MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 52 OF 2011
		23 December 2011

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

With effect 1 January 2012, Mediscor will be applying the scheme rules for Umvuzo Health Medical Scheme as outlined below.

Standard and Ultra Affordable Options: 

· GP Prescription claims – Use PrimeCure Claiming code (MDS0331 or MDS0300)

· Specialist Prescription Claims – Use Mediscor Scheme Code MDS0059

Supreme Option: 

· All claims – Use Mediscor Scheme Code MDS0059

Herewith the detail for submitting Acute Medicine claims from Specialists to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0059
2.	Switch Destination Code	2.	UHMS0001
3.	EDI Activation Code (Dispensing Doctors)	3.	No
4.	Reference Pricing	4.	Yes
5.	Maximum supply of medicine	5.	30 Days
6.	Days supply of the dispensed medicine	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 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.	9 digit NAPPI code of medicine dispensed	13.	Yes / Compulsory
14.	ICD-10 Diagnosis code	14.	Yes / Compulsory
15.	Membership number requirements	15	Min. 6 Numerical
16.	Chronic pre-authorisation	16.	Mediscor ChroniLine^TM
17.	Payments to Providers	17.	Umvuzo Health
18.	Reimbursement Structure - Pharmacies	18.	SEP + 28%/R28
19.	Over the counter (OTC)	19.	SEP + 28%/R28

· 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 rules for Umvuzo Health Medical Scheme effective 1 January 2012:

OPTION	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Standard	Savings	No Levy	Yes	1-7, 11, 14, 15, 16, 19, 21-25, 27, 30-32, 35, 38, 40, 41, 43-45, 47-53, 57-62
	Acute	No Levy Authorised Specialist consultation and prescription only
	Prescribe Minimum Benefits (PMBs)	No Levy DSP applicable
	Chronic	No Levy
	Surgical	No Levy
	Oncology	No Levy
	High Cost	No Levy
	HIV/AIDS	No Levy
Supreme	Acute	No Levy	Yes	1-7, 11, 14, 15, 16, 19, 21-25, 27, 30-32, 35, 38, 40, 41, 43-45, 47-53, 57-62
	Chronic	No Levy
	Prescribed Minimum Benefits (PMBs)	No Levy DSP applicable
	Surgical	No Levy
	Oncology	No Levy
	High Cost	No Levy
	HIV/AIDS	No Levy
	OTC	No Levy Max of R150 per prescription
Ultra Affordable	Savings	No Levy	Yes	1-7, 11, 14, 15, 16, 19, 21-25, 27, 30-32, 35, 38, 40, 41, 43-45, 47-53, 57-62
	Acute	No Levy Authorised Specialist consultation and prescription only
	Prescribed Minimum Benefits (PMBs)	No Levy DSP applicable
	Surgical	No levy
	High Cost	No Levy
	HIV/AIDS	No Levy

ADDITIONAL RULES

• Medicine prescribed by a Specialist: Will only pay if Specialist consultation was authorized by Umvuzo Health. Members to contact Umvuzo Health on 086 108 3084. Specialist Prescribers only.
• Surgical Benefit: Pre-authorisation obtained from Umvuzo Health on 086 108 3084.
• Chronic/Prescribed Minimum Benefits (PMBs) (DSP applicable): Members need to apply and register with Mediscor ChroniLine^TM on 0860 119 553

If you require any assistance, please contact:

Mediscor’s Call Centre	:	0860 113 238 or 0860 117 705
Mediscor ChroniLine™ Mediscor E-Mail	: :	0860 119 553 helpdesk@mediscor.co.za

Kind Regards

JACK PEREL