Medical Aid and Dentistry – What You Need to Know

Medical aid and dentistry don’t always go hand-in-hand because not all medical aid plans offer benefits for dentistry.

Some do and some don’t, so if you want to ensure you are going to get dental benefits with the medical aid scheme you choose, you really do need to do some homework before you commit to a monthly payment plan.

In-Hospital Versus Out-of-Hospital Medical Aid and Dentistry

In-hospital cover is just this: cover that pays for medical and (if applicable) dental expenses that you have when you are hospitalised. In terms of dentistry, this would usually apply to wisdom teeth that have become impacted or need to be removed under general anaesthetic for some reason, and for any other dental treatments that require a general anaesthetic.

Medical Aid and Dentistry - What You Need to KnowThe term out-of-hospital cover is also self-explanatory, relating to normal dentistry including fillings, extractions, root canal treatments and even some straightforward orthodontic work.

While many schemes will cover both medical aid and dentistry, it is essential to be aware that many do not. Many comprehensive medical aid schemes cover major dental-related care that involves maxillofacial surgery and even relatively minor surgical events like removing wisdom teeth that have become impacted. There are many dental procedures and treatments that are routinely excluded from medical aid and dentistry schemes.

Generally, it is the out-of-hospital cover that you need to focus on to be sure you understand exactly what will, and what won’t be covered in any medical aid and dentistry plan that you sign up for.

A Comparison of Medical Aid and Dentistry Cover

There are numerous options from South Africa’s best medical aid and dentistry providers that offer:

•    Basic and advanced dentistry
•    Only basic dentistry
•    A savings facility that can be used to pay for dentistry

Smiling LipsWhile you do need to examine all the plans offered by companies that offer medical aid and dentistry in South Africa, to be sure that what you think you are likely to need will be covered, here is an overview of what Bonitas, Discovery, Fedhealth, Genesis, Medihelp and Momentum offer in relation to the three categories listed above.

Basic and Advanced Dentistry cover is offered by a number of providers including Genesis, Bonitas Standard and Comprehensive and Medihelp Necesse, Prime 3, Elite & Plus.

Basic Dentistry only is covered be Discovery Keycare, Momentum Ingwe and Access and by BonitasBoncap, Bonsave and Bonitas Primary.

From Savings Options extend to several plans including Discovery Saver, Priority, Comprehensive and Executive plans; all the different Fedhealth options excluding Blue Door; Medihelp Prime 2; and Momentum’s Custom, Incentive & Extender Plan.

Some of these plans that you might identify as being for both medical aid and dentistry in fact exclude dentistry cover altogether, including BonitasBonEssential and Discovery Core Options.

Basic Dentistry Only

When you sign up for a medical aid and dentistry plan you need to know exactly what to expect. Bonitas and Medihelp use what is known as the DENIS dental network that has specific protocols. Genesis, Discovery and Momentum manage their own specific networks, most of which will give you similar cover that will include two checkups per year for each beneficiary. one filling and two scale and polish appointments each every year.

Advanced Cover for Medical Aid and Dentistry

This form of medical aid and dentistry cover normally includes non-cosmetic orthodontic work, some conservative, non-surgical periodontic work, and a minimal amount of maxillofacial surgery “in the chair”.

While in-hospital cover is similar (usually unlimited), the dentistry cover varies quite a lot. But it usually doesn’t cost much more to add dental treatment to an existing plan.