Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Medical scheme cover with generous dental benefits 2018

01 December 2017 Elmarie Jensen, Genesis Medical Scheme
Elmarie Jensen from Genesis Medical Scheme.

Elmarie Jensen from Genesis Medical Scheme.

Maintaining that perfect proverbial smile doesn’t come cheap. In fact, dental consultations, treatment and appliances are often more expensive than mainstream medical treatment. Expenses associated with braces, crowns, bridges and the like never come cheap and parents and individuals, who have not made provision for these types of expenses, may have to dig deep into their pockets.

Generally speaking and depending on the plan type you have chosen, some medical schemes may pay for dental procedures conducted in hospital up to a specified limit and at a defined percentage of the scheme rate. Certain plan types also required an upfront deposit.

Very few medical aids in South Africa make provision for out-of-hospital (day-to-day) dental expenses, such as routine check-ups, fillings, etc. These expenses are usually only covered from a member’s available medical savings account, if any.

Recognising the need for dental cover, Genesis Medical Scheme has designed their benefit offering across all plan options to provide good financial cover for basic dentistry, as well as some enhanced dentistry benefits. These dental benefits are not only available on the Scheme’s comprehensive medical aid plans, but also on the two hospital plan benefit options. If fact, of the approximately 22 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, on their hospital plans.

Dentistry benefits on Genesis are covered from 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.

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; 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 R10 000 per case.

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