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:
Which schemes and options will give you cover and which do not?
Basic and Advanced
|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|
|R1 Million LimitAny 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
R1 500 m
R3 200 m+2
|R0||Separate Benefits For Optical, GP etc.|
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