MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 45 OF 2011
		21 December 2011

Medical Scheme	DAY1 Health
Administrator	1 Doctor Health
Information Relevant to	Benefits and Options for 2012
Effective Date	1 January 2012

DAY1 Health is not a medical Scheme but a Pre-Paid Preventative Health Care Service supplied by a chosen Network doctor to cover day to day medical expenses.

Only acute and authorised chronic medicine restricted to a formulary, may be dispensed by pharmacies.

All DAY1 Health members are linked to Network doctors and the cover does not include specialist visits. Acute claims where the prescriber is a specialist will reject.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	MDS0053
2.	Switch Destination Code	DHEA0004
3.	EDI Activation Code (Dispensing Doctors)	Not applicable
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 11 alpha- numerical including dependant code
16.	Payments to Providers	1 Doctor Health
17.	Chronic pre-authorisation	1 Doctor Health
18.	Reimbursement structure – Pharmacies	SEP + 26%/R26

· SEP (VAT Incl.) and dispensing fee (VAT Excl.)

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

· 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 DAY1 Health effective from 1 January 2012:

OPTIONS	BENEFITS APPLICABLE	LEVY	MRP®	EXCLUSIONS
Day1 Health	Acute	No levies applicable	Yes	Restricted to an acute formulary. Please refer to on-line response.
	Chronic	Formulary: No Levy Non-Formulary: 15%	Yes	Restricted to Mediscor Core formulary. Please refer to on-line response.

If you require any assistance, please contact:

Mediscor’s Call Centre Mediscor E-Mail 1 Doctor Health

: : :

0860 113 238 or 0860 117 705 helpdesk@mediscor.co.za 0861 144 155

Kind regards.

JACK PEREL