CONTACT 0860 002 101
EMERGENCY 0860 255 426
FRAUD/ABUSE
0860 040 040 | mail@beheard.co.za

PRE-AUTHORISATION

HOW TO GET AUTHORISATION FOR A CHRONIC BENEFIT?

Mediscor PBM has been appointed by your medical scheme to administrate your chronic medicine. To obtain authorisation from ChroniLine® your doctor or pharmacist should phone ChroniLine® OR the administrator's Chronic Medicine division on your behalf. Alternatively you may e-mail or fax your prescription to ChroniLine®.

ChroniLine®

Phone: 0860 11 9553 (Monday to Friday between 8h00 and 17h00)
Fax: 0866 15 1509
Email: preauth@mediscor.net

Administrator's Chronic Medicine Division

Tel: 0860 002 101
Fax: 086 776 7671

Mediscor ChroniLine® may require additional information from your doctor or pharmacist. Based on this information your chronic condition will be registered and the appropriate medicines will be authorised. You will also be informed if you are liable to pay any co-payment/s or if the medicines are not covered on you medical scheme option.

Click here for a helpful article on The Meaning Behind Medicine Schedules.

PRE-AUTHORISATION REQUIRED

Most of the benefits in the MMP will be subject to pre-authorisation. Please call 0860 00 2101 also when you are unsure whether you should pre-authorize.

Note that the following do not require pre-authorisation:

  • Tonsils
  • Grommets
  • Normal delivery
  • Hysterectomy
  • Sterilisation
  • Cholecystectomy
  • Bunions
  • Cataracts
  • Breast biopsy
  • Varicose veins

We reserve the right to implement utilisation controls where health professionals seem to use the service more than usual.

CONTRIBUTIONS AND SAVINGS ACCOUNT (PMSA)

  1. Please contact the Scheme contact centre for your contribution table.
  2. The contribution table reflects the total contributions before employer subsidies. Your payroll will advise regarding the subsidies, where applicable.
  3. We collect contributions at the end of the month for which you have received benefits. It is important to pay contributions promptly. If contributions are more than 21 days overdue your benefits maybe suspened.
  4. Contributions, deductions and benefits are effective for the full calendar month. We are unable to proportion membership contributions or payments.
You may elect to pay Member portions, such as the difference between NHRPL (National Health Reference Price List) and the Alliance Midmed Rate and private rates from the Accumulated PMSA Balance (positive savings). We can, however, only do so where you give a specific instruction – the Scheme may not pay the amounts automatically.

You may also use the Accumulated PMSA from the previous year to fund Scheme exclusions with the approval of the Board of Trustees. Note however that consultation co-payments and optical amounts above the scheme benefits will not be paid by either the Scheme or from the current year’s PMSA Balance. Also note that from January 2019 your savings balance does not earn interest.

If you leave the Scheme, the PMSA balance will be paid to you after the expiry of five months, to ensure that all accounts have been settled - please ensure that we have your bank account and contact details for refunds. (However, where your new medical scheme has a savings account, the law requires that your positive savings are transferred to the Scheme.) Also, when you transfer to another scheme also at your employer, the five-month period still applies. The savings refund is taxable.

If the claims paid out of your PMSA exceed your contributions and PMSA value when you leave the Scheme, we will recover this amount from you.

We have had requests for contributions to be paid from available savings, which is unfortunately not allowed by law.

If you join Alliance Midmed any time after January in a calendar year, your benefits will be adjusted proportionately (e.g. if you join on 1 July, your savings will be 50% of what the full-year amount would have been.)

CLAIMS MANAGEMENT

HOW TO CLAIM?

Post your claims to:

Postal Address:
P.O. Box 90346, Garstfontein, 0042

Place it in the medical aid box at your Time Office.

You can also send your claims via email to service@alliancemidmed.co.za or use the FREE member app.

Click here for the contact numbers for pre-authorisation etc.