GMS 50

Step-by-Step Guide to Filing Claims with GMS 50

1. Log In to the GMS 50 Portal

• New Users:
  • Visit GMS 50 Login Portal and click “Register”.
  • Enter your policy number and certificate number (provided by your employer or insurer).
• Existing Users:
  • Log in using your credentials.

Key Note: Ensure your browser is updated to avoid compatibility issues 1.

‍2. Select the Appropriate Claim Type

‍GMS 50 supports claims for:

• Health Services (e.g., paramedical, prescriptions).
• Dental Services (e.g., cleanings, fillings).
• Travel Insurance (emergencies abroad).

Exclusions:

• Occupational Therapists and Social Workers must submit claims manually via mail 1.

3. Prepare Required Documentation

• Original Receipts: Must include:
  • Provider name, license number, and address.
  • Service date, description, and total cost.
• Completed Claim Form: Download from GMS Insurance Documents Hub (e.g., Health/Dental Claim Form)
• Procedure Codes: Include valid CPT/HCPCS and ICD-10 codes for medical services

Important:

• No Coordination of Benefits: GMS 50 does not support secondary claims submissions

4. Submit Your Claim Electronically

1. Upload Documents:
   • Log in to the portal and navigate to “Submit a Claim”.
   • Upload scanned copies of receipts and forms (JPEG/PDF/PNG).
2. Review Details:
   • Verify service dates, costs, and provider information.
3. Submit:
   • Click “Submit” and note the confirmation number.

Processing Time:

• Claims are adjudicated 24/7 (except Sundays 12 AM–7 AM EST) and typically processed within 1 business day

5. Track and Follow Up

• Check Status: Use the “Claims History” tab in the portal for real-time updates.
• Payment Details:
  • Direct Deposit: Payments are issued twice monthly (5th and 20th)
  • Cheques: Available for providers not registered electronically (a fee applies)

Denied Claims:

• Resubmit with corrected documentation or contact GMS Customer Care at 1-800-563-3274

Special Cases

Direct Billing for Providers

• Assignment of Payment: If your plan permits, providers can bill GMS 50 directly. Confirm eligibility with your healthcare provider

Travel Insurance Emergencies

1. Contact Assistance: Call the emergency number on your GMS travel insurance card.
2. Submit Post-Trip: Upload receipts and a completed Travel Claim Form

Key Tips for Success

• Avoid Delays: Submit claims within 12 months of the service date.
• No Predetermination Requests: GMS 50 does not accept electronic predetermination submissions
• Paper Statements: Providers can request paper statements via 1-800-563-3274

Troubleshooting

• Complaints: Escalate unresolved issues through GMS’s Complaint Resolution Policy:
  1. Contact Customer Care.
  2. Escalate to a supervisor.
  3. Submit to the GMS Ombudsman

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Frequently Asked Questions (FAQs): GMS 50 Insurance

1. What types of claims can I submit through GMS 50?

GMS 50 supports claims for health services (e.g., paramedical, prescriptions), dental services, and travel insurance emergencies. However, occupational therapists and social workers must submit claims manually via mail

2. How do I submit a health or dental claim online?

1. Log in to your My GMS account.
2. Navigate to “Submit a Claim” and select Health or Dental.
3. Upload original receipts (JPEG/PDF/PNG) and complete the claim form.
4. Submit and track status under “Claims History”.
   Note: Claims are processed within 1 business day (excluding Sundays 12 AM–7 AM EST)

3. Can my healthcare provider bill GMS 50 directly?

‍Yes! Use your GMS Pay-Direct Card at participating pharmacies, dentists, or paramedical providers (e.g., massage therapists, optometrists) to skip manual claims. Check eligibility using the Pay-Direct Provider Locator

‍4. What documents do I need for manual claims?

• Original receipts (photocopies not accepted) with:
  • Provider name, license number, and address.
  • Service date, description, and total cost.
• Completed claim form (download from GMS Forms Library)

5. How long does GMS 50 take to process claims?

• Online submissions: Typically processed within 1 business day.
• Mail submissions: Allow 7–14 business days plus mailing time

6. What is the deadline to submit claims?

‍Claims must be filed within 12 months of the service date. Travel insurance claims (e.g., baggage loss) also follow this deadline 67.

‍7. Does GMS 50 cover paramedical services like physiotherapy?

‍Yes! Most plans cover physiotherapy, chiropractic care, acupuncture, and massage therapy. Check your policy’s “Extended Health Benefits” section for annual limits (e.g., 250–250–500/year)

‍8. How do I track my claim status?

‍Log in to your My GMS account → Navigate to “Claims History” for real-time updates. Payments are issued twice monthly (5th and 20th) via direct deposit or cheque

‍9. What if my claim is denied?

‍Common reasons include:

• Missing receipts or incomplete forms.
• Exceeding coverage limits (e.g., annual paramedical caps).
• Services not covered under your plan.
  Resubmit with corrections or contact GMS Customer Care at 1-800-563-3274

10. How do I submit a travel insurance claim?

1. Emergency assistance: Call 1-800-459-6604 immediately 5.
2. Post-trip submission: Submit receipts and a completed Travel Claim Form online or mail to:
   GMS Travel Claims
   2055 Albert Street, PO Box 1949
   Regina, SK S4P 0E3 7.

11. Does GMS 50 support coordination of benefits?

‍No. GMS 50 does not process secondary claims. Submit to your primary insurer first

‍12. Can I upgrade my coverage mid-policy?

‍For Personal Health plans, benefits are fixed. Contact GMS at 1-800-667-3699 to explore new plans or add-ons (e.g., dental, travel insurance)

‍Key Tips

• Direct Deposit: Enroll via My GMS for faster reimbursements
• Travel Insurance: Verify if your plan includes coverage for emergencies abroad
• Reasonable & Customary Limits: Check your policy for maximum reimbursements based on provincial averages

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