Dentists

Dentistry is the known evaluation, diagnosis, prevention and treatment of diseases, disorders and conditions of the oral cavity and maxillo-facial area. This includes the adjacent and associated structures and their impact on the human body.

How we cover dentistry

Conservative dentistry

This may include consultations, basic x-rays, oral hygiene, extractions and fillings.

We pay for conservative dentistry done out-of-hospital from your Insured Out-of-Hospital (IOH) benefit on the Comprehensive and Classic options, subject to the overall annual limit and the sub-limit for the IOH.

A preventative basic dentistry will be available to members on the Classic and Comprehensive options in 2016. This will cover one dental examination per beneficiary including the infection control, prophylaxis, polishing and fluoride per annum payable from the overall annual limit. All other basic dentistry will continue to fund from the insured out-of-hospital benefit linked to the sub-limits and overall annual limit.

Conservative dentistry on the Standard option excludes dentures and specialised dentistry, provided that you obtain services from a dentist on the Remedi Standard Option Network which is managed by the Dental Risk Company

Specialised dentistry

This includes inlays, crown and bridgework, study models, dentures and the repair thereof, orthodontics, periodontics, prosthodontics and osseo-integrated implants.

Specialised dentistry out of hospital is covered on the Comprehensive option from the Risk Benefit. It is covered at 100% of the Scheme Rate subject to the sub-limit of R17 500 per beneficiary and an overall annual limit of R35 000 per family.

Specialised dentistry out of hospital is covered on the Classic Option paid from the Insured Out-of-Hospital Benefit (“IOH”) and the IOH benefit limits on this Option are as follows:

A combined family limit of:

R6 300 per principal member

R3 720 per adult dependant

R1 040 per child dependant up to a maximum of 3 children.

It is important to note that the IOH benefit limit on the Classic Option is not only available for Specialised Dentistry but benefits such as general practitioners and specialists, for example, are also paid from this limit as set out in the website, Remedi benefit brochure and registered Rules.

Major Maxillo Facial dentistry

Remedi will pay for Major Maxillo Facial dentistry in accordance with the requirements for Prescribed Minimum Benefits.