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Medical Aid
Medical Aid
CAMAF 2014 Year End Changes
CAMAF:
1. IMMUNISATION BENEFITS FOR 2014
SCHEME/PLAN IMMUNISATION MAX
ALLIANCE R3800.00 per beneficiary per annum.
DOUBLE PLUS
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.
KEYHEALTH:
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
716769
Blood Pressure Measurements
R110.00
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
Submitting Claims to Transmed State+ Universal Health
Electronic claims to be sent via MediSwitch EDI.
Universal’s telephone number is: 086 168 6278.
They are the administrators for Transmed’s State+ network option.
So firstly, inside Medinol … go into Files -> Medical Aid … then ADD a new medical aid called Transmed-Universal …. give it a Medical aid code let’s say TU
Be sure to enter the EDI code as: 194
Save this new medical aid.
Now re-enter any members covered by this option as members of the newly created TU.
Reinvoice them using the new member codes.
Create Batch and submit to Medi-Switch.
MOMENTUM MEDICAL TARIFFS 2016
Dear General Practitioner
Momentum Health Scheme Rate for 2016
Thank you for partnering with us in 2015. Your on-going support in 2016 will help ensure the provision of world class healthcare to our members.
We would like to confirm the increase in the reimbursement rates for 2016, which will be effective from 1 January 2016. The standard GP consultation rate (tariff code 0190) will be R323. Through our on-going quarterly profiling process, practices who qualify and comply can earn an additional R60 or R30 per consult, subject to being a Category 1 or 2 GP respectively. Your practice will receive a separate communiqué, should you qualify for this benefit.
For any other procedure, Momentum Health will be increasing the general Scheme Rate by 5%. This increase will be applicable on the current rate payable for procedures, and can be viewed on our website at www.provider.momentum.co.za.
Dispensed medicines and consumable products used as part of in-room procedures will be reimbursed as follows:
- All dispensed medicines (including unscheduled) are priced according to the SEP / List Cost Price + 30% to a maximum of R23.40 per item
- All unscheduled consumable products (0201) used during procedures are priced according to List Cost Price + 31% mark-up
- All scheduled consumable products (schedule 0 to 8) used during procedures are priced according to SEP + 30% to a maximum of R23.40 per item.
We thank you once again for being the custodians of our members’ healthcare, and wish you and your staff all the best for 2016.
Kind regards
Dewald van Jaarsveld
Provider Reimbursements
Discovery Premiums Massive Increase in 2017
Discovery Health has announced its new premiums for 2017, which are set to increase between 7.8% and 14.9%.
The average premium increase across Discovery Health’s plans are 10.2% – significantly higher than last year’s 8.6%, and even higher than the forecast CPI of 6.8%
The increases for individual Discovery Health plans are as follows:
- Executive and Comprehensive: 11.9%
- Coastal Core: 14.9%
- Coastal Saver: 7.8%
- All other plans: 9.9%
According to Milton Streak, Principal Officer at Discovery Health Medical Scheme, most of their members will see an increase of 9.9% or lower in 2017.
Discovery Health is the biggest medical scheme on the open market with over 2.7 million members. The group warned earlier this year that premiums would be going up due to significantly higher claims than in previous years.
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