|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 43OF2010 |
Date: 13 December 2010
|
|
Medical Scheme |
Hosmed Medical Scheme |
|
Administrator |
Allcare
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 Hosmed Medical Scheme as outlined below.
Herewith the detail for submitting
medicine claims to Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0021 |
|
2. |
Switch Destination Code |
2. |
THHM0000 |
|
3. |
EDI Activation Code (Dispensing Doctors) |
3. |
523P |
|
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. |
8 Numerical digits |
|
16. |
Payments to Providers |
16. |
Allcare Administrators |
|
17. |
Chronic/PMB pre-authorisation at Mediscor |
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 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 Hosmed Medical Scheme
effective from 1 January 2011:
|
OPTIONS |
BENEFIT STRUCTURE |
LEVY / |
MRP® |
EXCLUSIONS |
|
Plus Plan Value Plan |
Acute Benefit |
No Levy |
Yes |
1-5, 7-9, 11, 14, 15, 19-25,
27, 30-32, 35, 40, 41, 43-45,47,48, 51, 53, 55, 57, 56, 61, 62 |
|
Chronic Benefit |
Plus Plan: Mediscor
Standard Formulary: Non-formulary
products: 20% co-payment Value Plan: Mediscor
Basic Formulary: Non-formulary
products: 20% co-payment |
|||
|
Prescribed Minimum Benefits (PMBs) |
Plus Plan: Mediscor
Standard Formulary: Non-formulary
products: 20% co-payment Value Plan: Mediscor
Basic Formulary: Non-formulary
products: 20% co-payment |
|||
|
Appliances |
No Levy |
|||
|
Oncology |
No Levy |
|||
|
OTC/PAT |
No
Levy R110 max. per
prescription and 1 script every 3 days Plus Plan R160 max. per prescription and 1 script every 3 days |
|||
|
HIV |
No Levy |
Pre-authorised products will allow 1 fill every 26
days.
PRESCRIBED MINIMUM BENEFITS (PMBs):
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