Dental insurance - You can make it work for you

While many of the top-tier medical aid plans offer decent dental benefits, the lower-tier plans usually offer very limited in-hospital benefits.

This leaves many South Africans with no choice but to foot the bill for expensive out-of-hospital dental services for themselves and their family members. From root canals and wisdom teeth extraction to braces dental work is expensive. 

This is why more and more South Africans are opting to take out dental insurance over and above their medical insurance and, in some instances even just gap cover since medical aid schemes cap the amount they’ll pay towards certain dental procedures.

What your medical aid covers

As an example, let’s take a look at dental coverage offered by South Africa’s largest medical aid provider, Discovery. Their Essential Smart and Classic Smart plans allow you to visit the dentist for a check-up once a year provided that you pay the co-payment. This check-up will cover the consultation, two x-rays, scale and polish, and fluoride. If you’re on the Core plan, however, you’re not covered for this basic annual dental check-up.

Depending on whether you’re on their Executive, Classic or Essential, or Coastal Plans, you’ll have a set percentage that will be paid toward dental treatment. Dental appliances and orthodontic treatments will be covered from your day-to-day benefits. If your medical savings accounts are depleted you’ll have to cover the costs yourself. All their plans, however, cover severe dental and oral surgery procedures.

This means that if you have medical aid, you will be adequately covered for any in-hospital emergencies but, you’ll have no cover, limits, and co-payments to worry about when it comes to day-to-day dental care. This is why it’s crucial to properly assess your needs and any gaps in cover before taking out dental insurance.

Assessing your dental cover needs

If you have medical aid, it’s important to review your dental benefits carefully before deciding how much coverage you need (if you need any at all). If you’re on a lower-tier medical aid you may have very limited benefits which are also capped.

In such a case, taking out dental cover will certainly make a big difference and is advisable. If you have no medical aid at all and want to make sure that you can look after your teeth, a dental plan can help you do just that.

Types of cover

Just as you get a range of tiers with medical aid, dental plans are the same. Top-tier plans offer the highest level of coverage but come with higher premiums. Dental plans with lower premiums have fewer benefits and smaller coverage caps.

The type of cover that you opt for will depend on your needs and the needs of your dependents. People with children or elderly dependents may benefit significantly from top-tier dental plans. These plans offer lots of out-of-hospital or day-to-day benefits that most medical aids, and in particular the lower tier ones do not cover.

Dental plan cover options:

• Dentist consultations
• Root canals
• Fillings
• Crowns
• Wisdom tooth extractions
• Radiographs and x-rays
• Extractions
• Dentures
• Infection control and oral hygiene
• Polish and scale

How to make dental insurance work for you

It’s best to review dental insurance plans and make sure that you’ll benefit from the cover you take out.  You should also take note of what is covered and what isn’t as well as all the applicable caps. Two other important policies that you need to be familiar with include waiting periods and pre-authorization, which we’ll discuss below.

Important items to note regarding dental insurance

Waiting periods: Most providers of dental insurance will specify a waiting period that must pass before you’ll be allowed to make a claim. This can be anything from 3 months for basic dental services to 6 months for more specialized services.
To avoid having to pay out of pocket for a procedure you thought your dental insurance would cover, note these waiting periods.

Pre-authorization: For most dental procedures, you’ll have to obtain pre-authorization from your insurer. While most dentists will not proceed before obtaining an authorization number from you.

Exclusions: Your policy document will list a number of exclusions based on the plan that you choose. Generally speaking, all cosmetic dental work is not covered. This includes procedures such as teeth whitening, veneers, and braces.

Dental insurance providers in South Africa

There is a range of dental insurance providers who offer varying levels of dental cover to South Africans. These plans will offer you everything from basic cover for day-to-day dental care to more extensive cover for specialist procedures.

Alternatives to dental cover

Since top-tier medical aids will cover almost all of your dental needs as well as that of your dependents, always check your level of cover before considering dental cover. The best way to do this is to visit the website of your insurer and download their benefit documents or, alternatively log into your medical aid profile and review benefits there.

If you’re unsure about any benefits or want to check whether you’ll be covered for a specific procedure, contact your provider by telephone. While you’re there make sure to check your cover caps and ask what, if any, co-payments you’ll have to make.

Alternatively, you may want to set up private dental care savings account for your family where you can save regular amounts to ensure that you’ll be able to cover co-payments or full dental care and procedures when the need arises.

Protecting your smile

When it comes to dental care, there’s no way to avoid it. While some people are blessed with good genes and don’t require much dental work until later on in life, others struggle with various dental and gum issues and need to see their dentist regularly.

If you fall into the latter group, taking out comprehensive dental insurance or gap cover will save you a lot of money in the long run and help you maintain a bright, healthy smile.