MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 72 OF 2008
		18 December 2008

Medical Scheme	PUREhealth
Administrator	Eternity Private Health Fund Managers
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 PUREhealth Medical Scheme as outlined below.

Herewith the details for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0055
2.	Switch Destination Code	2.	NMBO0000
3.	EDI Activation Code (Dispensing Doctors)	3.	136P
4.	MRP®	4.	Yes – selected options
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.	Eternity
17.	Chronic pre-authorisation at Mediscor	17.	No - MHS
18.	Reimbursement structure - Pharmacies	18.	SEP + 26% / R26.00
19.	Reimbursement structure – Dispensing Doctors	19.	SEP + 16% / R16.00
20.	Reimbursement structure – Schedule 0 and Unscheduled Medicine	20.	SEP + 31% (Excl. VAT)

* 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 Scheme rules for PUREhealth effective from 1 January 2009:

OPTIONS	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MRP®	EXCLUSIONS
Topcare Savemed Famplus	Acute Benefit	Famplus – 20% Savemed – No Levy Topcare – No Levy	Yes Yes Yes	4, 5, 7-11, 14,15, 17, 19-20, 22-25, 27, 30-32, 38, 43, 45, 60-61
	Chronic	Famplus – Non-formulary 30% co-pay Savemed – Non-formulary 30% co-pay Topcare – Non-formulary 30% co-pay	Yes Yes No
	Prescribed Minimum Benefits (PMB)	Preferred Formulary Products (MHS Formulary) Famplus – No levy Topcare – No Levy Savemed - No Levy Non-Preferred Formulary Products (MHS Formulary) Famplus – 30% co-payment Topcare – 30% co-payment Savemed - 30% co-payment	Yes No Yes Yes No Yes
	OTC Benefit	Famplus – 20% Savemed – No Levy Topcare – No Levy	Yes Yes Yes
	Organ Transplant Benefit	Famplus – No Levy Savemed – No Levy Topcare – No Levy	Yes Yes Yes
	Oncology Benefit	Famplus – No Levy Savemed – No Levy Topcare – No Levy	Yes Yes Yes
	HIV Benefit	Famplus – No Levy Savemed – No Levy Topcare – No Levy	Yes Yes No
	Appliance	Famplus – No Levy Savemed – No Levy Topcare – No Levy	Yes Yes No

PRESCRIBED MINIMUM BENEFITS (PMBs) – MHS Formulary

Members need to apply for Prescribed Minimum Benefits at Managed Health Systems (MHS) –

0860 10 57 85.

If you require any assistance, please contact:

Mediscor’s Share Call Centre Helpline Managed Health System (MHS)

: :

0860 11 32 38 or 0860 11 77 05 0860 10 57 85

Kind regards

JACK PEREL