Terms and Conditions

Preferred Provider Negotiators “PPN” grants to the Member and the “Dependants/Proxy” signed up by the Member the rights to use the PPN Website online “www.ppn.co.za” services and the related software subject to the following terms and conditions. PPN hereby grants the User a non‐exclusive, non‐ transferable, and perpetual licence entitling the User to use the software for the User’s own personal purposes.

LICENCE

  • PPN retains ownership of all intellectual property rights in and to the software as well as any copy thereof.
  • The Member and its Dependants/Proxy will always keep related documents, submissions of transactions in strict confidence and will not remove or destroy any proprietary markings of PPN Website.
  • The terms and conditions will commence on the date of interaction on the platform
  • Termination of any Users/Dependants/Proxy on the membership of the Member rests on the Member to inform PPN/The Scheme in writing to either close or remove a User/Representative.

OBLIGATIONS OF PPN WEBSITE

  • To transfer all transactions and related information and documents of the Member to PPN.
  • Validate such transactions to the best ability of the system to ensure accuracy and expedite the transaction.
  • Store the transactions and related information in electronic format and provide a reference number for transactions actioned on the system.
  • On request from the Member provide an audit trail of each transaction for a 12 (twelve) month period.
  • Display/Distribute a copy of electronic responses and eRAs from the PPN Website system.
  • PPN for the duration of the relationship with the Medical Scheme and its beneficiaries maintain the PPN Website system and comprise testing of the system continuously when adjustments are necessitated, or new developments are rolled out in terms of the specifications

SUPPORT

  • PPN will give support where queries are logged on the PPN Website system or telephonic problems are logged in the call centre environment.
  • PPN will respond within a reasonable time to all queries.
  • PPN will communicate all upgrades to the system prior to changes.
  • Changes will not go live during 08:00 and 17:00 from Mondays to Fridays and 08:00 and 12:00 on Saturdays.
  • PPN warrants that PPN Website will perform substantially in accordance with its published specifications.

LIABILITY

  • PPN shall not be liable in respect of any incorrect information entered by Users/Dependants/Proxy of the Member.
  • PPN shall not be liable for any incorrect information provided by clients displaying on the online system and scheme rules will always be applicable.
  • PPN shall not be liable for any loss or damage or any loss of profit suffered in connection with the use of or reliance of incorrect data provided by the Users/Dependants/Proxy of the Member.

OBLIGATIONS

The Member:

  • shall always follow up on claims using the online interface.
  • shall report any irregularities or anomalies on the online system.
  • is required to at its own cost maintain the interfaces required to interface with PPN Website.
  • is required to define its own personal data and keep it confidential by providing access to only authorised Dependants/Proxy.
  • guarantees that the data which it submits are always accurate, within the rules of the Medical Schemes Act and does not encroach upon the protection of personal information of members of medical schemes.
  • will supply supporting documents for electronic submissions within 48 hours of the request logged with the Member
  • Except as expressly permitted in this Agreement, the User shall not:
    1. - sell, rent, lease, sub‐license or lend the Software.
      - redistributes the Software.
      - reverse engineer, decompile or disassemble the Software; or
      - wilfully removes or obscure any PPN patent, copyright, trademark, brand name or proprietary rights notices contained in or affixed to the Software

The PPN website and online system:

  • will provide a membership and benefit checker.
  • allow members to submit claims via the interface and allow for fields to capture all relevant required data.
  • allow members the ability to load a query to correct, reverse or update any claims information once rejected and intervention is required.
  • allow the Member access to their remittance advices electronically.
  • allow Members to submit any outstanding information using the query interface.
  • provide access to clinical and management care initiatives to administer the optical health record for such a member via the Biometrics platform.
  • maintain tariffs and medical aid benefits and provide rejections reasons to the members to remain informed of the status of their claim.
  • ensure that the most recent updates are communicated using the PPN platforms.
  • inform Members via instant notifications of any urgent updates or information relevant as a banner on the website.
  • will share all required documentation the Member may require for reconciliations or conclude queries

SERVICE FEE

The use off the PPN Website online system is FREE.

Value Added Tax shall always be added to the service fees indicated.

Any queries resulting in action required by PPN to correct the system will be done FREE.

PROTECTION OF INFORMATION:

Personal information submitted, processed, and recorded will be protected in accordance with Protection of Personal Information Act

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