 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.
FORTUNE CARE
 180 M  It’s wide affiliation and
 With over P180M in attendance include:
assets, Fortune Care is Charter member of the
one of the industry’s ASSOCIATION OF
leading players HEALTH
MAINTENACE
ORGANIZATION OF
THE PHILIPPINES
FORTUNE CARE
 Affiliated with over  FORTUNE CARE has
4,000 accredited 19 clinics and 23
medical and dental branches all over the
specialists nationwide 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
 PASIG (MAIN) Dominga Bldg, 606 Shaw Blvd.,
PAsig City
 MAKATI (Dela Rosa cor AMorsolo STs., MAkati
City)
 ALABANG (2nd Floor Joval Bldg., #52 National
Road, Putatan Muntinlupa
 MANILA (Trina Place, #507 Salas St., Ermita
Manila)
 CALOOCAN (#355 PPI Bldg., BAgong Barrio
Caloocan City)
 FORTUNE CARE OWNED
CLINICS
 ANGELES (CAP Bldg., Jake Gonzales Bldg., Angeles City)
 BACOLOD(2nd Flr St Francis Center, Araneta ST Brgy Sincang
Bacolod City
 CABANATUAN (2nd Flr Fortune Group Bldg., Zulueta Maharlika
Highway Cabanatuan City)
 CAVITE( Shop 3 & 4 MRDC Bldg., cor Ambrosia St E. Aguinaldo H-
way Anabu 1 Imus Cavite
 CEBU (2nd Flr Fortune Life Bldg, Osmena Blvd, Cebu City
 DAGUPAN CLINIC (G/F Music Warehouse Bldg., Dagupan City)
 DAVAO (Fernandez Germanos Bldg., MAgallanes St Davao City
 ILOILO (G/F Eternal Life Bldg, Ortiz St Iloilo City
 MEYCAUAYAN( 3rd Fl Aliw Cinema COmplez, McArthur H-way
Calvario Meycauayan Bulacan
 TARLAC (553 M.H. Del Pilar St Sto Ni Cristo, Tarlac City)
 SISTER COMPANIES of
FORTUNE CARE
 FORTUNE MEDICARE INC
 FORTUNE LIFE INSURANCE INC

 FORTUNE GUARANTEE & INSURANCE

CORPORATION

COMMITTED TO EXCELENCE SERVICE

 SISTER COMPANIES of
FORTUNE CARE
 ALC CONGLOMERATE
 MEMORIAL
 Eternal Garden’s Memorial Park Corp

 Eternal Crematory Corp

 BROADCASTING
 Aliw Broadcasting Corp, DWIZ-882 Khz-AM

 Home Radio (97.9FM Station)

 PRINTING & PUBLICATIONS

 Brown Madonna Press Inc

 Philippine Graphic Publication Inc

 Business Mirror
 SISTER COMPANIES of
FORTUNE CARE
 ENTERTAINMENT
 ALE Baliwag Cinema & Shopping Complex
 Aliw Cinema Complex
 Movie Houses
 Willand Enterprise
 Music Warehouse (Chick O’Clock)
 SISTER COMPANIES of
FORTUNE CARE
 SECURITY SERVICES
 Asian Security & Investigation Agency
 Eastern Defender Security & Protective Services
Inc.,
 HOTELS
 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 CLIENTS
1. Bureau of Jail Management and Penology
2. ABS-CBN Broadcasting Corp
3. Department of Foreign Affairs
4. Batangas electric Cooperative
5. Trade and Investment Corp
6. MActan-Cebu Int’l Airport
7. Dept. of Education (Nationwide)
8. Simon Group of Companies
9. San Jose City Water District
10. ABC Laboratories
11. PAcita Liner
12. P.Imes
13. East-West Seed
14. Hocheng Philippines
15. Palawan Electric Cooperative
16. Dept. of Justice
17. Dept of Agrarian Reform Employees Association
18. The SUlo Hotel
19. Social Welfare Employee Assoc.of the Phil.
20. LGU (Nationwide)
21. Phil. MAnsho Inc
22. Mekeni Foods Corp
23. Dept. of Labor and Employment
24. Phil. National Bank Club
25. NFA Multi –purpose cooperative
26. Commission on Appointments
27. Office of the Legal Affairs-Civil Service Commission
28. DPWH-Central Office
29. Sienna College
FORTUNE CARE

 CORPORATE
 Must have employer-employee relationship and the
account is duly registered with SEC
 TYPE OF ENROLLMENT
 Fully Subsidized
FORTUNE CARE
CORPORATE 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 CARE
Corporate 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
BENEFITS

 Out Patient Benefits

 In Patient Benefits

 Emergency Room Care Services

 Special Diagnostic Procedure

FORTUNE CARE
OUT-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 CARE
OUT-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 CARE
OUT 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 CARE
OUT 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 CARE
OUT 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, EXCEPT
1. SLMC
2. Mega clinic
3. DLSMC
4. FEU
FORTUNE CARE
OUT 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 CARE
OUT 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 CARE
OUT 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.
AVAILMENT PROCEDURES FOR OUT-PATIENT SERVICES IN
AREAS WITHOUT FORTUNE CARE OWNED CLINICS
(accredited Hospitals Only)

 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
FORTUNE CARE
IN-PATIENT BENEFITS
Extended for the treatment of
illness/injury requiring
hospitalization at
FORTUNE CARE
accredited hospitals
FORTUNE CARE
IN-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
PLDT TOLL-FREE: 1-800-10-633-888
Manila Hotline: 706-4849
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)

1. Member/Patient proceeds to the HMO/Industrial section or

Medical Coordinator of any FC accredited hospital to secure
FC approval
2. Secure needed admitting orders for the elective procedures.
3. Upon admission, member/patient call Fortune Care within 24
hours –to report your hospital confinement
PLDT TOLL-FREE: 1-800-10-633-888
Manila Hotline: 706-4849
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)
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

 ForSpecial Corporate Accounts, depends on

the agreed time frame stated in the contract.
DOCUMENTS REQUIRED
 If Out-patient
2. Request letter for reimbursement
3. Medical Certificate
4. Original Copy of the Official receipt
5. Police report for accidental injuries
6. Result of diagnostic procedure done
DOCUMENTS REQUIRED
 If in-patient
 Request letter for reimbursement
 Detailed Clinical Discharge Summary
 Operative records/histopathology report if surgical
procedure was performed
 Original receipts and invoices
 Statement of account
 Pharmacist’s certification of non-availability of stocks
 Police report for accidental injuries and medico legal cases
in which 3rd Party Liability applies
 Result of Diagnostic Procedure done
 Hospital’s certification of non-availability of room (if
applicable)
SPECIAL DIAGNOSTIC
PROCEDURE
1. All types of CAT scan (P5,000/availment/
disease)
2. All types of Stress Testing (P10,000/year)
3. Nuclear imaging(including parathyroid scan-
P5,000/disease/year)
4. Total Body Scan (P5,000/disease/year)
5. Bone Scan (P5,000/disease/year)
6. Renal Scan (P5,000/disease/year)
SPECIAL DIAGNOSTIC
PROCEDURE
1. Pulmonary Scan (P5,000/disease/year)
2. Thallium Scan (P5,000/disease/year)
3. Thyroid Scan (P5,000/disease/year)
4. Botox injection for non-cosmetic (P5,000)
5. All types of ECG (P5,000)
6. Flourescein angiography or angloscopy of
Eye total P2,500/eye/year
SPECIAL DIAGNOSTIC
PROCEDURE
1. Breast Scintigraphy (P5,000/breast/year)
2. Warts, except genital or sexually transmitted
(P2,500/year)
3. Magnetic resonance Imaging (MRI) up to a
maximum of (P5,000) only.
4. Laparoscopic, arthroscopic, and other endoscopic
diagnostic procedures shall be covered up to
P5,000.
5. 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:
 Ectopic
 Placenta previa
 Abruptio placenta
 Post-partumatony
LIMITATION ON ROOM &
BOARD ACCOMODATION

A member may only

occupy the type of
hospital room specified
in his plan
LIMITATION ON ROOM &
BOARD ACCOMODATION:
St. Lukes Cardinal Makati Medical The New Asian Hospital
Medical City Santos City Medical City
Medical Ctr

Ward Yes Yes Yes Yes No

Semi- Yes Yes Yes Yes No

Private
Private Yes Yes Yes Yes No

De Yes Yes Yes Yes No

Luxe
Suites Yes Yes Yes Yes No
LIMITATION ON ROOM &
BOARD ACCOMODATION:
 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 enrolment
b. Such illness/condition has been by the nature,
manifestation, and conditions evident to the member
c. 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”
 Coronary and hypertensive heart disease, valvular heart disease
 Chronic Obstruction Pulmonary Disease (COPD)
 Parenchymal liver disease (hepatomegaly), cirrhosis, newgrowth
 Bone marrow disease/Blood dyscrasias
 CNS lesions (CVA, tumors, epilepsy,slipped disc, post traumatic scars
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 a
Pre-Existing Disease
No. of Membership
years
1st year 2nd year 3rd year thereafter

Types of
Treatment

Medical/Minor No Covered Covered Covered

Surgery
Coverage

Major No No Covered Covered

Surgery Coverage Coverage

Waived No No No No
Disease Coverage Coverage Coverage 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
The following are classified as dreaded
diseases:

 Cerebrovascular accident (hemorrhage,

thrombosis, embolism
 Cardiovascular conditions:
 Myocardial infarction
 Congestive heart failure
 Cardiac arrthymia
 Cardaic temponade
 Coronary artery disease
 Cardiomyopathy
The following are classified as dreaded
diseases

 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 care

7. All other Cardiometric procedures not enumerated in Article II
Section 4 of the contract.
8. Services to diagnose and reverse fertility or infertility
9. Sexually transmitted disease, including gonorrhea, syphilis,
herpes and AIDS
10. Alcoholism, drug addiction or test substance abuse and
medical conditions attributed to them.
11. Diagnostic and treatment services for congenital deformities
12. 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
 GENERAL EXCLUSIONS
Medical Nature

1. Pregnancy and all pregnancy related

conditions requiring medical care
2. Treatment of injuries resulting from war
(declared or undeclared), riots,
demonstrations or while in a military police
or parliamentary service.
3. 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
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 nurse
b. Use of extra bed, television, electric fan, etc.
c. Toilet article
d. Extra food tray
e. Discharge (take-home) medications
f. Ambulance service
g. 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.