Dental Insurance – South Africa

Depending on the procedure, a visit to the dentist can be out of budget and therefore quite costly.

This gap can be successfully filled by purchasing a dental insurance policy that can fill the gap and ensure that crucial dental work is not delayed (or worse still, ignored) as a result of the costs associated with it. In addition, increasingly rising medical costs and insufficient medical cover, many South Africans are excluded from affordable, professional and quality primary health care services, which includes basic dentistry. South Africans are also increasingly becoming aware of the critical role of dentistry – combined with good oral hygiene – in continued good oral health.

Dental insurance can fill the gap!

Medical schemes that do not pay dental benefits from their risk pools either provide no cover for dentistry or expect members to fund these costs from their medical savings accounts. Few members maintain positive balances in these accounts, because the funds are often inadequate for their day-to-day expenses for the year.

Looking at the estimated price ranges of some of the more expensive dental procedures (that vary greatly in complexity and also between dentists), and as indicated in a recent article and provided by Dental Risk Company, a company that manages dental benefits on behalf of medical schemes, it becomes clear why South Africans are increasingly out of pocket for visiting the dentist:

  • A root canal: R900 to R2 500
  • A crown: R2 500 to R4 500
  • An implant (done in a dentist’s rooms): R8 000 to R13 000
  • An implant that requires bone augmentation: R20 000 to R25 000, plus R10 000 for theatre costs;
  • Removal of four wisdom teeth: R12 000 to R20 000 if done in hospital, R10 000 to R15 000 in a day clinic, or R7 500 to R9 000 in the dentist’s chair under conscious sedation
  • Orthodontic treatment (device only; some patients require extractions as well): R12 000 to R25 000.

While dental insurance is unlikely to cover an entire dental procedure, having a dental insurance policy could make the difference between you going for the most appropriate dental procedure that you need and a less expensive option that might not fulfil your needs. Having dental insurance will provide you with comfort when you need it, provided you know your dental needs and carefully investigate the cover provided by the various plans on offer before deciding to buy. The reason for this is that, as with all types of insurance, if it doesn’t meet your individual needs, you are essentially throwing money into the water!

With many South African consumers lacking the knowledge of where to start looking for a suitable dental insurance plan, many still have no knowledge of where they should start to look for a feasible dental insurance plan in South Africa. As a result, many choose the first best policy they come across, which is not always the best approach.

Various types of dental insurance plans are available, from plans offering basic dental care to those offering cover for a wide range of dental treatments, including fluoride treatment and X-rays when needed. Insurance plans that provide cover for cosmetic dentistry, or even a specific procedure within cosmetic dentistry, are also available. The most common and popular form of dental insurance takes the form of managed care plans through organisations.  Available at a small monthly amount, these are discounted fee schedules offered through and by participating dental practitioners rather than insurance in terms of the definition that applies to insurance.

Not all dental procedures are covered under all plans, so scrutinising the plan before making a decision is important to ensure it will meet your individual needs.  The structure of Indemnity Plans provide for a fixed monthly amount to be paid to the relevant insurance company.  When a claim is made for dental services rendered, a portion of the bill is paid (usually 80% after the ‘deductible’, also called a co-payment; that is the difference between the amount that your medical scheme will pay for the treatment amount and the actual cost of the procedure.

First things first: Your annual dental visits

When considering whether to buy dental insurance or not, one of the first aspects to consider is the number of your annual dental visits and the cost of the procedures you undergo during these visits. Looking at these visits, you can compare the total cost of dental treatments to the total cost of the insurance plan. Should your visits to the dentist be significantly more than just paying the dentist for the two cleanings as and when they are done.

Another aspect that is important to check before deciding to buy dental insurance is that of participating dentists. In this regard, check to see if your preferred dentist participates in the plan. In the event that he or she doesn’t participate, you should check to see whether a claim from a non-participating dentist will be honoured and paid. According to Affinity Health, one of the dental insurance providers, their dental plans enjoy the support and are accepted by more than 1,800 dentists countrywide.

The type of procedures covered by your preferred or chosen dental insurance plan is also important, as you don’t want to pay for insurance that doesn’t provide cover for your future dental needs, which might include implants to replace lost teeth. If you are likely to undergo this or a similar type of dental procedure in the future, you might want to consider purchasing a separate policy that would provide cover for this. Cosmetic dentistry, including porcelain veneers, tooth whitening and tooth-coloured fillings are usually not provided for by medical schemes, but check to see what dental insurance products are available that cover such procedures, should you consider cosmetic dentistry.

If you are formally employed and dental insurance can be obtained from your employer, perhaps as part of a bigger health insurance plan, this could be a good choice. While most comprehensive medical schemes in South Africa offer some dentistry benefits, the type of dental benefits you are afforded as well as how, from which benefit and at which rates dental procedures are reimbursed are determined by the Scheme Rules as well as the benefit option you have chosen.

In a recent article, Dr Gareth Hayton, managing director of Dental Information Systems (Denis) says South Africans using a dentist in private practice should consider making provision for the costs of dentistry, even if their medical scheme provides some dental benefits. The reason for this is that the costs of dentistry, like all medical costs, are rising above inflation. In addition, dental benefits offered by medical schemes to cover dentistry bills are evaporating.

Dr Hayton says that only about two million of South Africa’s 8.5 million medical scheme beneficiaries are on options that cover the costs of dentistry from their option’s general benefits (risk pool) rather than from their medical savings account. The problem with this is that very few members manage to maintain a positive balance in these savings accounts, as the funds are seldom sufficient to cover an individual member of family’s day-to-day health care needs.

Medical schemes, says Dr Hayton, should be obliged to provide a package of essential dentistry benefits that covers fillings, extractions, pain control, abscesses and root canals. This package should be part of the Prescribed Minimum Benefits (PMBs). If this package were in place, members of all schemes would have guaranteed benefits for essential dental treatment, because the PMBs cover treatment that legislation obliges schemes to pay.

Preventative dental plans

Some dental insurance plans available in South Africa, such as DenCap’s Preventative dental plans, makes it compulsory for you and/or your family to visit you dentist twice a year (or as specified by your dentist) for a consultation, during which all the required restorative work, scaling and polishing of teeth will be done in view of ensuring continued oral health.

Dental capitation: Low-claiming kids are free!

On-going dental care at an affordable cost, also driven by preventative health care, DenCap’s dental capitation plan includes all necessary ‘maintenance’ work. It operates on the assumption that early detection of problems ensures continuous dental health.  As an added bonus, no contributions are payable for children with low dental needs, up to the age of 18 years.  

The cost of dental insurance

Depending on the type of dental insurance plan you choose and bearing in mind the factors discussed above such as your annual dental visits as well as the type of dental procedures you and/or your family are likely to need, dental insurance can be affordable. Obtaining a quote from your chosen provider will provide you with much needed information on which to base your decision, while using the Internet to compare dental insurance offerings available prior to getting a quote is a good starting point.

A brief history of the toothbrush

As for the toothbrush, that indispensable instrument that greatly assists in maintaining good oral health, it is worthwhile to note, has been around for centuries!  As far back as 3000 BC, ancient civilisations such as the Egyptions and Babylonians are believed to have used a ‘chew stick’ to clean their teeth. This ‘chew stick’ was a thin twig with a frayed end, which they would use to chew and rub their teeth. The first bristle toothbrush can be traced back to its first humble beginnings in 1498, when it was invented in China, made from the course hairs from the back of a hog’s neck, and with a bone or bamboo handle. It was not until 1780 that a more modern design would emerge, created by one William Addis from England. While the bristles were still made from the hair of hog’s necks, the handle was carved from cattle bone. The effectiveness of a three-bristle toothbrush was discovered in 1844, while the toothbrush with its characteristic modern look sporting nylon bristles, was only introduced in 1938 by one Dupont de Nemours. Called Doctor West’s Miracle Toothbrush, it was used by soldiers fighting in World War II.

Self-insure: A cheaper alternative?

Dental insurance will stand you in good stead, whether you are supplementing your medical scheme benefits or using it as a stand-alone product to provide peace of mind when a dental emergency strikes. However, apart from medical scheme cover and dental insurance, one of the cheapest options for financing dentistry is to ‘self-insure’; that is setting aside an amount that you can afford on a monthly basis to meet these expenses when they arise. However, if you require an expensive dental procedure before you have been able to build up sufficient savings, you might not be able to afford the procedure.

To self-insure is a good option, but only if you are disciplined enough to ensure the money is put away on a monthly basis, that is in addition to providing for your retirement savings, dread disease cover as well as building up an emergency fund. Quite a mouthful if you have to do all of this from your after-tax income!

Your responsibility: Look after your oral health!

While dentists can intervene when necessary to prevent certain dental problems from becoming a health risk, maintaining good oral health is first and foremost your own responsibility! Good oral hygiene – that is clean teeth that are free of food debris, healthy and pink gums that are not painful and don’t bleed during brushing or flossing – starts with you, because good oral hygiene leads to good oral health, which in turn leads to good overall health.


Dental Insurance – SA Insurance Providers (8)