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 ensure you are going to get dental benefits with the medical aid scheme you choose. The way to do it is to do some homework. Do that before you commit to a monthly payment plan.

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

In-hospital cover is just that. It is cover that pays for medical and (if applicable) dental expenses that you have when you go to hospital. In terms of dentistry, this would usually apply to impacted wisdom teeth or teeth that need removal under general anaesthetic. And it would be 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 medical aids and dental insurance plans routinely exclude.

Generally, it is the out-of-hospital cover that you need to focus on to be sure you understand exactly what you have cover for in 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 for dentistry

Medical Aid and DentistryWhile 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.

You can get cover for Basic Dentistry only from 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.