STANDARD PROGRAM BENEFITS
Members may avail of any of the following Health Care Benefits at any Fortune CARE Clinics and/ or affiliated institutions.
PREVENTIVE HEALTH CARE SERVICES
The following healthcare services are available at Fortune CARE–owned clinics:
● Immunization excluding cost of sera
● Consultations and advice on diet, exercise and other healthy habits
● Family Planning and Counseling
● Well-baby care (for member’s unenrolled baby less than 3 months of age)
● Annual Physical Examination at Fortune CARE clinics or at company premises upon corporate account’s request
● Physical Examination and Medical History Taking
● Chest X-ray
● Urinalysis and Fecalysis
● ECG, Pap Smear, FBS (for 35 years old and above or if indicated)
OUT PATIENT CARE SERVICES
The out-patient benefits are provided for the diagnosis and treatment of illness or injury which does not require hospitalization. The following OPD services shall only be availed in any of our Fortune CARE owned clinics or through our Medical Coordinator in Fortune CARE accredited hospitals in provincial areas where there are no Fortune CARE owned clinics
● Consultation during clinic hours
● EENT (Eyes, Ears, Nose, Throat) Care
● Treatment of minor injuries, such as lacerations, abrasions, mild burns, sprains, etc.
● Minor Surgical procedures available at Fortune CARE Clinics for covered lesions
● Necessary routine laboratory test and commonly available diagnostic procedures, including ECG & X-ray examinations, as prescribed by Fortune CARE physicians & specialists
● Pre and post natal care in Fortune CARE-owned clinics only
● Out-patient services will include first dose of anti-rabies, anti-tetanus, anti-venom during emergency cases up to P5,000.00 per year (single availment only)
● Cauterization of warts except genital and sexually transmitted warts up to P2,500.00 per year.
IN-PATIENT CARE / HOSPITALIZATION CARE SERVICES
Extended for the treatment of illness/injury of the Fortune CARE accredited hospitals under the care of affiliated specialists.
Room and board up to the maximum daily rate stated in the contracted plan
Professional services of the Fortune CARE affiliated doctors/physicians
Use of Operating and Recovery Room
Whole blood, packed RBC, platelet concentrate, plasma and intravenous fluids
Drugs and medications during confinement
Oxygen and its administration
Dressings, plaster casts, sutures and other miscellaneous supplies directly used in the treatment of the covered ailment
Indicated use of ICU, CCU and special units subject to the maximum limits for the underlying dreaded disease
Routine laboratory examinations and commonly available diagnostic procedures as ordered by the Fortune CARE affiliated attending physician/ surgeon
EMERGENCY ROOM CARE SERVICES
Out-patient or In-patient services shall at anytime be provided to the member when he/she is brought to the emergency room (ER), i.e. the condition is one of immediate danger of death, loss of vital bodily function, member in severe chest and abdominal pain that would require immediate attention.
Medicine for immediate relief of pain and other symptoms administered in the Emergency Room
Oxygen and other intravenous fluids
Dressings, plaster casts and sutures
X-ray, laboratory and other tests necessary for patient’s emergency management.
For emergency treatment in a non-accredited hospital, Fortune CARE reimburses as much as 80% of what it would cost if treatment was done by an affiliated physician in an accredited hospital. Fortune CARE must be notified within 24 hours after patient is admitted/treated in a non-accredited hospital.
BENEFITS FOR SPECIAL DIAGNOSTIC PROCEDURES:
The member shall be entitled to any of the following procedures upon the request of a Fortune CARE affiliated Physician and approval by the Utilization Management Committee, except in emergency cases as herein defined:
Immunologic and Special Laboratory Examinations:
· Hepatitis profile, e.g. HbeAG, HBS AG, Anti HBC (IgM) and Anti-HAV (IgM)
· ANA profile, e.g. Anti-Nuclear-Antibody, Anti native-DNA, Anti-Sm, Anti-SSA, Beta-HCG, ANA
· Thyroid Profile, e.g. T3 T4, TSH, FTA-ABS.
· TORCH profile, e.g. Anti-Toxoplasma Gondii (IgM), Anti-Rubella, Anti-Cystomegalo-Virus (Total IgG).
· SLE test, FAT, Widal Test, ASO Titer, Serum IgG, Alpha-Feto protein, ESR
· Urine/ blood culture and sensitivity test.
· 24-hour protein determination
· Glycosylated Hemoglobin
· Prostate Specific Antigen (PSA)
Special and Computer-Based Diagnostic and Therapeutic Procedures:
2. Chest, Abdominal, thyroid, pelvic and transvaginal ultrasonography
3. All types of Ultrasound
4. Stress Testing (all types) P 10,000.00/year
5. All types of Cat Scan P 5,000.00/disease/year
6. Nuclear Imaging (including Parathyroid Scan) P 5,000.00/disease/year
7. Total Body Scan P 5,000.00/disease/year
8. Bone Scan P 5,000.00/disease/year
9. Renal Scan P 5,000.00/disease/year
10. Pulmonary Scan P 5,000.00/disease/year
11. Thallium Scan/ Thyroid Scan P 5,000.00/disease/year
12. Echocardiography (all types) P 5,000.00/disease/year
13. Fluorescein Angiography or Angiography of Eye Total P 2,500.00/eye/year 14. Warts, Except Genital and Sexually Transmitted Warts P 2,500.00/year
15. Breast Scintigraphy P 5,000.00/breast/year
16. Magnetic Resonance Imaging (MRI) P 5,000.00/disease Laparoscopic, arthroscopic and endoscopic diagnostic procedures Shall be covered up to the maximum amount of Philippine Pesos: Five Thousand Pesos (P5,000.00). The excess shall not be covered by Fortune CARE.
Note: Special Modalities or Diagnostic Procedure will be covered up to Five Thousand Pesos (P5,000.00) single availment only for the year.
DENTAL CARE SERVICES
Dental Care services may be availed from Fortune CARE OPD clinics or at any of the Fortune CARE accredited dental clinics in the locality:
● 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 Filling
● Recementation of the jacket crowns, inlays and onlays
● Treatment of minor gum lesions, wounds and burns
● Routine Gum Treatment
● Discounts for other Dental Services and products (not covered by the program) from affiliated dentists
WORLDWIDE EMERGENCY CARE
Fortune CARE will cover eighty percent (80%) of the total approved treatment and hospitalization charges incurred by the member when treated in a foreign country not to exceed the amount of what it could have cost if treatment was done by a Fortune CARE accredited Physician in an accredited hospital.
● Daily Hospitalization Income Benefit
Fortune CARE shall pay the Daily Hospitalization Income Benefit per standard schedule for the period of confinement for a covered disability or illness in a DOH-registered hospital or Fortune CARE accredited hospital for a maximum of three hundred and sixty-five (365) days in a contract year. Granting of Hospitalization Income Benefit (HIB) shall commence on day one (1) of confinement.
● Personal Accident Insurance
Fortune CARE shall pay the sum or percentage of the principal sum to the member in case of dismemberment and to the beneficiary/ies of the member in case of death resulting from an accident within one hundred eighty (180) days from date of occurrence.
Schedule of Indemnity
Both Hands or Both Feet or Sight of Both Eyes 10,000.00
One Hand and One Foot 10,000.00
One Hand or One Foot and Sight of One Eye 10,000.00
One Hand or One Foot or Sight of One Eye 5,000.00
● THIRD PARTY LIABILITY (TPL)/WORK-RELATED AND UNPROVOKED ASSAULT
Fortune CARE may cover medical and hospital services extended to a member for bodily injuries established to have been caused by any compensable act of a Third Party (Motor Vehicle Accidents), work related injuries and injuries cause by unprovoked assault up to P20,000.00 provided the necessary claim documents are duly filed. However, if the member’s bodily injuries arising from vehicular accidents, the same shall be covered up to the same amount.
● Financial Assistance equal to Ten Thousand Pesos (10,000.00) in case of death which are not due to accident.
**Benefits may vary on the type of the purchased program