Frequently asked questions

How to avail the Annual Physical Examination (APE)?

APE shall be conducted only at Forticare-accredited clinics and service providers on a scheduled date.

  1. Call the Forticare Hotline to request for a Letter of Authorization (LOA)
  1. Provide the requested information by the LOA Issuance Division for verification & approval purposes.
  2. Once LOA is approved, it will be sent directly to the requested service providers and copies will be also sent to members email address.
  3. Follow the scheduled date of the issued LOA. Proceed with the service provider HMO department for checking and assistance. Present the Forticare ID Card together with your valid ID if needed.
  4. Coordinate for the results and further evaluation with your Primary Care Physicians.

NOTE: Ensure to have you fasting at least 8-10 hours before your preferred schedule.

How to avail the Out-patient Consultation and Laboratory Procedures?

OPD Consultation and Laboratory/Diagnostics procedures shall be conducted only at Forticare accredited clinics and service providers. 

 Call the Forticare Hotline to request for a Letter of Authorization (LOA)

  1. Provide the requested information by the LOA Issuance Division for verification & approval purposes.
  2. Once LOA is approved, it will be sent directly to the requested service providers and copies will be also sent to members email address.
  3. Follow the instruction that indicated on the LOA. Proceed with the service provider HMO department for checking and assistance. Present the Forticare ID Card together with your valid ID if needed.
  4. Coordinate for the results and further evaluation with your Primary Care Physicians.

NOTE: Request for a LOA prior to your preferred visit and/or procedures.   Ensure to secure a LOA before any procedures have done as the coverage for each healthcare membership may vary depending on its terms & conditions.

How to avail Elective Surgical Procedures?

  • If there is a need for elective (non-emergency) and/or out-patient surgical procedures, kindly inform Forticare through the office of LOA Issuance Division for approval prior to procedures. You will be advised of all pre-surgery requirements, such as cardiopulmonary clearance, Philhealth requirements and/or scheduling etc.
  • Kindly accomplish your Philhealth forms before the scheduled surgery.
  • After approval and all requirements are accomplished, you will be given a Letter of Authorization (LOA) to be presented to the Out-patient Operating Room or Admitting Office if for confinement.
  • Proceed to the Admitting Office (if for confinement) or the Operating Room (for out-patient surgical procedures) on the scheduled date of operation. If for admission, choose a Room in accordance with your room plan as indicated in the Forticare ID Card. Present this card to the Admitting Officer or the Operating Room.
  • If admitted, kindly inform the Forticare Call Center of your confinement within 24hours from the time of admission.
  • Submit to the Philhealth Office of the Hospital the accomplished forms prior to discharge.
  • Settle all excess, or non-covered charges (if any) prior to discharge.

How to avail Forticare coverage during Emergency cases?

For emergency cases like danger of loss of life, or limb or in case of extreme pain, please follow these instructions:

 

Forticare Accredited Service Providers

  1. Proceed to the emergency room and present your Forticare ID Card for treatment.
  2. Ask the Providers HMO Department to contact Forticare LOA Division immediately for the approval of your emergency case.
  3. LOA will be provided as the guarantee that such procedures will be covered by your membership. 
  4. If the Emergency Room Physician deems that hospitalization is necessary, choose a room according to your plan type as indicated in Forticare ID Card.
  5. Please inform Forticare Call Center through your representative of your confinement within 24 hours of admission.
  6. Kindly complete the Philhealth Form and submit it to the Philhealth office of the hospital before your discharge date.

 Non-Accredited Service Providers

  1. Proceed to the Emergency Room for treatment.
  2. Pay for the cost of your treatment and secure pertinent Official Receipts, charge slips and ER Medical Certificate.
  3. Secure a Reimbursement Form from the Forticare Claims & Reimbursement Division.
  4. File your reimbursement within 30 days from the date of discharge.

NOTE: Non-emergency consultation/ Treatment at the Emergency Room shall not be covered.

How to avail Dental Care Coverage?

  • Schedule an appointment directly with the accredited dental service provider.
  • Request for Letter of Authorization (LOA) before visiting the service provider.
  • On scheduled visit, present the Forticare ID Card.

Where can I inquire about the coverage of my Forticare plan?

You may call our hotline at (02) 5314 2273 local 120 / 09272230304 / customercare.forticare@gmail.com

What will I do if I lose my Forticare ID Card?

To replace a lost ID, kindly coordinate with our Marketing Support Group at (02) 5314 2273 local 120 / msg.forticare@gmail.com and deposit payment amounting Php200 for issuance of the lost card. You may provide the payment via the following channels: 

 

  • Account Name: FORTICARE HEALTH SYSTEMS INTERNATIONAL, INC.
  • BDO Account Number: 011718000548 

After which, please email a scanned copy to msg.forticare@gmail.com. Your new card will be delivered to your nominated address in 5-7 working days. Thank you.

I am a freelancer; can I still avail of Forticare plans?

Yes, you can. You may reach with our Marketing Support Group at (02) 5314 2273 local 120 / 09272230304 / msg.forticare@gmail.com to provide the best suited plan membership for you. Thanks

 

How soon can I use my Forticare card?

Take note the Emergency Cases due to Accident will immediately covered from the moment you completed the required initial payment of your membership however for any other coverage of your membership like consultation, laboratory procedures and confinement; you need to wait for your Forticare ID Card to be delivered. ID cards processing may take 2-3 weeks after your complete application requirements.

How do I contact Forticare Customer Service Department?

You may reach our Customer Care Division 24/7 at (02) 5314 2273 local 120 / 09272230304 / customercare.forticare@gmail.com

How do I contact Forticare Claims & Reimbursement Department?

You may reach our Claims & Reimbursement Division at (02) 5314 2273 local 114 / 09693531884 / claimsdept.forticare@gmail.com

How do I request for Letter of Authorization?

You may reach our Letter of Authorization with our LOA Issuance Division at (02) 5314 2273 local 114 & 115 / 09693531884 / loa.forticare@gmail.com

I want to become an accredited doctor/dentist or want to have my hospital/clinic accredited.

You may get in touch with our Provider Relations Division at (02) 5314 2273 local 115 / 09277435328 / providers.forticare@gmail.com

What are PRE-EXISTING Conditions?

Pre-existing illness or injury, counts only those conditions for which the member received medical advice, diagnosis, care, or treatment prior to enrollment to the health care program and includes those condition that were never diagnosed. But caused symptoms for which an ordinary prudent person would have sought medical advice, care, or treatment.

Any pre-existing condition of the Member is NOT covered. However, in the event the Member opts to renew this Agreement, pre-existing illness or injury may be accepted subject to the terms and conditions of the renewal Agreement. Forticare will provide the Health Care Benefits to the Member after the first twelve (12) months of membership, if there is no failure to disclose, misrepresent or conceal material information in the original application or application for reactivation. Non withstanding the disclosure by the Member of a pre-existing condition, Forticare may permanently exclude from coverage a specific medical condition, illness, or injury upon written notice to the Member.