MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 23 OF 2009
		Date 24 December 09

Medical Scheme	MOTO Health Care
Administrator	Momentum Medical Scheme Administrators (MMSA)
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 MOTO Health Care as outlined below.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0049
2.	Switch Destination Code	2.	MHCA0001
3.	EDI Activation Code (Dispensing Doctors)	3.	940P
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.	9 digit NAPPI code of medicine dispensed	13.	Yes / Compulsory
14.	ICD-10 Diagnostic code	14.	Yes / Compulsory
15.	Membership number requirements	15.	Minimum 4 Numerical including dependant code
16.	Payments to Providers	16.	MMSA
17.	Chronic pre-authorisation	17.	MMSA
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

· 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 MOTO Health Care effective from 1 January 2010:

OPTION	BENEFIT STRUCTURE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Optimum & Classic	Acute	No Levy	Yes	1-5; 7-9; 11; 14-16; 19-22; 24; 25; 27; 30-35; 37; 38; 40; 41; 43-49; 52; 53; 56; 57; 59; 60; 62-64
	Chronic		Yes
	PMB	Otpimum: Mediscor Extended Formulary: No co-pay Out of formulary products: 10% co-pay Classic: Mediscor Standard Formulary: No Levy Non-Preferred Formulary as well as Out of formulary products: 10% co-pay	Yes
	HIV/AIDS	No Levy	Yes
	Appliance		N/A
	Organ Transplant
	Oncology
	Homeopathic
	Renal
	Maternity
	OTC (Max R120 per script)		Yes

OPTION	BENEFIT STRUCTURE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Hospicare	Chronic	No Levy	Yes	No Acute benefit. Only authorised products permitted
	PMB	Mediscor Basic Formulary: No Levy Non-Preferred Formulary as well as Out of formulary products: 10% co-pay	Yes
	HIV/AIDS	No Levy	Yes
	Appliance		N/A
	Organ Transplant
	Oncology
	Homeopathic
	Renal
	Maternity
Custom & Essential (Network provider options)	Acute (restricted to network provider formulary)	No Levy	Yes	Restricted to network provider formularies
	Chronic (restricted to network provider formulary)		Yes
	PMB (restricted to network provider formulary)		Yes
	HIV/AIDS (restricted to network provider formulary)		Yes
	Appliance		N/A
	Organ Transplant
	Oncology
	Renal
	Maternity

Limitations and Special Requirements:

Pre-authorisation for the following is required from MMSA:

• Oncology
• Immunosuppressive
• Anti-retroviral medication
• Oxygen and delivery systems
• Stomacare
• Prenatal vitamins
• Coal tar shampoos
• Medicines for Prescribed Minimum Benefits (PMB)

(Prescription refill once every 24 days)

Clinical DUR/Due Checks Applied to all Claims:

(Please check the on-line response)

• Drug to diagnosis/disease

• Dosage range checking

• Drug to age checking

• Drug to gender

• Duplicate therapy

IF YOU REQUIRE ANY ASSISTANCE, PLEASE CONTACT:

Mediscor’s Toll-free Call Centre Helpline : 0860 113 238 or 0860 117 705
MOTO Health Care Call Centre Helpline &

Medicine Pre-authorisation : 0860 101 047

MMSA Benefit Checker (24 Hours) : 0860 104 040

Kind regards

JACK PEREL