Discovery Severe Dental and Dental Trauma Benefits

Severe Dental and Oral Surgery Benefit

Discovery covers a short list of serious jaw, mouth and face operations through the Severe Dental and Oral Surgery Benefit, available on all plans. These operations are paid from your Hospital Benefit. You don’t pay anything upfront, and there is no overall limit.

The operations covered are:

• Internal jaw joint (temporomandibular joint, or TMJ) surgery
• Cleft lip and palate repairs
• Surgery for severe, life-threatening infections
• Cancer-related surgery

You must get approval (preauthorisation) from Discovery at least 48 hours before you go into hospital. Call 0860 99 88 77.

If you’re on a plan with a hospital network, such as the Delta, Coastal, Active, Smart or KeyCare plans, you need to use a network hospital. If you don’t, you’ll pay an amount upfront or cover part of the bill yourself, unless it’s an emergency.

The benefit doesn’t pay for dental appliances, such as implants, crowns, bridges and dentures, or for fitting them. These come from your day-to-day benefits, where your plan has them. On plans without day-to-day dental cover, such as the Core plans, you pay for these yourself.

Basic Dental Trauma Benefit

This benefit covers urgent dental treatment after a sudden, unexpected injury to your teeth or mouth, for example from an accident or an assault. It pays from your Hospital Benefit and doesn’t use up your day-to-day benefits.

If you qualify, Discovery pays up to R73,550 per person per year for dental appliances, such as implants and prostheses, and for fitting them.

Each claim is assessed on its own merits. To qualify:

• You must have lost part or all of one or more teeth.
• If you’ve lost part of a tooth, there isn’t enough left to repair it. The tooth has to be removed and replaced with an implant, because a crown on its own won’t work.
• Treatment must start within 30 days of the injury.
• Your dentist’s claim must include the codes that show the cause was an injury (the ICD-10 and external cause codes).

You don’t need to call Discovery first. The codes on your dentist’s claim decide whether it’s paid from this benefit.

If your treatment is done in hospital or a day clinic, you pay part of the account upfront:

This benefit is not available on the Active Core plan, the Essential Smart, Essential Dynamic Smart and Active Smart plans, or any of the KeyCare plans.