Dental treatment can be costly. Even with comprehensive medical aid plans, often you’ll find that not all expenses associated with dental treatments are covered. This is where gap cover becomes essential, bridging the gap between what your medical aid pays and the actual costs of the procedures, in this case, what your dental practitioners charge.
Total Risk Administrators (TRA) offers a Dental Cover Benefit as part of all our gap cover policies to help clients like yourself avoid unexpected out-of-pocket expenses when you require necessary dental treatments.
What is Dental Gap Cover?
Gap cover is a health insurance product that supplements your medical aid by covering the shortfall between what the medical aid pays vs. what the procedure actually costs. Dental Gap Cover is then a term used to describe gap cover specialising in dental cover/treatments.
In the event you process a medical aid claim for an authorised dental procedure, it will only cover their predetermined scheme tariff for the related dental treatment costs. If practitioners charge more than the scheme tariff, you are left with a shortfall payment. Dental gap cover will then address this difference.
Gap cover providers can specialise in dental insurance and dental gap cover, or more commonly; they can offer this coverage as a benefit within their policies.
Total Risk Administrators (TRA) offers a dental benefit within our Gap Cover policies.
It is important to note that gap cover is not a medical aid nor a substitute for medical aid. It is a health insurance product you get in addition to medical aid.
When Would You Need Gap Cover for Dental Procedures?
The following scenarios illustrate procedures often not fully covered by medical aid schemes due to their complexity and need for specialist practitioners. In this case, dental gap cover can become invaluable:
- Complex Procedures: Authorised procedures like the extraction of impacted wisdom teeth, apicectomies (root-end surgery), or extensive dental surgeries performed in hospital and/or doctors’ rooms, often requiring the patient to undergo anaesthesia.
- Children’s Dental Care: For dependants, up to 18 years old, common dental procedures such as orthodontics can be covered if their medical aid authorises the procedure.
- Emergency, Accidental and Illness-Related Dental Treatment: Unexpected accidents that result in tooth damage or extractions, as well as any treatments required due to illnesses like cancer.
How TRA’s Dental Benefit Works
TRA’s gap cover policies all include a dental benefit:
Please note that this benefit covers the shortfall after your medical aid processes a claim, specifically for authorised dental procedures (in hospitals or doctors’ rooms) paid from the in-hospital or major medical benefits only.
TRA’s dental gap cover applies to:
- Adults and dependants over 18: Coverage includes treatment for impacted wisdom teeth, extractions, apicectomies, or tooth loss due to trauma or oncology ONLY. The dental benefit does not apply for your general dentistry appointments as well as dental implants and any preparation for dental implants, and ANY other related costs, including any aftercare treatment and any co-payments, are NOT covered, irrespective of medical aid approval.
- Dependants up to 18 years old: Coverage applies to ANY authorised dental procedure or treatment, ensuring comprehensive care for children.
NB: For adults, dependents, and dependents under 18, the extent of the coverage is subject to the AGGREGATE ANNUAL LIMIT of R210 580 per insured person.
Affordable Gap Cover Policies for South Africans:
TRA offers four plans that include a dental benefit within its cover:
- Basic Cover 300 from R99 per month
- Vital Cover Plus from R300 per month
- Super Cover Plus from R330 per month
- Absolute Cover Plus from R590 per month
Each of these plans provides coverage for dental procedures but is subject to the aggregate annual limit per insured person.
Gap Cover That Makes You Smile with TRA
Total Risk Administrators (TRA) help our clients manage medical shortfalls effectively, ensuring peace of mind when it’s needed most.
By bridging the gap in medical treatments such as authorised dental procedures, TRA’s plans provide comprehensive coverage options at scaling prices to ensure an option for everyone.
Keep smiling, knowing that you have South Africa’s top gap cover provider on your side.
