Scheme Notes - Medscheme by jizhen1947

VIEWS: 17 PAGES: 19

									                                                                  Appendix: Pharmacy - Notes   March 2011
                                                                          Version 1




                                              NOTES:
                  No Changes




Highlighted lines denote an amendment or addition to scheme details                                   19
                                                                                                                                         Appendix A: Pharmacy                                                           March 2011
                                                                                                                                              Version 1




                                                                                                                                                                                                      Benefit booking
                                                                                                                  Scheme notes
                                                                             Generic price

                                                                                             MPL / NMPL
                                               Prefix code



                                                               Code



                                                                      Levy
                                                                                                                                 Chronic Benefit Disease                                  Effective




                                                                                                          DUE
            Medical Aid Scheme                                                                                                                                     Exclusions
                                                                                                                                          List                                              date



                                                                                                                                                            2-5,7-11,14,15,17,     20-
AECI Medical Aid Society                       303            AECIH   Nil                     Y           Y                                                        25,27,30-32,           1-Jan-10       Y
                                                                                                                                                               35,51,52,54,58,61,62
                                                                                                                                                            2-5,7-11,14,15,17,     20-
AECI Medical Aid Society - PAT                 303           AECIHP   Nil                     Y           Y                                                        25,27,30-32,           1-Jan-10       Y
                                                                                                                                                               35,51,52,54,58,61,62
AECI Medical Aid Society - AfA & Chronic
                                               303           AECIHQ   Nil                     Y           Y     C, F                      1-122                       None                24-May-04      Y
Medicine Management
AECI Medical Aid Society - Chemotherapy        303           AECIHX   Nil     N                           Y                                                            None               1-Jan-05      Y
                                                                                                                                                             3-5,6,7-9,10,11,12,13,14-
                                                                                                                                                                15,17,19-25,27,30-
AECI Medical Aid Society - Basic Carecross     460            AECIC   Nil                                 Y                                                                               1-Jan-08      N
                                                                                                                                                            32,35,36,37,38,51,52,54,59,
                                                                                                                                                                     60-62,64
AECI Medical Aid Society - Basic Carecross
                                               460           AECICQ   Nil                     Y           Y     C, F                                                                      1-Sep-05       Y
AfA
                                                                                                                                                             3-5,7-11,14,15,17,21-25,
Barloworld Medical Scheme                      050           BARLO    Nil                     Y           Y                                                 27, 30-32,35-38, 40,41, 43-   1-Jan-07       Y
                                                                                                                                                                45,51, 53,58,60-64
Barloworld Medical Scheme - AfA & Chronic
                                               050           BARCM    Nil                     Y           Y     C, F                      1-122                       None                1-Jan-06       Y
Medicine Management

Barloworld Medical Scheme - Chemotherapy       050           BARLOX   Nil     Y               Y           Y                                                           None                1-Nov-08      Y

                                                                                                                                                            3-5,7-9,10,11,14,17,19, 20-
BMW Employees Medical Aid Society              119            BMW     Nil                     Y                                                                25,27,30-32,35,36,37,      1-Jan-09       Y
                                                                                                                                                                38,45,51,53,60-64.
BMW Employees Medical Aid Society - AfA &
                                               119           BMWQHS   Nil                     Y                 C, F                      1-122                       None                21-Jun-04      Y
Chronic Medicine Management
BMW Employees Medical Aid Society -
                                               119           BMWX     Nil     Y               Y                                                                       None                1-Nov-08      Y
Chemotherapy
                                                                                                                                                            3-5,7-9,10,11,14,17,19, 20-
BMW Employees Medical Aid Society - PAT        119           BMWP     Nil                     Y                 R 200                                          25,27,30-32,35,36,37,      1-Jan-09       Y
                                                                                                                                                                38,45,51,53,60-64.
                                                                                                                                                             1-5,7-15,17,19-25,27,30-
Bonitas Medical Fund - Bonitas Standard        020           BONTA    Nil                     Y           Y     A, E                                            32,35-38 ,40,41,43-       1-Jan-08       Y
                                                                                                                                                                  45,51,58,60-64
                                                                                                                                 1-25,26-28,32,34,36,39,
Bonitas Medical Fund - Bonitas Standard -AfA
                                               020           BONTAQ   Nil                     Y           Y      C,F             47,50,55,57,66,72,74,82,             None                1-Jan-05       Y
& Chronic Medicine Management
                                                                                                                                     90,105,111,113
Bonitas Medical Fund - Bonitas Standard -
                                               020           BONTAX   Nil     Y               Y           Y                                                           None                1-Nov-08      Y
Chemotherapy
                                                                                                                                                             1-5,7-15,17,19-25,27,30-
Bonitas Medical Fund - Bonitas Standard -                                                                       No Rx
                                               020           BONTAP   Nil                     Y           Y                                                     32,35-38 ,40,41,43-       1-Jan-08       Y
PAT                                                                                                              limit
                                                                                                                                                                  45,51,58,60-64




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                             2
                                                                                                                                          Appendix A: Pharmacy                                                         March 2011
                                                                                                                                               Version 1




                                                                                                                                                                                                     Benefit booking
                                                                                                                  Scheme notes
                                                                             Generic price

                                                                                             MPL / NMPL
                                               Prefix code



                                                               Code



                                                                      Levy
                                                                                                                                 Chronic Benefit Disease                                 Effective




                                                                                                          DUE
            Medical Aid Scheme                                                                                                                                      Exclusions
                                                                                                                                          List                                             date



                                                                                                                                                                     3-5,10,12-
Bonitas Medical Fund - Bonitas Bonsave         240           BONSV    Nil                     Y           Y     A, E                                          14,17,20,24,25,30,31,36,   1-Jan-08       Y
                                                                                                                                                                 37,45,51,60,61,64
Bonitas Medical Fund - Bonitas Bonsave - AfA
                                               240           BONSVQ   Nil                     Y           Y      C,F                      1-25,39                      None              1-Jun-06       Y
& Chronic Medicine Management
Bonitas Medical Fund - Bonitas Bonsave -
                                               240           BONSVX   Nil     Y                           Y                                                            None              1-Jan-05      Y
Chemotherapy
                                                                                                                                                                     3-5,10,12-
Bonitas Medical Fund - Bonitas Bonsave -                                                                        No Rx
                                               240           BONSVP   Nil                     Y           Y                                                   14,17,20,24,25,30,31,36,   1-Jan-08       Y
PAT                                                                                                              limit
                                                                                                                                                                 37,45,51,60,61,64
                                                                                                                                                              1-5,7-15,17,19-25,27,30-
Bonitas Medical Fund - Bonitas Primary         277           BONPR    Nil                     Y           Y     A, E                                             32,35-38 ,40,41,43-     1-Jan-08       Y
                                                                                                                                                                     45,51,60-64
Bonitas Medical Fund - Bonitas Primary - AfA
                                               277           BONPRQ   Nil                     Y           Y      C,F                      1-25,39                      None              1-Jun-06       Y
& Chronic Medicine Management
Bonitas Medical Fund - Bonitas Primary -
                                               277           BONPRX   Nil     Y               Y           Y                                                            None              1-Nov-08      Y
Chemotherapy
                                                                                                                                            1-5,7-15,17,19-25,27,30-
                                                                                                       No Rx
Bonitas Medical Fund - Bonitas Primary - PAT   277           BONPRP   Nil                     Y Y                                              32,35-38 ,40,41,43-         1-Jan-08                     Y
                                                                                                        limit
                                                                                                                                                   45,51,60-64
Bonitas Medical Fund - Boncap                  470            BONC                           Capitation plan - Members must obtain their medication from a preferred provider.
Bonitas Medical Fund - Boncap - AfA            470           BONCQ    Nil                     Y         C,F                                                                1-Nov-06                     Y
Bonitas Medical Fund - Boncap -
                                               470           BONCX                           Capitation plan - Members must obtain their medication from a preferred provider.
Chemotherapy
                                                                                                                                                                     3-5,10,12-
Bonitas Medical Fund - Boncom                  477           BCOM     Nil                     Y           Y        H                                          14,17,20,24,25,30,31,36,   1-Jan-08      Y
                                                                                                                                                                 37,45,51,60,61,64
                                                                                                                                    1-25,26,27,32,33,34,
                                                                                                                                  36,39,41,45,47,50,51,55,
Bonitas Medical Fund - Boncom - AfA &
                                               477           BCOMQ    Nil                     Y           Y                       56,57,60,66,71,72,74,79,             None              1-Jan-07      Y
Chronic Medicine Management
                                                                                                                                 80,82,83,84,86,89,90,94,10
                                                                                                                                     2,104,105,111,113
Bonitas Medical Fund - Boncom -
                                               477           BCOMX    Nil                                 Y                                                            None              1-Jan-07      Y
Chemotherapy
                                                                                                                                                                     3-5,10,12-
                                                                                                                No Rx
Bonitas Medical Fund - Boncom - PAT            477           BCOMP                            Y           Y                                                   14,17,20,24,25,30,31,36,   1-Jan-08      Y
                                                                                                                 limit
                                                                                                                                                                 37,45,51,60,61,64
Bonitas Essential                              479    BONESS                                 This is only a hospital plan                                                                1-Jan-10      Y
                                                 CLICKS GROUP MEDICAL SCHEME and MOREMED MEDICAL SCHEME are merging to be HORIZON
CLICKS MEDICAL SCHEME                                                                                                                                                                    1-Jan-11     N
                                                                             MEDICAL SCHEME effective 01/01/2011
Eyethumed - Option 1                           891           Capitation plan - Members must obtain their medication from a preferred provider.                                           1-Jan-08      N
                                                                                                                                4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme - Ultimax             804     ULTIO    Nil             Y Y      D                                                                                               1-May-08       Y
                                                                                                                                       36,45, 61




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                            3
                                                                                                                                      Appendix A: Pharmacy                                                        March 2011
                                                                                                                                           Version 1




                                                                                                                                                                                                Benefit booking
                                                                                                              Scheme notes
                                                                           Generic price

                                                                                           MPL / NMPL
                                             Prefix code



                                                             Code



                                                                    Levy
                                                                                                                             Chronic Benefit Disease                                Effective




                                                                                                        DUE
           Medical Aid Scheme                                                                                                                                  Exclusions
                                                                                                                                      List                                            date



                                                                                                                              1-25,29,32-34,36,38,39,
                                                                                                                               41,46-48,51,55-57,62
Fedhealth Medical Scheme - AfA & Chronic
                                             804           ULTIOQ   Nil                     Y           Y      C                ,66,69-72,74,79-84,               None              1-May-08       Y
Medicine Management
                                                                                                                             89,90,94, 98,102-105, 111-
                                                                                                                                        113
Fedhealth Medical Scheme - Ultimax -
                                             804           ULTIOX   Nil                                 Y                                                         None              1-May-08       Y
Chemotherapy
                                                                                                                                                          4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme - Ultimax - PAT     804           ULTIOP   Nil                     Y           Y                                                                           1-May-08       Y
                                                                                                                                                                 36,45, 61
Fedhealth Medical Scheme - Ultima 300 A                                                                                                                   4,5, 17, 23-25, 30, 31,
                                             810           UULX     Nil                     Y           Y      D                                                                    1-May-08       Y
(OHEB)                                                                                                                                                           36,45, 61
                                                                                                                              1-25,29,32-34,36,38,39,
Fedhealth Medical Scheme - Ultima 300 A                                                                                         41,46-48,51,55-57,62
(OHEB) - AfA & Chronic Medicine              810           ULTXQ    Nil                     Y           Y      C                 ,66,69-72,74,79-84,              None              1-May-08       Y
Management                                                                                                                   89,90,94, 98,         102-
                                                                                                                                     105,111-113
Fedhealth Medical Scheme - Ultima 300 A
                                             810           ULTXX    Nil                                 Y                                                         None              1-May-08       Y
(OHEB) - Chemotherapy
Fedhealth Medical Scheme - Ultima 300 A                                                                                                                   4,5, 17, 23-25, 30, 31,
                                             810           ULTXP    Nil                     Y           Y                                                                           1-May-08       Y
(OHEB) - PAT                                                                                                                                                     36,45, 61
                                                                                                                                                          4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme - Ultima 200 B      805           ULTTS    Nil                     Y           Y                                                                           1-May-08       Y
                                                                                                                                                                 36,45, 61
                                                                                                                              1-25,29,32-34,36,38,39,
                                                                                                                               41,46-48,51,55-57,62,
Fedhealth Medical Scheme - Ultima 200 B -
                                             805           ULTTSQ   Nil                     Y           Y      C                 66,69-72,74,79-84,               None              1-May-08       Y
AfA & Chronic Medicine Management
                                                                                                                             89,90,94, 98,102-105, 111-
                                                                                                                                        113
Fedhealth Medical Scheme - Ultima 200 B -
                                             805           ULTTSX   Nil                                 Y                                                         None              1-May-08       Y
Chemotherapy
Fedhealth Medical Scheme - Ultima 200 B -                                                                                                                 4,5, 17, 23-25, 30, 31,
                                             805           ULTTSP   Nil                     Y           Y                                                                           1-May-08       Y
PAT                                                                                                                                                              36,45, 61
                                                                                                                                                          4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme - Maxima Exec       806           ULTXTX   Nil                     Y           Y                                                                           1-Jan-11       Y
                                                                                                                                                                 36,45, 61
                                                                                                                              1-25,29,32-34,36,38,39,
                                                                                                                               41,46-48,51,55-57,62
Fedhealth Medical Scheme - Maxima Exec -
                                             806           ULTTXQ   Nil                     Y           Y      C                ,66,69-72,74,79-84,               None              1-Jan-11       Y
AfA & Chronic Medicine Management
                                                                                                                             89,90,94, 98,102-105, 111-
                                                                                                                                        113
Fedhealth Medical Scheme - Maxima Exec -
                                             806           ULTTXX   Nil                                 Y                                                         None              1-Jan-11       Y
Chemotherapy
Fedhealth Medical Scheme - Maxima Exec -                                                                                                                  4,5, 17, 23-25, 30, 31,
                                             806           ULTTXP   Nil                     Y           Y                                                                           1-Jan-11       Y
PAT                                                                                                                                                              36,45, 61
                                                                                                                                                          4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme - Maxima Plus       800           MAXH     Nil                     Y           Y      D                                                                    1-May-08       Y
                                                                                                                                                                 36,45, 61




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                       4
                                                                                                                                     Appendix A: Pharmacy                                                            March 2011
                                                                                                                                          Version 1




                                                                                                                                                                                                   Benefit booking
                                                                                                             Scheme notes
                                                                          Generic price

                                                                                          MPL / NMPL
                                             Prefix code



                                                            Code



                                                                   Levy
                                                                                                                            Chronic Benefit Disease                                    Effective




                                                                                                       DUE
           Medical Aid Scheme                                                                                                                                   Exclusions
                                                                                                                                     List                                                date



                                                                                                                            1-25,32-34,36,39, 41, 47-
Fedhealth Medical Scheme -Maxima Plus -                                                                                      48,51,55,56,62, 72,74,82,
                                             800           MAXHQ   Nil                     Y           Y      C                                                    None                1-May-08       Y
AfA & Chronic Medicine Management                                                                                           89,90,94, 98,103-105,111-
                                                                                                                                       113
Fedhealth Medical Scheme -Maxima Plus -
                                             800           MAXHX   Nil                                 Y                                                           None                1-May-08       Y
Chemotherapy
Fedhealth Medical Scheme - Maxima Plus -                                                                                                                   4,5, 17, 23-25, 30, 31,
                                             800           MAXHP   Nil                     Y           Y                                                                               1-May-08       Y
PAT                                                                                                                                                               36,45, 61
                                                                                                                                                           4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme -Maxima Core        801           MAXL    Nil                     Y           Y      D                                                                        1-May-08       Y
                                                                                                                                                                  36,45, 61
                                                                                                                            1-25,32-34,36,39, 41, 47-
Fedhealth Medical Scheme -Maxima Core -                                                                                      48,51,55,56, 62,72,74,82,
                                             801           MAXQ    Nil                     Y           Y                                                           None                1-May-08       Y
Chronic Medicine Management                                                                                                 89,90,94, 98,103-105,111-
                                                                                                                                       113
Fedhealth Medical Scheme - Maxima Core -
                                             801           MAXLX   Nil                                 Y                                                           None                1-May-08       Y
Chemotherapy
Fedhealth Medical Scheme -Maxima Core -                                                                                                                    4,5, 17, 23-25, 30, 31,
                                             801           MAXLP   Nil                     Y           Y                                                                               1-May-08       Y
PAT                                                                                                                                                               36,45, 61
                                                                                                                                                           4,5, 17, 23-25, 30, 31,
Fedhealth Medical Scheme -Maxima Standard    802           MAXS    Nil                     Y           Y      D                                                                        1-May-08       Y
                                                                                                                                                                  36,45, 61
                                                                                                                            1-25,32-34,36,39, 41, 47-
Fedhealth Medical Scheme -Maxima Standard                                                                                    48,51,55,56, 62,72,74,82,
                                             802           MAXSQ   Nil                     Y           Y      C                                                    None                1-May-08       Y
- AfA & Chronic Medicine Management                                                                                         89,90,94, 98,103-105,111-
                                                                                                                                       113
Fedhealth Medical Scheme - Maxima
                                             802           MAXSX   Nil                                 Y                                                           None                1-May-08       Y
Standard - Chemotherapy
Fedhealth Medical Scheme -Maxima Standard                                                                                                                  4,5, 17, 23-25, 30, 31,
                                             802           MAXSP   Nil                     Y           Y                                                                               1-May-08       Y
- PAT                                                                                                                                                             36,45, 61

                                                                                                                                                          2-6,10,12,17,19-25,27,30-
Fedhealth Medical Scheme -Maxima Basis       803           MAXB    Nil                     Y           Y                                                 32,35,36,38,40,41,43-45,47-   1-May-08       Y
                                                                                                                                                            49,51,53,55,58,61-63

                                                                                                                            1-25,32-34,36,39, 41, 47-
Fedhealth Medical Scheme -Maxima Basis -                                                                                     48,51,55,56, 62,72,74,82,
                                             803           MAXBQ   Nil                     Y           Y      C                                                    None                1-May-08       Y
AfA & Chronic Medicine Management                                                                                           89,90,94, 98,103-105,111-
                                                                                                                                       113
Fedhealth Medical Scheme - Maxima Basis -
                                             803           MAXBX   Nil                                 Y                                                           None                1-May-08       Y
Chemotherapy

                                                                                                                                                          2-6,10,12,17,19-25,27,30-
Fedhealth Medical Scheme -Maxima Basis -
                                             803           MAXBP   Nil                     Y           Y                                                 32,35,36,38,40,41,43-45,47-   1-May-08       Y
PAT
                                                                                                                                                            49,51,53,55,58,61-63

Fedhealth Medical Scheme - Blue Door         816                          Capitation plan - Members must obtain their medication from a preferred provider.




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                          5
                                                                                                                                        Appendix A: Pharmacy                                                           March 2011
                                                                                                                                             Version 1




                                                                                                                                                                                                     Benefit booking
                                                                                                                 Scheme notes
                                                                            Generic price

                                                                                            MPL / NMPL
                                             Prefix code



                                                            Code



                                                                    Levy
                                                                                                                                Chronic Benefit Disease                                  Effective




                                                                                                         DUE
            Medical Aid Scheme                                                                                                                                   Exclusions
                                                                                                                                         List                                              date



HORIZON MAJOR MEDICAL                        461                                             Y           Y        P                                                                      1-Dec-10     N
HORIZON MAJOR MEDICAL PLUS                                 MMS
                                             462                                             Y           Y        P                                                                      1-Dec-10     N
CARECROSS
HORIZON HOSPITAL                             463                           Capitation - medication to be obtained from preferred provider                                                1-Dec-10     N

IMPERIAL MEDICAL SCHEME                    IMPERIAL GROUP MEDICAL SCHEME - discontinued - effective 01/01/2011 (Scheme change of Administrator)                                          1-Jan-11     N

                                                                                                                                                                 3-5,7-9,11-15,
Massmart Health Plan                         269           MMT      Nil                      Y                                                            17,19,23,24,25,27,       30-   1-Jan-08       Y
                                                                                                                                                          32,35-38,51,59, 60,61,62,64
Massmart Health Plan - AfA & Chronic
                                             269           MMTQ     Nil                      Y                  C, F                    1-122                        None                21-Jun-04      Y
Medicine Management

                                                                                                                                                                 3-5,7-9,11-15,
Massmart Health Plan - PAT                   269           MMTP     Nil                      Y                                                            17,19,23,24,25,27,       30-   1-Jan-08       Y
                                                                                                                                                          32,35-38,51,59, 60,61,62,64

Massmart Health Plan - Chemotherapy          269           MMTX     Nil      N                                                                                      None                 1-Jan-05      Y
                                                                                                                                                          3-15,17,19-25,27,     30-
MB MED - Plan A                              220           DCMA     Nil                      Y           Y                                                 32,35-38,40,41,     43-       1-Jan-08       Y
                                                                                                                                                                45,51,58-63,64
MB MED - Plan A - AfA & Chronic Medicine
                                             220           DCMAQ    Nil                      Y           Y      C, F                 1-122,124,125                   None                1-Jan-08       Y
Management
MB MED - Plan A - Chemotherapy               220           DCMAX    Nil      Y               Y           Y                                                          None                 1-Nov-08      Y
                                                                                                                                                          3-15,17,19-25,27,     30-
                                                                                                               No Rx
MB MED - Plan A - PAT                        220           DCMAP    Nil                      Y           Y                                                 32,35-38,40,41,     43-       1-Jan-08      Y
                                                                                                                limit
                                                                                                                                                                45,51,58-63,64
                                                                                                                                                          1-15,17,19-25,27,     30-
Metrocare                                    211           METR     Nil                      Y           Y                                                 32,35-38,40-41,     43-       1-Jan-10       Y
                                                                                                                                                                45,51,58-62,64
Metrocare - AfA & Chronic Medicine
                                             211           METRQ    Nil                      Y           Y      C,J                     1-122                        None                1-May-05       Y
Management
                                                                                                                                                          1-15,17,19-25,27,      30-
Metrocare - PAT                              211           METRP    Nil                      Y           Y                                                 32,35-38,40-41,     43-       1-Jan-10       Y
                                                                                                                                                                45,51,58-62,64
Metrocare - Chemotherapy                     211           METRX     Nil     N                           Y                                                          None                 1-Jan-05      Y
                                                                    20%                                                                                    3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Gold               520           NHPA                              Y           Y      K, N                                                                     1-Jan-11     N
                                                                   (R30)                                                                                        40-51,60-62,64
Namibia Healthcare Plan - Gold - AfA &                              20%
                                             520           NHPC                              Y           Y     K, M, N                                               None                1-Jan-09     N
Chronic Medicine Management                                        (R30)
Namibia Healthcare Plan - Gold -                                    20%
                                             520           NHPC                              Y           Y     K, M, N                                               None                1-Jan-09     N
Chemotherapy                                                       (R30)
                                                                                                                                                           3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Gold - PAT         520           NHPP     Nil                      Y           N        B                                                                      1-Jan-11
                                                                                                                                                               40-51,60-62,64




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                            6
                                                                                                                                             Appendix A: Pharmacy                                                       March 2011
                                                                                                                                                  Version 1




                                                                                                                                                                                                      Benefit booking
                                                                                                                     Scheme notes
                                                                                Generic price

                                                                                                MPL / NMPL
                                                Prefix code



                                                                 Code



                                                                         Levy
                                                                                                                                     Chronic Benefit Disease                              Effective




                                                                                                             DUE
            Medical Aid Scheme                                                                                                                                       Exclusions
                                                                                                                                              List                                          date



                                                                         20%                                                                                   3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Corporate             521            NHPA                              Y           Y      K, N                                                                  1-Jan-11     N
                                                                        (R30)                                                                                      40-51,60-62,64
Namibia Healthcare Plan - Corporate - AfA &                              20%
                                                521            NHPC                              Y           Y     K, M, N                                              None              1-Jan-09     N
Chronic Medicine Management                                             (R30)
Namibia Healthcare Plan - Corporate -                                    20%
                                                521            NHPC                              Y           Y     K, M, N                                              None              1-Jan-09     N
Chemotherapy                                                            (R30)
                                                                                                                                                               3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Corporate - PAT       521            NHPP      Nil                     Y           N        B                                                                   1-Jan-11
                                                                                                                                                                   40-51,60-62,64
                                                                                                                                                               3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Hospital Plus         522            NHPA      Nil                     Y           Y        K                                                                   1-Jan-11     N
                                                                                                                                                                   40-51,60-62,64

Namibia Healthcare Plan - Hospital Plus - PAT   522                                                              Members to claim from scheme                                             1-Jan-09     N

                                                                         20%                                                                                   3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Silver                523            NHPA                              Y           Y      K, N                                                                  1-Jan-11     N
                                                                        (R30)                                                                                      40-51,60-62,64
Namibia Healthcare Plan - Silver - AfA &                                 20%
                                                523            NHPC                              Y           Y     K, M, N                                              None              1-Jan-09     N
Chronic Medicine Management                                             (R30)
Namibia Healthcare Plan - Silver -                                       20%
                                                523            NHPC                              Y           Y     K, M, N                                              None              1-Jan-09     N
Chemotherapy                                                            (R30)
                                                                                                                                                               3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Silver - PAT          523            NHPP      Nil                     Y           N        B                                                                   1-Jan-11
                                                                                                                                                                   40-51,60-62,64
                                                                         20%                                                                                   3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Economic              524            NHPA                              Y           Y      K, N                                                                  1-Jan-11     N
                                                                        (R30)                                                                                      40-51,60-62,64
Namibia Healthcare Plan - Economic - AfA &                               20%
                                                524            NHPC                              Y           Y     K, M, N                                              None              1-Jan-09     N
Chronic Medicine Management                                             (R30)
Namibia Healthcare Plan - Economic -
                                                524                                                                                 No Benefit                                            1-Jan-11     N
Chemotherapy
                                                                                                                                                               3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Economic - PAT        524            NHPP      Nil                     Y           N        B                                                                   1-Jan-11
                                                                                                                                                                   40-51,60-62,64
                                                                                                                                                               3-17,19-25,31-32, 35,36,
Namibia Healthcare Plan - Blue Diamond          525            NHPA      Nil                     Y           Y        K                                                                   1-Jan-11     N
                                                                                                                                                                   40-51,60-62,64
Namibia Healthcare Plan - Blue Diamond - AfA
                                                525            NHPC      Nil                     Y           Y      K, M                                                None              1-Jan-09     N
& Chronic Medicine Management
Namibia Healthcare Plan - Blue Diamond -
                                                525                                                                                 No Benefit                                            1-Jan-11     N
Chemotherapy
Namibia Healthcare Plan - Blue Diamond -
                                                525                                                              Members to claim from scheme                                             1-Jan-09     N
PAT
                                                                                                                                                               3-5,7-27,30-32,35-38,40-
NAMMED - Trauma                                 531           NAMMEDA    Nil                     Y           Y        K                                                                   1-Jan-10     N
                                                                                                                                                                    51,53,56-62,64
NAMMED - Trauma - Chronic Medicine
                                                531           NAMMEDC    Nil                     Y           Y      K, M                                                None              1-Jan-09     N
Management
NAMMED - Trauma - Chemotherapy                  531           NAMMEDC    Nil                     Y           Y     K, M                                                 None              1-Jan-09     N
NAMMED - Trauma - PAT                           531                                                              Members to claim from scheme                                             1-Jan-09     N




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                             7
                                                                                                                                          Appendix A: Pharmacy                                                          March 2011
                                                                                                                                               Version 1




                                                                                                                                                                                                      Benefit booking
                                                                                                                   Scheme notes
                                                                              Generic price

                                                                                              MPL / NMPL
                                             Prefix code



                                                              Code



                                                                     Levy
                                                                                                                                  Chronic Benefit Disease                                 Effective




                                                                                                           DUE
           Medical Aid Scheme                                                                                                                                      Exclusions
                                                                                                                                           List                                             date



                                                                                                                                                             3-5,7-27,30-32,35-38,40-
NAMMED - Standard                            532           NAMMEDA   20%                       Y           Y        K                                                                     1-Jan-10     N
                                                                                                                                                                  51,53,56-62,64
NAMMED - Standard - Chronic Medicine
                                             532           NAMMEDC   20%                       Y           Y      K, M                                                None                1-Jan-09     N
Management
NAMMED - Standard - Chemotherapy             532           NAMMEDC   20%                       Y           Y     K, M                                                 None                1-Jan-09     N
NAMMED - Standard - PAT                      532                                                               Members to claim from scheme                                               1-Jan-09     N
                                                                                                                                                             3-5,7-27,30-32,35-38,40-
NAMMED - Comprehensive                       533           NAMMEDA   20%                       Y           Y        K                                                                     1-Jan-10     N
                                                                                                                                                                  51,53,56-62,64
NAMMED - Comprehensive - Chronic
                                             533           NAMMEDC   20%                       Y           Y      K, M                                                None                1-Jan-09     N
Medicine Management

NAMMED - Comprehensive - Chemotherapy        533           NAMMEDC   20%                       Y           Y      K, M                                                None                1-Jan-09     N

NAMMED - Comprehensive - PAT                 533                                                               Members to claim from scheme                                               1-Jan-09     N
                                                                                                                                                             3-5,7-27,30-32,35-38,40-
NAMMED - Essential                           534           NAMMEDA   20%                       Y           Y        K                                                                     1-Jan-10     N
                                                                                                                                                                  51,53,56-62,64
NAMMED - Essential - Chronic Medicine
                                             534           NAMMEDC   20%                       Y           Y      K, M                                                None                1-Jan-09     N
Management
NAMMED - Essential - Chemotherapy            534           NAMMEDC   20%                       Y           Y     K, M                                                 None                1-Jan-09     N
NAMMED - Essential - PAT                     534                                                               Members to claim from scheme                                               1-Jan-09     N

                                                                                                                                                            3-5,8,10,13,17-27,30-32,35-
NAMMED - Active                              538           NAMMEDA   20%                       Y           Y        K                                                                     1-Jan-10     N
                                                                                                                                                               38,40-51,53,56-62,64

NAMMED - Active - Chronic Medicine
                                             538           NAMMEDC   20%                       Y           Y      K, M                                                None                1-Jan-09     N
Management
NAMMED - Active - Chemotherapy               538           NAMMEDC   20%                       Y           Y     K, M                                                 None                1-Jan-09     N
NAMMED - Active - PAT                        538                                                               Members to claim from scheme                                               1-Jan-09     N
                                                                                                                                                               3-5,9,14,15,17,20,21,
NEDGROUP Medical Aid Scheme -
                                             930                     Nil                       Y           Y        P                                       2325,30,31,32,34,37, 40,43-   1-Nov-09      N
HOSPITAL
                                                                                                                                                                        45
                                                             NBG
                                                                                                                                                               3-5,9,14,15,17,20,21,
NEDGROUP Medical Aid Scheme - SAVINGS        931                     Nil                       Y           Y        P                                       2325,30,31,32,34,37, 40,43-   1-Nov-09      N
                                                                                                                                                                        45
NEDGROUP Medical Aid Scheme - Traditional
                                             932                            Capitation - medication to be obtained from preferred provider.                                               1-Jan-11      N
Plus
                                                                                                                                                               3-5,9,14,15,17,20,21,
NEDGROUP Medical Aid Scheme - Traditional
                                             933                     Nil                       Y           Y        P                                       2325,30,31,32,34,37, 40,43-   1-Jan-11      N
Plan
                                                                                                                                                                        45
                                                             NBG
                                                                                                                                                               3-5,9,14,15,17,20,21,
NEDGROUP Medical Aid Scheme -
                                             934                     Nil                       Y           Y        P                                       2325,30,31,32,34,37, 40,43-   1-Nov-09      N
PLATINUM
                                                                                                                                                                        45
OLD MUTUAL STAFF Medical Aid Fund -
                                             910                            Capitation - medication to be obtained from preferred provider                                                1-Nov-09      N
NETWORK




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                             8
                                                                                                                                       Appendix A: Pharmacy                                                          March 2011
                                                                                                                                            Version 1




                                                                                                                                                                                                   Benefit booking
                                                                                                                Scheme notes
                                                                            Generic price

                                                                                            MPL / NMPL
                                             Prefix code



                                                             Code



                                                                     Levy
                                                                                                                               Chronic Benefit Disease                                 Effective




                                                                                                         DUE
           Medical Aid Scheme                                                                                                                                   Exclusions
                                                                                                                                        List                                             date



OLD MUTUAL STAFF Medical Aid Fund -                                                                                                                       3-6,15,17,19,21,23-25,30-
                                             911                     Nil                     Y           Y       P                                                                     1-Nov-09      N
HOSPITAL                                                                                                                                                         32,40,43-46
OLD MUTUAL STAFF Medical Aid Fund -                                                                                                                       3-6,15,17,19,21,23-25,30-
                                             912                     Nil                     Y           Y       P                                                                     1-Nov-09      N
SAVINGS                                                                                                                                                          32,40,43-47
                                                            OMS
OLD MUTUAL STAFF Medical Aid Fund -                                                                                                                       3-6,15,17,19,21,23-25,30-
                                             913                     Nil                     Y           Y       P                                                                     1-Nov-09      N
TRADITIONAL                                                                                                                                                      32,40,43-48
OLD MUTUAL STAFF Medical Aid Fund -                                                                                                                       3-6,15,17,19,21,23-25,30-
                                             914                     Nil                     Y           Y       P                                                                     1-Nov-09      N
TRADITIONAL PLUS                                                                                                                                                 32,40,43-49
                                                                                                                                                            1-5,9,11,14-15,17,19-
Parmed Medical Aid Scheme                    007            PAR      Nil     N               Y                                                           25,27,30-32,40-42,44-45,47-   1-Jan-10       Y
                                                                                                                                                               53,58,60-62,64
Parmed Medical Aid Scheme - AfA & Chronic
                                             007            PARQ     Nil     N              N                  C, F                    1-122                       None                1-Jan-10       Y
Medicine Management

Parmed Medical Aid Scheme - Chemotherapy     007            PARX     Nil     N                                                                                     None                1-Jul-06      Y

                                                                                                                                                            1-5,9,11,14-15,17,19-
Parmed Medical Aid Scheme - PAT              007            PARP     Nil     N              N                                                            25,27,30-32,40-42,44-45,47-   1-Jan-10       Y
                                                                                                                                                               53,58,60-62,64
                                                                                                                                                            1-5,7-15,17,19-25,
SABC Medical Scheme                          009           SABCA     Nil                     Y           Y                                                 27,30-32,35-38,40,41,       1-Jan-08       Y
                                                                                                                                                              43-45,51,58-64
SABC Medical Scheme - AfA & Chronic
                                             009           SABCQ     Nil                     Y           Y     C,F                     1-122                       None                21-Jun-04      Y
Medicine Management
                                                                                                                                                             1-5,7-15,17,19-25,
SABC Medical Scheme - PAT                    009           SABCAP    Nil                     Y           Y     R 150                                       27,30-32,35-38,40,41,       1-Jan-08       Y
                                                                                                                                                               43-45,51,58-64
SABC Medical Scheme - Chemotherapy           009           SABCAX    Nil     N                           Y                                                          None               1-Jan-05      Y
                                                                                                                                                          1-5,7-15,17,19-25,27,30-
Sasolmed                                     881           SASOLA    Nil                     Y           Y                                                32,35-38,40,41,45,51,58-     1-Jan-08       Y
                                                                                                                                                                    62,64
Sasolmed - AfA & Chronic Medicine
                                             881           SASOLAQ   Nil                     Y           Y       C                     1-123                       None                1-Jan-08       Y
Management
Sasolmed - Chemotherapy                      881           SASOLAX   Nil     N                           Y                                                          None               1-Jan-08       Y
                                                                                                                                                          1-5,7-15,17,19-25,27,30-
Sasolmed - PAT                               881           SASOLAP   Nil                     Y           Y     R 100                                      32,35-38,40,41,45,51,58-     1-Jan-08       Y
                                                                                                                                                                    62,64

                                                                                                                                                         1,5-11,14-16,17,19-23,26-
Siemens Medical Scheme                       307             SIE     Nil                     Y                                                                                         1-Jan-10       Y
                                                                                                                                                          29,35,39-50,52-59,63-64




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                          9
                                                                                                                                     Appendix A: Pharmacy                                                          March 2011
                                                                                                                                          Version 1




                                                                                                                                                                                                 Benefit booking
                                                                                                              Scheme notes
                                                                          Generic price

                                                                                          MPL / NMPL
                                             Prefix code



                                                            Code



                                                                   Levy
                                                                                                                             Chronic Benefit Disease                                 Effective




                                                                                                       DUE
            Medical Aid Scheme                                                                                                                                Exclusions
                                                                                                                                      List                                             date



Siemens Medical Scheme - AfA & Chronic
                                             307           SIEQ    Nil                     Y                 C, F                    1-122                        None               24-May-04      Y
Medicine Management
Siemens Medical Scheme - Chemotherapy        307           SIEX    Nil     N                                                                                     None                1-Jan-05      Y

                                                                                                                                                       1,5-11,14-16,17,19-23,26-
Siemens Medical Scheme - PAT                 307           SIEP    Nil                     Y                                                                                         1-Jan-10       Y
                                                                                                                                                        29,35,39-50,52-59,63-64

Swazimed - High Benefit                      901                   Nil     N              N            N                                                         None                1-Jan-08
Swazimed - Standard Benefit                  902                   Nil     N              N            N                                                         None                1-Jan-08
Swazimed - Medium Benefit                    903           SWAZI   Nil     N              N            N                                                         None                1-Jan-08
Swazimed - Hospital Benefit                  904                   Nil     N              N            N                                                         None                1-Jan-08
Swazimed - Swazi-save                        905                   Nil     N              N            N                                                         None                1-Jan-08
                                                                                                                                                        1-15,17,19,20,23-25,27,
University of Witwatersrand Medical Fund     060            UNV    Nil                     Y           Y                                               30-32,35-38,40,41,    43-     1-Jan-08       Y
                                                                                                                                                            45,51,59-62, 64
University of Witwatersrand Medical Fund -
                                             060           UNVQ    Nil                     Y           Y     C, F                    1-122                       None                21-Jun-04      Y
AfA & Chronic Medicine Management
University of Witwatersrand Medical Fund -
                                             060           UNVX    Nil     N               Y           Y                                                         None                1-Nov-08      Y
Chemotherapy
                                                                                                                                                          1-5,7-9,11-15,17,19-
Xstrata Medical Aid Scheme                   107            XTR    Nil                     Y           Y                                               25,27,30-32,35-38,40-41,43-   1-Jan-06       Y
                                                                                                                                                           45,51,53,58,60-64
                                                                                                                                                          1-5,7-9,11-15,17,19-
Xstrata Medical Aid Scheme (Pensioners and
                                             107           XTRW    20%                     Y           Y          I                                    25,27,30-32,35-38,40-41,43-   1-Jan-06       Y
Widowers) Acute
                                                                                                                                                           45,51,53,58,60-64
Xstrata Medical Aid Scheme - AfA & Chronic
                                             107           XTRQ    Nil                     Y           Y     C, F                    1-122                       None                21-Jun-04      Y
Medicine Management

Xstrata Medical Aid Scheme - Chemotherapy    107           XTRX    Nil     Y               Y           Y                                                         None                1-Nov-08      Y

                                                                                                                                                          1-5,7-9,11-15,17,19-
                                                                                                              O,
Xstrata Medical Aid Scheme - PAT             107           XTRP    20%                     Y           Y                                               25,27,30-32,35-38,40-41,43-   1-Sep-09       Y
                                                                                                             R 150
                                                                                                                                                           45,51,53,58,60-64
                                                                                                                                                          1-5,7-9,11-15,17,19-
Xstrata Medical Aid Scheme - PAT
                                             107           XTRPW   20%                     Y           Y R 150, I                                      25,27,30-32,35-38,40-41,43-   1-Jan-06       Y
(Pensioners and Widowers)
                                                                                                                                                           45,51,53,58,60-64




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                       10
                                                                                       Appendix A: Pharmacy - PBM Info                                                                                      March 2011
                                                                                                  Version 1




                                                                                                          PMB Formulary                 Extended PMB Formulary                Medicine co-payments
                                                                         Designated Service                                                                                                             Effective
             Medical Aid Scheme                Prefix code      Code                                Comprehen- Restrictive DSP Comprehen-sive Restrictive DSP             Below limits   Above limits
                                                                           Provider (DSP)                                                                                                                 date
                                                                                                   sive formulary formulary      formulary      formulary                  (benefits)     (benefits)

AECI Medical Aid Society                          303          AECIHQ             No                   Yes                                                                     0%            0%
AECI Medical Aid Society - Basic Carecross        460          AECICQ                                   Capitation - PMB medication to be obtained from preferred provider.
Barloworld Medical Scheme                         050          BARCM              No                   Yes                                                                     0%            0%         1-Jan-06
BMW Employees Medical Aid Society                 119         BMWQHS              No                                    Yes                                                    25%           25%        1-Jan-10
                                                                                 Yes
                                                                                                     Yes               Yes
Bonitas Medical Fund - Bonitas Standard           020          BONTAQ   Above limits - State &                                                                                 40%           40%        1-Oct-06
                                                                                                Below limits      Above limits
                                                                                  PD
                                                                         Yes from Rand one                           Yes from
Bonitas Medical Fund - Bonsave                    240         BONSVQ                                                                                                           40%           40%        1-Oct-06
                                                                             State & PD                             Rand one
                                                                         Yes from Rand one                           Yes from
Bonitas Medical Fund - Bonitas Primary            277         BONPRQ                                                                                                           40%           40%        1-Oct-06
                                                                             State & PD                             Rand one
Bonitas Medical Fund - Boncap                     470                   Capitation - PMB medication to be obtained from preferred provider.                                                             1-Jan-08
                                                                                                  Yes from
Bonitas Medical Fund - Boncom                     477          BCOMQ              No                                                                                           40%           40%        1-Jan-07
                                                                                                 Rand one
                                                                         Yes from Rand one                           Yes from
Bonitas Essential                                 479          BONESS                                                                                                          40%           40%        1-Jan-10
                                                                             State & PD                             Rand one

CLICKS MEDICAL SCHEME                               CLICKS GROUP MEDICAL SCHEME and MOREMED MEDICAL SCHEME are merging to be HORIZON MEDICAL SCHEME effective 01/01/2011                                1-Jan-11

Eyethumed - Option 1                              891                                          Capitation - PMB medication to be obtained from preferred provider.                                      1-Jan-08
Fedhealth Medical Scheme - Ultimax (Xtracare
                                                  804          ULTIOQ             No                   Yes                                                                     0%            40%        1-May-08
& OHEB)
Fedhealth Medical Scheme - Ultima 300 A
                                                  810          ULTXQ              No                   Yes                                                                     0%            40%        1-May-08
(Xtracare & OHEB)
                                                                                  Yes
Fedhealth Medical Scheme - Ultima 200 B                                                                Yes             Yes
                                                  805          ULTTSQ    Above limits - Medirite                                                                               40%           40%        1-May-09
(Xtracare)                                                                                           Rand one       Above limits
                                                                               & State
                                                                                  Yes
                                                                                                       Yes             Yes
Fedhealth Medical Scheme - Maxima Exec            806          ULTTXQ    Above limits - Medirite                                                                               40%           40%        1-Jan-11
                                                                                                     Rand one       Above limits
                                                                               & State
Fedhealth Medical Scheme - Maxima Plus            800          MAXHQ              No                   Yes                                                                     0%            40%        1-May-08
                                                                          Yes from Rand one                          Yes from
Fedhealth Medical Scheme - Maxima Core            801           MAXQ                                                                                                           40%           40%        1-May-09
                                                                           Medirite & State                          Rand one
                                                                                  Yes
                                                                                                       Yes             Yes
Fedhealth Medical Scheme - Maxima Standard        802          MAXSQ     Above limits - Medirite                                                                               40%           40%        1-May-09
                                                                                                     Rand one       Above limits
                                                                                & State




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                 11
                                                                                            Appendix A: Pharmacy - PBM Info                                                                                          March 2011
                                                                                                       Version 1




                                                                               Yes from Rand one                             Yes from
Fedhealth Medical Scheme - Maxima Basis          803           MAXBQ                                                                                                                   40%           40%         1-May-09
                                                                                Medirite & State                            Rand one
Fedhealth Medical Scheme - Blue Door             816                                                         Capitation - PMB medication to be obtained from preferred provider.
HORIZON MAJOR MEDICAL                            461                            Clicks pharmacies                                                  Yes                                 25%           25%         1-Dec-10
HORIZON MAJOR MEDICAL PLUS
                                                 462                                  State                                                                          Yes               25%           25%         1-Dec-10
CARECROSS
                                                                                                                     Capitated option for CDL and few DTP's with Carecross
                                                                MMS           State               For
HORIZON HOSPITAL                                 463                          auths done by MHRS                                                                                                                 1-Dec-10
                                                                              that do not form part                                                                  Yes               25%           25%
                                                                                 of the capitation
                                                                                    agreement
IMPERIAL MEDICAL SCHEME                                               IMPERIAL GROUP MEDICAL SCHEME - discontinued - effective 01/01/2011 (Scheme change of Administrator)                                       1-Jan-11
Massmart Health Plan                             269            MMTQ                   No                     Yes                                                                       0%           25%         1-Jan-09
MB MED - Plan A                                  220           DCMAQ                   No                     Yes                                                                       0%            0%         1-Jan-08
Metrocare                                        211           METRQ                   No                     Yes                                                                      40%           40%         1-Jan-10
Namibia Healthcare Plan - Gold                   520
Namibia Healthcare Plan - Corporate              521
Namibia Healthcare Plan - Hospital Plus          522
Namibia Healthcare Plan - Silver                 523
Namibia Healthcare Plan - Economic               524
Namibia Healthcare Plan - Blue Diamond           525                                                    PMB's - not applicable to Namibia Healthcare Plan and NAMMED                                             1-Jan-09
NAMMED - Trauma                                  531
NAMMED - Standard                                532
NAMMED - Comprehensive                           533
NAMMED - Essential                               534
NAMMED - Active                                  538
                                                                                                                                                                                     25% non       25% non
                                                                                                                                                                                   DSP's. No co- DSP's. No co-
NEDGROUP Medical Aid Scheme - HOSPITAL           930                            Yes Scriptpharm                                                                                                                  1-Nov-09
                                                                                                                                                                                    pay if using  pay if using
                                                                                                                                                                                       DSP           DSP
                                                                 NBG
                                                                                                                                                                                     25% non       25% non
                                                                                                                                                                                   DSP's. No co- DSP's. No co-
NEDGROUP Medical Aid Scheme - SAVINGS            931                            Yes Scriptpharm                                                                                                                  1-Nov-09
                                                                                                                                                                                    pay if using  pay if using
                                                                                                                                                                                       DSP           DSP
NEDGROUP Medical Aid Scheme - Traditional
                                                 932                                                     Capitation - medication to be obtained from preferred provider.                                         1-Jan-11
Plus
                                                                                                                                                                                     25% non       25% non
NEDGROUP Medical Aid Scheme - Traditional                                                                                                                                          DSP's. No co- DSP's. No co-
                                                 933                            Yes Scriptpharm                                                                                                                  1-Jan-11
Plan                                                                                                                                                                                pay if using  pay if using
                                                                                                                                                                                       DSP           DSP
                                                                 NBG




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                         12
                                                                                   Appendix A: Pharmacy - PBM Info                                                                              March 2011
                                                                                              Version 1




                                                                 NBG
                                                                                                                                                                25% non       25% non
                                                                                                                                                              DSP's. No co- DSP's. No co-
NEDGROUP Medical Aid Scheme - PLATINUM           934                    Yes Scriptpharm                                                                                                     1-Nov-09
                                                                                                                                                               pay if using  pay if using
                                                                                                                                                                  DSP           DSP
OLD MUTUAL STAFF Medical Aid Fund -
                                                 910                                        Capitation - medication to be obtained from preferred provider.                                 1-Nov-09
NETWORK
                                                                                                                                                              25% on Non-
OLD MUTUAL STAFF Medical Aid Fund -                                                        Basic PMB and                                                                   25% on Non-
                                                 911                          No                                                                                formulary                   1-Nov-09
HOSPITAL                                                                                     Non-PMB                                                                      formulary drugs
                                                                                                                                                                  drugs
                                                                                                                                                              25% on Non-
OLD MUTUAL STAFF Medical Aid Fund -                                                        Basic PMB and                                                                   25% on Non-
                                                 912                          No                                                                                formulary                   1-Nov-09
SAVINGS                                                                                      Non-PMB                                                                      formulary drugs
                                                                                                                                                                  drugs
                                                                OMS
                                                                                                                                                              25% on Non-
OLD MUTUAL STAFF Medical Aid Fund -                                                        Advanced PMB                                                                    25% on Non-
                                                 913                          No                                                                                formulary                   1-Nov-09
TRADITIONAL                                                                                and Non-PMB                                                                    formulary drugs
                                                                                                                                                                  drugs
                                                                                                                                                              25% on Non-
OLD MUTUAL STAFF Medical Aid Fund -                                                        Advanced PMB                                                                    25% on Non-
                                                 914                          No                                                                                formulary                   1-Nov-09
TRADITIONAL PLUS                                                                           and Non-PMB                                                                    formulary drugs
                                                                                                                                                                  drugs
Parmed Medical Aid Scheme                        007            PARQ          No                 Yes                                                               0%            0%
SABC Medical Scheme                              009           SABCQ          No                 Yes                                                               0%            0%
Sasolmed                                         881          SASOLAQ         No                 Yes                                                              40%           40%         1-Jan-08
Siemens Medical Scheme                           307            SIEQ          No                 Yes                                                               0%            0%         1-Jan-07
Swazimed - High Benefit                          901
Swazimed - Standard Benefit                      902
Swazimed - Medium Benefit                        903            SWAZI                                             PMB's - not applicable to Swazimed                                        1-Jan-08
Swazimed - Hospital Benefit                      904
Swazimed - Swazi-save                            905
University of Witwatersrand Medical Fund         060            UNVQ          No                 Yes                                                               0%            0%

Xstrata Medical Aid Scheme                       107            XTRQ          No                 Yes                                                              20%           20%




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                    13
                                                                                                 Appendix A: Pharmacy - PBM Info                                                                                             March 2011
                                                                                                            Version 1




Notes
CMD - Chronic Medicine Dispensary
PD - Pharmacy Direct


Co-payments will be calculated by Medscheme and an information message will be returned to the provider with the appropriate co-payment.
The messages are:
1) PMB co-payment applied - Drug is out of formulary.
2) PMB co-payment applied - Claim not from DSP.

Medicine co-payment below benefit - If the medication dispensed is out of formulary OR it is not received from the schemes DSP (where applicable) and the patient still has benefits available, the co-payment noted in this column
is payable at point of sale.
Medicine co-payment above benefit - If the medication dispensed is out of formulary OR is not received from the schemes DSP and the patient has ZERO benefits available, then the co-payment noted in this column is payable
at point of sale.
Xstrata Medical Aid Scheme:
Pensioners and widowers: If medication dispensed is out of formulary, the co-payment is payable at the point of service;
Other members: if medication dispensed is out of formulary, the co-payment will be debited to the member.




Highlighted lines denote an amendment or addition to scheme details                                                                                                                                                                   14
                                                          Scheme Notes
A   Diane-35 will only be paid if prescribed by a Dermatologist.
B   No levy, except for price differences
    This plan is contracted to Aid for AIDS (AfA). Anti-retroviral therapy is reimbursable for authorised beneficiaries at the
C
    negotiated price. Details available on 0800 22 7700.
D   Plans with Threshold.
E   Roaccutane will only be paid if prescribed on routine medicine prescriptions by a Dermatologist.
F   Benefit booking can now be done on AFA claims by using the Medi-Serve claim code
G   Plans 423,447 and 449 have threshold.
H   A 10% levy and ather co-payments is payable by the member if the members saving is depleted.
    Xstrata - Pensioners and widowers must pay a 20% levy upfront. Please use these codes to claim for pensioners and
I
    widowers for acute and PAT claims.
J   Metrocare does have a Aids benefit and is is contracted to AfA from 1 May 05.
K   Namibia Healthcare Plan and NAMMED applies NMPL
L   This scheme is not contracted to AfA anymore.
M   CDL (Chronic Drug List) applied
N   Levies is 20% with a minimum of R30
    Please be advice that with effect 1 September 2009, for over the counter medicine benefit or PAT (pharmacy advices therapy),
O
    once the member’s limit has been reached, the member would need to pay cash at the point of sale.
P   MPL and Exclusion only applies to acute and PAT claims
Q   Levy only on Acute medicine claims
                                                   Exclusion Categories
Category                                                Description
   1     Oral and parental contraceptives
   2      IUD's and contraceptive foams
   3      Slimming prep's used to treat or prevent obesity
   4      Patent medicines, household remedies & proprietary preparations
   5      Food / Nutritional supplements including all baby food and special milk preparations
   6      Homeopathic and herbal medicines and remedies
   7      Medical appliances & devices
   8      Orthopaedic appliances and products
   9      Surgical appliances and products
   10     Stoma products and equipment & incontinence products
   11     Diagnostic agents
   12     Disease management disposables for diabetes
   13     Syringes & needles for diabetics
   14     Syringes & needles
   15     Bandages and dressings (except medicated dressings).
   16     Medicated dressings
   17     Oxygen (purchase or hire)
   18     Aerochambers
   19     Anti-smoking products
   20     Medicines used specifically to treat alcoholism & drug addiction
   21     Drugs used specifically to treat infertility
   22     Drugs for the treatment of impotence & sexual dysfunction
   23     Aphrodisiacs
   24     Anabolic steroids
   25     Soaps, scrubs & other cleansers
   26     Products for the treatment of lice
   27     Other medicated shampoos and conditioners
   28     Tar shampoos
   29     Coal tar products for psoriasis
   30     Sunscreening and suntanning preparations
   31     Cosmetic preparations, emolients / moisturisers - medicated or otherwise
   32     Contact lens preparations
   33     Flu vaccines
   34     Other vaccines (oral / parenteral)
   35     Immunoglobulins (oral / parenteral)
   36     Anti-retroviral agents
   37     Immunosuppressives
   38     Immunostimulants (Immunomodulators)
   39     Anti malarials for prophylactic use
   40     Registered multi-vitamin preparations and vitamin combinations including minerals
   41     Registered combined mineral preparations & trace elements (excluding iron, calcium,
          magnesium and potassium preparations)
   42     Registered pre-natal vitamins and vitamin / mineral supplements
   43     Registered geriatric vitamins / mineral supplements
   44     Registered single vitamin preparations
   45     Registered tonics & stimulants
   46     Haematinics
   47     Calcium supplements
   48     Magnesium supplements
   49     Potassium supplements
   50     Registered infant vitamins
   51     All non registered vitamins, multi-vitamins, minerals, trace elements & combinations thereof
   52     Bulk forming laxatives
   53     Stimulant laxatives
Category                                               Description
  54       Topical steroid preparations
  55       Topical anti-inflammatory preparations
  56       Topical acne preparations
  57       Oral acne preparations
  58       Contraceptives used for skin conditions
  59       Osteoporosis specific products
  60       Growth hormones
  61       Veterinary products
  62       Evening primrose oil & fish liver oil preperations & combinations
  63       Intestinal flora
  64       Erythropietin
                              CHRONIC MEDICINE BENEFIT DISEASE LIST


1 Addison’s Disease                 43 Chronic organic pain      84   Pemphigus
                                       syndromes
2 Asthma                            44 Cluster headaches         85 Peptic Ulcer Disease (including
                                                                    eradication therapy)
3 Bronchiectasis                    45 Connective tissue         86 Peripheral neuropathy
                                       disorders, including
                                       Beuchet's Syndrome,
                                       Discoid Lupus
                                       Erythematosus,
                                       Polychondritis,
                                       Polymyalgia
                                       Rheumatica,
                                       Polymyositis, Systemic
                                       Sclerosis, Wegener's
                                       Granulomatosis


4 Cardiac Failure                   46 Cystic fibrosis           87   Peripheral Vascular Disease
5 Cardiomyopathy                    47 Depression                88   Phobic disorders
6 Chronic Obstructive Pulmonary     47a Major Depression         89   Polyarteritis nodosa
  Disorder
7 Chronic Renal Disease             48 Dermatomyositis           90   Post Traumatic Stress Disorder
8 Coronary Artery Disease           49 Dystonias                 91   Post-herpetic neuralgia
9 Crohn’s Disease                   50 Eczema                    92   Psoriasis
10 Diabetes Insipidus               51 Endocrine disorders,      93   Psychotic disorders
                                       including pituitary,
                                       thyroid, parathyroid,
                                       ovarian, testicular and
                                       adrenal dysfunction.
                                       (but specifically
                                       excluding male
                                       menopause)

11 Diabetes Mellitus Type 1         52 Endometriosis             94   Pulmonary interstitial fibrosis
12 Diabetes Mellitus Type 2         53 Enuresis                  95 Raynauds disease
13 Dysrhythmias                     54 Essential Tremor          96   Renal Calculi
14 Epilepsy                         55 Gastro-oesophageal        97   Rickets
                                       Reflux Disease
                                       (complicated)
15 Glaucoma                         56 Generalised Anxiety       98   Scleroderma
                                       Disorder
16 Haemophilia                      57 Gout/Hyperuricaemia       99 Seborrheic dermatitis
17 Hyperlipidaemia                  58 Hepatitis B and C         100 Sjogren's Syndrome
18 Hypertension                     59 Hirsutism                 101 Spasticity (unrelated to stroke)
19 Hypothyroidism                   60 Huntington's Chorea     102 Stroke
20 Multiple Sclerosis               61 Iron Deficiency Anaemia 103 Thromboangiitis Obliterans
                                                                   (Buerger's Syndrome)
21 Parkinson’s Disease              62 Ischaemic Heart         104 Thrombocytopaenic Purpura
                                       Disease/Angina
22 Rheumatoid Arthritis             63 Liver failure           105 Tourette's Syndrome
23 Schizophrenia                    64 Macular degeneration      106 Transient Ischaemic Attacks
24 Systemic Lupus Erythematosus     65 Meniere's disease         107 Trigeminal Neuralgia
25 Ulcerative Colitis               66 Menopause                 108 Tuberculosis
                                       (female)/HRT
26 Acne                             67 Metabolic disorders       109 Urinary Incontinence
27 Allergic dermatitis              68 Migraine                  110 Urticaria
28 Allergic rhinitis                69 Motor Neuron Disease      111 Valvular heart disease
29 Alzheimer's Disease              70 Muscular dystrophy        112 Venous thrombotic disorders
30 Anaphylaxis                      71 Myasthenia Gravis         113 Zollinger- Ellison Syndrome
31 Angio-edema                      72 Narcolepsy                114 Sinusitis
32 Ankylosing spondylitis             73 Neurogenic bladder        115 Aplastic anaemia
33 Anorexia nervosa                   74 Obsessive Compulsive      116
                                                                         Nephrotic Syndrome
                                         Disorder
34 Attention Deficit Disorder         75 Onychomycosis             117 Obstructive/Reflux Nephropathy
35 Autoimmune disorders               76 Opthalmological
                                         disorders, including
                                         keratoconjunctivitis
                                         sicca, but specifically   118 Pyelonephritis
                                         excluding allergic
                                         conjunctivitis)
36 Barrett's oesophagitis             77 Osteoarthritis            119 Tic Disorder
37 Behavioural disorders              78 Osteopaenia               120 Cryoglobinaemia
38 Benign Prostatic Hypertrophy       79 Osteoporosis              121 Post Bowel Surgery
39 Bipolar mood disorder              80 Paget's disease           122 Endocarditis
40 Blood disorders (including nutrient - 81
                                            Pancreatic Disease     123 Erectile Dysfunction
   deficiency anaemias)
41 Bulimia                               82 Panic disorder         124 Alcoholism
42 Chronic infections (unrelated to      83
                                            Para/Quadriplegia      125 Irritable bowel syndrome
   HIV infection)

								
To top