|
|
MEDISCOR (PTY) LTD |
NOTIFICATION
55
OF
2008 |
15 December 2008
|
|
Medical Scheme |
GETMED |
|
Administrator |
GETMED |
|
Information Relevant to |
Benefits and Options for
2009 |
|
Effective Date |
1 January 2009 |
With
effect 1 January 2009, Mediscor will be applying the scheme rules for GETMED
Medical Scheme as outlined below.
Herewith
the details for submitting medicine claims to Mediscor:
|
1. |
Scheme
Code (PCN) |
1. |
MDS0060 |
|
2. |
Switch
Destination Code |
2. |
GETM0001
|
|
3. |
EDI
Activation Code (Dispensing Doctors) |
3. |
No |
|
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. |
11 Numerical digits |
|
16. |
Payments
to Providers |
16. |
GETMED |
|
17. |
Chronic
pre-authorisation Mediscor ChroniLine™ |
17. |
No |
|
18. |
Reimbursement structure – Pharmacies |
18. |
SEP + 26% / R26.00 |
|
19. |
Scheduled
0 or Unscheduled |
19. |
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 GETMED Medical Scheme
effective from 1 January 2009:
Options:
Gold
Range
·
G1000
·
G500
·
G200
Blue
Range
·
B300
·
B200
·
B100
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MRP® |
EXCLUSIONS |
|
G1000 G500 G200 B300 B200 B100 |
Acute |
No Levy |
Yes |
6, 37, 40, 51, 62 |
|
Chronic
(excluding B100) |
||||
|
HIV
/ AIDS |
||||
|
OTC |
No Levy G1000 – maximum of R75
per script G500 – maximum of R75
per script G200 – maximum of R75
per script B300 – maximum of R40
per script B200 – maximum of R40
per script B100 – maximum of R40
per script |
CHRONIC
MEDICINE APPLICATIONS:
Members
need to apply and register for Chronic Medicine Benefits with GETMED on
0800 002 505.
If
you require any assistance, please contact:
|
Mediscor’s Share Call Centre Helpline |
: |
0860 113 238 or 0860 117 705 |
Kind
regards.
JACK
PEREL