Does Medihelp offer dental benefits?
Yes: Medihelp’s dental benefits differ according to which plan you are on. Always check your plan’s benefits for terms and conditions before you undergo any treatment. Visit Medihelp’s Member Zone to find all the details on your dental benefits, or phone us on 086 0100 678. You can also find this information on Medihelp’s member app, available on iStore, Google Play Store and Windows Store.
Does Medihelp use a preferred provider for dental treatment?
Yes: Dental Risk Company (DRC) is a dental managed care solutions provider and is Medihelp’s preferred provider. DRC provides dental benefits in partnership with more than 2 200 dentists in South Africa.
How does the dental network apply to me?
Necesse members must use a DRC network dentist and the dental medicine formulary to qualify for benefits. Services will be paid from your available day-to-day benefits.
Unify members may visit any dentist, and benefits are paid from the available funds in your savings account. Removal of impacted teeth will be funded from core benefits, subject to DRC protocols.
Members on the Prime option range (non-network options) may use any dentist, but DRC protocols will apply. Benefits will be paid from either your day-to-day benefits or medical savings account depending on the cover provided on your benefit option.
When do I need pre-authorisation?
You must obtain pre-authorisation for dental procedures performed under general anaesthesia in hospital or under conscious sedation in the dentist’s chair, as well as for specialised dental services such as crowns and bridges, implants, and partial metal frame dentures.
When will out-of-pocket expenses apply?
- When the services exceed your available dental benefits, amounts, cycles or quantities as specified by your benefit option
- For maxillofacial surgery and oral pathology
- If DRC protocols weren’t followed
- A 20% co-payment will apply if you don’t obtain pre-authorisation for services
- A 35% co-payment will apply to members of Necesse and Prime network options who voluntarily make use of a non-network hospital/day clinic
- Necesse members who use non-network dentists or non-formulary dental medicine will be liable for the full account.