Focus on the Dental Benefit 2025

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
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists
Dentistry – specialised (such as bridges or crowns)Not covered
In-hospital dental and oral benefitsNot 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
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists

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 920 co-payment and pre-authorisation
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists
In-hospital dental and oral benefits:
Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7The 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 920 co-payment applies per authorisation
Dentistry related to traumaThe 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 teethThe hospital account is paid from the Major Medical Benefit, subject to a R3 450 co-payment for day hospitals and a R6 500 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 treatmentThe 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 750 co-payment and pre-authorisation
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists
In-hospital dental and oral benefits:
Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7The 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 750 co-payment applies per authorisation
Dentistry related to traumaThe 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 teethThe hospital account is paid from the Major Medical Benefit, subject to a R3 450 co-payment for day hospitals and a R6 500 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 treatmentThe 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 R17 300 per beneficiary, R44 900 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 750 co-payment and pre-authorisation
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists
In-hospital dental and oral benefits:
Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7The 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 750 applies per authorisation
Dentistry related to traumaThe 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 teethThe hospital account is paid from the Major Medical Benefit, subject to a R3 450 co-payment for day hospitals and a R6 500 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 treatmentThe 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 R33 300 per beneficiary
Out-of-hospital specialised dentistry (such as bridges or crowns)Limit of R19 800 per beneficiary, R47 700 per family. Subject to overall annual day-to-day limit of R33 000 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
Preventative dental careCovered up to R380 per beneficiary at at dentists, dental therapists and oral hygienists
In-hospital dental and oral benefits:
Maxillo-facial surgery (excluding implants) and general anaesthesia for children under 7The 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 R33 000 per beneficiary. 
Dentistry related to traumaThe 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 teethThe 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 treatmentThe 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


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