Frequently Asked Questions on Membership

1. How can I apply for membership?

May download application form thru this link:
http://www.fortunecare.com.ph/newface/downloads/Downloads.php 

After accomplishment of the application form along with a photocopy of any valid ID with signature, 
mail to: Fortune Medicare Inc., 3rd Floor, CityState Center, Shaw Blvd., Pasig City 1603. Please be 
reminded that all membership application will be subject to Medical Underwriting evaluation and approval.

2. Will membership automatically stop after reaching the age of 64?

No, membership will continue until the end of the current contract year. But no renewal will be 
applicable after reaching the age of 64 under the standard health care program.

3. How do I convert my Individual Program to Senior Citizen Program?

You may apply for a new healthcare program under Senior Citizens Program subject to medical
underwriting approval and evaluation. However, please be advised that Senior Citizens Program is 
offered to current members with at least ten (10) years continuous membership with Fortune CARE. 
Contestability clause shall be waived.

4. I am hospitalized under Fortune CARE, what would happen to my PhilHealth benefits?

Your contract with Fortune CARE is declared and agreed upon as integrated with PhilHealth coverage.
The benefits under PhilHealth shall be deductible in the computation of Fortune CARE coverage. 
You are required to secure and submit the necessary PhilHealth claim forms, duly accomplished, 
before discharge from the hospital. Otherwise, it is understood and agreed upon that you shall pay 
the cost equivalent of your Philhealth benefit prior to discharge from the hospital.

5. I still continue my Fortune Care Health Care Membership even if I resign from the company?

In the event that you wish to continue membership, after resignation from your present employer,
you should re-apply for a new membership under our Standard Health Care Program. Membership 
application shall be subject to medical underwriting evaluation and approval. One (1) year 
contestability period on pre-existing conditions shall be applied

6. have lost my membership ID card. How can I replace it?

Report to Fortune Care the loss of your membership ID Card thru our hotline after which you are
required to submit the following:
             a. Duly accomplished LOST ID FORM (click here to download the form)
             b. Photocopy of any valid ID
             c. Processing fee of P 50.00 (fifty pesos)

Replacement ID will be released within seven (7) days from date of receipt of all required documents.

7. My membership is already cancelled, can I just settle my membership fee to reinstate my membership?

For cancelled membership, please be advised that Fortune Care will not allow continuity 
of membership upon settlement of membership fee. The only option to re-activate the same is through
re-application of membership under a new Health Care Program. However, please be reminded that 
the membership application is subject to our underwriting evaluation and approval. Contestability on 
pre-existing conditions shall be applied. 

Note: All membership application shall undergo Underwriting evaluation and approval.

Inquiry Regarding Reimbursement

1. How can I file reimbursement for my medical expenses?

A Fortune CARE member may file a claim for reimbursement of expenses for covered emergency 
treatment/ hospitalization in a non-accredited hospital, or when the member had paid for charges 
incurred under covered services. 

I. Claim must be filed within 10 days after the services or date of discharge.

II. Documents required:

A. For OUT-PATIENT REIMBURSEMENT:

   1. Request letter for reimbursement signed by the member/payor
   2. Medical Certificate with indication of vital signs and final diagnosis
   3. Original copy of the official receipts both for hospital bills and professional fees
   4. Copy of operation record and histopath report in case a minor surgery is done. 
   5. Referral slip by accredited Fortune CARE physician if referred to a non-Fortune CARE 
        physician 
   6. Police report for vehicular accident and Incident Report for self accident 
   7. Result of Diagnostic Procedure done (MRI, CT-Scan, X-Ray, etc.)

B. For IN-PATIENT REIMBURSEMENT: 

   1. Request letter for reimbursement signed by the member/ payor. 
   2. Detailed Clinical Discharge Summary with indication of vital signs and final diagnosis
        duly signed by the attending physician.
   3. Operative Record and Histopath Record (if Surgery was done) 
   4. Original copy of Official Receipt (For Hospital Bill & Doctor’s Fees)
   5. Itemized summary of statement of account and/or invoice 
   6. Pharmacist's certification on non-availability of stocks identifying the
        medicines not available with doctor's prescription of medicines bought outside. 
   7. Referral slip by accredited Fortune CARE physician if referred to a non-Fortune CARE 
       physician 
   8. Police Report and Incident Report (For vehicular accident / self accident - submission 
        of incident report is required) 
   9. Result of Diagnostic Procedure done (MRI, CT-Scan, X-Ray, etc.) 
   10. Hospital’s certification of non-availability of room. 
   11. Birth Certificate for Maternity Cases. 
   12. Death Certificate or Marriage Contract for Deceased Patient. 

C. FOR THIRD PARTY & WORK-RELATED ACCIDENTS 

   1. Police Report/ Affidavit of the Claimant 
   2. Medical Bills and ORIGINAL Official receipts both for hospital bills and professional 
          fees 
   3. Physician’s prescription 
   4. Certificate of No Claim from Insurer of adverse party 
   5. Employer’s Certificate (for work-related cases) 
   6. Other documents to be required when necessary 

III. Additional requirement for emergency hospitalization expenses in a foreign country: - A certification from the Philippine Consulate that states all submitted documents are
truthful and genuine. 

Send to: FORTUNE MEDICARE INC.

Claims Department 

3rd Floor, Citystate Centre 709 Shaw Blvd., Pasig City 1630 

- All documents for expenses incurred in foreign country must be in English. 

IV. Fortune CARE will pay validated claims within 30 days after receipt of complete
documents. 

V. Approved claims will be payable directly to the member or the PAYOR if the patient is a 
minor dependent. Once the claim has been reimbursed, Fortune CARE will no longer be 
obliged to pay for any liabilities related to the charges. 

VI. Receipt of payment of the claim discharges/ releases Fortune CARE from all obligations 
and liabilities related to the charge subject of the stated hospital and physician services. 

VII. Information on disapproved or reduced reimbursement claims will be conveyed to the 
member together with the reason for said action by Fortune CARE. 

VIII. Where a claim for reimbursement has been denied, the member or his authorized 
representative may appeal the decision by filing a written request for reconsideration 
within 30 days from receipt of the denial stating new or additional information or reasons 
in support of said appeal.

2. What are the requirements in claiming my other financial claims?

The following documents are required in claiming your financial assistance benefit: 

A. REQUIREMENTS FOR FINANCIAL ASSISTANCE CLAIMS

             1. Death Certificate 
             2. Police Report if claim is accident related 
             3. Notarized Affidavit of the Claimant if death is due to illness
             4. Proof of Relationship of Beneficiary 
             5. Certificate of Insurance to surrender Fortune CARE ID 
             6. Other documents to be required when necessary 

B. DISABILITY CLAIMS 

             1. Police Report if claim is accident related
             2. Notarized Affidavit of the Claimant if due to illness
             3. Operation Record 
             4. Detailed clinical summary
             5. Certificate of Insurance 
             6. Picture of whole body with that body part missing or disabled
             7. Abstract or Discharge Summary indicating the functional level of the injured/lost body
             organ
             8. Other documents to be required when necessary

3. When do I need to file my financial assistance benefit?

Death and disability claims must be filed within 30 days from date of death or accident by the legal 
beneficiary and member, respectively.

Payment and Credit and Collection Concerns

1. What are the benefits during the grace period?

Member can still avail of Out- Patient consultations with Fortune Care Physicians at Fortune Care 
Owned clinics during grace period status. Health care benefits shall be restored immediately after of the unpaid dues.

2. Can I use my credit card in paying for my membership fee and NCC?

Yes, credit cards listed below can be used in paying your membership fee and Non-covered Charges 
(NCC) at the Head Office or Fortune Care Sales Office Branches. For e-payment, you may visit our 
website at http://www.fortunecare.com.ph to settle your membership fee and NCC:
to settle your membership fee and NCC: 
             1. MasterCard 
             2. Visa 
             3. Visa Electron
             4. American Express 
             5. JCB 
Moreover, you can also pay thru the following Authorized Collection Facilities:
             1. Any Citystate Savings Bank Inc. (CSBI) Branches 
             2. Any BDO Branches 
             3. Any United Coconut Planters Bank (UCPB) Branches 
             4. All Bancnet ATM cardholder can pay thru the ff: 
                   4.a. Bancnet Automatic Teller Machine (ATM)- any member banks 
                   4.b. For Bancnet on-line payment click link below: http://www.bancnetonline.com 
             5. Fortune CARE Head Office or any Branch Sales Offices 
             6. Any Fortune CARE Authorized Representative or Servicing Agent
             7. Any Bayad Center Branches 

When settling payment (membership fee or uncollected non-covered charges), please present 
Statement of Account (SOA) or collection letter.

3. A member under a group or corporate health care program settle membership fee individually?

No, group and corporate accounts should settle membership fees through a centralized and duly
appointed authority.

4. When is the restoration of benefits of a reinstated plan?

Restoration of benefits for an approved request for reinstatement shall commence after 72 hours from the date of reinstatement.