2017 Provider Manual - Welcome to Universal Healthcare · Welcome to the Universal Healthcare Provider Network (“Universal Network”). Universal Network is the Network Division

2017 Provider Manual

Provider Hotline Number: 086 102 0220

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Dental Provider Manual / 2017

Index1. Introduction 1

1.1. Universal Network – Clients 1

1.2. Identifying members/insured persons/employees 2

2. Benefits and Reimbursement for Dentist 8

2.1. Dental Benefits/Services 8

2.2. Basic dental services – benefit limits 9

2.2.1. All Universal Network Options except Universal Health & Accident Plan 9

2.3. Approved dental procedure codes and reimbursement rates 10

2.3.1. All Universal Network Options except Universal Health & Accident Plan 10

2.3.2. Universal Health & Accident Plan 12

3. Dentures 14

3.1. Benefits available 14

3.2. Approved denture procedure codes and fees 15

4. Specialised Dentistry 15

5. Medicines 16

5.1. Medicine benefits 16

5.2. Universal Dental Network – Medicine Formulary 17


1. IntroductionWelcome to the Universal Healthcare Provider Network (“Universal Network”).

Universal Network is the Network Division of Universal Care, an accredited managed care organisation within the Universal Healthcare Group.

Universal Care is contracted to Medical Schemes, Universal WorkerPlan and Universal Health & Accident Plan to establish and manage networks of healthcare providers to service beneficiaries/employees/insured persons in the lower income segments. Our goal is to provide affordable access to primary healthcare, within a provider network arrangement, without compromising the quality of care.

The market the Universal Group is targeting for participation in these network arrangements is not the current existing insured market. The concern of “buy downs” is not only a threat to the Dental Practitioners’ practices but seriously challenges the sustainability of these network arrangements from a funding perspective. Therefore the Universal Provider Network arrangements are definitely not a mechanism to discount the Dental Practitioners’ fee structure but rather a conduit to facilitate access to basic primary healthcare for beneficiaries/employees/insured persons who are currently not covered.

This Manual contains information to assist you, the Dental Practitioner, when servicing beneficiaries/employees/insured persons on any of the medical scheme options, occupational plans and insurance plans using the Universal Provider Network.

Beneficiaries/employees/insured persons may use any dentist on the Universal Network.

1.1. Universal Network – Clients

Name Options

AECI Medical Aid Society Value Option

CompCare Wellness Medical Scheme

NetworX Option

NetworX ED* Option

NetworX ED* PLUS Option

Massmart Health PlanNetwork Option

Essential Option

Tiger Brands Medical Scheme Mzansi Option

Transmed Medical Fund State Plus Network Option

Umvuzo HealthStandard Option

Ultra Affordable Option

Universal Health & Accident Plan(Insurance Plan)

Option A

Option APLUS

Option B

Option BPLUS

Universal WorkerPlan(Occupational Health Product)

truVALUE

truCARE

truHEALTH

truWELLNESS

Witbank Coalfields Medical Aid Scheme Ntsika Option

ED* = Efficiency Discounted

1 Dental Provider Manual / 2017

1.2. Identifying members/insured persons/employees All beneficiaries/employees/insured persons will carry a membership/policy card which will indicate that they are beneficiaries/insured persons/employees on any of the medical scheme options or health plans using the Universal Provider Network.

The following are examples of such cards:

AECI Medical Aid SocietyValue Option:

CompCare Wellness Medical Scheme (Old Cards)NetworX and NetworX Efficiency Discounted Options:

CompCare Wellness Medical Scheme (New Cards)NetworX Option:

NetworX Efficiency Discounted Option:

Dental Provider Manual / 2017 2

NetworX Efficiency Discounted Plus Option:

Massmart Health Plan (Old Cards)Essential and Network Options:

Massmart Health Plan (New Cards)Essential Option:

Network Option:


Tiger Brands Medical SchemeMzansi Option:

Transmed Medical Fund State Plus Network Option:

Umvuzo HealthStandard Option:

Ultra Affordable Option:


Universal Health & Accident Plan Option A:

Option APLUS:

Option B:

Option BPLUS:


Universal WorkerPlan truVALUE Option:

truCARE Option:

truHEALTH Option:

truWELLNESS Options:


Witbank Coalfields Medical Aid SchemeNtsika Option:

• Confirmation of membership/employee/insured person eligibility can be obtained from:• The Universal Call Centre on (011) 208-1000/1010/1020• The Universal website at: www.universal.co.za

• Service providers are urged to contact the Universal Call Centre to confirm membership/employee/insured person validity and confirm available benefits before providing services to the beneficiary/employee/insured person. Please also check the patient’s details against the patient’s identity book/passport.


2. Benefits and Reimbursement for DentistsEach Medical Scheme, Occupational Health Product or Insurance Plan on the Universal Provider Network has specific dental benefits which must be obtained from a Universal Network Dental Practitioner (or dental therapist, subject to scope of practice).

2.1. Dental Benefits/ServicesMedical Scheme /Occupational

Health Product/Insurance Plan

Options Basic dentistry

Accidental injury requiring

emergency dental treatment

Specialised dentistry Dentures


Only PMBs & pre-authorisation required

No benefitOne set p/b every 24 months. Limits apply

CompCare Wellness Medical

Scheme

NetworX; NetworX ED* and NetworX ED* Plus Options


Only for PMBs and pre-authorisation required. Subject to Annual Flexi Benefit

One set per p/b every 36 months. A 20% co-payment applies.

Massmart Health Plan

Network OptionOnly PMBs & pre-authorisation required

R3 250 p/b orR5 250 p/f. Subject to Annual Flexi Benefit

R3 250 p/b orR5 250 p/f. Subject to Annual Flexi benefit.

Essential OptionOnly PMBs & pre-authorisation required

Only for PMBs and pre-authorisation required

One set of plastic dentures per p/b every 36 months. Applicable to over 21 years of age.


Pre-authoristion required for 4 or more extractions


No Benefit

One set of plastic dentures per p/b every 36 months. 20% co-payment applies.

Transmed Medical Fund State Plus Option


No Benefit

One set of acrylic dentures p/f every 24 months. Limited to R3 160 per partial or full set of dentures.

Umvuzo Health

Standard OptionOnly PMBs & pre-authorisation required

No BenefitOne set p/f every24 months. Limited R2 835 per event

Ultra Affordable Option


No Benefit No Benefit

Universal Health & Accident Plan (Insurance Plan)

Option A, Option APLUS, Option B

and Option BPLUS

Emergency dental treatment only No benefit No Benefit No Benefit

Universal WorkerPlan

(Occupational Health Product)

truVALUE No Benefit No benefit No Benefit No BenefittruCARE No benefit No Benefit No Benefit

truHEALTH and truWELLNESS No benefit No Benefit

One set of plastic dentures per p/e every 36 months. Applicable to over 21 years of age.

Witbank Coalfields Medical Aid

SchemeNtsika Option



One set per p/b every 36 months. A 20% co-payment applies.

b = beneficiary f = familye = employeeED* = Efficiency Discounted


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Opti

on

8101

Cons

ulta

tion

R206

R107

8104

Lim

ited

oral

exa

min

ation

R100

R83

8107

Intr

a-or

al ra

diog

raph

s, p

er fi

lm (2

with

out

auth

orisa

tion

& 2

with

aut

horis

ation

per

b/

e pe

r yea

r)R8

3R8

0

8109

Infe

ction

Co

ntro

l/bar

rier

tech

niqu

es.

Code

810

9 in

clud

es t

he p

rovi

sion

by t

he

denti

st o

f new

rubb

er g

love

s, m

asks

, etc

., fo

r eac

h b/

e

R18

R18

8110

Ster

ilise

d in

stru

men

tatio

n. T

he u

se o

f th

is co

de is

lim

ited

to a

utoc

lave

d, v

apou

r or

hea

t st

erili

sed

inst

rum

ents

(i.e

. se

ts

of

long

- ha

ndle

d in

stru

men

ts

and/

or

forc

eps)

R48

R48

8112

Intr

aora

l ra

diog

raph

s –

bite

win

g.

per

film

(2

with

out

auth

orisa

tion

& 2

with

au

thor

isatio

n pe

r b/e

per

yea

r)R8

3R8

0

8131

Emer

genc

y de

ntal

trea

tmen

tR1

26R1

07

8132

Root

ca

nal

ther

apy

– gr

oss

pulp

al

debr

idem

ent

R206

−

8133

Re-c

emen

t in

lay,

crow

n or

brid

ge –

per

un

it/ab

utm

ent

R126

−

8145

Loca

l Ana

esth

etic

(1x

per e

vent

)R8

3R1

8

8155

Scal

ing

and

Polis

hing

– co

mpl

ete

denti

tion

(Onc

e a

year

)R1

26R1

02

8159

Scal

ing

and

Polis

hing

(Onc

e a

year

)R2

48R1

87

ED*

= Effi

cien

cy D

iscou

nted

N

ote:

All

fees

are

incl

usiv

e of

VAT


Code

Desc

riptio

n

AECI

Med

ical

Ai

d So

ciet

y

Com

pCar

e W

elln

ess M

edic

al

Sche

me

Mas

smar

t He

alth

Pla

n

Tige

r Bra

nds

Med

ical

Sc

hem

e

Tran

smed

M

edic

al

Fund

Um

vuzo

He

alth

Uni

vers

al

Wor

kerP

lan

(Occ

upati

onal

He

alth

Pro

duct

)

Witb

ank

Coal

field

s M

edic

al A

id

Sche

me

Dent

al

Fee

2017

Dent

al

Ther

apis

t Fe

e 20

17Va

lue

Opti

on

Net

wor

X; N

etw

orX

ED*

and

Net

wor

X ED

* Pl

us O

ption

s

Net

wor

k an

d Es

senti

al

Opti

ons

Mza

nsi

Opti

on

Stat

e Pl

us

Net

wor

k O

ption

Stan

dard

an

d U

ltra

Affor

dabl

e O

ption

s

truC

ARE,

tr

uHEA

LTH

and

truW

ELLN

ESS

Nts

ika

Opti

on

8161

Topi

cal a

pplic

ation

of fl

uorid

e (o

nce

ever

y 12

mon

ths)

. For

age

und

er 1

2 ye

ars

only

No

bene

fitR1

26R1

02

8163

Fiss

ure

seal

ant,

per

toot

h. F

or a

ge u

nder

12

yea

rs o

nly

No

bene

fitR8

3R7

5

8201

Extr

actio

n,

singl

e to

oth.

Co

de

8201

is

char

ged

for

the

first

ext

racti

on i

n a

quad

rant

R126

R120

8202

Extr

actio

n, e

ach

addi

tiona

l to

oth.

Cod

e 82

02

is ch

arge

d fo

r ea

ch

addi

tiona

l ex

trac

tion

in th

e sa

me

quad

rant

R51

R46

8220

Surg

ical

sut

ures

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitR1

39R1

24

8303

Pulp

cap

ping

, in

dire

ct.

The

perm

anen

t fil

ling

is no

t com

plet

ed a

t the

sam

e vi

sitR1

67R1

52

8307

Ampu

tatio

n of

pul

p (p

ulpo

tom

y)R1

65−

8341

Amal

gam

– o

ne s

urfa

ceR2

50R2

1983

42Am

alga

m –

two

surf

aces

R311

R269

8343

Amal

gam

– th

ree

surf

aces

R377

R330

8344

Amal

gam

– fo

ur a

nd m

ore

surf

aces

R420

R367

8351

Resin

rest

orati

on –

one

sur

face

, ant

erio

rR2

76R2

6583

52Re

sin re

stor

ation

– tw

o su

rfac

es, a

nter

ior

R346

R333

8353

Resin

re

stor

ation

–

thre

e su

rfac

es,

ante

rior

R414

R398

8354

Resin

re

stor

ation

–

four

an

d m

ore

surf

aces

R462

R444

8935

Trea

tmen

t of s

eptic

soc

ket

R92

R77

8937

Surg

ical

rem

oval

of t

ooth

R545

−

8941

Surg

ical

rem

oval

of i

mpa

cted

toot

h –

first

to

oth

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitR9

04−

8943

Surg

ical

rem

oval

of

impa

cted

too

th –

se

cond

toot

hN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

R485

−

8945

Surg

ical

rem

oval

of

impa

cted

too

th –

th

ird a

nd s

ubse

quen

t tee

thN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

No

bene

fitN

o be

nefit

R276

−

ED*

= Effi

cien

cy D

iscou

nted

N

ote:

All

fees

are

incl

usiv

e of

VAT


2.3.2. Universal Health & Accident Plans

Emergency Dental Events (Stated Benefits and Tariff Codes), subject to overall stated benefit limit of R1 240

The following procedures are reimbursed on the Universal Health & Accident Plans, subject to scope of practice. The reimbursement rates per procedure and acute medicines are in the tables listed below.

• Oral consultations for a specific problem• Oral consultations for a specific problem + pulp removal• Oral consultations for a specific problem + emergency dental treatment• Oral consultations for a specific problem + tooth extraction• Oral consultations for a specific problem + amalgam one surface• Oral consultations for a specific problem + amalgam two surface• Oral consultations for a specific problem + amalgam three surface• Oral consultations for a specific problem + amalgam four surface• Oral consultations for a specific problem + resin one surface, anterior• Oral consultations for a specific problem + resin two surface, anterior• Oral consultations for a specific problem + resin three surface, anterior• Oral consultations for a specific problem + resin four surface, anterior• Oral consultations for a specific problem + surgical removal of erupted tooth

Dental procedure codes Dental Fee 2017 Dental Therapist Fee 2017

1. Limited oral consultation for a specific problem 8104 – Limited oral examination for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R332 R2472. Limited oral consultation for a specific problem + pulp removal8132 - Pulp removal R206 -8104 - Limited oral consultation for a specific problem R100 -8109 - Infection control (gloves) R18 -8110 - Sterilised instruments R48 -8145 - Local anaesthetic per visit R83 -8107 - Intra-oral radiograph (X-ray) R83 - R538 -3. Limited oral consultation for a specific problem + emergency dental treatment8131 - Emergency dental treatment R126 R1078104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R458 R3544. Limited oral consultation for a specific problem + tooth extraction8201 - Extraction, tooth or exposed roots R126 R1208202 - Extraction each additional tooth or exposed roots limit to maximum amount if required R51 R468104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R1878107 - Intra-oral radiograph (X-ray) R83 R808220 - Cost of suture material R139 R1248937 - Sutures R545 - R1 193 R7065. Limited oral consultation for a specific problem + amalgam one surface8341 - Amalgam one surface R250 R2198104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R582 R466

12

6. Limited oral consultation for a specific problem + amalgam two surface8342 - Amalgam two surface R311 R2698104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 RR488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R643 R5167. Limited oral consultation for a specific problem + amalgam three surface8343 - Amalgam three surface R377 R3308104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R709 R5778. Limited oral consultation for a specific problem + amalgam four surface8344 - Amalgam four surface R420 R3678104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R752 R6149. Limited oral consultation for a specific problem + resin one surface, anterior8351 - Resin one surface, anterior R276 R2658104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R608 R51210. Limited oral consultation for a specific problem + resin two surface, anterior8352 - Resin, two surface, anterior R346 R3338104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R678 R58011. Limited oral consultation for a specific problem + resin three surface, anterior8353 - Resin, three surface, anterior R414 R3988104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80 R746 R64512. Limited oral consultation for a specific problem + resin Four surface, anterior8354 - Resin, four surface, anterior R462 R4448104 - Limited oral consultation for a specific problem R100 R838109 - Infection control (gloves) R18 R188110 - Sterilised instruments R48 R488145 - Local anaesthetic per visit R83 R188107 - Intra-oral radiograph (X-ray) R83 R80

R794 R69113. Limited oral consultation for a specific problem + surgical removal of erupted tooth8937 - Surgical removal of erupted tooth R545 -8104 - Limited oral consultation for a specific problem R100 -8109 - Infection control (gloves) R18 -8110 - Sterilised instruments R48 -8145 - Local anaesthetic per visit R83 -8107 - Intra-oral radiograph (X-ray) R83 - R877 -14. Acute Medication R177 -


3. Dentures3.1. Benefits availableDentures are limited to the list of benefits as outlined per each plan (for medical indications only).

Medical Scheme /Occupational

Health product/Insurance Plan

Options

Denture Benefit

Plastic dentures Acrylic dentures Benefit Limit

Pre-authorisation

required


One set p/b every 24 months. For beneficiaries over 21 years

− 100% of Scheme tariff Yes

CompCare Wellness Medical Scheme

Options

NetworX; NetworX ED* and NetworX

ED* Plus


−

80% of cost payable by the scheme and includes professional and laboratory fees. 20% member liability

Yes


Network Option

Dentures are included in the Specialised Dentistry Limit

Subject to the Annual Flexi Benefit and limited to R3 250 p/b andR5 250 p/f

Yes

Essential Option


− 100% of Scheme tariff Yes



−


Yes

Transmed Medical Fund

State Plus Network Option −

One set p/f every 24 months

Limited to R3 160 per partial or full set of dentures Yes

Umvuzo HealthStandard Option One set p/f every

24 months −100% of agreed tariff includes professional and laboratory fees. Limited to R 2 835 per event

Yes

Ultra Affordable Option No benefit − No Benefit N/A


Option A, Option APLUS, Option B

and Option BPLUSNo benefit − No Benefit N/A



truVALUE and truCARE No benefit − No Benefit N/A

truHEALTH and truWELLNESS

One set p/e every 36 months. For employees over 21 years

−

Employee to pay at point of service and claim back from Universal WorkerPlan. Service includes professional and laboratory fees. Employee liable for 20%. Limited to R2 247

Yes


SchemeNtsika Option


−


Yes

b = beneficiary, e = employee, f = familyED* = Efficiency Discounted


3.2. Approved denture procedure codes and fees

Code Description Denture Code Fee 2017

8231 Complete dentures - maxillary and mandibular R 2 036

8232 Complete dentures – maxillary or mandibular R 1 256

8233 Partial Denture – one tooth R 584

8234 Partial Denture – two teeth R 584

8235 Partial Denture – three teeth R 873

8236 Partial Denture – four teeth R 873

8237 Partial Denture – five teeth R 873

8238 Partial Denture – six teeth R 1 159

8239 Partial Denture – seven teeth R 1 159

8240 Partial Denture – eight teeth R 1 159

8241 Partial Denture – nine or more teeth R 1 159

8259 Re-line complete or partial denture R 476

8269 Repair of/add to denture R 161

8271 Add tooth to existing partial denture R 116

8273 Impression to repair/addition R 92

Listed fees do not include laboratory fees

4. Specialised DentistrySpecialised dentistry is available on:

• CompCare Wellness Medical Scheme: NetworX, NetworX ED* and NetworX ED* Plus Options• Massmart Health Plan: Network Option• Tiger Brands Medical Scheme: Mzansi Option

All specialised dentistry must be pre-authorised by Universal Care.

All dentistry admissions must be pre-authorised by Universal Care, including emergency, urgent and elective procedures/treatments. Only dentistry PMB’s are covered.

Procedures must be authorised at least 48 hours prior to admission and all emergency treatments must be authorised on the first working day after the admission. Failure to pre-authorise, or late authorisations (i.e. not within 48 hours), will result in a co-payment by the member per admission. The value of these co-payments will be determined by the Medical Scheme.

For authorisations: Please contact Universal Care – contact details are on the back cover of this Manual.

Specialised dentistry is not available on:

• AECI Medical Aid Society – Value Option• Massmart – Essential Option• Transmed Medical Fund – State Plus Network Option• Umvuzo Health – Standard and Ultra Affordable Options• Universal Health & Accident Plan• Universal WorkerPlan – truVALUE, truCARE, truHEALTH and truWELLNESS Options• Witbank Coalfields Medical Aid Scheme – Ntsika Option

ED* = Efficiency Discounted


5. Medicines5.1. Medicine benefitsIf medicines are required for dental pain or sepsis treatment, the medicines prescribed must be in accordance with the Medicine Formulary and are subject to the Formulary Reference Price (FRP). Only medicines on the formulary will be covered. The medicines can be obtained from a Universal Network pharmacy. See page 17 for the Medicine Formulary.

Medical Scheme Plan/Occupational

Health product/Insurance Plan

Options Acute Medicine Benefit Benefit Limit Formulary Out-of-formulary

medicines

AECI Medical Aid Society Value Option YES Unlimited, if on

formulary YES No Benefit

CompCare Wellness Medical

Scheme

NetworX, NetworX ED* and NetworX ED* Plus Options YES Unlimited, if on



Network Option YES Unlimited, if on formulary YES 25% co-payment

Essential Option YES Unlimited, if on formulary YES 25% co-payment

Tiger Brands Medical Scheme Mzansi Option YES Unlimited, if on


Transmed Medical Fund State Plus Network Option YES Unlimited, if on


Umvuzo Health

Standard Option YES Unlimited, if on formulary YES No Benefit

Ultra Affordable Option YES Unlimited, if on formulary YES No Benefit


Option A, Option APLUS, Option B and Option BPLUS YES

Included in the Stated Benefit, subject to overall limit of R1 240

YES No Benefit



truVALUE No benefit No benefit No benefit No benefit

truCARE, truHEALTHand truWELLNESS YES Unlimited, if on



SchemeNtsika Option YES Unlimited, if on



5.2. Universal Dental Network – Medicine Formulary

Category Therapeutic Description Active Ingredient Example of product name

Infections

Antibiotics - Cephalosporins

Cefaclor

Ceclor 375mg Tab, Vercef 375 mg Tab

Ceclor 187mg/5ml Susp, Vercef 187mg/5ml Susp

Ceclor 375mg/5ml Susp, Vercef 375mg/ 5ml Susp

Cephalexin

Belex 250mg Cap, CPL Alliance Cephalexin 250mg Cap

Belex 500mg Cap, CPL Alliance 500mg Cap

CPL Alliance Cephalexin 125mg/5ml Susp, Ranceph 125mg/5ml Susp

Ranceph 250mg/5ml Susp

Antibiotics - Erythromycin and other macrolides

Azithromycin Varimax 250mg Cap

Zithrogen 500mg Tab

Clarithromycin

Clarihexal 250mg Tab, Klarizon 250mg Tab

Klarithran 500mg MR Tab, Klarizon 500mg Tab

Clarihexal 125mg/5ml Susp, Simayla Clarithromycin 125mg/5ml Susp

Clarihexal 250mg/5ml Susp, Simayla Clarithromycin 250mg/ml Susp

Erythromycin Estolate

Purmycin Cap, Spectrasone Cap

Purmycin 125mg/5ml Susp

Spectrasone 250mg/5ml Susp

Erythromycin Stearate Betamycin Tab, Eryko Tab

Antibiotics - Other agents Clindamycin Dalacin C Cap

Antibiotics - Penicillins

Amoxicillin

Allmox 250mg Cap, Auro amoxicillin 250mg Cap, Moxan 250mg Cap

Allmox 500mg Cap, Auro amoxicillin 500mg Cap, Moxan 500mg Cap

Allmox S 125mg/5ml Susp, Moxypen 125mg/5ml Susp

Allmox SF 250mg/5ml Susp, Moxypen 250mg Susp

Amoxicillin + Floxacillin Macropen Susp

Macropen Cap

Amoxicillin + K Clavulanate

Amoclan 375mg Tab, Sandoz Co Amoclav 375mg Tab



Amoclan 125mg/5ml Susp, Sandoz Co Amoclav S 125mg/5ml Susp

Amoclan SF 250mg/5ml Susp, Sandoz Co Amoclav SF 250mg/5ml Susp

Sandoz Co Amoclav BD 457mg/5ml Susp

Cloxacillin Cloxin 250mg Cap

Cloxin 500mg Cap

Penicillin V Potassium Betapen 250mg Tab

Betapen 125mg/5ml Syr

Antibiotics - Quinolones Ciprofloxacin

Cilofloc 250mg Tab, Ciploxx 250mg Tab

Cilofloc 500mg Tablets, Ciprogen 500mg Tab

Austell Ciproflox 750mg Tab, Cifloc 750mg Tab


Category Therapeutic Description Active Ingredient Example of product name

Infections

Antibiotics – Sulphonamides & combinations

Sulphamethoxazole + Trimethoprim

Cozole 400/80mg Tab, Purbac 400/80mg Tab

Sandoz Co-Trimoxazole 800/160mg Tab, Purbac DS 800/160mg Tab

Co-trim Susp, Cozole Susp

Antibiotics - TetracyclinesDoxycycline

Cyclidox EC 50mg Cap

Doxycyl 100mg Cap

Oxytetracycline Be-Oxytet 250mg Cap

Anti-fungal agents Fluconazole

Mylan Fluconazole 50mg Cap

Aspen Fluconazole 150mg Cap, Fluzol 150mg Cap

Diflucan 50mg/5ml Susp

Diflucan 200mg/5ml Susp

Antimicrobial - Anaerobic and antiprotozoal agents Metronidazole

Acuzole 200mg Tab, Amzole 200mg Tab

Acuzole 400mg Tab, Amzole 400mg Tab

Flagyl Susp

Inflammation Non-Steroidal Anti-inflammatories (NSAIDs)

Ibuprofen

Betagesic 400mg Tab, Ibumax 400mg Tab, Inza 400mg Tab

Betagesic 200mg Tab, Ibumax 200mg Tab, Inza 200mg Tab

Ibugesic Susp, Ibumax Susp

Meloxicam Flexocam 7.5mg Tab, Medoxicam 7.5mg Tab

Naproxen Napflam 250mg Tab, Naproscript 250mg Tab,

Napflam 500mg Tab, Naproscript 500mg Tab

Local anaesthetics and

antiseptics

Mouth and throat preparations

Benzocaine Trochain Loz, Orocaine Loz

Chlorhexidine Gluconate

Corsodyl Soln, Corsodyl Soln Mint

Povidone + Iodine Septadine Oral Antiseptic, Dermadine Gargle

Tetracaine Dynexan Oint

Pain

Analgesics - combination

Paracetamol + Codeine + Caffeine + Meprobamate

Go-Pain Tab, Painagon Tab

Paracetamol + Codeine Spectrapain Cap

Adco-Napacod Tab , Codorol Tab, Empacod Tab, Painamol Plus Tab

Paracetamol + Promethazine + Codeine

Ban Pain Syr, Painagon Syr, Stilpane Syr

Analgesics - plain

Aspirin Bayer Aspirin 300mg Tab

Paracetamol

Gulf Paracetamol mg Tab Paingesic Tab, Zydus-Paracetamol Tab

Adco-Paracetamol Syr, Go-Pain P Syr, Painamol Syr

Empaped 125mg Supp

Empaped 250mg Supp


Notes


Notes


Universal Healthcare Provider NetworkTel: +27 11 208 1000/1010/1020 / Fax: +27 11 807 4496

Email: Claims queries: [email protected] / Provider Network queries: [email protected]: www.universal.co.za

Universal HealthcareUniversal House, 15 Tambach Road, Sunninghill Park, Sandton / PO Box 1411, Rivonia, 2128

Dental AuthorisationsAECI Medical Aid Society – 0861 234 007 / CompCare Wellness Medical Scheme – 0861 222 777

Massmart Health Plan – 0860 002 117 / Tiger Brands Medical Scheme – 0800 002 636Transmed Medical Fund – 0861 686 278 / Umvuzo Health – 0861 728 737

Documents

2017 Provider Manual - Welcome to Universal Healthcare · Welcome to the Universal Healthcare Provider Network (“Universal Network”). Universal Network is the Network Division