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GMS Health Insurance Review 2024
GMS Health Insurance provides comprehensive health coverage options for individuals and families across Canada. There are three plans that individuals can choose from—BasicPlan, ExtendaPlan, and OmniPlan. Coverage options include prescription drugs, dental care, vision, travel insurance, and more. The cost of coverage varies based on the individual’s age, plan choice, and location, with premiums ranging between $103.25 and $226.75 per month.
- What are the key features of health insurance from GMS?
- What are the different GMS health insurance plans I can choose from?
- Who is eligible for GMS personal health insurance?
- Does GMS cover prescription drugs?
- Does GMS cover dental care?
- Does GMS health insurance cover travel?
- How much does health insurance from GMS cost?
- What are the pros and cons of GMS health insurance?
- What do we like about GMS health insurance plans?
- Frequently asked questions
GMS (Group Medical Services) is a well-established provider of health insurance in Canada, offering a wide range of coverage options for individuals and families. With over 70 years of experience, GMS is known for delivering flexible and comprehensive insurance solutions designed to meet the diverse needs of Canadians.
In this review, we’ll explore the key features of GMS health insurance, the different plans available, what’s covered, who is eligible, the associated costs, and the pros and cons of choosing GMS to safeguard your health.
What are the key features of GMS health insurance?
GMS (Group Medical Services) offers a variety of health insurance plans with flexible coverage options. The coverage amount varies depending on the selected plan and is available for individuals up to 80 years old, though eligibility becomes stricter for those over 55, particularly when it comes to pre-existing conditions. Premiums are based on several factors, including age, gender, and the specific plan type.
Key features of GMS health insurance
| Feature | Details |
| Coverage amount | Varies depending on the plan specifics |
| Age | Available for individuals up to 80 years old. Eligibility becomes stricter for those over 55, especially regarding pre-existing conditions |
| Premiums | Determined by age, gender, and plan choice |
| Waiting period | 2 days for medical conditions if purchased within 30 days of arrival in Canada; 7 days if purchased later |
| Plans | BasicPlan, ExtendaPlan, and OmniPlan |
| Eligibility | Must be a Canadian resident and covered under a provincial health plan. Additional criteria may apply based on age and medical history |
| PolicyAdvisor rating | 4.5/5 |
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What are the different GMS health insurance plans I can choose from?
GMS personal health insurance offers three comprehensive plans—BasicPlan, ExtendaPlan®, and OmniPlan®—each designed to cater to different healthcare needs. The BasicPlan provides essential coverage with options for prescription drugs and dental care, while the ExtendaPlan® offers enhanced benefits such as broader dental coverage and a higher limit for health practitioners.
The OmniPlan® is the most comprehensive option, covering a wider range of services, including enhanced health practitioner coverage, private room hospital benefits, and increased limits for both prescription drugs and dental care.
GMS health insurance plans
| Benefit | BasicPlan | ExtendaPlan® | OmniPlan® |
| Prescription drugs
(add-on) |
Basic prescription drugs: Up to $3,500/year
Enhanced prescription drugs: Up to $5,000/year, including $800 for drugs prescribed for pre-existing conditions |
||
| Dental care
(add-on) |
Basic dental: Year 1 – 75% to $500,
Year 2 – 80% basic, 50% major to $750, Year 3 – 80% basic, 50% major to $1,000 |
||
| Vision care | Not included | 80% coverage to $250/2 years (combined) | 90% coverage to $250/2 years for frames & lenses. 1 eye exam per 2 years |
| Health practitioners | 70% to $250 combined max per policy year | 80% to $350 combined max per policy year | 90% to $300 per health practitioner per policy year |
| Counselling services | Not included | $65 per visit for 10 visits per policy year | $65 per visit for 15 visits per policy year |
| Speech pathologist/Therapist | $45 per visit for 5 visits per year | $45 per visit for 10 visits per year | $45 per visit for 10 visits per year |
| Ambulance | $2,000 per person per year | Unlimited | Unlimited |
| Air ambulance | Unlimited | ||
| Hearing aids | Not included | $500 every 5 years | $800 every 5 years |
| Casts & crutches | Unlimited | ||
| Medical equipment & supplies | Not included | $500 per person per year | $500 per person per year |
| Annual travel | Not included | 48 days, $500,000 max; 48 days, $2M max; 63 days, $2M max | 30 days outside Canada, 183 days in Canada, $2M max |
| Diabetic supplies & equipment | Not included | $300 per year | $300 per year |
| Oxygen equipment | Not included | $500 per year, max $1,500 lifetime | $500 per year, max $2,500 lifetime |
| Blood pressure monitors | Not included | 1 per policy per 5 years | 1 per policy per 5 years |
| Custom foot orthotics | Not included | 80% coverage, 1 pair/3 years for adults, 1 pair/year for children | 80% coverage, 1 pair/3 years for adults, 1 pair/year for children |
| Mobility aids | Not included | $300 per person per year | $300 per person per year |
| Preferred hospital room | $500 per person per year | $1,000 per person per year | $3,500 per person per year (45 days) |
| Private duty nursing | 80% to $1,500 per year | 80% to $3,000 per year | 80% to $5,000 per year |
| Accidental dental | $500 per injury | $2,000 per injury | $5,000 per injury |
| Wheelchairs, motorized scooters & hospital beds | $500 per person per 5 years | $750 per person per 5 years | $1,000 per person per 5 years |
| Prosthetic appliances | Artificial limbs, eyes, breasts, surgical bras | ||
| Patient walkers | 80% to $300 per person per 5 years | ||
| GMS Care Network | Included | ||
| Hospital cash | Coverage for extended hospital stays with daily payments up to $3,000 annually | ||
Who is eligible for GMS personal health insurance?
To be eligible for GMS personal health insurance, you must be a resident of Canada and insured under a provincial health plan.
Additionally, there are specific age-related restrictions where individuals over the age of 55 may face stricter conditions regarding pre-existing medical issues when applying for coverage. These criteria help ensure that GMS health plans meet the needs of residents while accounting for potential health risks as individuals age.
Does GMS cover prescription drugs?
Yes, GMS health insurance covers prescription drugs. All three plans cover basic prescription drugs for up to $3,500 per person per year. This includes the drugs listed on your provincial health plan, medications prescribed for newly diagnosed conditions, and hormonal contraceptives.
However, it excludes drugs not listed on your provincial plan, over-the-counter drugs, those prescribed for pre-existing conditions before enrolling in GMS, experimental drugs, weight loss drugs, and several other types of medications such as smoking cessation drugs or fertility drugs.
For enhanced prescription drugs, the coverage is up to $5,000 per person per year, which also includes $800 for drugs prescribed for pre-existing conditions. This coverage also includes medications not covered under your provincial drug plan, as well as prescriptions excluded under the BasicPlan. A $6 deductible applies to each eligible prescription.
Does GMS cover dental care?
Yes, GMS health insurance provides coverage for dental care, which includes both basic and major dental services. Basic dental services, such as exams and fillings, are covered in all three plans along with major services like crowns, bridges, and dentures. The coverage amount increases over three years.
- Year 1: Covers 75% of basic dental services, up to a maximum of $500
- Year 2: Covers 80% of basic services and 50% of major services, with a combined maximum of $750
- Year 3: Covers 80% of basic services and 50% of major services, with a combined maximum of $1,000
Additionally, a three-month waiting period may apply before GMS dental coverage kicks in.
Does GMS health insurance cover travel?
Yes, the ExtendaPlan and OmniPlan by GMS health insurance provide travel coverage for both domestic and international trips. Annual travel coverage is included for Saskatchewan ExtendaPlan and OmniPlan customers, offering emergency medical coverage for trips within and outside of Canada.
Policyholders can choose from coverage options that provide up to $2 million in emergency medical coverage. These options allow policyholders to cover an unlimited number of trips per year, each lasting up to 15, 30, or 48 days. However, for travellers aged 80 years or older, emergency medical coverage is only available within Canada.
How much does health insurance from GMS cost?
The cost of GMS health insurance ranges between $103.25 and $226.75 across different age groups and plan types. These premiums may increase or decrease depending on the specific coverage options chosen by the individual.
Cost of GMS personal health insurance
| Age | Premiums (per month) |
| 25 years, male/ female | $103.25 to $206.50 |
| 35 years male/ female | $113.25 to $228.50 |
| 45 years male/female | $122.75 to $241.25 |
| 55 years, male/female | $127.50 to $242.25 |
| 75 years, female/female | $129.00 to $226.75 |
What are the pros and cons of GMS health insurance?
GMS health insurance offers a range of benefits, including comprehensive coverage for different needs, coverage for stable pre-existing conditions after a waiting period, and 24/7 customer service with easy claims processing.
However, the plans may come with higher premiums for older individuals or those with pre-existing conditions, limited customization options in group plans, and some exclusions related to risky activities or high-cost treatments
| Pros | Cons |
| Coverage for stable pre-existing conditions after a waiting period | Higher premiums for older individuals or those with pre-existing conditions |
| Seamless customer service with quick claims processing | Limited customization options within group plans |
| Optional add-ons like travel medical insurance and hospital cash allowances | Exclusions related to risky activities or certain high-cost treatments |
| Pay-Direct Provider locator lets policyholders find health practitioners who will bill GMS directly |
What do we like about GMS health insurance plans?
Our advisors recommend GMS health insurance plans since they offer a variety of benefits to meet diverse health insurance needs. These plans provide direct billing through the Pay-Direct Provider Locator, making it easy to find health providers who will bill GMS directly.
The GMS Care Network also stands out, offering around-the-clock access to services such as life coaching, professional counselling, virtual doctor visits, and more. Plus, the customizable add-on coverage options like dental, prescription drug, travel, and hospital cash insurance, allow individuals to personalize their plan for extra peace of mind.
How can I get a health insurance quote from GMS?
You can get a health insurance quote from GMS by visiting their website, choosing a plan, and filling out the application form. For a more customized experience, speak to a PolicyAdvisor expert who will help you compare and choose the best plan based on your requirements and budget.
With PolicyAdvisor, you also get free instant quotes, the lowest rates across the market, and lifetime after-sales support. Schedule a free consultation with one of our licensed advisors today!
Frequently Asked Questions
What is the waiting period for GMS health insurance coverage?
The waiting period for GMS health insurance is typically 2 days for medical conditions if the policy is purchased within 30 days of arrival in Canada. If the policy is purchased after this period, the waiting period extends to 7 days. This waiting period applies to most coverage, ensuring new policyholders are eligible for benefits once it’s over.
How does GMS handle claims processing?
GMS health insurance processes claims efficiently, with many claims being processed within a few business days. Policyholders can submit claims easily through the My GMS portal or the mobile app, helping to expedite the claims process. While the exact timeframe may vary based on the complexity of the claim, GMS prioritizes swift and hassle-free claim resolutions.
Can I add family members to my GMS health insurance plan?
Yes, GMS health insurance allows policyholders to add family members to their personal health insurance plans. To be eligible, each family member must meet the requirements of being a resident of Canada and insured under a provincial health plan, ensuring that coverage extends to loved ones under the same policy.
Does GMS offer monthly payment options for health insurance?
GMS health insurance offers flexible monthly payment options, making it easier for policyholders to manage premiums. Instead of paying annually upfront, individuals can choose to spread their payments across the year with convenient monthly billing.
- GMS provides a variety of plans (BasicPlan, ExtendaPlan, OmniPlan) with coverage for prescription drugs, dental care, health practitioners, and more
- The plans are available to Canadian residents under 80, with stricter eligibility for individuals over 55, particularly regarding pre-existing conditions
- The cost of GMS health insurance ranges between $103.25 and $226.75 across different age groups and plan types
- GMS includes optional add-ons like travel insurance, hospital cash, and extended coverage for pre-existing conditions, with a waiting period
