When you leave a group benefits plan you don’t have to live without the health insurance services and supports you count on. GMS Replacement Health is health insurance for retirees and the newly self-employed. With a Replacement plan you can have coverage that is similar to the group insurance you are used to, and you can count on GMS’s service and support.
When the unexpected happens, your health insurance will cover the costs of ground and air ambulance, preferred hospital rooms, medical equipment, and more to make sure you get the care you deserve.
Is Replacement Health only for the self-employed or retirees?
The Replacement Health Plan is a great choice for retirees and self-employed Canadians, but it’s also designed for anyone without workplace benefits. If you work part-time, are between jobs or are a young adult no longer covered by your parents’ plan, Replacement Health replaces group benefits, including prescription drugs, vision care, dental, travel, and more.
Health insurance plans can cover health care costs government health plans don’t. Things like contacts lenses and glasses, dental exams, and massage treatments that help you feel and be your best.
Replacement Plans have Guaranteed Acceptance so you don’t have to worry
If you’re leaving a group benefits plan, GMS is happy to offer you guaranteed acceptance for Replacement Health coverage. You won’t be bothered with pesky medical questions — all you have to do is apply and they’ll get you started!
You can apply for any GMS plan as long as
- You are a Canadian resident
- You apply within 90 days after your group health plan ends
- You have valid provincial health insurance in place.
And, its great you know that your coverage can start on the date you choose, as long as its within 90 days of your other health benefits ending.
How do I choose the GMS Replacement Plan that’s right for me?
GMS Replacement Health Plans provide coverage for dental and/or prescription drug coverage, healthcare practitioners, home nursing care and emergency travel insurance. There are three easy to use, easy to choose GMS Replacement plans: EssentialPlan, ChoicePlan and PremierPlan.
Here is what’s built into all of these plans
Direct billing available
Use the GMS Pay-Direct Provider Locator to find health providers like pharmacies, dentists, and health and vision practitioners like massage therapists, chiropractors and optometrists near you that will bill GMS and they’ll pay them directly. Then there is no need for you to submit a claim yourself. For other covered expenses, you just send your claim online and sign up for direct deposit – you will get your money back faster.
GMS Care Network
Care Network is included in all Replacement Health Coverage Plans – at no extra charge. This assistance program offers services to help you with your physical, mental, financial and social wellbeing so you can be your best and most productive self.
GMS makes getting support easy, any time of day, any day of the year. You can access help just by using your phone or go online from wherever you are. Because you are unique, with your own needs, challenges, preferences and progress, Care Network treats you that way with life coaching to professional counselling, virtual doctor visits, and other secure online services.
Read this to discover everything the network offers: Let GMS Health Insurance Help You Live Well With Care Network – Special Benefits Insurance Services
Prescription Drug Lookup Tool
Use the GMS Prescription Drug Lookup Tool to stretch your benefit dollars and find out which drugs are covered under your plan. No more costly surprises when you visit the pharmacist. As part of their commitment to coverage and care, GMS Replacement Health customers are eligible for coverage for a wider range of prescription drugs than other insurance providers. If you can’t find what you’re looking for on the list, it doesn’t mean it won’t be covered; you just call GMS to find out. When a generic equivalent to a brand name drug exists, GMS will reimburse you based on the cost of the generic option. They offer coverage up to 80% of the generic price.
Looking for Extended Health and Dental Coverage Only? Choose EssentialPlan
The EssentialPlan covers the essentials that aren’t part of a government health plan so you can keep living a healthy lifestyle. Benefits include eye exams and glasses, chiropractor, naturopath, massage treatments, and dental coverage.
EssentialPlan also covers the added costs of an emergency, from ambulance, both ground and air, to the cost of medical equipment such as crutches or wheelchairs. With this plan, you don’t have to worry about anything other than the important things during an emergency.
Looking for Prescription coverage and Travel Insurance protection too? ChoicePlan is for you.
ChoicePlan is the plan for you. Benefits include prescription drugs, including ones for current health conditions, coverage for eyeglasses and contact lenses.
ChoicePlan also provides benefit coverage for a wide variety of other health needs, from dental coverage, acupuncture and chiropractor, a generous benefit for preferred hospital rooms and private-duty nursing plus, you get emergency medical travel coverage for an unlimited number of trips up to seven days outside of Canada and 183 days within Canada. The best part of this plan is the comfort of knowing you can keep your loved ones healthy and happy.
Want coverage for a current health condition and plan on travelling more? Choose PremierPlan.
This plan is called “Premier” for a reason. It provides the most comprehensive guaranteed issue coverage available from GMS and allows you to take care of your family even if your employment situation changes. It provides coverage for prescriptions drugs, including ones for current health conditions, dental coverage, and coverage for services such as massage and physiotherapy.
With the PremierPlan you are covered for everyday and emergency medical needs and enjoy the highest benefit for eye exams and eye wear. Emergency medical travel coverage is included for trips up to 15 days outside of Canada and 183 days within Canada.
Why purchase a Replacement health plan over a GMS Personal plan?
Both GMS Replacement Health and Personal Health products offer coverage for healthcare costs not covered by the government. Both types of plans have similar benefits, but Replacement Health plans are only for people losing coverage from a group benefits plan.
You can apply for a medically underwritten GMS Personal Health plan if you’re leaving a group plan. These plans are designed to give you choice and flexibility when it comes to which benefits you’d like to include. And if you have a pre-existing condition like high blood pressure, asthma or depression, a Personal Health Plan with the Enhanced Prescription Drugs Benefit option lets you use $800 of your yearly limit for drugs to treat pre-existing conditions.
Here’s what you should keep in mind: you have this one chance to buy the most comprehensive coverage with no questions asked. If you have a health condition, you will be covered.
You may decide to start with a basic plan to save money if you are in good health right now. If your health changes for the worse, you may need more protection – but you may have lost your chance to get it. When you upgrade, you will be asked medical questions. You may not be able to get an upgrade, you may be assessed a premium adjustment, or your condition may not be covered under the plan.
On the other hand, if you choose to start with the best plan but find you don’t need that much protection, it’s simple to “step down” to a less comprehensive plan (on your renewal date), and you will get the coverage you want.
Comparing plans can be tricky but getting coverage is easy!
Choosing the perfect health insurance plan takes some thought, but at SBIS we make applying for coverage easy! Go online and in a few minutes, your application will be on its way to GMS.
At SBIS, we can help you choose the GMS plan that best suits your needs and budget. Call us at 1-800-667-0429 or 416-601-0429 . Our business hours are Monday to Friday 8:45 a.m. – 4:45 p.m. eastern time.
