Discovery Health dental benefits, in plain language

Discovery Health funds routine dentistry differently depending on your plan tier, so how your plan pays matters more than the scheme name on the card. On Executive, the Comprehensive series, the Priority series and the Saver series, your check-ups, cleans and fillings are paid from your Medical Savings Account — your own funds, not scheme risk — with the Personal Health Fund as a further funding source on Executive and Comprehensive. Executive, Comprehensive and Priority add an Above Threshold Benefit that starts paying again once your day-to-day claims cross the threshold; on the Saver series there is no threshold, so once your savings run out, the rest of the year is self-paid.

The Smart plans and Smart Saver work on a different logic: each person gets one defined check-up a year as an insured benefit — a consultation, two bitewing X-rays, a scale and polish and fluoride — with a fixed co-payment of R130 or R195 paid at the visit, depending on the plan. KeyCare Plus and KeyCare Start also pay routine dentistry from scheme risk, but only at a KeyCare network dentist — there is no benefit outside that network.

Two rules run across nearly every plan: Discovery pays at its own Discovery Health Rate (DHR), and charges above that rate are for your account; and serious conditions fall under the Severe Dental & Oral Surgery Benefit, which covers a defined list with pre-authorisation.