MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 47 OF 2009
		17/12/2009

Medical Scheme	CompCare Wellness Medical Scheme
Administrator	Status Medical Aid Administrators
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 CompCare Wellness Medical Scheme as outlined below.

Please note that effective 1 January 2010 CompCare will have a new scheme code MDS0014.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0014
2.	Switch Destination Code	2.	SSCC0000
3.	EDI Activation Code (Dispensing Doctors)	3.	129P
4.	MRP® / FRP	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 3 digits
16.	Payments to Providers	16.	Status
17.	Chronic pre-authorisation Mediscor ChroniLine™	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

· FORMULARY REFERENCE PRICE (FRP) – 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 CompCare Wellness Medical Scheme effective from 1 January 2010:

OPTIONS	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MRP® / FRP	EXCLUSIONS
Pinnacle Dynamix Mumed Symmetry Axis Networx	Acute (Axis not applicable)	Networx: Limited to formulary Pinnacle / Dynamix / Mumed / Symmetry: 25% co-pay on ethical’s where no generic exists.	MRP	3-5, 6-9, 11, 19-25, 27, 30, 32, 40-41, 43-45, 47-51, 60-62
	Chronic (Mumed, Axis and Networx not applicable)	Pinnacle / Dynamix: Mediscor Standard Formulary Non-formulary products: 25% co-payment Symmetry: Mediscor Basic Formulary Non-formulary products: 25% co-payment	MRP
	OTC (Axis, Networx not applicable)	Pinnacle: No Levy Max of R150 per prescription Dynamix : No Levy Max of R140 per prescription Symmetry / Mumed: No Levy Max of R125 per prescription	MRP
	Oncology	No Levy	MRP
	HV/AIDS	No Levy	MRP
	Prescribed Minimum Benefits (PMB)	Pinnacle / Dynamix: Mediscor Standard Formulary Non-formulary products: 25% co-payment Mumed / Symmetry: Mediscor Basic Formulary Non-formulary products: 25% co-payment Axis: Mediscor Core Formulary Non-formulary products: 25% co-payment	MRP
		Networx: Mediscor Core Formulary Non-formulary products: No co-payment (subject to Formulary Reference Price)	FRP
	Biological Benefits (Networx not applicable)	Pinnacle: No Levy Dynamix/ Symmetry / Mumed / Axis : 25% co-payment	MRP
	Contraception	Pinnacle / Dynamix: Max of R100 per prescription Symmetry: Max of R70 per prescription Mumed: Max of R60 per prescription	MRP

ADDITIONAL CUSTOMISED EXCLUSIONS:

1. Nootropil™

2. Phenolphthalein laxatives™

3. Phensydyl™ and generic equivalents

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