YPO-WPO Healthwise

Global Health Solution

IS YOUR FAMILY COVERED?

What price would you pay to protect your loved ones in a crisis? If you or a family member experienced a medical event, would you know what to do? If diagnosed with a serious medical condition, where would you go to find a specialist and coordinate care?

With YPO-WPO Healthwise, you can connect your entire family to a global network of medical support professionals anywhere in the world. This optional benefit, supported by M2Mx, provides you and your family (spouse or partner, children and parents) with facilitated appointments, doctor referrals, multilingual medical filing, and responses to medical questions when you need them most. Also available is access to medical second opinions, genetic testing, facilitated multilingual medical filing and non-emergent medical guidance at a discounted rate.

Register for YPO-WPO Healthwise when you renew your YPO-WPO annual membership (or by 30 June 2016) and receive a full year of coverage for you and your family (including spouse or partner, children and parents) for just USD399. The base package includes services from PinnacleCare, Medical Opinion and Europ Assistance.

SIGN UP BY 30 JUNE

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You must enroll by 30 June 2016 during online membership renewal, via the online form at ypowpo.org/healthwise or by contacting YPO-WPO at membership@ypowpo.org or by phone: United States and Canada at +1 972 587 1618 or +1 800 773 7976; South Africa at +27 768 994 117.

WHAT’S INCLUDED:

Medical Referrals, Research and Facilitated Appointments• Customized physician referrals profiling world-leading experts best suited to patient’s needs, includes physician background,

education, areas of specialty, location, board certifications, hospital a�liations and insurances accepted

• Facilitated appointments at medical Centers of Excellence based on specific diagnosis

• Comprehensive research reports on diagnosis and treatment options, when appropriate

• Two referrals, appointments or research services per family annually for care in the United States, no limit to services for care outside the United States

Medical Questions, Answered• Answers to general medical questions by an appropriate medical specialist

• Quick written response, confidentiality ensured

• Five services per family annually

Digital Medical Record Storage and Retrieval• Digital file created and self-managed online provides 24/7 access to medical records

• Available for printing in 18 di�erent languages

• Files can be managed and uploaded for additional fee of USD650

In addition, members have access to the following services at a reduced rate:

Medical Second Opinions• Professional medical opinion in writing from a leading expert in the field

• File created including specific questions and requests for evaluation

• Comprehensive and fully understandable medical report delivered in 10 business days

• Fee of USD390 per case

Doctor On Call• Access to an on call doctor for non-emergent medical guidance

• English, Spanish or French language support

• Access through M2Mx and after hours directly with provider

• Fee of USD350 per call

Genetic Testing Options• Access to nutritional genetic testing and the Mediterranean Diet Program based upon genetic testing results

• Focus on prevention – report includes structural analysis of genes that play key roles in the regulation of metabolic processes

• Results determine personal predisposition in relation to foods, lactose intolerance, free radicals, B vitamins, metabolism, sugar, fats, bone metabolism, smoking addiction and physical activity.

• Pricing starts at USD398

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YPO-WPO MEMBER SERVICES 600 East Las Colinas Blvd., Suite 1100 Irving, Texas 75039, USAUnited States: 1 800 773 7976, +1 972 587 1618 or +1 972 587 1500 South Africa: +27 768 994 117

FAX: +1 972 587 1611 or +1 972 587 1612 EMAIL: membership@ypowpo.org

Member Name:

Primary Chapter:

Member ID:

Email Address:

YPO-WPO HEALTHWISE: AN M2MX GLOBAL HEALTH SOLUTIONThis optional benefit connects you and your family (spouse, partner, children and parents) to a global network of medical professionals through M2Mx to provide facilitated appointments at top hospitals, doctor recommendations, multilingual medical record filing, and responses to your medical questions—all available at your fingertips for annual fee of USD399. Also available is access to medical second opinions, genetic testing, facilitated multilingual medical filing, and nonemergent medical guidance at a discounted rate. This benefit is only available for purchase during membership renewal. Must purchase by 30 June 2016.

YPO-WPO Heathwise USD399

PAYMENT DETAILS (Please Print)Note: Members may want to inform banking institutions prior to making payment to ensure smooth processing.Please enter all currency amounts in U.S. dollars only, including all zeros and commas (e.g. USD10,000 = 10 thousand U.S. dollars).

p PAY BY CREDIT CARD: USD_______________________________

Only these cards are accepted: p Visa p MasterCard p American Express p Discover

Credit Card Number: Expiration Date (Month/Year):

Cardholder Name: Cardholder Signature: (As it appears on credit card)

Cardholder Address:

City: Province/State:

Zip/Postal Code: Country:

p PAY BY CHECK: (Please make checks payable to YPO-WPO and include your name and member ID number on check.) MAIL CHECKS TO: YPO-WPO, P.O. Box 202590, Dallas, Texas 75320-2590, USASEND COURIER (OVERNIGHT) MAIL TO: YPO-WPO – 202590, 2975 Regent Blvd., Irving, Texas 75063, USA

p PAY BY WIRE TRANSFER: (Note: Copy of wire transfer confirmation must accompany invoice)

To ensure the security of our member data, we have relocated wire instructions and details to our secure member website. Please go to http://www.ypowpo.org/wirepaymentsUSD to access the wire instructions.

YPO-WPO Healthwise Enrollment

PLEASE PROVIDE THE FOLLOWING INFORMATION WHEN MAKING PAYMENT.

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