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What does “100% of Medical Aid Rate” mean?

Dental benefits at Genesis explained

Genesis offers amazing basic dentistry benefits to all members on ALL our benefit options.

Do you know about this benefit?  And do you know how to use it?

Why are our dental benefits unique?

Only a handful of medical schemes in South Africa include out-of-hospital (day-to-day) dental benefits as part of their standard benefits structure.  These expenses are usually only covered from a member’s available medical savings account, if any, while members on hospital plans usually have to fund their dental expenses from their own pocket.

Recognising the need for dental cover, we have designed our benefit offering across all benefit options to provide good financial cover for basic dentistry, as well as some specialised dentistry benefits. These dental benefits are not only available for Genesis members on the Private Plus and Private Comprehensive options, but also to members on our two hospital plans (Private and Private Choice).

Dental benefits on Genesis are covered from our members’ risk benefits, meaning that members don’t have to pay for their available dental benefits from their medical savings accounts, or their own pockets, provided that their Dental Practitioner charges Medical Aid Rates.

List of qualifying dental benefits

Dental benefits are covered at the lower of cost or Medical Aid Rate for the following qualifying annual benefits when obtained from a registered Dental Practitioner:

  • Three (3) dental oral examinations
  • Six (6) fillings
  • Unlimited tooth extractions
  • Six (6) plain X-rays for conservative dentistry (excluding wide angle / panorex imaging and CT / MRI scans)
  • Two (2) root canal treatments, excluding root canal treatment on wisdom teeth
  • Crowns, bridges or dentures are paid at the lower of cost or Medical Aid Rate, further limited to R3 500
  • Surgical removal of bony impacted wisdom teeth where pathology and pain are directly associated with the wisdom teeth
  • In-hospital extractions and fillings (once only, lifetime limit) for child beneficiaries under the age of nine (9) years

Do we pay for scaling and polishing?

We may cover some of the cost for scaling and polishing from your available savings benefit (if any).  It is not included in your risk benefits (in other words, it is not funded by the Scheme).

Scaling and polishing are regarded as preventative care, whereas our basket of dental benefits is essentially aimed at restorative treatment.

Will your qualifying accounts always be settled in full?

YES, if your Dental Practitioner charges our Medical Aid Rates.  In the event where he / she charges more than this rate, you may have a co-payment.

Always check with your Dental Practitioner what rate he / she charges.  If they charge private rates, you could request him / her to charge you Medical Aid Rates.  Service providers in general are often open to negotiate their rates.

Most Medicross dental practices throughout South Africa charge Medical Aid Rates and submit their accounts for Genesis members directly to us.

When are dental procedures covered in hospital?

Members have a dental in-hospital benefit for the removal of bony, impacted wisdom teeth, where pain and pathology are directly associated with the wisdom teeth.  Members are entitled to one such dental hospital admission per annum.

In addition, children under the age of nine (9) years have a once in a lifetime in-hospital benefit for fillings and extractions.

In both instances, Genesis will cover the cost of in-hospital dental procedures at cost up to 100% of Medical Aid Rate, further limited to R10 000 per case, inclusive of all costs.

Theatre time and Anesthetist costs over and above hospital costs and the fees charged by your Dental Practitioner, can easily push the cost of in-hospital dental procedures up to R30 000.  Members often opt to have the above in-hospital procedures done in the Doctor’s room under conscious sedation, where the total cost (and therefore the member’s co-payment) would be a lot less.

Benefits reflected in this schedule are for the full benefit year and will be pro-rated for those members joining us during the benefit year.

If in any doubt, please give us a call.

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