Focus on the Dental Benefit

This document provides a clear overview of dental benefits across Momentum Medical Scheme options.

1. Ingwe Option

• 1.1 Basic Dentistry (Extractions, Fillings):
  • Benefit: Basic dental services (examinations, fillings, x-rays).
  • Limit: One dental consultation per beneficiary per year.
  • Coverage: Specified tariff codes. Pre-authorization required for more than four fillings or extractions.
• 1.2 Specialized Dentistry (Bridges, Crowns):
  • Benefit: Not covered.
• 1.3 In-Hospital Dental and Oral Benefits:
  • Benefit: Not covered.
  • Coverage: Trauma-related dental care at state facilities (Prescribed Minimum Benefits).

2. Evolve Option

• 2.1 Basic Dentistry (Extractions, Fillings):
  • Benefit: Basic dental services.
  • Coverage: Payable from HealthSaver+, subject to available funds.
• 2.2 Specialized Dentistry (Bridges, Crowns):
  • Benefit: Specialized dental services.
  • Coverage: Payable from HealthSaver+, subject to available funds.

3. Custom Option

• 3.1 Basic Dentistry:
  • Benefit: Basic dental services.
  • Coverage: Payable from HealthSaver+, subject to available funds.
• 3.2 Out-of-Hospital Specialized Dentistry (Bridges, Crowns):
  • Benefit: Specialized dental services.
  • Coverage: Payable from HealthSaver+, subject to available funds.
  • Wisdom Teeth Extraction:
    • Coverage: Anaesthetist and dental specialist accounts covered under Major Medical Benefit (100% of Momentum Medical Scheme Rate).
    • Co-payment: R1,830.
    • Requirement: Pre-authorization.
• 3.3 In-Hospital Dental and Oral Benefits:
  • Maxillo-facial Surgery (Excluding Implants) and General Anaesthesia (Children under 7):
    • Anaesthetist: 100% of Momentum Medical Scheme Rate.
    • Hospital: Full at negotiated rate.
    • Dental, Specialist, Maxillo-facial Surgeon: Payable from HealthSaver+, subject to available funds.
    • Co-payment: R1,830 per authorization.
    • Requirement: Pre-authorization.
  • Dentistry Related to Trauma:
    • Hospital: Full at negotiated rate.
    • Anaesthetist, Dentist, Specialist, Maxillo-facial Surgeon: 100% of Momentum Medical Scheme Rate.
  • Extraction of Impacted Wisdom Teeth:
    • Hospital: Major Medical Benefit.
    • Co-payment: R3,300 (day hospitals), R6,150 (other hospitals) per authorization.
    • Dental, Specialist, Maxillo-facial Surgeon, Anaesthetist: 100% of Momentum Medical Scheme Rate (Major Medical Benefit).
  • Implants and Other In-Hospital Dental Treatment:
    • Benefit: Not covered.
    • Coverage: Payable from HealthSaver+, subject to available funds.

4. Incentive Option

• 4.1 Basic Dentistry (Extractions, Fillings):
  • Benefit: Basic dental services.
  • Coverage: Payable from Savings plan or HealthSaver+, subject to available funds.
• 4.2 Specialized Dentistry (Bridges, Crowns):
  • Benefit: Specialized dental services.
  • Coverage: Payable from Savings plan or HealthSaver+, subject to available funds.
  • Wisdom Teeth Extraction (Doctor's Office):
    • Anaesthetist and Dental Specialist: Major Medical Benefit (100% of Momentum Medical Scheme Rate).
    • Co-payment: R1,670.
    • Requirement: Pre-authorization.
• 4.3 In-Hospital Dental and Oral Benefits:
  • Maxillo-facial Surgery (Excluding Implants) and General Anaesthesia (Children under 7):
    • Anaesthetist: 200% of Momentum Medical Scheme Rate.
    • Hospital: Full at negotiated rate.
    • Dental, Specialist, Maxillo-facial Surgeon: Payable from Savings or HealthSaver+, subject to available funds.
    • Co-payment: R1,670 per authorization.
    • Requirement: Pre-authorization.
  • Dentistry Related to Trauma:
    • Hospital: Full at negotiated rate.
    • Anaesthetist, Dentist, Specialist, Maxillo-facial Surgeon: 200% of Momentum Medical Scheme Rate.
  • Extraction of Impacted Wisdom Teeth:
    • Hospital: Major Medical Benefit.
    • Co-payment: R3,300 (day hospitals), R6,150 (other hospitals) per authorization.
    • Anaesthetist: 100% of Momentum Medical Scheme Rate.
    • Dental, Specialist, Maxillo-facial Surgeon: 100% of Momentum Medical Scheme Rate (Major Medical Benefit).
  • Implants and Other In-Hospital Dental Treatment:
    • Benefit: Not covered.
    • Coverage: Payable from Savings or HealthSaver+, subject to available funds.

5. Extender Option

• 5.1 Out-of-Hospital Basic Dentistry (Extractions, Fillings):
  • Benefit: Unlimited basic dental procedures (within General Rule guidelines).
  • Coverage: 25% of contribution allocated to Savings. Extended Cover after self-funding gap threshold. Momentum Medical Scheme Rate, subject to sub-limits.
• 5.2 Out-of-Hospital Specialized Dentistry (Bridges, Crowns):
  • Limit: R16,400 per beneficiary, R42,600 per family.
  • Coverage: Includes in- and out-of-hospital specialist accounts.
  • Wisdom Teeth Extraction (Doctor's Office):
    • Anaesthetist and Dental Specialist: Major Medical Benefit (100% of Momentum Medical Scheme Rate).
    • Co-payment: R1,670.
    • Requirement: Pre-authorization.
• 5.3 In-Hospital Dental and Oral Benefits:
  • Maxillo-facial Surgery (Excluding Implants) and General Anaesthesia (Children under 7):
    • Anaesthetist: 200% of Momentum Medical Scheme Rate.
    • Hospital: Full at negotiated rate.
    • Dental, Specialist, Maxillo-facial Surgeon: Day-to-day Benefits, subject to limits.
    • Co-payment: R1,670 per authorization.
    • Requirement: Pre-authorization.
  • Dentistry Related to Trauma:
    • Hospital: Full at negotiated rate.
    • Anaesthetist, Dentist, Specialist, Maxillo-facial Surgeon: 200% of Momentum Medical Scheme Rate.
  • Extraction of Impacted Wisdom Teeth:
    • Hospital: Major Medical Benefit.
    • Co-payment: R3,300 (day hospitals), R6,150 (other hospitals) per authorization.
    • Anaesthetist: 100% of Momentum Medical Scheme Rate.
    • Dental, Specialist, Maxillo-facial Surgeon: 100% of Momentum Medical Scheme Rate (Major Medical Benefit).
  • Implants and Other In-Hospital Dental Treatment:
    • Benefit: Not covered.
    • Coverage: Payable from Day-to-day Benefits, subject to limits.

6. Summit Option

• 6.1 Out-of-Hospital Basic Dentistry (Extractions, Fillings):
  • Limit: R31,300 per beneficiary per year (overall day-to-day limit).
• 6.2 Out-of-Hospital Specialized Dentistry (Bridges, Crowns):
  • Limit: R18,800 per beneficiary, R45,300 per family (within R31,300 overall day-to-day limit).
  • Coverage: Includes in- and out-of-hospital specialist accounts.
  • Wisdom Teeth Extraction (Doctor's Office):
    • Anaesthetist and Dental Specialist: Major Medical Benefit (100% of Momentum Medical Scheme Rate).
    • Requirement: Pre-authorization.
• 6.3 In-Hospital Dental and Oral Benefits:
  • Maxillo-facial Surgery (Excluding Implants) and General Anaesthesia (Children under 7):
    • Anaesthetist: 300% of Momentum Medical Scheme Rate.
    • Hospital: Full at negotiated rate.
    • Dental, Specialist, Maxillo-facial Surgeon: Day-to-day Benefits, within R31,300 limit.
  • Dentistry Related to Trauma:
    • Hospital: Full at negotiated rate.
    • Anaesthetist, Dentist