Dentistry
Dentistry is the evaluation, diagnosis, prevention and treatment of diseases, disorders and conditions of the mouth, maxillofacial area and the adjoining and related structures and their impact on the human body.
Cover for dentistry is dependent on your chosen health plan. For more details choose your plan type below:
Executive Plan
- Dentistry is limited to R30 500 for each person each year for both in-hospital and out-of-hospital dentistry
- We pay the hospital account from your Hospital Benefit and your related accounts, for example anaesthetist and dentist, from your Medical Savings Account and Above Threshold Benefit, subject to available funds, and your available dentistry limit. All accounts (including the full hospital account and related accounts) add up to the dentistry limit, including claims paid by you before reaching the Annual Threshold.
- We pay dentistry done out-of-hospital from your Medical Savings Account or Above Threshold Benefit, subject to available funds, and your available dentistry limit.
- If you need orthognathic surgery performed as part of orthodontic treatment, we pay the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. We pay your related accounts, for example dentist, anaesthetist from your Medical Savings Account or Above Threshold Benefit and add up these claims towards your dentistry limit.
Comprehensive Series
Cover for dental treatment in hospital
You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies depending on your age and the place of treatment.
| Hospital | Day clinic | |
|---|---|---|
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
We pay the balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate.
We pay the related accounts, which include the dental surgeon accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
No overall dental limit
There is no overall limit for dental treatment. However, all dental appliances and orthodontic treatments (including the related accounts for orthognathic surgery) are paid at 100% of the Discovery Health Rate from your day-to-day benefits, up to an annual sub-limit of R17 400 a person. If you join the medical scheme after January, you won't get the full dental appliance limit because it is calculated by counting the remaining months in the year.
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limits. This benefit is subject to authorisation and the Scheme’s rules and guidelines.
Priority Series
Cover for dental treatment in hospital
You need to pay a portion (deductible) of your hospital or day clinic account upfront for dental admissions. This amount varies depending on the member’s age and the place of treatment.
| Hospital | Day clinic | |
|---|---|---|
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
We pay the balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate.
We pay the related accounts, which include the dental surgeon accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
No overall dental limit
There is no overall limit for dental treatment. However, all dental appliances and orthodontic treatments (including the related accounts for orthognathic surgery) are paid up to 100% of the Discovery Health Rate from your day-to-day benefits, up to an annual sub-limit of R10 850 a person. If you join the medical scheme after January, you won't get the full dental appliance limit because it is calculated by counting the remaining months in the year.
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures with no upfront payment and no overall limits. This benefit is subject to authorisation and the Scheme’s rules and guidelines.
Saver Series
Cover for dental treatment in hospital
You need to pay a portion (deductible) of your hospital or day clinic account upfront for dental admissions. This amount varies depending on the member’s age and the place of treatment.
| Hospital | Day clinic | |
|---|---|---|
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
We pay the balance of the hospital account from your Hospital Benefit up to 100% of the Discovery Health Rate.
We pay the related accounts, which include the dental surgeon accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
No overall dental limit
- There is no overall limit for dental treatment. We pay for all dental appliances,their placement and orthodontic treatment (including the related accounts for orthognathic surgery) from your Medical Savings Account up to 100% of the Discovery Health Rate from your Medical Savings Account, as long as you have money available.
Severe dental and oral surgery
- The Severe Dental and Oral Surgery Benefit covers a defined list of procedures with no upfront payments and no overall limits. This benefit is subject to authorisation and the Scheme’s rules and guidelines.
Core Series
Cover for dental treatment in hospital
You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment:
| Hospital | Day clinic | |
|---|---|---|
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
We pay the balance of the hospital account from your Hospital Benefit up to 100% of the Discovery Health Rate.
We pay the related accounts, which include the dental surgeon account, from the Hospital Benefit up to 100% of the Discovery Health Rate.
Dental appliances and orthodontic treatment
You are responsible for paying the costs of all dental appliances, their placement and orthodontic treatment (including the related accounts for orthognathic surgery).
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures with no upfront payments and no overall limits. This benefit is subject to authorization and the Scheme’s rules and guidelines.
KeyCare Series
- In-hospital dentistry is not covered on the KeyCare Plans
- Approved, defined major maxillo-facial surgery for both the KeyCare Core and Plus Plans is paid from Hospital Benefit.
KeyCare Plus Plan only
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Out-of-hospital dentistry: we cover consultations, fillings and tooth removal at a dentist in the KeyCare dentist network.
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The KeyCare Core Plan does not cover dentistry.
