Dentists
Dentistry is the known evaluation, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body.
Cover for dentists is dependent on your plan type. For more details select your plan type below:
Executive plan
- Dentistry is limited to R26 000 for each person each year for both in-hospital and out-of-hospital dentistry
- We pay the hospital account from your Hospital Benefit and your related accounts, for example anaesthetist and dentist, from your Medical Savings Account and Above Threshold Benefit, subject to available funds, and your available dentistry limit. All accounts (including the full hospital account and related accounts) add up to the dentistry limit, including claims paid by you before reaching the Annual Threshold.
- We pay dentistry done out-of-hospital from your Medical Savings Account or Above Threshold Benefit, subject to available funds, and your available dentistry limit.
- If you need orthognathic surgery performed as part of orthodontic treatment, we pay the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. We pay your related accounts, for example dentist, anaesthetist from your Medical Savings Account or Above Threshold Benefit and add up these claims towards your dentistry limit.
Comprehensive Series
- Dentistry is limited to R18 500 for each person each year for both in- and out-of-hospital dentistry
- We pay the first R1 975 of the hospital account from the Medical Savings Account or Above Threshold Benefit. We pay the balance of the hospital account from the Hospital Benefit. We pay related accounts, for example dentists and anaesthetists, from the Medical Savings Account or Above Threshold Benefit. Your claims are subject to available funds and your available dentistry limit. All accounts (including the full hospital account and related accounts) add up to the dentistry limit, including claims paid by you before reaching the Annual Threshold.
- We pay dentistry done out-of-hospital from your Medical Savings Account or Above Threshold Benefit, subject to available funds, and your available dentistry limit.
- Approved, defined major maxillo-facial surgery* is paid from the Hospital Benefit and is not limited to the dentistry limit
- If you need orthognathic surgery performed as part of orthodontic treatment, we pay the first R1 975 of the hospital account from your Medical Savings Account or Above Threshold Benefit. We pay the balance of the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. We pay your related accounts, for example dentist and anaesthetist, from your Medical Savings Account or Above Threshold Benefit and add up these towards your dentistry limit.
- The R1 975 co-payment does not apply when children 12 years or younger are admitted to hospital
*The list of “defined major maxillo-facial surgery” is available from Discovery Health upon request.
Priority Series
- Dentistry is limited to R13 100 for each person each year for both in- and out-of-hospital dentistry
- We pay the first R1 975 of the hospital account from the Medical Savings Account or limited Above Threshold Benefit. We pay the balance of the hospital account from the Hospital Benefit. We pay related accounts, for example dentists and anaesthetists, from the Medical Savings Account or limited Above Threshold Benefit. Your claims are subject to available funds and your available dentistry limit. All accounts (hospital and related) add up to the dentistry limit, including claims paid by you before reaching your Annual Threshold.
- We pay dentistry done out-of-hospital from your Medical Savings Account or limited Above Threshold Benefit, subject to available funds, and your available dentistry limit.
- Approved, defined major maxillo-facial surgery* is paid from the Hospital Benefit and is not limited to the dentistry limit.
- If you need orthognathic surgery performed as part of orthodontic treatment we pay the first R1 975 of the hospital account from your Medical Savings Account or limited Above Threshold Benefit. We pay the balance of the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. We pay your related accounts, for example dentist and anaesthetist, from your Medical Savings Account or limited Above Threshold Benefit and add up these towards your dentistry limit.
- The R1 975 co-payment does not apply when children 12 years or younger are admitted to hospital
*The list of “defined major maxillo-facial surgery” is available from Discovery Health upon request.
Saver Series
- Dentistry is limited to R13 100 for each person each year. This limit applies to the hospital account only.
- We pay the first R1 975 of the hospital account from the Medical Savings Account. We pay the balance of the hospital account from the Hospital Benefit. Your full hospital account is subject to the dentistry limit. We pay related accounts, for example dentists and anaesthetists, from the Medical Savings Account.Only the hospital account adds up to the dentistry limit, including any portion paid by you.
- We pay dentistry done out-of-hospital from available funds in your Medical Savings Account.
- Approved, defined major maxillo-facial surgery* is paid from the Hospital Benefit and is not limited to the dentistry limit
- If you need orthognathic surgery performed as part of orthodontic treatment we pay the first R1 975 of the hospital account from your Medical Savings Account. We pay the balance of the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. We pay your related accounts, for example dentist and anaesthetist, from available funds in your Medical Savings Account.
- The R1 975 co-payment does not apply when children 12 years or younger are admitted to hospital
Core Series
- Dentistry is limited to R13 100 for each person each year. This limit applies to the hospital account only.
- You pay the first R1 975 of the hospital account from your pocket. We pay the balance of the hospital account from the Hospital Benefit. Your full hospital claim is subject to the dentistry limit. You pay related accounts, for example dentists and anaesthetists from your pocket.
- You do not have cover for dentistry that is done out-of-hospital.
- Approved, defined major maxillo-facial surgery* is paid from the Hospital Benefit and is not limited to the dentistry limit
- If you need orthognathic surgery performed as part of orthodontic treatment you pay the first R1 800 of the hospital account from your pocket. We pay the balance of the hospital account from your Hospital Benefit. We do not add up the hospital account to your dentistry limit. You pay for the related accounts, for example dentist and anaesthetist from your pocket.
- The R1 975 co-payment does not apply when children 12 years or younger are admitted to hospital
*The list of “defined major maxillo-facial surgery” is available from Discovery Health upon request.
KeyCare Series
- In-hospital dentistry is not covered on the KeyCare Plans
- Approved, defined major maxillo-facial surgery for both the KeyCare Core and Plus Plans is paid from Hospital Benefit.
KeyCare Plus Plan only
- Out-of-hospital dentistry: selected, basic dentistry such as consultations, fillings and extractions are covered subject to a list of procedure codes only at a dentist in the KeyCare dentist network.
- The KeyCare Core Plan has no cover for dentistry
KeyCare hospitals
* These hospitals have a casualty unit, but it is not a preferred casualty unit.
** These hospitals have a preferred casualty unit.
Please note that this list of hospitals is subject to change. Go to www.discovery.co.za for the latest list of hospitals and casualty units or phone us.
