A: A condition, disease or illness is considered pre-existing if it exists before the effectivity date of membership.

A condition, disease or illness is considered pre-existing if:
a. Any pre-enrollment professional advice or treatment was obtained by the member for such illness or injury.
b. Such illness/condition had been by its nature, manifestations, and conditions evident to the member.
c. The disease by its pathogenesis can be clinically determined to have its onset prior to member’s enrollment.

THE FOLLOWING ARE EXAMPLES OF CONSIDERED PRE-EXISTING CONDITIONS:
1. Bronchial Asthma & Systemic Allergies
2. Diabetes Mellitus
3. Hyperthyroidism
4. Tuberculosis
5. Chronic EENT conditions that may require surgery
6. Chronic cholecystitis/cholelithiasis
7. Benign newgrowth
8. Hypertension of whatever etiology
9. Endometriosis
10. Hernia
11. Hemorrhoids, anal fistula
12. Urolithiasis and Chronic Glumerulonephritis
13. Coronary/ Valvular/ Hypertensive Heart Disease
14. Parenchymal liver disease (hepatomegaly, cirrhosis, newgrowth)
15. Kidney diseases with impaired renal functions (obstructive uropathies, hydronephrosis, previous nephrectomy, nephrotic syndrome)
16. Chronic Obstructive Pulmonary Disease (COPD)
17. Bone marrow diseases/blood dyscrasias
18.CNS lesions (CVA, tumors, epilepsy, post traumatic scars, paresis or paralysis)
19.Peptic ulcer and Chronic GI tract disease (esophageal varices, newgrowths, radical bowel resections)
20. Bonemarrow Disease/ Blood dyscrasias
21. CNS lesions (CVA, tumors, epilepsy, post-traumatic head injury, paresis and paralysis)
22. Collagen Disease
23. All malignant new growths
24. Diabetes Mellitus with vascular/ neurologic degenarative complications
25. Scoliosis, kyposis and other similar skeletal deformities 

A:Any serious or catastrophic illness or injury that may require special treatment, ICU confinement or prolonged confinement is subject to the Annual Benefit Limit. However, if condition is considered Pre-existing, the capped/limit for the 1st and 2nd year shall apply.

Dreaded Diseases, as follows:
a. Chronic Obstructive Pulmonary Disease (COPD)
b. Major renal damage or renal failure & its complications
c. Cerebrovascular Accident (Hemorrhage, Thrombosis, Embolism and Ruptured aneurysm)
d. Cardiovascular conditions (Myocardial infarction, Cardiac Arrest, Congestive Heart Failure, Cardiac Arrhythmia, Cardiac Tamponade, Coronary Artery Disease, Cardiomyopathies and Valvular Disease)
e. Neuro-surgical interventions/ major neurological diseases
f. Blood Dyscrasias
g. Cirrhosis of the liver and acute necrotizing pancreatitis
h. Poliomyelitis and its complications
i. Collagen diseases, Chronic Degenerative Bone and Joint Diseases, requiring major surgery i.e. hip replacement, knee replacement
j. Encephalitides and complications/ sequelae
k. Meningitis and its complications/ sequelae
l. Malignant new growth (including indicated chemotherapy or radiotherapy)
m. Serious accidental injuries 2nd and 3rd degree burns, injuries to extremities that may require amputation, injuries to vital organs such as liver, pancreas, spleen, kidneys, spinal cord and intracranial injuries, and the like except as excluded under the pertinent provisions in Exclusions from coverage.
n. Immuno-compromised clinical conditions and Nosocomial infections that may require over-extended hospital confinement
o. Indicated use of ICU or CCU in confinement
p. All vascular and neurologic degenerative complications of Diabetes Mellitus
q. Such other conditions of a serious nature as to require extraordinary treatment measures as Fortune CARE may deem classify as dreaded disease from time to time.