Do full cover medical aid or hospital plans offer dental benefits?
Of the approximately 36 hospital plans available from open medical aid schemes in South Africa (excluding capitation options where members have to make us of certain Designated Service Providers, or DSPs), Genesis Medical Scheme is the only scheme that offers rich basic, as well as some enhanced basic dentistry benefits.*
These dental benefits are available on all benefit options, including the Scheme’s two hospital plan options.
Dentistry benefits on Genesis are covered from members’ risk benefits, meaning that members don’t have to pay for their basket of available dental benefits from their medical savings accounts, or their own pockets.
Dental benefits are covered at the lower of cost or Medical Aid Rate, up to R25 000 per beneficiary per annum, for the following qualifying benefits when obtained from a registered Dental Practitioner:
- Three (3) dental consultations per annum;
- Six (6) fillings per annum;
- Unlimited tooth extractions;
- Six (6) plain X-rays per annum for conservative dentistry (excluding wide angle / panorex imaging and CT / MRI scans);
- Two (2) root canal treatments per annum, 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 200 per annum;
- Surgical removal of impacted wisdom teeth where pathology and pain are directly associated with the wisdom teeth; and
- In-hospital extractions and fillings (once only, lifetime limit) for child beneficiaries under the age of nine (9).
Hospital admissions are limited to 1 admission per beneficiary per annum and are covered at 100% of the cost up to Medical Aid Rate, limited to the lower of cost or R9 000 per case.
For further information, contact the Genesis Medical Scheme on 0860 10 20 10.
Terms & conditions apply as set out in the Registered Rules of Genesis Medical Scheme.
* Benefits information has been obtained from BrokerTools.