Description of Benefits

If you are an Active Member, the benefits in this section apply to you and your eligible Dependents. WorldCare Second Opinion benefits cease in accordance with the “Termination of Member Coverage” provision or upon attainment of age seventy, whichever is earlier.

As the practice of medicine becomes more highly specialized, it can be difficult for any one physician to be aware of all of the latest information relating to the diagnosis and treatment of serious or complex diseases.

This benefit provides second opinion e-consultation services if you are diagnosed with a serious illness. Your medical records will be collected at the WorldCare hub in Boston and then forwarded to one of the leading medical institutions in the United States where a team of physicians will review your case. These experts will provide you and your physician with a report, confirming or modifying the diagnosis and suggesting the best treatment options.

The second opinion includes:

• Review of relevant medical records and supporting diagnostic information, and the interpretation of CT scans, MRI scan, X-ray, ultrasound, or other radiology or pathology studies by specialists,
• A written report which confirms a diagnosis and a suggested treatment plan,
• One follow-up second opinion, if necessary, and if additional diagnostic or consultation reports or questions related to the initial second opinion request are submitted within thirty days of receipt of the initial opinion report,
• An audio or video conference, if needed, between your physician and the consulting physician from the WorldCare network. 

Covered Serious Illnesses

Members and their eligible Dependents are entitled to receive Second Opinions for the following acute, complicated and serious medical conditions:

• Aids
• Hip/knee replacement
• Amyotrophic lateral sclerosis (ALS)
• Kidney failure
• Loss of speech
• Alzheimer’s disease
• Major or severe burns
• Any amputation
• Major organ transplant
• Any life threatening illness
• Major trauma
• Benign brain tumour
• Cancer
• Cardiovascular conditions
• Chronic pelvic pain
• Coma
• Deafness
• Multiple Sclerosis
• Neuro-degenerative disease
• Paralysis
• Parkinson’s Disease
• Rheumatoid Arthritis
• Embolism/Thrombophlebitis
• Stroke
• Emphysema
• Sudden blindness due to illness

Each Member or eligible Dependent is entitled to two Second Opinions in each year, up to a maximum of six per lifetime. 

Exclusions and Limitations

Conditions resulting from the following are excluded from coverage:

• Attempted suicide, self-inflicted injuries or injuries caused by a third person with the member’s knowledge,
• Alcohol or drug abuse,
• Radioactive contamination
• War or warlike operations (whether declared or not), riot, civil commotion, revolution, insurrections, conspiracy, or any events or causes which determine the proclamation or maintenance of martial law or state of siege
• Natural disasters such as fire, flood, earthquake, tornado, hurricane, and other Acts of God
• Poisoning or poisonous gas inhalation. 

How to Use the Program

To initiate your WorldCare consultation, contact WorldCare at the following number:

• Toll-free number 1-877-676-6439
• You may also learn more at www.worldcare.com.