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MEDISCOR
(PTY) LTD |
NOTIFICATION 42OF2010 |
Date: 13 December 2010
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Medical Scheme |
Tiger Brands Medical Scheme |
|
Administrator |
Universal Health
Administrators |
|
Information Relevant to |
Benefits and Options
for 2011 |
|
Effective Date |
1 January 2011 |
With effect 1 January 2011, Mediscor will be
applying the scheme rules for Tiger Brands Medical Scheme as outlined below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0064 |
|
2. |
Switch Destination Code |
2. |
TIGE0000 |
|
3. |
EDI Activation Code (Dispensing Doctors) |
3. |
228P |
|
4. |
MMAP© / MRP® |
4. |
Yes |
|
5. |
Maximum supply of medicine |
5. |
30 Days |
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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 |
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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 |
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12. |
Practice number of the prescriber |
12. |
Yes / Compulsory |
|
13. |
ICD-10 diagnostic code |
13. |
Yes / Compulsory |
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14. |
9 digit NAPPI code of medicine dispensed |
14. |
Yes / Compulsory |
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15. |
Membership number requirements |
15. |
7 Numerical digits |
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16. |
Payments to Providers |
16. |
Universal Health
Administrators |
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17. |
Chronic pre-authorisation Mediscor ChroniLine™ |
17. |
Yes |
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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
- 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 Tiger Brands Medical
Scheme effective from 1 January 2011:
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP©/
MRP® |
EXCLUSIONS |
|
Tiger A Tiger B Tiger C |
Acute (Routine Care) |
20% Levy |
MRP® |
1-6, 7-11, 14-15, 19,
21-25, 27, 30-32, 41, 43-45, 48, 58, 61-62 |
|
Vaccines |
No Levy |
MRP® |
||
|
Chronic |
Formulary Products: 20% Levy Non-Formulary Products: 20% Levy |
MMAP© |
||
|
HIV / AIDS |
No Levy |
MMAP© |
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|
Organ Transplant |
No Levy |
MMAP© |
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Prescribed Minimum
Benefits (PMB) |
Formulary Products: No Levy Non-Formulary Products: 20% Levy |
MMAP© |
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|
Oncology |
No Levy |
MMAP© |
||
|
OTC |
No Levy Tiger A: Maximum
of R120.00 per day Tiger B: Maximum
of R110.00 per day Tiger C: Maximum
of R100.00 per day |
MRP® |
Pre-authorised products will allow 1 fill every 26
days.
PRESCRIBED MINIMUM BENEFITS (PMBs):
- Mediscor Basic Formulary
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