About PPN and Our Offers
Optical Benefit Design, Sunglass Paradigm, ReadyMade Readers Benefit, Lens Savings, Fundus Photography, Biometrics, Second Benefit Warranty, Fraud Prevention and Authenticate It
PPN has redesigned our optical benefit in line with International thinking for the need for UV protection. All our Prescription spectacle lenses have some form of UV filter, so the beneficiaries who require corrective spectacles are receiving protection. However this leaves the balance of beneficiaries with no protection.
In other countries it is now compulsory for all school children to wear sun hats and sunglasses for protection.
Through negotiation with the retail suppliers of quality Sunglasses, we have been able to affordably include a sunglass benefit into our design.
The sunglass benefit is intended only as an alternative to prescription spectacles; i.e. beneficiaries can either utilize their prescription spectacles benefit or the sunglass benefit, but not both.
The intended sunglass benefit varies between R 750 to R 1400 where these amounts can be used to cover up to 50% of any quality sunglass.
It is a widely held opinion, that exposure to UV causes early cataract. Cataract surgery is now a top ten procedure for most medical aids to cope with.
At PPN can assist schemes and their beneficiaries in dealing with this problem, because PPN can include a Sunglass benefit for your Schemes.
2019 Basic Optical Benefit Design Example
Each beneficiary is entitled to:
One Composite Consultation inclusive of a Refraction, Tonometry and Visual Field
Either Spectacles or Contact Lenses
A frame/lens enhancement benefit to an agreed value and one pair of clear standard/basic Single Vision or Bifocal or Multifocal lenses OR contact lenses
(Ready Made Readers are optional and part of the Spectacle lens benefit design.)
Alternative to Optical Benefit
A Sunglasses benefit of 50% of the retail cost of any sunglasses up to a contribution of R750
within their 24 month benefit cycle
PPN Contracted Medical Aids & Cost
RISK : PPN will provide a cost per life per month quotation for any scheme interested in our offering. The quotation is subject to the scheme providing PPN with statistical data to enable us to accurately determine the capitation cost.
ADMINISTRATION : PPN can provide an administration fee per month for any scheme interested in our offering. PPN takes full responsibility for service levels. The quotation is subject to PPN making payment to network providers and applying rules to an agreed benefit design or sublimits from savings or day to day limits.
Sunglass Cost to Scheme
We have been able to affordably include the sunglass benefit into our design, for schemes who would like to offer it to their beneficiaries PPN will include the cost in the capitation proposal to the scheme.
ReadyMade Readers Benefit
We have been able to affordably include a ReadyMade Readers benefit into our design, for schemes who would like to offer it to their beneficiaries PPN will include the cost in the capitation proposal to the scheme.
PPN optometrists have contracted to charge cost effective rates for clear standard/basic lenses in return for better professional fees, this has resulted in cost effective pricing with no compromise of professional standards or quality of product.
Other Initiatives/Authenticate It
PPN has also invested in Biometrics and a Laboratory Lens monitoring platform to help us and the industry address fraudulent claiming. Biometrics will be used to ensure no card swopping happens and also for members to access their digital record card. The Laboratory Lens monitoring platform (Authenticate IT) is available to verify that the multifocal lenses on the invoice is the lenses that are ordered from the laboratory. With this initiative we also negotiate up to 40% discount from laboratories.
Tariffs are up to 77% lower compared to the Optical Assistant (OA) pricing charged by NON PPN providers for certain lens prescriptions:
|PPN LENS TARIFF VS OA COMPARISON||2018||2019|
|PPN1||OA||PPN1 vs OA||PPN1||OA||PPN1 vs OA|
|STANDARD SINGLE VISION PER LENS|
|GLASS||R 175.00||R 300.00||R 125.00||42%||R 175.00||R 318.00||R 143.00||45%|
|HIGHER GLASS||R 175.00||R 727.00||R 552.00||76%||R 175.00||R 770.00||R 595.00||77%|
|CR39||R 175.00||R 299.00||R 124.00||41%||R 175.00||R 317.00||R 142.00||45%|
|HIGHER CR39||R 175.00||R 639.00||R 464.00||73%||R 175.00||R 677.00||R 502.00||74%|
|STANDARD BIFOCAL PER LENS|
|GLASS||R 380.00||R 870.00||R 490.00||56%||R 410.00||R 922.00||R 512.00||56%|
|CR39||R 380.00||R 676.00||R 296.00||44%||R 410.00||R716.00||R 306.00||43%|
|STANDARD MULTIFOCAL PER LENS|
|GLASS||R 695.00||R1370.00||R 675.00||49%||R 710.00||R1439.00||R 729.00||51%|
|CR39||R 695.00||R1223.00||R 528.00||43%||R 710.00||R1296.00||R 586.00||45%|
We promote the clinical significance of Fundus Photography to all our medical schemes. Payment by the Scheme is subject to the online PPN ophthalmologist providing an opinion and the confirmation of positive pathology.
PPN has developed a Biometric Digital record card that, with the consent of the medical aid member, 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 will report the information to PPN and we will investigate the details previously provided.
Should the fingerprint not correspond with a previous fingerprint recorded on the system then the PPN system will flag such a member to our forensic department to ensure no card swopping has occurred. All fraudulent activities will be reported to the scheme.
Second Benefit Warranty
PPN has negotiated a second benefit for members who lost, damage or have broken their spectacles within their benefit cycle. The benefit entails a PPN frame and one pair of spectacle lenses based on the last script provided by the practice on the PPN system. Medical aids that would like to include this option should discuss this with the PPN management team. Terms & Conditions applicable.
PPN is constantly improving the filters in our system to improve the clinical management of claims submitted and the identification of fraudulent claiming.
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If you would like more information about PPN and our offerings or would like to arrange a meeting, please contact our management team on firstname.lastname@example.org