FC WILL NOT COVER THE FOLLOWING SERVICES, PRODUCTS, OR CONDITIONS UNLESS OTHERWISE PROVIDED IN YOUR BENEFIT SUMMARY:
Medical In Nature 1. Services and hospitalization in non-accredited hospitals, attended to by non-affiliated doctors, except for covered emergency conditions.
2. Adverse medical conditions arising from treatment by non-affiliated physicians.
3. Plastic or reconstructive surgery for cosmetic purposes.
4. Dental Related Confinement and emergency cases.
5. Experimental medical procedures, acupuncture, speech therapy and chiropractic services.
6. Hyperalimentation, organ transplant procedures, psychiatric care, rehabilitative physical therapy.
7. All other Cardiometric procedures not enumerated in the benefits for Special Diagnostic and Therapeutic Procedures.
8. Services to diagnose and reverse fertility or infertility.
9. Sexually-transmitted diseases, including gonorrhea, syphilis, herpes and AIDS.
10. Alcoholism, drug addiction or test substance abuse and medical conditions attributed to same.
11. Diagnostic and treatment services for congenital deformities and abnormalities including heritable diseases (Hemolytic Anemia, Spherocytosis).
12. Confinement which is for purely diagnostic purposes except when covered under a special provision of the contract (i.e. Executive Check-Up).
13. Pregnancy and all pregnancy related conditions requiring medical care, unless specially provided herein.
14. Human blood products, (fibrinogen, plasma, albumin, immunoglobin preparations).
15. Treatment services for injuries/ illnesses which are attributed to the member’s own misconduct:
| -Services of a private nurse |
| -Use of extra bed, television, electric fans, |
| -Electronic entertainment equipments and other amenities |
| -Toilet articles |
| -Extra food tray |
| -Discharge (take-home) medications |
| -Ambulance service |
| -Other items not directly related to the medical management of the patient |
SPECIAL SURGICAL PROCEDURES
Fortune CARE shall provide coverage of up to a maximum of Philippine Pesos: Twenty Five Thousand Pesos (PHp25,000.00) should a member opt for a medical procedure other than or in lieu of the traditional cutting surgery, for the following conditions:
1. Lithotripsy for Urolithiasis
2. Laparoscopic Cholecystectomy
3. Fibro Endoscopic Sinus Surgery
4. Arthroscopic Knee Surgery
NOTE: Special Modalities or Diagnostic Procedures not listed under the covered procedure will be covered up to Five Thousand Pesos (P5,000.00) single availment only for the year.
GENERAL LIMITATIONS AND SERVICES
Room Assignment - a member may only occupy the type of hospital room specified in his plan. If the member chooses to stay in a room higher than his specified plan, he will pay for the following:
1. Excess in room rate charges
2. Ancillary surcharges as a result of the room upgrade (e.g. operating room and recovery room, lab & diagnostic procedures, central supplies, professional fees, etc.).
| -Negligence |
| -Intemperate use of drugs or alcoholic liquor |
| -Vicious or immoral habits |
| -Participation in the commission of a crime whether consummated or not |
| -Acts in violation of law or ordinance |
| -Unnecessary exposure to imminent danger or hazard to life or health |
| -Treatment of injuries resulting from war (declared or undeclared), riots, demonstrations or while in a military police or parliamentary service |
| -Medical care for pre-existing diseases (PED) and Dreaded Disease (DD), concealed by the applicant at the time of enrollment, regardless of any lapse of time before concealment is discovered |
Non-Medical In Nature
1. Corrective lenses, artificial hearing aids, prosthetic devices and services related to their application.
2. Orthopedic hardware used in nailing, pinning, bracing and the like.
3. Purchase or lease of durable medical equipment, oxygen dispensing equipment, & medical oxygen (except what is used during covered in-patient care).
4. Medical examinations required for obtaining or continuing employment, insurance or government licensing.
5. Hospital expenses in excess of member’s program limits in room rates, including the resulting rate differences for operating room fees, professional fees, diagnostic procedures, laboratory examinations and all other ancillary surcharges set by the hospital. Also such extra hospital goods and services such as but not limited to:
FAQs 
