MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 20 OF 2009
		03/12/2009

Medical Scheme	Hosmed Medical Scheme
Administrator	Allcare Administrators
Information Relevant to	Benefits and Options for 2010
Effective Date	1 January 2010

With effect 1 January 2010, Mediscor will be applying the scheme rules for Hosmed Medical Scheme as outlined below.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0021
2.	Switch Destination Code	2.	THHM0000
3.	EDI Activation Code (Dispensing Doctors)	3.	523P
4.	*MRP®	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.	8 Numerical digits
16.	Payments to Providers	16.	Allcare Administrators
17.	Chronic/PMB pre-authorisation at Mediscor	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 REFERENCE PRICE (MRP®) – information available on www.mediscor.net
• 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 Hosmed Medical Scheme effective from 1 January 2010:

OPTIONS	BENEFIT STRUCTURE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Plus Plan Value Plan	Acute Benefit	No Levy	Yes	1-9,11,14,15, 17,19-28, 30-32, 40,41,43-45,47, 48,51,56,62
	Chronic Benefit	Plus Plan: Mediscor Standard Formulary: Non-formulary products: 20% co-payment Value Plan: Mediscor Basic Formulary: Non-formulary products: 20% co-payment
	Prescribed Minimum Benefits (PMBs)	Plus Plan: Mediscor Standard Formulary: Non-formulary products: 20% co-payment Value Plan: Mediscor Basic Formulary: Non-formulary products: 20% co-payment
	Appliances	No Levy
	Oncology	No Levy
	OTC/PAT	No Levy R110 max. per prescription (Value Plan) R160 max. per prescription (Plus Plan)
	HIV	No Levy

Pre-authorised products will allow 1 fill every 26 days. 

PRESCRIBED MINIMUM BENEFITS (PMBs):

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 Toll-free Call Centre Helpline	:	0860 113 238 or 0860 117 705
Mediscor ChroniLine™	:	0860 119 553

Kind regards.

JACK PEREL