Members of the Value Care Plan are entitled to the following dental benefits:
Cleaning, scaling, polishing and fluoride treatment are limited to one treatment per beneficiary per year.
Fillings, X-rays, extractions and consultations are limited to one consultation per beneficiary per year. Specific codes will be paid if clinically appropriate. Authorisation needed for 5 or more extractions.
One set of acrylic dentures per family every 2 years. Benefit only for members over the age of 21 years and subject to authorisation and a co-payment of 20% per set.
Treatment of pain, sepsis and extractions at a non-network provider are limited to one event per beneficiary per year and are paid at the Prime Cure agreed rate.
Dental hospital admission
For children under the age of 7, for the removal of impacted third molars and trauma (PMB), subject to authorisation and the Family Hospital Limit of R173 000 per year.