|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 10OF2009 |
22 June
2009
|
|
Medical Scheme |
Naspers Medical Fund |
|
Administrator |
Naspers Medical Fund |
|
Information
Relevant to |
New Benefits for 2009 |
|
Effective Date |
1 July 2009 |
With
effect 1 July 2009, Mediscor will be applying the scheme rules for Naspers Medical Fund as outlined below.
Herewith the details
for submitting medicine claims to Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0013 |
|
2. |
Switch Destination Code |
2. |
NSNP0000
|
|
3. |
EDI Activation Code (Dispensing Doctors) |
3. |
512P |
|
4. |
MMAP© |
4. |
Yes
|
|
5. |
Maximum supply of medicine |
5. |
30 Days |
|
6. |
Days of supply of the dispensed medication |
6. |
Yes /Compulsory |
|
7. |
Membership number as per membership card |
7. |
Yes / Compulsory |
|
8. |
Dependant code as per membership card |
8. |
Yes / Compulsory |
|
9. |
Dependant first name as per the membership card |
9. |
Yes / Compulsory |
|
10. |
Dependant date of birth |
10. |
Yes /Compulsory |
|
11. |
Dependant’s gender (male/female) |
11. |
Yes / Compulsory |
|
12. |
Practice number of the prescriber |
12. |
Yes / Compulsory |
|
13. |
ICD-10 diagnostic code |
13. |
Yes / Compulsory |
|
14. |
9 digit NAPPI code of medicine dispensed |
14. |
Yes / Compulsory |
|
15. |
Membership number requirements |
15. |
6
Numerical |
|
16. |
Payments to Providers |
16. |
Mediscor |
|
17. |
Chronic pre-authorisation Mediscor
ChroniLine™ |
17. |
Yes |
|
18. |
Reimbursement structure – Dispensing Doctors |
18. |
SEP
+ R20/30% |
|
19. |
Reimbursement
structure – Pharmacies |
19. |
SEP +
R26/26% |
|
20. |
Scheduled 0 or Unscheduled |
20. |
SEP +
max mark-up of 31% (VAT Excl.) |
* MEDISCOR FORMULARIES – information
available on www.mediscor.net
* ICD-10 CODES – information available on www.medicalschemes.com
IMPORTANT: The details below serve as a GUIDELINE ONLY. Due to the complexities of various Levy,
Co-payment, Formulary and Exclusion criteria; SERVICE PROVIDERS MUST
refer to our on-line responses to apply the correct rules.
Herewith the scheme rules
for Naspers Medical Fund effective from 1 January
2009:
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP© |
EXCLUSIONS |
|
NOption Plus NOption Basic |
Acute |
No Levy |
Yes |
2-5, 7-11,14-15,17, 19-25,
27, 30-34, 45, 60-62 |
|
Chronic (Only
NOption Plus) |
No Levy |
Yes |
||
|
Prescribed Minimum Benefits (PMB) |
NOption Plus Mediscor
Extended Formulary Formulary
Products – No Levy NOption Basic Mediscor
Standard Formulary Formulary
Products – No Levy Non-formulary
Products – 20% co-payments |
Yes |
||
|
OTC |
NOption Plus No Levy Maximum of R300 per day NOption Basic No Levy Maximum of R120 per day |
No |
||
|
HIV/AIDS |
No Levy |
No |
||
|
Oncology |
No Levy |
Yes |
||
|
Immunisation / Vaccines |
No Levy |
Yes |
||
|
Ex-Gratia |
No Levy |
No |
ADDITIONAL CUSTOMISED EXCLUSIONS:
1.
Nootropil™
2.
Phenolphtalein laxatives
3.
Histaglobin™
4.
Phensydyl™ and generic equivalents
PRESCRIBED MINIMUM BENEFITS (PMBs):
- Mediscor Standard and Extended Formularies
Members need to apply and register for PMBs and Chronic Medicine Benefits with Mediscor
ChroniLine™ on 0860 119 553.
If you require any assistance, please contact:
|
Mediscor’s Share Call Centre Helpline |
: |
0860 113 238 or 0860 117 705 |
|
Mediscor
ChroniLine™ |
: |
0860 119 553 |
Kind regards.
JACK
PEREL