Of the approximately 40 hospital plans available from open medical schemes in South Africa (excluding capitation options where members have to make us of certain Designated Service Providers, or DSPs), Genesis Medical Scheme is one of less than a handful of schemes that offers rich basic dentistry benefits. These dental benefits are available on all benefit options, including the Scheme’s 2 hospital plans.
Unlike the vast majority of medical aid benefit options available from open medical schemes, basic dentistry benefits on Genesis are covered from members’ risk benefits, meaning that members don’t have to pay for basic dentistry from their medical savings accounts, or their own pockets.
Benefits for basic dentistry will be covered at the lower of cost or Medical Aid Rate, up to R25 000 per beneficiary per annum, for the following qualifying dental benefits when obtained from a registered Dental Practitioner:
- Three (3) general consultations;
- Unlimited fillings;
- Unlimited tooth extractions;
- Unlimited x-rays for conservative dentistry (excluding wide angle / panorex imaging and CT / MRI scans);
- Unlimited root canal treatment excluding root canal treatment on wisdom teeth;
- Crowns and temporary crowns are paid at the lower of cost or Medical Aid Rate, limited to R2 500 per crown, further limited to two (2) such crowns 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 eight (8).
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.
If in any doubt, please contact the Scheme on 0860 10 20 10.
Terms & conditions apply as set out in the Registered Rules of Genesis Medical Scheme.