Dental Management

The GEMS dental benefit ensures that members have access to cost-effective, quality dental healthcare. Pre-authorisation for specialised dentistry Pre-authorisation means that you must get the Scheme's authorisation to use certain medicine or undergo a certain procedure at least 48 hours before it happens. Failure to obtain, will lead to a penalty payment of R1 000 out of your own pocket.

Members and dependants need pre-authorisation for the following treatment types:
  • Any treatment in hospital,
  • Conscious sedation,
  • Crown and bridge treatment,
  • Maxillofacial surgery,
  • Orthodontics,
  • Periodontal treatment, and
  • Plastic dentures (Tanzanite One and Beryl options).

To request pre-authorisation, ask your dental service provider to complete and submit the ‘Periodontal’ form (for Periodontal treatment) or the ‘Dental Report’ form (for all other treatment). The forms are available under Forms on the GEMS Information Centre page.

Dental treatment under general anaesthesia or conscious sedation
Under certain circumstances and for certain procedures, your dental provider may inform you that your dental procedure will be performed under either general anaesthesia or conscious sedation. Under general anaesthesia you will be asleep throughout the procedure. This is generally done in a hospital environment. Conscious sedation means you are partially awake, but you are relaxed during the procedure. This treatment is done in the dental chair.

Benefits for treatment under general anaesthesia or conscious sedation are not available for members or dependants older than six years, unless for impacted teeth or severe trauma. The treating dentist or dental specialist must provide GEMS with the medical reason for general anaesthesia or conscious sedation before the procedure is performed.

You need pre-authorisation for all procedures that require general anaesthesia or conscious sedation. In an emergency, pre-authorisation may not be required, but we advise that you contact us as soon as possible to avoid paying a penalty.

Dental treatment in hospital
Dental hospitalisation is allowed only for patients younger than six years, impacted teeth, or severe trauma (PMBs). Contact us for pre-authorisation for hospitalisation at least 48 hours before treatment unless it is an emergency.

In the event of an admission to a private facility for an emergency dental condition, the Scheme must be notified of such admission within one working day after the admission, failing which, a co-payment of R1 000 per admission will apply.

If you are on the Tanzanite One or Emerald Value option, you must use a State or Network facility; failing which, the Scheme will not be liable to fund the first R12 000 of such a facility’s bill.

Use a GEMS network hospital to avoid any out-of-pocket expenses. You can access the search function for Network Hospitals under the ‘For Individuals’ tab. Alternatively, contact GEMS for assistance on 0860 004 367.

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