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MyCare HBO

Mycare Health Benefit Option

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 Mayo Clinic 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 through our partner. MyCare HBO Plan Members may upgrade to MyCare Advantage to receive medical treatment at Mayo Clinic.

  • Medical File Compilation: Our partner 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.
  • Our partner will transfer your medical file using Mayo Clinic's Clinicdesk e-format interface for medical file review by the appropriate Mayo Clinic physician(s).
  • Retest of Pathology: If pathology specimens have been taken, our partner will request PMI Labs of Vancouver, BC to collect specimens to re-stain and re-analyse. Test results will be forwarded to our partner for file inclusion and electronic transfer to Mayo Clinic.
  • Additional Specialist(s) assessments or Diagnostic scans (MRI, CT, PET, etc.) required to obtain a diagnosis, or as recommended by Mayo Clinic, are performed in Canada.
  • Mayo Clinic 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).

To learn more about MyCare HBO, call (778) 331-0386 or toll-free at 1-855-491-8808.

Why would Canadians want a medical second opinion?

U.S. statistics reveal that more than 50% of serious illness are initially misdiagnosed, and it is likely that these statistics are just as applicable in Canada. MyCare HBO offers more than a second opinion; it also includes a Mayo Clinic eConsult, retest of pathology at Canadian-approved labs, and additional diagnostic tests if required (MRI, CT, PET Scans).

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 Mayo Clinic facility for serious illness and/or major orthopaedic conditions occurring after inception of the Policy. Click here for more information on MyCare Advantage.

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 provider who initiates an eConsult formulates a specific clinical question for the Mayo Clinic team. The question is received electronically, along with the patient's medical record, including test results and imaging studies. After reviewing the information, the Mayo Clinic specialist(s) answers the question and sends a recommendation back to the original provider, who shares the information with the client's attending physician.

How long does the process take from beginning to end?

Depending on the complexity of the case and whether additional Specialist assessments and/or diagnostic imaging scans are required, the process, including pathology re-testing, typically takes from 4-6 weeks.

What if Mayo Clinic recommends additional diagnostic scans or Specialist assessments?

Our partner 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. Our partner will add diagnostic imaging results and Specialist assessments reports to the medical file and electronically forward to Mayo Clinic for additional review.

What if my attending physician wishes to discuss my case with Mayo Clinic?

Once Mayo Clinic has thoroughly evaluated the Plan Member's medical file and our partner 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 Mayo Clinic physician(s) providing the report.

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 group membership. Services will not be available for the same medical condition(s) for the 12 months following the effective date of the group membership (not applicable to groups with over 50 eligible certificate holders). Major exclusions include congenital conditions, chronic conditions and related medical conditions.

How is Serious Illness defined?

Serious illness: A sickness or injury 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 health and wellbeing, disability or death.
  3. Major Orthopaedic conditions or procedures

In the case of a Medical Second Opinion, what if Mayo Clinic recommendations go against my current prescribed course of treatment?

Copies of all test results, as well as the analysis and treatment recommendations made by Mayo Clinic, are forwarded to the attending Canadian physician(s). The Canadian physician will be able to discuss the reports in detail with their patient and make knowledgeable recommendations to continue or change treatment based on the eConsult report prepared by the Mayo Clinic physician. MyCare HBO members who have upgraded to MyCare Advantage may opt to receive treatment at the appropriate Mayo Clinic facility.

Who is responsible for the administration of MyCare HBO?

MyCare HBO is administered by Pacific Rim Administration Services Ltd. (PRAS), Burnaby, BC . PRAS has 32 years' experience in administrating private health insurance plans and corporate group benefits programs. PRAS has the requisite licensing, systems and experience required to efficiently administer the MyCare group programs in Canada.

MyCare HBO references PMI Labs-what does PMI offer?

PMI Labs (Perceptronix Medical Inc. Laboratories) is a private anatomical pathology laboratory with focus on quality and fast turn-around time. PMI will provide their services to MyCare patients for a full spectrum of diseases, with specialized expertise in oncologic pathology, cytopathology, oral pathology, and pathology consultation. http://www.pmilabs.com