OUR MISSION 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. OUR VISION 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.
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OUR MISSIONWe 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.
OUR VISIONTo 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.
FORTUNE CARE
180 M With over P180M in
assets, Fortune Care is one of the industry’s leading players
It’s wide affiliation and attendance include: Charter member of the ASSOCIATION OF HEALTH MAINTENACE ORGANIZATION OF THE PHILIPPINES
FORTUNE CARE
Affiliated with over 4,000 accredited medical and dental specialists nationwide
FORTUNE CARE has 19 clinics and 23 branches all over the Philippines
FORTUNE CARE OWNED CLINICS
1. DE LOS SANTOS MEDICAL CENTER (RM253 Delos Santos Medical Center, 201 E. Rodriguez Blvd., Espana Ext., Quezon City)
2. MEGAMALL CLINIC (5/F Bldg. B Megaclinic, Mandaluyong)
3. FEU-NRMF Clinic (Rm207 Marian Medical Arts Bldg., Dahlia cor. Regalado Ave., West Fairview QC)
4. ST LUKE’S MEDICAL CENTER (RM207 Medical Arts Bldg, E.Rodriguez Ave QC)
FORTUNE CARE OWNED CLINICS
5. PASIG (MAIN) Dominga Bldg, 606 Shaw Blvd., PAsig City
6. MAKATI (Dela Rosa cor AMorsolo STs., MAkati City)
Cherry Blossoms Hotel Citystate Tower Hotel Manila Grand Opera Hotel
SISTER COMPANIES of FORTUNE CARE
FINANCIAL SERVICES CityState Insurance Corp CityState Savings Bank Inc Eternal Plans Inc Fortune General Insurance Corp Key Finance & Investment Corp Fortune Life Insurance Co,Inc Triple A Southeast Equities
TRANSPORTATION GENCARS, Inc
REAL ESTATE ALC Industrial & Commecial Development Corp ALC Realty Development Corp
FOOD Chow Rite Food Inc
(3 Franchised Chow king Store located at Palanca, MEycauayan, PAterno)
WHAT BUSINESS ARE WE IN?
HMO-Health Maintenance Organization Fortune Care manages the premium paid by the members It has pre-payment mechanism that is defined in terms of
the amount of membership fee and payment frequency for a specific period
Negotiate with the providers the medical and professional services at discounted rate
It has a team of medical providers Looks clients to avail of the healthcare coverage at an
affordable cost Gives customer care to clients Monitor utilization of clients under the supervision of UMC
OUR MAJOR CLIENTS1. Bureau of Jail Management and Penology2. ABS-CBN Broadcasting Corp3. Department of Foreign Affairs4. Batangas electric Cooperative5. Trade and Investment Corp6. MActan-Cebu Int’l Airport7. Dept. of Education (Nationwide)8. Simon Group of Companies9. San Jose City Water District10. ABC Laboratories11. PAcita Liner12. P.Imes13. East-West Seed14. Hocheng Philippines15. Palawan Electric Cooperative16. Dept. of Justice17. Dept of Agrarian Reform Employees Association18. The SUlo Hotel19. Social Welfare Employee Assoc.of the Phil.20. LGU (Nationwide)21. Phil. MAnsho Inc22. Mekeni Foods Corp23. Dept. of Labor and Employment 24. Phil. National Bank Club25. NFA Multi –purpose cooperative26. Commission on Appointments27. Office of the Legal Affairs-Civil Service Commission28. DPWH-Central Office29. Sienna College
FORTUNE CARE
CORPORATE Must have employer-employee relationship and the
account is duly registered with SEC TYPE OF ENROLLMENT
Fully Subsidized
FORTUNE CARECORPORATE ACCOUNT
AGE ELIGIBILITY 18-64 Years old
QUALIFIED DEPENDENTS Single Principal Payor:
Parents 60-64 years old Married Principal Payor:
Legal spouse 18 up to 64 years old Legal children 90 days -20 years old
Single Parent Legal children 90 days – 20 years old
FORTUNE CARECorporate Account
If count is <50 principal members: Partial coverage of PED up to P10,000
If count >50 principal members: Full coverage of PED
May or may not follow Published Standard Rates for Corporate, subject to the following: If count >100 principal members, please refer to
ACTUARIAL If count < or = 100 principal members, standard
rates
FORTUNE CARE B E N E F I T S
Out Patient Benefits In Patient Benefits Emergency Room Care Services Special Diagnostic Procedure
FORTUNE CAREOUT-PATIENT BENEFITS
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.
FORTUNE CAREOUT-PATIENT BENEFITS
Preventive HealthCare Services Annual Physical Examination- at any of the Fortune Care full
service clinics or authorized accredited medical facilities only Medical History Taking Physical Examination Chest X-ray Laboratory Complete Blood Count (CBC) Stool examination Urinalysis Electrocardiogram (ECG) Pap Smear (for 35 years & above or as recommended by the
physicians) Fasting Blood Sugar (FBS)
FORTUNE CAREOUT PATIENT BENEFITS
APE can be availed even on the first year as long as the equivalent annual premium is paid subject to prior appointment Annual Mode -Anytime within the contract year Semi-Annual Mode -After paying the 2nd
Semi-Annual membership fee Quarterly Mode -After paying the last quarterly
membership fee Monthly Mode -After paying the last monthly
membership fee (12th month)
FORTUNE CAREOUT PATIENT BENEFITS
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: Request letter for reimbursement Official receipts (original copy) Photocopy of the APE result
FORTUNE CAREOUT PATIENT BENEFITS
Preventive HealthCare Services Administration of vaccine/immunization (excluding cost of
sera/vaccine Advice on diet, exercise and other healthful habits Family planning and counseling Well baby care ( even for member’s unenrolled baby less
that 3 month of age t be availed of at Fortune Care full service Clinics only, EXCEPT1. SLMC2. Mega clinic3. DLSMC4. FEU
FORTUNE CAREOUT PATIENT BENEFITS
Out Patient Care Services Unlimited Consultation (during clinic hours) First Aid Treatment of minor lesions, burns,
sprains and the like Necessary Lab routine tests and commonly
available diagnostic procedures, including ECG X-ray, as prescribed by Fortune Care affiliated physicians & specialists.
Pre and post natal care consultation in FC owned full service clinic only EXCEPT at SLMC, DLSMC, FEU and Megaclinic
FORTUNE CAREOUT PATIENT BENEFITS
Out Patient Care Services Eye, Ears, Nose & Throat First-dose of anti rabies, anti tetanus, anti-venom
during emergency cases up to P5,000 per year (single availment only) except ERIG
Cauterization of warts except genital and sexually transmitted warts up to P2,500.
Sclerotheraphy up to P5,000 Botox injection up to P5,000
FORTUNE CAREOUT PATIENT BENEFITS
Only members with Private, De Luxe and Suite plans have
access to St. Luke’s Medical Center, Cardinal Santos Medical Center and The
Medical City.
AVAILMENT PROCEDURES FOR OUT-PATIENT SERVICES IN AREAS WITH FORTUNE CARE OWNED CLINICS
1. Go to any FORTUNECARE clinic in MetroManila or in areas with provincial branch clinics.
2. Present your Fortune Care membership card for the necessary consultation and treatment of illness;
3. For conditions requiring elective or non-emergency confinement secure approval from the Clinic Operations Manager.
Proceed to the Hospital Coordinator, Out-Patients Department/Industrial Department/HMO Department
Present your Fortune Care membership card for the necessary consultation/treatment of your illness
AVAILMENT PROCEDURES FOR OUT-PATIENT SERVICES IN AREAS WITHOUT FORTUNE CARE OWNED CLINICS
(accredited Hospitals Only)
FORTUNE CAREIN-PATIENT BENEFITS
Extended for the treatment of illness/injury requiring
hospitalization at
FORTUNE CARE
accredited hospitals
FORTUNE CAREIN-PATIENT BENEFITS
No admission deposit in affiliated hospitals Room and board Operating and recovery room Services of Physician, Surgeon, w/ surgery Administered Medicines and Med Supplies Transfusions of Blood Maternity assistance benefit ICU & CCU Hospital Income Benefit (HIB)
AVAILMENT PROCEDURES FOR IN-PATIENT SERVICES IN AREAS WITH FORTUNE CARE OWNED CLINICS
For elective or non-emergency confinement secure prior approval from the Clinic Operations Manager. Approval is needed in Metro Manila and in areas with Fortune Care branch clinics.
Go to information/Admitting Office of accredited hospital;
Present your Fortune Care membership card/admitting orders from the attending physicians;
AVAILMENT PROCEDURES FOR IN-PATIENT SERVICES IN AREAS WITH FORTUNE CARE OWNED CLINICS
1. Member/Patient proceeds to fortune Care clinic to obtain FC approval for the elective major surgical diagnostic procedure.
2. Member/Patient proceeds to Accredited Hospital/Clinic then present hospital requirements and membership card.
3. Upon admission, member/patient call Fortune Care within 24 hours –to report your hospital confinement
4. FC Medical Liaison Officer/Provincial Coordinator visits member/patient and issues Letter of Authorization (LOA)
5. Member/Patient files Philhealth for Philhealth requiring admission/procedures
6. Member/Patient signs Statement of Account (SOA) prior to discharge and pays incremental charges (if any)
AVAILMENT PROCEDURES FOR OUT-PATIENT SERVICES IN AREAS WITHOUT FORTUNE CARE OWNED CLINICS (accredited Hospitals Only)
EMERGENCY ROOM CARE SERVICES
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
Cases of accidental injury
BASIC EXAMPLE OF EMERGENCY CASES
Stroke Convulsion Heart attack Massive bleeding Acute appendicitis Diarrhea with severe dehydration Fractures and multiple injuries secondary to
accident Hypertensive emergency Status asthmatics
EMERGENCY ROOM CARE SERVICES
BENEFITS IN ACCREDITED HOSPITAL Doctor’s services Medicines for immediate relief of pain and other
symptoms administered in the emergency room Oxygen and intravenous fluids Dressing, plaster casts, and sutures X-ray, laboratory and other tests necessary for
patient’s emergency management
EMERGENCY ROOM CARE SERVICES
BENEFITS IN NON-ACCREDITED HOSPITALS
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 Secure documents 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.
CLAIMS:REIMBURSEMENT OF EXPENSES
Within 30 days after discharge
Payment: Within 30 days after receiving complete document
For Special Corporate Accounts, depends on the agreed time frame stated in the contract.
DOCUMENTS REQUIRED
If Out-patient
1. Request letter for reimbursement
2. Medical Certificate
3. Original Copy of the Official receipt
4. Police report for accidental injuries
5. Result of diagnostic procedure done
DOCUMENTS REQUIRED If in-patient
1. Request letter for reimbursement2. Detailed Clinical Discharge Summary3. Operative records/histopathology report if surgical
procedure was performed4. Original receipts and invoices5. Statement of account6. Pharmacist’s certification of non-availability of stocks7. Police report for accidental injuries and medico legal cases
in which 3rd Party Liability applies8. Result of Diagnostic Procedure done9. Hospital’s certification of non-availability of room (if
applicable)
SPECIAL DIAGNOSTIC PROCEDURE
1. All types of CAT scan (P5,000/availment/ disease)
12. Flourescein angiography or angloscopy of Eye total P2,500/eye/year
SPECIAL DIAGNOSTIC PROCEDURE
13. Breast Scintigraphy (P5,000/breast/year)14. Warts, except genital or sexually transmitted
(P2,500/year)15. Magnetic resonance Imaging (MRI) up to a
maximum of (P5,000) only.16. Laparoscopic, arthroscopic, and other endoscopic
diagnostic procedures shall be covered up to P5,000.
17. All other modern modalities of therapeutic procedures not specifically mentioned shall be covered up to P5,000 per member per year. This includes hospital and doctor’s fee.
OTHER FEATURES
Dental Care Services (Optional) Worldwide Emergency Care Third Party Liability (TPL)/Work Related
(ECC) and Unprovoked Assault Abnormal Pregnancy
DENTAL CARE SERVICE
Dental services at any of our FortuneCare owned clinics and in
other accredited dental clinics
DENTAL CARE SERVICES(Optional) Any reasonable number of consultations Oral prophylaxis (once a year) including Ultrasonic scaling for
mild to moderate calcular deposits; Dental extraction (except surgery for impaction) Temporary filing Recementation of jacket crown; inlays & onlays Treatment of minor mouth lesions, wounds and burns Gum treatment 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.
WORLDWIDE EMERGENCY CARE
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.
MATERNITY ASSISTANCE
Abnormal Pregnancy, P5,000.00 annual maximum medical services shall be given to help defray hospitalization charges for abnormal pregnancy:
If member chooses to stay in a room higher than his specified plan, he will pay for the ff:
a. Excess in Room Rate charges
b. 30% Ancillary surcharges as a result of the room upgrade
i.e. operating room & recovery room, laboratory & diagnostic procedures, medicines, central supplies, professional fees, etc.
LIMITATION ON SPECIAL SURGICAL PROCEDURES:
FC shall provide coverage up to P25,000.00 should the member opt for medical procedure other than the traditional cutting surgery>
Lithotripsy for Urolithiasis (Kidney) Arthroscopic Knee Surgery Endoscopic Cholecystectomy (Gallstone) Endoscopic Sinus Surgery Laparoscopic Pelvic Operation
LIMITATION/CONDITIONS OF A PRE-EXISTING DISEASE
A condition, disease o illness is considered pre-existing if during the period prior to
the effectivity date of Contract or Approval date of reapplication in case of a
Lapsation:a. Any treatment or medical advice was given for such illness/condition prior to enrolmentb. Such illness/condition has been by the nature, manifestation, and conditions evident to the memberc. The pathogenesis of the condition can clinically determine the onset of the disease as prior to the date of enrolment.
The following are considered Pre-existing Disease (PED) Bronchial asthma & systemic allergies Diabetes mellitus Hyperthyroidism Tuberculosis Chronic cholecystitis/cholelithiasis Benign new growths Hypertension or whatever etiology Endometriosis Hemorrhoids, anal fistula Hernia Urolithiasis and Chronic Glomerulonephritis Acid peptic Disease
Pre-existing conditions that require a voluntary execution of “Waiver”
with seizure episode, Parkinson’s Disease, Multiple Sclerosis) Collagen disease 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 aPre-Existing DiseaseNo. of Membership
years1st year 2nd year 3rd 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
DREADED DISEASE
Any serious illness or injury that may require special treatment or prolonged confinement.
FC shall cover hospital & doctors’ services up to a certain maximum amount per illness per year
Neuro-surgical conditions Blood dyscracias Renal parechymal disease, renal failure Cirrhosis of the liver and acute necrotizing pancreatitis Poliomyelitis and its complications Collagen diseases Chronic Obstructive Pulmonary Disease (COPD) Encephalitides and complications/sequelae Meningitis and its complications/sequelae Malignant newgrowth (including indicated chemo or radiotherapy
The following are classified as dreaded diseases
Serious accidental injuries: Including 2nd & 3rd degree burns Injuries to extremeties that may require amputation Injuries to vital organs suchas
Liver Pancreas spleen Kidneys Spinal cord Intracranial injuries, and the like
The following are classified as dreaded diseases
Immuno-compromised clinical conditions that require over-extended or multiple hospital confinements
Indicated use of Intensive Care Unit or Cardiac Unit (CCU) in confinement
All vascular and neurologic complications of Diabetes Mellitus
Nosocomial infections
GENERAL EXCLUSIONS Medical Nature
1. Services and hospitalizations in non-affiliated hospitals, attended to by non accredited doctors, except for covered emergency conditions.
2. Adverse medical conditions arising from treatment by no-affiliated physicians
3. Plastic or reconstructive surgery for cosmetic purposes.
4. Dental care following accidental injury to teeth for reconstructive surgery, orthodontic procedures or supply of dentures
5. Experimental medical procedures, acupuncture and speech therapy
GENERAL EXCLUSIONS Medical Nature
6. Hyperalimentation, organ transplant procedures, psychiatric care7. All other Cardiometric procedures not enumerated in Article II
Section 4 of the contract.8. Services to diagnose and reverse fertility or infertility9. Sexually transmitted disease, including gonorrhea, syphilis,
herpes and AIDS10. Alcoholism, drug addiction or test substance abuse and
medical conditions attributed to them.11. Diagnostic and treatment services for congenital deformities12. Confinement which is for purely diagnostic purposes (i.e.
Executive check-up)
GENERAL EXCLUSIONS Medical Nature
13. Human blood products (fibrinogen, plasma, albumin, immunologic preparations).
14. Treatment services for injuries, illnesses which are attributable to the member’s own misconduct
-negligence-Intemperate use of drugs/alcohol/liquor-Vicious or immoral habits-Participation or commission of crime whether
consummated or not-Acts in violation of law or ordinance.-Unnecessary exposure to imminent danger or
hazard to life or health
15. Pregnancy and all pregnancy related conditions requiring medical care
16. Treatment of injuries resulting from war (declared or undeclared), riots, demonstrations or while in a military police or parliamentary service.
17. Medical care for pre-existing diseases (PED), concealed by the applicant at the time of enrollment regardless of any lapse of time before concealment is discovered.
GENERAL EXCLUSIONS Medical Nature
GENERAL EXCLUSIONS Non-Medical Nature
1. Corrective lenses, artificial hearing aids, prosthetic devices and services related to their application.
2. Orthopedic hardware used in nailing, pinning, bracing
3. Purchase or lease of durable medical equipment, oxygen (except what is actually used during covered in-patient care)
GENERAL EXCLUSIONS Non-Medical Nature
Also excluded are other hospital goods and services, such as:
a. Services of a private nurseb. Use of extra bed, television, electric fan, etc.c. Toilet articled. Extra food traye. Discharge (take-home) medicationsf. Ambulance serviceg. Items not directly used in the medical treatment
of the patient.
PREPARATION OF MANUAL NOTICE TO PREPARE CONTRACT
Manual NTPC signed by the: Soliciting agent/BGAM Marketing Division Head (for new business) Approved proposal SEC registration 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.