PPN MANUAL 2016optimum.ppn.co.za/downloads/PPN Manual 20160105 v2_Updated.pdf · PPN manual 2016 Compiled 21/12/2015CG 1 . PPN MANUAL 2016 . Description Page . 1. Important 2016 Updates

PPN manual 2016 Compiled 21/12/2015CG

1

PPN MANUAL 2016

Description Page

1. Important 2016 Updates P.2 a. Consultation and Lens Pricing b. List of 2016 Contracted medical schemes c. Lab discounts negotiated for PPN providers d. Second benefit warranty e. Fundus Photography f. CPD g. Digital Record Card - Controlled by Patient Biometrics

2. Split Billing P.6 3. PPN network P.7 4. PPN filters P.7 5. Settlement Discount and Offering P.7 6. PPN Rebate offering P.8 7. PPN frames P.9 8. PPN Ready Made Readers P.10 9. Optimum P.11 10. NVS P.11 11. PPN professional indemnity P.12 12. Stale claim period P.13 13. RSC P.13 14. Validate IT and Laboratory Information P.13 15. Motivations procedure P.14 16. VAT registration details P.14 17. Rate a PPN practice P.16 18. PPN Invoicing and Payment P.16 19. Biometrics P.17

Annexure A: PPN Medical Aid Breakdown Annexure B: PPN Tariff Listing

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1. IMPORTANT 2016 UPDATES We negotiated the following improvements to the benefit and service deliveries for 2016:

A. Consultation & Lens Pricing

Consultations We have successfully negotiated an increase of our ALL INCLUSIVE CONSULTATION fee (Refraction, Tonometry, Visual Fields, Biometrics, Blood Pressure, Blood glucose, Cholesterol and Dispensing within the benefit design) of R 665 for 2016. Consultation Changes

Description 2016 Code Comprehensive Consultation R490 70001 Dispensing within the benefit R95 70005 Blood Glucose & Cholesterol R50 70006 Blood Pressure R25 70007 Biometric Fingerprint R5 70008 Consultation only R430 70002 Consultation and Tonometry/Visual Fields R460 70003 Re-Examination R340 70004 Contact Lens Re-Examination R215 21844 Contact Lens Re-Examination (Bankmed) R235 20844

Base Lens Pricing The lens pricing on PPN 1 and PPN 2 remain constant for 2016. Lens Enhancements The Lens enhancements have been adjusted for 2016.

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B. List of 2016 PPN Contracted Medical Schemes for full administration and payment.

Administration only: (Separate call centre, claims and network administration)

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Notes on Scheme changes (Please see Medical Aid summary for more information - Annexure A): The additional Medical Schemes under PPN administration for 2016 are: GEMS – Administration only and at Gems tariff (Not PPN tariff) IMPORTANT NOTICE - GEMS : PPN has been awarded the administration contract of the GEMS Network for Optical Benefit Management as of

January 2016. Please contact the GEMS provider line 0860 436 777 and refer members to their normal GEMS call

centre 0860 00 4367 for all scheme related queries. (Follow the Interactive Voice Recordings).

The Gems Network, benefit design and tariff structure, remains separate to that of the PPN network The PPN benefit design and tariff structure remains separate to that of the Gems network. To avoid confusion : If you are a PPN provider but have not signed the GEMS network provider agreement, you will

not automatically have access to Gems members. You will have to request the Gems network agreement via

[email protected] or via the GEMS Provider call centre.

Sizwe – PPN network and PPN tariff Topmed Network Option (ex Carecross Topmed) – PPN network and PPN tariff Option Terminations: Medimed - Standard option only Bankmed - Plus option only Bankmed - Carecross Basic option only

C. LAB DISCOUNTS NEGOTIATED FOR PPN PROVIDERS Two laboratories, Essilor and Hoya, approached PPN and have offered the network 37.5% and 40% wholesale discount respectively. In addition they agreed to work with us by adjusting the basic clear lens pricing by only 2% as of January 2016. As a PPN practice you now automatically qualify for these discounts exclusively for any PPN lens order once you have signed a PPN addendum for the lab ordering process. When ordering, you will need to quote a PPN reference/order number. This reference/order number can only be obtained via Optimum when submitting your claim details for payment. PPN has to guarantee the laboratories immediate payment for these lenses and the practice needs to sign a PPN Addendum for the lab ordering process before we activate the Lab ordering system for your practice. Any abuse of this arrangement will cause the PPN to remove the provider from making use of the Lab ordering functionality on Optimum. You are under absolutely no obligation to use these laboratories and the lens ordering process. PPN has merely negotiated this opportunity for those members’ optometrists who would like to take advantage of this offer for ordering spectacles for PPN medical aid members. PPN has negotiated this pricing arrangement to ensure that all of its members can sustain profitability when dispensing at the PPN lens tariffs.

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PPN manual 2016

D. SECOND BENEFIT WARRANTY PPN has designed a second optical benefit for members who have lost, damage or broken their spectacles within their benefit cycle. PPN Providers who wish to participate need to sign a PPN second benefit warranty addendum and like the PPN lab ordering process, participation is completely voluntary. The medical aid member needs to contact the PPN call centre directly on 086 1103 529 to activate his/her benefit. Proof of broken, damaged or lost spectacles for may be required for approval. The Second benefit warranty is limited to : A PPN frame and one pair of standard clear lenses either single vision, bifocal or multifocal based on the last script of the member registered on the PPN system . No consultation is required as this warranty provides for replacement only. The member will have a co-payment of R150.00 on SV, R250 on BF and R350 on MF . The Second Benefit Warranty is only available on our Capitated contracts .The medical aids participating in the second benefit are therefore : Bankmed Traditional & Comprehensive, Bestmed, BPSA, Camaf, Hosmed, MBMed, Medimed, Medihelp, PG Group, Polmed, Remedi Standard, Thebemed Terms & Conditions:

• The medical aid member needs to apply to PPN for an authorisation number; • The replacement benefit is only available at a PPN provider where the initial claim originated or the

nearest PPN provider if the originating provider has not signed the addendum to facilitate the second benefit warranty;

• The dependent has used their current optical benefit for the current cycle and is not in benefit; • A consultation is not covered and only the current prescription that is registered with PPN will be

used for the replacement pair; • The spectacles MUST be ordered online via the PPN lab ordering process on the Optimum

system; • The cover includes a PPN frame and one pair of clear standard lenses to your last prescription and

a copayment at a PPN provider is applicable; • As applicable to the normal optical benefit, the member can choose an alternative frame and lens

enhancements which becomes a copayment between the provider and member; • The Second benefit warranty is only available once off and cannot be used simultaneously with

the normal optical benefit; • Proof of broken, damaged or lost/stolen spectacles can be requested

E. FUNDUS PHOTOGRAPHY

PPN has promoted the clinical significance of Fundus Photography to all medical aids. Transmed is the first medical aid to subscribe to this philosophy. The payment on code 20012 R 150 is subject to the photograph being uploaded on Optimum by a PPN provider and a PPN ophthalmologist confirming positive pathology for the benefit to be activated. The Fundus photograph needs to be made available on referral to an ophthalmologist.

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F. CPD For Free PPN has worked this year on establishing relationships where we can add value to our optometrists in the form of providing accredited CPD articles and points. We will upload articles every quarter on the PPN website. All articles have been selected by our Wellness Manager and internal optometrist, Molebogang Lephatsoana, and approved by the HPCSA. We hope that our providers will find value in the information provided by these articles. Optometrists can register on the PPN website: www.ppn.co.za (Click on PROVIDER, Click on CPD) PPN Optometrists can download the articles, print and or read them online and then start the questionnaire. The system automatically reviews the answers and awards the marks accordingly. Certificates of competency will automatically be issued on the PPN website upon successful completion (+ 70% score required).

G. DIGITAL RECORD CARD - CONTROLLED BY PATIENT BIOMETRICS

PPN has developed a Digital record card that, with the consent of the medical aid member, via the members Biometric Finger Print, will give a PPN practice the ability to access the member's previous clinical information recorded on the PPN system:

• Script information - VA, IOP, VF • Screening information - BP, BG, Cholesterol • Lenses dispensed • Cataract information • Retinal degenerative disorders • Fundus photograph • Last Date of Service

No previous provider information will be displayed, but should the practice test the member and find that the information on the historical record card doesn’t correlate, then the practice should report the information to PPN via our call centre on 086 1103 529 or by submitting the information on Optimum Support and we will investigate and revert soonest. 2. SPLIT BILLING

Split billing is not permitted according to a ruling by the Health Professions Council and the Medical Schemes Act of 1998.

According to the above ruling medical service providers are not allowed to use split billing when charging for their services. What is split billing? Split billing occurs when the Provider submits more than one account for the same service. The reason why split billing is not allowed is that

• it is of paramount importance to be able to track the full healthcare services and associated costs provided to a member of a medical aid

• split billing makes it possible for providers to disguise the fact that they are dispensing alternative products or charging more than the recommended negotiated rates

We regard split billing as an act of fraud. Please note that should split billing be identified your contract with PPN will be instantly terminated in terms of breach.

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3. PPN NETWORK As at the end of 2015, the PPN network membership stood at OVER 2600 practices. This represents 97% of all registered optometrists in South Africa. Membership of PPN is voluntary. There are no membership fees. 4. PPN FILTERS PPN is constantly improving the filters in our system to improve the clinical management of claims submitted to our network. As a result of these filters, your practice will be required to submit record cards, lab orders and motivations to facilitate formal approval where deemed necessary. PPN believes that these filters will ensure and maintain the required professional standards that we insist on within our network. 5. SETTLEMENT DISCOUNT AND OFFERING SETTLEMENT DISCOUNTS - DO NOT DEDUCT THE SETTLEMENTS PRIOR TO INVOICING

A. PPN 1 Tariff Medical Schemes : Frame & Lens Enhancement Benefit PPN will continue with the R150 settlement discount on the Frame & Lens Enhancement Benefit PPN will deduct R 150 off the frame/lens enhancement value designated per medical aid. Example

Frame Benefit Invoice ValueSettlement

DiscountPaid to

practiceDue by

Member

PPN Frame R 150 R 150 R 0 R 0R 450 R 450 R 150 R 300 R 0R 450 R 600 R 150 R 300 R 150

B. PPN 2 CONTRACTED MEDICAL SCHEMES

A 10% settlement discount on materials only will apply. This settlement discount applies to the higher lens tariff values of PPN 2 and the frame value.

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C. CASH PATIENTS

Members of PPN contracted medical aids who choose to pay cash must be invoiced using the associated PPN tariff. The pricing may not exceed the prescribed PPN tariff amounts. If a member is identified as a PPN contracted member after having been charged SAOA codes, then the claim will need to be reversed and the applicable PPN tariff invoiced. This might result in members receiving a refund from the practice. It is therefore crucial that all relevant medical aid data appears on the cash invoice to facilitate member refunds. It terms of Competition Law PPN providers are entitled to charge less than the PPN tariff amounts, but not more than. PPN has agreed with Medshield and Medihelp to charge PPN2 pricing for the following scheme option members as they do not have designated optical benefits. Medshield – Core Plus and Medihelp – Dimension Prime 1. We have done this in order to assist these members with their out of pocket costs. Members of these options need to pay cash, and PPN Optometrists need to make sure the correct PPN 2 tariff is used when raising the invoice. This will allow for correct tax certificate information when requested by members: 6. PPN FRAME REBATE – CONTROLLED ONLINE THROUGH OPTIMUM Whenever PPN deducts R 150 frame settlement on PPN 1 claims presented, PPN allocates either a R 50 rebate or a PPN Frame replacement to be utilized by the practice in the following way. The process is fully administered on the Optimum website interface: o PPN Frame dispensed

When a PPN frame has been dispensed on PPN 1 a R150 settlement applies and the frame is replaced no charge. PPN will supply the practice with a PPN frame.

o Frame of higher value than a PPN frame dispensed Every accepted transaction on our PPN 1 medical aids where a frame or extras have been

approved and R150 settlement discount has been deducted, PPN will reimburse the practice with R50 credit per claim at the end of each month.

o Credits can be used in the following way The practice may elect to receive the accumulated credit value in either cash, PPN/Stepper

frames or a combination of both. In the event that the practice doesn’t have access to the internet, PPN will only transact these re-imbursements/replacements based on written communication received by your practice. The reimbursement of money will be transacted at the end of the calendar quarter. Frame orders can be placed at multiple intervals, but only one shipment will be for free of courier charges; thereafter the practice will pay 1 credit per shipment to cover the courier. The practice should manage the PPN rebate offering process on Optimum.

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7. PPN FRAMES

It is COMPULSORY that all PPN practices carry a minimum stock of 20 PPN frames. The PPN frames must be clearly displayed and identifiable by the members of our contracted schemes. What does the PPN Frame benefit entail? All PPN 1 contracted medical aids benefit structures include a PPN frame benefit at a PPN practice. Therefore, it is compulsory for all the PPN practices to carry a minimum stock of 20 PPN frames. These PPN frames must be clearly displayed so that they can be identifiable by the members of PPN’s contracted schemes. All the PPN practices are obliged to first offer the PPN frames to all the members of PPN 1 contracted medical aid schemes. What is the procedure for PPN frames? PPN frames cost R50-00 each excluding V.A.T. The amount charged is a once off payment and a refundable deposit, meaning that when the practice resigns PPN membership, PPN will refund the deposit on receipt of the remaining stock of PPN frames from the practice. Bank details: Yellow Zebra Optical, Standard Bank, Acc nr 080265146, Branch code 051001 Tariff codes: PPN practices must use tariff code 70406 to invoice PPN frames for replacement. PPN Frame Replacements: see point 6 PPN will replace the PPN frames where the tariff code 70406 was charged at the end of every month once the practice has sold a minimum of 5 frames. The practice will not be charged for the replacement of PPN frames after the initial refundable deposit providing they use the code 70406. Should the practice order frames directly from the supplier, they will be charged for additional stock. Please note that all PPN frames include a (two) 2 year guarantee. Ordering more stock: Go to www.optimum.co.za and view the PPN frame catalogue/availability if you are unsure of the models you would like to purchase under the PPN Rebate Offering section. You can order additional stock directly from the supplier, Yellow Zebra Optical, by speaking to Romelda Page on 041 409 4000 or via e-mail [email protected] How to handle the old stock or the slow movers for PPN frames: PPN practices are also allowed to exchange the old stock and or the slow movers in their practice for the new PPN frames range. Return the current PPN frames the practice wants to exchange to Yellow Zebra Optical with the requested list of frames they would like to order as replacements. Go to www.ppn.co.za and view the PPN frame catalogue if you are unsure of the models you would like to be sent. The practice will be liable for the courier charges accrued in the process of returning PPN frames to Yellow Zebra Optical. Contacts: (1) For PPN frame replacement information please contact the PPN call centre on 086 1103 529 or forward your comments concerning the PPN fames to [email protected] (2) For exchanging the old stock or the slow movers please contact Romelda Page on 041 409 4000 or e-mail [email protected] (3) If you are not sure if the PPN frames were sent to your practice, please contact Brit Plaatjies on 041 506 5938, or email [email protected].

http://www.ppn.co.za/

mailto:[email protected]

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8. PPN READY MADE READERS

As of 1/1/2012 a Ready Made Reader benefit was written as part of the guaranteed benefit for the following medical aids: Bankmed, PG Group, MBMed The benefit value for readers will be R75 per pair of readers and the member will be entitled to 2 pairs within their benefit cycle. The benefit was designed to assist those members over the age of 40 who only require reading assistance and who prefer to wear Ready-Made Readers. As a PPN provider you should carry stock of PPN Ready-made Readers that will retail at R75. The practice does not have to stock the Yellow Zebra Optical range if they have readers available in their practice but please ensure that your practice can cater for Readymade Readers within the R75 price range. To ensure that you have access to a range of Ready-made Readers, PPN has arranged that you can source them directly from Yellow Zebra Optical (Please order from either Rochelle Canon or Romelda Page on 041-4094000 : The cost of the PPN readers is R40 excluding vat.) Medical aid members will be allowed to view the Ready-made Readers catalogue and/or view readers on the public PPN website. This benefit will be confirmed by the PPN call centre. The benefit for these options will be written as follows:

One Composite Consultation AND EITHER

Spectacles inclusive of Ready-Made Readers: Frame and Lens enhancements to the value of R"x" together with one pair of Aquity Clear lenses:

2 x Single Vision Lenses to the value of R150per lens; or 2 x Bifocal Lenses to the value of R325per lens; or 2 x Multifocal Lenses to the value of R600per lens

and/or Ready-Made Readers (inclusive in cost of lenses): 2 x Ready-Made Readers to the value of R75 per pair

OR Contact Lenses

Contact lenses to the value of R"x" Rules for Ready-Made Readers:

• Members can claim for 2 pairs of Ready-Made readers within their optical cycle. • The Readers benefit is an "either or" benefit which will result in a co-payment of R75 per ready-

made reader claim, where the member elects both spectacle lenses and readymade readers within their benefit cycle.

• Should the member claim for a Spectacle lens(es) and afterwards claim for Ready-Made readers then the member will have to co-pay for the Ready-Made Readers

• Should the member claim for Ready-Made readers and at a later stage want to claim for spectacle lenses then he will have to co-pay on the spectacle lenses

• Due to this benefit being written as part of the optical benefit and in the instance where the member elects both Spectacle lenses and Readers resulting in the readers being a co-payment, the provider can still claim for the code 70005 - Dispensing within the benefit, as long as there is no co payment on the frame/lens enhancements and/or branded lenses.

• The PPN Ready-made Readers Tariff code to be used is 61007 • Ready-Made Readers will only be available from registered PPN providers and no refund will

be given to members who buy readers from their pharmacy, clicks or other retail outlets.

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9. OPTIMUM Optimum is becoming a reliable, easy, fast and trusted claim submission method for PPN network providers. To date over 90% of PPN optometrists are currently registered on optimum for real time capturing. Please make sure that your practice is registered to use the Optimum website. This is a FREE service for PPN providers – with no switching fees. This website allows you to -

• biometric management, • frame rebate management, • validate membership, • view benefits/remittances, • list claims, • online capturing, • receive the latest news/updates, • do credit notes, • capture cataract information and retinal degenerative disorders, • view and correct Validate IT claims, • provide online support, • lab ordering reference for discounts, and • upload documents

To register contact Brit Plaatjies at PPN on 041-506 5938 or request one of the agents at the PPN call centre on 086 1103 529 or 086 1101 477 to fax the registration form to your practice. Once you are registered as a user, you can LOGIN to the website: www.optimum.co.za Should there be a requirement for in-house training, please log a call on the Optimum website by using the SUPPORT button to set up a date and time with our RSC. 10. NVS – NATIONAL VERIFICATION SYSTEM The NVS system was discontinued in June 2015. This was to enable the system to be re-engineered; PPN will communicate with the network once the new system has been implemented.

http://www.optimum.co.za/

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11. PPN PROFESSIONAL INDEMNITY Affiliation to the PPN network requires that each provider supplies proof of professional indemnity cover. Providers are entitled to source their own cover. Very cost effective cover is available to all PPN members by subscribing to the PPN cover arranged through Glenrand MIB (AON) at the following rates:

Period of Insurance : 1 September 2015 to 31 August 2016 Underwriter:

ACE Insurance Limited

Limit of Indemnity Deductible/ Excess Annual Premium

Inc VAT

Option 1

(PI/MM - Professional Indemnity & Medical Malpractice cover)

R2.5 mill any one claim aggregating to

R5 mill per period of Insurance Per Insured

Option 2

(PI/MM & Public Liability)

R2.5 mill any one claim aggregating to


R1, 000

(each and every claim)

R1, 000 (PI/MM)

R2, 500 (P/L)


R600.00

R905.00

Option 3 (Higher limit)

(PI/MM - Professional Indemnity & Medical Malpractice cover)

R5 mill any one claim aggregating to


Option 4 (higher limit)

(PI/MM & Public Liability)

R5 mill any one claim aggregating to


R1, 000


R1, 000 (PI/MM)

R2, 500 (P/L)


R685.00

R1, 170.00

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* Overseas cover is on referral and excluded in the above option/cover. To subscribe to the PPN Professional Indemnity offering, please contact Brit Plaatjies at the PPN membership department at [email protected] or 041 506 5938. Banking details: Glenrand MIB (AON) Nedbank Account Nr. 1454006951 Branch Code. 198405 12. STALE CLAIM PERIOD The stale claim period for claims is 60 days after original DOS (NOT RESUBMISSION). No resubmissions will be accepted for payment if the resubmission is submitted after this 60 day period. Any exception to this rule will require PROOF OF SUBMISSION. The stale date period for submissions of motivation is 4 months from date of service. If additional information is required by the PPN Committee the stale date period is 2 months from the date of the request. Although PPN would follow up with Providers to request additional information that might be needed, it is still the responsibility of the provider to send all documents that would be required within the specified periods. 13. REGIONAL SUPPORT COORDINATOR (RSC) Please do not hesitate to contact Petruschka Dekker on 083 454 2404 or via email [email protected] should you require any PPN training. 14. VALIDATE IT Fraudulent claiming is a problem for medical aids. The optical benefit has been abused by some members of medical aids in collusion with optometrists. PPN has been working on ways to reduce fraud, and introduced Validate IT in 2011.All claims for either bifocal or multifocal prescription lenses, that form part of a claim raised with PPN, must include the accredited laboratory used and the order number identified with the manufacture of the specific lenses claimed for. All laboratories can apply to become accredited. PPN will only have access to the claims information supplied on each PPN claim, which is information made known to PPN through the claim itself. Laboratories are subjected to a PPN audit to prove compliance. Claims that exclude Validate IT information will not be paid in line with agreements reached with the schemes that PPN administers. Medical aids have welcomed this step to eradicate fraud and expose those few optometrists who succumb to participating in fraudulent behavior. For more information contact Tulani Booysen at PPN on 041 506 5900 or via email on [email protected]



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15. MOTIVATION PROCEDURE PPN has dedicated Motivations coordinators. All motivations that fall outside of the clinical rule set, are forwarded to Pax Ramela for his professional opinion and adjudication. It is imperative that you provide PPN with all the necessary information required in order to facilitate and substantiate the motivation submitted. Please make note of the requirements listed on the Optical Motivations Sheet loaded on the Optimum Website under News Help & Training before submitting your motivation. To assist a smooth motivation process we have introduced pre-authorisation. If you would like to secure authorisation PRIOR to dispensing, PPN will undertake to give a ruling within 7 days and allocate a motivation number if approved. All you then need to do is quote this number and if appropriate, supply a copy of the lab order and lab invoice and the claim will be paid. PPN rule set:

1) No single vision Rx < 0.50 Diopter will be paid or considered for payment 2) No bifocal/varifocal adds for less than 1 Diopter will be paid or considered for payment. 3) No varifocals to children under age 18 years will be paid or considered for payment with the

exception of post cataract surgery. Bifocals to be considered for children under the age of 18 years on motivation only.

4) No contact lenses to children under age 16 years unless motivated. 5) Vertical prism > 1 Diopter should be motivated

Please complete the motivations sheet on News/Help & Training on Optimum and submit it directly to the motivation coordinators via fax on 086 6441 165 or email them on [email protected] who will co ordinate with the optometrist reviewing the motivation. NB - Stale Motivation period: As mentioned under point 12 of this document, the stale date period for submissions of motivation is in total 4 months from date of service (see stale claim period under point 12). The stale claim period also applies if additional information is required by the PPN Committee and the motivation will be deemed stale after a 2 months period from the date of the request. Although PPN would follow up with Providers to request additional information that might be needed, it is still the responsibility of the provider to send all documents that would be required within the specified periods. 16. VAT REGISTRATION DETAILS

In November 2014, PPN requested confirmation of VAT registration from all our providers. PPN would like to thank those providers that have either confirmed they are VAT registered through submission of their VAT certificates or have indicated they are not VAT registered. You are able to update your VAT information as well as upload a copy of your VAT certificate via the practice portal on Optimum. Please log onto Optimum to provide or update your details or, should you not have access to Optimum, email your VAT status along with all supporting documentation to [email protected] so that we can verify and update accordingly.


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17. RATE A PPN PRACTICE (IN PLACE SINCE 2014) A member can only rate your practice if they had either an eye test or materials dispensed i.e. a claim on the system, will we allow them to rate your practice. This will result in an overall star rating for your practice. The star rating will appear on the public website inclusive of comments made by the member. These comments will be displayed to new potential members looking for a practice where they can have their eyes tested. We will automatically email/fax your practice the moment a member rates your practice and provide you with a report based on their rating. Members can only rate your practice ONCE per transaction on the system and they CANNOT change the rating once they have submitted their final comment. The feedback will provide your practice with service information and feedback from a PPN member's perspective on how they experienced the service delivery in your store. PPN will automatically publish all 4 and 5 star ratings. We will however first obtain feedback for all 3 to 1 star ratings prior to publishing these details on our public website. We will follow the following process:

a. The PPN service team will contact the member to find out why they rated your practice with 3 or less stars (focusing on the questions rated 3 stars and less)

b. We will contact you to obtain more information on what you discussed with the member c. Confirm if the rating is a true reflection of the services received in store d. Should we find that a member rated your practice to harshly, we will after reviewing the feedback

from the member/practice and obtaining approval from the member, change their original rating and publish the new rating.

e. If the member would like to keep their rating, we will inform your practice at which stage you can interact with the member, but if the member is determined that this is the rating they would give your practice we will have to publish the rating given by the member.

The final rating is based on the following initial questions:

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18. PPN INVOICING & PAYMENT PPN will reject all claims without prescribed information: PPN will reject the full claim and give the practice an opportunity to resubmit for payment providing the resubmission is received prior to the stale claim deadline. Please note that it is vital to have the following information on your invoice to receive payment – if this information does not appear on your invoice to PPN your claim will be rejected: PRACTICE DETAILS The practice number must be clearly represented on all claims PATIENT DETAILS Name of the patients accompanied by the medical aid name and option/plan Full and correct membership number as depicted on the medical aid card Full name of Patient Date of birth of patient PROFESSIONAL FEES: For 70001 – Supply VA, IOP, Visual fields, Screening information For 70004 – Supply VA (Aided) For 70006/7 - Supply readings of Screenings For 70201 – Supply VA, IOP, Visual fields For 70202 – Supply VA (Aided) For 70203 – Supply VA Aided) and either IOP or VF reading All of the above will require full script details irrespective of whether materials were dispensed or not. LENSES: Full Prescription for spectacle lenses and contact lenses (incl. the add for Bifocals and Multifocal lenses). If lenses with prism corrections are dispensed, the practice must supply full details of the prism and prism base. FRAMES: NVS tag number ICD10 CODES LAB INFORMATION Lab number and Order number : all Bifocal and Multifocal claims- Please register any unlisted labs with PPN membership We have catered for all of the above on the Optimum website http://optimum.ppn.co.za If you submit your claims via EDI or XML and you would like to confirm that all your information gets through to PPN please ensure that you use the following Tariff Codes: TARIFF DESCRIPTION PPN INFORMATION 00099 005 000055 LAB code & order number 00098 SS123582 NVS number 00100 VA6/6,VA6/9,IOP10R,IOP12L,VisfieldFULLR,VisfieldFULL Clinical Information 00100 BP, BG & Cholesterol Clinical information

http://optimum.ppn.co.za/

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19. BIOMETRICS PPN developed Biometrics in 2013. The official roll out began in 2014 with free installation. The free installation will continue through to the end of March 2016. Thereafter, any existing PPN network provider requiring installation will be charged an installation fee. There will be no installation fee for new PPN network members. PPN has developed access to a Biometric fingerprint controlled record card. Members of contracted medical aids will be able to give their exclusive consent to access their personal clinical information for the practice at which they have made an appointment. No previous provider information will be displayed, but should the practice test the member and find that the information on the historical record card is incorrect, then you can report the information to PPN via our call centre on 086 1103 529 or by submitting the information on Optimum Support and we will investigate and revert soonest. Biometric Devices: We only roll out to providers who have signed the Biometric agreement - if you have not done so, please contact our membership department, Brit Plaatjies on [email protected] or 041 506 5938, to obtain the agreement and device.

01 01 2016 PPN Tariffs - PPN 1 Full administration

Medical aid - PPN 1 (GRID 1) Option START All Inclusive Consultation Contact Lens Re-examination Frame/Lens Enhancements Single Vision Bifocal Multifocal Contact Lenses Fundus Photography Readers BenefitCOMPREHENSIVE PLAN YOC R 665 225.00R PPN FRAME / PMA 150.00R 325.00R 600.00R R1395 - Annual

TRADITIONAL PLAN YOC R 665 225.00R R 800.00 150.00R 325.00R 600.00R R1260 - AnnualBEAT 3 DOS R 665 3 x R220 R 550.00 150.00R 325.00R 600.00R 1 000.00R BEAT 4 DOS R 665 R 500.00 150.00R 325.00R 600.00R 1 210.00R PACE 1 DOS R 665 R 550.00 150.00R 325.00R 600.00R 1 000.00R PACE 2 DOS R 665 R 550.00 150.00R 325.00R 600.00R 1 210.00R PACE 3 DOS R 665 R 550.00 150.00R 325.00R 600.00R 1 400.00R PACE 4 DOS R 665 R 1 050.00 150.00R 325.00R 600.00R 1 710.00R

BPSA MEDICAL AID SOCIETY BPSA Fixed R 665 R 750.00 150.00R 325.00R 325.00R 1 225.00R FIRST CHOICE DOS R 665 R 550.00 150.00R 325.00R 600.00R 800.00R

NETWORK CHOICE DOS R 665 R 550.00 150.00R 325.00R 600.00R 800.00R DE BEERS BENEFIT SOCIETY (DBBS) DBBS Fixed R 570 R 1 250.00 150.00R 325.00R 600.00R R1500 - Annual

PLUS YOC R 665 R 870.00 150.00R 325.00R 600.00R R 2 915.00 ACCESS YOC R 665 R 315.00 150.00R 325.00R 325.00R 820.00R

ESSENTIAL YOC R 665 PPN Frame at R150 150.00R 325.00R 325.00R 445.00R VALUE YOC R 665 R 580.00 150.00R 325.00R 325.00R R 1 810.00

MBMED MBMED DOS R 665 R 800.00 150.00R 325.00R 600.00R 1 635.00R 2 x R85 per pair NECESSE NETWORK DOS R 665 R 200.00 150.00R 325.00R 325.00R 395.00R DIMENSION PRIME 2 DOS R 665 R 200.00 150.00R 325.00R 325.00R 950.00R DIMENSION PRIME 3 DOS R 665 R 600.00 150.00R 325.00R 325.00R 1 000.00R

DIMENSION ELITE DOS R 665 R 750.00 150.00R 325.00R 600.00R 1 510.00R MEDIHELP PLUS DOS R 665 R 750.00 150.00R 325.00R 600.00R 1 660.00R

MANAGED CARE ECIPA YOC R 665 R 200.00 150.00R 325.00R 325.00R 650.00R MEDISAVE ESSENTIAL YOC R 665 R 200.00 150.00R 325.00R 325.00R 650.00R

UDIPA / PEGP YOC R 665 R 200.00 150.00R 325.00R 325.00R 650.00R PG GROUP MEDICAL SCHEME PG GROUP DOS R 665 3 x R220 R 850.00 150.00R 325.00R 600.00R 1 560.00R 2 x R75 per pair

AQUARIUM (FORMERLY LOWER PLAN) YOC R 665 3 x R220 580.00R 150.00R 325.00R 325.00R R555 - AnnualMARINE (FORMERLY HIGHER PLAN) YOC R 665 3 x R220 950.00R 150.00R 325.00R 600.00R R1510 - Annual

REMEDI MEDICAL AID SCHEME STANDARD DOS R 665 R 200.00 150.00R 325.00R 325.00R R 450.00 SISONKE HEALTH MEDICAL SCHEME PRIDE OPTION YOC R 665 PPN Frame at R150 150.00R 325.00R 325.00R 475.00R

ENERGY DOS R 665 R 650.00 150.00R 325.00R 325.00R 1 120.00R UNIVERSAL DOS R 665 R 600.00 150.00R 325.00R 325.00R 1 120.00R

TOPMED NETWORK OPTION DOS R 665 PPN Frame at R150 150.00R 325.00R 325.00R 400.00R STATE PLUS OWN CHOICE DOS R 665 R 500.00 150.00R 325.00R 600.00R 1 110.00R

SATS PENSIONERS (GUARDIAN) DOS R 665 R 500.00 150.00R 325.00R 600.00R 1 110.00R

Second Benefit Warranty Applicable as per rules in Manual on: Bankmed, Bestmed, Camaf, Hosmed, MBMed, Medimed, Medihelp, PGGroup, Polmed, Remedi, Thebemed

IMPORTANT INFORMATION :

TRANSMED MEDICAL FUND

Tariff codes 70005 - 70008 can be used in conjunction with 70001 - 70004 (Excl DeBeers Benefit Society - Code 70001 - 4 and 70006-7 applicable)Beneficiaries are only entitled to claim once every 24 months as of the Date of Service (DOS) or Year of Claiming (YOC) or Fixed cycle (2015/2016/2017)

THEBEMED

POLMED

BANKMED

BESTMED

Medihelp Prime 2: No contact lens benefit out of network

2 x R80 per pair

Positive Pathology per eye (Tariff code 20012)

MEDIMED

Full Administration (PPN tariff 1) Medical Schemes - 01 January 2016BENEFITS/CLAIM QUERIES : ONLINE on OPTIMUM or via Call centre 086 1103 529 OR 086 1101 477

CAMAF

HOSMED

MEDIHELP MEDICAL SCHEME

01 01 2016 PPN Tariffs - PPN 1 Full administration

Medical aid - PPN 1 (TARIFF GRID 2) Scheme/Option Composite

Consultation Frame/Lens Enhancements Single Vision

Bifocal Multifocal Contact Lenses

Option COption D

PRIMECAREIMPRESSIVE DESIGNSUNITY A COMPULSORYUNITY B COMPULSORYUNITY C COMPULSORY

UNITY A SMALL COMPULSORY GROUPUNITY B SMALL COMPULSORY GROUPUNITY C SMALL COMPULSORY GROUP

UNITY A VOLUNTARY GROUPUNITY B VOLUNTARY GROUPUNITY C VOLUNTARY GROUP

BESTMED PULSE 1DOMESTICAREPLUS (2 MONTH WAITING PERIOD)DOMESTICARE PLUS (6 MONTH WAITING PERIOD)

HORIZON HOSPITAL PLUS NETWORK PLANLIBERTY TRADITIONAL STANDARD

MOTOHEALTH CARE CUSTOMMOTOHEALTH CARE ESSENTIAL

MEDICALL HEALTHCAREOCSACARE SILVER PLUS (3 MONTH WAITING PERIOD)OCSACARE SILVER PLUS (6 MONTH WAITING PERIOD)

OCSACARE GOLD (NO WAITING PERIOD)OCSACARE GOLD (3 MONTH WAITING PERIOD)OCSACARE GOLD (6 MONTH WAITING PERIOD)

OCSACARE GOLD ACKERMANS (6 MONTH WAITING PERIOD)OCSACARE GOLD SCORPIONS (NO WAITING PERIOD)

GOLD ADCORP (3 MONTH WAITING PERIOD)OCSACARE GOLD MASSMART (6 MONTH WAITING PERIOD)

OCSACARE GOLD TRUWORTHS (6 MONTH WAITING PERIOD)OLD MUTUAL STAFF NETWORK PLAN

SELFMED SELFNET OPTIONWOOLTRU CORE OPTION

495.00R LIMITED TO 1 FRAME PER BENEFICIARY PER CYCLE 150.00R 325.00R 600.00R SUBJECT TO FRAME & LENSES BENEFIT (ANNUAL BENEFIT FOR CL)

495.00R LIMITED TO 1 FRAME PER BENEFICIARY PER CYCLE 150.00R 325.00R 600.00R SUBJECT TO FRAME & LENSES BENEFIT (ANNUAL BENEFIT FOR CL)

495.00R LIMITED TO 1 FRAME PER BENEFICIARY PER CYCLE 150.00R 325.00R

R600 (Multifocals subject to Sublimit of R450 per

lens)

SUBJECT TO FRAME & LENSES BENEFIT (ANNUAL BENEFIT FOR CL)

SAVINGS SUBJECT TO AVAIL MSA SUBJECT TO AVAIL MSA

SUBJECT TO AVAIL

MSA

SUBJECT TO AVAIL

MSA

SUBJECT TO AVAIL

MSA SUBJECT TO AVAIL MSA (ANNUAL BENEFIT FOR CL)

Combined Frame/Lenses benefit: M R1120 / M+1 R1240 / M+2 R1290 / M+3 R1350 / M+4 R1460 /M+5 R1570 / M+6 R1630 (35% TINT AVAILABLE ON LENSES SUBJECT TO FRAME AND LENSES BENEFIT)

PLEASE NOTE : NO OPTICAL BENEFIT AVAILABLE OUT OF NETWORK FOR CARECROSS, AFRICAN UNITY HEALTH, UNITY HEALTH

400.00R 325.00R 325.00R 150.00R

SIZWE

AFFORDABLE * Combined Frame/Lenses benefit: M R1570 / M+1 R1680 / M+2 R1900 / M+3 R2020 / M+4 R2080 /M+5 R2130 / M+6 R2190 (Designer Multifocals subject to Sublimit of R680 per lens) (35% TINT AVAILABLE ON LENSES SUBJECT TO FRAME AND

LENSES BENEFIT)

FULL CARE * Combined Frame/Lenses benefit: M R2360 / M+1 R2470 / M+2 R2810 / M+3 R2920 / M+4 R3030 / M+5 R3150 / M+6 R3200 (Designer Multifocals subject to Sublimit of R680 per lens) (35% TINT AVAILABLE ON LENSES SUBJECT TO FRAME AND

LENSES BENEFIT)

PRIMARY *

No benefit applicable325.00R 325.00R PPN Frame of R150

PPN Frame of R150

CARECROSS

150.00R

325.00R 325.00R 150.00R

UNITY HEALTH 495.00R

495.00R

490.00R PPN Frame of R150

AFRICAN UNITY HEALTH

BLACK BIRD GET SAVVI

Full Administration (PPN 1 Tariff) Medical Schemes - 01 January 2016BENEFITS/CLAIM QUERIES : ONLINE on OPTIMUM or via Call centre 086 1103 529 OR 086 1101 477

Beneficiaries are only entitled to claim once every 24 months as of the Date of ServiceCONSULTATION Tariff codes 70001 - 70004 AND 70008 BIOMETRICS applicable (CARECROSS excludes Biometric fingerprint)

No benefit applicable

01 01 2016 PPN Tariffs - Fee for Service

SCHEME A R 150 R 185 R 430 R 430 R 450SCHEME B R 550 R 185 R 430 R 430 R 1 050SCHEME C R 850 R 185 R 430 R 430 R 1 350

SCHEME ISS R 550 R 185 R 430 R 430 R 1 050SCHEME U R 550 R 185 R 430 R 430 R 1 050

COMPLETE PLUS 2016 (claiming date) R 1 540 FAMILY LIMIT: R2370

100% of LMS Rate subject to MSF and THB limited to R3900 per beneficiary (PPN Tariff applies)

and R10 000 per family .NO EXTRAS PAYABLE FROM FRAME BENEFIT. EXTRAS PAYABLE UP TO

BENEFICIARY AND FAMILY LIMIT.

PREMIUM PLUS Subject to Personal Savings Account. Includes repair costs

R130 (SUBJECT TO PERSONAL SAVINGS

ACCOUNT)

Subject to Personal Savings Account. Subject to Personal Savings Account.

MEDISAVER (FORMERLY STANDARD) Subject to Personal Savings Account. Includes repair costs

R130 (SUBJECT TO PERSONAL SAVINGS

ACCOUNT)

Subject to Personal Savings Account. Subject to Personal Savings Account.

MEDIBONUS OPTICAL LIMIT: R2500.00 PER BENEFICIARY EVERY 2 YEARS

MEDIPLUS OPTICAL LIMIT: R1650.00 PER BENEFICIARY EVERY 2 YEARS

MEDIVALUE OPTICAL LIMIT: R1450.00 PER BENEFICIARY EVERY 2 YEARS

MOTO CLASSIC R 700 R 1445 (annual) Subject to annual savings: Member R7 068; Adult R6 000 and Child R1 776

MOTO OPTIMUM R 1 100 R 2148 (annual) Subject to Day to Day : Member R21 400; Member +1 R29 800 Member +2 R34 500 and Member +3 R40 500

REMEDI COMPREHENSIVE R 1 060 R 2 120 R2 820 PER BENEFICIARY PER ANNUM ; FAMILY LIMIT R5 640

REMEDI CLASSIC R 925 R 1 840 R2 450 PER BENEFICIARY PER ANNUM ; FAMILY

LIMIT R4 900 (SUBJECT TO IOH - INSURED OUT OF HOSPITAL)

TOPMED RAINBOW COMPREHENSIVE100% of Cost from Yearly Limit

thereafter R1100 accrues to Threshold - Frame only

R2160 pbpa

100% of Cost from Yearly Limit thereafter PPN rates from Extended Cover. (Claims accrue to Threshold at PPN rate). No benefit for both spectacles and contact lenses in same

year. No extras payable.

TOPMED PROFESSIONAL100% of Cost from Yearly Limit


R1625 pbpa Limited to R 2 220 per beneficiary, R 6 420 per family. (Extras can be paid for out of the beneficiary and family

limits).

TOPMED PALADIN COMPREHENSIVE100% of Cost from Yearly Limit


R1836 pbpa

100% of Cost from Yearly Limit thereafter PPN rates from Extended Cover. (Claims accrue to Threshold at PPN rate). No benefit for both spectacles and contact lenses in same

year. No extras payable.

MEDICAL AID OPTION COMPOSITE CONSULTATION SV BF MF

MEDIHELP DIMENSION PRIME 1

MEDSHIELD MEDICORE (FORMERLY COREPLUS)

FEE FOR SERVICE Tariff 2 Medical Schemes - 01 January 2016

PPN Tariff 2 applicable, but MEMBER LIABLE FOR THE ACCOUNT TO THE PROVIDER - Please submit account to PPN for clearing and tax purposes.

R 490 R 185 R 430 R 750

TOPMED 2016 R 495 R 185 R 430 R 750

R 750

REMEDI MEDICAL AID SCHEME 2016 R 495 R 185 R 430 R 750

MOTO HEALTH CARE Year of Claming (Spectacles) R495 - Annual R 185 R 430

R 750

24 Mnts from DOS Subject to Optical Limit. Includes repair costs

R130 (SUBJECT TO OPTICAL LIMIT) Subject to Optical Limit.

R 495 (SUBJECT TO PERSONAL SAVINGS

ACCOUNT)

R 495

R 750

FAMILY LIMIT: R2370 Tints payable from the Frame and Lens enhancement benefit

LIBERTY MEDICAL SCHEME

COMPLETE STANDARD / COMPLETE SELECT 24 Mnts from DOS

R 495

BENEFICIARY LIMIT: R1480 frame / lens enhancements

FAMILY LIMIT ON FRAMES: R2970

R 185

MEDSHIELD

2016

R 185 R 430

BOMAID 24 Mnts from DOS R 490

R 430

BENEFITS/CLAIM QUERIES : ONLINE on OPTIMUM or via Call centre 086 1103 529 OR 086 1101 477BENEFITS are subject to either Threshold/Family/Beneficiary/Savings AVAILABILITY. Ensure your account is submitted soonest to avoid Benefit availability rejections.

CONSULTATION Tariff codes 70001 - 70004 AND 70008 BIOMETRICS applicable (BOMAID excludes Biometric fingerprint)MEDICAL AID OPTION BENEFIT CYCLE COMPOSITE

FRAME SV BF MF READERS CL OTHER

PPN Tariff File: 01 January 2016 PPN GRID

Updated 30 November 2015

CLEAR LENS CLEAR LENSLENS TYPE PPN 1 PPN 2 PGX HARDCOAT VAC COAT<35% VAC COAT>35% AR MULTI AR SUPER FIXED TINT< 35% FIXED TINT>35%

61122 62222 61322 61622 61722 69599 62422 61522 61822 61922R 150 R 185 R 218 R 131 R 198 R 286 R 430 R 456 R 218 R 263

LENS TYPE PPN 1 PPN 2 GREYMATIC HARDCOAT UV400 POLARIZED AR MULTI AR SUPER GRADIENT TINT GRADIENT TINT61121 62221 61321 61621 61421 69499 62421 61521 61821 61921R 150 R 185 R 495 R 114 R 152 R 1 473 R 340 R 395 R 131 R 131

LENS TYPE PPN 1 PPN 2 PGX HARDCOAT VAC COAT<35% VAC COAT>35% AR MULTI AR SUPER FIXED TINT< 35% FIXED TINT>35%61124 62224 61324 61624 61724 69599 62424 61524 61824 61924R 325 R 430 R 203 R 131 R 198 R 286 R 430 R 456 R 218 R 263


LENS TYPE PPN 1 PPN 2 PGX HARDCOAT VAC COAT<35% VAC COAT>35% AR MULTI AR SUPER FIXED TINT< 35% FIXED TINT>35%61126 62226 61326 61626 61726 69599 62426 61526 61826 61926R 600 R 750 R 346 R 131 R 198 R 286 R 430 R 456 R 218 R 263


PPN TARIFF 1 2 & 3 PPN MAX PRICE PPN MAX PRICEConsultation: VA VF IOP 70001 R 490 69259 R 657

Consultation only 70002 R 430 69359 R 1 400Consultation & Tonometry 70003 R 460 69459 R 1 425

Re-Examination 70004 R 340Dispensing within the benefit 70005* R 95Blood Glucose & Cholesterol 70006* R 50 MED. AID PPN MAX PRICE

Blood Pressure 70007* R 25 Bankmed 20844 R 235Biometric Fingerprint 70008* R 5 Other 21844 R 220

PPN00098

FRAME PPN MAX PRICE 00099Frame 70405 0 00100

FREE PPN frame 70406 R 150

* Payble as per the Medical Aid summary and negotiations with contracted schemes. Use the consultation codes 70001 - 70004 for all

PPN 1 & 2 schemes NVS TagLAB Ref / Order Number

TRANSITION ADD ONSINGLE VISION

MULTIFOCALBIFOCAL

V/A IOP VISFIELD REF

CONTACT LENS CONSULTATIONSContact Lens Re-ExaminationContact Lens Re-Examination

PPN TARIFF 1 2 & 3

PPN TARIFFS 1 JANUARY 2016

AQUITY Multifocal Polymer

ALL LENS PRICES INCLUDE THE COST OF EXTRA LARGE BLANKS AND PRISMThese prices are the maximum amount that PPN will pay out towards the codes set out below. Prices are inclusive of VAT.

ADD ONS

SINGLE Vision Glass

AQUITY Multifocal Glass

AQUITY Bifocal Plastic

AQUITY Bifocal Glass

SINGLE Vision Plastic

PPN Tariff File: 01 January 2016 Consultations

Updated 30/11/2015CG

PPN DESCRIPTION PRICE70001 Composite Consultation R 49070002 Consultation Only R 43070003 Consultation & Tonometry/Visual Fields R 46070004 Re-Examination R 340 22001 Binocular Instability Evaluation - Simple Case R 45521844 Contact Lens Re-Examination R 220 22002 Binocular Instability Evaluation - Complex Case R 910

22003 Visually Related Learning Disorders Evaluation R 1 36522004 Eye Movements Evaluation (E.G. Visigraph) R 455

20001 Cycloplegic Refraction R 22720002 Preferential Looking (Infants < Two Years) R 22720003 Corneal Topography R 259 22005 Reading Rate- screening R 22720004 Gonioscopy R 129 22006 Reading Ortho-Didactical skills evaluation R 68220005 Dilated Fundus Examination / BIO R 129 22007 Colorimetry Intuitive - evaluation R 90920006 Visual Field - Evaluation R 19420007 Visual Field - Threshold Testing R 32320008 Clolour Vision Evaluation R 194 22008 Vision Training - Home Therapy Instruction R 15220009 Contrast Sensitivity Evaluation R 129 22009 Vision Training - Individual (per 15 minutes) R 22720010 Lacrimal System Evaluation R 129 22010 Vision Training - Individual (per 30 minutes) R 45520011 Photography of Anterior Segment R 129 22011 Vision Training - Group per Patient (per 15 minutes) R 5720012 Photography of Fundus R 150 22012 Vision Training - Away From Practice (add to 22009 or 22011) R 38920013 Photographic Materials20014 Pachymetry R 15220015 Retinal Nerve Fibre Layer Analysis (RNFLA) R 35520016 Visual Evoked Potentials (VEP) - Unilateral R 30320017 Visual Evoked Potentials (VEP) - Bilateral R 530

22201 Low Vision Assessment per 30 mins R 45522202 Low Vision Training per 30 mins R 455

20018 Refractive Status Evaluation R 30320019 Ocular Pathology Screening R 22720020 Keratometry R 150 20201 Sports Vision Individual Screening R 30320021 Tonometry (Non-contact) R 150 20202 Sports Vision Individual Evaluation R 68220022 Tonometry (Aplanation) R 150 20203 Sports Vision Individual Training (per 15 minutes) R 22720023 Colour Vision Screening R 76 20204 Sports Vision Group Screening R 5720024 Visual Field - Screening R 150 20205 Sports Vision Group Evaluation R 133

20206 Sports Vision Group Training (per 15 minutes) R 57

21001 C Lens Consultation Basic - per visit R 200 20207 Sports Vision Individual Screening R 45521002 C Lens Consultation Complex - per visit R 606 20208 Sports Vision Individual Evaluation R 91021003 C Lens Consultation Advanced/Therapeutic - per visit R 758 20209 Sports Vision Individual Training (per 15 minutes) R 22721004 C Lens follow-up Examination/Basic Case - per visit R 227 20210 Sports Vision Group Screening R 9521005 C Lens follow-up Examination/Complex Case - per visit R 379 20211 Sports Vision Group Evaluation R 18921006 C Lens follow-up Examination/Advanced/Therapeutic Case - pe R 455 20212 Sports Vision Group Training (per 15 minutes) R 5721007 C Lens Related ProblemsAssessment - Monocular R 15221008 C Lens Related Problems Assessment- Binocular R 22721009 C Lens Instruction R 227 20025 Dispensing Fee - Single Vision R 7621010 C Lens Dispensing and/or Assessment R 227 20026 Dispensing Fee - Bifocals R 152

20027 Dispensing Fee - Varifocals R 227

20031 Screening School (per hour) R 91020032 Screening Industrial (per hour) R 910 20028 After Hours or Away from Practice Visit R 200

20029 Broken Appointments PPN USE IN CONJUCTION WITH CONSULTATION (70001) PRICE

79001 Report at request of Medical Aid. R 227 70005 Dispensing within the benefit R 9579002 Report at Patient's request (arising from Consultations) R 379 70006 Blood Glucose & Cholesterol R 20

70007 Blood Pressure R 10

The Low Vision Assessment examination is performed in addition to a visual examination where patients present with visual acuity that is worse than 6/18 or visual fields that are

severely restricted.

PPN Consultations - 01 January 2016OPTOMETRIC EXAMINATIONS BINOCULAR VISION/ORTHOPTICS

These evaluations are done in addition to an Optometric Examination. Special examination techniques apply to this area of expertise. The differentiating factor regarding Simple and Complex cases is by default: Complex cases have to do with Eccentric Fixation and / or

Anomalous Retinal Correspondence.

Code 70001: Composite consultation includes Refraction, Tonometry and Visual Field Screening

VISUALLY RELATED DISORDERSDIAGNOSTIC PROCEDURES

These are procedures based on findings arising out of the Optometric Examination.

COLORIMETRY CODES

VISUAL THERAPY/ ORTHOPTICS TRAINING

LOW VISION

REPORTS etc

LOW VISION ASSESSMENT& TRAINING (per half hour)PROCEDURES DONE IN ISOLATION

Follow-up procedures or specific requests by patients or medical practitioners. The clinical rule that applies:Codes can be used as a professional fee in isolation but may not be charged

in conjunction with Optometric Examinations. SPORTS VISION

SPORTS VISION - IN OFFICES PROCEDURES

CONTACT LENS PROFESSIONAL FEES & PROCEDURESCode 21010 refers to OTC dispensing ; either re-ordered or from other practices SPORTS VISION - PROCEDURES DONE IN THE FIELD

DISPENSING FEE (per pair)

OPTOMETRIC SCREENING SERVICESSERVICES OUTSIDE OF REGULAR OFFICE HOURS

PPN Tariff File: 01 January 2016 Lens Extras


PPN DESCRIPTION - CR39 PRICE PPN DESCRIPTION - GLASS PRICE

62623 Bifocal - Aspheric Lenticular/Elipsoid R 561 63624 Bifocal - Solid 38mm Seg R 3662723 Bifocal - Executive 74mm R 678 62724 Bifocal - Executive 60mm R 84062823 Trifocal - Flat-Top/Executive 74mm R 737 62824 Trifocal - Flat-Top 68x28 Seg R 1 006

69159 Removal Of Tint / COAting R 180 61559 Blue/Silver/Gold Mirror R 67569399 Mirror COAt (Blue/Silver/Gold) R 531 68959 VC - Removal of COAting R 130

69859 Prism Fresnel R 838 61659 Prism Fresnel R 86569659 Prism For Centration R 138 61759 Prism For Centration R 21569759 Special Surfacing R 166 61859 Special Surfacing R 195

62523 35m/m Seg Flat Top - Bifocal R 794 69335 Frosting R 11569239 HRI up to 1.56 SV R 327 63421 HRI up to 1.6 SV R 61062121 HRI up to 1.6 SV R 303 62122 HRI up to 1.7 SV R 84769339 HRI up to 1.7 SV R 2 044 63422 HRI up to 1.8 SV R 1 87062123 HRI up to 1.6 FTBF R 1 072 63423 HRI up to 1.6 FTBF R 50062125 HRI Trivex 1.53 R 1 141 62124 HRI up to 1.7 FTBF R 1 84169735 35m/m Seg Flat Top - Trifocal R 1 433 69436 Special base curve R 20069835 Frosting R 104 69535 Lenticular Concave R 21769935 Special Base Curve R 167 62524 35m/m Seg Flat Top - Bifocal R 1 14169635 Lenticular Concave R 1 121 62624 35m/m Seg Flat Top - Trifocal R 66062923 Atoric/Aspheric Back Surface R 45069978 HRI - Polycarbonate 1.6 R 1 016 61005 Low vision aid/appliances Specify

PPN DESCRIPTION PRICE PPN DESCRIPTION PRICE

61006 Sunglasses 61009 Complete Realignment of Frame R 13561007 Ready Made Readers61008 Spectacle Case 66026 Fitting Nylon / Rimless R 220

63136 Alter/transfer Rimless R 13169019 Frame Repairs or Sundry Items - to be specified

61004 Transfer - Nylon Supra or Rimless R 25561003 Transfer - Zyl or Metal Frame R 145 61199 Medical Aid Benefit

61299 Discount61399 Parcelling / Packaging or Delivering

61001 Re-Edge - Zyl Or Metal Frame R 19061002 Re-Edge - Nylon Supra Frame/Rimless R 316 69119 Materials not listed (must be specified)

Additional: Frame Extras/Add-Ons

Additional: Lens Extras/Add-Ons 01 January 2016

These prices are the maximum amount that PPN will pay out towards the codes set out below

ADD-ONS - LENSES ADD-ONS - LENSES

ADD-ONS - TINTS / COATINGS ADD-ONS - TINTS / COATINGS

ADD-ONS - POWERS ADD-ONS - POWERS

ADD-ONS - SPECIAL DESIGNS AND/OR MATERIALS ADD-ONS - SPECIAL DESIGNS

LOW VISION AIDS (LVA) / APPLIANCES

RE-EDGING, RE-SHAPING AND TRANSFERRING AT LABORATORY RISK (per pair of lenses)

FRAMES - SPECTACLE & SUNGLASSES FRAME MAINTENANCE PROCEDURES (Per Frame)

SUNDRY WORKSHOP PROCEDURES (Per Lens)

TRANSFERRING AT LABORATORY RISK TO IDENTICAL FRAME (per pair of lenses)

ACCOUNTING CODES

Glass Branded Lens Additions - 01 January 2016


CODE GROUP DESCRIPTION PRICE65122 Group 1 Single Vision Glass branded add on 100.00R 65222 Group 2 Single Vision Glass branded add on 200.00R 65322 Group 3 Single Vision Glass branded add on 300.00R 65422 Group 4 Single Vision Glass branded add on 400.00R 65522 Group 5 Single Vision Glass branded add on 500.00R 65622 Group 6 Single Vision Glass branded add on 600.00R 65722 Group 7 Single Vision Glass branded add on 900.00R 65822 Group 8 Single Vision Glass branded add on 1 350.00R 65922 Group 9 Single Vision Glass branded add on 2 200.00R

CODE GROUP DESCRIPTION PRICE65124 Group 1 Bi-Trifocal Glass branded add on 150.00R 65224 Group 2 Bi-Trifocal Glass branded add on 350.00R 65324 Group 3 Bi-Trifocal Glass branded add on 500.00R

26200 Varifocal Distance to Near 600.00R CODE GROUP DESCRIPTION PRICE63126 Group 1 Varifocal Glass branded add on -R 64426 Group 2 Varifocal Glass branded add on 100.00R 63326 Group 3 Varifocal Glass branded add on 200.00R 63426 Group 4 Varifocal Glass branded add on 300.00R 63526 Group 5 Varifocal Glass branded add on 400.00R 63626 Group 6 Varifocal Glass branded add on 500.00R 63726 Group 7 Varifocal Glass branded add on 800.00R 63826 Group 8 Varifocal Glass branded add on 1 100.00R 63926 Group 9 Varifocal Glass branded add on 1 200.00R 64126 Group 10 Varifocal Glass branded add on 1 300.00R 64226 Group 11 Varifocal Glass branded add on 1 500.00R 64326 Group 12 Varifocal Glass branded add on 2 200.00R 64526 Group 13 Varifocal Glass branded add on 3 000.00R

Visit Optimum for the Branded Lens breakdown

VARIFOCAL BRANDED (Add to 26200(PPN1) or PPN2)

GLASS - SINGLE VISIONS/V BRANDED (Add to SV PPN 1 / 2)

GLASS - BIFOCALBI-TRIFOCAL (Add to PPN 1 / 2)

GLASS - MULTIFOCAL

CR39/Polymer Branded Lens Add ons - 01 January 2016


CODE GROUP DESCRIPTION PRICE65121 Group 1 Single Vision Polymer/CR39 branded add on -R 65221 Group 2 Single Vision Polymer/CR39 branded add on 100.00R 65321 Group 3 Single Vision Polymer/CR39 branded add on 200.00R 65421 Group 4 Single Vision Polymer/CR39 branded add on 300.00R 65521 Group 5 Single Vision Polymer/CR39 branded add on 400.00R 65621 Group 6 Single Vision Polymer/CR39 branded add on 500.00R 65721 Group 7 Single Vision Polymer/CR39 branded add on 600.00R 65821 Group 8 Single Vision Polymer/CR39 branded add on 700.00R 65921 Group 9 Single Vision Polymer/CR39 branded add on 800.00R 65021 Group 10 Single Vision Polymer/CR39 branded add on 900.00R 66121 Group 11 Single Vision Polymer/CR39 branded add on 1 100.00R 66221 Group 12 Single Vision Polymer/CR39 branded add on 1 300.00R 66321 Group 13 Single Vision Polymer/CR39 branded add on 1 400.00R 66421 Group 14 Single Vision Polymer/CR39 branded add on 1 600.00R 66521 Group 15 Single Vision Polymer/CR39 branded add on 2 100.00R 66621 Group 16 Single Vision Polymer/CR39 branded add on 2 200.00R 66721 Group 17 Single Vision Polymer/CR39 branded add on 2 300.00R

CODE GROUP DESCRIPTION PRICE65123 Group 1 Bifocal Polymer/CR39 branded add on -R 65223 Group 2 Bifocal Polymer/CR39 branded add on 100.00R 65323 Group 3 Bifocal Polymer/CR39 branded add on 200.00R 65423 Group 4 Bifocal Polymer/CR39 branded add on 300.00R 65523 Group 5 Bifocal Polymer/CR39 branded add on 400.00R 65623 Group 6 Bifocal Polymer/CR39 branded add on 500.00R 65723 Group 7 Bifocal Polymer/CR39 branded add on 600.00R 65823 Group 8 Bifocal Polymer/CR39 branded add on 800.00R 65923 Group 9 Bifocal Polymer/CR39 branded add on 1 300.00R 65023 Group 10 Bifocal Polymer/CR39 branded add on 2 100.00R

25100 84500 Base Varifocal 600.00R 25207 84000 Intermediate to Near 600.00R CODE GROUP DESCRIPTION PRICE63125 Group 1 Varifocal Polymer/CR39 branded add on -R 65425 Group 2 Varifocal Polymer/CR39 branded add on 100.00R 63325 Group 3 Varifocal Polymer/CR39 branded add on 200.00R 63425 Group 4 Varifocal Polymer/CR39 branded add on 300.00R 63525 Group 5 Varifocal Polymer/CR39 branded add on 400.00R 63625 Group 6 Varifocal Polymer/CR39 branded add on 500.00R 63725 Group 7 Varifocal Polymer/CR39 branded add on 600.00R 63825 Group 8 Varifocal Polymer/CR39 branded add on 700.00R 63925 Group 9 Varifocal Polymer/CR39 branded add on 800.00R 64025 Group 10 Varifocal Polymer/CR39 branded add on 900.00R 64125 Group 11 Varifocal Polymer/CR39 branded add on 1 000.00R 64235 Group 12 Varifocal Polymer/CR39 branded add on 1 200.00R 64325 Group 13 Varifocal Polymer/CR39 branded add on 1 300.00R 64425 Group 14 Varifocal Polymer/CR39 branded add on 1 400.00R 64525 Group 15 Varifocal Polymer/CR39 branded add on 1 500.00R 64625 Group 16 Varifocal Polymer/CR39 branded add on 1 600.00R 64725 Group 17 Varifocal Polymer/CR39 branded add on 1 900.00R 64825 Group 18 Varifocal Polymer/CR39 branded add on 2 000.00R 64925 Group 19 Varifocal Polymer/CR39 branded add on 2 300.00R 65025 Group 20 Varifocal Polymer/CR39 branded add on 2 400.00R 65125 Group 21 Varifocal Polymer/CR39 branded add on 3 500.00R

Visit Optimum for the Branded Lens breakdown

VARIFOCAL BRANDED (Add to PPN1 25100 0R 25207 or PPN 2)

POLYMER - SINGLE VISIONS/V BRANDED (Add to SV PPN 1 / 2)

POLYMER - BIFOCALBIFOCALS (Add to PPN 1 / 2)

POLYMER - MULTIFOCAL

PPN CL PriceList 01 January 2016

Compiled 30/11/2015SG

PPN PPNPack Code Price

Air Optix Aqua Hydrogel 6-pack 18605 R 572Air Optix Aqua Multifocal 6-pack 18561 R 874Air Optix Astigmatism 6-pack 18567 R 853Air Optix Night & Day Aqua 3 pack 18590 R 358Air Optix Night & Day Aqua 6-pack 18621 R 700Air Optix Colors 2-pack 18530 R 380Focus Dailies Aqua Comfort Plus 30-pack 18518 R 357Focus Dailies Aqua Comfort Plus 90-pack 18556 R 845Dailies Aqua Comfort Plus Toric 30-pack 18515 R 419Dailies Aqua Comfort Plus Multifocal 30-pack 18528 R 424Dailies Total 1 30-pack 18541 R 392Dailies Total 1 90-pack 18521 R 930Focus Dailies Toric 30-pack 18527 R 394Freshlook Colours 2-pack 18622 R 366Freshlook ColourBlends 2-pack 18623 R 366Freshlook Dimen (RX) 6-Pack 18591 R 733Freshlook Dimension (plano) 2-pack 18624 R 366Freshlook One Day Colour 10-pack 18558 R 244Freshlook Illuminate 10-pack 18559 R 358

Biotrue ONE day 30-pack 18636 R 445Biotrue ONE day 90-pack 18637 R 1 126Biotrue ONE day for Presbyopia 30-pack 18638 R 831Biotrue ONE day Multifocal 30-pack 18501 R 505Ultra 6-pack 18502 R 663Purevision 6-pack 18550 R 472Purevision 2 HD for Astigmatism 6-pack 18594 R 926Purevision 2 HD 6-pack 18602 R 531Purevision 2 HD Multi Focal 6-pack 18633 R 942Purevision Multi Focal 6-pack 18535 R 909Purevision Toric 6-pack 18546 R 909Soflens 38 6-pack 18603 R 435Soflens 66 Toric 6-pack 18566 R 898Soflens Comfort (Soflens 59) 6-pack 18516 R 435Soflens Daily Disposable 30-pack 18514 R 311Soflens Daily Disposable 90-pack 18526 R 780Soflens Daily Disposable Toric 30-pack 18604 R 486Soflens Natural Colors 1-blister 18574 R 365Softlens Multifocal 6-pack 18581 R 909

PPN CONTACT LENS PRICES 1 JANUARY 2016 v2

ALCON (CIBA VISION)

BAUSCH & LOMB




Aquity II 6-pack 18606 R 465Aquity PC 6-pack 18607 R 539Aquity SI 6-pack 18608 R 543Healthy Vision 6-pack 18557 R 492Avaira Silicone Hydrogel 6-pack 18536 R 417Biofinity Multifocal 6-pack 18615 R 794Biofinity 6-pack 18539 R 543Biofinity Toric 3-pack 18578 R 423Biofinity Toric XR 3-pack 18576 R 517Biofinity Sphere XR 3-pack 18634 R 630Biomedics One Day Toric 30-pack 18531 R 423Clariti 1-Day Sphere 30-pack 18503 R 349Clariti 1-Day Toric 30-pack 18504 R 426Clariti 1-Day Multifocal 30-pack 18505 R 445Colour Tones 2-Pack 18555 R 206Expressions Colors 3-pack 18626 R 215Frequency XC/ Softique 6-pack 18540 R 514Frequency 55 Aspheric 6-pack 18568 R 465Provision 6-pack 18583 R 427Frequency 55 XCEL Toric XR 3-pack 18629 R 475Frequency 55 XCEL Toric 3-pack 18628 R 359Monthly Vision 6-pack 18525 R 465MyDay 30-pack 18522 R 384Hydrasoft Toric Each 18538 R 1 350OmniFlex Toric Rx Each 18586 R 1 350Proclear One Day 30-pack 18524 R 300Proclear Compatibles 6-pack 18609 R 539Proclear Multifocal 6-pack 18616 R 791Proclear One Day Multifocal 30-pack 18563 R 423Proclear Multifocal Toric XR 3-pack 18575 R 698Proclear Multifocal Toric XR Trial Singles 18543 R 165Proclear Multifocal XR 3-pack 18592 R 563Proclear One Day 90-pack 18544 R 766Proclear Sphere & RX Each 17126 R 853Proclear Tailor Made Toric Rx Each 18587 R 1 434Proclear Toric 6-pack 18564 R 775Proclear Toric XR 3-pack 18630 R 549Z 6 RP Toric Rx Each 18588 R 1 434Zero 6 14.0 Each 17121 R 853Zero 6 RX Each 17122 R 853

COOPER VISION




Adore Colour 2-pack 15017 R 692CM GM3 Sphere Each 17123 R 1 068CM GM3 Toric Each 18640 R 1 240Dispo Air Multi 6-pack 18577 R 742Dispo Day-by-Day 32-pack 18517 R 407Dispo Multi 6-pack 18582 R 985Dispo Toric 6-pack 18595 R 985Dispo 6-pack 18639 R 498Dispo Enhancing Colors 6-pack 18613 R 1 068Expo Each 17120 R 866Kristal 6-pack 18523 R 799Eye-Q Multifocal Toric Each 18618 R 2 006Eye-Q Multifocal Each 17115 R 1 503Toric-Lite Each 18589 R 1 459Soft K67% Each 18617 R 2 707Soft K67% Toric Each 18562 R 3 010SH Soft K 67% Each 18542 R 1 750SH Soft K 67% Toric Each 18545 R 1 913SH Soflex Toric Each 18601 R 1 017SH Soflex Sphere Each 18614 R 844SH Soflex Sphere Infant Each 18552 R 610Dark Brown Iris - Pinhole Each 17000 R 1 754Hand Painted Iris - Pinhole Each 17116 R 4 725Sport Tinted lens Each 17117 R 1 616CLL SH Infant lens Each 18537 R 42238% TruSphere Each 17118 R 955CLL Low DK to 50 Each 14048 R 1 068CLL Mid DK to 100 Each 14051 R 1 393CLL High DK from101 Each 14049 R 1 494CLL Optimum Extreme DF Each 14053 R 2 907CLL Optimum Extreme DF with Exchange Each 14052 R 2 326

EGP Each 14038 R 988EXM Each 14037 R 1 085EXT Each 14042 R 1 085HDP Each 14013 R 1 085HGP Each 14039 R 940MGP Each 14040 R 891PMMA Each 14025 R 678

CONTACT LENS LABORATORY OF SOUTH AFRICA

AVA CL




HDK (Asticon,Keratocon,Multicurve,LDL) Each 14006 R 1 221HDK (Back Toric and Front Toric) Each 14028 R 1 386HDK (C2,C3,Tricon,Pericon,Mina,Menicon) Each 14004 R 1 202HDK (C4,Tetracon,Aspheric) Each 14005 R 1 202LDK (Back Toric and Front Toric) Each 14007 R 1 040LDK(Asticon,Keratocon,Multicurve,LDL) Each 14003 R 854LDK(C2,C3,Pricon,Mina,Menicon) Each 14001 R 764LDK(C4,Tetracon,Aspheric (Jat) Each 14002 R 832MDK (Asticon, Keratocon,Multicurve, LDL) Each 14026 R 1 143MDK (C4,Tetracon,Aspheric) Each 14024 R 1 124MDK Back Toric and Front Toric Each 14021 R 1 308MDK(C2,C3,Tricon,Pericon,Mina,Menicon) Each 14022 R 1 124HDK (Bifocal) Each 14043 R 1 454PMMA (Asticon,Keratocon,Multicurve, LDL) Each 14010 R 606PMMA (Back Toric and Front Toric) Each 14009 R 793PMMA (C2,C3,Tricon,Pericon,Mina,Menicon) Each 14015 R 518PMMA (C4, Tetracon,Aspheric) Each 14011 R 586Analysis Each 17000 R 115Chemical Cleaning and Polishing Each 17000 R 226Curve/Diameter adjustments on existing lenses Each 17000 R 190GP High DK-Euro60,Paragon60,LDF90,Paragon Each 17000 R 443GP Low DK-LDF10 Clear,Grey & Blue Each 17000 R 246GP Med DK-LDF 30,40,Vista50,Fluroperm30,Pa Each 17000 R 378Power Changes Each 17000 R 145Service and Polish Each 17000 R 213

Biogel 60% Each 17111 R 533Biogel 60% Lenticular Each 17112 R 581Biogel 72% Each 17113 R 581Biogel 72% Lenticular Each 17114 R 640Analyzing Each 17000 R 48Cleaning Each 17000 R 78

Acuvue 2 6-pack 18551 R 496Acuvue Advance / Hydraclear 6-pack 18579 R 328Acuvue Moist 1 Day 30-pack 18554 R 424Acuvue Moist 1 Day 90-pack 18584 R 1 056Acuvue Moist for Astigmatism 30-pack 18532 R 519Acuvue Oasis for Astigmatism 6-pack 18631 R 601Acuvue Oasis with Hydraclear 6-pack 18612 R 436Acuvue True Eyes 1 Day 30-pack 18610 R 496

GENOP

HINS

MOSCON OPTICS (J & J)




Aqueous Each 14027 R 1 066Aspherics Each 14029 R 97Boston II Each 14018 R 979Boston XO / EO Each 14033 R 1 027LDF 25 Each 14012 R 979LDF 50 Each 14041 R 1 027PMMA Each 18571 R 591XL 40 Each 14016 R 979Bi - Toric Each 17000 R 252Concentric Bifocal Each 17000 R 174Hire of Fitting Set Each 17000 R 194Lenticular Each 14030 R 97Toric Base Curve Each 14019 R 174Toric Second Curve Each 14014 R 97Multiple Adjustments Each 17000 R 68Single Adjustments Each 17000 R 136Toric Front Curve Each 17000 R 174

Visaq 3-pack 18593 R 425Xtensa Toric 3-pack 18580 R 655Xstensa Multifocal 3-pack 18569 R 655Silicone Hydrogel 6-pack 18620 R 706Saphir Rx Toric 3-pack 18565 R 2 525Saphir Rx Sphere 3-pack 18619 R 2 525Saphir Rx Multifocal Toric 3-pack 18627 R 2 525Saphir Rx Multifocal 3-pack 18632 R 2 525Xtensa Rx Toric 3-pack 18520 R 1 964Saphir Multifocal Toric 2-pack 17000 R 2 525Saphir Toric 2-pack 18508 R 1 904Saphir Multifocal 2-pack 18506 R 1 904Saphir Sphere 2-pack 18507 R 1 785

Contact lens Accessories Each 13230Contact lens Solutions Each 13130Materials not listed (Specify) 17000

OTHER

TONY VINE

SPECIAL BRANDED

PPN MANUAL 2016optimum.ppn.co.za/downloads/PPN Manual 20160105 v2_Updated.pdf · PPN manual 2016 Compiled 21/12/2015CG 1 . PPN MANUAL 2016 . Description Page . 1. Important 2016 Updates

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