GENERAL PRACTITIONER 2019 PROVIDER MANUAL - Provider Hotline Number: 086 102 0220
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2 0 19 P R O V I D E R M A N U A L GENERAL PRACTITIONER Provider Hotline Number: 086 102 0220
Summary of benefits/services
Medical Schemes
AECI Medical Aid CompCare Wellness Old Mutual Staff Tiger Brands Medical Transmed Medical Witbank Coalfields
Massmart Health Plan Umvuzo Health
Society Medical Scheme Medical Aid Fund Scheme Fund Medical Aid Scheme
Benefits
NetworX & NetworX Network & Network Primary Plus Option Link Plan Ultra Affordable Ultra Affordable
Value Option Network Option Essential Option Standard option Ntsika Option
ED* Options SELECT Plans (Name change) (Name change) Option Value Option (NEW)
Unlimited at a Unlimited at a
Limited to: Unlimited at select
Universal Network GP. Unlimited at a Unlimited at a Universal Network GP.
M: 8 Universal Network GP.
Limited to 6 visits Limited to 6 visits Universal Network GP. Universal Network GP.
Clinical motivation M+1: 12
General per beneficiary per per beneficiary per Clinical motivation
Unlimited at a may be required Unlimited at a Unlimited at a M+2: 14 Beneficiaries are
practitioner annum at a Universal annum at a Universal Beneficiaries are Beneficiaries are may be required
Universal Network GP. to authorise more Universal Network GP. Universal Network GP. M+3+: 15 required to utilise
consultations Network GP, without Network GP, without required to nominate required to nominate to authorise more
than 3 GP visits visits per annum at a selected Network
per-authorisation per-authorisation. a Universal Network a Universal Network than 6 GP visits
per beneficiary per nominated Universal Provider from the
GP after 10 visits. GP after 8 visits. per beneficiary per
annum. Network GP. first visit
annum.
Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary Acute formulary
Acute Medication
medicines only. medicines only. medicines only. medicines only. medicines only. medicines only. medicines only. medicines only. medicines only. medicines only. medicines only.
26 PMB CDL 26 PMB CDL 26 PMB CDL 26 PMB CDL 36 PMB CDL 26 PMB CDL 26 PMB CDL 26 PMB CDL 26 PMB CDL 26 PMB CDL 26 PMB CDL
conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT conditions + HRT
Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary Chronic formulary
Chronic
medicine only medicine only medicine only medicine only medicine only medicine only medicine only medicine only medicine only medicine only medicine only
Medication
Registration & Registration & Registration & Registration & Registration & Registration & Registration & Registration & Registration & Registration & Registration &
authorisation authorisation authorisation authorisation authorisation authorisation authorisation authorisation authorisation authorisation authorisation
required. required. required. required. required. required. required. required. required. required. required.
Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes
Pathology Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal
Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP.
Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes Specific codes
Radiology (x-rays) Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal Referral by a Universal
Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP. Network GP.
Registration on Registration on Registration on Registration on Registration on Registration on Registration on Registration on Registration on Registration on Registration on
the Universal HIV the Universal HIV the Universal HIV the Universal HIV the Universal HIV the Universal HIV the Universal HIV RX Health HIV RX Health HIV RX Health HIV the Universal HIV
HIV Programme and Programme and Programme and Programme and Programme and Programme and Programme and Programme and Programme and Programme and Programme and
formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines formulary medicines
General Practitioner Provider Manual / 2019
only. only. only. only. only. only. only. only. only. only. only.
Referral by Network Referral by Network Limited to: Limited to:
Subject to day-to-day Referral by Network M: R2 990 M: R1 550
GP. GP. Referral by Network
benefit of R4 510 per GP. M+R4 380 M+R3 380
GP.
family Pre-authorisation Pre-authorisation Referral by Network Referral by Network Referral by selected
Pre-authorisation Referral by Network Referral by Network
required. required. Pre-authorisation GP. GP. Network GP.
Referral by Network required. Referral by Network GP. GP.
required.
GP. 2 visits per 2 visits per GP. Pre-authorisation Pre-authorisation Pre-authorisation
3 visits per Pre-authorisation Pre-authorisation
beneficiary, max 3 per beneficiary, max 3 per 2 visits per required from RX required from RX required from RX
Specialist Pre-authorisation beneficiary, max 3 Pre-authorisation required.
family. family. beneficiary, max 3 per required. Health. Health. Health.
required. per family. Subject to required. family. 3 visits per 2 visits per
AFB** 8 additional 6 additional RX Health contact RX Health contact RX Health contact
6 additional Limited to PMB’s only. beneficiary, max 5 per beneficiary, max 3 per
ante-natal visits ante-natal visits 2 additional ante- number: number: number:
ante-natal visits 2 additional ante- family. family.
per pregnancy at a per pregnancy at a natal visits per 0861 083 084 0861 083 084 0861 083 084
per pregnancy at a natal visits per
Universal Network Universal Network pregnancy subject to 2 additional ante- 12 additional
Universal Network GP pregnancy subject to
GP, midwife or GP, midwife or AFB** natal visits per ante-natal visits per
or gynaecologist. AFB**
gynaecologist. gynaecologist. pregnancy pregnancy
ED* = Efficiency Discounted
AFB** = Annual Flexi BenefitOccupational Health Product
Universal Worker Plan
Benefits
truVALUE truCARE truHEALTH truWELLNESS
General practitioner consultations Unlimited at a Universal Network GP. Unlimited at a Universal Network GP. Unlimited at a Universal Network GP. Unlimited at a Universal Network GP.
Acute Medication Acute formulary medicines only. Acute formulary medicines only. Acute formulary medicines only. Acute formulary medicines only.
6 PMB CDL conditions 32 PMB CDL conditions 33 PMB CDL conditions
Chronic Medication No Benefit Chronic formulary medicine only Chronic formulary medicine only Chronic formulary medicine only
Registration & authorisation required. Registration & authorisation required. Registration & authorisation required.
Specific codes Specific codes Specific codes Specific codes
Pathology
Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP.
Specific codes Specific codes Specific codes Specific codes
Radiology (x-rays)
Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP.
Registration on the Universal HIV Programme and Registration on the Universal HIV Programme and
HIV No Benefit No Benefit
formulary medicines only. formulary medicines only.
Specialist No Benefit No Benefit No Benefit No Benefit
Universal Insurance Plan
Universal Health & Accident Plan
Benefits
Essential & Essential Advance Standard & Standard Advance Comprehensive & Comprehensive Advance
Limited to 3 visits per insured person at a Universal Network GP. Limited to 5 visits per insured person at a Universal Network GP. Unlimited at a Universal Network GP.
General practitioner consultations
Stated Benefit amounts apply Stated Benefit amounts apply Stated Benefit amounts apply
Acute Medication Acute formulary medicines only. Acute formulary medicines only. Acute formulary medicines only.
15 conditions. Subject to 25 conditions. Subject to
11 PMB CDL conditions. Subject to Stated benefit amount per condition. Stated benefit amount Stated benefit amount
General Practitioner Provider Manual / 2019
per condition per condition
Chronic Medication Chronic formulary medicine only Chronic formulary Chronic formulary
medicines only. medicines only.
Registration & authorisation required. Registration & Registration &
authorisation required authorisation required
Specific codes Specific codes Specific codes
Pathology
Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP.
Specific codes Specific codes Specific codes
Radiology (x-rays)
Referral by a Universal Network GP. Referral by a Universal Network GP. Referral by a Universal Network GP.
HIV No Benefit No Benefit No Benefit
Specialist No Benefit No Benefit No BenefitINDEX
1. Introduction 1
1.1 Universal Network – Clients 1
1.2 Identifying beneficiaries/employees/insured persons 2
2. GP Reimbursement (excluding Universal Health & Accident Plans) 3
2.1 Consultation fees 3
2.2 Tariff Codes included in consultation fee 4
2.3 Tariff codes reimbursable over and above the consultation fee 5
3. GP Reimbursement for Universal Health & Accident Plan 6
3.1 Consultation fees 6
3.2 Stated Benefits reimbursable per event 6
4. Pathology 7
5. Radiology 8
6. Specialist Referrals 9
7. HIV Benefits 11
8. Screening and Preventative Care 13
9. Medicines and Medicine Formularies 15
9.1 Acute Medicines 15
9.2 Chronic Medicines 16
9.3 Universal Acute Medicines Formulary 20
9.4 Universal Chronic Medicines Formulary 30
10. Forms 56
10.1 Pathology Request Form 57
10.2 Radiology Request Form – Universal 58
10.3 Radiology Request Form – Universal Health & Accident Plan 59
10.4 Specialist Referral Form 60
10.5 Chronic Medicine Application Form 61
10.6 Patient Consent Form (HIV) 63
HIV Registration Form (excluding Umvuzo Health) Please use Chronic Medicine Application Form
General Practitioner Provider Manual / 20191. Introduction
Welcome 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 and Health Plans to establish and manage networks of healthcare providers to service
patients in the lower income segments. Our goal is to provide affordable access to primary healthcare, within a provider network
arrangement, without compromising 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 General Practitioners’ practices but seriously challenges the sustainability of
these network arrangements from a funding perspective. Therefore, the Universal Provider Network Agreements are definitely not a
mechanism to discount the General Practitioners’ fee structure but rather a conduit to facilitate access to basic primary healthcare for
patients who are currently not insured.
This manual contains information to assist you, the General Practitioner, when servicing patients on any of the medical scheme options
and health plans using the Universal Provider Network.
Patients are required to use a General Practitioner from the list of Universal Network General Practitioners.
1.1 Universal Network – Clients
Medical Schemes Options/Plans
AECI Medical Aid Society Value Option
NetworX Option
CompCare Wellness Medical Scheme
NetworX ED* Option
Network Option
Massmart Health Plan
Essential Option
Network Plan
Old Mutual Staff Medical Aid Fund
Network SELECT Plan
Tiger Brands Medical Scheme Primary Plus Option (Name change)
Transmed Medical Fund Link Plan (Name change)
Standard Option
Umvuzo Health Ultra Affordable Option
Ultra Affordable Value Option (New)
Witbank Coalfields Medical Aid Scheme Ntsika Option
ED* = Efficiency Discounted
General Practitioner Provider Manual / 2019 1Occupational Health Product Plans
truVALUE
truCARE
Universal WorkerPlan
truHEALTH
truWELLNESS
Universal Insurance Plan Plans
Essential
Essential Advance
Standard
Universal Health & Accident Plan
Standard Advance
Comprehensive
Comprehensive Advance
1.2 Identifying beneficiaries/insured persons/employees
All beneficiaries/employees/insured persons will carry a membership/policy card which will indicate that they are beneficiaries/
employees/insured persons. We urge you to confirm membership/employee/insured persons eligibility to avoid claim rejections.
Confirmation of membership/employee/insured persons 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 validity/employee eligibility/insured
person validity and available benefits before providing services to the beneficiaries/employees/insured persons.
Please also check the patient’s details against the patient’s identity book/passport.
2 General Practitioner Provider Manual / 20192. GP Reimbursement (excluding Universal Health and
Accident Plans)
Each Medical Scheme, Occupational Health Product or Insurance Plan on the Universal Provider Network has specific GP benefits which
must be obtained from a Universal Network General Practitioner.
2.1 Consultation fees
The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192
2019 Fees
Category Category Description
(inclusive of VAT)
Category A Dispensing doctors: Consultation fee including acute medication R392
Category B Non-dispensing doctors: Consultation fee including acute medication dispensed by a
R392
Universal Network Pharmacy
Category C Non-dispensing doctors: Consultation fee excluding acute medication (consultations only) R271
Capitation Fees where agreed, if more than 50 patients:
2019 Fees
Capitation Fees
(inclusive of VAT)
Capitation fee per beneficiary/employee per month
Age under 18 years R45
Age 18 – 59 years R57
Age 60 years or older R65
Plus: Category A and B
Consultation fee per beneficiary/employee per visit.
• The consultation fee includes the cost of acute medication. R185
• All fees are inclusive of VAT.
• The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192
Plus: Category C
Consultation fee per beneficiary/employee per visit.
• The consultation fee excludes the cost of acute medication. R66
• All fees are inclusive of VAT.
• The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192
General Practitioner Provider Manual / 2019 32.2 Tariff Codes included in consultation fees
Where clinically indicated and where the Universal Network GP is able and willing to perform the services, no additional fees will be
paid for the following codes. These services are included in the consultation fee paid to the Network GP and therefore may not be
claimed as a separate item and members/employees will not be required to pay for them.
Tariff Code Tariff Description
0146 For emergency or unscheduled consultation/visit at the doctor’s home or rooms, all hours
0147 For emergency or unscheduled consultation/visit away from the doctor's home or rooms, all hours
0201 Cost of material
0202 Setting of sterile tray
0206 Intravenous infusions (push-in)
0207 Intravenous treatment: Intravenous infusions (cut-down)
0222 Intralesional injection into areas of pathology e.g. Keloid: Single
0223 Intralesional injection into areas of pathology e.g. Keloids: Multiple
0225 Epilation: Per session
Special treatment of severe acne cases, including draining of cysts, expressing of cleaning of Comedones and/or
0227
steaming, abrasive cleaning of skin and UVR per session
0228 PUVA Treatment: Maximum of 21
0229 PUVA: Follow-up or maintenance therapy once a week
0230 UVR-Treatment
0231 UVR-Follow-up - for use of ultraviolet lamp -Treatment of benign skin lesion by chemo-cryotherapy
0233 Biopsy without suturing: First lesion
0234 Biopsy without suturing: Subsequent lesions (each)
0235 Biopsy without suturing: Maximum for multiple additional lesions
0237 Deep skin biopsy by surgical incision with local anaesthetic and suturing
0241 Treatment of benign skin lesion by chemo-cryotherapy: First Lesion
0242 Treatment of benign skin lesion by chemo-cryotherapy: Subsequent lesions (each)
0243 Treatment of benign skin lesion by chemo-cryotherapy: Maximum for multiple additional lesions
0316 Fine needle aspiration for soft tissue (all areas)
0317 Aspiration of cyst or tumour
1037 Diathermy to nose or pharynx
1136 Nebulisation (in rooms)
1186 Flow volume test: Inspiration/expiration
1188 Flow volume test: Inspiration/expiration/pre- and post-bronchodilator
1189 Forced expirogram only
1190 Determination of resistance to airflow in paediatric patients, impulse oscilimetry
1191 N2 single breath distribution
1192 Peak expiratory flow only
1228 General Practitioner's fee for the taking of an ECG only: Without effort
1229 General Practitioner's fee for the taking of an ECG only: Without and with effort
1230 Physician's fee for interpreting an ECG: Without effort
1231 Physician's fee for interpreting an ECG: Without and with effort
1232 Electrocardiogram: Without effort
1233 Electrocardiogram: Without and with effort
Effort electrocardiogram with the aid of a special bicycle ergometer, monitoring apparatus and availability of
1234
associated apparatus
1235 Multi-stage treadmill test
4 General Practitioner Provider Manual / 2019Tariff Code Tariff Description
2125 Destruction of condylomata/chemo- or cryotherapy: Limited number: Male
2127 Destruction of condylomata
2129 Electrodesiccation: Limited number
2131 Electrodesiccation: Multiple extensive
2271 Removal of tag or polyp
2272 Removal of small superficial benign lesions
2316 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: First lesion: Female
2317 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Repeat: Female
2318 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Widespread: Female
2399 Punch biopsy (excluding after-care)
2400 Biopsy during pregnancy (excluding after-care)
2403 Wedge biopsy: Cervix (excluding after-care)
2404 Biopsy: Wedge during pregnancy: Cervix (excluding after-care)
2405 Cone biopsy: Cervix (excluding after-care)
2957 Individual psychotherapy: Per short session (20 minutes)
2958 Psychoanalytic therapy: Per 60-minute session
2962 Directive therapy to family, parent(s), spouse: Per 20-minute session
2963 Pairs, marriage or sex therapy: Per 20-minute session
Group therapy: Adults (specify number): Tariff per person per 80-minute session; Children (specify number): Tariff per
2968
person per 80-minute session
3171 Excision of Meibomian cyst. Additional fee for sterile tray
3304 All other physical treatments carried out: Complete physical treatment: Specify treatment
3762 Full blood count (including items 3739, 3762, 3783, 3785, 3791)
4050 Glucose strip-test with photometric reading
4188 Urine dipstick, per stick (irrespective of the number of tests on stick)
2.3 Tariff codes reimbursable over and above the consultation fee
The codes listed in the Table below will be the only codes paid for and these will be paid for at the fees listed. No other codes or fees will
be paid unless pre-authorisation is obtained and members/employees will not be required to pay for them.
Please note: The fee includes any consumables that may be used.
2019 Fees
Tariff Code Tariff Description
(inclusive of VAT)
0255 Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail R316
0259 Removal of foreign body superficial to deep fascia (except hands) R451
Stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia): Including
0300 R432
normal after-care)
0301 Stitching of soft-tissue injuries: Additional wounds stitched at same session (each) R90
Excision and repair by direct suture; excision nail fold or other minor procedures of similar
0307 R540
magnitude
0887 Limb cast (excluding after-care) (modifier 0005 not applicable) R477
General Practitioner Provider Manual / 2019 53. GP Reimbursement for Universal Health & Accident Plan
An event consists primarily of a Consultation and Treatment. Any other related events, as listed below, may be claimed for in addition
to the Consultation and Treatment per event, depending on the health treatment required, and claimed for according to the tariff. Only
listed stated benefits amounts will be reimbursed.
3.1 Consultation fees
The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192
2019 Fees
Category Category Description
(inclusive of VAT)
Category A Dispensing doctors: Consultation fee including acute medication R392
Category B Non-dispensing doctors: Consultation fee including acute medication dispensed by a
R392
Universal Network Pharmacy
Category C Non-dispensing doctors: Consultation fee excluding acute medication (consultations only) R271
3.2 Stated Benefits reimbursable per event
Procedures that may be claimed for in addition to the Consultation and Treatment per event.
2019 Fees
Tariff Code Tariff Description
(inclusive of VAT)
0233 Biopsy without suturing: First lesion R80
0234 Biopsy without suturing: Subsequent lesions (each) R119
0237 Deep skin biopsy by surgical incision with local anaesthetic and suturing R433
0255 Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail R316
0259 Removal of foreign body superficial to deep fascia (except hands) R452
0300 Stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia):
R432
Including normal after-care)
0301 Stitching of soft-tissue injuries: Additional wounds stitched at same session (each) R90
0302 Stitching of soft-tissue injuries: Deep laceration involving limited muscle damage R612
0307 Excision and repair by direct suture; excision nail fold or other minor procedures of similar
R540
magnitude
0887 Limb cast (excluding after-care) (modifier 0005 not applicable) R477
3615 Routine obstetric ultrasound at 10 to 20 weeks gestational age preferable at 10 to 14 weeks
R674
gestational age to include nuchal translucency assessment
3617 Routine obstetric ultrasound at 20 to 24 weeks to include detailed anatomical assessment R674
6 General Practitioner Provider Manual / 20194. Pathology
Pathology Benefits
Only certain Pathology tests are covered. See page 57 for the Pathology Request Form.
Pathology tests that are not listed on the Universal Network Pathology request form will not be funded unless pre-authorisation is
obtained from Universal Care.
Pathology Services may only be rendered by a Universal Network Preferred Pathology Provider except in the case of emergencies.
General Practitioner Provider Manual / 2019 75. Radiology
Radiology Benefits
Only certain Radiology tests are covered. See page 58 for the Radiology Request Forms.
Radiology tests that are not listed on the Universal Network Radiology request form will not be funded unless pre-authorisation is
obtained from Universal Care.
Radiology tests on the Universal Health & Accident Plan are paid according to the negotiated stated benefit for x-rays, as part of the
allocated GP event. Please refer to page 59 for the Universal Health & Accident Radiology Request Form.
Advanced Radiology (i.e. any other radiology investigations including CT and MRI scans) are limited to benefits as stipulated in the rules
of the Scheme and must be pre-authorised.
Medical Scheme Options/Plans Advanced Radiology
Limited to PMB’s only, subject to pre-
AECI Medical Aid Society Value Option
authorisation
NetworX Option Limited to PMB’s only, subject to pre-
CompCare Wellness Medical Scheme
NetworX ED* Option authorisation
Limited to R12 700 per family (combined
Network Option
in-and-out-of-hospital limit)
Massmart Health Plan
Limited to PMB’s only, subject to pre-
Essential Option
authorisation
Network Plan Limited to a combined in-and-out-of-
Old Mutual Staff Medical Aid Fund hospital benefit limit of R13 400 per family
Network SELECT Plan per year, subject to pre-authorisation
Limited to PMB’s only, subject to pre-
Tiger Brands Medical Scheme Primary Plus Option
authorisation
Limited to R21 890 per family per year,
Transmed Medical Fund Link Plan
subject to pre-authorisation
Standard Option
Limited to PMB’s only, subject to pre-
Umvuzo Health Ultra Affordable Option
authorisation
Ultra Affordable Value Option
Limited to PMB’s only, subject to pre-
Witbank Coalfields Medical Aid Scheme Ntsika Option
authorisation
Occupational Health Plans Advanced Radiology
truVALUE
truCARE
Universal WorkerPlan No Benefit
truHEALTH
truWELLNESS
Universal Insurance Plan Plans Advanced Radiology
Essential
Essential Advance
Standard
Universal Health & Accident Plan No Benefit
Standard Advance
Comprehensive
Comprehensive Advance
8 General Practitioner Provider Manual / 20196. Specialist Referrals
Specialist benefits/consultations are only available on the following Medical Schemes/Occupational Health Product/Insurance Plan.
These benefits are subject to specific conditions.
Referral by
Pre-
Specialist Universal
Medical Schemes Options/Plans Ante-natal Consultations authorisation
Consultations Network
required
Provider
Subject to day-to- Limited to 6 additional ante-natal
AECI Medical Aid day benefit of consultations with a Network GP or
Value Option
Society R4 510 per member Gynaecologist and limited to two 2D
family Scans per pregnancy
NetworX Option Limited to 2 per
CompCare Wellness beneficiary, max 3 Limited to 2 additional ante-natal
Medical Scheme NetworX ED* per family. Subject visits per pregnancy, subject to AFB**
Option to AFB**
Limited to 8 additional ante-natal
Limited to 4 per
Network Option visits per pregnancy by a GP, midwife
family
Massmart Health or Gynaecologist
Plan Limited to 2 per Limited to 6 additional ante-natal
Essential Option beneficiary max 3 visits per pregnancy by a GP, midwife
per family or Gynaecologist
Network Plan Limited to any Universal Network
Old Mutual Staff
Network SELECT PMB’s only GP and limited to two 2D Scans per
Medical Aid Fund
Plan pregnancy.
Limited to 2 per
Tiger Brands Primary Plus Limited to 2 additional ante-natal
beneficiary max 3
Medical Scheme Option visits per pregnancy, subject to AFB**
per family
Limited to 2 additional ante-natal
Limited to 3 per visits per pregnancy.
Transmed Medical
Link Plan beneficiary max 5 Limited to rand limit of:
Fund
per family M: R2 850
M+ R4 170
Standard Option Pre-
Ultra Affordable authorisation
Option Subject to available by Rx Health.
Umvuzo Health No Benefit
benefits Telephone
Ultra Affordable number:
Value Option 0861 083 084
Limited to 2 per
beneficiary max 3
Witbank Coalfields per family.
Limited to 12 additional ante-natal
Medical Aid Ntsika Option Limited to a rand
visits per pregnancy and two 2D scans
Scheme value of:
M: R1 550
M+ R3 380
General Practitioner Provider Manual / 2019 9Referral by
Pre-
Occupational Specialist Universal
Plans Ante-natal Consultations authorisation
Health Product Consultations Network
required
Provider
truVALUE
Universal truCARE
No Benefit No Benefit No Benefit No Benefit
WorkerPlan truHEALTH
truWELLNESS
Referral by
Pre-
Universal Specialist Universal
Plans Ante-natal Consultations authorisation
Insurance Plan Consultations Network
required
Provider
Essential
Essential Advance
Standard
Universal Health &
Standard Advance No Benefit No Benefit No Benefit No Benefit
Accident Plan
Comprehensive
Comprehensive
Advance
Specialist Referral procedure
Out-of-hospital Specialist visits require referral by a Network GP and must be pre-authorised by Universal Care prior to the visit.
A Specialist referral form must be completed by the referring Network GP when referring a patient to a Specialist. See page 60 for the
Specialist Referral Form.
NB: *To obtain pre-authorisation please see Contact Details (back cover).
Specialist costs are funded at Scheme rates and are subject to the beneficiary’s available Medical Scheme day-to-day benefits.
Authorisations are only valid for a specified date period and the beneficiary must visit the Specialist within the authorised date period.
No additional authorisation is required should the Specialist require Pathology tests as specified on the Universal Network Pathology
request form.
No additional authorisation is required should the Specialist require Radiology tests as specified on the Universal Network Radiology
request form.
NB: Pre-authorisation is required for any Pathology tests or Radiology procedures required by the Specialist, that are not listed on the
Universal Network Pathology and/or Universal Network Radiology request forms. (Please refer to pages 57 and 58 for the Pathology
and Radiology request forms).
Any medicine prescribed by a Specialist is subject to the Universal Network medicine formulary.
10 General Practitioner Provider Manual / 20197. HIV Benefits
Beneficiaries employees of the Medical Scheme/Occupational Health Product managed within the Universal Network have access to
an HIV Disease Management programme; this excludes insured persons on the Universal Health & Accident Plan and certain Universal
WorkerPlan options.
All HIV+ve beneficiaries/employees should be registered on the HIV Disease Management programme. HIV positive patients on the HIV
programme receive telephonic supportive counselling for HIV from specially trained HIV nurse counsellors. The HIV nurses follow up
regularly with each patient registered on the programme to monitor disease progression and compliance.
The table below shows the HIV Programme providers per Medical Scheme/Occupational Health Product.
Registration on
HIV Programme Universal Medicines
Medical Schemes Options/Plans the Universal HIV
Provider Formulary
Programme
AECI Medical Aid
Value Option Universal Care
Society
CompCare Wellness NetworX Option
Universal Care
Medical Scheme NetworX ED* Option
Network Option Universal Care
Massmart Health Plan
Essential Option Universal Care
Old Mutual Staff Network Plan
Universal Care
Medical Aid Fund Network SELECT Plan
Tiger Brands Medical
Primary Plus Option Universal Care
Scheme
Transmed Medical Fund Link Plan Universal Care
Standard Option
Registration on
Umvuzo Health Ultra Affordable Option the Rx Health HIV Rx Health
Ultra Affordable Value Programme
Option
Witbank Coalfields
Ntsika Option Universal Care
Medical Aid Scheme
Registration on
Occupational Health HIV Programme Universal Medicines
Plans the Universal HIV
Product Provider Formulary
Programme
truVALUE No Benefit No Benefit No Benefit
truCARE Universal Care
Universal WorkerPlan
truHEALTH No Benefit No Benefit No Benefit
truWELLNESS Universal Care
Registration on
Universal Insurance HIV Programme Universal Medicines
Plans the Universal HIV
Plan Provider Formulary
Programme
Essential
Essential Advance
Universal Health & Standard
Accident Plan No Benefit No Benefit No Benefit
(Insurance Plan) Standard Advance
Comprehensive
Comprehensive Advance
General Practitioner Provider Manual / 2019 11Each HIV patient has access to the following benefits for HIV:
• Supportive HIV counselling and HIV disease information.
• Regular follow up GP visits.
• Antiretroviral treatment (ART) prescribed according to the HIV formulary.
• Appropriate pathology tests for HIV management.
• Monitoring and treatment during pregnancy to prevent Mother to Child Transmission (PMTCT). Access to Post Exposure Prophylaxis
(PEP) after accidental exposure to HIV or sexual assault.
• Treatment is to be commenced as soon as possible after exposure and four weeks treatment will be authorised.
• Prophylactic treatment for TB and PCP (Isoniazid, Purbac)
• Vaccination (Flu, Pneumonia)
Patients registered on the HIV programme qualify for the following GP consultations and pathology tests for the management of
their condition:
No. of procedures or tests per year,
Tariff code Tariff Description
dependent on patient’s control
0190-0192 GP consultations 2-4
3816 CD4 cell count 2-3
4057 Fasting glucose 1
3755 Full blood count 2-3
4531 Hepatitis Screen (Hep B) 1
4025 Lipogram 1
4130-4131 Liver function test 2-3
3974 PCR qualitative, in PMTCT only (newborn) 1
3881,3885,3893,3916,4188,4651 TB screen 1
4032, 41151 Urea and creatinine 2-3
4429 Viral load 2-3
If the patient requires antiretroviral medicine (ART), these medicines must be prescribed according to the Universal Chronic Medicine
Formulary. The prescribed medicines must be pre-authorised by the HIV Programme.
A completed chronic application or a prescription may be emailed or faxed to the HIV Programme. The HIV programme performs a
review of the treatment prior to the authorisation of the medicine. After the medicines have been authorised the HIV counsellors
contact the patient to arrange for the medicine to be obtained from the Scheme’s Preferred Pharmacy or from the doctor’s practice.
A patient consent form is available on page 63. Please refer to the chronic medicines formulary for a list of medicines covered for HIV.
The HIV nurses from the HIV programme regularly contact the patient telephonically to monitor disease progression and compliance to
the HIV treatment plan.
Universal Care HIV Programme Contact details:
Tel: 086 011 1900
Fax: 086 295 7305
E-mail: diseasemanagement@universal.co.za
Web: www.universal.co.za
Umvuzo Health (HIV Programme)
Tel: 0861 083 084 / (012) 845 0099
Fax: 0866 859 709
E-mail: wellness.management@rxhealth.co.za
12 General Practitioner Provider Manual / 20198. Screening and Preventative Care
Each Medical Scheme/Occupational Health Product on the Universal Provider Network offers screening and preventative care subject to available benefits and limits as indicated in the table below.
Medical Schemes
Witbank
CompCare Old Mutual Tiger Brands
AECI Medical Transmed Coalfields
Wellness Massmart Health Plan Staff Medical Medical Umvuzo Health
Aid Society Medical Fund Medical Aid
Medical Scheme Aid Fund Scheme
Scheme
Benefits
Standard, Ultra
NetworX & Network &
Network Essential Primary Plus Affordable & Ntsika
Value Option NetworX ED* Network Link Plan
Option Option Option Ultra Affordable Option
Options SELECT Plans
Value Options
Flu Vaccine
Mammogram No Benefit No Benefit No Benefit
Pap smear No Benefit No Benefit No Benefit
PSA No Benefit No Benefit No Benefit
Glucose test (finger prick) No Benefit
Lipogram No Benefit No Benefit
Rapid HIV Test No Benefit No Benefit
General Practitioner Provider Manual / 2019
HPV (Cervical Cancer) No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Adult pneumococcal
No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
vaccine
1314
Occupational Health Product
Benefits Universal WorkerPlan
truVALUE, truHEALTH, truCARE & truWELLNESS
Flu Vaccine
Mammogram No Benefit
Pap smear No Benefit
PSA
Glucose test (finger prick)
Lipogram
Rapid HIV Test
HPV (Cervical Cancer) No Benefit
Adult pneumococcal vaccine No Benefit
Universal Health & Accident Plan
Benefits Comprehensive & Comprehensive
Essential & Essential Advance Standard & Standard Advance
Advance
Flu Vaccine No Benefit No Benefit No Benefit
Mammogram No Benefit No Benefit No Benefit
Pap smear No Benefit No Benefit No Benefit
PSA No Benefit No Benefit No Benefit
Glucose test (finger prick) No Benefit No Benefit No Benefit
Lipogram No Benefit No Benefit No Benefit
Rapid HIV Test No Benefit No Benefit No Benefit
General Practitioner Provider Manual / 2019
HPV (Cervical Cancer) No Benefit No Benefit No Benefit
Adult pneumococcal vaccine No Benefit No Benefit No Benefit9. Medicines and Medicine Formularies
9.1 Acute Medicines:
All members/ employees/insured persons are covered for acute medicines according to the Universal Network Acute Medicine Formulary and are subject to the Formulary Reference Price (FRP).
Medicines that are not on the medicine formulary will not be paid for.
• The cost of any acute medicine prescribed by a Universal Network GP and dispensed by a pharmacy, forms part of the consultation fee and will be subtracted from the fixed rate consultation
fee as listed in Section 2 of this Manual. (Category B doctors).
• For dispensing doctors registered as such on the Universal GP network, the cost of any acute medicines dispensed by the GP forms part of the consultation fee and may not be charged
separately. (Category A doctors).
On the Universal Health & Accident Plan, acute medicines form part of the consultation and treatment event and are paid according to Stated Benefit values. Please refer to Stated Benefits per event.
General Practitioner Provider Manual / 2019
1516
9.2 Chronic Medicines:
All chronic medicines (as per the list of conditions covered in the Tables below), are subject to the Universal Chronic Medicine Formulary and the Formulary Reference Price (FRP). A Stated Benefit
value is applicable per condition on the Universal Health& Accident Plan.
These chronic medicines may be dispensed by a contracted dispensing GP or obtained from a pharmacy within the Universal Network. The cost of chronic medication does not form part of the
consultation fee.
All chronic patients need to register on the Universal Chronic Programme and all chronic medicines must be pre-authorised. A Chronic Medicine application may be completed by the GP, or
alternatively the GP may contact 0860 111 900 to register the condition telephonically. Please refer to page 61 for the Chronic Medicine application form.
CompCare
AECI Medical Aid Massmart Health Old Mutual Staff Tiger Brands Transmed Witbank Coalfields
Wellness Medical Umvuzo Health
Society Plan Medical Aid Fund Medical Scheme Medical Fund Medical Aid Scheme
Scheme
Conditions Ultra Affordable
NetworX & Network &
Network & Primary Plus & Ultra
Value Option NetworX ED* Network SELECT Link Plan Standard Option Ntsika Option
Essential Options Option Affordable Value
Options Plans Options
Acne (cystic nodular) No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Addison’s Disease
Allergic rhinitis (if
beneficiary has asthma No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
or is under 12 years)
Anxiety No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Asthma
Atopic Eczema No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Benign Prostatic
No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Hypertrophy
Bipolar Mood Disorder
Bronchiectasis
Cardiac Arrhythmias
General Practitioner Provider Manual / 2019
Cardiomyopathy
Chronic Obstructive
Pulmonary Disease
Chronic Renal Failure
Congestive Cardiac
Failure
Coronary Artery Disease
Crohn’s Disease
Depression No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Diabetes Insipidus
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2CompCare
AECI Medical Aid Massmart Health Old Mutual Staff Tiger Brands Transmed Witbank Coalfields
Wellness Medical Umvuzo Health
Society Plan Medical Aid Fund Medical Scheme Medical Fund Medical Aid Scheme
Scheme
Conditions Ultra Affordable
NetworX & Network &
Network & Primary Plus & Ultra
Value Option NetworX ED* Network SELECT Link Plan Standard Option Ntsika Option
Essential Options Option Affordable Value
Options Plans Options
Epilepsy
Glaucoma
Gout No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Haemophilia
HIV
Hormone Replacement
No Benefit
Therapy (Female HRT)
Hyper-cholesterolemia /
Hyper-lipidaemia
Hypertension
Hyper-parathyroidism No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Hypothyroidism
Major Depression No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Migraine prophylactics
No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
(prevention)
Multiple Sclerosis
Osteoarthritis No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Parkinson’s Disease
Post-traumatic Stress
No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Disorder (PTSD)
Peripheral Vascular
No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
General Practitioner Provider Manual / 2019
Disease
Psoriasis No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Raynaud’s Disease No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Rheumatoid Arthritis
Schizophrenia
Stroke No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit
Systemic Lupus
Erythematosus
Ulcerative Colitis
Total number of Chronic
28 27 28 37 28 28 31 28 28
Conditions covered
1718
Occupational Health Product
Conditions Universal WorkerPlan
truHEALTH truCARE truWELLNESS
Addison’s Disease No Benefit
Asthma
Atopic Eczema No Benefit
Benign Prostatic Hypertrophy No Benefit
Bipolar Mood Disorder No Benefit
Bronchiectasis No Benefit
Cardiac Arrhythmias No Benefit
Cardiomyopathy No Benefit
Chronic Obstructive Pulmonary Disease No Benefit
Chronic Renal Failure No Benefit
Congestive Cardiac Failure No Benefit
Coronary Artery Disease No Benefit
Crohn’s Disease No Benefit
Diabetes Insipidus No Benefit
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Epilepsy No Benefit
Glaucoma No Benefit
HIV No Benefit
Hormone Replacement Therapy (Female HRT) No Benefit
Hypercholesterolemia/Hyperlipidaemia
Hypertension
General Practitioner Provider Manual / 2019
Hypothyroidism No Benefit
Parkinson’s Disease No Benefit
Peptic Ulceration No Benefit
Peripheral Vascular Disease No Benefit
Psoriasis No Benefit
Raynaud’s Disease No Benefit
Rheumatoid Arthritis No Benefit
Schizophrenia No Benefit
Systemic Lupus Erythematosus No Benefit
Ulcerative Colitis No Benefit
Total number of Chronic Conditions covered 32 6 33Universal Health & Accident Plan
Conditions Essential & Standard & Comprehensive &
Essential Advance Standard Advance Comprehensive Advance
Addison’s Disease No Benefit No Benefit
Asthma
Bronchiectasis No Benefit
Cardiac Arrhythmias
Cardiomyopathy No Benefit
Chronic Obstructive Pulmonary Disease
Chronic Renal Failure No Benefit No Benefit
Congestive Cardiac Failure
Coronary Artery Disease
Crohn’s Disease No Benefit No Benefit
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Epilepsy
Glaucoma No Benefit
Hypercholesterolemia/Hyperlipidaemia
Hypertension
Hypothyroidism
Menopause No Benefit No Benefit
Multiple Sclerosis No Benefit No Benefit
General Practitioner Provider Manual / 2019
Parkinson’s Disease No Benefit
Psoriasis No Benefit No Benefit
Rheumatoid Arthritis No Benefit No Benefit
Stroke No Benefit No Benefit
Systemic Lupus Erythematosus No Benefit No Benefit
Ulcerative Colitis No Benefit No Benefit
Total number of Chronic Conditions covered 11 15 25
1920
9.3 Universal Acute Medicines Formulary
Category Therapeutic Description Active Ingredient Example of product name
Benzoyl Peroxide Benzac AC Gel
Acne Topical acne agents
Tretinoin Ilotycin A Gel
Beclomethasone Beclate Aquanase Spray
Allergic rhinitis Corticosteroids - Nasal
Fluticasone Flonase Aq Nasal Spray
Gulf Cetirizine Tab, Zinallerg Tab
Cetirizine
Cetirizine Hexal Syr
Allergex Tab
Chlorpheniramine
Allergex Syr
Antihistamines Clarityne Tab, Lormeg Tab, Lorano Tab
Allergy and Loratadine
AP Loratadine Syr
dermatitis
Phenergan 10mg Tab
Promethazine Phenergan 25mg Tab
Prohist Syr, Lenazine Syr
Diphenhydramine + Calamine + Phenol Biohist Lotion
Antihistamine Topical
Promethazine Phenergan Cream
Betanoid Tab
Betamethasone
Betanoid Syr, Steromien Syr
Corticosteroids - Oral Capsoid Tab, Lenisolone Tab
Prednisolone
Adco-Prednisolone Syr
Prednisone Be-tabs Prednisone Tab, Panafcort Tab
General Practitioner Provider Manual / 2019
Topivate Cream
Allergy and
Betamethasone Lenovate Oint
inflammation
Betnovate SC Scalp Application
Dovate Cream
Corticosteroids -Topical
Clobetasol Dermovate Oint, Dovate Oint
Clobex Shampoo
Biocort Cream
Hydrocortisone
Mylocort Oint
Hexal-MPA 5mg Tab
Amenorrhoea Progestogens Medroxyprogesterone
Hexal-MPA 10mg TabCategory Therapeutic Description Active Ingredient Example of product name
Ferrous Fumarate + Folic Pregamal Tab
Ferrous Sulphate 30mg Tab
Anaemia Haematinics Ferrous Sulphate
Ferrous Sulphate 75mg
Iron Polymaltose Ferofols Syr
Zentel Tab
Albendazole
Zentel Susp
Adco-Wormex 100mg Tab
Adco-Wormex 500mg Tab, Wormstop 500mg Tab
Mebendazole
Anthelminthics Anthelminthics Cipex 100mg/5ml Susp, Wormstop 100mg/5ml Susp
Vermox SD 500mg/10ml Susp
Piperazine SB Tox Worm Syr
Cysticide 500mg Tab
Praziquantel
Biltricide 600mg Tab
Mylan Alprazolam 0.25mg Tab, Zopax 0.25mg Tab
Alprazolam Mylan Alprazolam 0.5mg Tab, Zopax 0.5mg Tab
Mylan Alprazolam 1mg Tab, Zopax 1mg Tab
Anxiety and stress Benzodiazepines Sandoz Bromazepam 3mg Tab
Bromazepam
Sandoz Bromazepam 6mg Tab
Doval 5mg Tab
Diazepam
Pax 10mg Tab
Atrovent 20mcg HFA Inh
Ipvent 40mcg Inh
Anticholinergics Ipratropium
Adco-Ipratropium 0.25mg/2ml Neb
General Practitioner Provider Manual / 2019
Adco-Ipratropium 0.5mg/2ml Neb
Asthavent Inh, Venteze Inh
Venteze 2mg Tab
Bronchospasm Venteze 4mg Tab
B2 agonists Salbutamol Asthavent Syr, Venteze Syr
Ventolin 2.5mg/2.5ml Neb
Ventolin 5mg/2.5ml Neb
Venteze Resp Solution
Norstan-Ted 100mg Tab
Methylxanthines Aminophylline
Norstan-Ted 200mg Tab
2122
Category Therapeutic Description Active Ingredient Example of product name
Sandoz Theophylline 200mg Tab
Bronchospasm Theophylline Sandoz Theophylline 300mg Tab
Methylxanthines (continued)
(continued) Alcophyllin Syr
Theophylline + Etofylline Theophen Elixir
Coagulation
Haemostatics Tranexamic Acid Tranic Tab
disorders
Drinasal 0.025% Drops, Zadin Paed 0.025% Drops, Drinasal 0.025% Nasal Spray
Oxymetazoline Zadin Adult 0.05% Drops, Drixine 0.05% Nasal Spray
Decongestant- Nasal Iliadin 0.1% Drops
Phenylephrine Naphensyl Drops, Naphensyl Paed Drops
Phenylephrine + Naphazoline Nasdro Drops, Sinus S Drops
Adco-Sufedrin Tab, Sudafed Sinus Tab
Pseudoephedrine
Decongestants - Oral Sinumed Syr
Colds and sinus Triprolidine + Pseudoephedrine + Vit C Coryx Paed Syr
Chlorphen + Ephedrine +Paracetamol + Caffeine Colcleer Tab, Sinuend Tab
Chlorphen + Phenyleph +Paracetamol + Caffeine Colcleer Paed Syr
Decongestants, analgesic DM + Phenylpropanolamine + Paracetamol Flustat Syr
combinations Phenyleph + Chlorphen + DM +Paracetamol Kiddyflu Syr
Pseudoephedrine + Paracetamol Sinugesic Tab
Pseudoephedrine + Paracetamol Sinumax Paed Syr
Saline nasal agents Saline Just Saline Nasal Spray, Simply Saline Nasal Spray
Levonorgestrel Hy-an Tab, Microval Tab
Hormonal-progesterone Medroxyprogesterone Depo Provera Inj, Petogen Fresenius Inj
General Practitioner Provider Manual / 2019
Norethisterone Nur-isterate Inj
Ethinyl Oestradiol + Cyproterone Diva Tab
Contraception
Ethinyl Oestradiol + Desogestrel Marvelon Tab
Hormonal- oestrogen and
Ethinyl Oestradiol + Gestodene Minulette Tab
progesterone combination
Ethinyl Oestradiol + Levonorgestrel Biphasil Tab, Levette Tab, Logynon ED Tab,
Ethinyl Oestradiol + Norgestrel Famynor Tab, Ovral Tab
Aminophylline + Diphenhyd +AmCl Lotussin Expectorant
Bromhexine + Orciprenaline Adco-Linctopent Syr, Duro-Tuss Syr
Coughs Antitussives and expectorants
Cocillana + Terpin Hydr Cocillana Compound Syr
Codeine Phosphate Syr Codeine PhosCategory Therapeutic Description Active Ingredient Example of product name
Dextromethorphan (DM) + AmCl Broncol Syr, Histador Linct
Diphenhyd + AmCl + Sod Citrate + Menth Allergin Expectorant, Clear Cough Syr, Phenorant Syr, Famtuss Syr
Ephedrine + DM + AmCl Linctodyl Syr
Ephedrine + Promethazine + Cod Brunacod Syr, Dequa-Coff Syr
Ephedrine + Pyrilamine + Pholcod Acugest Syr, Docsed Syr
Benylin wet cough Syr, Broncholin Expect Syr, LCC G Guaiphenesin Cough
Antitussives and expectorants Guaifenesin
Coughs (continued) Remedy Syr, Flutex Cough Mixture
(continued)
Ipecac + Squill + Tolu Linctus Tussi Infans Syr
Pseudoephedrine + Triprolidine Decofed Syr
Pseudoephedrine + Triprolidine + Cod Acugest Co Linctus, Fludactil Co Syr
Pseudoephedrine + Triprolidine + DM Acugest DM Adult Linctus
Theophylline + Etofylline + Diphenhyd + AmCl Alcophyllex Syr
Theophylline + Etofylline + Diphenylpyraline Theophen Co Elixir
Mucokleer Cap
Coughs and colds Mucolytics Carbocysteine Mucospect Paed Syr
Bronchette Syr, CoFlem Syr, Flemgo Syr
Trepiline 10mg Tab
Amitriptyline
Gulf amitryptyline 25mg Tab, Trepiline 25mg Tab
Depression Anti-depressants Austell-Citalopram 10mg Tab
Citalopram
Adco-Talomil 20mg Tab, Cilate 20mg Tab
Fluoxetine Deprozan Cap, Prolax Cap, Ranflocs Cap
Kaolin + Pectin Colopect Susp, Enterolyte Susp, Gastropect Susp
Kaolin + Pectin + Bism Carb Biskapect Susp
Anti-diarrhoeals
General Practitioner Provider Manual / 2019
Diarrhoea Cipla loperamide Tab, Norimode Tab
Loperamide
Adco Loperamide Syr, Gastron Syr
Electrolyte replacement NaCl + Na Bicarb + KCl + Dextrose Electropak Powder, Rehidrat Sachets
Al HCl + Mg Oxide + Dicyclomine Alumag D Susp
Antacids
Al Hydrox + Mg Trisilicate Mayogel Susp
Al Hydrox + Mg Oxide + Dicycl + Dimeth Medigel Susp
Dyspepsia, Antacids + Antispasmodics
Al Hydrox + Mg Oxide + Dicyclomine Amgel Susp, Neutragel D Susp
heartburn, gastric
& peptic ulcers Acidown 200mg Tab, Bio-cimetidine 200mg Tab
Cimetidine
Bio-Cimetidine 400mg Tab, Lenamet 400mg Tab
H2 receptor antagonists
Gulf-ranitidine 150mg Tab, Ranit 150mg Tab
Ranitidine
CPL Alliance-ranitidine 300mg Tab, Ranit 300mg Tab
2324
Category Therapeutic Description Active Ingredient Example of product name
Altosec 10mg Cap, Rapacid 10mg Cap
Omeprazole
Adco-omeprazole 20mg Cap, Probitor 20mg Cap
Dyspepsia,
heartburn, gastric Lancap 15mg Cap, Burnloc 15mg Cap
Proton pump inhibitors (PPIs) Lansoprazole
& peptic ulcers Adco roznal 30mg Cap, Lancap 30mg Cap, Lansoprazole Unicorn 30mg Cap
(continued)
Mylan Pantoprazole 20mg Tab, Peploc 20mg Tab, Prazoloc 20mg Tab
Pantoprazole
Mylan-Pantoprazole 40mg Tab, Pantocid 40mg Tab, Prazoloc 40mg Tab
Phenazone Otophen Ear Drops
Ear infections Anti-infectives Benzocaine + Phenazone Otised Ear Drops
Neomycin + Sodium Propionate Neopan Ear Drops
Dipyrone + Scopolamine + Butylbromide Buscopan Co Tab
Gastric Mebeverine Bevispas Tab, Mylan mebeverine Tab
Antispasmodics
antispasmodics Hyospasmol Tab, Scopex Tab
Scopolamine + Butylbromide
Hyospasmol Syr, Scopex Syr
Austell Allopurinol 100mg Tab
Allopurinol
Gout Anti-gout Lonol 300mg Tab, Sandoz allopurinol 300mg Tab
Colchicine Aspen Colchicine 0.5mg Tab
Bismuth + Resorcinol + Zinc + Balsam + Boric acid Anusol Supp
Bismuth + Resorcinol + Zinc + Balsam Anusol Oint
Haemorrhoids Suppositories and anal oint
Prednisolone + Cinchocaine Scheriproct Supp
Prednisolone + Cinchocaine Scheriproct Oint
Fucidin Cream
Fusidic Acid
Fucidin Oint
General Practitioner Provider Manual / 2019
Anti-bacterial antiseptic Iodoquinol + Chlorobutanol + Benzocaine Viodor Cream
agents Bactroban Topical Cream
Mupirocin
Banogon Topical Oint, Nuban Oint
Povidone + Iodine Septadine Oint, Germadine Oint
Infections
Vercef 375 mg Tab
Cefaclor
Vercef 375mg/ 5ml Susp
Belex 250mg Tab, CPL Alliance Cephalexin 250mg Cap
Antibiotics - Cephalosporins
Belex 500mg Cap, CPL Alliance 500mg Cap
Cephalexin
Ranceph 125mg/5ml Susp
Ranceph 250mg/5ml SuspCategory Therapeutic Description Active Ingredient Example of product name
Chlorphen Cap
Antibiotics - Chloramphenicol Chloramphenicol
Chlorcol Susp
Clamelle 250mg Tab, Varimax 250mg Cap
Azithromycin
Azero 500mg Tab
Klaribin 250mg Tab
Klarithran 500mg MR Tab, Mylan Clarithromycin 500mg Tab
Clarithromycin
Antibiotics - Erythromycin and Claren 125mg/5ml Susp
other macrolides Claren 250mg/ml Susp, Klarithran 250mg/5ml Susp
Adco erythromycin 250mg Cap
Erythromycin Estolate Betamycin 125mg/5ml Susp, Erymycin P Syr
Purmycin 250mg/5ml Susp, Xeramel 250/5ml Susp
Erythromycin Stearate Eryko Tab, Merck Erythromycin Tab
Antibiotics - Other agents Clindamycin Clindahexal Cap
Austell Amoxicillin 250mg Cap, Ipcamox 250mg Cap
Allmox 500mg Cap, Austell Amoxicillin 500mg Cap
Amoxicillin
Allmox S 125mg/5ml Susp, Promoxil 125mg/5ml Susp
Infections Amyn SF 250mg/5ml Susp, Promoxil 250mg/5ml Susp
(continued) Macropen Susp
Antibiotics - Penicillins Amoxicillin + Floxacillin
Macropen Cap
Austell Co Amoxiclav 375mg Tab, Clamentin 375mg Tab
Austell Co Amoxiclav 625mg Tab, Auro Amoxiclav 625mg Tab
Amoxicillin + K Clavulanate
Austell Amoxiclav 1000mg Tab, Curam 1000mg Tab
Austell Amoxiclav 1000mg Tab, Curam 1000mg Tab
Amoclan 125mg/31.25mg /5ml Susp, Augmaxcil S 125mg/31.25mg/5ml Susp,
General Practitioner Provider Manual / 2019
Sandoz Amoxiclav S 125mg/5ml Susp
Amoxicillin + K Clavulanate (continued) Amoclan SF 250mg/62.5mg /5ml Susp, Sandoz Co Amoclav SF
250mg/62.5/5ml Susp
Antibiotics - Penicillins Sandoz Co Amoclav BD 400mg/57mg/5ml Susp
(continued) Cloxin 250mg Cap
Cloxacillin
Cloxin 500mg Cap
Betapen Tab
Penicillin V Potassium
Athlone Phenoxymethylpenicillin Syr, Betapen Syr
Biotech Ciprofloxacin 250mg Tab, Ciprogen 250mg Tab
Antibiotics - Quinolones Ciprofloxacin Austell Ciprofloxacin 500mg Tab, Cifran 500mg Tab, Flopro 500mg Tab
Austell Ciproflox 750mg Tab, Biotech Ciprofloxacin 750mg Tab
2526
Category Therapeutic Description Active Ingredient Example of product name
Cozole 400/80mg Tab, Ilvitrim 400/80mg Tab
Antibiotics - Sulphonamides &
Sulphamethoxazole + Trimethoprim Durobac DS 800/160mg Tab, Sandoz Co-Trimoxazole 800/160mg Tab
combinations
Cotrim Susp, Doctrim Susp
Dumoxin 50mg Cap
Doxycycline
Antibiotics - Tetracyclines Doxycyl 100mg Cap, Doxytet 100mg Cap
Oxytetracycline Nucotet Cap, Pharmatet Cap
Aricon 50mg Cap
Auro Fluconazole 150mg Cap, Gulf fluconazole 150mg Cap
Fluconazole
Diflucan 50mg/5ml Susp
Antifungal agents Diflucan 200mg/5ml Susp
Microcidal 125mg Tab
Griseofulvin
Microcidal 500mg Tab
Nystatin Candacide Susp, Canstat Susp
Infections Clotrimazole Canex Topical Cream, Gynezol Cream, Innospore Cream
(continued) Ketoconazole Ketazol Cream
Antifungal agents- Topical
Canstat Cream
Nystatin
Nystacid Oint
Anaerobyl 200mg Tab, Metazol 200mg Tab
Anaerobic and antiprotozoal
Metronidazole Amzole 400mg Tab, Suprazole 400mg Tab
agents
Flagyl Susp
Acyclovir Biotech 200mg Tab, Acyclovir Sandoz 200mg Tab, Lovire 200mg Disp Tab
Acyclovir Biotech 400mg Tab, Lovire 400 Disp Tab
Anti-viral agents - Oral Acyclovir
Zovirax Susp
General Practitioner Provider Manual / 2019
Adco acyclovir Cream, Beta Vira Cream
Corticosteroids with anti-
Iodoquinol + Hydrocortisone Viocort Cream
infective agents
Clindamycin Dalacin Vaginal Cream
Vaginal preparations
Clotrimazole A-Por Vag Cream, Canex Vag Cream, Gynezol Vag Cream, Fungispor Vag Cream
Ibucine 200mg Tab, Ibunate 200mg Tab
Ibuprofen Bren 400mg Tab, Betaprofen fc 400mg Tab, Ranfen 400mg Tab
Non-Steroidal Anti- Ibugesic Susp, Influmax Paed Susp
Inflammation
inflammatories (NSAIDs) Meloxicam Apex meloxicam 7.5mg Tab, Medoxicam 7.5mg Tab
Mylan naproxen 250mg Tab, Naproscript 250mg Tab
Naproxen
Bio naproxen 500mg Tab, Napflam 500mg TabYou can also read
