List of benefits

(click to expand)

  • Prime 1 Option:
  • The following procedures are covered on Prime 1 Option:

    No cover for conservative dentistry

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes).

    • Impacted teeth in the chair. Conscious sedation in the dentist’s rooms – only covered for item codes 8941, 8943 and 8945.

    Dental Services/surgery rendered in Hospital (General Anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable

    • Impacted teeth in the hospital. Once per lifetime. A co-payment of R3000 is applicable per admission.
    • Extensive dental treatment in hospital for children younger than 5 years. Once per lifetime. A co-payment of R3000 is applicable per admission. Member liable for Dentist account.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation


  • Prime 2 & Unify Option.
  • The following procedures are covered on Prime 2 and Unify Option. NB All conservative dental treatment are payable from members savings account.

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • An examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination)
    • Intra-oral X-rays - more than 6 require pre-authorisation.
    • Gloves for the dentist and his assistant, to prevent infection (max of 2 per visit).
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six month). No benefits for oral hygiene instructions/evaluation and limited to beneficiaries 12 years and older. Code 8159 is covered for beneficiaries older than 12 years and code 8155 for beneficiaries younger than 12 years.
    • A fluoride treatment for children (once every six month). Limited to beneficiaries from 5 – 13 years.
    • Fissure Sealants – Limited to children older than 5 years and younger than 16 years of age on permanent teeth only.
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
    • Metal and white fillings subject to dental protocol are covered. Pre-authorisation required for:
    • More than four fillings per year.
    • More than 2 front teeth restorations per visit.
    • One restoration per tooth number within 12 months from date of service.
    • Incision and drainage of abscess. Limited to treatment in the consultation rooms.
    • Root canal treatment on permanent teeth limited to beneficiaries 12 years and older. Retreatment subject to pre-authorisation and managed care protocols.
    • Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period from date of service.
    • Metal frame dentures must be pre-authorised. One partial frame denture (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.Payable from members savings account
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits shall be granted on crowns or crown retainers on third molars and Pontics on second molars. Clear, well defined (no cone-cutting) radiographs are required to support crown authorisations
    • Orthodontic treatment: Limited to beneficiaries younger than 18 years. Payable from member’s savings account. Failure to pre-authorise orthodontic treatment shall result in benefits only being granted from the date of authorisation for the remaining month of treatment, provided that the treatment is approved as per managed care protocols.
    • Periodontic treatment: Periodontic treatment is limited to conservative, non-surgical therapy only. This benefit will be applied to members who qualify for and are registered on the Periodontal Programme via standard pre-authorisation channels.
    • Maxillofacial surgery and oral pathology: Limited to certain maxillofacial procedures.
    • Implants - No theatre or hospital benefit for placement of implants. Implant benefit is limited only to the placement of the implant components and does not cover any surgeries associated with bone augmentation. Implant supported dentures and crowns will be covered from the applicable (if available) denture and crown benefits. No benefits shall be granted on implants on wisdom teeth (third molars).

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes).

    • Impacted teeth in the chair. Conscious sedation in the dentist rooms. Limited to the removal of impacted third molars Once per lifetime. Payable from members savings account.

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • Impacted teeth in the hospital. Once per lifetime. A co-payment of R3000 is applicable per admission.
    • Extensive dental treatment for children younger than 5 years. Once per lifetime. A co-payment of R3000 is applicable per admission. Dental account payable from Savings account. This is only applicable for members on Prime 2. Members on Unify do not have this benefit.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Prime 3 & Elite Options:
  • The following procedures are covered on Prime 3 and Elite Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • An examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays - more than 6 require pre-authorisation.
    • Gloves for the dentist and his assistant, to prevent infection (max of 2 per visit).
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six month). No benefits for oral hygiene instructions/evaluation and limited to beneficiaries 12 years and older. Code 8159 is covered for beneficiaries older than 12 years and code 8155 for beneficiaries younger than 12 years.
    • A fluoride treatment for children (once every six month). Limited to beneficiaries from 5 – 13 years.
    • Fissure Sealants – Limited to children older than 5 years and younger than 16 years of age on permanent teeth only.
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
    • Metal and white fillings subject to dental protocol are covered. Pre-authorisation required for:
    • More than four fillings per year.
    • More than 2 front teeth restorations per visit.
    • One restoration per tooth number within 12 months from date of service.
    • Incision and drainage of abscess. Limited to treatment in the consultation rooms.
    • Root canal treatment on permanent teeth limited to beneficiaries 12 years and older.Retreatment subject to pre-authorisation and managed care protocols.
    • Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period from date of service.
    • Metal frame dentures must be pre-authorised.
    • Prime 3 - One partial frame denture (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Elite - Two partial frame dentures (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits shall be granted on crowns or crown retainers on third molars and Pontics on second molars. Clear, well defined (no cone-cutting) radiographs are required to support crown authorisations.
    • Prime 3: One crown annually per family, limited to once per tooth per 5 year period from date of service.
    • Elite: Two crowns annually per family, limited to once per tooth per 5 year period from date of service
    • Orthodontic treatment: Limited to beneficiaries younger than 18 years. Failure to pre-authorise orthodontic treatment shall result in benefits only being granted from the date of authorisation for the remaining month of treatment, provided that the treatment is approved as per managed care protocols.
    • Prime 3: R8 650 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year
    • Elite: R11 300 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year
    • Periodontic treatment: Periodontic treatment is limited to conservative, non-surgical therapy only. This benefit will be applied to members who qualify for and are registered on the Periodontal Programme via standard pre-authorisation channels.
    • Maxillofacial surgery and oral pathology: Limited to certain maxillofacial procedures.
    • Implants - No benefits

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • Impacted teeth in the chair. Conscious sedation in the dentist’s rooms. Limited to the removal of impacted third molars once per lifetime.
    • Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved.

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable

    • Impacted teeth in the hospital. Once per lifetime. A co-payment of:
    • Prime 3: R880 per admission is applicable.
    • Elite: R820 per admission is applicable.
    • Extensive dental treatment for children younger than 5 years Multi surface restorations require motivation when less than 3 teeth are involved. Once per lifetime. A co-payment of:
    • Prime 3: R880 per admission is applicable.
    • Elite: R820 per admission is applicable.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.
  • Plus Options:
  • The following procedures are covered on Plus Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per beneficiary.)
    • An examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays - more than 6 require pre-authorisation.
    • Gloves for the dentist and his assistant, to prevent infection (max of 2 per visit).
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six month). No benefits for oral hygiene instructions/evaluation and limited to beneficiaries 12 years and older. Code 8159 is covered for beneficiaries older than 12 years and code 8155 for beneficiaries younger than 12 years.
    • A fluoride treatment for children (once every six month). Limited to beneficiaries from 5 – 13 years.
    • Fissure Sealants – Limited to children older than 5 years and younger than 16 years of age on permanent teeth only.
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
    • Metal and white fillings subject to dental protocol are covered. Pre-authorisation required for:
    • More than four fillings per year.
    • More than 2 front teeth restorations per visit.
    • One restoration per tooth number within 12 months from date of service.
    • Incision and drainage of abscess. Limited to treatment in the consultation rooms.
    • Root canal treatment on permanent teeth limited to beneficaries 12 years and older.Retreatment subject to pre-authorisation and managed care protocols.
    • Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period from date of service.
    • Metal frame dentures must be pre-authorised. Two partial frame dentures (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits shall be granted on crowns or crown retainers on third molars and Pontics on second molars. Clear, well defined (no cone-cutting) radiographs are required to support crown authorisations.
    • Three crowns annually per family, limited to once per tooth per 5 year period from date of service.
    • Orthodontic treatment: Limited to beneficiaries younger than 18 years. Failure to pre-authorise orthodontic treatment shall result in benefits only being granted from the date of authorisation for the remaining month of treatment, provided that the treatment is approved as per managed care protocols. R14 000 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year.
    • Periodontic treatment: Periodontic treatment is limited to conservative, non-surgical therapy only. This benefit will be applied to members who qualify for and are registered on the Periodontal Programme via standard pre-authorisation channels.
    • Maxillofacial surgery and oral pathology: Limited to certain maxillofacial procedures.
    • Implants - Implant benefit is limited only to the placement of the implant components and does not cover any surgeries associated with bone augmentation. Implant supported dentures and crowns will be covered from the applicable (if available) denture and crown benefits. No benefits shall be granted on implants on wisdom teeth (third molars). Two implants per beneficiary per 5-year period. Benefits for the implant components are limited to R2 390 per implant.

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • Impacted teeth in the chair. Conscious sedation in the dentist’s rooms. Limited to the removal of impacted third molars once per lifetime. Once per lifetime.
    • Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved.

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable

    • Impacted teeth in the hospital. Limited to the removal of impacted third molars once per lifetime. Other impacted teeth and tooth exposures are subject to the approval and cover of an orthodontic treatment plan as per the member’s Option. Clear well defined radiographs required with authorisation submission.
    • Extensive dental treatment for children younger than 5 years Multi surface restorations require motivation when less than 3 teeth are involved. Once per lifetime.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.:


  • Necesse Options (NB Network Providers and Hospitals)
  • The following procedures are covered on Necesse Options (NB Network Providers and Hospitals):

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done. One consultation per 365 days per beneficiary.
    • Four Intra-Oral X-rays annually per beneficiary.
    • Gloves for the dentist and his assistant, to prevent infection (max of 2 per visit).
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (one per 365 days per beneficiary from date of service). No benefits for oral hygiene instructions/evaluation and limited to beneficiaries 12 years and older. Code 8159 is covered for beneficiaries older than 12 years and code 8155 for beneficiaries younger than 12 years.
    • A fluoride treatment for children (one treatment annually). Limited to beneficiaries from 5 – 13 years.
    • Fissure Sealants – Limited to children older than 5 years and younger than 16 years of age on permanent teeth only.
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation
    • Metal and white fillings subject to dental protocol are allowed Limited to four fillings annually per beneficiary (One restoration per tooth number within 12 months from date of service) Resin posterior restoration covered to the value of amalgam restorations.
    • Incision and drainage of abscess. Limited to treatment in the consultation rooms.
    • Root canal treatment on permanent teeth limited to beneficiaries 12 years and older. Retreatment subject to pre-authorisation and managed care protocols. Limited to two teeth annually per beneficiary.
    • Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 2-year period from date of service. Benefits are granted for 1 set of plastic dentures per family every 2 years for patients 21 years and older, provided that - The benefit is payable at 80% of the MDT. No benefits shall be granted for the clinical fee for denture repair, denture tooth replacements and the addition of a soft base to new dentures, but the laboratory fee will be covered. No benefits shall be granted for any metal dentures (full or partial), including the laboratory cost
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits.
    • Orthodontic treatment: No Benefits
    • Periodontic treatment: No Benefits
    • Maxillofacial surgery and oral pathology: Limited to PMB. Treatment must be pre-authorised and benefits are subject to clinical protocols
    • Implants: No Benefits

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • Impacted teeth in the chair: No Benefits
    • Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved. Once per lifetime. Services rendered by a network dental practitioner.

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable

    • Impacted teeth in the hospital: No Benefits
    • Extensive dental treatment for children younger than 5 years Multi surface restorations require motivation when less than 3 teeth are involved. Once per lifetime. Benefits are limited to relevant health services prescribed by a network dental practitioner as being essential and rendered at a Necesse network hospital. Failure to pre-authorise the admission will result in a 20% co-payment on the benefit amount, a 35% co-payment will be applied to service outside a Necesse Hospital Network. In the event of an emergency the admission must be authorised on the following workday after the admission, in which case the co-payment shall not apply.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.
  • Discovery Health KeyCare Plus & KeyCare Start Option,

    LA Health KeyCare Option,

    Quantum KeyCare Option & TFG Health Option:
  • The following procedures are covered for Discovery Health KeyCare Plus and KeyCare Start Option, LA Health KeyCare Option, Quantum KeyCare Option and TFG Health Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period.
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • A fluoride treatment for children under 12 years (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of up to two other teeth in the same part of your mouth more require authorisation
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option. Be aware that more than four fillings per year requires authorisation. More than 2 front teeth restorations per visit, require authorisation.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.

  • Discovery LA Health Focus & Anglo Med (Standard Core Plan):
  • The following procedures are covered for Discovery LA Health Focus and Anglo Med (Standard Core Plan):

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period.
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • A fluoride treatment for children under 12 years (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of up to four other teeth in the same part of your mouth more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option. Be aware that more than five fillings per year requires authorisation. More than 2 front teeth restorations per visit, require authorisation.
    • Plastic dentures are also covered (once every 4 years per beneficiary) – Pre-authorisation required.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Primary Care Option:
  • The following procedures are covered for Primary Care Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period.
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • A fluoride treatment for children under 12 years (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of up to two other teeth in the same part of your mouth more require authorisation
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • Only 2 posterior grey restorations are permitted per member and 1 anterior restoration per member is permitted. Be aware that more than four fillings per year requires authorisation. More than 2 front teeth restorations per visit, require authorisation.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Remedi Standard
  • Remedi Standard(Administered by Discovery) The following procedures are covered for Remedi Standard:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • A fluoride treatment for children under 12 years (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of each additional tooth in the same part of your mouth, more than 3 require authorisation
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option.
    • Be aware that more than three fillings per year requires authorisation. More than 2 front teeth restorations per visit, require authorisation

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Bankmed Basic Option
  • The following procedures are covered for Bankmed Basic Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • An examination is used to determine the cause of a specific dental problem, and to decide on how to treat it.
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • A fluoride treatment for children under 12 years (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of each additional tooth in the same part of your mouth, more than 3 require authorisation.
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option.
    • Be aware that more than three fillings per year requires authorisation. More than 2 front teeth restorations per visit, require authorisation
    • Plastic dentures are also covered – pre-authorisation required.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • NUFAWSA Standard & Select options,

    FURNMED Compulsory & Continuation Options:
  • The following procedures are covered for NUFAWSA Standard and Select options, FURNMED Compulsory and Continuation Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays are allowed for you in a visit. More than two intra-oral x-rays requires pre-authorisation. Only 1 black and white X-ray with a specific examination
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • The pulling (extraction) of a single tooth (1 per quadrant per visit)
    • The pulling (extraction) of up to one other tooth in the same part of your mouth (four and more require pre-authorisation).
    • The first phase of a root canal treatment, to relieve an infection or abscess
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. If you want a white filling, which is more expensive, you will need to pay the difference in cost between a grey filling and a white one.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Classic, Optimum and Classic Network Options:
  • The following procedures are covered for ,Classic, Optimum and Classic Network Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • Intra-Oral X-rays of your mouth. More than 7 per member per year requires pre authorisation
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • A fluoride treatment for adults (once every six months).
    • Your teeth can be treated for sensitivity, this can either be caused by hot or cold food.
    • You are allowed to remove one tooth per quadrant in your mouth. (maximum of 1 per quadrant).
    • A maximum of 7 teeth is allowed to be removed on each quadrant of your mouth. 4 per quadrant for children.
    • Grey/metal and/or white restorations are covered to a maximum of 3 teeth in a visit, if more restorations are required, they need to be pre-authorised.
    • Root canal treatment is covered for all the teeth and are subject to available funds.
    • Plastic Dentures (false teeth) are covered but require pre-authorisation and are subject to available funds
    • Specialised treatment is available for Crowns, Wisdom extractions but all require authorisation from Dental Risk Company and are subject to the availability of funds please see your member guide or contact your scheme to confirm available funds
    • Conscious sedation in the dentist’s room, usually when wisdom teeth are removed (pre-authorisation required).
    • General anaesthetic for surgery (pre-authorisation required).

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Pro-Pinnacle, Pro-Pinnacle Savvy, ProSecure Plus, ProSecure Plus Savvy, ProSecure, ProSecure Savvy, ProActive Plus and ProActive Plus Savvy:
  • The following procedures are covered for the traditional options named Pro-Pinnacle, Pro-Pinnacle Savvy, ProSecure Plus, ProSecure Plus Savvy, ProSecure, ProSecure Savvy, ProActive Plus and ProActive Plus Savvy:

    • All basic and specialised dentistry are covered subject to the available dentistry limit.
    • Only day to day procedures that are cosmetic in nature or listed as a scheme exclusion like bleaching will not be covered, kindly consult your member guide for the scheme exclusion list.
    • Specialised dentistry like crown and bridgework is covered up to the available dentistry limit. Although you do not need to pre-authorise, it is encouraged as it will give you a clearer indication of how much the treatment procedures cost and this we do encourage it as you will get a clearer understanding of how much is covered on expensive items that may exhaust your available benefit.
    • The Hospital Plan Options named ProActive Plus, and ProActive have the following procedures covered in hospital:
    • Hospital plans only cover extensive restorative treatment in hospital for children under 8 years old and Impacted wisdom removals.
    • Extensive restorative treatment in hospital for children under 8 years old and Impacted wisdom removals
    • ProActive Plus and ProActive Plus Savvy - Dental benefit is subject to day to day limits
    • ProActive and ProActive Savvy have a small day to day rand limited, which only covers basic dental procedures in dental rooms subject to availability of benefits. You need to contact your scheme to ascertain the Rand value.
    • Please ensure that the correct designated service providers are used when referring members on the Network based Savvy options to hospitals or specialists, as failure to do so will result in a member being liable to a R10 000 co-payment per admission

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Combined, Day to Day, Gold 2018, Platinum 2018, Titanium 2018, Classic, Gold Max, Platinum Max and Titanium Max:
  • The following procedures are covered on the Combined, Day to Day, Gold 2018, Platinum 2018, Titanium 2018, Classic, Gold Max, Platinum Max and Titanium Max:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • You are allowed to remove one tooth per quadrant in your mouth. (maximum of 1 per quadrant).
    • A maximum of 3 teeth is allowed to be removed on each quadrant of your mouth, if you require to remove more, pre-authorisation is required.
    • The first phase of a root canal treatment, to relieve an infection or abscess
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option. More than 3 fillings require pre-authorisation.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Chrome 2018, Primary Plus, Bronze 2018, Silver 2018, Platinum and Silver Max
  • The following procedures are covered on the Chrome 2018, Primary Plus, Bronze 2018, Silver 2018, Platinum and Silver Max:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • Polishing of your teeth once every six months.
    • Maximum of 3 extractions per annum.
    • More than 3 fillings require pre-authorisation (no cover for anterior restorations). Resin posterior covered to the value of amalgam restorations.
    • Please consult your member guide to confirm dental limits.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Silver Option
  • The following procedures are covered on the Silver Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of two intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months).
    • Maximum of 3 extractions per annum.
    • The first phase of a root canal treatment, to relieve an infection or abscess
    • Metal and white fillings are allowed. Maximum of 3 fillings per year

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Gold Option
  • The following procedures are covered on the Gold Option

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of three intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months).
    • The pulling (extraction) of a single tooth (up to five in one year).
    • Metal and white fillings are allowed. Maximum of 4 fillings per year
    • Root canal treatment (maximum of 1 tooth per year per member). Benefit include emergency root canal.
    • Surgical removal of Impacted teeth – Applicable on wisdom teeth only. Maximum of 2 extractions per year.
    • One crown (porcelain/ceramic) per year

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Platinum Option
  • The following procedures are covered on the Platinum Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of four intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months) and must be combined with a full mouth consultation.
    • Maximum of 7 extractions per annum.
    • Metal and white fillings are allowed. Maximum of 5 fillings per year.
    • Root canal treatment (maximum of 2 teeth per year per member). Benefit include emergency root canal.
    • Surgical removal of Impacted teeth – Applicable on wisdom teeth only. Maximum of 3 extractions per year.
    • Maximum of 2 crowns (porcelain/ceramic) per year.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Platinum Plus Option
  • The following procedures are covered on the Platinum Plus Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of four intra-oral X-rays per member, per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months) and must be combined with a full mouth consultation.
    • The pulling (extraction) of a tooth (up to seven in one year per member).
    • Metal and white fillings are allowed. Maximum of 5 fillings per year
    • Root canal treatment (maximum of 2 teeth per year per member). Benefit include emergency root canal.
    • Surgical removal of Impacted teeth – Applicable on wisdom teeth only. Maximum of 3 extractions per year.
    • Maximum of 2 crowns (porcelain/ceramic) per year.
    • One set of partial plastic dentures every 48 months is covered per member.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Topmed Network Option:
  • The following procedures are covered on the Topmed Network Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of seven intra-oral X-rays per member, per year. (Maximum of 2 films per visit per member)
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months).
    • A fluoride treatment for children (once every six months).
    • A fluoride treatment for adults (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of up to three other teeth in the same part of your mouth. More than 4 extractions per visit require pre-authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. (White fillings will be paid to the value of a metal filling). Pre Authorisation required for:
    • More than 3 restorations per visit.
    • More than 4 restorations per year.
    • More than 2 white fillings per visit on front teeth.
    • Plastic dentures are also covered - pre-authorisation require.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Plus and Value Options:
  • The following procedures are covered for Plus and Value Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat it (not within 4 weeks of a full mouth examination).
    • A maximum of seven intra-oral X-rays per member, per year. (Maximum of 2 films per visit per member).
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit.
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment
    • Cleaning and polishing of your teeth (once every six months).
    • A fluoride treatment for children (once every six months).
    • A fluoride treatment for adults (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of up to three other teeth in the same part of your mouth. More than two extractions per visit require pre-authorisation. Maximum seven per quadrant per permanent dentition and four per primary dentition.
    • Root canal treatment is covered for all permanent teeth. (2 per family per annum.)
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. (White fillings will be paid to the value of a metal filling). Pre Authorisation required for:
    • Back teeth - more than 3 restorations per visit.
    • More than 4 restorations per year.
    • More than 2 white fillings per visit on front teeth.
    • Pre Authorisation and x-rays required for more than 3 restorations per visit.

    Specialised Dentistry (e.g. Crowns & Bridgework, Plastic and Metal frame Dentures, Orthodontics, non-Surgical Periodontics and Implants) – Subject to pre-authorisation, treatment protocol and availability of specialised benefits.


    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Access and Essential Options:
  • The following procedures are covered for Access and Essential Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination).
    • A maximum of seven intra-oral X-rays per member, per year. (Maximum of 2 films per visit per member).
    • Two intra-oral X-rays per member, per full examination.
    • One intra-oral X-rays, per member, per consultation for specific problem.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Cleaning and polishing of your teeth (once every six months).
    • A fluoride treatment for children (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). More than two extractions per visit require pre-authorisation. Maximum seven per quadrant per permanent dentition and four per primary dentition.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. (White fillings will be paid to the value of a metal filling). Pre Authorisation required for:
    • Back teeth for more than 3 restorations per visit.
    • More than 4 restorations per year.
    • More than 2 white fillings per visit on front teeth.
    • Pre Authorisation and x-rays required for more than 3 restorations per visit.

    All clinically valid specialised dental treatment on the Access Option are covered from MSA (Medical Savings Account) including 1 set op plastic dentures per member every 4 years.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Plan B, Plan B Plus and Plan C Options:
  • The following procedures are covered for Plan B, Plan B Plus, Plan C and Plan D Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination).
    • Two intra-oral X-rays per member per visit.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • Cleaning and polishing of your teeth (once a year).
    • A fluoride treatment for members younger than 12 years (once every 6 months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit).
    • A maximum of 3 teeth is allowed to be removed on each quadrant of your mouth, if you require to remove more, pre-authorisation is required.
    • Only the first phase of a root canal treatment, to relieve an infection or abscess is covered.
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. (White fillings will be paid to the value of a metal filling). Pre Authorisation required for:
    • More than 4 restorations per year.
    • More than 2 white fillings per visit on front teeth.
    • Pre Authorisation and x-rays required for more than 2 anterior restorations per visit.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Top-Up Option:
  • The following procedures are covered for Top-Up Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six-month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination)
    • Two intra-oral X-rays per member per visit.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • Cleaning and polishing of your teeth (once a year).
    • A fluoride treatment for members younger than 12 years (once every 6 months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). Four or more extractions per annum require pre-authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. (White fillings will be paid to the value of a metal filling). Pre Authorisation required for:
    • More than 4 restorations per year.
    • More than 2 white fillings per visit on front teeth.
    • Pre Authorisation and x-rays required for more than 2 anterior restorations per visit.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Comprehensive and Day to Day Options:
  • The following procedures are covered for Comprehensive and Day to Day Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination).
    • Two intra-oral X-rays per member per year.
    • Gloves and masks for the dentist and his assistant are charged for each dental visit as a benefit. Maximum 2 per visit
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • A single injection to numb your mouth is allowed in a visit, this ensures you don’t experience pain during your treatment
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess. Not covered on primary teeth.
    • Metal and white fillings are allowed. Please consult your dentist and/or scheme on the amount of restorations permitted as per your benefit option. More than 3 fillings require pre-authorisation.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Prime Option
  • Please note Drum codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Prime Option:

    • Two full mouth examinations per year.
    • Two fillings per member per year.
    • Two Black-and-white X-rays of your mouth per member per year.
    • The pulling (extraction) of a tooth (up to two per member per year).
    • Emergency root canal treatment, maximum 2 events per year per member.
    • All specialised dentistry benefits must be pre-authorised.
    • Impacted wisdom teeth in the chair – 2 teeth per year.
    • Two temporary crowns per member per year

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Bronze Option

  • Please note Drum codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Bronze Option:

    • Three full mouth examinations per year.
    • Three fillings per member per year.
    • Three intra-oral X-rays per member per year.
    • The removal of two teeth is allowed per member per year.
    • Emergency root canal treatment, maximum of 3 events per member per year.
    • One Bite plate per annum.
    • One mouth Guard per 24-month cycle.
    • One PAN scan per member - Compulsory before any specialised dentistry can be authorised or paid.
    • All specialised dentistry benefits must be pre-authorised
    • Dentures – One full set per member in five years.
    • One temporary Crown per annum.
    • One crown per year

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Silver Option
  • Please note Drum codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Silver Option:

    • Four full mouth examinations per year.
    • Four fillings per member per year.
    • Five intra-oral X-rays per member per year.
    • The removal of three teeth is allowed per member per year.
    • Emergency root canal treatment, maximum of 3 events per member per year.
    • One Bite plate per annum.
    • One mouth Guard per 24-month cycle.
    • Cleaning and polishing of your teeth once per annum.
    • One PAN scan per member - Compulsory before any specialised dentistry can be authorised or paid.
    • All specialised dentistry benefits must be pre-authorised.
    • Root canal treatment, maximum of 2 events per member per year.
    • Impacted wisdom teeth in hospital – 2 teeth per year.
    • Impacted wisdom teeth in the chair – 4 teeth per year.
    • One crown (porcelain/ceramic) per year.
    • Two temporary Crowns per annum
    • One implants per year.
    • Dentures – One full set per member in five years.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Gold Option
  • Please note Drum codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Gold Option:

    • Five full mouth examinations per year.
    • Four fillings per member per year.
    • Six intra-oral X-rays mouth per member per year.
    • The removal of four teeth is allowed per member per year.
    • Emergency root canal treatment, maximum of 3 events per member per year.
    • One Bite plate per annum.
    • One mouth Guard per 24-month cycle.
    • Cleaning and polishing of your teeth every 6 months.
    • One PAN scan per member - Compulsory before any specialised dentistry can be authorised or paid.
    • All specialised dentistry benefits must be pre-authorised.
    • Root canal treatment, maximum of 3 events per member per year.
    • Impacted wisdom teeth in hospital – 4 teeth per year.
    • Impacted wisdom teeth in the chair – 4 teeth per year.
    • Three temporary Crowns per annum.
    • Two crowns (porcelain/ceramic) per year.
    • Two implants per year.
    • Dentures – One full set per member in five years.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Solution A
  • Please note that Stratum Codes will be paid to the maximum of the stated benefit. The following procedures are covered on Solution A:

    • Two full mouth examinations per year.
    • Two fillings per member per year.
    • Two intra-oral X-rays mouth per member per year.
    • The removal of two teeth is allowed per member per year.
    • Emergency root canal treatment, maximum 2 events per member per year.
    • All specialised dentistry benefits must be pre-authorised
    • Impacted wisdom teeth in the chair – 2 teeth per year.
    • Two temporary Crown per annum.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Solution B
  • Please note that Stratum Codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Solution B:

    • Four full mouth examinations per year.
    • Four fillings per member per year.
    • Five intra-oral X-rays per member per year.
    • The removal of three teeth is allowed per member per year.
    • Emergency root canal treatment, maximum 3 events per member per year.
    • One Bite plate per annum.
    • One mouth Guard per 24-month cycle.
    • Cleaning and polishing of your teeth once per annum.
    • One PAN scan per member - Compulsory before any specialised dentistry can be authorised or paid
    • All specialised dentistry benefits must be pre-authorised.
    • Root canal treatment, maximum of 2 events per year per member.
    • Impacted wisdom teeth in hospital – 2 teeth per year.
    • Impacted wisdom teeth in the chair – 4 teeth per year.
    • One crown (porcelain/ceramic) per year.
    • Two temporary Crowns per annum
    • One implants per year.
    • Dentures – One full set per member every five years.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Solution C
  • Please note that Stratum Codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Solution C:

    • Two full mouth examinations per year.
    • Two fillings per member per year.
    • Two intra-oral X-rays per member per year.
    • The removal of two teeth is allowed per member per year.
    • Emergency root canal treatment, maximum 2 events per member per year.
    • Cleaning and polishing of your teeth once per year.
    • One PAN scan per member - Compulsory before any specialised dentistry can be authorised or paid.
    • All specialised dentistry benefits must be pre-authorised.
    • Root canal treatment, maximum of 2 events per year per member.
    • Impacted wisdom teeth in hospital – 2 teeth per year.
    • Impacted wisdom teeth in the chair – 4 teeth per year.
    • One crown (porcelain/ceramic) per year.
    • One implant per year.
    • Dentures – One full set per member every five years.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Docsure Options
  • Please note all relevant codes are covered to the maximum of the stated benefit. The following procedures are covered on the Primary, Intermediate, Advance, Simunye and Dema-Sure:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (maximum of 2 per member per annum)
    • Two intra-oral X-rays per member per year.
    • The removal of two teeth is allowed per member per year.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey or metal filling at the back of the mouth, on one, two, three or four surfaces. Maximum of 2 fillings per year.
    • Surgical removal of Impacted teeth – Applicable on wisdom teeth only. Two per annum
    • Two crown (porcelain/ceramic) per year

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.

  • Medisec Options
  • Please note all relevant codes are covered to the maximum of the stated benefit. The following procedures are covered on the Private and Corporate Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • Single Member: 2 visits per annum
    • Family max 3: 4 visits per annum
    • Family max 5: 6 visits per annum in the next six months.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • MediClub Elite Option:
  • The following procedures are covered on the MediClub Elite Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination).
    • Two intra-oral X-rays per member, per year.
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 5 fillings require pre-authorisation.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Classic, Establish and Enhance Options:
  • The following procedures are covered on the Classic, Establish and Enhance Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat (not within 4 weeks of a full mouth examination).
    • Two intra-oral X-rays per member, per year,
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 4 fillings require pre-authorisation.

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Basic, Balance, Balance Plus, Boost Plus, Comprehensive, Day to Day, 55 Plus 4 U, Essential Lite, DD17, DD21, DD25 and DD29 Options:
  • The following procedures are covered on the Basic, Balance, Balance Plus, Boost Plus, Comprehensive, Day to Day, 55 Plus 4 U, Essential Lite, DD17, DD21, DD25 and DD29 Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays – 2 per member per consultation not more than 4 per year.
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 4 fillings require pre-authorisation. One restoration code per tooth number in a 9 month time period.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • DD33, DD37, DD41 and DD45 Options:
  • The following procedures are covered on the DD33, DD37, DD41 and DD45 Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays – 2 per member per consultation not more than 4 per year.
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 4 fillings require pre-authorisation. One restoration code per tooth number in a 9 month time period
    • One Root canal treatment is covered per member per year.
    • One crown (porcelain/ceramic) per member per 24 month period. Resin filling included.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • DD49, DD53, DD57 and DD61 Options:
  • The following procedures are covered on the DD49, DD53, DD57 and DD61 Options:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays – 2 per member per consultation not more than 4 per year.
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit).
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 4 fillings require pre-authorisation. One restoration code per tooth number in a 9 month time period.
    • Two Root canal treatment per year.
    • Two crown (porcelain/ceramic) per member per 24 month period. Resin filling included.
    • Specialised Benefit of R2000 limited to be applied in event of shortfall.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Student Protector Option:
  • The following procedures are covered on the Student Protector Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.


  • Essential Junior Option:
  • The following procedures are covered on the Essential Junior Option:

    • A full mouth examination checks the health of your teeth and gums and determines if any dental work needs to be done within the six month period (once every 6 months per member)
    • A specific examination is used to determine the cause of a specific dental problem, and to decide on how to treat. (not within 4 weeks of a full mouth examination).
    • Intra-oral X-rays – 2 per member per consultation not more than 4 per year.
    • Gloves for the dentist and his assistant, to prevent infection maximum of 2 per visit.
    • Sterilisation of the instruments to be used in your mouth (one per visit)
    • An injection to numb your mouth, so that you don’t experience pain during the treatment.
    • Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
    • A fluoride treatment for children under 12 years (once every six months).
    • Polishing your teeth (once every six months).
    • The pulling (extraction) of a single tooth (1 per quadrant per visit). The pulling (extraction) of teeth in the same part of your mouth, 4 and more require authorisation.
    • The first phase of a root canal treatment, to relieve an infection or abscess is covered.
    • A grey/metal/white filling at the back of the mouth, on one, two, three or four surfaces. More than 4 fillings require pre-authorisation.
    • Specialised Benefit of R1000 sedation in chair (Once per policy per lifetime) and R10 000 cover for braces with a network registered dentist (split over a 12 month period) only available once per child.

    If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 012-741 5101 for authorisation.