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MYCARE HEALTH BENEFIT OPTION (HBO)

MYCARE HEALTH BENEFIT OPTION (HBO)

Time is of the essence when a serious illness strikes. MyCare Health Benefit Option (HBO) provides the ultimate health benefit to Canadians. MyCare provides members and their families immediate access to a collaborative Mayo Clinic consultation in the event of a serious illness or major orthopaedic issue which includes:

 

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 plans 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

 

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.

 

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 Mayo Clinic 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 Mayo Clinic. 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 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 using Mayo Clinic’s Clinic desk e-format interface for medical file review by the appropriate Mayo Clinic 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 Mayo Clinic.

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

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).

 

APPLY FOR MYCARE HBO

Please note that MyCare HBO is only eligible to group members. Payment of premiums will be completed via your employer's Third Party Administrator - please contact them for any questions regarding applying.

MyCare Health Benefit Option - Frequently Asked Questions

  • 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 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 using Mayo Clinic’s Clinic desk e-format interface for medical file review by the appropriate Mayo Clinic 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 or Mayo Clinic, 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 Mayo Clinic 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 Mayo Clinic for additional review as required.

  • 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 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 Mayo Clinic 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 or Mayo Clinic, and access to a Mayo Clinic eConsult.

  • 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 an 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 you and make knowledgeable recommendations to continue or change treatment based on the eConsult report prepared by the Mayo Clinic physician. MyCare HBO members who also have the MyCare Advantage upgrade may opt to receive treatment at the appropriate Mayo Clinic 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 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.

  • 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.

MAYO CLINIC IS A WORLD-RENOWNED MEDICAL FACILITY

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Specialized Doctors

Mayo Clinic doctors cover virtually every specialty and subspecialty.

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Complete specialty medical services all under one roof.

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Reinvesting earnings to improve medical practice, research and education.

Contact Us

The goal of MyCare HBO is to provide access to medical services by world-renowned Mayo Clinic in the case of serious illness or major orthaepadic conditions. We value your feedback and will take the time to carefully review your questions and submissions regarding MyCare programs and our website in general.

For questions, concerns or other requests, please do not hesitate to contact us.

MyCare HBO Program
Phone: 1-877-497-9495
Email: info@mycare.ca


MyCare HBO Program
PO Box 36045, Lakeview RPO
Calgary, AB T3E 7C6

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