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1. What is the Preferred Care program?
2. What does it cover?
3. What is a critical condition and how does it differ from other conditions?
4. Why these condition treatments? Six does not seem like many conditions.
5. Why do you call this a "program"; isn't it just medical insurance for treatment in the U.S.?
6. You mention "top-rated U.S. hospitals"; which specifically do you mean and how do I know that they are really the best?
7. What are the eligibility requirements and will I need to have a medical examination to join?
8. This program sounds too expensive for me. What does it cost?
Policy and Benefits Questions
9. How soon after joining can I request treatment for a covered condition?
10. Whom should I contact first when I believe that I may have a covered condition that requires treatment?
11. How often can I request treatment?
12. Do I have to pay for this "diagnosis verification and treatment plan" if I am a member of Preferred Care?
13. Will my doctor be comfortable sharing my medical information with the PGH National Medical Advisor and U.S. Medical Specialist? Will I need to sign a "release" for my medical records to be sent to PGH's National Medical Advisor?
14. Will my membership fee increase if I request or am approved for treatment?
15. How long does it typically take for me to receive a Diagnosis Verification and Treatment Plan (DVTP) once my medical file is dispatched to the U.S for review?
16. What happens if my request for treatment in the U.S. is turned down or if there is a difference of medical opinion between my personal physician and U.S. medical specialist?
17. Who decides at which U.S. hospital I receive care?
18. How does PGH decide where a patient receives care?
19. What if I want to be treated at a different hospital than the one PGH has selected?
20. How will my U.S.-based specialist be chosen and what if I would prefer another doctor?
21. If I decide to seek treatment in the U.S. after I receive my Diagnosis Verification and Treatment Plan (DVTP), will the same specialist who completed my DVTP be the specialist who will be my treating physician in the U.S.?
22. Once my treatment is approved, what happens next?
23. How long does it take to make the treatment and travel arrangements?
24. May I purchase my own airplane tickets for my trip to the U.S.?
25. May I take my spouse and children with me?
26. What if I and/or my companion need a visa?
27. If I choose not to take a companion with me to the U.S., do I get to keep the excess money from my travel limit?
28. Will I receive an itinerary before I leave and will I know the length of my stay before departure?
29. Will I be met at the airport upon arrival at the U.S. treatment destination, and if so by whom? If I am not fluent in English, will this person speak my language?
30. What if my flight is delayed or some unforeseen eventuality was to happen en-route to my treatment destination in the U.S.?
31. How is an "Episode of Treatment" defined?
32. What if my condition recurs when I return to my home country?
33. What if illness strikes while I am on visiting the U.S. (on vacation or business for instance)?
34. What if I need or want additional treatment performed during my approved treatment in the U.S. that is not a covered condition under the Preferred Care program?
1. What is the Preferred Care program?
Preferred Care is an innovative health care program designed to increase your chance of survival when diagnosed with a critical illness. It gives its members access to critical illness treatment at a top U.S. hospital and provides financial protection for care and treatment. Preferred Care bridges the gap in health care by bringing top medical expertise to local care. It identifies, finances and delivers global best practice while quality-controlling the entire process from initial diagnosis to recovery, and eliminating the need for the patient to worry about things like reimbursement hassles and scheduling appointments, therefore fostering a focus on getting well. Preferred Care provides support to the patient by giving them a team of professionals working for them and being there every step of the way.
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The program covers six major critical condition treatments:
- Cancer treatment
- Heart surgery for coronary bypass, valve replacement or repair
- Intervention to open narrowed coronary arteries
- Neurosurgery for tumors and vascular repair
- Major vascular surgery
- Major organ transplants
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3. What is a critical condition and how does it differ from other conditions?
Critical conditions, also known as “Tertiary Conditions”, are classified as the highest, and subsequently most life-threatening, level of medical condition. These conditions by their very nature require the most advanced modern medical technology and expertise available to achieve the most effective treatment and rapid recovery. The United States is the undisputed leader in this field.
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4. Why these condition treatments? Six does not seem like many conditions.
The above critical conditions represent more than 80% of the critical conditions that people travel to seek advanced treatment. While Preferred Care covers six conditions, the list of diagnoses that fall in the condition categories is quite broad. For example, Preferred Care covers all types of cancers (with the exception of non-invasive skin cancers), while many lump-sum critical illness insurance providers seemingly include more conditions but are restrictive. The Preferred Care program is not designed to compete with or replace treatment for lower level conditions that can frequently be treated effectively in a member’s local country.
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5. Why do you call this a “program”; isn’t it just medical insurance for treatment in the U.S.?
Many companies can offer payment for treatment abroad and will claim to offer you coverage for your choice of treatment in the United States or Europe. If you read the fine print though, you will discover that coverage is only offered under special conditions (such as temporary trips overseas, emergencies, etc). Furthermore, making and paying for all the necessary arrangements is strictly your burden, and many times you have to pay for all of it out of your own pocket, meanwhile hoping that reimbursement comes before the crushing financial burden of bill payment causes you and your family serious disruption.
The Preferred Care program was designed specifically to bring you to the top-ranked hospitals in the United States, where our best practice approach can currently be supported. PGH makes the payment directly to the provider, causing you no financial disruption. Furthermore, Preferred Care pays for all the necessary additional services for you and a companion. This includes airfare and a generous accommodation allowance, all up to a limit of USD 20,000 - the highest you are likely to find anywhere. And perhaps most importantly, you and your family have the full support of a team of trained professionals to quality control the treatment process and be there with you every step of the way, from the time you first indicate and are approved for treatment, to the time you are happily recovered back in your home country.
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6. You mention “Top-Rated U.S. Hospitals”; which specifically do you mean and how do I know that they are really the best?
The Preferred Care program only participates and approves for members U.S. hospitals that have been ranked in the top 1% of those listed in U.S. News & World Report’s “America’s Best Hospitals” issue and guidebook. U.S. News & World Report is a globally recognized U.S. newsmagazine that specializes in objective evaluation of leading U.S. medical and educational institutions. It is PGH’s pledge to always strive for the most accurate and unbiased selection of the finest U.S. hospitals for its members. PGH is not owned in any part by any U.S. hospital and can therefore guarantee a completely fair and objective selection of top U.S. hospitals for members.
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7. What are the eligibility requirements and will I need to have a medical examination to join?
The program is available to all, except residents of the United States, U.S. Virgin Islands, Bermuda, and Puerto Rico, (including non-U.S. resident expatriates) who are between the ages of 1 and 74 (although you are only eligible to join up until the age of 74, members can renew their policies until the age of 99). Only a simple application and medical questionnaire need to be filled out to apply. In most cases a medical examination is not necessary.
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8. This program sounds too expensive for me. What does it cost?
Surprisingly less than you imagine. See your local sales agent or contact PGH by telephone at +1 617 369 7900 or by e-mail at info@pghworld.com for more information and to get a free quote for you, your loved ones, and your co-workers.
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Policy and Benefit Questions
9. How soon after joining can I request treatment for a covered condition?
You may request treatment 90 days after approval for the Program for all covered conditions that have not been specifically excluded or except for pre-existing conditions. A pre-existing condition is defined as any medical conditions for which the Covered Person received medical treatment or advice within forty-eight (48) months prior to the effective date of his/her Policy coverage, or conditions of which the Covered Person was aware before the effective date of his/her Policy. It does not include any such conditions, which had been given to the Company in writing and had been accepted by the Company.
After 24 months of continuous coverage the Covered Person will be eligible to apply for insurance cover of any excluded condition, provided that the Covered Person has not consulted any physician for advice, treatment or any medical examination and has remained free from taking any form of medication including drugs, medicines, special diet or injections for the condition in question for such continuous forty-eight (48) month period prior to receiving treatment for such condition.
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10. Whom should I contact first when I believe that I may have a covered condition that requires treatment?
You should first notify Preferred Care’s Member Services by calling +1 617 369 7920. This will connect
you with PGH Care Management Services.
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11. How often can I request treatment?
The Preferred Care program has no limitations on the number of times you may request treatment.
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12. Do I have to pay for this “Diagnosis Verification and Treatment Plan" (DVTP) if I am a member of Preferred Care?
The diagnosis verification is your right as a Preferred Care member.
Nonetheless, the cost of the necessary preliminary diagnostic tests required to initiate the diagnosis verification is not covered under the program. These costs can either be paid by you directly to your personal physician or can be covered by your primary medical insurance or national health care system, whichever is applicable in your particular case. Therefore it is important that you consult with your personal physician before initiating a
diagnosis verification from the Preferred Care program.
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13. Will my local doctor be comfortable sharing my medical information with the PGH National Medical Advisor and U.S. Medical Specialist? Will I need to sign a “release” for my medical records to be sent to PGH’s National Medical Advisor?
The PGH National Medical Advisor will work with your local doctor to
provide the highest level of professional care. Your personal doctor should do whatever is required to give you the peace of mind that you deserve when you face treatment for a critical condition.
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14. Will my membership fee increase if I request or am approved for treatment?
No. The membership fee will not automatically increase.
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15. How long does it typically take for me to receive a Diagnosis Verification and Treatment Plan once my medical file is dispatched to the U.S. for review?
PGH tries to ensure that diagnosis verification and a suggested treatment plan are available within 7 to 10 business days from the time that all of your medical records and required test results are received by the U.S. medical specialist who will be performing the diagnosis verification.
Care Management Services works to identify the most appopriate specialist to complete the DVTP as soon as a member notifies PGH of a covered condition diagnosis. Usually a specialist is chosen before the medical records even arrive in the U.S.
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16. What happens if my request for treatment in the U.S. is turned down or if there is a difference of medical opinion between my personal physician and U.S. medical specialist?
It is very unusual for a member to be denied a request for treatment when the diagnosis verification process is followed appropriately. Our only reason for denying treatment is if it is for the safety of our members. It is Preferred Care’s commitment to process your diagnosis verification quickly and equitably. You can rest assured that PGH, who coordinates and makes final decisions on treatment approval, will always approve treatment that is medically necessary. Since PGH is not an insurer, but an independent company contracted to coordinate expert diagnosis verification and provide patient support, it can guarantee an equitable decision. It will always be our commitment and in our interest that you, the member, are given the best and fairest treatment that you deserve.
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17. Who decides at which U.S. Hospital I receive care?
PGH.
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18. How does PGH decide where a patient receives care?
A number of factors influence this, including:
- Where PGH believes a high degree of quality care can be obtained given a patient’s particular situation.
- The urgency of a patient’s situation
- How quickly PGH can get a patient into a hospital or to a certain physician for needed care
- Available hospital and physician capacity
- Quality of service and attentiveness to a Preferred Care member’s needs from particular hospitals
- Member's personal physician’s preferences, if preferences are backed up by meaningful medical reasons.
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19. What if I want to be treated at a different hospital than the one PGH has selected?
While PGH will give all consideration to reasonable treatment location
requests when medically sound, final decisions on location of treatment will be at PGH’s sole discretion.
Teaming for success is essential; we work with those hospitals that see the value of the PGH model and welcome the Personal Care Manager as part of the team.
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20. How will my U.S.-based specialist be chosen and what if I would prefer another doctor?
PGH Care Management services identifies specialists that are Harvard-affiliated (usually this means that they are professors of medicine at Harvard Medical School) and have certain credentials. These credentials can include level of expertise in a certain condition or procedure, experience, research interests and involvement, and other factors that PGH feels would best qualify them to treat our members. PGH often looks to its medical board to make recommendations on the best physician for the patient. The specialists who complete the Diagnostic Verification and Treatment Plan (DVTP) are also chosen in this manner.
Because PGH is confident in the quality of its specialist recommendations, requests by our members for a particular specialist will be considered by PGH if preferences are backed up by meaningful medical reasons.
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21. If I decide to seek treatment in the U.S. after I receive my Diagnosis Verification and Treatment Plan (DVTP), will the same specialist who completed my DVTP be the specialist who will be my treating physician in the U.S.?
It is common that a specialist who completes a DVTP for a member then becomes the U.S.-based treating physician, although it does not always occur. Usually this will be determined according to scheduling and the urgency of the patient's condition.
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22. Once my treatment is approved, what happens next?
PGH Care Management Services will be in close contact with you and make all the necessary arrangements for your travel, accommodations and medical services.
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23. How long does it take to make the treatment and travel arrangements?
Within 48 hours of your indicating that you wish to receive care in the U.S., PGH Care Management Services (in cooperation with you, your personal physician and the U.S. hospital) will schedule an admission/commencement of treatment date within the following 4 weeks.
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24. May I purchase my own airplane tickets for my trip to the U.S.?
PGH Care Management Services will arrange air travel. If you wish to alter or upgrade your ticket, which results in an increase over the air travel allowance for the most direct flight to the U.S., the difference in cost will be your financial responsibility.
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25. May I take my spouse and children with me?
You may take whomever you like; however, the Preferred Care program travel and accommodation allowance will only cover air transportation and accommodations for one companion. PGH Care Management Services can make all the necessary arrangements, but the financial responsibility for the additional cost will be yours.
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26. What if I and/or my companion need a visa?
Obtaining a visa is the member’s responsibility.
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27. If I choose not to take a companion with me to the U.S., do I get to keep the excess money from my travel limit?
No. Only actual travel expenses are subject to this benefit.
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28. Will I receive an itinerary before I leave and will I know the length of my stay before departure?
You will be provided with a full itinerary and briefed in as much detail as possible in advance of your departure on the length of your projected treatment plan. Your treatment plan will be based on the U.S. medical specialist’s best estimates for treatment and recovery times. As is the case with any medical treatment, much depends upon your particular condition and response to prescribed care, unforeseen medical complications, varying recovery times, and changes in treatment plan.
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29. Will I be met at the airport upon arrival at the U.S. treatment destination, and if so by whom? If I am not fluent in English, will this person speak my language?
You will be met by a member of PGH’s Care Management Team, who either will be able to effectively communicate with you or be accompanied by a professional translator to facilitate communication if necessary. Your PGH Care Manager will personally accompany you to your accommodations and provide you with a full orientation on all the details of your stay, your specific treatment plan, and will have been pre-notified and made suitable arrangements for any special dietary, religious, or other special needs you may have.
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30. What if my flight is delayed or some unforeseen eventuality was to happen en-route to my treatment destination in the U.S.?
Before departure PGH will provide you with contact information, and vice-versa, so that we can get in touch with you. PGH Care Management Services is available 24 hours a day, if necessary. Care Management Services will be monitoring the status of your arrival and will be available and prepared to assist you in meeting any eventualities that may delay your arrival.
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31. How is an “Episode of Treatment” defined?
An Episode of Treatment is a time period beginning upon your arrival in the United States for pre-approved treatment, and ending when you are
medically approved to travel back to your home country. It encompasses the treatment of a given condition that is paid for by the Policy (with the
exception of organ transplantation, which is specified in the Benefits
Section), not to exceed 90 days duration or not to exceed 365 days duration for extended oncology related services. Each Episode of Treatment will be subject to all terms and conditions of the Policy before payment of charges. Medical treatment beyond this period will be your financial responsibility. The program episodes have been carefully designed to offer ample time for
treatment in the U.S. for the covered conditions.
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32. What if my condition recurs when I return to my home country?
If you have a relapse or complications arising from the treatment received in the United States within 30 days from the initiation of the treatment in the United States, and after consultation between the medical practitioners
involved in the case it was concluded that it was necessary and safe to return the member to the U.S., you would be approved for a return to the U.S. If you suffered a relapse after the episode treatment time window, this would be considered a new episode with all the benefits and restrictions applying.
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33. What if illness strikes while I am visiting the U.S. (on vacation or business for instance)?
If you need treatment for a condition covered under the Program, your
treatment and travel expenses to the most appropriate PGH approved
hospital will be covered. Costs related to preliminary diagnostic tests performed by the immediate U.S. physician who verified the case will be your financial responsibility. You should contact the Preferred Care Member Services at +1 617 369 7920. The Preferred Care Member Service Agent will advise you on how to interact with PGH directly through the Boston office as necessary. If it is not reasonable/feasible to move you to the nearest PGH approved hospital, your costs of approved care at the hospital that you are in will be covered. If it is reasonable or feasible to move you to a PGH approved hospital and you choose to remain at a non-approved hospital, your costs of care will be covered in accordance with the out-of-network benefit schedule.
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34. What if I need or want additional treatment performed during my approved treatment in the U.S. that is not a covered condition under the Preferred Care program?
As long as this treatment does not conflict with the treatment plan covered under the program and you have arranged in advance for payment of this additional treatment, you may do so. The Preferred Care program will in no way cover payment, nor assume any responsibility, financial, legal or otherwise, for this additional treatment.
Preferred Care is available worldwide with the exception
of
residents in the United States, U.S. Virgin Islands, and Puerto Rico.
