Medicinal Cannabis Benefits – Effective November 2020, benefits payable as of 9th September 2020
Medicinal Cannabis has now been approved for benefits under a members Pharmacy cover. Benefits are paid as per the usual Pharmacy claim process but with new item and provider number (item PCANN, provider CANNABIS).
In the instance where one of the following Medicinal Cannabis items is billed, a further $25.00 is also payable, due to an agreement between HIF and the supplier, Little Green Pharma. This will be paid using a separate item number (item MCANN).
The items supplied by LGP and entitled to a further $25.00 benefit are:
LGP Classic 10:10
LGP Classic 20:5
LGP Classic 1:20
LGP Classic CBD50
LGP Classic 1:100
It is also important to note that some members using products from LGP may be included in the Quest research project, which means they will be billed only $150.00 for the item. Any service listed above that is billed at $150.00 is NOT entitled to the further $25.00 benefit, as the research project already provides a significant discount on the overall cost of the product.
How to claim for medicinal cannabis?
You can submit your claim for medicinal cannabis through the app, email or post. (pharmacy is not accepted through OMC).
What is required to claim?
A copy of the official pharmacy receipt will be required in order for HIF to assess your claim. This must be accompanied by a copy of your SAS and MAP approval forms.
Any claim for Medicinal Cannabis where one of the above items is listed in the pharmacy invoice should be referred to a Claims Team Leader to be processed.
Claims Team Leader Note (not to be done by any other person)
To process the applicable benefits for the above LGP items, please follow the below steps:
Assess the Medicinal Cannabis pharmacy claim using item PCANN and provider CANNABIS
Add a second line to the claim using provider CANNABIS and item MCANN, using the same date of service as the initial pharmacy line and a charge of $25.00.
Assess the MCANN line – a benefit of $25.00 will pay. This benefit does not come out of the members Pharmacy limit.
Finalise the claim as normal.
Nothing further needs to be done.