Do Medical Aid Schemes In South Africa Cover Dentistry?

Medical care forms a critical part of your quality of life, and all South Africans should have access to trustworthy dental practitioners. However, your dentist spent many hours and countless resources to develop their expertise and experience. As an important doctor in the healthcare society, they deserve adequate compensation for their service.

Luckily, medical aid schemes in South Africa offer dental benefits on most options. But which procedures will be covered by your medical aid? The answer depends on the level of coverage you have opted for as well as the reason behind the procedure. Let’s answer some of your most frequent questions about dental needs and medical schemes in South Africa.

Do Medical Aid Schemes In South Africa Cover Cosmetic Dental Procedures?

Medical aids do not cover purely cosmetic plastic surgery, but some schemes’ comprehensive plans include dental appliances (implants), prostheses and reconstructive procedures as part of their trauma benefits.

Which Dental Procedures Will My Medical Aid Scheme Cover?

Entry-level medical aid plans usually pay for dental costs from members’ savings, whereas top-tier plans may cover the expenses from medical aid benefits. Schemes may pay for anything from basic dentistry all the way to specialised procedures, but even basic plans usually cover routine procedures such as fillings, extractions, x-rays, scaling and polishing, root canal treatment and standard plastic dentures. Benefits are typically limited if you’ve opted for a basic plan, and pre-authorisation is required.

If you anticipate needing specialised dental procedures like crowns, implants, bridges, orthodontics, periodontics or dentures, you’ll have more peace of mind if you choose a comprehensive medical aid product. Schemes may still cap the amount they pay for a particular treatment or procedure or insist that their members adhere to a managed care protocol.

What Should I Do Before I Sign Off on Any Kind of Dental Work?

Before you sign off on any kind of dental work, educate yourself about your medical scheme’s rules, the listed medication and treatments (formularies) for your specific condition, as well as their list of Designated Service Providers (DSPs). Also, get as much information as possible about your condition and the appropriate intervention and treatments to address it.

It might be tempting but don’t bypass the system. If your medical aid scheme prescribes that you must use a GP to refer you to a specialist, then do so and make use of your medical scheme’s DSPs as far as possible.

It’s also critical to ensure your dentist submits a complete account to the medical scheme and that the correct ICD-10 code is reflected. Don’t forget to follow up and check that your account is submitted within four months and paid within 30 days after the claim was received (accounts older than four months aren’t paid by medical schemes).

What Happens If My Medical Aid Pays Only a Partial Amount of My Dental Fee?

At Family Dental Care, we understand that life happens and that your medical aid payments might fall short. That’s why we offer three-month interest-free payment plans on selected dental treatments using MediWallet. MediWallet is a flexible and affordable payment solution but is not a medical scheme, and the coverage (benefits and contributions) is not the same as that of a medical scheme. Some Ts and Cs apply, and you can have a look at them on our website.

As a patient, you need to feel comfortable discussing the cost of dental services upfront. Most South African dentists accept various medical aid plans, potentially reducing your out-of-pocket expenses. Understanding the ins and outs of your medical aid coverage, including any co-payments, is crucial. Remember, a reputable dental clinic will be transparent about its billing practices. They also won’t upsell you on unnecessary treatment but will provide a comprehensive service package that caters to your overall dental health.

If you’re looking for a top-tier dental practice, you’ve found it in Family Dental Care! Schedule an appointment with us today or find your nearest branch and experience the difference that outstanding dental care can make to your health and well-being.

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