About PPN and Our Offers
PPN continuously redesign and add to our optical benefit package. All prescription spectacle lenses have some form of UV filter, so the beneficiaries who require corrective spectacles are receiving protection.
The Optical Benefit Design requirements are subject to numerous factors which are negotiated with the Medical Scheme per option and then applied according to a Schemes election and budget. Importantly, at PPN our focus is quality service and products for medical aid members and eliminating waste and abuse through fraud prevention initiatives.
The benefit is designed to make members visually efficient without having to make a co-payment at a network provider. However this does not mean members cannot elect to top up their benefit. Members are not restricted in network to the product negotiated. They always have a choice to top-up their basic optical benefit. Members can discuss this during dispensing with the optometrist.
PPN has a variety of products available for Medical Schemes. All options are offered to Schemes and they elect to include additional options to further enhance their optical benefit per option. These options include Ready-Made Readers for members over the age of 40, Fundus Photography for Diabetic members or to detect early pathology, PMB management and participation in other Artificial Intelligence initiatives.
Included in most of the PPN benefit designs are a Second Benefit Warranty option for members who unfortunately become victim to theft, breakage or the loss of spectacles within their normal two year optical benefit period.
2021 BASIC OPTICAL BENEFIT DESIGN EXAMPLE
Each beneficiary within a two year cycle is entitled to:
Composite Consultation inclusive of a Refraction, Tonometry and Visual Field (AI)
Either Spectacles or Contact Lenses
EITHER 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
PPN CONTRACTED MEDICAL AIDS AND COST
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 per life per month cost over a 24 month benefit cycle as an INSURED optical benefit.
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 sub-limits from savings or day to day limits.
ARTIFICIAL INTELLIGENCE (AI)
PPN network providers are part of a Proof of Concept initiative. This AI has been described as the "gold standard" screening tool by a leading South African Ophthalmologist. After researching and testing several AI applications, the application PPN selected is the most effective AI for Diabetic Retinopathy (least amount of false positives) and its currently developing screening for Glaucoma and AMD.
PPN has also invested in a Laboratory Lens monitoring platform to help us and the industry address fraudulent claiming. The Laboratory Lens monitoring platform (Authenticate IT) is available to verify that bifocal and multifocal lenses on the invoice are the lenses that are the lenses ordered from the laboratory.
PPN Network providers 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. (The same product at a better negotiated rate)
Tariffs are up to 75% lower compared to the Optical Assistant (OA) pricing charged by NON PPN Providers for certain lens prescriptions:
|PPN LENS TARIFF VS OA COMPARISON||2020||2021|
|PPN1||OA||PPN1 vs OA||PPN1||OA||PPN1 vs OA|
|STANDARD SINGLE VISION PER LENS|
|GLASS||R 185.00||R 332.00||R 147.00||44%||R 210.00||R 344.00||R 134.00||39%|
|HIGHER GLASS||R 185.00||R 805.00||R620.00||77%||R 210.00||R 833.00||R 623.00||75%|
|CR39||R 185.00||R 331.00||R 146.00||44%||R 210.00||R 343.00||R 133.00||39%|
|HIGHER CR39||R 185.00||R 707.00||R 522.00||74%||R 210.00||R 732.00||R 522.00||71%|
|STANDARD BIFOCAL PER LENS|
|GLASS||R 420.00||R 963.00||R 543.00||56%||R 445.00||R 997.00||R 552.00||55%|
|CR39||R 420.00||R 748.00||R 328.00||44%||R 445.00||R774.00||R 329.00||43%|
|STANDARD MULTIFOCAL PER LENS|
|GLASS||R 745.00||R1504.00||R 759.00||50%||R 770.00||R1557.00||R 787.00||51%|
|CR39||R745.00||R1296.00||R 551.00||43%||R 770.00||R1401.00||R 631.00||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.
DIGITAL RECORD CARD
PPN has developed a 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
• 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.
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 041 506 5900 or using the form below.