Frequently Asked Questions

We have a network of brokers offering our products in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Newfoundland, Nova Scotia, and Prince Edward Island. Please call our Customer Care Centre toll-free at 1.800.667.3699 to find the broker nearest you.

You sure can. When you sign up for a My GMS account on gms.ca, you can submit and view processed claims and payments, sign up to have claims deposited directly into your bank account, and view your Explanation of Benefits – anytime!

Our policy for non-sufficient funds (NSF) payments reads as follows: When Group Medical Services (GMS) receives payment that, when deposited, is returned marked Non-Sufficient Funds (NSF) or Funds Not Cleared, GMS shall provide an opportunity for the payer to make proper payment or to arrange for a satisfactory payment schedule. A $25 fee will be collected from the payer by GMS to cover administrative and banking fees related to the returned payment. As well, all claims payments will be put on hold until full payment plus NSF fee is made. If payment is not received within thirty (30) days or the payment schedule is not adhered to, GMS will take the appropriate action. Effective April 1, 2010

We have a Privacy Policy that sets out our commitment to responsibly using the personal information we need to provide products and services. The policy outlines the restrictions on our collection and use of personal information and the safeguards we have in place to protect it.

 
Step therapy is a program for people who take prescription drugs regularly to treat a medical 
condition, such as arthritis, asthma or high blood pressure. It allows you and your family to receive 
the affordable treatment you need and helps your organization continue with prescription-drug 
coverage. 
In step therapy, drugs are grouped in categories, based on treatment and cost: 
 
 • Front-line drugs — the first step — are generic and sometimes lower-cost brand drugs proven to be safe, effective and affordable. In most cases, you should try these drugs first because.They usually provide the same health benefit as a more expensive drug, at a lower cost. 
 
• Back-up drugs — Step 2 and step 3 drugs — are brand-name drugs that generally are necessary for only a small number of patients. Back-up drugs are the most expensive option. 
 
Download additional materials to learn more about how Step Therapy works.

Start with a first-step drug  

• Your health care provider diagnoses you with a condition needing treatment.  
• You’re prescribed a first-step drug (cost-effective option), and your claim is automatically approved and paid.  
 
 You can qualify for a second-step drug  

• If the first step drug doesn’t deliver or stops delivering the desired health benefits, then you can try a more expensive second step drug.  
• If you are seamlessly eligible for a second step drug at the pharmacy, the claim will automatically be paid and approved. Please note actual out of pocket will be dependent on drug cost and plan design.  
 
Find the Step Therapy Drug List here.

When you save a quote, you’ll receive an email notification with your quote information. We’ll keep that information for 60 days so you can complete your purchase when it works best for you. When you’re ready to return to the application, click the “Buy Now” button in your notification email. You’ll receive a reminder email ten days before your quote expires.

No. A quote isn’t guaranteed. A number of changes to the saved quote, such as a change in age or rate changes, could impact the quoted premium. We will automatically update any current saved quotes to reflect price changes. If there is a price change you'll be notified when you open a saved quote. The rate will be updated and a pop-up message will inform you of the updated premium. The expiry date is also always noted on the quote PDF.

Yes. By returning to the original quote and saving it again. The new quote will be re-saved for another 60 days. Please note a new quote number will be issued.

Using our online Claim Submission Form is a quick and easy way to send us your claim—plus it is available 24/7. Please note you will need to send scans of your receipts when using the online form. To make sure your claim is processed quickly and accurately please:

• check-off the Declaration statement;
• use the Attachments section to include your scanned receipts; and
• click the “Submit Claim” button.

If you're sending us health and dental claims through the mail, simply complete a GMS Health Benefits Claim Form and attach the original receipts for the product or service you're claiming. Completed forms and receipts can be mailed to:

Group Medical Services
Claims Department
2055 Albert Street
PO Box 1949
Regina, SK S4P 0E3

Please Note:

• GMS does not return receipts, so be sure to keep copies of receipts if you require them to co-ordinate claims with other insurers or for income tax purposes.
• Claims must be submitted within 12 months of the date of service in order to be eligible for reimbursement.
• If your individual or group health and dental policy terminates, you must submit claims to GMS within 30 days following the date of termination of the policy.

Yes! Using your Pay-Direct card, Dentists, Pharmacists as well as certain Health and Vision service providers can bill GMS directly. That means you don't have to fill out any claim forms. Check our Provider Locator to find Health and Vision service providers in your area.

They're a maximum amount for a service or item that we set. When reviewing claims, the R&C for a service or item is factored in.

To come up with these limits, we calculate the average cost health providers charge for their service or item. We also account for the province where the service is provided.

R&C limits reduce the likelihood of claims fraud or abuse. And that helps keep the price of our plans competitive.