Understanding your in-hospital dentistry benefits

Dental health is an integral part of overall wellbeing, and for many, certain dental procedures require hospitalisation. Remedi Medical Aid Scheme recognises this need and offers in-hospital dentistry benefits tailored to each benefit option and makes provision for dental procedures such as oral surgery, implants, crowns and severe dental trauma from your in-hospital benefits. The in-hospital dentistry benefit aims to provide financial relief and access to quality care when specialised dental treatment becomes necessary.

Depending on your chosen benefit option, you are covered for in-hospital dentistry as follows:

Remedi Comprehensive Option

The Comprehensive Option offers the most extensive coverage for in-hospital dental procedures. Here's what members can expect:

1. For severe dental and oral surgery, as well as orthognathic surgery:

You must get preauthorisation: You must preauthorise your admission at least 48 hours before you go in (call 0860 116 116).
You don't have an upfront payment on the facility fees and surgeon costs. We pay 100% of the agreed rate if the provider is one of our designated service providers (DSPs) or up to 150% of the Remedi Rate if they are not a DSP. We pay these costs from the hospital benefits.
Facility Fees and Surgeon Costs: 100% of the agreed rate if part of our Designated Service Providers Arrangements (DSPs) or up to 150% of the Remedi Rate where not part of our DSPs from hospital benefits
Dental Appliances (Specialised Dentistry): Implants and crowns are funded up to 100% of the Remedi Rate from specialised dentistry and/or available Insured Out-of-Hospital (IOH) or Personal Medical Savings Accounts (PMSA), as may be applicable.

2. Other Specialised Dentistry: In-hospital dentistry not classified as Severe dental and Oral surgery or Orthognathic surgery

Members pay a deductible upfront for specific procedures:

Hospital admission:
1. Under 13 years: R2,500
2. 13 years or older: R6,250
Day clinic admission:
1. Under 13 years: R1,500
2. 13 years or older: R3,750

We pay the rest of your hospital account (after the upfront amount) from your hospital benefit.

We pay the related accounts (such as the claims from your anaesthesiologist and dental surgeon) from your hospital benefit.

Dental Appliances (Specialised Dentistry): Implants and crowns are funded up to 100% of the Remedi Rate from specialised dentistry and/or available Insured Out-of-Hospital (IOH) or Personal Medical Savings Accounts (PMSA), as may be applicable.

Remedi Classic Option

The Classic Option offers solid coverage for in-hospital dental care, though slightly less extensive benefits than what is available on the Comprehensive Option.

1. For severe dental and oral surgery, as well as orthognathic surgery, where pre-approved:

Facility fees and surgeon costs:
Paid up to 100% of the Remedi Rate for hospital admissions. Related accounts, including anaesthetists and dental surgeons, are covered under hospital benefits.
Dental appliances:
Implants and crowns are funded up to 100% of the Remedi Rate from the available Insured Out-of-Hospital (IOH) benefits.

2. Other Specialised Dentistry: In-hospital dentistry not classified as severe dental and oral surgery or orthognathic surgery:

Members pay a deductible upfront for specific procedures:
- Hospital admission:
  - Under 13 years: R2,500
  - 13 years or older: R6,250
- Day clinic admission:
  - Under 13 years: R1,500
  - 13 years or older: R3,750

Dental Appliances (Specialised Dentistry): Implants and crowns are funded up to 100% of the Remedi Rate from Insured Out-of-Hospital (IOH).

Remedi Standard Option

In-hospital dentistry is not covered on the Standard Option, except in cases of severe dental and oral surgery, where preauthorised. Costs for appliances will be funded from your available IOH. To obtain preauthorisation you must contact us at least 48 hours before you are admitted into hospital (call 0860 116 116).

For all other basic dentistry benefit you can contact the Dental Risk Company (DRC) (call 087 943 9611).

Value for Remedi members

In-hospital dental procedures can be expensive, especially when factoring in surgeon fees, anaesthesia and hospital costs. By covering these expenses under hospital benefits and allowing funding for appliances from IOH or PMSA on the Comprehensive and Classic Options, Remedi ensures members has access to cover on the top-end range of benefit options available.

Remedi's in-hospital dentistry benefits provide members with financial security and access to specialised care when needed most. Whether you choose Comprehensive for extensive coverage, Classic for balanced benefits, or Standard for essential protection, the Remedi benefit options ensure that dental health is never compromised.

Your smile matters and with Remedi, you can face dental challenges with confidence.