 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, MB, NS, PE – title of act may vary by 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.
Pursuant to the Insurance Act, the relevant statutory conditions which relate to individual health and travel insurance products have been provided below.
1. The contract
The application, this policy, any document attached to this policy when issued, and any amendments to the contract agreed upon in writing after the policy is issued, constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions.
- The insurer shall be deemed not to have waived any condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.
Copy of application
- The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application.
2. Material facts
No statement made by the insured or person insured at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability.
3. Termination by insured
The insured may terminate this contract at any time by giving written notice of termination to the insurer by registered mail to its head office or chief agency in the province, or by delivery thereof to an authorized agent of the insurer in the province, and the insurer shall upon surrender of this policy refund the amount of premium paid in excess of the short rate premium calculated to the date of receipt of such notice according to the table in use by the insurer at the time of termination.
4. Termination by insurer
- The insurer may terminate this contract at any time by giving written notice of termination to the insured and by refunding concurrently with the giving of notice the amount of premium paid in excess of the pro rata premium for the expired time.
- The notice of termination may be delivered to the insured, or it may be sent by registered mail to the latest address of the insured on the records of the insurer.
- The insurer may deliver notice of termination to the insured by personal delivery, regular post (notice by regular post not valid in AB, ON & BC) or registered mail. Where notice is delivered by:
- personal delivery, 5 days’ notice of termination shall be given which notice shall begin on the date of personal delivery;
- regular post, 10 days’ notice of termination shall be given which notice shall begin on the day following the date of mailing of notice; or
- registered mail, 15 days’ notice of termination shall be given which notice shall begin on the day following delivery of the registered letter to the insured’s address.
5. Notice and proof of claim
The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of any of them, shall:
a. give written notice of claim to the insurer:
- by delivery thereof, or by sending it by registered mail to the head office or chief agency of the insurer in the province; or
- by delivery thereof to an authorized agent of the insurer in the province; not later than 30 days from the date a claim arises under the contract on account of an accident, sickness or disability;
b. within 90 days from the date a claim arises under the contract on account of an accident, sickness or disability, furnish to the insurer such proof as is reasonably possible in the circumstances of the happening of the accident or the commencement of the sickness or disability, and the loss occasioned thereby, the right of the claimant to receive payment, his age, and the age of the beneficiary if relevant; and
c. if so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the accident, sickness or disability for which claim may be made under the contract and as to the duration of such disability.
6. Failure to give notice of proof
Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the accident or the date a claim arises under the contract on account of sickness or disability if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.
7. Insurer to furnish forms for proof of claim
The insurer shall furnish forms for proof of claim within 15 days after receiving notice of claim, but where the claimant has not received the forms within that time he may submit his proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss.
8. Rights of examination
As a condition precedent to recovery of insurance moneys under this contract:
- the claimant shall afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim hereunder is pending; and
- in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
9. When moneys payable other than for loss of time
All moneys payable under this contract, other than benefits for loss of time, shall be paid by the insurer within 60 days after it has received proof of claim.
REQUESTING A REFUND
Full refunds are available if no travel has taken place, when your request for a refund is received:
- prior to the effective date as shown on your confirmation document; or
- 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.
Partial refunds are available, with an administration fee, in the following situations.
- 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.
- You return to your country of origin. The refund will be calculated from the date you departed Canada (proof of departure will be required).
- 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.
- Your death occurs during the policy period. The refund will be calculated from the date of your death.
Refunds are not available when:
- a claim has been reported under this policy; or
- you request a refund after the expiry date of your policy.
The following conditions apply to partial refunds issued under
- 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:
- proof of travel showing the date you departed from Canada;
- proof of coverage under a government health plan including effective date of coverage;
- in the case of a your death, a copy of the death certificate; or
- 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.
- 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:
- GMS’ Travel Assistance was only contacted once during the period of coverage; and
- no payment for emergency medical treatment was issued or pending. Refunds are subject to GMS’ review and approval.
- 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
- A refund is calculated using the number of unused days and the daily rate applie based on your original trip length. The number of unused days is calculate based on your departure date unless otherwise indicated in the Requesting a Refund section above under 2. a., b., c., and d.
- Refunds will be processed as follows:
- payment made by credit card will be credited to the credit card on file;
- payment made by cash or cheque will be payable to you unless an alternative payee has been assigned;
- all refunds requested after the effective date shown on your confirmation document are subject to an administration fee;
- no refund will be issued by cheque for amounts under $5.
EXTENSIONS & POLICY CHANGES
It is your responsibility to advise GMS of any changes to your health which have occurred after your application date and prior to the start date of a change or extension to your policy. A change in your health may affect your eligibility to extend or change coverage. Changes to your health that do not affect eligibility will still constitute a change in stability and may limit your available coverage.
- You may change your effective date by contacting GMS:
- prior to arriving in Canada; and
- within 30 days of arriving in Canada with proof of your arrival date. Requests to change the effective date will not be accepted if:
- the policy has expired;
- the request is made more than 30 days after your arrival in Canada;
- the effective date is more than 12 months from the original effective date selected when you applied; or
- you will be 80 years of age on the new effective date.
- You may not change your deductible or policy dollar limit after your effective date. Contact GMS to change your deductible or policy dollar limit before your effective date.
- Newborns are eligible for coverage under this plan forty-eight (48) hours after release from hospital. You must add the newborn to your application and pay the appropriate premium.
Automatic Policy Extensions
Your Immigrants & Visitors to Canada plan coverage will automatically be extended at no additional cost in certain situations. The extended coverage is payable up to your policy dollar limit under these conditions:
- If coverage expires while hospitalized due to a medical emergency, coverage will continue for you, your spouse and any dependants travelling with you and are listed on your application during your hospitalization and for up to seventy-two (72) hours after discharge from hospital.
- During your transit to Canada from your country of origin provided you:
- purchased your coverage prior to departing your country of origin; and
- arrive in Canada within 48 hours of departing your country of origin.
- During your transit from Canada to your country of origin provided you;
- have coverage on the day you depart for your country of origin; and
- arrive in your country of origin within 48 hours of departing Canada. Coverage under 2. and 3. above is subject to proof of travel and compliance with the conditions set out under the Policy Changes section.
- You may purchase additional days to extend your coverage subject to GMS’ approval if:
- you contact GMS forty-eight (48) hours prior to the expiry date of the existing coverage;
- during your period of coverage, you have not required medical treatment (whether a claim was submitted or not), excluding a medical evaluation required to satisfy travel visa requirements;
- your total period of coverage, including all extensions, does not exceed one (1) year; and
- you will not be eighty (80) years of age or older as of the start date for the policy extension. To avoid a waiting period, extend coverage before your policy expires. Payment must be made at time of the policy change or extension by credit card (Visa or MasterCard) for the change or extension to be accepted.
MANAGING A MEDICAL EMERGENCY
Regardless of your plan deductible, in the event of a medical emergency:
- You are required to contact GMS Travel Assistance 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.
- GMS Travel Assistance will:
- offer telephone interpretation services in many languages;
- monitor progress during your medical consultation and medical treatment; and
- coordinate all medical treatment, transport and repatriation.
MAKING A CLAIM
1. 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. Notice of claim form will be provided to you by GMS Travel Assistance on your initial contact.
2. Proof of Claim:
To be eligible to claim, you must submit the following documentation to GMS as soon as possible and no more than 90 days from when the illness or injury occurred:
- 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 of the accident;
- proof of the travel dates including your departure date from your country of origin and visa documentation, if requested by GMS;
- your historical records, if requested by GMS; and
- in the case of claims involving your death, GMS may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
3. Limitation Period:
Expenses must be submitted to GMS no later than 12 months from the date of the last eligible expense to be considered for reimbursement.
a happening due to external, sudden, fortuitous causes beyond your control.
activities of daily living (ADL):
activities such as personal hygiene and grooming; dressing and undressing; self-feeding; functional transfers (getting into and out of bed or a wheelchair, getting onto or off the toilet, etc); and bowel and/or bladder management that you require daily assistance with.
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 prior to 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).
the day you apply and pay for your insurance policy.
is a condition that continues to exist for a long period of time or is expected to exist for a long period of time.
a conveyance (bus, taxi, train, boat, airplane or other vehicle), that is licensed, intended and used to transport paying passengers.
country of origin:
the country in which you maintain a permanent residence prior to entry into Canada.
the day you leave your country of origin, or departure point.
country you depart from on the first day of your intended travel period.
any unmarried child of you or your spouse (including step-child, adopted child, or a child for whom you have been granted custody pursuant to an Order of the Court) who is chiefly dependent upon you or your spouse for support and maintenance, and is eighteen (18) years of age and under.
when applying in Canada, the effective date is the later of:
- the date you applied for coverage; or
- the date you chosen by you and indicated on your confirmation.
when applying outside of Canada, the effective date is:
- the date you arrive in Canada, provided GMS is advised within 30 days of your arrival; or
- the date indicated on your confirmation if GMS is advised more than 30 days after you arrived.
the date on which your coverage ends under our insurance.
Group Medical Services and/or its authorized agents, representatives, affiliates or other service providers.
GMS Travel Assistance:
the assistance service which has been appointed by GMS to perform all assistance services where indicated under this policy.
government health plan:
any plan of insurance provided by or under the administrative control of any provincial or territorial government or agency in accordance with any law (other than the Unemployment Insurance Act of Canada) or any plan providing insurance coverage regulated by any government.
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.
an institution licensed as a hospital which is primarily engaged in providing medical, diagnostic and surgical services for the care and treatment of sick or injured persons on an in-patient basis, and, which has a laboratory, a registered graduate nurse and physician always on duty and an operating room where surgical operations are performed by a legally licensed medical physician(s). In no event shall the term “hospital” or “general active treatment hospital” mean any hospital or institution or part of such hospital or institution licensed or used principally as a clinic, continued care or extended care facility, convalescent home, rehabilitation centre, rest home, nursing home for the aged, health spa or treatment centre for drug addiction or alcoholism.
immediate family member:
your legal or common-law spouse, parent, brother, sister, legal guardian, step-parent, step-child, step-brother, step-sister, grandparent, grandchild, in-law, or natural or adopted child.
is the impairment of your physical condition caused from a sudden and unforeseen accidental event that is independent from an illness or disease which includes but is not limited to a physical wound, fracture or blow to the body.
are any irregularities to your health such as an illness, injury or emotional, psychological or psychiatric condition(s):
- for which you receive medical treatment or medical consultation;
- related to undiagnosed symptoms for which you received medical treatment or medical consultation; or
- related to undiagnosed symptoms which would have caused an ordinary person to seek medical treatment or 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/or medical treatment of a medical condition, illness or injury.
a sudden or urgent happening that arose during your trip and requires immediate action. A medical emergency no longer exists when the medical evidence indicates that no further treatment is required at your destination, or indicates you are able to return to your country of origin for further 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.
steroids that are swallowed to treat a lung condition. They do not include steroids that are inhaled to prevent asthma attacks or to temporarily trea and relieve inflammation of the airway.
period of coverage:
the number of days of coverage for which a premium has been paid and for the dates indicated on your application. physician: a duly qualified doctor of medicine, who is not an immediate family member, and is entitled under the laws of the Province, State or Country where the services are rendered to prescribe drugs and administer medical treatment. A physician does not include a naturopath, herbalist, or homeopath.
policy dollar limit:
the maximum amount of insurance payable, which you selected at the time of purchase, or which applies automatically to, a given insurance coverage. policyholder: the person who has applied and paid the premiums to GMS for a plan and whose application has been approved by GMS. reasonable and customary: charges that are reasonably comparable to those normally charged for that service in the particular area where the service is received. return date: the date on which you are scheduled to return to your departure point, as shown on your application.
a brief add-on or short trip that is off the main route of an itinerary or the main trip.
the person to whom you are legally married or with whom you have resided for at least twelve (12) months and whom you present publicly as your spouse.
a medical condition is stable if:
- you have no reason to expect medical treatment after your effective date for the medical condition or any symptoms;
- you have not received new or different medical treatment for the medical condition;
- you have not had an alteration to an existing prescription drug or were prescribed a new prescription drug for the medical condition;
- your medical condition has not become worse;
- you have not experienced new, more frequent or more severe symptoms;
- you have not had or needed medical consultation for undiagnosed symptoms;
- you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and
- you have not had tests or further investigation, whether you know the results or not, related to the medical condition.
the calendar date on which a change or an extension to coverage is to begin.
a physician who practices surgery.
a disease that cannot be cured and is reasonably expacted to result in death.
an act, including but not limited to the use of force or violence and/or the threat thereof, including hijacking or kidnapping, of an individual or group in order to intimidate or terrorize any government group, association or the general public for religious, political or ideological reasons or ends, and does not include any act of war, act of foreign enemies or rebellion.
means economy class transport on a common carrier whether by land, air or sea.
armed conflict, whether or not war has been declared, between nations or factions within a nation.
you or your:
any person who is eligible for coverage for any benefit under this policy.
- Immigrants & Visitors to Canada insurance is designed to cover losses resulting from sudden, unexpected and unforeseen circumstances. It is important that you read and understand your policy as your coverage may be subject to certain exclusions or limitations.
- A pre-existing medical exclusion applies to medical conditions and/or symptoms that existed prior to your trip. Check the policy to see how this applies to you.
- In the event of an accident, injury or sickness, your prior medical history may be reviewed when a claim is reported.
- Your policy provides assistance for medical emergencies. If you experience a medical emergency, you must notify GMS Travel Assistance centre prior to treatment, where possible, and no later than twenty-four (24) hours after receiving medical treatment or being admitted to hospital. Your policy may limit benefits should you not contact GMS Travel Assistance centre.
- This policy contains a provision removing or restricting the right of the insured to designate a person to whom or for whose benefit insurance money is to be payable.
PLEASE READ YOUR POLICY CAREFULLY AT THE TIME OF PURCHASE
For medical emergencies and assistance, we’re available 24-hours a day, 7 days a week.
(within Canada & US)
(from all other locations)
For General Inquiries.
toll-free 1.800.667.3699 or firstname.lastname@example.org