ISO LESO OPTICS LTD (“ISO LESO”)
OPTION TO ELECT TO PARTICIPATE IN THE PARTICIPATING PROVIDER AGREEMENTS TO BE ENTERED INTO BETWEEN ISO LESO AND INDIVIDUAL OPTOMETRISTS IN RELATION TO MEMBERS OF DISCOVERY KEYCARE PLUS, LA KEYCARE PLUS AND QUANTUM KEY PLUS (“the contracts”)
1. The full versions of the abovementioned contracts shall be placed on the ISO LESO website as soon as they have been finalised.
2. The contract option form set forth below, which is to be used only if you decide to participate as a provider in the above contracts, must be returned to Iso Leso, Unit 16, Northcliff Office Park, 203 Beyers Naude Drive, Northcliff, 2195; Fax: 011 782 0207.
3. ISO LESO requires each optometrist who does wish to participate in the contracts, to return a signed contract option form.
4. Therefore, if you decide NOT to participate in the contracts, you need not return this contract option form.
To: Iso Leso
Unit 16 Northcliff Office Park
203 Beyers Naude Drive
Northcliff
2195
Fax: 011 782 0270
Please be advised that I DO wish to participate in the contracts referred to above, with effect from the date stated below, the salient terms and conditions of which contracts are attached to this option form and which I have read and accept.
______
Signature Print Name
______
Print Practice Name Practice Number
______
Date
20 December 2007
NOTICE
CAPITATION CONTRACT IN RELATION TO MEMBERS OF DISCOVERY KEYCARE PLUS, LA KEYCARE PLUS AND QUANTUM KEY PLUS
I refer to the contracts that Iso Leso has entered into with Discovery Health, LA Health and Quantum. The contracts are for the delivery of clinically appropriate eye care for the abovementioned members who belong to the Discovery KeyCare Plus, LA KeyCare Plus and Quantum Key Plus plans, in return for payment of an agreed fee. Please carefully study the salient features of the contracts below (as well as the detailed contracts that will be placed on the Iso Leso website) and thereafter complete and return the option form to elect to participate in the Participating Provider Agreement which is aligned to the Managed Health Care Contract (collectively, "the Contracts").
PARTIES TO THE AGREEMENT:
1.1 Discovery Health Medical Scheme, LA Health and Quantum
1.2 Iso Leso Optics Limited
1.3 Effective date: 1 January 2008
HIGHLIGHTS OF THE CONTRACTS
1. Eye care services means those optometric services and/or optical dispensing services and supplies which the participating optometrist is required to provide to beneficiaries in terms of his relevant benefit plan. The services relating to the contracts are as follows:
A. Beneficiaries who belong to one of the Discovery KeyCare Plus, LA KeyCare Plus or Quantum Key Plus options shall be entitled to
ONE OF
1.1 one consultation, and one pair of single vision lenses and a spectacle frame;
OR
1.2 one consultation, and one pair of flat top bifocal lenses and a spectacle frame;
OR
1.3 one consultation, and one pair of multifocal lenses and a spectacle frame:
OR
1.4 one consultation, and contact lenses to the total value of one
pair of single vision lenses.
B. Iso Leso shall pay the provider directly who rendered services to beneficiaries of the aforesaid plans, subject to the amount available to the beneficiary for optical benefits.
C. The following conditions shall apply to the services as herein provided:
1. Each beneficiary is entitled to one claim only during a two-year period, which entitlement commences either on 1 January 2008, or two years from the last date on which a beneficiary last used his optometric benefit, whichever date is the latest.
2. The optometric benefits shall be inclusive of a full vision examination and shall cover all visits by the beneficiary to the original provider for eye care during the benefit period.
3. The frame shall be a basic frame from a good quality standard range of frames and Iso Leso undertakes to ensure that each provider shall stock of frames in a range appropriate to the Bronze Vision benefit, which shall be any frame on display priced up to R250,00.
4. Where the beneficiary does not clinically require spectacles, the provider who conducted the vision examination shall be entitled to a consultation fee of R265,00.
5. There shall be no differentiation between glass and plastic lenses.
6. There shall be no differentiation between low and high powers.
7. Should the beneficiary choose a frame from outside the Bronze Vision Option a discount of R 150,00 shall apply to the frame dispensed. The balance shall be payable by the beneficiary to the provider.
8. The following coding structure and fees shall apply to services rendered to beneficiaries who belong to any of the aforementioned options:
BENEFIT REQUIRED / CODE / PRICEVision Examination
- If no spectacles are clinically required / 11001 / R 265.00
Vision Examination, Single Vision Lenses and Frame / 93200 / R 500.00
Vision Examination, Bifocal Lenses and Frame / 93300 / R 800.00
Vision Examination, Multifocal Lenses and Frame / 93500 / R 1 000.00
Vision Examination and Contact Lenses / 93800 / R 500.00
9. Iso Leso reserves the right to amend the coding structure and fees as set out above, if this is deemed necessary in its sole and absolute discretion and by giving proper notice thereof to participating optometrists.
Yours sincerely
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ZENA JACOBSON
CEO, Iso Leso Optics Ltd
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