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|
MEDISCOR
(PTY) LTD |
NOTIFICATION 25OF2009 |
03/12/2009
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|
Medical Scheme |
Naspers Medical Fund |
|
Administrator |
Naspers Medical Fund |
|
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 Naspers Medical Fund as outlined below.
Herewith the detail 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 2010:
|
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 |
No Levy (max 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 Toll-free Call
Centre Helpline |
: |
0860 113 238
or 0860 117 705 |
|
Mediscor ChroniLine™ |
: |
0860 119 553 |
Kind regards.
JACK PEREL