IFB Spring 2015 Summits:Living Well with Group Medical Services.

Agenda

• About GMS• Target Market Segments• Features• Individual Health Plan Types• Additional Coverage Options• Completing an Online Application

GMS Individual Health InsurancePresenter: David Roberts

About GMS (Group Medical Services)

• GMS has been providing a complete range of health and travel insurance to groups and individuals since 1949.

• Our head office is in Regina, Saskatchewan

• We underwrite our health, dental and travel products

• We have clients and brokers coast to coast

Individual Health & Dental:Target Market Segments1. Guaranteed Replacement Health – Employee Transition (June 1st 2015).

2. Personal Health (Sole Proprietors, Contractors, Home based business).

3. Seniors 65+ supplemental coverage.

Target Market Segments

• Those without a group benefits plan− Young adults – who are no longer dependents− Young families− Entrepreneurs and home-based business owners – with fewer than 3

employees− Contract/part-time workers− Retirees – replacement for their group plan− Seniors – ambulance coverage for unexpected emergencies− Great for transitioning away from a traditional group plan!

FeaturesUnderwritten plan & Guaranteed Replacement.

GMS Individual Health Features

• Comprehensive Coverage – to supplement provincial health coverage

• Flexible Plan Design – freedom to customize with many options

• Outstanding Customer Service – dedicated broker assistance line

• Quick Manual Claims Turnaround – within three to five days, new Client Portal with claims submission & look up.

• “My GMS” for online claims submission & claims history…so you can get money in your hands faster!

• Affordable Premiums – annual or monthly.

• Pay-Direct Card – for drugs, dental & travel.

Individual Health Plan Types1. Core Personal Coverages: Omni, Extenda & Basic…Plus flex-options.

2. Guaranteed Replacement Health, Launch: June 2015. Includes three comprehensive options: PremierPlan, ChoicePlan, EssentialPlan.

Summary of BenefitsBenefits OmniPlan® ExtendaPlan® BasicPlan

Eye Exams $90 per 2 years $90 per 2 years n/a

Eyeglasses & Contact Lenses $200 per 2 years n/a n/a

Health Practitioners $35/visit, maximum $300 per specialty $35/visit, $250 combined maximum n/a

Hearing Aids $800 per 5 years $500 per 5 years n/a

Health Supplies & Equipment $500 $500 n/a

Diabetic Supplies & Equipment

$300 $300 n/a

Oxygen Equipment $500/year; $2,500 lifetime max $500/year; $1,500 lifetime max n/a

Blood Pressure Monitor 1 per policy per 5 years 1 per policy per 5 years n/a

Custom Made Foot Orthotics 80% - 1 per 3 years adults; 1 per year <16 years 80% - 1 per 5 years adults; 1 per year <16 years n/a

Therapeutic Shoes $225 $225 n/a

Mobility Aids $300/policy/year $300/policy/year n/a

Ostomy Supplies $300 $300 n/a

Funeral Expenses $4,000 n/a n/a

Out-of-Province Referral $50,000 per person lifetime max $50,000 per person lifetime max n/a

Ambulance Unlimited Unlimited $2,000

Air Ambulance Unlimited Unlimited Unlimited

Casts and Crutches Unlimited Unlimited Unlimited

Preferred Hospital Rooms 45 days to $3,500 $1,000 $500

Private Duty Nursing 80% to $5,000 80% to $3,000 80% to $1,500 (in-hospital only)

In-Hospital Drugs $2,000 $1,000 $1,000

Accidental Injury to Natural Teeth $5,000 per injury $2,000 per injury $500 per injury

Wheelchairs, Motorized Scooters& Adjustable Beds

$1,000 per person per 5 years $750 per person per 5 years $500 per person per 5 years

Artificial Eyes, Limbs & Larynx $5,000 $5,000 $5,000

Patient Walkers 80% to $300/policy/5years 80% to $300/policy/5years 80% to $300/policy/5years

Breast Prosthesis $325 single;$650 bi-lateral/2 years  $325 single;$650 bi-lateral/2 years  $175 single;$350 bi-lateral/2 years 

Travel30 days, $2,000,000 maximum out-of –country and out-of-province

48 or 63 days, $500,000 to $2,000,000 max, out-of country and out-of-province

n/a

BasicPlan

Contains 11 benefits not included in provincial health plans including:

Preferred hospital rooms

In-hospital private duty nursing

In-hospital drugs

Ground & air ambulance

BasicPlan Benefits

Ground Ambulance: $2,000

Air Ambulance: unlimited

Casts & Crutches: unlimited

Preferred Hospital Rooms: $500

Private Duty Nursing: 80% to $1500 (in-hospital only)

In-Hospital Drugs: $1,000

Accidental Injury to Natural Teeth: $500/injury

Wheelchairs, Scooters & Adjustable Beds: $500/person/5 years

Artificial Limbs, Eyes & Larynx: $5,000

Patient Walkers: 80% to $300/policy/5 years

Breast Prosthesis: $175 single; $350 bilateral/2 years

ExtendaPlan®

More extensive coverage and higher maximums: Ambulance: unlimited Air Ambulance: unlimited Diabetic Supplies: $300 Eye Exams: $90 per 2 years Preferred Hospital Rooms: $1,000 Private Duty Nursing: 80% to $3,000 Accidental Dental Injury: $2,000 per injury Wheelchairs, Motorized Scooters

& Adjustable Beds: $750/person/5 years Breast Prosthesis: $325 single; $650 bilateral/2 years Travel: 48 or 63 days, $500,000 to $2 million coverage

ExtendaPlan® - Additional Benefits

Health Practitioners: $35 per visit/$250 combined max

Hearing Aids: $500/5 years

Health Supplies & Equipment: $500 per policy per year

Oxygen Equipment: $500 per year; $1500 lifetime max

Blood Pressure Monitors: 1 per policy per 5 years

Therapeutic Shoes: $225 per policy per year

Custom Made Foot Orthotics: 80% - 1 per 5 yrs adults; 1 per yr < 16 years

Mobility Aids: $300 per policy per year

Ostomy Supplies: $300 per policy per year

Out-of Province Referral: $50,000 per person lifetime maximum

OmniPlan®

Our most comprehensive plan. Includes all the benefits of ExtendaPlan® with these enhancements:

Health Practitioners - $300 per specialty

Hearing Aids - $800 per 5 years

Oxygen Equipment - $2,500 lifetime max

Custom Made Foot Orthotics - 1 per 3 years

Preferred Hospital Rooms - 45 days to $3,500

In-Hospital Drugs - $2,000

Accidental Dental Injury - $5,000 per injury

Wheelchairs, Motorized Scooters & Adjustable Beds - $1,000/person/5 years

OmniPlan® - Additional Benefits

Eye Exams: $90 per 2 years

Eyeglasses & Contact Lenses: $200 per 2 years

Funeral Expenses: $4000 (accidental death)

Travel: 30 days, $2 million maximum coverage

Additional Coverage OptionsPrescription Drugs, Dental & Emergency Travel

Additional Coverage OptionsBasic Prescription Drug Coverage – $3,500 for formulary drugs (excludes pre-existing conditions). A $4 charge per prescription applies.

Enhanced Prescription Drug Coverage – $5,000 per person/year for formulary prescription drugs and oral contraceptives. Includes $800 formulary and non-formulary for pre-existing conditions A $4 charge per prescription applies.

Hospital Cash – $100 per day up to $3000 per policy year. Cash can be used for personal expenses. Coverage begins on 4th day for accident/sickness; 7th day for maternity

Dental Care – three month wait period1st year - 75% basic to $500 max2nd year - 80% basic/50% major to $750 max*3rd year - 80% basic/50% major to $1000 max

*GMS will bump individuals to 3rd year dental if coming off another dental plan.

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Formulary and Non-Formulary Drugs

Each province has a listing of therapeutically effective and proven high quality drugs that have been approved for coverage under the province’s drug plan

Non-formulary drugs are not included in the provincial formulary and may have different costs involved

GMS Individual Health Overview

• Online application with immediate approval

• GMS very rarely declines applications and effective in June 2015 Replacement Health will launch.

• One year renewable product.

• Effective date is either the 1st or 15th of month.

• Family policy includes up to six individuals.

GMS Individual Health Overview

• No wait period for most benefits

• One year waiting period for hearing aids, wheelchairs, motorized scooters, and adjustable beds

• If converting from a GMS group plan within 60 days, no medical underwriting is required

• Dental waiting period of 3 months unless purchased within 60 days of leaving another plan

• Upgrading to 3rd year dental if previous coverage was similar

Upgrades & Changes

• Plan upgrades can be made at any time during policy year. The policy is cancelled and a new policy is applied for.

• Clients pay the prorated balance for remaining term of policy year

• Plans may be cancelled at any time during policy year

• Options may be deleted or changed only on the policy renewal date

• Travel benefits have no waiting period and are effective the date of the upgrade

Completing an Online ApplicationFast and Efficient!

Getting Started: Using the GMS Broker Portal

Go to www.gms.ca and click on login on the top right

The login screen will appear prompting you to enter your username and password

The Applications Shortcuts on the left side of the broker page provides access to all GMS online applications

Click Individual Health under application shortcuts

GMS provide web-links from your site to our online system…just let us know your interested.

Payment

When paying annually, three payment options are presented:

• Credit card (Visa or Mastercard)• Cheque• Cash

GMS Travel InsurancePresenter: David Roberts

Product Overview

TravelStar® Travel InsuranceEmergency Medical CoverageTrip Cancellation & Interruption

CoverageSingle-Trip and Multi-Trip Annual

Plan Types

Additional CoverageBaggage Loss, Damage & Delay

Increased Per Item Baggage Limit$1,000 increase per item or set of items

Sporting GoodsAdditional $2,000 per item insured

Computer EquipmentAdditional $2,000 per item insured

Trip Delay Upgrade (for delays longer than 12 hours)

$500 per day subsistence expense $200 entertainment and same class

tickets

Immigrants & Visitors to Canada

Target Market

Visitor(s) or immigrant(s) travelling to Canada

The visitor(s) or immigrant(s) Canadian family.

VTC Daily vs Annual Plan?

DailyPurchased for the number of days

required to maximum of 365 days

Policy ends when policyholder returns to country of origin

For short-term travel needs

Up to $150,000 in coverage

Provides an option for a refund on unused days

AnnualPurchased for 365 days from the

effective date of plan

No limitations on number of trips or duration of stay in Canada

Can travel to USA, Mexico and back to country of Origin

Up to $150,000 in coverage

No Refunds

StudentPlanOutside the province or Country.

StudentPlan: Who’s covered?

The student

Spouse of the student

Parents of the student

Looking for more CE credits?GMS Learning Centre

https://learning.gms.ca/#/login

GMS Living WellSocial Media Brand

@GMSLivingWell

QuestionsThank you for considering Group Medical Services!