New limits for specialised dentistry in 2025
From 2025, new limits will be applied to specialised dentistry services to ensure comprehensive and equitable cover for all members. These changes are designed to provide better financial management while maintaining access to essential dental care.
Specialised dentistry includes a wide range of treatments such as:
- Inlays
- Crowns
- Bridges
- Study models
- Metal-base dentures and their repair
- Oral medicine
- Periodontics
- Orthodontics
- Prosthodontics
- Osseo-integrated implantology
- Theatre procedures
Annual limits
- Overall family limit: R17,400 per family per year.
- Sub-limit per beneficiary: R10,000 per beneficiary per year.
These limits are structured to accommodate the varying needs of families, ensuring that each member receives adequate cover for specialised dental procedures.
If specialised dental treatment is performed in theatre with preauthorisation, the entire treatment event, including all related accounts (eg, dentist, surgeon), will be covered under the specialised dentistry limit. However, theatre and anaesthetist accounts will be paid from the unlimited hospital benefit.
When a maxillo-facial surgeon performs a standard dental procedure in theatre, the event will still be payable from the annual specialised dentistry limit for the family. This ensures that even complex dental procedures are covered without additional financial strain.
These updates reflect a commitment to providing high-quality dental care while managing costs effectively. For more detailed information about your cover and benefits for dentistry, read the official Engen Medical Benefit Fund guide.