MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 30 OF 2009
		14/12/2009

Medical Scheme	Pharos
Administrator	Private Healthcare Administrators
Information Relevant to	Benefits and Options 2010
Effective Date	1 January 2010

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

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0016
2.	Switch Destination Code	2.	PVPH0000
3.	EDI Activation Code (Dispensing Doctors)	3.	583P
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.	10 Numerical
16.	Payments to Providers	16.	Private Health Administrators
17.	Chronic pre-authorisation at Mediscor	17.	Yes
18.	Reimbursement structure – Dispensing Doctors	18.	SEP + 30% / R20.00
19.	Reimbursement structure – Pharmacies	19.	SEP + 26% / R26.00
20.	Reimbursement structure – Schedule 0 and Unscheduled medicine	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 PHAROS effective from 1 January 2010:

Pharos Options:
· Rainbow Comprehensive	· Footprint Comprehensive
Rainbow Plus	· Footprint Primary
· Rainbow Primary	· Methcare
· Paladin Comprehensive

BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Acute (excluding Rainbow Primary and Footprint Primary)	Rainbow Comprehensive / Rainbow Plus / Paladin Comprehensive / Footprint Comprehensive No Levy Methcare 20% Levy	Rainbow Plus (except acute and OTC) Rainbow Primary Paladin Comprehensive Footprint Comprehensive Footprint Primary Methcare	3-6, 11, 14, 15, 19, 21-25, 27, 30, 40, 41, 43-45, 48, 50, 51, 53, 61, 62
Chronic (excluding Rainbow Plus / Rainbow Primary / Footprint Comprehensive / Footprint Primary	Rainbow Comprehensive No Levy Paladin Comprehensive and Methcare Formulary products: No Levy Non-Formulary products: 30% Levy
OTC (excluding Rainbow Primary / Footprint Primary)	Rainbow Comprehensive / Rainbow Plus / Paladin Comprehensive / Footprint Comprehensive No Levy
Prescribed Minimum Benefits (PMB)	Rainbow Comprehensive / Rainbow Primary / Footprint Comprehensive / Footprint Primary No Levy Rainbow Plus / Paladin Comprehensive / Methcare Formulary products: No Levy Non-Formulary products: 30% co-payment
HIV / AIDS	No Levy
Oncology	Rainbow Comprehensive / Rainbow Plus / Rainbow Primary / Footprint Comprehensive / Footprint Primary / Paladin Comprehensive No Levy Methcare 20% Levy

If you require any assistance, please contact:

Mediscor’s Share Call Centre Helpline Mediscor ChroniLine™

: :

0860 113 238 or 0860 117 705 0860 119 553

Kind regards

JACK PEREL