List of benefits

• A co-payment of R3430 is applicable per admission.
• Extensive dental treatment for children younger than 7 years - Member liable for Dentist account.

• Conservative/Basic Dentistry (Subject to available savings):
  Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to six quantities annually. More than six X-rays require pre-authorisation.Please contact us for a benefit check.
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per visit.
• Preventative Care: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation.
• Fluoride treatment for children only, covered once every six months. Limited to members from 5 to 13 years.Please contact us for a benefit check.
• Restorative Treatments: Fissure Sealants are covered and are limited to children older than 5 years and younger than 16 years of age.Applicable to permanent teeth only.
• Restorations: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. Managed care protocol rules apply. Please contact us for a benefit check.
• Extraction: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• 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 - Two partial frame denture (an upper and or a lower jaw) per member per 5 year period from date of service.Payable from members savings account.
• Pan Scan (Extra-oral x-ray) - One per member in a 3-year period from date of service. Benefit limited to members older than 5 years. Motivations will be accepted on case basis, please note that a motivation is not a guarantee of approval. Payable from members savings account.
• Crowns and Bridges: No benefits will 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. Payable from members savings account.
• Orthodontic treatment: Limited to members younger than 18 years. Only one member per family may commence with orthodontic treatment in a calendar year. 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. Payable from members savings account.
• 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. Payable from members savings account.
• 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). Payable from members savings account.

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

• Impacted teeth in the hospital. A co-payment of R3 560 is applicable per admission.
• Extensive dental treatment for children younger than 7 years. Once per lifetime. A co-payment of R3 560 is applicable per admission. Dental account payable from member’s Savings account.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to six quantities annually. More than six X-rays require pre-authorisation. Please contact us for a benefit check.
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per visit.
• Preventative Care: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation.
• Fluoride treatment for children only, covered once every six months. Limited to members from 5 to 13 years. Please contact us for a benefit check.
• Restorative Treatments: Fissure Sealants are covered and are limited to children older than 5 years and younger than 16 years of age. Applicable to permanent teeth only.
• Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. Managed care protocol rules apply, please contact us for a benefit check.
• The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• 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.

• Limited to the removal of impacted third molars once per lifetime – only covered for item codes 8941, 8943 and 8945.
• Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved.

• o Impacted teeth in the hospital - only covered for item codes 8941, 8943 and 8945. Once per lifetime
• Prime 3: R1500 per admission is applicable.
• Elite: R935 per admission is applicable.
• Extensive dental treatment for children younger than 7(seven) years Multi surface restorations require motivation when less than 3 teeth are involved. A co-payment of:
• MedPrime and MedPrime Elect: R1600 per admission is applicable.
• MedElite: R970 per admission is applicable.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to six quantities annually. More than six X-rays require pre-authorisation. Please contact us for a benefit check.
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per visit.
• Preventative Care: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation. .
• A fluoride treatment for children only, covered once every six month. Limited to members from 5 to 13 years. Please contact us for a benefit check.
• Restorative Treatments: Fissure Sealants are covered and are limited to children older than 5 years and younger than 16 years of age. Applicable to permanent teeth only.
• Restorations: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. Managed care protocol rules apply, Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• 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.

• Limited to the removal of impacted third molars once per lifetime – only covered for item codes 8941, 8943 and 8945.
• Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved.

• Impacted teeth in the hospital - only covered for item codes 8941, 8943 and 8945. Once per lifetime
• Extensive dental treatment for children younger than 7 years Multi surface restorations require motivation when less than 3 teeth are involved. Limited to once per 365 days per beneficiary.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 365 days per member from date of service.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to four quantities annually. Please contact us for a benefit check.
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per visit.
• Preventative Care: This includes polishing of children teeth aged younger than 12 years, covered once 365 days per member from date of service. Scale and polish of adult teeth from 12 years and older, covered once per 365 days per member from date of service. Please note that there is no benefits for oral hygiene instructions/evaluation.
• A fluoride treatment for children only, covered at one treatment annually. Limited to beneficiaries from 5 to 13 years. Please contact us for a benefit check.
• Restorative Treatments: Fissure Sealants are covered and are limited to children older than 5 years and younger than 16 years of age. Applicable to permanent teeth only.
• Restorations: Dental fillings/ restorations are covered at four quantities annually. Managed care protocol rules apply, Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Restorations: Fillings are 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).
• Incision and drainage of abscess. Limited to treatment in the consultation rooms.
• 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

• Impacted teeth in the chair: Limited to the removal of impacted third molars once per lifetime – only covered for item codes 8941, 8943 and 8945.
• Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved. Limited to 4 restorations annually per member. Services rendered by a network dental practitioner.

• Impacted teeth in the hospital: only covered for item codes 8941, 8943 and 8945. Once per lifetime.
• Extensive dental treatment for children younger than 7 years Multi surface restorations require motivation when less than 3 teeth are involved. Limited to 4 restorations annually per member. Limited to once every 365 days per beneficiary. 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.

• Conservative/Basic Dentistry (Subject to available savings):
  Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Please contact us for a benefit check. Payable from members savings account
• Oral radiographs: Intra-oral X-rays are limited to six quantities annually. More than six X-rays require pre-authorisation.Please contact us for a benefit check.Payable from members savings account
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per visit. Payable from members savings account
• Preventative Care: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there are no benefits for oral hygiene instructions/evaluation.
• Fluoride treatment for children only, covered once every six months. Limited to members from 5 to 13 years. Payable from members savings account. Please contact us for a benefit check.
• Restorative Treatments: Fissure Sealants are covered and are limited to children older than 5 years and younger than 16 years of age.Applicable to permanent teeth only. Payable from members savings account
• Restorations: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. Managed care protocol rules apply. Please contact us for a benefit check. Payable from members savings account
• Extraction: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Incision and drainage of abscess. Limited to treatment in the consultation rooms. Payable from members savings account
• Root canal treatment on permanent teeth limited to beneficiaries 12 years and older. Retreatment subject to pre-authorisation and managed care protocols. Payable from members savings account
• Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period from date of service. Payable from members savings account

• Metal frame dentures - Two partial frame denture (an upper and or a lower jaw) per member per 5 year period from date of service.Payable from members savings account.
• Pan Scan (Extra-oral x-ray) - One per member in a 3-year period from date of service. Benefit limited to members older than 5 years. Motivations will be accepted on case basis, please note that a motivation is not a guarantee of approval. Payable from members savings account.
• Crowns and Bridges: No benefits will 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. Payable from members savings account.
• Orthodontic treatment: Limited to members younger than 18 years. Only one member per family may commence with orthodontic treatment in a calendar year. 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. Payable from members savings account.
• 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. Payable from members savings account.
• 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). Payable from members savings account.

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

• Impacted teeth in the hospital. A co-payment of R3 560 is applicable per admission.
• Extensive dental treatment for children younger than 7 years. Once per lifetime. A co-payment of R3 560 is applicable per admission. Dental account payable from member’s Savings account.

• Benefits are subject to managed care and protocols. Services must be obtained from a network provider and an R110.00 co-payment on the benefit amount is applicable per consultation

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 365 days per member from date of service
• Oral radiographs: Intra-oral X-rays are limited to four x-rays per valid consultation. Please contact us for a benefit check.
• Gloves as infection control and prevention is covered to the maximum of 2 per visit.
• An injection and sterilisation of instruments are covered once per valid consultation.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven X-rays require pre-authorisation. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit subject to the following supporting treatments: Extraction, drainage of abscess
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation
• Fluoride treatment for members younger than 12 years and older than 12 years, covered once every six months (service codes vary). Please contact us for a benefit check.
• Extraction: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.
• Please note that specialised dentistry is not covered.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Maximum two x-rays per visit per member. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings. Sterilisation of instruments are covered once per visit subject to the following supporting treatments: Extraction, and drainage of abscess.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months.
• Scale and polish of adult teeth from 12 years and older, covered once every six months.Please note that there is no benefits for oral hygiene instructions/evaluation.
• Fluoride treatment for members younger than 12 years and older than 12 years, covered once every six months (service codes vary). Please contact us for a benefit check.
• Extraction: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.
• Please note dentures require pre-authorisation. No authorisation No cover, as late authorisation requests will not be accepted. One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period per member. No benefits shall be granted for any metal dentures (full or partial), including the laboratory cost
• Incision and drainage of abscess. Limited to treatment in the consultation rooms.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 365 days after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven X-rays require pre-authorisation. Maximum two X-rays per visit per member. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings. Sterilisation of instruments are covered once per visit subject to the following supporting treatments: Extraction, and drainage of abscess.
• Cleaning and polishing of your teeth (once every six months). This is only applicable for people over the age of 12 years.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation. Please contact us for a benefit check.
• Extraction: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per 365 days). Additional extractions are limited to 1 in the same quadrant per 365 days. Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities annually, more than three dental fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.
• Incision and drainage of abscess is covered. Limited to treatment in the consultation rooms.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member. When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Maximum two x-rays per visit per member. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation.
• Scale and polish of adult teeth from 12 years and older, covered once every six months.
• Please note that there is no benefits for oral hygiene instructions/evaluation.
• Fluoride treatment for members younger than 12 years and older than 12 years, covered once every six months (service codes vary). Please contact us for a benefit check.
• Extraction The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation. Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.

If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member. When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months) . Motivations received after the claim period will be rejected as stale. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Maximum two x-rays per visit per member. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months.
• Scale and polish of adult teeth from 12 years and older, covered once every six months. Please note that there is no benefits for oral hygiene instructions/evaluation. Fluoride treatment for members younger than 12 years and older than 12 years, covered once every six months (service codes vary). Please contact us for a benefit check.
• Extractions: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation. Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities annually, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.
• Please note dentures require pre-authorisation. No authorisation No cover, as late authorisation requests will not be accepted. One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 24 months per member. No benefits shall be granted for any metal dentures (full or partial), including the laboratory cost

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months.
• Scale and polish of adult teeth from 12 years and older, covered once every six months.
• Fluoride treatment for members younger than 12 years and older than 12 years, covered once every six months (service codes vary). Please contact us for a benefit check.
• Extractions: The pulling (non-surgical extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Root Canal Treatment Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. The completion of the Root Canal Treatment is only covered on permanent teeth subject to available limits (Pre-authorisation required) Please contact us for a benefit check.
• Restorative Treatments Dental fillings/ restorations are covered at three quantities per visit, more than three fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check
• Classic and Classic Network option:
  • Specialised dentistry (Subject to managed care protocols, pre-authorisation and available savings): Authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Please confirm available rand value limit/available savings with your scheme.
• Optimum option:
  • Specialised dentistry (Subject to managed care protocols, pre-authorisation and available savings): Authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Please confirm available rand value limit/available savings with your scheme.
• Please note dentures require pre-authorisation. One set of full/partial dentures (upper and/or lower jaw) per beneficiary per four years per member.
• Conscious sedation: In dentist’s rooms, Pre-authorisation required for wisdom removals. Managed care protocols apply.
• General anaesthetics for surgery: Pre-authorisation required. Managed care protocols apply.
• Please confirm available rand value limit/available savings with your scheme.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Emergency examination is covered subject to covered service code Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to two quantities annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months.
• Fluoride treatment for members younger than 12 years, covered once every six months. Please contact us for a benefit check.
• Extractions: Four extractions per year, more than 4 requires pre-authorisation.
• Emergency root canal treatment is covered on permanent teeth. No cover for root canal treatment completion. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities per annum. More than 3 restorations require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.

• Dental Limits for 2022:
  • Chrome and Affinity Reef – R1500 per annum
  • Bronze and Delta Max – R1750 per annum
  • Silver Max – R2000 per annum
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per annum.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Emergency examination is covered subject to covered service codePlease contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to two quantities annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per annum
• Scale and polish of adult teeth from 12 years and older, covered once per annum. Please contact us for a benefit check.
• Extractions: Three per member per annum.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities per annum. More than 3 restorations requires pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.

• Dental Limits for 2022:
  • Limited to R800 per event
  • Limited to R2400 per member per 18 months'per annum.
• Consultation: One full mouth examination is covered once per annum.
• Oral radiographs: Intra-oral X-rays are limited to three quantities annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Scale and polish: limited once per annum. Please contact us for a benefit check.
• Extractions: Three per member per annum.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities per annum.
• Surgical Removals: Surgical removals are only covered when authorised.
• Managed care protocol rules apply, please contact us for a benefit check.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period is applicable.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to two quantities annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months. Please contact us for a benefit check.
• Non-surgical Extractions: Three per member per annum.
• Emergency root canal treatment is covered on permanent teeth. Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.

If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period is applicable.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to three quantities per member annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months. Please contact us for a benefit check.
• Non-surgical Extractions: Five per member per annum.
• Emergency root canal treatment is covered on permanent teeth..
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. All benefits are subject to available funds and three months waiting period are applicable:
  • Root Canal Treatment – Maximum of 1 tooth per annum.
  • Impactions – Maximum of 2 extractions per annum. Applicable to Wisdom teeth only.
  • Crowns –1 Crown per annum.
• Completion of Root Canal Treatment is covered at one tooth per annum. Pre-authorisation required, please submit your request to auth@dentalrisk.com Please contact us for a benefit check

Please contact Dental Risk Company on 087-943 9611 for authorisation.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period is applicable.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to four quantities per member annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months. Please contact us for a benefit check.
• Non-surgical Extractions: Seven per member per annum.
• Emergency root canal treatment is covered on permanent teeth.
• Restorative Treatments: Dental fillings/ restorations are covered at five quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. All benefits are subject to available funds and three months waiting period are applicable:
  • Root Canal Treatment – Maximum of 2 tooth per annum.
  • Impactions – Maximum of 3 extractions per annum. Applicable to Wisdom teeth only.
  • Crowns – 2 Crown per annum.

Please contact Dental Risk Company on 087-943 9611 for authorisation.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period is applicable.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to four quantities per member annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months. Please contact us for a benefit check.
• Non-surgical Extractions: Seven per member per annum.
• Emergency root canal treatment is covered on permanent teeth.
• Restorative Treatments: Dental fillings/ restorations are covered at five quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. All benefits are subject to available funds and three months waiting period are applicable:
  • Root Canal Treatment – Maximum of 2 tooth per annum.
  • Impactions – Maximum of 3 extractions per annum. Applicable to Wisdom teeth only.
  • Crowns – 2 Crown per annum.
  • Dentures - One set of partial plastic dentures every 48 months per covered member to the maximum of the benefit.

Please contact Dental Risk Company on 087-943 9611 for authorisation.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once every 6 months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Please contact us for a benefit check.Protocol rules apply.
• One Pan scan is covered once per member per 24 months.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once every six months.
• Scale and polish of adult teeth from 12 years and older, covered once every six months.
• Fluoride treatment for members younger than 12 years covered once every six months. Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Root Canal Treatment: Benefit is subject to managed care protocol and limited to 2 treatments per family per annum. Only covered on permanent teeth. (Pre-authorisation required) Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Specialised dentistry (e.g Crowns, Bridgework, Dentures, Orthodontics, Impactions, Implants and non-surgical Periodontics) - Subject to pre-authorisation, treatment protocols and available savings: Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. All benefits are subject to available funds:
• Please note dentures require pre-authorisation. No authorisation No cover, as late authorisation requests will not be accepted One set of full/partial dentures (upper and/or lower jaw) per beneficiary per four years per member.
• Conscious sedation: in dentist’s rooms, Pre-authorisation required for wisdom removals and conservative dental treatment for children older than 5 years and younger than 12 years of age. Managed care protocols apply.
• General anaesthetics for surgery: Pre-authorisation required. Managed care protocols apply.
• Benefit is payable from hospital only in the following cases: Extensive conservative treatment for children under 7 years of age and more than 3 teeth involved (limited to once per 365 days per beneficiary). Removal of symptomatic impacted wisdom teeth if pre-authorised as a day case only. One event per person per lifetime

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Subject to managed care protocols.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities per member annually. Limited to three X-rays with a full mouth examination and one X-ray with a specific orientated consultation. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings. Sterilisation of instruments are covered once per visit subject to the following supporting treatments: drainage of abscess and extractions.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months.
• Fluoride treatment covered for members younger than 12 years once every six months. Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). Please contact us for a benefit check- Protocol rules apply
• Emergency root canal treatment is covered on permanent teeth.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Please note dentures require pre-authorisation. No authorisation No cover, as late authorisation requests will not be accepted. One set of full/partial dentures (upper and/or lower jaw) per member per four years.
• Conscious sedation: in dentist’s rooms, Pre-authorisation required for conservative dental treatment for children older than 5 years and younger than 12 years of age. Managed care protocols apply

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Subject to managed care protocols.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Please contact us for a benefit check. Protocol rules apply. One Pan scan is covered once per member per 3 years.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months.
• Fluoride treatment for members younger than 13 years covered once every six months. Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Root Canal Treatment: Benefit is subject to managed care protocol. Only covered on permanent teeth. Excluding wisdom teeth (3rd molars). (Pre-authorisation required) Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• One set of full/partial dentures (upper and/or lower jaw) per member per four years.
• Specialised dentistry (e.g Crowns, Bridgework, Dentures, Orthodontics, Impactions and non-surgical Periodontics) - Subject to pre-authorisation, treatment protocols. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims. Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review.
• Conscious sedation: In dentist’s rooms, Managed care protocols and pre-authorisation required for conservative dental treatment for children older than 5 years and younger than 12 years of age. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims.
• General anaesthetics for surgery: Pre-authorisation is required to managed care protocols. If authorisation is obtained after the procedure has been done, a 20% co-payment will be applied on the hospital account.
• General anaesthetic benefits are available for: Extensive conservative treatment for children under 5 years of age and more than 3 teeth involved (limited to once per 365 days per beneficiary). Removal of symptomatic impacted teeth

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Subject to managed care protocols.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Please contact us for a benefit check. Protocol rules apply. One Pan scan is covered once per member per 3 years.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months.
• Fluoride treatment for members younger than 13 years covered once every six months. Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Root Canal Treatment: Benefit is subject to managed care protocol. Only covered on permanent teeth. Excluding wisdom teeth (3rd molars). (Pre-authorisation required) Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• One set of full/partial dentures (upper and/or lower jaw) per member per four years.
• Specialised dentistry (e.g Crowns, Bridgework, Dentures, Orthodontics, Impactions and non-surgical Periodontics) - Subject to pre-authorisation, treatment protocols. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims. Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review.
• Conscious sedation: In dentist’s rooms, Managed care protocols and pre-authorisation required for conservative dental treatment for children older than 5 years and younger than 12 years of age. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims.
• General anaesthetics for surgery: Pre-authorisation is required to managed care protocols. If authorisation is obtained after the procedure has been done, a 20% co-payment will be applied on the hospital account.
• General anaesthetic benefits are available for: Extensive conservative treatment for children under 5 years of age and more than 3 teeth involved (limited to once per 365 days per beneficiary). Removal of symptomatic impacted teeth

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Subject to managed care protocols.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities annually. More than seven x-rays require pre-authorisation. Please contact us for a benefit check. Protocol rules apply. One Pan scan is covered once per member per 3 years.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: This includes polishing of children teeth aged younger than 12 years, covered once per six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six months.
• Fluoride treatment for members younger than 13 years covered once every six months. Please contact us for a benefit check.
• Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 4 extractions per visit require pre-authorisation.
• Root Canal Treatment: Benefit is subject to managed care protocol. Only covered on permanent teeth. Excluding wisdom teeth (3rd molars). (Pre-authorisation required) Please contact us for a benefit check.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum, more than four fillings will require pre-authorisation. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• One set of full/partial dentures (upper and/or lower jaw) per member per four years.
• Specialised dentistry (e.g Crowns, Bridgework, Dentures, Orthodontics, Impactions and non-surgical Periodontics) - Subject to pre-authorisation, treatment protocols. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims. Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review.
• Conscious sedation: In dentist’s rooms, Managed care protocols and pre-authorisation required for conservative dental treatment for children older than 5 years and younger than 12 years of age. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims.
• General anaesthetics for surgery: Pre-authorisation is required to managed care protocols. If authorisation is obtained after the procedure has been done, a 20% co-payment will be applied on the hospital account.
• General anaesthetic benefits are available for: Extensive conservative treatment for children under 5 years of age and more than 3 teeth involved (limited to once per 365 days per beneficiary). Removal of symptomatic impacted teeth

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Subject to pre-authorisation and treatment protocol.
• Conscious sedation: In dentist’s rooms, Managed care protocols and pre-authorisation required for conservative dental treatment for children older than 5 years and younger than 12 years of age. If authorisation is obtained after the procedure or treatment has been done, a 20% co-payment will apply to all related claims.
• General anaesthetics for surgery: Pre-authorisation is required to managed care protocols. If authorisation is obtained after the procedure has been done, a 20% co-payment will be applied on the hospital account.
• General anaesthetic benefits are available for: Extensive conservative treatment for children under 5 years of age and more than 3 teeth involved (limited to once per 365 days per beneficiary). Removal of symptomatic impacted teeth

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment.
• Rand values are overall limitations for dental benefits:
  • Plan B R1650 per family per annum.
  • Plan B plus R1650 per family per annum.
  • Plan C R1650 per family per annum.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per annum per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to two quantities annually. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments are covered once per visit.
• Cleaning: Scale and polish of adult teeth from 12 years and older, covered once per annum.
• Fluoride treatment is covered once per six months for members younger than 12 years. Please contact us for a benefit check.
• Non-surgical Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit) Maximum of three non-surgical extractions per member per annum. Please contact us for a benefit check- Protocol rules apply
• Emergency root canal treatment is covered on permanent teeth.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment.
• Consultation: A full mouth examination for clinical assessment which includes a treatment plan is covered once per annum per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Motivations may be required in case of extensive dental conservative services. Motivations are to be submitted within the claim period (4 months). Motivations received after the claim period will be rejected as stale.
• Emergency examination is covered subject to covered service codes. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to seven quantities per member annually. Limited to three X-rays with a full mouth examination and one X-ray with a specific orientated consultation. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings. Sterilisation of instruments are covered once per visit subject to the following supporting treatments: drainage of abscess and extractions.
• Cleaning This includes polishing of children teeth aged younger than 12 years, covered once every six months.
• Scale and polish of adult teeth from 12 years and older, covered once per six month per member.
• Fluoride treatment is covered once per six months for members younger than 12 years. Please contact us for a benefit check.
• Non-surgical Extractions: The pulling (extraction) of a single tooth (1 per quadrant per visit). Please contact us for a benefit check- Protocol rules apply.
• Emergency root canal treatment is covered on permanent teeth.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment.
• Consultation: Three consultations per member per year. Full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to two quantities per member annually. Please contact us for a benefit check.Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments is covered once per visit.
• Cleaning: No Cover.
• Non-surgical Extractions: The pulling (extraction) of a single tooth, maximum two per year.. Please contact us for a benefit check- Protocol rules apply.
• Restorative Treatments: Dental fillings/ restorations are covered at two quantities per annum. Managed care protocol rules apply, Please contact us for a benefit check.
• Trauma: covered to the maximum stated benefits. Once per year at R16 770.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period applicable.
• Consultation: Three consultations per member per year. Full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to three quantities per member annually.
• Pan scans are covered once per lifetime. Please contact us for a benefit check. Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments is covered once per visit.
• Cleaning: A polish is covered once per annum for members younger than 12 years.
• Scale and polish of adult teeth from 12 years and older, covered once per annum. Please contact us for a benefit check.
• Non-surgical Extractions The pulling (extraction) of a single tooth, maximum two per year. Please contact us for a benefit check- Protocol rules apply
• Emergency root canal treatment is covered on permanent teeth. Maximum of two annually.
• Restorative Treatments: Dental fillings/ restorations are covered at three quantities per annum Managed care protocol rules apply, please contact us for a benefit check.
• Mouth guard: one per member per annum
• Bite plate: one per member per annum.
• Temporary Crown : Including lab costs, 1 per member per annum. Pre-authorisation is required, submit request to auth@dentalrisk.com
• Dentures: One full set of plastic dentures per member every 5 years. All specialised dentistry must be pre-authorised and are paid according to the stated benefit
• Trauma: covered to the maximum stated benefits. Once per year at R26 200.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Three months waiting period applicable.
• Consultation: Four consultations per member per year. Full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to five quantities per member annually.
• Pan scans are covered once per lifetime. Please contact us for a benefit check- Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments is covered once per visit.
• Cleaning: A polish is covered once per annum for members younger than 12 years.
• Scale and polish of adult teeth from 12 years and older, covered once per annum. Please contact us for a benefit check.
• Non-surgical Extractions: The pulling (extraction) of a single tooth, maximum three per year. Please contact us for a benefit check. Protocol rules apply.
• Emergency root canal treatment is covered on permanent teeth. Maximum of three annually.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.
• Root Canal Treatment: Maximum of two root canal treatments per annum , pre-authorisation required. No late authorisation requests will be accepted.
• Mouth guard: One per member per annum.
• Bite plate: One per member per annum.
• Specialised dentistry (Subject to managed care protocols and pre-authorisation and are paid according to the state benefits. Six months waiting period applicable on all specialised dentistry.): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. No late authorisation requests will be accepted.
• Crown: Including lab costs, 1 per member per annum.
• Temporary Crown: Including lab costs, 2 per member per annum. Pre-authorisation is required, submit request to auth@dentalrisk.com
• Dentures: One full set per member per five years' period.
• Implants: One implant per member per annum.
• Impactions (In the rooms): Maximum of 4 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48)
• Impactions (In Hospital): Maximum of 2 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48)
• Trauma: covered to the maximum stated benefits. Once per year at R26 200.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Consultation: Five consultations per member per year. Full mouth examination for clinical assessment which includes a treatment plan is covered once per six months per member.
• When the full mouth examination is not available, a distinct/alternative consultation which excludes a treatment plan may be charged once per 4 weeks after the previous consultation. Please contact us for a benefit check.
• Oral radiographs: Intra-oral X-rays are limited to six quantities per member annually.
• Pan scans are covered once per lifetime. Please contact us for a benefit check.Protocol rules apply.
• Gloves and mask as infection control and prevention is covered to the maximum of 2 per visit.
• An injection is covered once per visit. Sterilisation of instruments is covered once per visit.
• Cleaning: A polish is covered once per six months for members younger than 12 years.
• Scale and polish of adult teeth from 12 years and older, covered once per six months. Please contact us for a benefit check.
• Non-surgical Extractions: The pulling (extraction) of a single tooth, maximum four per year. Please contact us for a benefit check- Protocol rules apply.
• Emergency root canal treatment is covered on permanent teeth. Maximum of three annually.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, please contact us for a benefit check.
• Mouth guard: one per member per annum.
• Bite plate: one per member per annum.
• Specialised dentistry (subject to managed care protocols and pre-authorisation and are paid according to the state benefits. Six months waiting period applicable on all specialised dentistry): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. No late authorisation requests will be accepted.
• Impaction(In the rooms) : Maximum of 4 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48)
• Impaction(In Hospital) :Maximum of 4 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48).
• Crowns: Including lab costs, two teeth per member per annum. At the value of R4000 per crown.
• Dentures: One full set per member per five years' period.
• Implants: Two implants per member per annum.
• Trauma : covered to the maximum stated benefits. Once per year at R26 200.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Conservative/Basic Dentistry (Subject to managed care protocols): Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. Six months waiting period applicable.
• Consultation: A full mouth examination for clinical assessment which include a treatment plan is covered once per six months per member.
• Oral radiographs: The pulling (extraction) of a single tooth, only 1 per quadrant. Authorisation required for more than four extrations. Please contact us for a benefit check. Protocol rules apply.
• Non-surgical Extractions: The pulling (extraction) of a single tooth, maximum two per year. Please contact us for a benefit check- Protocol rules apply.
• Emergency root canal treatment is covered on permanent teeth. Maximum of two annually.
• Restorative Treatments: Dental fillings/ restorations are covered at four quantities per annum. Pre-authorisation required for more than 4 restorations per annum. No late pre-authorisation requests will be accepted. Managed care protocol rules apply, Please contact us for a benefit check.

Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

• Limited to R800 per event.
• Limited to R2400 per member per 18 months’ period.
• Emergency treatment.
• Removal of teeth covered to maximum 4 per visit.
• One surgical removal subject to pre-authorisation with supporting documents.

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 087-943 9611 for authorisation.

• 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).
• Intra-Oral X-rays of your mouth. Only 7 per member per year, more requires motivation.
• Pan Scan (Extra-oral x-ray) - One per beneficiary per year from date of service.
• Gloves for the dentist and his assistant, to prevent infection (max of 2 per visit).
• Sterilisation of the instruments to be used in your mouth (max of 1 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 patients 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).
• Fissure sealant for children older than 5 years and younger than 18 years. Limited to permanent molars and pre-molars. Not within 2 years of previous treatment.
• The pulling (extraction) of a single tooth (1 per quadrant per visit). More than 5 extractions require motivation and pre-authorisation.
• Metal and white fillings subject to dental protocol are covered (4 restorations per year). Pre-authorisation required for:
  • More than four fillings per year.
  • Once per tooth number in 365 days from date of service.
• All specialised dentistry are subject to managed care protocols, pre-authorised and annual day to day Special dental limits
• Root canal treatment on permanent teeth only.
  Exclusion: Emergency root canal/pulp removal (polypectomy) charged on the same day as complete therapy. Rubber dam per arch.
• Plastic Dentures – One set of full/partial dentures (upper and/or lower jaw) per beneficiary per 4-year period from date of service No cover for metal frame dentures.
• Crowns and Bridges: Limited to I crown per tooth number every 5 years.
  Exclusions: Composite or porcelain veneers. Laboratory fabricated crowns are not covered on primary tooth or third molars. Clear, well defined (no cone cutting) radiographs are required to support crown authorisations. Subject to availability of funds please see your member guide or contact your scheme to confirm available funds.
• Maxillofacial surgery: Limited to certain maxillofacial procedures.
• Implants - No benefits
• Orthodontic treatment: Benefits are applicable to functional treatment for beneficiaries younger than 18 years.
  Exclusions: Re-treatment, loss of appliances, repair, remounting or replacement of fixed orthodontic brackets is not covered. Lingual or ceramic orthodontist brackets are not covered.
• Conscious sedation in the dentist’s room. Benefits are subject to managed care protocols and pre-authorisation. Procedure must be covered for sedation benefit to be payable.

Dental Services/surgery rendered in Hospital (General anaesthesia):
Benefits are subject to managed care protocols and pre-authorisation. Limited to available overall annual hospital benefit.

• Removal of impacted third molars. Once per lifetime
• Extensive dental treatment for children younger than 7 years. Benefits are limited to extensive dental treatment (more than 3 teeth) in accordance with managed care protocols.

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 087-943 9611 for authorisation.

• 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 087-943 9611 for authorisation.

• Consultation: 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).
• Oral Radiographs: 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: 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).
• 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.
• 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.
• Restoration: Dental fillings/restorations are covered but pre-authorisation required for more than 4 restorations per year. 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 087-943 9611 for authorisation.

• Consultation: 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).
• Oral Radiographs: IIntra-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: 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).
• Extractions: 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.
• 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
• Restoration: Dental fillings/restorations are covered but pre-authorisation required for more than 4 restorations per year. One restoration code per tooth number in a 9 month time period
• Root Canal Treatment: One Root canal treatment is covered per member per year.
• Crown: One crown (porcelain/ceramic) per member per 24 month period.

If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.

• Consultation: 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).
• Oral radiographs: 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: 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).
• Extraction: 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.
• 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.
• Restorations: Dental Fillings/restorations are covered. Pre-authorisation required for more than 4 restorations per year. One restoration code per tooth number in a 9 month time period.
• Root Canal Treatment: Two Root canal treatments per year. Please contact us for a benefit check. Protocol rules apply.
• Crowns: Two crown (porcelain/ceramic) per member per 24 month period. Please contact us for a benefit check. Protocol rules apply.
• Dentures: One denture to the value of R2000 per policy per annum

If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.

• Limited to R800 per event.
• Limited to R2400 per member per 18 months’ period.
• One full mouth examination is covered annually.
• One scale and polish per annum
• Removal of teeth covered to maximum 3 per visit.
• Three restorations are covered annually.
• Surgical removal subject to pre-authorisation with supporting documents.

Please consult your member guide for rand value limitations Kindly contact Dental Risk Company on 087-943 9611 for more information.

Please note that there is a three months waiting period applicable to obtain cover for the following benefits:

• Full Mouth Examination: Covered once per member per annum.
• Infection control such as gloves, sterilisation of instruments, and an injection per visit.
• Cleaning of teeth: Scale and polish for patients older than 12 years, covered once per member per annum. Polish for patients younger than 12 years, covered once per member per annum.
• Intra-oral radiographs: maximum of two quantities covered per member per annum.
• Basic extractions: maximum of two extractions are covered per member per annum.
• Restorations: maximum of 2 restorations are covered per member per annum. DRC protocol rules apply.

Kindly note that there is a claim period of four months. Claims submitted after the four months, accounts will be rejected as stale. Network providers are to confirm benefits online or contact our call centre to confirm benefits.

For any queries relating to this scheme, please send your response to enquiries@dentalrisk.com