Dental Benefits
KeyHealth’s dental benefits range from basic / conservative to specialised treatments.
DENIS (Dental Information Systems (Pty) Ltd) manages beneficiaries’ dental benefits on behalf of the Scheme (except for the Origin and Essence options).
Dental Benefits
KeyHealth’s dental benefits cover everyday procedures, such as cleaning, fillings and extractions, to specialised treatments, such as tooth replacement, dentures, crowns, and removal of impacted teeth.
ESSENCE
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs before benefit application.
- There is no benefit for root canal therapy, dentures, specialised dentistry or in-hospital dental treatment.
- The only exception is a benefit for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
ORIGIN
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs before benefit application.
- There is no benefit for root canal therapy, dentures, specialised dentistry or in-hospital dental treatment.
- The only exception is a benefit for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
EQUILIBRIUM
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
SILVER
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 890 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
GOLD
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, crowns and bridges, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
PLATINUM
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, crowns and bridges, implants, plastic and/or partial chrome cobalt frame dentures, periodontics and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
ESSENCE
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs before benefit application.
- There is no benefit for root canal therapy, dentures, specialised dentistry or in-hospital dental treatment.
- The only exception is a benefit for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
ORIGIN
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs before benefit application.
- There is no benefit for root canal therapy, dentures, specialised dentistry or in-hospital dental treatment.
- The only exception is a benefit for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
EQUILIBRIUM
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
SILVER
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
GOLD
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, crowns and bridges, plastic dentures and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.
PLATINUM
- Dental benefits are paid at 100% of the KeyHealth Dental Tariff (KDT).
- Dental benefits are subject to managed care protocols and managed care interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
- There are benefits for root canal therapy, crowns and bridges, implants, plastic and/or partial chrome cobalt frame dentures, periodontics and orthodontic treatment.
- There are benefits for the removal of impacted teeth under general anaesthetic in hospital or under moderate or deep sedation in the dental rooms or inhalation sedation in the dental chair. This benefit is subject to pre-authorisation.
- R1 980 co-payment per hospital admission (no co-payment for day hospitals).
- If authorisation is applied for after the treatment has been done, the member will pay a 20% penalty fee.
- Scheme exclusions apply to dental benefits.
In the event of a dispute, the rules of the Scheme will prevail.