Group Medical Services (GMS) Health Plans

Group Medical Services has proven itself to be a contender in the benefit field for Canadians. Please look closely at these plan features, and give us a call to see if they would fit your needs:

Individual Health Plans

 Information provided by GMS:

No matter what stage of life you’re in, you can ensure your family’s health care security, with supplemental health insurance coverage for everyday health needs, unexpected medical emergencies and protection from rising health, drug and dental costs.

OmniPlan®
Your premier health insurance choice. You get extensive health benefit coverage including health practitioner services like physiotherapy and message therapy, vision care, glasses and much more.

ExtendaPlan®
Comprehensive coverage with a wide range of benefits including coverage for medical emergencies, medical supplies & equipment and a variety of health specialists.

BasicPlan
Ideal coverage for unexpected emergencies including those essential health benefits not covered under your provincial health plan – like ambulance services, preferred hospital rooms and in-hospital drugs.

Additional Coverage Options
Complete your coverage with options for Prescription Drugs, Dental Care, Hospital Cash and Travel Medical.

Why Select an Individual Health Plan from GMS?

  • Comprehensive Coverage. Provincial health plans offer limited medical coverage for such things as ambulance services, casts, crutches, artificial limbs, in-hospital private-duty nursing and numerous others. Use GMS Individual Health to supplement your provincial health coverage or employer-sponsored plan.
  • Flexible Plan Design. You can customize your plan with several options such as dental care, prescription drugs, hospital cash and travel medical for one low annual premium.
  • Outstanding Customer Service. Our representatives are available to answer all or your questions and assist you whenever necessary (and, they answer your phone call in person).
  • Quick Claims Turnaround. In most cases, claims are paid within 5 working days from date of receipt.
  • Pay-Direct Service. GMS pays many health and dental providers directly. Present your GMS pay-direct ID Card at participating pharmacies and dental offices to save on out-of-pocket expenses.
  • Affordable Premiums. With several health plan choices, and a range of optional coverage, GMS provides health customers with affordable annual premiums and a choice of annual and monthly payment methods. 

Here is a basic comparison of plans that will vary by province:

Benefit         Omni                Extenda                Basic
Goods & Services Goods and services may be purchased anywhere in Canada. Goods can be purchased anywhere in Canada. Services must be received in your province of residence. Goods can be purchased anywhere in Canada. Services must be received in your province of residence.  
Eye Exam $75 / 2 most recent policy years N/A N/A  
Eye Glasses, Contacts, or Laser Eye Surgery $200 / 2 most recent policy years N/A N/A  
Health Practitioners Maximum $35 per visit to a maximum of $300 per specialty, per person, per policy year Maximum $35 per visit to a maximum of $250 combined per person, per policy year N/A Acupuncture, chiropractic, chiropody/podiatry, clinical psychology, speech therapy, massage therapy, naturopath and physiotherapy treatments.
Hearing Aids $800 / 5 years $500 / 5 years N/A One year waiting period.
Health Supplies & Equipment $500 / person / year $500 / person / year N/A See policy wording for a complete list of eligible items. Requires a Physician’s written prescription.
Diabetic Supplies & Equipment $300 / person / year $300 / person / year N/A Diabetic supplies and equipment, including testing devices when ordered in writing by a Physician. One year waiting period on testing devices.
Oxygen Supplies & Equipment $500 / person / year to a lifetime maximum of $2,500 $500 / person / year
to a lifetime maximum of $1,500
N/A Does not cover the cost of oxygen. One year waiting period on CPAP supplies.
Blood Pressure Monitors 1 in a 5 year period 1 in a 5 year period N/A Require Physician’s written order.
Custom Foot Orthotics 80% - 1 per 3 years per adult and 1 per year for children under 16 80% – 1 per 5 years per adult and 1 per year for children under 16 N/A  
Therapeutic Shoes $200 / person / year $200 / person / year N/A Require a Physician’s written prescription.
Mobility Aids $300 / policy / year $300 / policy / year N/A Canes, reaching aids, raised toilet seats, grab bars, bath safety rails and transfer benches when accompanied by a Physician’s letter of necessity.
Ostomy Supplies & Equipment $300 / person / year $300 / person / year N/A  
Accidental
Death
$4,000 for funeral expenses in the case of accidental death N/A N/A  
Out-of-Province Referral $50,000 / lifetime $50,000 / lifetime N/A Requires prior written approval from GMS.
Ground Ambulance Unlimited Unlimited $2,000 / person / year 100% emergency transport to hospital; 50% return of bedridden patients.
Air Ambulance $8,000 / person / year $5,000 / person / year $3,000 / person / year Transport within your province of residence.
Casts and Crutches Unlimited Unlimited Unlimited Fibreglass casts and the purchase or rental of crutches.
Preferred Hospital Rooms 45 days up to $3,500 / person / year $1,000 / person / year $500 / person / year Private or semi-private hospital room costs
Private Duty Nursing 80% to $2,500 per person per year for in-hospital or in-home as palliative care nursing. 80% to $2,500 per person per year for in-hospital or in-home as palliative care nursing. 80% to $1,500 per person per year for in-hospital nursing. In-home nursing is for palliative care only; must be prescribed by a Physician.
In-Hospital Prescription Drugs $2,000 / person / year $1,000 / person / year $1,000 / person / year  
Accidental Injury to Natural Teeth $5,000 / injury $2,000 / injury $500 / injury Services over $300 must be pre-approved. 
Wheelchairs, Motorized Scooters & Adjustable Beds 100% of purchase or rental to a maximum of $1000 / 5 years 100% of purchase or rental to a maximum of $750 / 5 years 100% of purchase or rental to a maximum of $500 / 5 years These benefits have a one year waiting period and require a Physician’s written order.
Artificial Limbs, Eyes & Larynx $5000 / person / year $5000 / person / year $5000 / person / year  
Patient Walker 80% of purchase or rental to a max. of $300 / 5 years / policy 80% of purchase or rental to a max. of $300 / 5 years / policy 80% of purchase or rental to a max. of $300 / 5 years / policy This benefit has a one year waiting period, and requires a Physician’s written order.
Breast Prosthesis $325 / 2 yrs lateral
$650 / 2 yrs bilateral
$325 / 2 yrs lateral
$650 / 2 yrs bilateral
$175 / 2 yrs lateral
$350 / 2 yrs bilateral
Excludes surgical brassieres.
Additional Coverage Options
Prescription Drugs 
Coverage for prescription drugs listed under your provincial drug formulary (as detailed under your province’s drug or pharmacare plan/program) up to $3,500 per person, per year. Pay only $4.00 for each eligible prescription. Use our convenient pay-direct card and reduce your out-of-pocket expenses. Prescriptions for pre-existing medical conditions are not eligible for coverage.
Prescription Drugs - Enhanced
Coverage for prescription drugs and oral contraceptives up to $5,000 per person, per year. Includes up to $500 coverage per person, per year for prescription medications for pre-existing medical conditions and legal prescriptions for medications not listed under your provincial drug formulary. Pay only $4.00 for each eligible prescription. Use our convenient pay-direct card.
Dental
1st yr - 75% to $500; basic services
2nd yr - 80% basic, 50% major to $750
3rd yr - 80% basic, 50% major to $1,000A three month waiting period applies to all dental services. Services over $300 must be
pre-approved by GMS.
Hospital Cash $100 / day, up to 30 consecutive days.Begins on the 4th day of hospitalization and on the 7th day if hospitalization is due to maternity. 30 day waiting period.
Travel
$2 Million coverage3 options:
15 days per trip
30 days per trip
48 days per tripSubject to exclusions for pre-existing conditions. GMS indiv policy wording for complete detail.

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