Dentistry

Cleaning, scaling, polishing and fluoride treatment are limited to one treatment per beneficiary per year. Pre-authorisation is needed for members over the age of 12 years.

Fillings, X-rays, extractions and consultations are limited to one consultation per beneficiary per year. Specific codes will be paid if clinically appropriate. Pre-authorisation is needed for 3 or more X-rays (up to a maximum of 4), 4 or more restorations or 5 or more composite fillings.

A family is entitled to 80% of the Prime Cure agreed tarriff of two sets of acrylic dentures every 36 months for beneficiaries over the age of 21 years. You need to get authorisation and use a Prime Cure dentist. Your co-payment, the balance of 20% is to be paid to the dentist at the time of placing an order for dentures. A family is also entitled to two repairs within a 12-month cycle, six months after receiving a denture.

Treatment of pain, sepsis and extractions at a non-network provider are limited to one event per beneficiary per year and are paid at the Prime Cure agreed rate.

For children under the age of 7, for the removal of impacted third molars and trauma (PMB), subject to authorisation and the Family Hospital Limit of R189 900 per year.