MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 51 OF 2009
		Date 22 December 09

Medical Scheme	ThebeMed Medical Scheme
Administrator	Thebe Ya Bophela Healthcare 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 THEBEMED Medical Scheme as outlined below.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0033
2.	Switch Destination Code	2.	TBEN0001
3.	EDI Activation Code (Dispensing Doctors)	3.	769P
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.	7 Numerical
16.	Payments to Providers	16.	ThebeMed
17.	Chronic pre-authorisation at Mediscor	17.	Yes
18.	Reimbursement structure – Dispensing Doctors	18.	SEP + R16/16%
19.	Reimbursement structure – Pharmacies	19.	SEP + R26/26%
20.	Reimbursement structure – Schedule 0 and Unscheduled medicine	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 THEBEMED effective from 1 January 2010:

OPTION	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Frontier Energy Universal	Acute Benefit	No levy	Yes	1-9,11,14-15,17, 19-28,30-32,40-41, 45,47-48
	Chronic Benefit	No levy
	Prescribed Minimum Benefits (PMB)	Frontier / Energy Mediscor Standard Formulary: No levy Non-formulary products: 30% Co-payment Universal Mediscor Basic Formulary: No levy Non-formulary products: Reject
	Oncology	No Levy
	HIV / AIDS	No Levy
	Appliance (Except Universal)	No levy
	OTC Benefit (Except Universal)	No levy Max. R100 per prescription

Additional Customised Exclusions:

1.	Nootropil™
2.	Celebrex™, Mobic™, Coxflam™
3.	Phensydyl™ and generic equivalents
4.	Histaglobin™

If you require any assistance, please contact:

Mediscor’s Toll-free Call Centre Helpline Mediscor ChroniLine™

: :

0860 113 238 or 0860 117 705 0860 119 553

Kind regards

JACK PEREL