|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 6OF2009 |
24 April
2009
|
|
Medical Scheme |
GETMED |
|
Administrator |
GETMED |
|
Information Relevant to |
New option on GETMED
(Student Plan) |
|
Effective Date |
1 May 2009 |
Please note the new option under GETMED Medical Scheme effective
01 May 2009:
·
Student
Plan (MDS0060)
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
o G1000
o G500
o G200
Blue Range
o B300
o B200
o B100
Student Plan
o SP500
|
OPTIONS |
BENEFITS
APPLICABLE |
LEVY
/ CO-PAYMENT |
MRP® |
EXCLUSIONS |
|
G1000 G500 G200 B300 B200 B100 SP500 |
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 SP500 – 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