As per discussion with 3Sixty (administrator of Sizwe including the Sizwe Essential Copper Option):
• The Essential Copper Option (ex Gomomo Option) is no longer administered by Enablemed.
• Beneficiaries on this option need to select a primary GP, but Sizwe is still busy with this process. In due course patient lists will be sent to each GP
• A network contract needs to be signed by the GP, agreeing to the rules and peer review. Peer review protocols and processes are still being worked on by the administrator of Sizwe.
• GP’s to bill fee for service whenever these patients are seen at the practice; no preauthorisation is required for GP visits; all conditions are covered including PMB’s in respect of GP’s
• Hospital cover is for PMB’s and requires preauthorisation. Same applies to specialist referrals.
ECIPA Healthcare 