Ingwe Option
| Dentistry – basic (such as extractions or fillings) | Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if you have more than 4 fillings or 4 extractions |
| Dentistry – specialised (such as bridges or crowns) | Not covered |
| In-hospital dental and oral benefits | Not covered. Dentistry related to trauma covered at State facilities, limited to Prescribed Minimum Benefits |
Evolve Option
| Dentistry – basic (such as extractions or fillings) | Payable from HealthSaver+ if available |
| Dentistry – specialised (such as bridges or crowns) | Payable from HealthSaver+ if available |
Custom Option
| Basic dentistry | Payable from HealthSaver+ , if available |
| Out-of-hospital specialised dentistry (such as bridges or crowns) | Payable from HealthSaver+ , if available For extraction of impacted wisdom teeth in doctors’ rooms, anaesthetist and dental specialist accounts are covered from the Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to R1 830 co-payment and pre-authorisation |
In-hospital dental and oral benefits: | |
| Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7 | The anaesthetist account is covered up to 100% of the Momentum Medical Scheme Rate and the hospital accounts are paid in full at the negotiated rate. The dental, dental specialist and maxillo-facial surgeon accounts are not covered but can be paid from HealthSaver+ , if available. In-hospital dentistry is subject to pre-authorisation and a R1 830 co-payment applies per authorisation |
| Dentistry related to trauma | The hospital accounts are paid in full at the negotiated rate. The anaesthetist account and the dentist, dental specialist or maxillo-facial surgeon accounts are covered up to 100% of the Momentum Medical Scheme Rate |
| Extraction of impacted wisdom teeth | The hospital account is paid from the Major Medical Benefit, subject to a R3 300 co-payment for day hospitals and a R6 150 co-payment for other hospitals, per authorisation. Dental, dental specialist, maxillo-facial surgeon and anaesthetist accounts are paid from the Major Medical Benefit, up to 100% of the Momentum Medical Scheme Rate |
| Implants and all other in-hospital dental treatment | The cost of implants and all other in-hospital treatment is not covered. All accounts, are subject to HealthSaver+ , if available |
Incentive Option
| Basic dentistry (such as extractions or fillings) | Payable from Savings or HealthSaver+ , if available |
| Out-of-hospital specialised dentistry (such as bridges or crowns) | Payable from Savings or HealthSaver+ , if available For extraction of impacted wisdom teeth in doctors’ rooms, anaesthetist and dental specialist accounts are covered from the Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to R1 670 co-payment and pre-authorisation |
In-hospital dental and oral benefits: | |
| Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7 | The anaesthetist account is covered up to 200% of the Momentum Medical Scheme Rate and the hospital accounts are paid in full at the negotiated rate. The dental, dental specialist and maxillo-facial surgeon accounts are paid from Savings or HealthSaver+ , if available. In-hospital dentistry is subject to pre-authorisation and a R1 670 co-payment applies per authorisation |
| Dentistry related to trauma | The hospital accounts are paid in full at the negotiated rate. The anaesthetist account and the dentist, dental specialist or maxillo-facial surgeon accounts are covered up to 200% of the Momentum Medical Scheme Rate |
| Extraction of impacted wisdom teeth | The hospital account is paid from the Major Medical Benefit, subject to a R3 300 co-payment for day hospitals and a R6 150 co-payment for other hospitals, per authorisation. Dental, dental specialist, maxillo-facial surgeon and anaesthetist accounts are paid from the Major Medical Benefit, up to 100% of the Momentum Medical Scheme Rate |
| Implants and all other in-hospital dental treatment | The cost of implants and all other in-hospital treatment is not covered. All accounts, are subject to Savings or HealthSaver+ , if available |
Extender Option
| Out-of-hospital basic dentistry (such as extractions or fillings) | Unlimited within the provisions of the General Rule applicable to all Day-to-day Benefits on the Extender Option: 25% of your contribution is available to cover day-to-day expenses. This is known as Savings. If this component is not enough to cover your annual day-to-day expenses, you will have a self-funding gap to pay out of your own pocket, up to the Threshold determined by your family size. Once you have reached this Threshold, your claims will be paid by the Scheme from Extended Cover. Claims add up to the Threshold and are paid from Extended Cover at the Momentum Medical Scheme Rate subject to the sub-limits specified below. The sub-limits apply before and after the Threshold is reached. |
| Out-of-hospital specialised dentistry (such as bridges or crowns) | Limit of R16 400 per beneficiary, R42 600 per family. Both in-and out-of-hospital dental specialist accounts accumulate towards the specialised dentistry limit For extraction of impacted wisdom teeth in doctors’ rooms, anaesthetist and dental specialist accounts are covered from the Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to R1 670 co-payment and pre-authorisation |
In-hospital dental and oral benefits: | |
| Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7 | The anaesthetist account is covered up to 200% of the Momentum Medical Scheme Rate and the hospital accounts are paid in full at the negotiated rate. The dental, dental specialist and maxillo-facial surgeon accounts are paid from available Day-to-day Benefits, subject to day-to-day limits. In-hospital dentistry is subject to pre-authorisation and a co-payment of R1 670 applies per authorisation |
| Dentistry related to trauma | The hospital accounts are paid in full at the negotiated rate. The anaesthetist account and the dentist, dental specialist or maxillo-facial surgeon accounts are covered up to 200% of the Momentum Medical Scheme Rate |
| Extraction of impacted wisdom teeth | The hospital account is paid from the Major Medical Benefit, subject to a R3 300 co-payment for day hospitals and a R6 150 co-payment for other hospitals, per authorisation. The anaesthetist account is covered up to 100% of the Momentum Medical Scheme Rate and the dental, dental specialist and maxillo-facial surgeon accounts are paid from the Major Medical Benefit, up to 100% of the Momentum Medical Scheme Rate |
| Implants and all other in-hospital dental treatment | The cost of implants and all other in-hospital treatment is not covered. All accounts are paid from available Day-to-day Benefits, subject to the day-to-day limits |
Summit Option
| Out-of-hospital basic dentistry (such as extractions or fillings) | Subject to overall annual day-to-day limit of R31 300 per beneficiary |
| Out-of-hospital specialised dentistry (such as bridges or crowns) | Limit of R18 800 per beneficiary, R45 300 per family. Subject to overall annual day-to-day limit of R31 300 per beneficiary. Both in- and out-of-hospital dental specialist accounts accumulate towards the limit Anaesthetist and dental specialist accounts for extraction of impacted wisdom teeth in doctors’ rooms: Covered from the Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to pre-authorisation |
In-hospital dental and oral benefits: | |
| Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7 | The anaesthetist account is covered up to 300% of the Momentum Medical Scheme Rate and the hospital accounts are paid in full at the negotiated rate. The dental, dental specialist and maxillo-facial surgeon accounts are paid from the Day-to-day Benefit and accumulate towards the overall day-to-day limit of R31 300 per beneficiary. |
| Dentistry related to trauma | The hospital accounts are paid in full at the negotiated rate. The anaesthetist account and the dentist, dental specialist or maxillo-facial surgeon accounts are covered up to 300% of the Momentum Medical Scheme Rate |
| Extraction of impacted wisdom teeth | The hospital and anaesthetist accounts are paid from the Major Medical Benefit. Dental, dental specialist and maxillo-facial surgeon accounts are paid from the Major Medical Benefit, up to 100% of the Momentum Medical Scheme Rate |
| Implants and all other in-hospital dental treatment | The cost of implants and all other in-hospital treatment is not covered. All accounts are payable from available Day-to-day Benefits, subject to the day-to-day limits |