PREFERRED PROVIDER NETWORK …

1 GEMS Optometry NETWORK Agreement Page 1 of 4 Please insert Practice Number: ..Mail merge number and name of initial here .. Annexure B PREFERRED PROVIDER NETWORK ARRANGEMENTS APPLICABLE TO THE GEMS RUBY, EMERALD VALUE, EMERALD AND ONYX BENEFIT OPTIONS This annexure sets out the NETWORK arrangements for Covered Services to be provided to the Members of the Ruby, Emerald Value, Emerald and Onyx benefit options of the Scheme. 1. Covered Services The Covered Services for purposes of this arrangement will be the optometry healthcare services as specified in the Rules and Benefit Schedule for the Ruby, Emerald value, Emerald and Onyx benefit options of the Scheme.

2 The applicable Covered Services are set out in summarised format in Schedule 1 to this Annexure. 2. Conditions for Participation In order to participate in this Scheme specific arrangement, the Participating Optometrist agrees to the following: adhere to the terms of the main Agreement to which this is an annexure; and charge for Covered Services rendered according to the Scheme tariffs as determined by the Rules; and not to levy any co-payments or hold a member liable for payment for Covered Services outside of the Scheme tariffs as determined by the Rules and Benefit Structure. However, should a member receive on his/her own request relevant health services that are not part of the Covered Services, it will be for the member s own account; and maintain the following minimum service hours: Weekdays 08h00 to 17h00.

3 The Participating Optometrist is not obliged, but shall endeavour, to also operate on Saturdays between 08h30 to 12h30; and abide to the Scheme s claims submission processes by providing correct ICD 10 coding and submit all claims lines, unaided visual acuity and lens prescription information; and make his practice available to be audited pursuant to this Agreement by the Scheme upon request subject to the rules and regulations of the Health Professions Council of South Africa ; and function as an appointed member of the PREFERRED PROVIDER NETWORK (PPN) as defined in the Act for purposes of this Annexure; and accept the role of the Clinical Coordination Committee and peruse his/her practice s results on at least a quarterly basis and submit to peer mentoring and review.

4 3. Service levels In providing the Covered Services the Participating Optometrist will adhere to the service levels as set out below: Service Description Service Level 1. Clinical Quality Assurance Ensure that cost-effective and appropriate care is rendered to members in respect of the optical benefits as contained in the Rules. Ongoing 2. Utilisation reviews Assist in conducting utilisation analyses for each benefit option. Ongoing 3. Fee compliance Ensure adherence to applicable fee 100% compliance with monthly reporting on compliance. GEMS Optometry NETWORK Agreement Page 2 of 4 Please insert Practice Number.

5 Mail merge number and name of initial here .. schedules with no balance billing of members Schedule 1 to Annexure B COVERED SERVICES FOR RUBY, EMERALD VALUE, EMERALD AND ONYX BENEFIT OPTIONS This schedule provides a summary of the covered services to be provided to the members of the Scheme as set out in the Benefit Schedule. This summary is however subject to the full registered Rules of the Scheme in respect of the year under consideration. 1. Summary of Covered Services: One examination per beneficiary per year. (Glaucoma testing is included in the examination for all ages, where relevant.)

6 Benefits per beneficiary for single vision, bi-focal and multi-focal (vari-focal distance to near vision and intermediate to near vision) spectacle lenses in glass and plastic subject to block benefit and/or PMSA optical benefit limit. Subject to the Optical Managed Care Programme Spectacles and contact lenses are mutually exclusive in a benefit year. This excludes variable tint and photo chromic lenses The optometrist may provide a motivation for clinically essential items such as spectacle lenses and clinically appropriate add-ons that are not normally covered by the optometric benefit. A decision will be made whether to pay claims of this nature based on the clinical necessity of these items.

7 Please note: Optical benefit is not pro-rated irrespective of date of registration. Plano (zero power) lenses for both eyes will not be covered by the Scheme. Sunglasses and transition lenses are also not covered by the Scheme. 2. Benefit Limits: Ruby 100% of Scheme Rate. Subject to PMSA or Block Benefit Emerald Value 100% of Scheme Rate Sublimit as set out in the Benefit Schedule per beneficiary every second year and an annual limit as set out in the Benefit Schedule per family Sub-limit as set out in Benefit Schedule per frame Emerald 100% of Scheme Rate Sublimit as set out in the Benefit Schedule per beneficiary every second year and an annual limit as set out in the Benefit Schedule per family Sub-limit as set out in Benefit Schedule per frame Onyx 100% of Scheme Rate GEMS Optometry NETWORK Agreement

8 Page 3 of 4 Please insert Practice Number: ..Mail merge number and name of initial here .. Overall limit as set out in Benefit Schedule per beneficiary every second year and an annual limit as set out in the Benefit Schedule per family Sub-limit as set out in the Benefit Schedule per frame 3. Benefit Reimbursement Rate Out of benefit upgrades selected by members are payable directly to the participating Optometrist at no more than the relevant GEMS Optometric Tariff. The Scheme accepts no responsibility for accounts for extras chosen by beneficiaries.

9 4. Proviso From time to time it may be necessary for the Scheme to make minor changes to the methodology in this model. Unless these changes have a material effect on the outcome of this model the Scheme reserves the right to make these minor changes without necessarily adding an addendum to this Agreement, but shall provide the Participating Optometrist with notification such change at least 30 (thirty) days prior to the date of implementation of such change. Accepted/Declined (Please delete whichever is not applicable) _____ Initials and surname _____ Date GEMS Optometry NETWORK Agreement Page 4 of 4 Please insert Practice Number.

10 Mail merge number and name of initial here .. SCHEDULE 1 PARTICULARS OF OPTOMETRIST .. (initials and surname of the Participating Optometrists) HPCSA Identity Number: .. Partnership/Group Practice Number (if applicable) .. Individual Practice Numbers of all the Optometrists participating: .. Accounts submitted using: Individual Practice number Partnership/Group Practice Number SAOA Membership number :.. Physical address: .. Street:.. Surburb:.. Town:.. Postal Code: .. Postal address.