MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 42 OF 2011
		20 December 2011

Medical Scheme	Universal Worker Plan
Administrator	Universal Healthcare
Information Relevant to	Benefits and Options for 2012
Effective Date	1 January 2012

With effect 1 January 2012, Mediscor will be applying the scheme rules for Universal Worker Plan as outlined below

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	MDS0067
2.	Switch Destination Code	UHEA0001
3.	EDI Activation Code (Dispensing Doctors)	431P
4.	Reference Pricing	Yes
5.	Maximum supply of medicine	30 Days
6.	Days supply of the dispensed medicine	Yes /Compulsory
7.	Membership number as per membership card	Yes / Compulsory
8.	Dependant code as per membership card	Yes / Compulsory
9.	Dependant first name as per membership card	Yes / Compulsory
10.	Dependant date of birth	Yes /Compulsory
11.	Dependant’s gender (male/female)	Yes / Compulsory
12.	Practice number of the prescriber	Yes / Compulsory
13.	ICD-10 diagnosis code	Yes / Compulsory
14.	9 digit NAPPI code of medicine dispensed	Yes / Compulsory
15.	Membership number requirements	Minimum 13 numerical excluding dependant code
16.	Payments to Providers	Universal Healthcare
17.	Chronic pre-authorization	Universal Healthcare
18.	Reimbursement structure – Doctors	SEP + 30%/R23.40
19.	Reimbursement structure – Pharmacies	SEP + 26%/R26
20.	Over the counter (OTC)	SEP + 26%/R26

· SEP (VAT Incl.) and Dispensing Fee (VAT Excl.)

· Reimbursement structure will be applied on scheduled medicines (0 – 8) and unscheduled products.

· Formulary Reference Price (FRP) – information available on www.mediscor.net

· 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 Worker Plan effective from 1 January 2012:

OPTIONS	BENEFITS APPLICABLE	LEVY	MRP®/FRP	EXCLUSIONS
TRUVALUE	Acute	No levies applicable	Yes	Restricted to a formulary. Please refer to on-line response.
	OTC	Restricted to a maximum of R60 per Rx	Yes
TRUHEALTH	Acute	No levies applicable	Yes	Restricted to a formulary. Please refer to on-line response.
	Chronic	No levies applicable	FRP
	OTC	Restricted to a maximum of R60 per Rx	Yes
TRUWELLNESS	Acute	No levies applicable	Yes	Restricted to a formulary. Please refer to on-line response.
	Chronic	No levies applicable	FRP
	OTC	Restricted to a maximum of R60 per Rx	Yes
	HIV/AIDS	No levies applicable	FRP

If you require any assistance, please contact:

Mediscor’s Call Centre Mediscor E-Mail Universal Healthcare

: : : :

0860 113 238 or 0860 117 705 helpdesk@mediscor.co.za 0861 989 887 workerplan@universal.co.za

Kind regards.

JACK PEREL