Registration Number 2007/019358/07

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Frequently Asked Questions

01

HOW THE PRODUCTS WORK
  • Procedures may only be provided by registered general dentists (preferably on the DRC list)

  • The procedure or service being claimed for must be provided while the policy is in force

  • For a list of our DRC preferred provider list click on PROVIDER SEARCH above BUT remember that you may use any provider, whether on the list or not!

  • Principle / Main member must be 18 years or older

04

WHEN AM I COVERED?

WHEN ARE YOU COVERED?

  • As soon as any relevant waiting periods expired and all premiums are paid up to date – please refer to the benefit table   and

  • b)  A Compulsory Panoramic scan has been submitted - a Panoramic scan is required to activate benefits - no claim or pre-authorisation will be processed if this scan has not been received)

 

PANORAMIC SCAN: This is a full mouth   X-ray that will only be covered when joining the Bronze, Silver and Gold options as an individual, over the age of 18 years. The Panoramic radiograph will only be paid by DRUM once the scan has been received by DRUM via email smile@dentalrisk.co.za. The cover is limited to Medicross (a list is available on our website homepage) or any other facilities that has a panoramic radiograph machine. A benefit of R300 per nominated beneficiary is available and it is compulsory to submit this X-ray to DRUM for capturing and releasing of future Specialised Dental benefits. Should pre-authorisation for any specialised dentistry be submitted prior to receiving the panoramic radiograph, these pre-authorisation requests will not be honoured.

NOTE: Medicross facilities do not charge a consultation fee. Should you not have access to a Medicross and need to use another provider, please only do the Pan scan after your 3 month waiting period is over to allow for the consultation benefit to also be accessed

 

Once DRUM has received the panoramic scan, DRUM will identify all:

  • missing teeth,

  • existing crowns,

  • existing implants and

  • existing temporary crowns.

Existing crowns, existing implants and existing temporary crowns will be ruled as pre-existing conditions and will have an additional waiting period applied to them for a period of 5 (five) years. After the additional period of 5 years is completed, the policyholder may apply to have these procedures redone.

WHAT IS THE PROCEDURE WHEN CLAIMING?

Once the procedure / service has been completed:     

 

  • If you have paid the provider directly, we will refund you up to the maximum benefit allowed according to your option choice, into your bank account on receipt of  a provider invoice / statement and proof of payment. Please submit a Member Reimbursement Form with such claims 

  • OR the claim will be paid up to the maximum benefit allowed directly to the provider on receipt of the invoice 

  • All claims must be submitted within 1 month of the event occurring

  • Claim documentation can be emailed to  smile@dentalrisk.co.za OR faxed 086 687 1285

02

03

05

HOW DO I CHANGE/UPDATE POLICY DETAILS?

No forms required! Simple send us a detailed email instruction to smile@dentalrisk.co.za - to:

1. change bank details

2. add or remove dependants

3. cancel your policy

4. upgrade or downgrade

 

06

CAN A FAMILY HAVE MORE THAN 1 POLICY?

No! One household has to have the same policy option  - so one policy. Its easy : if numerous family members have to use the same bank account for their policy debit order, then 1 policy has to be taken for those members.

UPGRADING OR DOWNGRADING

 

Upgrading: 2 e.g’s:

 

1) From PRIME OR BRONZE to either SILVER OR GOLD:
  • Basic Dentistry benefit (3 months waiting period line items) – no waiting periods: immediate cover
  • All the SPECIALISED DENTISTRY benefits (those with 6 months waiting periods) will have the 6 months waiting period instilled for the higher option value!