Visiting a dentist
The Scheme has contracted the Dental Risk Company (DRC) to provide a range of basic dental services at an agreed network rate. Members visiting a network provider will not have to pay upfront or experience co-payments when receiving these services.
If you choose to use a dentist outside the network, you will have to pay a co-payment (the difference between 80% of the Scheme Reimbursement Rate and the claimed amount). Services are limited to the basic dental services listed below and subject to DRC protocols.
Members on the Standard Care Plan have a basket of basic dentistry available to them:
Every 180 days: 1 consultation, 1 scaling, polishing and fluoride treatment; 2 intra-oral radiographs per visit; 1 local anaesthetic per visit; 4 extractions, 5 restorations (amalgam or resin) per year; one pair of plastic dentures every 4 years including 1 annual relining and repair per year.
Authorisation is required for more than 4 extractions or more than 5 resin restorations.
Subject to DRC protocols.
If the range of basic dental services is insufficient, a limited extended dental benefit can be used for additional basic or specialised dentistry.
A list of DRC network providers is available by calling the Call Centre on 0860 222 633.
Additional basic and specialised Dentistry Family Limit
R1 325 per adult and R330 per child per year. This limit applies to both network and non-network providers.
You need to call the Scheme to receive authorisation before undergoing dental treatment 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).