Dental Treatment

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment (deductible) and no overall limit. This benefit is subject to authorisation and the Scheme's rules.

You must preauthorise your admission to hospital

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

• We cover you in full at private hospitals and day clinics in the Delta Hospital Network
• For planned admissions at hospitals outside the network, you must pay an amount of R7 650 upfront to the hospital. This does not apply in an emergency

Other dental treatment in hospital

You need to pay part of your hospital or day-clinic account for dental admissions upfront (also called a deductible). This amount varies, depending on your age and the place of treatment. We pay:

• The balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate
• The related accounts, which include the dental surgeon’s account, from your Hospital Benefit, up to 100% of Discovery Health Rate
• Anaesthetists up to 200% of the Discovery Health Rate - on Classic plans

For members who are 13 years old or older, we cover routine conservative dentistry, such as preventive treatment, simple fillings and root canal treatment from your available day-to-day benefits.

Dental limit

There is no overall limit for basic dental treatment. Yet, we pay:

• All dental appliances and their placement as well as orthodontic treatment (including related accounts for orthognathic surgery) at 100% of the Discovery Health Rate
• Up to 200% of the Discovery Health Rate for anaesthetist on the Classic plans
• Claims from your day-to-day benefits, up to a yearly limit of R27 300 a person

If you join the Scheme after January, you will have a lower limit because we calculate the limit by counting the remaining months in the year.

We pay basic dental treatment done in the dentist’s rooms from your day-to-day benefits

We pay for basic dental treatment done in the dentist’s or dental specialist’s rooms at 100% of the Discovery Health Rate from the available money in your Medical Savings Account and from the Above Threshold Benefit once your claims add up to the Annual Threshold.

The Classic Comprehensive Zero MSA Plan does not have a Medical Savings Account, so there is no benefit for day-to-day medical expenses until you reach the Annual Threshold. After this, we pay claims from the Above Threshold Benefit.

If you have run out of money in your Medical Savings Account and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts. This is not a separate benefit; limits apply to claims paid from:

• Your Medical Savings Account
• Your own pocket (if you are in a Self-payment Gap)
• Your Above Threshold Benefit

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment (deductible) and no overall limit. This benefit is subject to authorisation and the Scheme's rules.

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

Other dental treatment in hospital

You need to pay part of your hospital or day-clinic account for dental admissions upfront (also called a deductible). This amount varies, depending on your age and the place of treatment. We pay:

• The balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate
• The related accounts, which include the dental surgeon's account, from your Hospital Benefit, up to 100% of the Discovery Health Rate
• Anaesthetists up to 200% of the Discovery Health Rate - on the Classic Plan

For members who are 13 years old or older, we cover routine conservative dentistry, such as preventive treatment, simple fillings and root canal treatment from your available day-to-day benefits.

Dental limit

There is no overall limit for basic dental treatment. Yet, we pay:

• All dental appliances and their placement as well as orthodontic treatment (including related accounts for orthognathic surgery) at 100% of the Discovery Health Rate
• Up to 200% of the Discovery Health Rate for anaesthetists - on the Classic Plan
• Claims from your day-to-day benefits, up to a yearly limit of R17 000 a person.

If you join the Scheme after January, you will have a lower limit because we calculate the limit by counting the remaining months in the year. The overall Above Threshold Benefit (ATB) limit applies.

We pay basic dental treatment done in the dentist’s rooms from your day-to-day benefits

We pay for basic dental treatment done in the dentist's or dental specialist's rooms at 100% of the Discovery Health Rate from the available money in your Medical Savings Account and from the limited Above Threshold Benefit once your claims add up to the Annual Threshold.

If you have run out of money in your Medical Savings Account and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts. This is not a separate benefit; limits apply to claims paid from:

• Your Medical Savings Account
• Your own pocket (if you are in a Self-payment Gap)
• Your Above Threshold Benefit.

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme's rules.

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

• We cover you in full at private hospitals and day clinics in the Delta Hospital Network
• For planned admissions at hospitals outside the network, you must pay an amount of R7 650 (also called a deductible) upfront to the hospital. This does not apply in an emergency

• You must go to a hospital in one of the four coastal provinces for a planned hospital admission
• If you don't use a coastal hospital, the Scheme will pay up to a maximum of 70% of the hospital account and you must pay the difference

Other dental treatment in hospital

You need to pay part of your hospital or day-clinic account for dental admissions upfront (also called a deductible). This amount varies, depending on your age and the place of treatment. We pay:

• The balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate
• The related accounts, which include the dental surgeon's account, from your Hospital Benefit, up to 100% Discovery Health Rate
• Anaesthetists up to 200% of the Discovery Health Rate - on Classic plans

For members who are 13 years old or older, we cover routine conservative dentistry, such as preventive treatment, simple fillings and root canal treatment from your available Medical Savings Account.

Dental limit

There is no overall limit for basic dental treatment. Yet, we pay all dental appliances and their placement as well as orthodontic treatment (including related accounts for orthognathic surgery) at 100% of the Discovery Health Rate from your Medical Savings Account. This is as long as you have money available.

We pay basic dental treatment done in the dentist's rooms from your day-to-day benefits

We pay for basic dental treatment done in the dentist's or dental specialist's rooms from the day-to-day benefits at 100% of the Discovery Health Rate. If you don't have money available in your Medical Savings Account, you must pay the dentist's and dental specialist's account from your pocket.

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment (deductible) and no overall limit. This benefit is subject to authorisation and the Scheme’s rules.

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

You are covered in full at private hospitals in the Smart Plan Hospital Network. For planned admissions at hospitals outside the network, you must pay an amount of R8 800 upfront (also called a deductible) to the hospital. This does not apply in an emergency.

Other dental treatment in hospital

You need to pay part of your hospital or day-clinic account for dental admissions upfront (also called a deductible). This amount varies, depending on your age and the place of treatment. We pay:

• The balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate
• The related accounts, which include the dental surgeon’s account, from your Hospital Benefit, up to 100% of Discovery Health Rate
• Anaesthetists up to 200% of the Discovery Health Rate

For members who are 13 years old or older, you must pay for routine conservative dentistry, such as preventive treatment, simple fillings and root canal treatment.

In-hospital dental treatment is not covered on the Essential Smart Plan.

Dental limit

There is no overall dental limit. Yet, you must pay the cost of all dental appliances and their placements as well as all orthodontic treatment (including the related accounts for orthognathic surgery).

We pay basic dental treatment done in the dentist’s rooms from your day-to-day benefits

Smart Plan members have cover for one defined dental check-up for each member each year at any dentist or dental therapist. This check-up covers you for:

• A consultation
• Two bitewing X-rays
• Scale and polish
• Fluoride.

You need to pay a fee of R100 on the Classic Smart Plan and R150 on the Essential Smart Plan and we pay the balance of this fee up to the Discovery Health Rate.

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment (deductible) and no overall limit. This benefit is subject to authorisation and the Scheme’s rules.

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

• You are covered in full at private hospitals and day clinics in the Delta Hospital Network
• For planned admissions at hospitals outside the network, you must pay an amount of R7 650 upfront (also called a deductible) to the hospital. This does not apply in an emergency

• You must go to a hospital in one of the four coastal provinces for a planned hospital admission
• If you don't use a coastal hospital, the Scheme will pay up to a maximum of 70% of the hospital account and you must pay the difference

Other dental treatment in hospital

You need to pay part of your hospital or day-clinic account for dental admissions upfront (also called a deductible). This amount varies, depending on your age and the place of treatment. We pay:

• The balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate
• The related accounts, which include the dental surgeon's account, from your Hospital Benefit, up to 100% of Discovery Health Rate

Anaesthetists up to 200% of the Discovery Health Rate - on Classic plans

Dental limit

You are responsible for paying the cost of all dental appliances and their placements as well as orthodontic treatment (including the related accounts for orthognathic surgery).

Basic dental treatment done in the dentist's rooms

Core plans do not cover out-of-hospital day-to-day costs so you must pay these costs from your pocket.

Severe Dental and Oral Surgery Benefit

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment (deductible) and no overall limit. This benefit is subject to authorisation and the Scheme’s rules.

• At least 48 hours before you go in
• Please call 0860 99 88 77 or send an email to preauthorisation@discovery.co.za

For planned hospital admissions:

• You have full cover for the hospital account in the Full Cover Hospital Network
• You have cover for up to 70% of the Discovery Health Rate in the Partial Cover Hospital Network
• If you use a hospital outside the network, you will have to pay these costs from your pocket.

For planned hospital admissions, you are covered in full at your chosen KeyCare Start Network hospital. If you use a hospital outside the network, you will have to pay these costs from your pocket.

Other dental treatment in hospital

We do not cover in-hospital dental treatment on KeyCare plans.

Dental limit

You are responsible for paying the cost of all dental appliances and their placements as well as orthodontic treatment (including the related accounts for orthognathic surgery).

Basic dental treatment done in the dentist’s rooms

We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply.

Important information you need to know

Dental Benefit Guide