3. Our Medical Second Opinion Program
why and how does it work?
When one of your Insured is facing a serious illness, the feeling is nothing short
of overwhelming. So your Insured and his/her doctor want to be certain they’re
looking at every available option when they’re making critical decisions about the
health of your customer.
Our Medical Second Opinion program is a unique service available through
MediGuide Insurance Services International, a subsidiary of MediGuide America
a global leader in Second Opinion services. Members who have been diagnosed
with certain illnesses (more than 150 life threatening conditions) - can have their
diagnoses and perhaps even more importantly, their treatment plans evaluated by
researchers that are at the cutting edge of the science across the globe.
Giving your Insured access to an independent review from a World Leading
Medical Center(WLMC) - at no cost to them -, is the right thing to do and a good
first step. The program provides them with comprehensive information and
advice to help them make critical decisions about their health. And since time is
of the essence, Second Opinions are typically provided by the WLMC in writing
within ten business days - complete with background information on the
advising doctors and the WLMC. LifeLink will use the Medical Second Opinion as
a pre-certification for treatment in the selected World Leading Medical Center
- a cashless service for the insured - in case the Insured is eligible.
Because with a serious illness at hand, peace-of-mind may often be one of the
best medicines.
Questions & Answers
When should an Insured consider seeking a Second Opinion?
The universal and compelling need for a Second Opinion can be best arrived at
through an open discussion between the primary care physician, the Insured and
their family members.
Will MediGuide select the World Leading Medical Center?
MediGuide will - based on the condition of the Insured - select three highly
specialized Medical Centers. Based on the information that our medical doctor
will provide, the Insured can chose the WLMC that he/she believes is the best
choice.
If the insured chooses to receive a Second Opinion,
is there any cost?
No. There are absolutely no out-of-pocket costs for requesting or receiving a
Second Opinion. The Insured need make only a single phone call. MediGuide
does everything else, including collecting the Insured’s medical records and test
results, including pathology slides, when appropriate.
Will the Insured be seen by a doctor at the medical center they select?
No, their medical files will be collected and forwarded by overnight courier to the
selected Medical Center by MediGuide. Within ten business days your Insured and
his/her physician will receive an independent, written review of both the original
diagnosis and, very importantly, the proposed treatment plan.
Who will collect their medical records and will they remain private?
MediGuide will work with your Insured’s physicians to collect relevant medical
records and transmit them to the selected Medical Center. Be assured that we are
following the guidelines governing disclosure of personal medical information.
4. CANCER CONDITIONS
Adrenal cancer
Bladder cancer
Bone cancer - all forms
Breast cancer
Cervical cancer
Colon cancer
Colorectal cancer
Duodenal cancer
Endometrial cancer
Esophageal cancer
Eye cancer
Follicular cancer
Gallbladder cancer
Gastric cancer
Kidney cancer
Intestinal cancer
Laryngeal cancer
Liver cancer
Lung cancer
Malignant Soft Tissue
Medullary cancer
Melanoma
Metastatic Spine Tumor
Multiple Myeloma
Myelodysplastic Syndrome
(Myelodysplasia)
Neuroblastoma
Oral Cavity cancer
Ovarian cancer
Pancreatic cancer
Papillary cancer
Parotid cancer
Prostate cancer
Rectal cancer
Sarcomas
Skin cancer, non-melanoma
Stomach cancer
Testicular cancer
Thyroid cancer
Uterine cancer
Vaginal cancer
Vocal cord cancer
All cancers, whether listed above or
not, are covered by LifeLink
5. What is LifeLink and how will it help
your customers?
What is covered?
Once the Insured has decided to pursue treatment in one of our
World Leading Medical Centers for a treatment covered by LifeLink,
all medical expenses - up to the agreed upon limit ($500,000 to $1,000,000)
- are covered.
This includes doctor’s expenses, use of operation room, pharmaceutical
products and medicines, blood transfusions, and other medical expenses.
Business Class travel and lodging accommodation expenses during the
stay at the hospital are covered as well.
MISI has created the service package below to assist the Insured in this time
of stress.(on page 3 and following).
Which are the treatments covered
by LifeLink?
L Cancer treatment: including all treatments of a malignant tumor
diagnosed to have spread to surrounding areas or other organs
[Stages II, III or IV]. Possible treatments include chemotherapy, X-ray
therapy, and/or surgery.
L Neurosurgery: including any surgery or procedure that involves the
nervous system, this includes the brain, spinal cord and peripheral
nerves. Examples of conditions: brain tumors, aneurysm, injuries, etc.
L Coronary Artery By-Pass Surgery: includes open heart surgery that
restores normal blood flow to the heart that has been damaged by at
least 2 clogged or blocked arteries.
L Heart Valve Replacement: meaning a surgical procedure during which
surgeons remove or repair a damaged valve from the heart and substi-
tute a healthy one.
L Living Organ Donor Transplant: includes the transplant of a single kidney,
lung, segment of liver, or a portion of the pancreas.
The Insured’s organ is replaced with a compatible organ donated by a
compatible living donor.
L Bone Marrow Transplant: includes the transplant of bone marrow.
The bone marrow is compatible with another of the same kind,
originating from either the Insured (Autologous); or donated by a living
donor (Allogeneic).
The services rendered to the donor inclusive of accommodation and
medical expenses are included in the LifeLink program.
The costs of the treatment as well as the services (see next pages) are cash-
less to the Insured.
6.
7. How does your customer get to
the World Leading Medical Center,
and who will pay for it?
If an Insured makes the life-changing decision to have the medical treat-
ment for his/her life threatening situation in a foreign country, we will be of
assistance to assure that the additional challenges of such a trip are taken
care off. Given the serious condition of your Insured, LifeLink covers the
expenses of a round trip in Business Class for both the Insured and one
companion.
The Insured only need to call our local assistance center to get the journey
organized. Our local representative will book the trip and help with possible
Visa requirements.
LifeLink pays for the lodging of the Insured and a companion of the
Insured’s choosing, as well. If prior to the admittance in the World Leading
Medical Center, the Insured needs to spend a few nights in an hotel, those
expenses also will be covered. The lodging expenses of the companion will
be covered for a suggested period of 30 days (sub-limits may apply).
Our local representative will locate a good quality hotel as close to the
WLMC as possible.
In order to make the journey as smooth as possible, the Insured and their
companion will be picked up at the airport and driven to the hotel or WLMC.
Other than the incidentals, the Insured nor the companion will incur any
out-of-pocket expenses.
9. What if my customer doesn’t speak
the language of the country
they go for treatment?
Translation services
Because LifeLink covers your Insured in a foreign country exclusively (1)
, chances are that
the Insured is confronted with a medical team that doesn’t speak his/her native language.
LifeLink has organized a telephone translation service manned by medically trained staff, to
make sure that your Insured can have simultaneous translation when needed.
This translation service is available
365 days per year,
and 24 hours per day.
MISI offers - through a specialized provider -
a network of more than 10,000 inde-
pendently contracted global linguists that
offer a full suite of translation, localization
and interpretation solutions in over 200
languages.
The ability of our partner to take custom in-
formation relevant to each call means that
they can record vital extra information on
each call record. Commonly in insurance
this could be a claim number that their
systems can capture and present in the
management information, enabling you to
tie up who called, where they called from,
why they called, what the call was with
reference to.
This is on top of the standard call data of
start time, end time, language required, and
interpreter used.
Inbound calls can be met with IVR instantly
or by an agent within, at most, 15 seconds
of inbound activation. The finding of an
available interpreter is typically 20-30 sec-
onds for established clients (Our partner
connects over 95% of customer calls to an
Interpreter within an average of 60 seconds
monthly, and 85% of calls connected within
an average of 15-30 seconds monthly).
In case a pair of languages needs to be
matched that does not include English, the
calls will be scheduled and/or time slots for
the calls will be booked.
Consistent with our clients’ requirements,
all staff are required to sign strict confiden-
tiality and non-disclosure agreements.
The Linguists must also affirm that they
have read and agreed to comply with
industry recognized Codes of Ethics and
Professional Responsibility, which includes
the International Medical Interpreters Asso-
ciation (IMIA) Code of Ethics, established in
1987 and revised in 2006, and those of the
National Association of Judicial Interpreters
and Translators (NAJIT) and the American
Translators Association (ATA).
These processes ensure that protected
information that is disclosed during the
performance of an interpretation is held in
the strictest confidence.
(1)
China only plans are an exception to this rule.
10.
11. What if the treatment fails, and
the Insured dies in a foreign
country?
Repatriation of mortal remains
We will make sure your customers are getting ‘Closest to the Cure’.
However, no one can promise a cure and sometimes we will face the fact
that there is no cure.
The administrative processes that accompany the repatriation of a de-
ceased are not to be underestimated. In addition to that, the cost of the
transportation is very high.
In case of death of the Insured, this additional benefit will remove an enor-
mous burden from the family.
In the event of death of the Insured Person, LifeLink will organize and pay
the cost of returning his/her mortal remains to the Country of Residence or
the reasonable funeral and related costs if the body is buried or cremated
at the place of death.
LifeLink will also pay the cost of the coffin up to $1,000 (can be altered) in
the event the body is repatriated to the Insured’s country of residence.
13. Process to implement LifeLink
Non Disclosure Agreement:
outlines confidential material, knowledge, or information that the parties wish to share with
one another for the purpose of LifeLink, but wish to restrict access to or by third parties.
Memorandum of Understanding:
outlines the work and the commitment as well as the preparatory work that the various part-
ners - the Insurer, the Re-Insurer and MediGuide - have to perform within an agreed upon
time frame.
Re-Insurance Treaty:
the re-insurance treaty between the Insurer and Swiss Re outlines which part of the risk the
Insurer agrees to cede and which part Swiss Re agrees to accept.
Logistical (services and claims) flow:
LifeLink offers besides an insurance coverage a whole series of services that customers can
access. Service Level Agreements have been put in place with the various provides.
At the local level these global arrangements have to be localized.
Training:
LifeLink is a new concept, it is important that internal and external stakeholders are properly
trained.
Test & Launch
Who Covers What?
Medical Medical Travel Lodging Airport Translation Repatriation
Second Expenses Expenses Expenses Pick Up Services of Mortal
Opinion Remains
Insurer Q/S Q/S Q/S Q/S Q/S
Swiss Re Q/S Q/S Q/S Q/S Q/S
MISI 100% 100%
6
1
2
3
4
5
14. LifeLink
Swiss Re: MediGuide:
Asia: Christian Liechti +852 2582 5697 Danny Ramjit: + 1 302 425 5900
LatAm: Rolf Steiner +55 11 3073 8180
Europe: Agata Wielicka +49 89 3844 3944 MediGuide Insurance Services International
Africa: Henk Meintjes +272 1469 8463 Paul Vermeulen: +32 477 130 641
MediGuide | Insurance Services International | 162 Stone Block Row, Greenville DE 1980 | USA
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