Health Benefits Claim Form

For health claims submitted for the following plans: GMS Personal & Replacement Health Plans, GMS Group Advantage® and GMS Insured Group Benefit Plans. This form can also be used to submit dental claims. Here are some helpful hints on How to complete the Health Benefits Claim Form

Hospital Cash Claim Form

For Personal Health Plans with the Hospital Cash Option. Only for Hospital Cash claims.

Travel Emergency Medical Claim Form

Applicable to all emergency medical claims made while travelling outside your province of residence. Includes claims made in relation to these products: TravelStar® Single-Trip & Multi-Trip Annual Travel Plans, StudentPlan, GMS Personal and Replacement Health Plans. Also used for GMS Group Advantage® and GMS Insured Group Benefit Plans that include travel coverage.

Immigrants & Visitors to Canada Claim Form

For emergency medical claims made under GMS Immigrants & Visitors to Canada Daily and Annual Plans.

Trip Cancellation & Interruption Claim Form

For TravelStar Trip Cancellation & Interruption claims.

Baggage Claim Form

For TravelStar® Baggage Loss, Damage & Delay claims and Golf Clubs, Skis, Sports Equipment, Laptop & Computer Equipment claims.

Cost Plus Claim Form

For claims submitted through our Cost Plus Service.

General Forms

Information Update Form

For coordinating benefits from an existing health insurance plan with your GMS Personal Health Plan (Required if you have existing health coverage. See your policy for a definition of coverage that applies.)

Pre-Authorized Debit (PAD) Agreement

Authorizes a monthly debit from your bank account to pay your premium. This form can also be used to make changes to your pre-authorized debit information.

Pre-Authorized Debit (PAD) Cancellation Notice

Cancels a monthly debit from your bank account

Electronic Funds Transfer (EFT) Agreement

Authorizes direct deposit of Personal, Replacement Health and Group Plan claim payments to your designated bank account via electronic funds transfer

Request for Information Form

Request for the release of personal GMS information

Consent to Disclose Personal Information Form

Authorization for the release of personal information by GMS

GMS Privacy Release Form

Authorizes GMS to release information about a claim to a broker

GMS Out-of-Province Referral Approval Form

Request approval for an out-of-province medical referral

GMS Assignment of Payment Form

Assigns refunds or payments to another person

GMS Over-Age Student Dependant Declaration Form

Confirms an over-age dependant is enrolled in a post-secondary educational institution and is eligible for coverage or they are no longer enrolled and should be removed from a plan.

Application Form

TravelStar® Application Form

Application for TravelStar® Emergency Medical and Trip Cancellation & Interruption coverage.

Effective September 1, 2015

Policy Wording & Wallet Card

TravelStar Emergency Medical Policy Wording

Policy wording for TravelStar® Emergency Medical coverage.

Effective September 1, 2014

TravelStar Trip Cancellation & Interruption Policy Wording

Policy wording for TravelStar® Trip Cancellation & Interruption coverage.

Effective September 1, 2014

TravelStar Policy Wording Booklet

Combined policy wording for Emergency Medical and Trip Cancellation & Interruption coverage.

Effective September 1, 2014

TravelStar Emergency Assistance Card

Wallet card with GMS Travel Assistance phone numbers and space to fill in name, policy number, and policy expiry date.

Brochure with Rates

TravelStar® Brochure

Overview of the plan, including premium rates.

Effective September 1, 2015

Translated Brochures

TravelStar® Punjabi Brochure

Overview of the plan, including premium rates.

Effective September 1, 2015

TravelStar® Simplified Chinese Brochure

Overview of the plan, including premium rates.

Effective September 1, 2015

Application Form

Personal Health & Travel Coverage Application Form - Saskatchewan Residents

Printable application form for BasicPlan, ExtendaPlan® or OmniPlan® and Prescription Drugs, Dental Care, Hospital Cash and Annual Travel Options.

Effective Date: June 7, 2017

Personal Health Coverage Application Form - BC, AB, MB, ON, NS, PE, NL, YU, NWT, NU Residents

Printable application form for BasicPlan, ExtendaPlan® or OmniPlan® and Prescription Drugs, Dental Care, Hospital Cash and Annual Travel Options.

Effective Date: June 1, 2017

Personal Health & Travel Coverage Upgrade Form - Saskatchewan Residents

Printable form to upgrade plan type (ex: BasicPlan to ExtendaPlan) and/or add additional coverage options such as Prescription Drugs, Dental Care, Hospital Cash and Annual Travel.

Effective Date: June 1, 2017

Personal Health Coverage Upgrade Form - BC, AB, MB, ON, NS, PE, NL, YU, NWT, NU Residents.

Printable form to upgrade plan type (ex: BasicPlan to ExtendaPlan) and/or add additional coverage options such as Prescription Drugs, Dental Care, Hospital Cash and Annual Travel.

Effective Date: June 1, 2017

Policy Wording

Personal Health & Travel Coverage Policy Wording - Saskatchewan Residents.

Complete plan details and policy wording booklet.

Effective June 1, 2017

Personal Health Coverage Policy Wording - BC, AB, MB, ON, NS, PE, NL, YU, NWT, NU Residents.

Complete plan details and policy wording booklet.

Effective June 1, 2017

Brochures with Rates

Personal Health Coverage Brochure- Saskatchewan Residents

Overview of GMS Personal Health and additional coverage options; includes rate schedule and side-by-side benefit comparison of plan options.

Effective June 1, 2017

Personal Health Coverage Brochure - Alberta & Northwest Territories Residents

Includes the Alberta and Northwest Territories rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Personal Health Coverage Brochure - British Columbia & Yukon Residents

Includes the British Columbia and Yukon rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Personal Health Coverage Brochure- Manitoba & Nunavut Residents

Includes the Manitoba and Nunavut rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Personal Health Coverage Brochure - Ontario Residents

Includes the Ontario rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Personal Health Coverage Brochure - Atlantic Residents (NS, PEI, NL)

Includes the Nova Scotia, Prince Edward Island and Newfoundland and Labrador rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Translated Brochures - Simplified Chinese

Simplified Chinese Personal Health Coverage Brochure- Saskatchewan Residents

Overview of GMS Personal Health and additional coverage options; includes rate schedule and side-by-side benefit comparison of plan options.

Effective June 1, 2017

Simplified Chinese Personal Health Coverage Brochure - Alberta & Northwest Territories Residents

Includes the Alberta and Northwest Territories rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Simplified Chinese Personal Health Coverage Brochure - British Columbia & Yukon Residents

Includes the British Columbia and Yukon rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Simplified Chinese Personal Health Coverage Brochure- Manitoba & Nunavut Residents

Includes the Manitoba and Nunavut rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Simplified Chinese Personal Health Coverage Brochure - Ontario Residents

Includes the Ontario rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Simplified Chinese Personal Health Coverage Brochure - Atlantic Residents (NS, PEI, NL)

Includes the Nova Scotia, Prince Edward Island and Newfoundland and Labrador rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Translated Brochures - Punjabi

Punjabi Personal Health Coverage Brochure- Saskatchewan Residents

Overview of GMS Personal Health and additional coverage options; includes rate schedule and side-by-side benefit comparison of plan options.

Effective June 1, 2017

Punjabi Personal Health Coverage Brochure - Alberta & Northwest Territories Residents

Includes the Alberta and Northwest Territories rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Punjabi Personal Health Coverage Brochure - British Columbia & Yukon Residents

Includes the British Columbia and Yukon rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Punjabi Personal Health Coverage Brochure- Manitoba & Nunavut Residents

Includes the Manitoba and Nunavut rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Punjabi Personal Health Coverage Brochure - Ontario Residents

Includes the Ontario rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Punjabi Personal Health Coverage Brochure - Atlantic Residents (NS, PEI, NL)

Includes the Nova Scotia, Prince Edward Island and Newfoundland and Labrador rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Application

Replacement Health Plan Application Form

Printable application form for Replacement Health Coverage.

Effective June 1, 2015

Policy Wording

Replacement Health Coverage Policy Wording Booklet

Complete plan details and policy wording booklet.

Effective June 1, 2017

Brochures with Rates

Replacement Health Coverage Brochure - Saskatchewan

Includes the Saskatchewan rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Replacement Health Coverage Brochure - Alberta and Northwest Territories

Includes the Alberta and Northwest Territories rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Replacement Health Coverage Brochure - British Columbia & Yukon

Includes the British Columbia and Yukon rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Replacement Health Coverage Brochure - Manitoba & Nunavut

Includes the Manitoba and Nunavut rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Replacement Health Coverage Brochure - Ontario

Includes the Ontario rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

Replacement Health Coverage Brochure - Atlantic (NS, PEI, NL)

Includes the Nova Scotia, Prince Edward Island and Newfoundland and Labrador rate schedule and side-by-side comparison of plan benefits.

Effective June 1, 2017

GMS Group Advantage® Documents

GMS Group Advantage Application Form

Application for GMS Group Advantage® insurance

Effective January 1, 2017

GMS Group Advantage Employee Enrolment/Change Form

For enrolling employees into a GMS Group Advantage® plan and/or changing information for existing members

Effective January 1, 2017

GMS Group Advantage Booklet Package

Overview of GMS Group Advantage® including rates, plan comparisons, FAQ, and forms

Effective January 1, 2017

Custom Group Benefit Plan Documents

GMS Group Benefit Plan Application – AL

Application for Custom Quoted Group Benefit insurance *Life & Disability Benefits provided by Assumption Life

GMS Group Benefit Plan Enrolment Change Form – AL

For enrolling employees into a GMS Group Benefit Plan and/or changing information for existing members *Life & Disability Benefits provided by Assumption Life

GMS Group Benefit Plan Application – CO

Application for Custom Quoted Group Benefit insurance *Life & Disability Benefits provided by Co-operators Life

GMS Group Benefit Plan Enrolment Change Form – CO

For enrolling employees into a GMS Group Benefit Plan and/or changing information for existing members *Life & Disability Benefits provided by Co-operators Life

Group Benefit Plan Application Form - WA

Application for Custom Quoted Group Benefit insurance *Life & Disability Benefits provided by Wawanesa Life

Group Benefit Plans Employee Enrolment/Change Form - WA

For enrolling employees into a GMS Group Benefit Plan and/or changing information for existing members *Life & Disability Benefits provided by Wawanesa Life

Group Benefit Plan Application Form - Without Life

Application for Custom Quoted Group Benefit insurance *For use with group plans which do not include Life & Disability Benefits

Group Benefit Plans Employee Enrolment/Change Form - Without Life

For enrolling employees into a GMS Group Benefit Plan and/or changing information for existing members *For use with group plans which do not include Life & Disability Benefits

Brochure

Group Benefit Plans Brochure

Overview of GMS Group Advantage® and customized group benefit plans

Effective January 1, 2017

Other Forms

Waiting Period Waiver Form

Application to waive standard waiting period for group benefit coverage

Over-Age Student Dependant Declaration Form

Confirms an over-age dependant is enrolled in a post-secondary educational institution and is eligible for coverage or they are no longer enrolled and should be removed from a plan.

Online Administration Account Registration Form

Application to create an account to use the online plan administrator's tool

Application Form & Eligibility Questions

GMS Immigrants & Visitors to Canada Application Form

Use this printable version of GMS Immigrants & Visitors to Canada application to apply for coverage.

Effective March 2017

GMS Immigrants & Visitors to Canada Eligibility Questions

A one-page summary of the questions used to determine if a person can purchase an plan.

Effective January 2017

GMS Immigrants & Visitors to Canada Claim Refund Waiver

Use this form when requesting a refund on a GMS Immigrants & Visitors to Canada policy.

Effective March 1, 2016

Policy Wording & Wallet Card

GMS Immigrants & Visitors to Canada Policy Wording

Policy wording for GMS Immigrants & Visitors to Canada plan

Effective March 2017

GMS Immigrants & Visitors to Canada Emergency Assistance Card

Wallet card with GMS Travel Emergency numbers and space to fill in name, policy number and policy expiry date.

Brochure with Rates

GMS Immigrants & Visitors to Canada Brochure

Overview of the GMS Immigrants & Visitors to Canada plan with benefit listing and premium rates

Effective March 2017

Translated Brochure & Eligibility Questions

GMS Immigrants & Visitors to Canada Punjabi Brochure

Overview of the GMS Immigrants & Visitors to Canada plan with benefit listing and premium rates

Effective March, 2017

GMS Immigrants & Visitors to Canada Simplified Chinese Brochure

Overview of the GMS Immigrants & Visitors to Canada plan with benefit listing and premium rates

Effective March, 2017

GMS Immigrants & Visitors to Canada Traditional Chinese Brochure

Overview of the GMS Immigrants & Visitors to Canada plan with benefit listing and premium rates

Effective March, 2017

GMS Immigrants & Visitors to Canada Eligibility Questions - Punjabi

A one-page summary of the questions used to determine if a person can purchase an plan in Punjabi.

Effective January 2017

GMS Immigrants & Visitors to Canada Eligibility Questions - Simplified Chinese

A one-page summary of the questions used to determine if a person can purchase an plan in Simplified Chinese.

Effective January 2017

GMS Immigrants & Visitors to Canada Eligibility Questions - Traditional Chinese

A one-page summary of the questions used to determine if a person can purchase an plan in Traditional Chinese.

Effective January 2017

Application Form

StudentPlan Application Form

Application for the plan, including premium rates

Effective June 1, 2009

Policy Wording

StudentPlan Policy Wording

Overview of the plan, premium rates and policy wording

Effective July 1, 2012

Brochure with Rates

StudentPlan Brochure

Overview of the plan, including premium rates

Effective June 1, 2009

Submitting Claims

Help on submitting your health and travel claims

General Frequently Asked Questions

Answers to common questions about GMS