MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 46 OF 2009
		17/12/2009

Medical Scheme	Ingwe Health Plan
Administrator	Momentum Medical Scheme Administrators (MMSA)
Information Relevant to	Benefits and Options for 2010
Effective Date	1 January 2010

With effect 1 January 2010, Mediscor will be applying the scheme rules for Ingwe Health Plan as outlined below.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0047
2.	Switch Destination Code	2.	IHEA0000
3.	EDI Activation Code (Dispensing Doctors)	3.	520P
4.	MMAP©	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.	Minimum 4 numerical including dependant code
16.	Payments to Providers	16.	MULTIMED
17.	Chronic pre-authorisation Mediscor ChroniLine™	17.	MULTIMED
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.)

• 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 Ingwe Health Plan effective from 1 January 2010:

OPTIONS	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MMAP©	EXCLUSIONS
Ingwe Capitation Hospital Plus Pioneer Medicare	Acute	No Levy	Yes	1-9, 10, 11, 14, 15, 17-28, 30, 32, 33-35, 38-49, 52, 53, 55, 57-62, 64
	Chronic		Yes
	PMB		Yes
	HIV/Aids		No
	Appliance		Yes
	Organ Transplant		Yes
	Oncology		No

LIMITATIONS AND SPECIAL REQUIREMENTS:

Pre-authorisation for the following is required from MMSA:

• Out-of-Network Acute
• Oncology
• Immunosuppressive
• Growth Hormones
• Erythropoietin
• Surgical, medical and orthopaedic appliances
• Diagnostic agents and appliances
• Oxygen and delivery systems
• Stomacare
• Medicines for Prescribed Minimum Benefits (PMB)

(Prescription refill every 24 days)

HIV/AIDS medicines require pre-authorisation from MMSA - Tel 0860 109 793.

CLINICAL DUR CHECKS APPLIED TO ALL CLAIMS

(Please check the on-line response)

• Drug to diagnosis/disease
• Dosage range check
• Drug to age checking
• Drug to gender
• Duplicate therapy

If you require any assistance, please contact:

Mediscor’s Share Call Centre Helpline	:	0860 113 238 or 0860 117 705
INGWE Customer Care Line & Pre-authorisation	:	0860 102 493

Kind regards.

JACK PEREL