Medical Scheme MASSMART Health Plan - …

1 MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001 NOTIFICATION 72 OF 2013 17 December 2013 Medical Scheme Option MASSMART Health plan Choice and Network Options Administrator Universal Healthcare Information Relevant to Benefits and Options for 2013 Effective Date 21 December 2013 With effect 21 December 2013 (submission date), Mediscor will be applying the Scheme rules for MASSMART Health plan as outlined below. Providers can contact Universal Healthcare administrators on 0860 002 117 for reversal queries prior to 21 December 2013. Herewith the detail for submitting medicine claims to Mediscor: 1. Scheme Code (PCN) MDS0085 2. Switch Destination Code MSSS0000 3. EDI Activation Code (Dispensing Doctors) 038P 4. Reference Pricing Yes 5. Maximum supply of medicine 30 Days 6. Days of supply of the dispensed medicine Yes / Compulsory 7.

2 Membership number as per membership card Yes / Compulsory 8. Dependant code as per membership card Yes / Compulsory 9. Dependant first name as per membership card Yes / Compulsory 10. Dependant date of birth Yes / Compulsory 11. Dependant s gender (male/female) Yes / Compulsory 12. Practice number of the prescriber Yes / Compulsory 13. ICD-10 Diagnosis code Yes / Compulsory 14. 9 digit NAPPI code of medicine dispensed Yes / Compulsory 15. Membership number requirements Min 7 numerical digits 16. Payments to Providers Universal Healthcare 17. Pre-authorisations Universal Healthcare 18. Reimbursement structure - Doctors SEP + 30%/R27 19. Reimbursement structure Pharmacies SEP + 30%/R30 20. Over the counter (OTC) SEP + 30%/R30 SEP (VAT Incl.) and dispensing fee (VAT Excl.) Reimbursement structure will be applied on scheduled medicines (0 8) and unscheduled products. ICD-10 codes information available on IMPORTANT: The details below serve as a GUIDELINE ONLY.

3 Due to the complexities of various levies, co-payments, formularies and exclusion criteria; service providers must refer to our on-line responses to apply the correct rules. Herewith the Scheme rules for MASSMART Health plan effective from 21 December 2013: OPTIONS BENEFITS APPLICABLE LEVY REFERENCE PRICING EXCLUSIONS CHOICE Acute No MRP 3-5, 7-9, 11, 14, 15, 17, 19, 20-25, 27, 30-32, 35, 27, 30-32, 35, 37, 38, 43, 45, 60, 64 OTC Chronic PMB Non-formulary or Non-DSP 25% Chronic Non-PMB Oncology No Specialised benefit Onco Organ Transplant HIV/AIDS Non-formulary or Non-DSP 25% Haematology No Specialised benefit Non-Onco Appliance NETWORK Acute No MRP 1-5, 7-9, 10, 11, 14, 15, 17, 19-21, 23-25, 27, 30-32, 35, 37, 38, 40-45, 47-51, 60,64 Acute: Non-formulary 25% Chronic Non-formulary or Non-DSP 25% Oncology No Organ Transplant HIV/AIDS Non-formulary or Non-DSP 25% Appliance No IF YOU REQUIRE ANY ASSISTANCE, PLEASE CONTACT: Mediscor s Contact Centre Mediscor ChroniLine Mediscor E-mail Universal Healthcare.

4 0860 113 238 or 0860 117 705 0860 119 553 0860 002 117 Please send any questions regarding this communiqu to Kind Regards ILSE STEYN