You should have received these in your emailed manual, but if you have not received a provider manual, please call GEMS on 0860 436 777 to request one. You can also download the dental provider manual here
Although the benefit allows for any four resin fillings per beneficiary per year, a posterior resin filling will be paid to the same Rand value as a same surfaces amalgam filling. Two events per year applies.
All procedures performed in-hospital require pre-authorisation at least 48 hours before admission. All procedures which require pre-authorisation must be done by completing the form which is available on the GEMS website:click here to download.
In addition, certain out-of-hospital procedures also require pre-authorisation and these include:
Sapphire and Beryl options - More than four fillings and extractions and all denture-related procedures.
Ruby, Emerald and Onyx Options - Specialised dental procedures such as crowns, veneers, inlays or onlays and bridges, orthodontic treatment and periodontal treatment.
If there is a difference in treatment your claims may be short paid. We suggest that any authorised treatment plan which has changed, be updated with the Scheme before treatment is received in order to avoid short-payment or non-payments of claims.