MyCare Advantage | FAQ

• How would MyCare Advantage benefit me and my family?

  Serious illness can strike at any time. 

  When faced with a serious illness it is important to have access to credible knowledge and expertise, information about all possible treatment options, and the ability to receive timely treatment. 
  
  The MyCare Insurance Program allows you to access this expertise as an extension of the care you already receive in Canada. This collaboration provides what we believe to be the most patient-centred care model for Canadians.

• Why would Canadians want a medical second opinion?

  U.S. statistics reveal that more than 50% of serious illnesses are initially misdiagnosed, and it is likely that these statistics are just as applicable in Canada. MyCare Advantage offers much more than a second opinion. It includes coverage for a consultation, e-Consult, a retest of pathology at Canadian-approved labs as appropriate, additional diagnostic tests if required (ex. MRI, CT, PET scans), in addition to treatment recommendations.

  The process may also involve collaboration with your Canadian physicians, coordinated through MyCare's medical director. MyCare Advantage intends to relieve some of the stress when dealing with a Serious illness and provides Canadians with a complete picture of the medical options available to them through the MyCare Insurance Program.

• What is the pre-existing condition clause?

  The intent of MyCare Advantage is to provide the Insured Person access to Top North American Healthcare Facilities expertise for medical opinions and medical services and/or treatment for a serious illness or a major orthopaedic concern, which occurs or is diagnosed after the inception date of the Policy.

  A Pre-Existing Condition* means:

  • Congenital and chronic medical conditions, and bariatric surgery.
  • Medical conditions for which the Insured Person received treatment prior to the inception date of the policy and for which they have not received medical care, services, medication, diagnosis, diagnostic test or consultation in the 24 months prior to the Insured Person’s effective date of coverage may be covered by the policy.
  • Related chronic medical conditions, which in the 24 months prior to the inception date of the policy, existed, was suspected to exist or has been diagnosed, are not covered by the policy. An example would be a heart condition that occurs as a result of diabetes.

  * The Pre-Existing Condition descriptions are for illustration purposes only. While every effort has been made to ensure the accuracy of these descriptions your rights and benefits are governed by the Policy wording. The Policy wording will prevail if they differ from the descriptions above.

• What if I have symptoms and have seen a doctor, but don't yet have a diagnosis and/or can't be diagnosed?

  Prior to the effective date of coverage, any symptoms that would cause someone to seek a medical diagnosis or treatment qualifies under the pre-existing condition clause.

• How long will it take for the MyCare Advantage program to obtain my medical records, send them to a Top North American Healthcare Facility, and receive the medical report?

  In Canada, medical files belong to the patient. Clinics are obligated to provide file copies upon request. Once received, the file is entered into a secure electronic medical file system and forwarded to a Top North American Healthcare Facility. If required, arrangements will be made with the patient to obtain previously acquired pathology samples or specimens for re-testing, the results of which will again be electronically transferred to the chosen Healthcare Facility. Once all documents are received by the claims coordinator, we estimate this process will take seven to 14 days, inclusive of claims approval and receipt of the analysis and treatment reports from the Healthcare Facility.

• If this is the first supplemental health care insurance product of its kind available in Canada, how do I know my claims will be covered? How do I know this is a valid insurance product?

  MyCare Advantage is the first of its kind. While other medical opinion programs may be available, they do not compare with the collaborative and leading-edge eConsult method or provide the coverage of diagnostic testing and treatment to Canadians that the MyCare Insurance Program offers.

  MyCare Insurance Program has been sold since 2011 and is underwritten through various globally respected, international health insurance providers.

• What types of diagnosis or medical conditions warrant a reassessment?

  Any serious illness such as cancer, heart or a major orthopaedic condition, as well as complex, difficult to diagnose health issues, are eligible for a medical opinion.

• What will happen in the event that the recommendations go against my current prescribed course of treatment?

  Copies of all test results, as well as the analysis and treatment recommendations made by the Healthcare Facility are forwarded to the attending Canadian physicians. The attending physician may occasionally request a direct discussion with the healthcare facility physician who performed the eConsult. This request can be made through the MyCare Medical Director.

  The attending Canadian physician will be able to discuss reports in detail with their patients and make knowledgeable recommendations to continue or change treatment based on the eConsult report provided. When eligible and if necessary, patients are able to receive treatment at an appropriate North American Healthcare Facility. 

• How long will it take for me to be assigned testing or treatment procedures at a North American Healthcare Facility?

  Once approved, testing and treatment at the chosen Healthcare Facility is coordinated by the scheduling office, usually within seven to 10 days.

• When does the MyCare Advantage policy take effect?

  Pending review, coverage begins on the first of the month following the date of your application. 

• What defines a serious illness?

  MyCare Advantage is intended to cover serious illness or major orthopaedic conditions occurring or diagnosed after the inception of the policy, including conditions that have not been diagnosed in Canada within 60 days of the first evaluation. Serious illness means any illness or injury (as defined) that:

  1. requires inpatient care in a hospital or other medical facility; or
  2. if left untreated is likely to result in significant deterioration of heath or wellbeing, disability or death.
  3. relates to major orthopaedic conditions as defined provided they fall within a) or b) above.

  Major orthopaedic condition means any condition or procedure concerned with the musculoskeletal system, including bone and joint replacement and spinal procedures, excluding arthroscopic procedures, day procedures or those conditions or procedures which do not meet the definition of serious illness.

• How does MyCare Advantage differ from critical illness insurance products currently offered in Canada?

  MyCare Advantage is focused exclusively on offering a clear path, consistent advice, and comprehensive support. It aims to provide the best available health care options, in the least amount of time, while minimizing patient stress.

  Critical Illness (CI) programs provide a cash payout should the client receive a diagnosis of a life-threatening or incurable illness (ex. Alzheimer’s disease). Statistics reveal that in most cases people receiving a CI payout do not use the funds as intended: to investigate and access alternative health care options.

• Will all records of any procedure or test I undergo be communicated to my Canadian physician(s)?

  Yes. All test results, treatment recommendations, and reports on treatment provided are copied and forwarded by MyCare to the attending Canadian physician(s). On occasion, the patient’s Canadian physician(s) may also request, through the MyCare Medical Director, a direct consultation or discussion with the physician(s) involved in the case.

• How will the process of post-operative or post-procedural care be undergone? Will the Healthcare Facility remain in communication with my physician(s) after these procedures? For how long?

  As physicians collaborate every step of the way with the MyCare Medical Director, follow-up care or continued medical treatment can occur through the patient's provincial health plan in their province of residence. Once a client becomes a patient, ongoing interaction with the treating physician will depend on the diagnosis and level of acuity. If you receive care and so authorize, the treating facility will send a medical summary to your treating physician in Canada.

• Does MyCare Advantage cover my course of treatment should I choose to participate in a research or clinical trial?

  No, the policies do not include coverage for participation in research or clinical trials.

• What is an eConsult and how does it work?

  An eConsult is an electronic consultation between two 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 patient's medical record, test results and imaging studies are forwarded electronically to the chosen Healthcare Facility by our MyCare Medical Director, with a request for initial diagnosis assistance or a medical second opinion. After a thorough file review, the specialist(s) send back their diagnosis, medical second opinion and/or recommendations. All information is shared with the client's attending physician.
   

• Is MyCare available for my group or employees?

  Yes. See Employers & Groups. Please email us at info@mycare.ca for more information or call 1.877.497.9495.

• As an agent or broker, can I sell the MyCare Advantage to my clients?

  Yes. Please visit the Agent & Brokers section of our site to obtain more information.

• Can I use my Private Health Services Plan (PHSP) with MyCare Advantage?

  Yes. If you already have a PHSP set up, the premiums can be paid via the PHSP, creating a tax deduction for the corporation (employer) and a non-taxable benefit to the employee. Please email us at info@mycare.ca for more information.