In terms of Section 63 of the Medical Schemes Act, Act No 131 of 1998, the Boards of Trustees of the Government Employees Medical Scheme (“GEMS”) and the Medical Scheme for the Department of Correctional Services (“MEDCOR”) has given their members notice of the proposed transfer of the business of MEDCOR to GEMS, effective 1 January 2010. In light of this proposed business transfer, we would like to inform all current MEDCOR service providers of the following important facts and processes:
- MEDCOR Medical Scheme will cease to operate as from the 31st of December 2009.
- The normal 4 month wind down period for a Medical Scheme will apply.
- Current active MEDCOR members have been given the opportunity to apply for membership with GEMS. Importantly, no member will be defaulted to GEMS or any other Medical Scheme.
- Agility Global Health Solutions (formerly known as Full Circle Health) will remain responsible for administering all MEDCOR claims with a service date prior to 1 January 2010. This will be in accordance with the Medical Schemes Act and MEDCOR Scheme Rules which provides for a 4 month period after the service date before claims are deemed ‘stale’. Valid claims with a service date earlier than 1 January 2010 will be honored up to 30 April 2010 by MEDCOR Medical Scheme.
- MEDCOR claims for service dates prior to 1 January 2010 should still be submitted to Agility Global Health Solutions (please refer to the below contact details).
Important information pertaining to Managed Health Care:
- Members currently on Chronic medication MUST submit a chronic application form, with a script, to GEMS or the Medical Scheme of their choice in order to receive medication as from January 2010.
- Members currently undergoing Orthodontic treatment must obtain authorisation from GEMS or the Medical Scheme of their choice for 2010 service dates.
- All hospital accounts must to be closed on the 31st of December 2009 @24h00 (midnight) and reauthorised with GEMS or the other Medical Scheme.
Contact details for claims and queries prior to 1 January 2010 service dates through Agility Global Health Solutions:
Paper claims can still be posted to the following address:
Private bag X128
For telephonic queries, please use the following numbers:
- 0861 000 402 – GP
- 0861 000 404 – Specialist
- 0861 000 406 – Hospital
- 0861 000 408 – Dental
- 0861 000 410 – Optical
- 0861 000 412 – Pharmacy
- 0861 000 414 – Auxilliary
For electronic enquiries, please use the following e-mail address: firstname.lastname@example.org
Existing EDI and real-time codes should be used for electronic submission of 2009 service date claims.
MEDCOR members may join GEMS or any other medical scheme from 1 January 2010. Claims for services dated 1 January 2010 and beyond should be submitted directly to GEMS or the Medical Scheme chosen by the member.
Yours in good health
MEDCOR Medical Scheme and Agility Global Health Solutions