The Dentistry Benefit on the Managed Care Plan includes:
- Conservative treatments including fillings, x-rays, extractions and oral hygiene.
- Specialised treatments including crowns, bridges, inlays, study models, dentures, orthodontics, osseo-integrated implants or similar tooth implants and periodontics.
The Scheme pays up to a Family Limit of R 3 970 per adult and R 1 500 per child per year.
Cost above the Scheme Reimbursement Rate (SRR) may be paid from your available MSA upon instruction. Once your dental benefit is depleted, payment will be from available funds in your MSA.
The reimbursement rate is up to 125% of SRR for non-PMB specialised dental services, performed by a dental specialist.
You need to call the Scheme to receive authorisation before undergoing dental treatments in hospital
- in the case of trauma
- if patients are under the age of 7 years requiring anaesthetic,
- for the removal of impacted molars or
- maxillo-facial and oral surgery (PMB conditions).
Authorised specialist services in hospital are paid at the Top-Up rate of 230% of SRR, or in full if PMB