List of benefits

(click to expand)

  • Prime 1 & Prime 1 Hospital Network:
  • The following procedures are covered on the Prime 1 and Prime 1 Hospital Network Option:

    Please note that there is no cover for conservative dentistry or specialised dental services. Dental surgery in the dentist rooms are limited to removal of Impacted teeth. Sedation for extensive dental treatment for children younger than 12 years will not be covered.

    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocol and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (subject to approved codes).

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

    Dental Services/surgery rendered in Hospital (General Anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable. Limited to extensive dental treatment for children younger than 7 years once per 365 days and the removal of impacted third molars in hospital. Members that have selected the Network option for Prime 1 and have selected to use an out of network hospital, will have an extra co-payment of 35%. Only 65% of the hospital account will be covered according to the scheme tariff.

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

    Kindly refer to your member guide for rand value limitations. Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information


    Contact Our Team:
    Enquiries – medihelp@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Prime 2, Prime 2 Hospital Network & Unify:
  • NB All conservative dental treatment are payable from members savings 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.


    The following procedures are covered on the Prime 2 and Unify Option:
    • 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.


    Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Failure to obtain pre-authorisation for the following procedures will result in a 20% co-payment on scheme tariff/ approved service codes:

    • 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.
    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Limited to removal of impacted third molars once per lifetime – only covered for item codes 8941, 8943 and 8945. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes).

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

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.Members that have selected the Network option for Prime 2 and use an out of Network Hospital, will have an extra co-payment of 35%. We will only cover 65% of the hospital account according to scheme tariff.

    • Impacted teeth in the hospital. A co-payment of R3430 is applicable per admission.
    • Extensive dental treatment for children younger than 7 years. Once per lifetime. A co-payment of R3 430 is applicable per admission. Dental account payable from member’s Savings account.

    Kindly refer to your member guide for rand value limitations.Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.


    Contact Our Team:
    Enquiries – medihelp@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Prime 3 and Prime 3 Hospital Network & Elite:
  • 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. The following procedures are covered on the Prime 3, Prime 3 Hospital Network and Elite Option:

    • 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.
    • Extractions: 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.

    Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Failure to obtain pre-authorisation for the following procedures will result in a 20% co-payment on scheme tariff/ approved service codes:

    • Metal frame dentures must be pre-authorised.
    • Prime 3 - One partial frame denture (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Elite - Two partial frame dentures (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits shall be granted on crowns or crown retainers on third molars and Pontics on second molars. Clear, well defined (no cone-cutting) radiographs are required to support crown authorisations.
    • Prime 3: One crown annually per family, limited to once per tooth per 5 year period from date of service.
    • Elite: Two crowns annually per family, limited to once per tooth per 5 year period from date of service
    • Orthodontic treatment: Limited to beneficiaries younger than 18 years. Failure to pre-authorise orthodontic treatment shall result in benefits only being granted from the date of authorisation for the remaining month of treatment, provided that the treatment is approved as per managed care protocols.
    • Prime 3: R9350 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year
    • Elite: R12 260 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year
    • Periodontic treatment: Periodontic treatment is limited to conservative, non-surgical therapy only. This benefit will be applied to members who qualify for and are registered on the Periodontal Programme via standard pre-authorisation channels.
    • Maxillofacial surgery and oral pathology: Limited to certain maxillofacial procedures.
    • Implants - No benefits
    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • 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.

    Dental Services/surgery rendered in Hospital (General anaesthesia):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.Members that have selected the Network option for Prime 3 and use an out of Network Hospital, will have an extra co-payment of 35%. We will only cover 65% of the hospital account according to scheme tariff

    • 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 years Multi surface restorations require motivation when less than 3 teeth are involved. A co-payment of:
    • Prime 3: R1500 per admission is applicable.
    • Elite: R935 per admission is applicable.

    Kindly refer to your member guide for rand value limitations.Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.


    Contact Our Team:
    Enquiries – medihelp@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Plus Options:
  • 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. The following procedures are covered on the Plus Option:

    • 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.

    Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Failure to obtain pre-authorisation for the following procedures will result in a 20% co-payment on scheme tariff approved service codes:
    • Metal frame dentures must be pre-authorised. Two partial frame dentures (an upper and or a lower jaw) per beneficiary per 5 year period from date of service.
    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service. 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.
    • Crowns and Bridges: No benefits shall be granted on crowns or crown retainers on third molars and Pontics on second molars. Clear, well defined (no cone-cutting) radiographs are required to support crown authorisations.
    • Three crowns annually per family, limited to once per tooth per 5 year period from date of service
    • Three crowns annually per family, limited to once per tooth per 5 year period from date of service.
    • Orthodontic treatment: Limited to beneficiaries younger than 18 years. Failure to pre-authorise orthodontic treatment shall result in benefits only being granted from the date of authorisation for the remaining month of treatment, provided that the treatment is approved as per managed care protocols. R15 270 per beneficiary per lifetime, limited to patients younger than 18 years. Only one beneficiary per family may commence with orthodontic treatment in a calendar year.
    • Periodontic treatment: Is limited to conservative, non-surgical therapy only. This benefit will be applied to members who qualify for and are registered on the Periodontal Programme via standard pre-authorisation channels.
    • Maxillofacial surgery and oral pathology: Limited to certain maxillofacial procedures.
    • Implants - Implant benefit is limited only to the placement of the implant components and does not cover any surgeries associated with bone augmentation. Implant supported dentures and crowns will be covered from the applicable (if available) denture and crown benefits. No benefits shall be granted on implants on wisdom teeth (third molars). Two implants per beneficiary per 5-year period. Benefits for the implant components are limited to R2600 per implant.
    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • 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.

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

    • Impacted teeth in the hospital - 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.

    Kindly refer to your member guide for rand value limitations. Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.


    Contact Our Team:
    Enquiries – medihelp@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Necesse Options (NB: This is a network option, only Network Providers and Hospitals)
  • The following procedures are covered on Necesse Options (NB: This is a network option, only Network Providers and Hospitals):

    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. The following procedures are covered on the Plus Option:

    • 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

    Specialised dentistry (Subject to managed care protocols and pre-authorisation): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. Failure to obtain pre-authorisation for the following procedures will result in a 20% co-payment on scheme tariff approved service codes:

    • Pan Scan (Extra-oral x-ray) - One per beneficiary in a 3-year period from date of service.
    • Crowns and Bridges: No benefits.
    • Orthodontic treatment: No Benefits
    • Periodontic treatment: No Benefits
    • Maxillofacial surgery and oral pathology: Limited to PMB. Treatment must be pre-authorised and benefits are subject to clinical protocols
    • Implants: No Benefits
    Dental Services/surgery rendered in the dentist rooms (Conscious Sedation):
    Benefits are subject to managed care protocols and pre-authorisation. Failure to pre-authorise the procedure will result in a 20% co-payment on scheme tariff (of approved codes). Procedure must be covered for sedation benefit to be payable.

    • Impacted teeth in the chair: No Benefits
    • Extensive dental treatment for children younger than 12 years. More than 3 teeth needs to be involved. Limited to 4 restorations annually per member. Services rendered by a network dental practitioner.

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

    • Impacted teeth in the hospital: No Benefits
    • Extensive dental treatment for children younger than 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.

    Kindly refer to your member guide for rand value limitations. Dentists or members are advised to contact our DRC client service team on 087 943 9611 for further information.

    Contact Our Team:
    Enquiries – medihelp@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Discovery Health KeyCare Plus & KeyCare Start Option,

    LA Health KeyCare Option,

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

    Conservative/Basic Dentistry: Providers are to contact our call centre for benefits confirmation on 087 93 9611 prior to treatment. All members are to visit a contracted dentist. Claims submitted by non-network dentists will be rejected. The following procedures are covered:

    • 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. PPE increased rate only applicable until further notice.
    • 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.

    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Discovery LA Health Focus & Anglo Med (Standard Care Plan)
  • The following procedures are covered for Discovery LA Health Focus and Anglo Med (Standard Care Plan):

    • 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. PPE increased rate only applicable until further notice.
    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Primary Care Option (Active, Advanced and Household)
  • The following procedures are covered for Primary Care Option (Active, Advance and Household):

    • 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. PPE increased rate only applicable until further notice.
    • 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.
    • 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 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Discovery Flexicare (Flexicare and Flexicare Plus Options)
  • The following procedures are covered for Discovery Flexicare (Flexicare and Flexicare Plus Options):

    • 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. PPE increased rate only applicable until further notice.
    • 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.
    • 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 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Remedi Standard
  • Remedi Standard(Administered by Discovery) The following procedures are covered for Remedi Standard:

    • 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. PPE increased rate only applicable until further notice.
    • An injection is covered once per visit subject to the following supporting treatments: extractions, and fillings. 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. 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Bankmed Basic Option
  • The following procedures are covered for Bankmed Basic Option:

    • 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. PPE increased rate only applicable until further notice.
    • 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.
    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Classic, Optimum and Classic Network Options:
  • The following procedures are covered for , Classic, Optimum and Classic Network Options:

    • 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
    • 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:
    • 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. Managed care protocols apply.
    • General anaesthetics for surgery: Pre-authorisation required. Managed care protocols apply.
    • Crowns and Bridges, Orthodontic treatment, bite plates and implants must be pre-authorised and will be covered as per the available savings. Contact us for benefit check.
    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Pro-Pinnacle, Pro-Pinnacle Savvy, ProSecure Plus, ProSecure Plus Savvy, ProSecure, ProSecure Savvy, ProActive Plus and ProActive Plus Savvy:
  • The following procedures are covered for the traditional options named Pro-Pinnacle, Pro-Pinnacle Savvy, ProSecure Plus, ProSecure Plus Savvy, ProSecure, ProSecure Savvy, ProActive Plus and ProActive Plus Savvy:

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

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Combined, Day to Day, Gold Max, Platinum Max and Titanium Max:
  • The following procedures are covered on the Combined, Day to Day, Gold Max, Platinum Max and Titanium Max:

    • 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. 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.

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Chrome, Bronze, Silver Max, Affinity Reef and Delta Max:
  • The following procedures are covered on the Chrome, Bronze, Silver,Affinity Reef and Delta Max:

    • Dental Limits for 2021:
      • 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.

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Silver Option
  • The following procedures are covered on the Silver Option:

    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Gold Option
  • The following procedures are covered on the Gold Option

    • 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:
    • 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
    • Impaction removals, crowns are covered subject to pre-authorisation. Managed care protocols apply.

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Platinum Option
  • The following procedures are covered on the Platinum Option:

    • 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:
    • Completion of Root Canal Treatment is covered at two teeth per annum. Pre-authorisation required, please submit your request to auth@dentalrisk.com Please contact us for a benefit check
    • Impaction removals, crowns are covered subject to pre-authorisation. Managed care protocols apply.

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Platinum Plus Option
  • The following procedures are covered on the Platinum Plus Option:

    • 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:
    • Completion of Root Canal Treatment is covered at two teeth per annum. Pre-authorisation required, please submit your request to auth@dentalrisk.com Please contact us for a benefit check
    • Impaction removals, dentures, crowns are covered subject to pre-authorisation. Managed care protocols apply.

    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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Plus, Value Options and Value Core Options:
  • The following procedures are covered for Plus, Value Options and Value Core Options:

    • 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: 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. (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 (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:
    • 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. Managed care protocols apply.
    • General anaesthetics for surgery: Pre-authorisation required. Managed care protocols apply.
    • Crowns and Bridges, Orthodontic treatment, bite plates and implants must be pre-authorised and will be covered as per the available savings. Contact us for benefit check.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Access and Essential Options:
  • The following procedures are covered for Access and Essential Options:

    • 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.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Plan B, Plan B Plus and Plan C Options:
  • The following procedures are covered for Plan B, Plan B Plus, Plan C and Plan D Options:

    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Top-Up Option:
  • The following procedures are covered for Top-Up Option:

    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Prime Option
  • Please consult your member guide for rand value limitations as certain codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Prime Option:

    • 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 000.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Bronze Option

  • Please consult your member guide for rand value limitations as certain codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Bronze Option:

    • 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 R25 000.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Silver Option
  • Please consult your member guide for rand value limitations as certain codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Silver Option:

    • 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): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. No late authorisation requests will be accepted. All benefits are subject to available funds and six months waiting period are applicable:
    • Temporary Crown: Including lab costs, 1 per member per annum. Pre-authorisation is required, submit request to auth@dentalrisk.com
    • Crown: Including lab costs, 1 per member per annum. Pre-authorisation is required, submit request to auth@dentalrisk.com
    • Dentures: One full set per member per five years period, at the value of R3000
    • Implants: One implant per member at the value of R5000
    • Impactions (In the rooms): Benefits are subject to managed care protocols and pre-authorisation. Maximum of 4 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48)
    • Impactions (In Hospital): Benefits are subject to managed care protocols and pre-authorisation. 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 R25 000.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Gold Option
  • Please consult your member guide for rand value limitations as certain codes will be paid to the maximum of the stated benefit. The following procedures are covered on the Gold Option:

    • 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): Pre-authorisation requests are to be submitted to auth@dentalrisk.com for clinical review. No late authorisation requests will be accepted. All benefits are subject to available funds and six months waiting period are applicable. Managed care protocol rules apply:
    • Root Canal Treatment : maximum of three per annum, pre-authorisation required. No late authorisation requests will be accepted.
    • Impaction(In the rooms) :Benefits are subject to managed care protocols and pre-authorisation. Maximum of 4 extractions per year. Applicable to Wisdom teeth only (tooth 18, 28, 38 and 48)
    • Impaction(In Hospital) :Benefits are subject to managed care protocols and pre-authorisation. 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, at the value of R3500
    • Implants: Two implants per member at the value of R6000 each.
    • Trauma : covered to the maximum stated benefits. Once per year at R25 000.

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


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • Comprehensive Advanced, Comprehensive Plus, Comprehensive Standard and Primary Standard
  • The following procedures are covered on the Comprehensive Advanced, Comprehensive Plus, Comprehensive Standard and Primary Standard Options

    Please note all relevant codes are covered to the maximum of the stated benefit on the following Docsure Options: Comprehensive Advanced, Comprehensive Plus, Comprehensive Standard and Primary Standard:

    • 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.

    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • NBCRFLI Option
  • The following procedures are covered on NBCRFLI:

    • 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.

  • Option A and Option B Plus
  • The following procedures are covered on Option A and Option B Plus:

    • 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.

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

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

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.


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

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

    Please consult your member guide for rand value limitations If you need more dental work than is listed here, you will need to contact the Dental Risk Company on 087-943 9611 for authorisation.


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

    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • DD33, DD37, DD41 and DD45 Options:
  • The following procedures are covered on the DD33, DD37, DD41 and DD45 Options:

    • 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).
    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • DD49, DD53, DD57 and DD61 Options:
  • The following procedures are covered on the DD49, DD53, DD57 and DD61 Options:

    • 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.


    Contact Our Team:
    Enquiries – enquiries@dentalrisk.com
    Authorisation requests – auth@dentalrisk.com
    Claim submissions – claims@dentalrisk.com
  • NBCPSS
  • The following procedures are covered on NBCPSS (National Bargaining Council for the Private Security Sector):

    • 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.