We contribute to uplift the quality of human life by providing efficient, affordable and accessible healthcare service programs to the broadest domestic and international clientele using our vast resources of qualified providers, medical facilities and our people whom we regard as our most important asset.
To become a leader in the market segment we serve as the chosen carrier in the managed healthcare programs addressing a mass based clientele in the Philippines and in the Asia Region.
The out-patient benefits are provided for the diagnosis and treatment of illness or injury which does not require hospitalization. The following Out-Patient Services shall only be availed of in any of our Fortune Care owned clinics or through our Medical Coordinator in Fortune Care affiliated hospitals in the provinces where there are no Fortune Care owned clinics.
For APE performed at clinics or hospital with medical facilities other than our Fortune Care owned clinics. Fortune Care shall reimburse the member based on the existing schedules but not to exceed P450.00 after submission of all supporting documents:
Out-patient or In-patient services shall anytime be provided to the member when he/she is brought to the emergency room (ER)., ie. The condition is such serious nature that failure to obtain immediate care within 24 hours from the time of the accident injury was sustained or within 12 hours from the onset of symptoms or a serious illness.
How then do we say that we are in Emergency case?
Sudden and unexpected onset of illness that would place the patient’s life in jeopardy.
Cause serious impairment or loss of bodily functions not immediately attended to
Cases of severe chest and abdominal pain requiring immediate attention as stated in the records of the ER
Whether as in-patient or out-patient, FORTUNE CARE shall reimburse 80% of the approved covered fees and charges to a member who has received and paid for emergency care in a non-accredited hospital whether located in the Philippines or abroad but not to exceed the amount of what if could have cost of treatment was done by a Fortune Care physician in an affiliated provider.
AVAILMENT PROCEDURES FOR EMERGENCY CARE SERVICES IN ACCREDITED HOSPITAL
Proceed to ER of nearest Accredited Hospital
Present Fortune Care Card
If admitted -Call nearest Fortune Care Medical Office within 24 hrs, to report confinement
Fortune care liaison officer will visit member
Obtain Philhealth Form from the Company/Patient’s employer (if patient is Philhealth member)
Pay excess charges (if there are any
AVAILMENT PROCEDURES FOR EMERGENCY CARE SERVICES IN NON-ACCREDITED HOSPITAL
Proceed to ER of nearest Non-accredited Hospital
Call the nearest Fortune Care Medical Office within 24 hrs to report confinement
Pay Hospital Bill & Professional Fee
File reimbursement at Fortune Care branch/Head Office within 30 days from date of discharge
Fortune Care will reimburse 80% of the total FORTUNE CARE approved hospital bill and professional fees.
Oral prophylaxis (once a year) including Ultrasonic scaling for mild to moderate calcular deposits;
Dental extraction (except surgery for impaction)
Recementation of jacket crown; inlays & onlays
Treatment of minor mouth lesions, wounds and burns
All dental services other than the standard benefits prescribed by FORTUNE CARE dentist shall be availed of at discounted prices upon prior arrangement with FORTUNECARE affiliated dentist (10-15% discount). Any treatment beyond the standard dental benefits shall be for the member’s account.
FORTUNE CARE will cover 80% of the total approved emergency treatment and hospitalization charges while in the course of travel incurred by the member when treated in a foreign country not to exceed the amount of what it could have cost if treatment is done by a FORTUNE CARE affiliated physicians in an affiliated hospitals.
THIRD PARTY LIABILITY (TPL)/WORK RELATED (ECC) AND UNPROVOKED ASSAULTS
FORTUNE CARE may cover Medical and Hospital Services extended to a member for bodily injuries established to have been cause by any compensable act to a Third Party (Motor Vehicle accidents), work related injuries caused by Unprovoked assaults up to P20,000.00 provided the necessary claim document are duly filed.
A member may only occupy the type of hospital room specified in his plan
LIMITATION ON ROOM & BOARD ACCOMODATION: St. Lukes Medical City Cardinal Santos Medical Ctr Makati Medical City The New Medical City Asian Hospital Ward Yes Yes Yes Yes No Semi-Private Yes Yes Yes Yes No Private Yes Yes Yes Yes No De Luxe Yes Yes Yes Yes No Suites Yes Yes Yes Yes No
CNS lesions (CVA, tumors, epilepsy,slipped disc, post traumatic scars with seizure episode, Parkinson’s Disease, Multiple Sclerosis)
All malignant new growths
Diabetes Mellitus with vascular, renal and neurologic degenerative complications.
Kidney Disease with impaired renal function (Obstructive Urophaties, Hydronephrosis, previous Nephrectomy, Nephrotic Syndrome)
Peptic Ulcer and Chronic GI tract disease that may require surgery (Esophageal Varices, New growths, Radical Bowel Resections)
Scoliosis, kyphosis and other similar skeletal deformities.
Coverage of a Pre-Existing Disease No. of Membership years 1 st year 2 nd year 3 rd year thereafter Types of Treatment Medical/Minor Surgery No Coverage Covered Covered Covered Major Surgery No Coverage No Coverage Covered Covered Waived Disease No Coverage No Coverage No Coverage No Coverage
Coverage of Consultations and Lab/Work-ups to “Rule Out” (R/O) or “To-Consider” (T/C) a Pre-existing Disease
INITIAL CONSULTATION (under program with standard benefits) during contestability period wherein the attending physician’s diagnosis is to R/O or T/C a pre-existing disease is COVERED.
Note: Regardless whether the patient is seen in our clinic or in our accredited hospitals by our affiliated doctors-MSUs
Also excluded are other hospital goods and services, such as:
Services of a private nurse
Use of extra bed, television, electric fan, etc.
Extra food tray
Discharge (take-home) medications
Items not directly used in the medical treatment of the patient.
PREPARATION OF MANUAL NOTICE TO PREPARE CONTRACT
Manual NTPC signed by the:
Marketing Division Head (for new business)
Letter of Intent
List of Members
Soft&hard Copy (excel form)
All newly closed corporate accounts with a minimum of fifty one (51) enrollees shall submit a softcopy in excel format containing data to Marketing Service Dept. or agent at least fifteen (15) days before the start of effectivity date of the contract.