Replacement Health Insurance

What is Replacement Health? Do I need it?

Leaving a group benefits plan shouldn’t mean losing the health services and supports you count on. Replacement Health is health insurance for retirees and the newly self-employed. We designed our health plans to give similar coverage to the group insurance you’re used to from your employer, but with GMS’s signature service combination of support, honesty, and ease.

Whether you’re recently retired or starting a new business on your own, what sets Replacement Health apart is our acceptance guarantee. This means you’re guaranteed coverage for the same health conditions and medications you had under your group plain.

The GMS difference

  • Comprehensive coverage. Don’t let a new venture or chapter stop you from accessing the services and supports you need.

  • Expert help when you need it. The GMS Customer Care team is here to answer questions and cheer you on.

  • Easy to enroll. Easy to claim. Skip the medical questions with guaranteed acceptance and submit your claims online to get cash back sooner.

Three easy to choose, easy to use health plans

EssentialPlan, ChoicePlan, and PremierPlan all deliver big benefits:

  • Guaranteed acceptance: Guaranteed acceptance means you’re minutes away from health insurance coverage. No questions asked.  
  • Direct billing available: Use our Pay-Direct Provider Locator to find health providers near you that will bill us and we’ll pay them directly.  

 

  • GMS Care Network: From life coaching to professional counselling, virtual doctor visits, and other secure online services, access around-the-clock care with GMS Care Network.
  • Prescription Drug Lookup Tool: Use our Prescription Drug Lookup Tool to stretch your benefit dollars and find out which drugs are covered under your plan.

Compare Replacement Health coverage

BenefitEssentialPlanChoicePlanPremierPlan
Prescription Drugs Not included80% coverage (maximum $1,250)80% coverage to (maximum $2,500).
Dental Care (Preventative, Basic, and Major Services)
  • 80% preventative & basic
  • 50% major
  • $1,000 combined maximum
  • 80% preventative & basic
  • 50% major
  • $1,250 combined maximum
  • 80% preventative & basic
  • 50% major
  • $1,500 combined maximum
Accidental Dental$2,000 maximum per injury$2,000 maximum per injury$2,000 maximum per injury
Private Duty Nursing80% coverage (maximum $1,000)80% coverage (maximum $3,000)80% coverage (maximum $5,000)
Preferred Hospital Room80% coverage (maximum $2,000)80% coverage (maximum $5,000)80% coverage (maximum $10,000)
Custom Foot Orthotics & Orthopedic Shoes$300$300$300
Health Practitioners 50% coverage ($600 combined maximum)80% coverage ($600 combined maximum)$600 combined maximum
Counselling Services Combined maximum of $65 per visit x 5 visitsCombined maximum of $65 per visit x 10 visitsCombined maximum of $65 per visit x 10 visits
Vision Care $100 per two years combined maximum, including one eye exam every two years$150 per two years combined maximum, including one eye exam every two years$300 per two years combined maximum, including one eye exam every two years
Hearing Aids$500 every five years$500 every five years$800 every five years

Coverage is per person. This is a summary of benefits only. 

Not sure which plan is right for you?


We’re happy to make a recommendation. Our Help Me Choose tool can recommend a plan for you in minutes.

Looking for a resouce?

Check out the GMS Resource Hub for a sample policy, forms, and other helpful information about replacement health insurance.

Visit the Resource Hub

Frequently asked questions (FAQs)

Am I eligible to buy a Replacement Health plan?

You can buy Replacement Health insurance if your coverage starts within 90 days of leaving a group plan. Replacement Health insurance is an excellent option if you recently retired, left your job to start a new business, are changing jobs, aged out of your parents’ work benefits plan, or changed your work hours and lost coverage as a result.

What’s the difference between a Replacement Health plan and a Personal Health plan?

Both are great health insurance options (if we do say so ourselves) because they cover health care costs that government plans don’t. Although they have similar benefits, Replacement Health plans are only available to people losing coverage from a group benefits plan. With Replacement Health, you’ll maintain coverage for conditions you were covered for under your group plan. Replacement Health plans come bundled based on typical group package offerings, so if flexibility is what you’re after then you may want to check out our Personal Health insurance plans. These plans are underwritten and priced based on a series of medical questions. 

When can my Replacement Health coverage start?

As long as your coverage starts within 90 days of your group benefits ending, the date is up to you.

Don’t see your question here? Check out our full list of Replacement Health insurance FAQs or contact us and we’ll get you an answer. 

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