For Employers & Groups | MyCare Health Benefit Option (HBO) |

MyCare HBO Plan Details

Medical Second Opinions

A MyCare HBO plan member uncertain of a diagnosis or concerned about the prescribed treatment plan may request a medical second opinion.

No medical qualification, deductibles or co-payments
Limited travel expenses are included
Coverage to age 80
Cost paid directly to medical service provider(s)

Plan members may upgrade to MyCare Advantage. MyCare Advantage covers qualifying conditions that occur after policy inception.
*Per employee or association member.

A MyCare Second Opinion member uncertain of a diagnosis or concerned about the prescribed treatment plan may request a medical second opinion. This includes:

Complete file compilation
Electronic transfer of files
Retest of pathology
Additional specialist assessment(s)* if recommended by reviewing physician
Additional diagnostic scan(s)** if recommended by reviewing physician
Travel costs for approved specialist assessment(s) and diagnostic scan(s)
Analysis report including a review of current treatment protocol
Collaboration with attending Canadian physician
Direct consultation with reviewing physician(s)
Access to collaborative expertise by a team of physicians representing virtually every subspecialty of medicine.
Optional upgrade to full medical insurance for treatment. Medical services provided through MyCare Advantage.

*All specialist assessments performed in Canada.
** All diagnostic scans performed in Canada.

Pre-existing condition clause

Please inquire with us on a possible waiver of the pre-existing condition clause for MyCare Second Opinion, only when 50 or more members are added as a group.

Initial Diagnosis Assistance

Many Canadians have experienced long delays in finalizing a diagnosis of a serious illness* which can severely impact health and result in prolonged illness, delayed treatment and even death. Complex conditions requiring multiple specialist consultations can take years to diagnose and in some cases may never be accurately diagnosed. MyCare HBO works to ensure a correct diagnosis and treatment plan are identified in days or weeks, instead of months or years.

MyCare HBO members may request initial diagnosis assistance when their attending primary care physician (PCP) or attending specialist have a documented medical reason to suspect a serious illness may exist, as defined by the certificate, and that has not been diagnosed within sixty (60) days of the first evaluation.

*A sickness or injury that:
a) required inpatient care in a hospital or other medical facility; or
b) if left untreated is likely to result in significant deterioration of health and well-being, disability or death
c) relates to a major orthopaedic condition

Many Canadians have experienced long delays in finalizing a diagnosis of a serious illness which can severely impact health and result in prolonged illness, delayed treatment and even death. Complex conditions requiring multiple specialist consultations can take years to diagnose and in some cases may never be accurately diagnosed. MyCare Second Opinion works to ensure a correct diagnosis and treatment plan are identified in days or weeks, instead of months or years.

MyCare Second Opinion provides the following features:

Medical file compilation and review
Electronic transfer of files
Retest of pathology
Additional specialist assessment(s)
Additional diagnostic scans (MRI, CT, PET, etc.)
Travel costs for approved specialist(s) assessments and diagnostic scans
Collaboration with attending Canadian physicians
Analysis reports including treatment recommendations
Complex or difficult diagnosis – multiple specialist consultations
Optional upgrade to full medical insurance for surgery or treatment at a US Centres of Excellence via MyCare Advantage Insurance.

MyCare HBO Plan Details

If a plan member is uncertain of a diagnosis or has failed to obtain a diagnosis for a suspected serious illness within sixty (60) days of their first physician appointment, the plan member may request MyCare HBO assistance by emailing claims@mycare.ca or by calling 1-877-497-9495.

Medical File Compilation: MyCare will assist the plan member in collecting all pertinent medical information including medical records, test results, diagnostic imaging studies, treatment plans and any other information available. All information is accumulated and reviewed by our medical director or physicians associated with MyCare.

MyCare may transfer your medical file for medical file review by the appropriate treating physician(s).

Retest of Pathology: If pathology specimens have been taken, MyCare will collect those specimens to re-stain and re-analyze. Test results will be forwarded to MyCare for file inclusion and electronic transfer to treating facility.

Any additional specialist assessments or diagnostic scans (MRI, CT, PET, etc.) required to obtain a diagnosis, or as recommended by MyCare or the treating facility, are typically performed in Canada at approved diagnositic imaging centers.

The treating facility will thoroughly evaluate the information and provide a medical opinion on the diagnosis, recommended treatment options and/or surgical decisions. All recommendations are shared with the plan member’s attending Canadian physician(s).

WHAT DOES MYCARE HBO PROVIDE?

Upon verification and approval of the claim, MyCare HBO provides:

Medical file compilation*

Additional diagnostic scan(s) (MRI, CT, PET/CT, etc.)*
Collaboration with attending Canadian physician(s)
Electronic transfer of medical files to a top tier US healthcare facility as required
Diagnosis assistance for complex or difficult to diagnose conditions
Limited travel costs for approved specialist assessment(s) and diagnostic scan(s)

*As requested by MyCare Medical Director or treating facility. Note all specialist assessments and diagnostic scans are performed in Canada.

MyCare does not interfere in emergency medical care or medical services already scheduled in the public system.

MYCARE HBO IS SUBJECT TO A PRE-EXISTING CONDITION CLAUSE

A pre-existing condition means a condition for which a plan member is given medical care, treatment, services, medication, diagnosis, diagnostic test or consultation during the 24 months prior to the plan member’s effective date of plan membership. Services will not be available for the same medical condition(s) for the 12 months following the effective date of the plan membership (not applicable to groups with over 50 eligible employees). Major exclusions include congenital conditions, chronic conditions and related medical conditions.

MyCare HBO | FAQ

What is MyCare Health Benefit Option (HBO)?

MyCare HBO provides Plan Members access to the expertise and diagnostic excellence of world renowned Mayo Clinic. The collaboration between the top tier US healthcare facility and the Plan Member's Canadian physician(s) provides what we believe to be the most patient-centered health care model available.
How does MyCare HBO work?
If a Plan Member is uncertain of a diagnosis or has failed to obtain a diagnosis for a suspected Serious Illness within sixty (60) days of their first physician appointment, the Plan Member may request MyCare HBO assistance by emailing claims@mycare.ca.
- Medical File Compilation: MyCare will assist the Plan Member in collecting all pertinent medical information including medical records, test results, diagnostic imaging studies, treatment plans and any other information available. All information is accumulated and reviewed by our Medical Director or physicians associated with MyCare HBO.
- MyCare may transfer your medical file for medical file review by the appropriate treating physician(s).
- Additional Specialist(s) assessments or Diagnostic scans (MRI, CT, PET, etc.) required to obtain a diagnosis, as recommended by our MyCare Medical Director, are performed in Canada.
- All medical informaton will be thoroughly evaluated and a Medical Opinion will be provided on the diagnosis and recommended treatment options. All recommendations are shared with the Plan Member’s attending Canadian physician(s).
What if the treating facility recommends additional diagnostic scans or specialist assessments?

MyCare will schedule, in consultation with the plan member, required additional diagnostic scans (MRI, CT, PET, etc.) and/or specialist assessments in the geographical location closest to the plan member. Your MyCare HBO benefit covers all costs of these services including approved travel costs. MyCare will add diagnostic imaging results and specialist assessments reports to the medical file and electronically forward to the facility for additional review as required.
What if my attending physician wishes to discuss my case with the treating facility?

Once the treating facility has thoroughly evaluated the Plan Member's medical file and MyCare has forwarded the evaluation report to the Plan Member's physician, the attending physician may request to discuss the results and recommendations with the MyCare Medical Director, and if appropriate, a teleconference call will be arranged with the treating physician(s) providing the report.
How long does the process take from beginning to end?

The process typicaly takes from 2-4 weeks, depending on how quickly your medical file is received, the complexity of the case, and whether additional Specialist assessments and/or diagnostic imaging scans are required.
Does MyCare HBO have a pre-existing condition clause?

MyCare HBO is subject to a pre-existing condition clause. A pre-existing condition means a condition for which a Plan Member is given medical care, treatment, services, medication, diagnosis, diagnostic test or consultation during the 24 months prior to the Plan Member’s effective date of Plan Membership. Services will not be available for the same medical condition(s) for the 12 months following the effective date of the Plan Membership (not applicable to groups with over 50 eligible employees). Major exclusions include congenital conditions, chronic conditions and related medical conditions.

Note: a pre-existing condition applies when a Plan Member has consulted with one learned in medicine, regardless if a diagnosis has been provided or not.
How is serious illness defined?
Serious illness: A sickness or injury that:
1. requires Inpatient care in a hospital or other medical facility for 3 days or more; or
2. if left untreated is likely to result in significant deterioration of health, disability or death.
3. relates to a Major Orthopaedic condition
Why would Canadians want a medical second opinion?

Statistics reveal that more than 50% of serious illnesses are initially misdiagnosed. MyCare HBO offers more than just a medical second opinion; it also includes a complete review of your medical file, additional diagnostic tests if required (MRI, CT, PET Scans) as determined by our MyCare Medical Director, and access to an eConsult.
In the case of a medical second opinion, what if the treating facility recommendations go against my current prescribed course of treatment?

Copies of all test results, as well as an analysis and treatment recommendations made by the treating facility, are forwarded to the attending Canadian physician(s). The Canadian physician will be able to discuss the reports in detail with you and make knowledgeable recommendations to continue or change treatment based on the eConsult report prepared by the physician. MyCare HBO members who also have the MyCare Advantage upgrade may opt to receive treatment at the appropriate facility.
What is an eConsult and how does it work?

An eConsult is an electronic consultation between two or more health care providers designed to give patients the care they need while sparing them the time, stress and cost of unnecessary doctor's appointments and travel. The provider who initiates an eConsult formulates a specific clinical question for the treating physician. The question is received electronically, along with the patient's medical record, including test results and imaging studies. After reviewing the information, the specialist(s) answers the question and sends a recommendation back to the original provider, who shares the information with the client's attending physician.
What is MyCare Advantage?

MyCare Advantage is an optional insurance upgrade for MyCare HBO Plan Members. MyCare Advantage provides insurance coverage for medical treatment and related travel costs at the appropriate US healthcare facility for serious illness and/or major orthopaedic conditions occurring after inception of the Policy. Click here for more information on MyCare Advantage.