1. IMMUNISATION BENEFITS FOR 2014
SCHEME/PLAN IMMUNISATION MAX
ALLIANCE R3800.00 per beneficiary per annum.
R1890.00 per Adult per annum (22 years and older)
R3150.00 per Child per annum (0 – 21 years)
VITAL R1260.00 per beneficiary per annum.
ESSENTIAL PLUS R1260.00 per beneficiary per annum.
FIRST CHOICE R1260.00 per beneficiary per annum.
NETWORK CHOICE R1260.00 per beneficiary per annum.
2. ACUTE MEDICINE BENEFIT CHANGE:
Effective 1 January 2015, 2nd and 3rd line anti-depressants, inhalers and Nexiam 40mg will be allowed 3 fills from the Acute/Savings
benefit. Rejection RMR 558 “Individual Protocol Quantity Exceeded” will be returned to the provider on the 4th fill if these items
have not yet been authorised on Chronic.
1. CHRONIC BENEFITS FOR EQUILIBRIUM PLAN MEMBERS
Effective 1 January 2015, the following Chronic conditions will be covered for authorised KeyHealth Equilibrium option members. A
10% co-payment will apply. An additional 30% co-payment will apply if dispensed by a non-DSP pharmacy.
Allergic Rhinitis (Patients under age 21)
Acne (Patients under age 21)
Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) (Patients under age 21)
2. PRE-NATAL VITAMIN BENEFITS
In 2015, based on registration on the program, pre-natal vitamins, to the value of R1500.00 per pregnant female (for the duration of
the pregnancy) will be covered from the Health Booster benefit.
3. HEALTH ASSESMENT BENEFIT INCREASE
Effective 1 January 2014 reimbursement of KeyHealth Health Assessment tests submitted on the customised tariff code indicated in
the table below will increase to R110.00
NAPPI CODE DESCRIPTION PRICE
Blood Pressure Measurements
Health Assessment – Blood Glucose Screening (finger prick)
Health Assessment – Cholesterol Screening (finger prick)
Health Assessment – Body Mass Index
Phlebotomy for PSA test
Brought to you by: Medinol Medical Billing and Claims Software