GMS TravelStar Application
Instructions
• If you are 60 years of age and over and are applying for emergency medical coverage please fill in all sections except C, F and J.
• If you are less than 60 years of age and are applying for emergency medical coverage please fill in all sections except C, D, F and J.
• If you are applying for trip cancellation and interruption coverage please fill in all sections except B, D, F and J.
• If you would like to have an optional medical review of your application, complete section F in addition to the other applicable sections.
Important Information
• Medical conditions which are not stable for 180 days prior to your departure will not be covered under a TravelStar Emergency Medical Policy.
• A medical condition is stable if, during the period of time specified, you:
• have not received new medical treatment;
• have not been prescribed a new prescription drug;
• have not had a change in medical treatment;
• have not had an alteration in a prescribed drug;
• have not experienced a deterioration in your condition;
• have not experienced new, more frequent or more severe symptoms;
• have not had or required medical consultation to investigate symptoms that remain undiagnosed;
• have not required in-hospital care or a referral to a specialist, including initial follow-up visits, test or investigations related to the medical condition and pending results; and/or
• do not anticipate further medical treatment after departure from your province of residence.
• When purchasing a Multi-Trip Annual plan, medical conditions you experience after the effective date but prior to the departure date of any trip are subject to the stability exclusion.
• Should any changes to your health occur after the application date and prior to the effective date, GMS must be notified and the application updated.
A change in your health may:
• affect your eligibility for coverage; or
• increase your required premium.
Changes to your health that do not affect eligibility will still constitute a change in stability and may limit your available coverage.
• In the event of a medical emergency you must call GMS Travel Assistance no later than 24 hours after receiving medical treatment or being admitted to a hospital:
Toll-free (within Canada and the USA): 1 800 459 6604
Collect (from all other locations): 1 905 762 5196
Failure to contact GMS Travel Assistance may limit your benefits.
• In the event of a claim, documentation confirming departure and return dates will be required. Examples of this documentation include airline tickets or itineraries, gas receipts, and hotel receipts.
B. Eligibility for Emergency Medical Coverage
You (refers to any person who is eligible for coverage) are not eligible to purchase emergency medical coverage if:
• you will be 80 years of age or older on the effective date when purchasing a Multi-Trip Annual plan;
• you have an Implantable Cardioverter Defibrillator (ICD);
• you have ever been diagnosed with congestive heart failure (CHF);
• you are awaiting further tests or treatment for heart disease which includes but is not limited to angina, irregular heartbeat, heart attack, ischemic heart disease, valvular heart disease, and/or myocardiopathy;
• you require insulin to treat diabetes and also take prescription drugs for heart disease (see 4. above for heart disease description);
• you have been diagnosed with metastatic cancer;
• you have cancer (except breast or prostate cancer treated exclusively with hormonal therapy or basal cell carcinoma) which requires chemotherapy, radiotherapy or other medical treatment other than routine follow-up;
• you have any vascular aneurysm that remains surgically untreated;
• you have undiagnosed episodes of fainting or falling (syncope);
• you take oral steroids for a lung condition;
• you are 70 years of age or older and require assistance from another person(s) with activities of daily living (ADL) which include, but are not limited to, personal hygiene and grooming; dressing and undressing; self-feeding; functional transfers (getting into and out of bed or a wheelchair, getting onto or off of the toilet, etc.); bowel and bladder management; and/or medication management;
• have any medical condition necessitating the use of home oxygen;
Within 12 months prior to applying you have been diagnosed with any of the following conditions or you have any of the following conditions which have not been stable for 12 months prior to applying:
• Acquired Immune Deficiency Syndrome (AIDS)
• peripheral vascular disease;
• terminal illness (an advanced stage of a progressive disease with an
• stroke/transient ischemic attack (TIA); unfavourable prognosis and no known cure);
• blood clot(s);
• atrial flutter
• gastrointestinal bleeding; and/or
• atrial/ventricular fibrillation;
• kidney/liver failure;
Within 12 months of applying you have undergone any of the following procedures:
• kidney dialysis
• valve surgery or replacement and/or
• organ, stem cell and/or bone marrow transplant
• you are not a Canadian resident with valid provincial health coverage for the entire duration of your trip;
• you are purchasing after your departure or outside of your province of residence, unless purchased as a top-up to an existing GMS policy; or
• your total trip length exceeds the total number of days allowable under your government health plan.
C. Eligibility for Trip Cancellation & Interruption Coverage
You (refers to any person who is eligible for coverage) are not eligible to purchase trip cancellation and interruption coverage if:
• you are not a Canadian resident;
• you purchased the plan after your departure date;
• you did not purchase through a travel supplier or arranged through a licensed travel agent;
• your trip destination is deemed a country to avoid non-essential travel or avoid all travel as identified in Foreign Affairs and International Trade Canada; and
• if your trip is valued at $12,000 per person or greater you do not meet the Eligibility for emergency medical coverage (section B.) as well.
Trips booked under a Multi-Trip Annual plan must start and end after the effective date and prior to the expiry date of the plan and must meet eligibility conditions 2 through 5 to be eligible for coverage under the plan.
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Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel
Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel