What You Ought to Know About Medical Aid and Dentistry

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Do all medical aid schemes offer dental benefits, and if so, what is really covered?

For background and easier understanding, I would like to split dental benefits into 2 parts :

In-Hospital and Out-of-Hospital

The first would be for dental procedures performed in hospital, i.e. removal of impacted wisdom teeth and extensive dental treatments under general anaesthetic.

The second is for your day-to-day basic dental visits, fillings and extractions, as well as advanced dentistry such as orthodontic and root canal treatment. 

Schemes That Cover and Schemes That Don’t 

Nearly all medical aid schemes will cover part of your in-hospital dental treatment. On most schemes maxillofacial surgery and removal of impacted wisdom teeth will be covered.

However, there’s usually a portion of the treatment/procedure that is excluded from the schemes’ rules.

We won’t focus on the in-hospital treatment in this article, as I believe the basic and advanced dentistry benefits that take place in the dental practitioners’ rooms are far more interesting and commonly used.

We will use the following medical aid schemes in our comparison:

  • Bonitas
  • Discovery
  • Fedhealth
  • Genesis
  • Medihelp
  • Momentum

Which schemes and options will give you cover and which do not? 

No Cover

From Savings

Basic Dentistry
Only

Basic and Advanced
Dentistry

Bonitas BonEssential Discovery Saver, Priority, Comprehensive and Executive Bonitas Boncap, Bonsave, Primary Bonitas Standard and Comprehensive
Discovery Core options All Fedhealth options (excl. Blue Door) Momentum Ingwe and Access Genesis (all options) 
  Medihelp Prime 2 Discovery Keycare Medihelp Necesse, Prime 3, Elite & Plus
  Momentum Custom, Incentive & Extender    

What Does Basic Dentistry Cover?

Both Medihelp and Bonitas make use of the DENIS dental network and protocols, which offer very similar benefits on all their options. The Genesis, Momentum and Discovery basic dentistry is managed by their own networks, but in general you can expect the following cover: 

Check-Ups: 2 per beneficiary per year
X-rays: Subject to scheme’s protocols
Oral Hygiene: 2 scale and polishing per beneficiary per year
Fillings: 1 per tooth per year
Root Canal: Subject to scheme’s protocols
Dentures: 1 set of plastic dentures per 4 years

What Does Advanced Dentistry Cover?

This would include the following treatments:

Orthodontic: For persons under age 18, non-cosmetic only
Periodontic: Benefit limited to conservative, non-surgical therapy only (root planting)
Maxillofacial: Surgery in the chair subject to protocols

Comparison of Some of the Medical Aid Options Above:

SCHEME AND OPTION GENESIS PRIVATE BONITAS PRIMARY MOMENTUM CUSTOM MEDIHELP PRIME 3
HOSPITAL COVER

Unlimited

Any Hospital

 

R1 Million LimitAny Hospital

Unlimited

Network Hospitals

Unlimited

Any Hospital

 

CHRONIC MEDICINE BENEFIT 26 PMBs 26 PMBs 26 PMBs 26 PMBs
DENTISTRY R25 000 Basic Dentistry (incl. R1 000 for crowns)

Unlimited Basic Dentistry

Subject to Protocols

1 Dentist Consultation Per Year

Basic & Advanced Dentistry

Subject To Protocols

SAVINGS/
DAY-TO-DAY
R0

R1 500 m

R2750 m+1

R3 200 m+2

 

R0 Separate Benefits For Optical, GP etc.
PREMIUM

R1185 member

R1185 spouse

R335 child

R1274 member

R997 spouse

R406 child

R914 member

R691   spouse

R323  child

R1740  member

R1476  spouse

R510  child


If you weigh the cost of dental treatment and the cost of a plan which covers you dental benefits, you will not be paying much more than on your current medical aid option.

So, why not consider changing your plan to get the cover you really benefit from.  If you weigh the cost of dental treatment and the cost of a plan which covers you dental benefits, you will not be paying much more than on your current medical aid option.

Not on a medical aid yet? Fill in the form below and on of our trusted medical aid partners will get back to you with a free quote:

[gravityform id=”1″ name=”Medical Aid SA”]

Should you wish to find out more about an of the schemes mentioned, please contact the schemes directly for more detailed information :

www.bonitasmedicalfund.co.za  or telephone:  (0860) 002 108
www.genesismedical.co.za or telephone: (0860) 564 6669
www.momentumhealth.co.za or telephone: (0860) 117 859
www.discovery.co.za or telephone (0860) 99 88 77
www.fedhealth.co.za or telephone: (0860) 002 153
www.medihelp.co.za or telephone (0860) 100 678

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About Author

Nelda Celliers is a medical aid advisor based in Cape Town. She has a Higher Certificate in Insurance through the Insurance Institute of South Africa. Nelda obtained her licenses from the Financial Services Board and Council for Medical Schemes to operate her own medical aid practice, Medical Benefit Advisors.