|
|
MEDISCOR (PTY) LTD |
NOTIFICATION
56
OF
2008 |
15 December 2008
|
|
Medical
Scheme |
Solvita Medical Scheme |
|
Administrator |
Prosperity Health |
|
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 Solvita
Medical Scheme as outlined below.
Herewith
the details for submitting medicine claims to Mediscor:
|
1. |
Scheme
Code (PCN) |
1. |
MDS0051 |
|
2. |
Switch
Destination Code |
2. |
SMSC0002
|
|
3. |
EDI
Activation Code (Dispensing Doctors) |
3. |
270P |
|
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. |
Prosperity |
|
17. |
Chronic
pre-authorisation Mediscor ChroniLine™ |
17. |
Yes |
|
18. |
Reimbursement
structure – Dispensing Doctors |
18. |
SEP
+ 16% / R16.00 |
|
19. |
Reimbursement structure – Pharmacies |
19. |
SEP + 26% / R26.00 |
|
20. |
Scheduled
0 or Unscheduled |
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 Solvita Medical Scheme
effective from 1 January 2009:
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MRP® |
EXCLUSIONS |
|
Protea Kosmos Iris |
Acute |
No Levy |
Yes |
3-5, 7-9, 11, 14-27, 30-32, 35, 40-41, 43-45,
47-48, 50-51, 53, 55, 60-62 |
|
Chronic (excluding Kosmos) |
No Levy |
|||
|
Prescribed
Minimum Benefits (PMB) |
Preferred products: No
Levy Non-Preferred products: Reject |
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|
HIV/AIDS |
No Levy |
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|
Oncology |
No Levy |
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|
Organ
Transplant |
No Levy |
|||
|
External
Appliances |
No Levy |
|||
|
OTC (Member Claim) |
Iris: maximum of R260 per script Protea: maximum of R200 per script Kosmos: maximum of R140 per script |
Additional
Customised Exclusions:
|
1. |
Phenolphthalein™
laxatives |
|
|
|
2. |
Histaglobin™ |
|
|
|
3. |
Nootropil™ |
|
|
|
4. |
Urinary
Alkalinizers |
|
|
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 Share Call Centre Helpline |
: |
0860 113 238 or 0860 117 705 |
|
Mediscor ChroniLine™ |
: |
0860 119 553 |
Kind
regards.
JACK PEREL