5 Best Medical Aids in South Africa Covering Braces
⚠️Notice
Please be advised that coverage for braces will only be provided by your selected medical aid plan if it is deemed medically necessary due to impaired teeth, jaw, or mouth.
Do medical aids cover braces in South Africa?
We tested them side by side and verified the best medical aid options that cover braces.
This is a complete guide to the best medical aids that cover braces in South Africa.
In this in-depth guide you’ll learn:
- What is a Medical Aid?
- Which medical aids cover braces?
- Which medical aids cover dentistry only?
- Which medical aid offers payment plans for braces?
- What is the best way to sign up for medical aid for the first time?
So if you’re ready to go “all in” with the best medical aid that covers braces in South Africa, this guide is for you.
Let’s dive right in…
Best Medical Aids in South Africa Covering Braces (2024)
- Discovery Medical Aid – Specialised dentistry (including braces) are subject to option specific criteria and protocols.
- Bonitas Medical Aid – Specialised dentistry (including braces) subject to option specific criteria and protocols.
- Momentum Health – Cover of braces available on specific options and subject to specific criteria and protocols.
- BestMed Medical Aid – Specialised dentistry (including braces) are subject to option specific criteria and protocols.
- Fedhealth – Cover for braces are subject to specific options and subject to criteria and protocols.
Introduction to Medical Aid Support & Coverage of Braces (Orthodontics)
👉 Braces are one of the devices used in orthodontics, a subspeciality of dentistry, that treats abnormalities of the jaws and teeth.
👉 Orthodontics entails affixing braces or plastic aligners to the front or back surfaces of the teeth, with the goal of properly aligning the jaws and improving the bite.
👉 The pricey nature of orthodontics can be attributed to both the expense of the necessary appliances and the specialised nature of the treatment itself.
👉 In fact, the suggested therapy will determine how much you will need to spend on braces, which, at the time of writing this article, can range anywhere from R3 000 to R55 000.
👉 These costs include the following:
➡️ Consultations, x-rays, diagnostic photos and a treatment plan – around R 2 800
➡️ Outside or labial braces – around R26 000
➡️ Inside or lingual braces – around R44 000
➡️ Optional tooth coloured brackets – around R2 800 (upper) or R1 800 (lower)
➡️ Post-treatment x-rays, photos and retention appliances – around R2 900
👉 The vast majority of different medical aids in South Africa do have options with a specific Specialised Dentistry benefit which will cover some of the costs associated with orthodontic treatment and up to a specified limit. Most often an once per lifetime benefit and mainly for members younger than 18 years old. These benefits could be subject to pre-authorisation. Medical Aids may differ in their approach.
👉 Your chosen option and monthly contribution has a direct bearing on the extent of orthodontics coverage that you will have available. If you pay the highest available premium, your medical aid option will make you eligible for more comprehensive coverage.
👉 In some cases, you will be able to consult the specialist of your choice without having to make any co-payments out of your own pocket and without having to contribute any of your own hard-earned money. Pre-Authorization and protocols may be applicable.
👉 If you have an option that has a lower premium or a lower level of coverage, there is a chance that you won’t be covered at all.
👉 If you are fortunate enough to be eligible for orthodontic benefits, you will quickly learn that co-payments are the standard, and benefits often only apply to designated service providers (DSPs), also known as network orthodontists.
👉 In South Africa, the government does not foot the bill for orthodontic work, so you will not be eligible for free braces. Some health insurance plans may however cover part of it.
READ more about the 5 Best Dental Gap Cover
5 of the Best Known Medical Aids in South Africa & Their Coverage of Braces
👉 Most medical aids in South Africa do cover some costs of orthodontic treatment but the coverage varies from one scheme to the next.
In this article, coverage by Discovery Health, Bonitas Medical Aid, Momentum Health, BestMed Medical Aid and Fedhealth is discussed.
1. Discovery Health
Who is Discovery Health?
👉 Discovery Health is the leading medical insurance provider in South Africa, with over two million members, R7 billion in reserves, and an AA+ global credit rating. This medical aid provider was founded in 1992 and is one of four businesses owned by Discovery, a JSE-listed firm with about 5,200 employees.
👉 Discovery Health is a non-profit organisation administered by the Medical Schemes Act and regulated by the Council of Medical Schemes.
👉 Members own the Scheme, which is administered by an independent Board of Trustees. It is operated by a separate authorised financial services provider, Discovery Health (Pty) Ltd.
Discovery Health Options
👉 The Discovery options range from the most comprehensive healthcare cover to the most basic options, which offer you cost-effective private healthcare coverage through a large network of providers.
👉 You can make your selection from the following available health plans:
👉 The Discovery Executive option offers members extensive cover for in-hospital and day-to-day benefits, as well as extended chronic medicine coverage and unlimited Above Threshold Benefit.
👉 Discovery Comprehensive option range provide similar cover for in-hospital and day-to-day cover with extended chronic medicine coverage and unlimited Above Threshold Benefit.
👉 The Discovery Priority option range offer cost-effective in-hospital cover, essential chronic medicine cover and day-to-day benefits with a limited Above Threshold Benefit.
👉 The Discovery Saver option range offer economical in-hospital cover, essential chronic medicine cover and day-to-day benefits through a Medical Savings Account.
👉 The Discovery Core option range is a value-for-money series of hospital option that provide unlimited private hospital coverage, and essential chronic medicine coverage, but no day-to-day cover.
👉 The Discovery Smart option range provide cost-effective in-hospital cover, essential chronic medicine cover and limited day-to-day cover if using specified network providers.
👉 The Discovery Keycare option range are a very basic series of option that offer affordable medical cover providing members use specified network providers for both in-hospital and out-of-hospital treatment.
Orthodontic Benefits with Discovery Health
👉 Discovery covers a well-defined list of maxillo-facial procedures through its Severe Dental and Oral Surgery Benefit.
👉 This Severe Dental and Oral Surgery Benefit pays the list of procedures from the Hospital Benefit according to your chosen health plan.
👉 The applicable procedures that are covered include:
➡️ Internal temporomandibular joint (TMJ) surgery
➡️ Cleft lip and palate repairs
➡️ Surgery for severe life-threatening infections
➡️ Cancer-related surgery
👉 You can further benefit by using specialists whom Discovery has a payment arrangement with, since their approved procedures will be covered in full from your Hospital Benefit. Services from other specialists may incur a co-payment.
👉 GPs and other healthcare professionals are covered up to 200% of the Discovery Health Rate (DHR) on the Executive and Classic option range and 100% of the Discovery Health Rate (DHR) on the Essential, Coastal and Key Care option range, and paid from the Hospital Benefit.
👉 Discovery pays dental appliances, their placement and orthodontic treatment from the available funds in the day-to-day benefits (Medical Savings Account (MSA) and Above Threshold Benefit (ATB)) up to a limit per person per year regardless of place of service. These are not separate benefits.
👉 A Basic Dental Trauma Benefit covers unanticipated injury to teeth and mouth that requires urgent dental treatment after an accident or trauma injury.
How to Join Discovery’s Severe Dental and Oral Surgery Benefit
👉 Discovery’s Severe Dental and Oral Surgery Benefit may form part of the option you have chosen.
👉 It covers a set list of procedures, for which no upfront payment is needed and no overall limit applies.
👉 This benefit is however subject to the Scheme’s rules and preauthorisation. You must get pre-authorisation to the hospital at least 48 hours before admission by calling 0860 99 88 77.
👉 If you are a member of the Classic Delta Saver or Essential Delta Saver options, you also need to use a hospital in the Delta Network of Hospitals.
How Much Are Discovery Monthly Premiums?
👉 Monthly premiums start from R1,102 per member for the Keycare options range with medical cover for both in-hospital and out-of-hospital treatment by providers in a specified network and goes up to R10,303 per member for the Executive Plan with extensive cover for in-hospital and day-to-day benefits, extended chronic medicine cover, and unlimited Above Threshold Benefit.
What Is the Waiting Period for Discovery’s Benefits?
👉 Discovery Health’s general waiting period is 3 months and the condition-specific waiting period is 12 consecutive months. This applies to first time joiners or members who had a break in medical aid membership of more than 90 days.
How to Claim for your Brace Benefits from Discovery
👉 You can submit a claim fast and easily in the following ways:
➡️ Scan and upload your claims on the website.
➡️ Scan and email your claims to [email protected].
➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
➡️ You can also submit your claims by post.
Discovery Contact Details
PO Box 784262,
Sandton,
2146
Phone: 0860 99 88 77
READ more about Discovery Health versus Medshield compared and revealed.
2. Bonitas Medical Aid
Who is Bonitas Medical Aid?
👉 Bonitas Medical Aid has been in operation for several decades, during which time it has developed a solid comprehension of the South African private healthcare market.
👉 Bonitas, which was founded in 1982, is the second-largest medical aid provider in South Africa. Its South African beneficiaries include, among others, youthful employees of multinational corporations. The global credit rating for Bonitas is AA-.
👉 Its team of professionals is continually looking into new ways to ensure that members are provided with health and dental care that is both affordable and of high quality.
👉 Keeping up with technological advances, managing treatment in such a way that lifestyle diseases are detected before they develop into chronic conditions, and negotiating better rates are all necessary steps in this process.
👉 In addition, their finances are sound, they have sufficient reserves, and their key indications of fiscal health are strong.
👉 The management of Bonitas has a great deal of experience, and the organization is overseen by an independent Board of Trustees consisting of professionals from the medical, legal, financial, and business disciplines who are not members of Bonitas.
👉 Dentistry is covered by select Bonitas options.
Bonitas Options
👉 Bonitas offers a wide range of options which provide cover for various needs.
👉 The options are divided into different categories, easy to understand while helping the member to find the most suitable option.
The Edge Category of options
👉 This category gives members access to day-to-day benefits such as unlimited GP consultations, virtual care, dental and optical consultations, a private hospital network and more.
👉 Options in this category includes BonStart, which is designed for economically active singles and BonStart Plus, for young, economically active couples looking to expand their family.
The Traditional Category of options
👉 The options in this category give an overall day-to-day limit with sub-limits for GP and specialist consultations, X-rays and blood tests, acute and over-the-counter medicine, and other out-of-hospital expenses.
👉 This category includes a traditional Standard Option that offers good day-to-day benefits and comprehensive hospital cover; a Standard Select option that uses quality network of providers that offers good day-to-day benefits and hospital cover; a Primary option that offers simple day-to-day benefits and hospital cover, and a Primary Select option that also uses a network of quality providers to offer modest day-to-day benefits and hospital cover.
The Savings Category of options
👉 These options give members a set amount that they can use for out-of-hospital costs like doctor visits, optometry, and dentistry. They also provide in hospital cover and additional benefits for maternity, wellness, and preventative care.
👉 These options are called BonFit Select, that offers essential hospital cover and basic cover for day-to-day medical needs; BonSave, a savings option that offers sufficient funds to use for medical expenses and extensive hospital cover; BonComplete that offers generous funds, an above threshold benefit and good hospital cover; BonClassic a savings option with a wide range of in and out of hospital benefits; and BonComprehensive, a first-class savings plan that offers ample savings, an above threshold benefit and extensive hospital cover.
The Hospital Option Category
👉 These options cover members for emergency and planned procedures in hospital while they can also get access to some additional benefits for wellness and preventative care. The plans include a Hospital Standard option that offers hospital benefits with some value-added benefits; BonEssential option that offers comprehensive hospital benefits with some value-added benefits; BonEssential Select that offers comprehensive hospital benefits and some value-added benefits for services offered in a provider network.
Income-based options
👉 Bonitas’ BonCap income based entry-level option offers very basic day-to-day benefits and hospital coverage when using the prescribed network of doctors, providers and hospitals.
Orthodontic Benefits with Bonitas
👉 Bonitas dental benefits are managed by DENIS, the largest network of dental professionals in South Africa.
BonComprehensive Benefits
👉 The BonComprehensive dental benefits are paid at the Bonitas Dental Tariff (BDT) from the member’s available Savings and/or Threshold Limit.
👉 The dental benefits are subject to DENIS managed care protocols and interventions which may include the requirement of prior treatment plans and/or radiographs.
👉 Scheme protocols and/or exclusions may apply to dental benefits.
Bonclassic Benefits
👉 Bonclassic dental benefits are paid at the Bonitas Dental Tariff (BDT) subject to the available limit.
👉 Benefits are subject to managed care protocols and interventions which may include the requirement of prior treatment plans and/or radiographs and scheme exclusions and protocols may apply to benefits.
👉 For this option a co-payment is levied on a hospital account. Hospital facilities that are contractually excluded by the scheme will incur a further co-payment of 30%.
Standard, Standard Select, & Boncomplete Benefits
👉 Dental benefits are paid at the Bonitas Dental Tariff (BDT), subject to managed care protocols and interventions which may require treatment plans and/or radiographs prior to benefit payments.
👉 On these options co-payments are levied for Orthodontics and on the hospital account, while the use of facilities contractually excluded by the scheme will incur a further 30% co-payment.
👉 Benefits on the Bonitas Standard Select option are subject to the use of a Designated Service Provider (DSP) on the DENIS Dental Network.
👉 Should a member use a non-network hospital for a procedure, a 30% co-payment will be applicable.
👉 Hospitalisation, and certain dentistry procedures and treatments must be pre-authorised to attract a benefit. In some cases procedures and treatments not pre-authorised will incure a 20% penalty after the treatment. Penalties do not apply in the case of emergency hospital admission.
Primary Select Benefits
👉 Dental benefits under Primary Select options are paid at the Bonitas Dental Tariff (BDT), subject to managed care protocols and interventions which may require prior obtaining treatment plans and/or radiographs.
Bonsave Benefits
👉 Bonsave dental benefits are paid at the Bonitas Dental Tariff (BDT), subject to managed care protocols and interventions. This may include the requirement of treatment plans and/or radiographs prior to benefit application and scheme exclusions will apply.
👉 A co-payment is charged on the hospital account and facilities contractually excluded by the scheme will incur a further 30% co-payment.
👉 Dental procedures and treatment must be pre-authorized.
Bonfit Select Benefits
👉 On the BonFit Select option PMB (Prescribed Minimum Benefits) treatment is the only dental treatment covered in hospital.
👉 Bonfit Select preventative dental benefits are managed by DENIS and only specified dental codes will be paid.
👉 Dental benefits are subject to managed care protocols and pre-authorization is required by DENIS for any dental related PMB hospitalization.
Boncap Benefits
👉 Dental benefits are managed by DENIS and paid at the Bonitas Dental Tariff (BDT).
👉 Only listed dental codes are covered under this option, except in the case of authorized Prescribed Minimum Benefit (PMB) events.
👉 This option does not have benefits for any Specialized Dentistry.
Hospital Standard Benefits
👉 On the Hospital Standard option a co-payment is levied on the hospital account and dental benefits are paid at the Bonitas Dental Tariff (BDT).
👉 Dental benefits are subject to managed care protocols and interventions like prior treatment plans and/or radiographs prior to benefit. Procedures and treatments not pre-authorized will not get a benefit.
👉 Facilities contractually excluded by the scheme will incur a 30% co-payment.
Bonessential & Bonessential Select Benefits
👉 Dental benefits are subject to managed care protocols and managed care interventions which may include the requirement of treatment plans and/or radiographs prior to benefit application. Dental benefits are paid at the Bonitas Dental Tariff (BDT).
Bonstart & Bonstart Plus Benefits
👉 PMB treatment is the only dental treatment covered in hospital on these options.
👉 Only listed dental codes are covered under this option, subject to managed care protocols.
👉 Pre-authorization by DENIS is required for any dental related PMB hospitalization at a BonStart and BonStart Plus Hospital Network.
👉 A co-payment applies to all non-network admissions.
How to Join Bonitas’ Dental Care Programme
👉 DENIS is contracted by medical schemes like Bonitas to provide services relating to dental benefits. Members do not have to separately join the programme, but their benefits will depend on the option they chose.
How Much Are Bonitas Monthly Premiums?
👉 Bonitas monthly contributions start at R 2 287 for a Principal Member, R 1 690 for a spouse/adult dependent and R 739 per child (max 3) on the BonEssential Hospital Plan and go up to R9,853 for a main member, R9,292 for additional adult, and R2,006 for a child for the BonComprehensive plan that offers abundant savings, an above threshold benefit and extensive hospital cover.
What Is the Waiting Period for Bonitas Benefits?
👉 The general waiting period for Bonitas medical aid is three months for all benefits and a waiting period of 12 months on all pre-existing conditions. This can apply to first time joiners or members who had a break of more than 90 days in medical aid membership prior joining.
How to Claim from Bonitas
👉 You can send in your claim in the following ways:
➡️ Email your claims to [email protected].
➡️ Post your claims to Bonitas Claims Department, PO Box 74, Vereeniging, 1930.
➡️ Submit your claims in person at one of the walk-in centers.
👉 Follow these simple steps to get your claims paid quickly:
➡️ Ensure your banking details are correct for refunds by electronic transfer (EFT) into your bank account
➡️ Make sure that your account and receipt show your name and initials, membership number, treatment date, the name of the patient as shown on your membership card, amount charged and ICD-10 code.
Bonitas Contact Details
34 Melrose Blvd,
Birnam
Johannesburg
Phone for General Queries: 0860002108
Email: [email protected]
Email: [email protected]
READ more about Bonitas vs. Discovery Health
3. Momentum Health
Who Is Momentum?
👉 Momentum Health is a medical aid that ranks among the top three largest open medical aids in South Africa.
👉 It is administered by Momentum Medical Scheme Administrators, which is a part of the Momentum Metropolitan Life Limited (MMI) Group (Pty) Ltd.
👉 Momentum Health is very sustainable and is in a good position to take care of the needs of its members both now and in the future thanks to its solvency ratio, which is greater than 31%.
👉 Momentum Health is a non-profit open medical aid registered under the Medical Schemes Act 131 of 1998, as amended.
👉 Its Board of Trustees is elected at an Annual General Meetings and consists of several individuals with experience and skills in a variety of medical, accounting and legal fields.
Momentum Health Options
👉 Momentum Medical Aid provides a wide range of options and benefits, including the following:
👉 The Evolve Option that covers hospitalization from the Evolve Network of private hospitals with no overall annual limit. Members get access to 2 virtual doctors’ consultations and some additional day-to-day benefits.
👉 The Custom Option provides comprehensive hospital and chronic cover from any provider. Members can choose to have access to treatment at any hospital or save on contributions by using a specific list of private hospitals.
👉 The Incentive Option provides extensive hospital and chronic cover from any provider. Day-to-day expenses is covered by a medical savings account funded by 10% of members’ monthly contributions.
👉 The Extender Option provides extensive hospital cover and additional chronic cover from any provider. 25% of members’ contributions go towards a dedicated medical savings account from which day-to-day expenses are paid. Members get the Extended Cover benefit once they have reached a Threshold.
👉 The Summit Option provides unlimited private hospital cover from any provider. Chronic cover is available for an additional 36 conditions and day-to-day benefits up to a certain amount per beneficiary per year are covered.
👉 The Ingwe Option provides affordable and accessible entry-level medical cover under which a member can get treatment from any hospital, the Ingwe Network of private hospitals, or State hospitals.
Orthodontic Benefits on Momentum Health Option Options
👉 Dentistry of a fundamental and emergency nature is covered under Momentum Health options, and its practise is sanctioned in accordance with the standards of the Dental Network.
👉 Every dentist on the Dental Network is required to claim the cost of basic dental care from Momentum Health. This includes procedures like fillings, extractions, and infection control, as well as cleaning and polishing of teeth.
👉 There is no cover for specialized dental care, such as dental bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures, or orthodontic appliances like braces.
👉 You are free to go to any dentist who is part of the Dental Network for fundamental dental care, including fillings, extractions, infection prevention, as well as teeth cleaning and polishing.
👉 The dental office will forward the bill to Momentum to be paid.
👉 Dentistry that falls under the category of “specialized dentistry,” such as bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures, and braces, are not included in the cover provided.
👉 Your dentist will let you know if a certain dental surgery that you require is not covered by your option, and you will be responsible for paying for it out of your own personal funds.
How to Join Momentum Health’s Dental Care Programme
👉 Members do not have to apply or join Momentum’s dental care programme, their benefits will depend on the option they chose, and the scheme’s general rules as set out above.
How Much Are Momentum Health’s Monthly Premiums?
👉 Momentum’s monthly premiums start at R1 119 for the main member on the Fusion Option and go up to R13,573 for the main member on the Summit Option.
What Is the Waiting Period for Momentum Benefits?
👉 A waiting period of three months and a 12 months exclusion on all pre-existing conditions may be applied to new members joining, or new members who had a break of more than 90 days in medical aid membership prior joining.
How to Claim from Momentum
👉 You can submit a claim in several ways:
➡️ Use the Momentum App
➡️ Use the web chat facility in the bottom left corner.
➡️ Send an email to [email protected] or send normal mail to PO Box 2338, Durban, 4000
👉 To make sure your claim is processed quickly and accurately, include the following information:
➡️ Membership number.
➡️ Principal member’s surname, initials, and first name.
➡️ Patient’s surname, initials, and first name.
➡️ Date of treatment.
➡️ Amount charged.
➡️ ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
➡️ Service provider’s name and practice number.
➡️ Proof of payment if you’ve paid the claim out of your own pocket.
Momentum Contact Details
201 Umhlanga Ridge Blvd
Cornubia
Blackburn
PO Box 2338
Durban
4. BestMed Medical Aid
Who is BestMed?
👉 BestMed is amongst the Top 5 medical aids in South Africa. They offer their members an extensive range of options to suite every one’s unique individual needs.
👉 BestMed claims to be South Africa’s largest self-administered medical aid and the country’s fourth largest open medical aid.
👉 Bestmed prides itself on single-digit increases for 5 years in a row and 13 options for every stage of life and budget.
👉 All their options come with great benefits for preventive health care, like female contraceptives, pneumonia, flu vaccines and more.
👉 Bestmed’s affordable entry level options provide access to networks of specialists and hospitals all over South Africa, including more than 4,300 family doctors.
👉 The Executive Leadership of BestMed consists of Leo Dlamini as CEO/Principal Officer, Pieter Van Zyl as COO, Ntando Ndonga as Executive: Legal, Risk & Corporate Governance, Elmarie Jooste as Zxecutive: Corporate Relations & Wellness, Jessogan Chetty as CFO, Dr Dion Kapp as Executive: Managed Healthcare and Service Providers, and Madelein Barkhuizen as Executive: Sales & Marketing. They are supported by teams of Member Elected Trustees and Board Appointed Trustees.
BestMed Options
👉 BestMed members can choose between Hospital Options, Network Options, Savings Options, and Comprehensive Options.
Hospital Options
👉 The Beat1 Network Option covers you at a range of network hospitals.
👉 The Beat1 Option provides cover in any private hospital
Network Options
👉 BestMed Network Plans include:
👉 Offers unlimited in-hospital cover in a Network Hospital and limited essential day-to-today benefits, or comprehensive savings for consultations with designated healthcare providers.
👉 Offers unlimited in-hospital in a Network Hospital and limited essential day-to-today benefits, or comprehensive savings for consultations with designated healthcare providers. This options contribution is dependent on various income levels.
Savings Options
👉 BestMed Savings Options include the following:
Beat2 –
👉 The Beat 2 plan offers extensive hospital cover at private hospitals and a savings account from which general day-to-day expenses are paid.
Beat2 Network –
👉 The Beat 2 Network option offers extensive hospital cover as well as access to a savings account for general day-to-day expenses. This plan is associated with certain Network hospitals and providers.
Beat3 –
👉 Beat 3 offers extensive in-hospital cover as well as savings and additional benefits.
Beat3 Network –
👉 Beat3 Network Savings Plan offers extensive in-hospital cover with savings and additional benefits. This plan is associated with a network of hospitals and providers.
Comprehensive Options
👉 BestMed Comprehensive Plans include the following:
Pace1 –
👉 The Pace 1 plan provides excellent hospital benefits with extensive day-to-day cover. It is ideal for those who want quality benefits but at an affordable price.
Beat4 –
👉 The Beat 4 comprehensive plan is suitable for people with specific healthcare needs, it includes additional chronic benefits and savings.
Pace2 –
👉 Pace 2 offers comprehensive cover with in- and out-of-hospital benefits are provided on this option with additional chronic conditions covered.
Pace3 –
👉 Pace 3 offers comprehensive cover for members that have more extensive medical needs. It includes comprehensive chronic benefits and cover additional chronic conditions.
Pace4 –
👉 The Pace 4 option is for those that need the comfort of extensive benefits and cover for hospital expenses because they have above-average medical costs. This option covers additional chronic conditions.
👉 It has the added benefit of an individual medical savings account which offers extra payment flexibility.
Orthodontic Benefits on BestMed
👉 Only selected Preventative Dentistry Benefits are offered on most of the BestMed options.
👉 Benefits on Beat & Pace Options include the following:
➡️ General full-mouth examination by a general dentist
➡️ Full-mouth intra-oral radiographs
➡️ Intra-oral radiographs
➡️ Scaling and/or
➡️ polishing
➡️ Fluoride treatment
➡️ Fissure sealing
➡️ Space maintainers During primary and mixed denture stage
👉 The dental benefits are for basic dentistry only and are subject to clinical protocols and an approved tariff list. Braces and other specialised dentistry are covered from Beat3 upwards.
How to Join BestMed’s Dental Care Programme
👉 Members do not have to apply or join BestMed’s dental care programme, their benefits will depend on the option and the scheme’s general rules as set out above.
How Much Are BestMed’s Monthly Contributions?
👉 At the time of writing, monthly contributions for the cheapest BestMed Beat1 Network Hospital Plan started at R1,873 for a member, with an additional R1,456 for an adult dependant and R789 for a child dependant, to a maximum of 3 child dependants. Additional children join at no additional cost.
👉 The most expensive plan at the time was the Pace4 Comprehensive Plan, with monthly contributions of R10,343 per member and R10,343 per adult dependant. For a child dependant the extra contribution was R2,423 up to 3 child dependants with additional children added as beneficiaries of the scheme at no extra cost.
What is the Waiting Period for BestMed membership?
👉 There can be a general waiting period of three months or a specific waiting period of 12 months for pre-existing conditions. This can apply to first time joiners or members joining who had a break in medical aid membership of more than 90 days.
👉 Bestmed Medical Scheme will sometimes only pay a claim if it is a PMB. This can happen if you are in a waiting period or if you are getting treatment for a condition that your plan doesn’t cover.
How to Claim from BestMed
👉 If your healthcare provider does not submit claims to BestMed, you must submit the original claim directly to the fund administrators.
👉 You can claim by means of the BestMed App, or by scanning and emailing your claim to them.
👉 Details that should appear on all claim documents include:
➡️ Member’s name and contact details
➡️ BestMed membership number
➡️ Patient’s details
➡️ Service provider’s name, contact details and practice number
➡️ Details of treatment, including applicable tariff and ICD-10 codes
➡️ Whether payment should be done to the service provider or the member
👉 You will receive an email confirmation when your claim is received and indexed.
BestMed Contact Details
Head Office:
Glenfield Office Park
361 Oberon Avenue
Faerie Glen
Pretoria
PO Box 2297
Pretoria
Emails: [email protected]; [email protected],
Phone: +27 (0)86 000 2378
READ more about BestMed Medical Scheme vs Discovery Health
5. Fedhealth
Who Is FedHealth?
👉 Fedhealth was established in 1936 as the Reef Medical Scheme, making it one of the oldest medical aid providers in South Africa.
👉 It’s an established and financially secure company, with a global credit rating of -AA and a large membership base.
👉 Fedhealth gives its members access to medical care that they can manage themselves to a large extent.
👉 Fedhealth is also known for its unique benefits paid from Risk, which help members get more value from their regular benefits.
👉 The company is still run by members for its members and is always looking for new ideas to meet the needs of people who want to take care of their health in an ever-changing world.
FedHealth Options
👉 Fedhealth medical aid plans are made to fit all people’s needs, budgets, and stages of life.
👉 Customers can choose from a variety of options, including coverage if they’ve never had medical aid before, the innovative flexiFED options that let them “create” their own option and the maxiFED options with the most comprehensive medical aid coverage.
👉 Options include myFED which offers affordable (salary-banded) cover for lower-income, previously uncovered employees; the affordable flexiFED Savvy for young, healthy people who just started a first job and need a personalised, customised and affordable hospital plan with a day-to-day back-up plan.
👉 flexiFED 1 is another affordable hospital option that gives great medical aid coverage at a good price, with access to Fedhealth Savings for unexpected day-to-day medical bills and a Threshold Benefit that kicks in once claims have reached a certain level.
👉 flexiFED 2 is a family hospital option for young parents, with generous maternity and childhood benefits, access to Fedhealth Savings and a Threshold Benefit that kicks in when claims have reached a certain level.
👉 flexiFED 3 is for young, growing families who need generous maternity and childhood benefits. Members also have access to Fedhealth Savings for unforeseen medical expenses, and a Threshold Benefit that kicks in once claims have reached the correct level.
👉 flexiFED 4 provides cover for mature families with comprehensive in-hospital cover, Fedhealth Savings for unplanned medical bills and a Threshold benefit once claims have accumulated to a certain level.
👉 The maxima EXEC and maxima PLUS options offers comprehensive all-around cover for mature members. They offer extensive medical cover for every aspect of your healthcare, like the in-hospital cover, chronic medicine, screening and additional benefits, a day-to-day savings portion, a Threshold benefit, and an optional hospital expense benefit.
Orthodontic Benefits under Fedhealth Options
👉 Your out-of-hospital benefits and/or savings component, whichever is applicable, will be used by Fedhealth to cover the cost of any orthodontic treatment that has been pre-authorised.
How to Join Fedhealth’s Dental Care Programme
👉 Members do not need to apply or join Fedhealth’s dental care programme.
👉 Applicable benefits will depend on the option they have chosen and the scheme’s general rules.
How Much Are FedHealth’s Monthly Contributions?
👉 The monthly contributions for the salary-banded myFED option is from R1,590 per month for the main member.
👉 The maxima PLUS extensive medical cover will cost R14,289 per month for the main member.
What Is the Waiting Period for FedHealth Benefits?
👉 The general waiting period for FedHealth benefits are usually three months. The waiting period for pre-existing conditions is 12 months. This is applicable to first time joiners or members who had a break of more than 90 days in medical aid cover prior joining.
How to Claim from FedHealth
👉 Members can submit claims using one of the following:
➡️ On the Fedhealth Family Room,
➡️ Through a WhatsApp service
➡️ On the Fedhealth Member Phone App
➡️ You may also email, fax or post the claims to email: [email protected], fax: (011) 671 3842 or post to Private Bag X3045, Randburg, 2125.
FedHealth Contact Details
Flora Centre Shop 21 and 22
Corner Conrad street and Ontdekkers Rd
Florida Glen
Johannesburg
Phone: 0861 116 016
READ more about Fedhealth versus Momentum Medical Scheme compared and revealed.
Frequently Asked Questions
Will your medical aid pay for braces?
Your medical aid will not necessarily pay for braces. You usually have to pay the cost of all dental appliances and their placements as well as orthodontic treatment.
Are there medical aids in South Africa that cover braces?
Yes, there are medical aids in South Africa that pay for braces, but that would probably only be applicable to the more expensive options. Furthermore, the benefit may be paid from your savings portion and be subject to certain limits.
How much does it cost to get braces in South Africa?
The cost of dental braces in South Africa will vary depending on the style and type of orthodontic device needed but it can can cost anywhere from R3 000 to R58 000.
Does medical insurance cover the cost of braces?
Yes, some medical insurance policies may cover the cost of braces – in whole or partly.
Can you have medical aid & medical insurance at the same time to cover braces?
Yes, you can have medical aid and medical insurance at the same time to cover a larger portion of the cost of braces.
How long do you have to be a member of a medical aid to get braces covered?
The time you have to be a member of a medical aid to get braces covered will entirely depend on the Scheme and option you choose.
