Corporate Fc Presentation

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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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My FC-Corporate presentation

Transcript of Corporate Fc Presentation

Page 1: Corporate Fc Presentation

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.

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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

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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

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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)

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FORTUNE CARE OWNED CLINICS

5. PASIG (MAIN) Dominga Bldg, 606 Shaw Blvd., PAsig City

6. MAKATI (Dela Rosa cor AMorsolo STs., MAkati City)

7. ALABANG (2nd Floor Joval Bldg., #52 National Road, Putatan Muntinlupa

8. MANILA (Trina Place, #507 Salas St., Ermita Manila)

9. CALOOCAN (#355 PPI Bldg., BAgong Barrio Caloocan City)

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FORTUNE CARE OWNED CLINICS

10. ANGELES (CAP Bldg., Jake Gonzales Bldg., Angeles City)11. BACOLOD(2nd Flr St Francis Center, Araneta ST Brgy Sincang

Bacolod City12. CABANATUAN (2nd Flr Fortune Group Bldg., Zulueta Maharlika

Highway Cabanatuan City)13. CAVITE( Shop 3 & 4 MRDC Bldg., cor Ambrosia St E. Aguinaldo H-

way Anabu 1 Imus Cavite14. CEBU (2nd Flr Fortune Life Bldg, Osmena Blvd, Cebu City15. DAGUPAN CLINIC (G/F Music Warehouse Bldg., Dagupan City)16. DAVAO (Fernandez Germanos Bldg., MAgallanes St Davao City17. ILOILO (G/F Eternal Life Bldg, Ortiz St Iloilo City18. MEYCAUAYAN( 3rd Fl Aliw Cinema COmplez, McArthur H-way

Calvario Meycauayan Bulacan19. TARLAC (553 M.H. Del Pilar St Sto Ni Cristo, Tarlac City)

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SISTER COMPANIES of FORTUNE CARE

FORTUNE MEDICARE INC FORTUNE LIFE INSURANCE INC FORTUNE GUARANTEE & INSURANCE

CORPORATION

COMMITTED TO EXCELENCE SERVICE

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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

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SISTER COMPANIES of FORTUNE CARE

ENTERTAINMENT ALE Baliwag Cinema & Shopping Complex Aliw Cinema Complex Movie Houses Willand Enterprise Music Warehouse (Chick O’Clock)

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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

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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)

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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

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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

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FORTUNE CARE

CORPORATE Must have employer-employee relationship and the

account is duly registered with SEC TYPE OF ENROLLMENT

Fully Subsidized

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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

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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

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FORTUNE CARE B E N E F I T S

Out Patient Benefits In Patient Benefits Emergency Room Care Services Special Diagnostic Procedure

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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.

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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)

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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)

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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

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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

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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

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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

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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.

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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.

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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)

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FORTUNE CAREIN-PATIENT BENEFITS

Extended for the treatment of illness/injury requiring

hospitalization at

FORTUNE CARE

accredited hospitals

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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)

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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;

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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: 1-800-10-633-888Manila 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)

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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: 1-800-10-633-888Manila 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)

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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.

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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

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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

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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

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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.

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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

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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.

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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.

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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

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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)

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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)

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SPECIAL DIAGNOSTIC PROCEDURE

7. Pulmonary Scan (P5,000/disease/year)

8. Thallium Scan (P5,000/disease/year)

9. Thyroid Scan (P5,000/disease/year)

10. Botox injection for non-cosmetic (P5,000)

11. All types of ECG (P5,000)

12. Flourescein angiography or angloscopy of Eye total P2,500/eye/year

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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.

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OTHER FEATURES

Dental Care Services (Optional) Worldwide Emergency Care Third Party Liability (TPL)/Work Related

(ECC) and Unprovoked Assault Abnormal Pregnancy

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DENTAL CARE SERVICE

Dental services at any of our FortuneCare owned clinics and in

other accredited dental clinics

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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.

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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.

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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.

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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

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LIMITATION ON ROOM & BOARD ACCOMODATION

A member may only occupy the type of

hospital room specified in his plan

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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

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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.

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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

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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.

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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)

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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.

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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.