Know your dental benefits

Sapphire and Beryl options

Sapphire and Beryl (SB) members are restricted to the use of an approved list of benefits and Designated Service Providers (DSP) on the GEMS Network and the use of a medicine formulary (available on GEMS website). A list of contracted dentists for these options can be obtained from the GEMS website (www.gems.gov.za) or by calling 0860 00 4367.

SB members have in-hospital benefits for removal of impacted third molars (also known as wisdom teeth). The benefit is subject to the use of a DSP day clinic or hospital, which must be pre-authorised. Failure to obtain pre-authorisation for planned services from a GEMS DSP may result in members being liable for the payment of the services. Authorisations must be updated when dates or procedure codes change to ensure the correct payment of the account.

SB members do not have benefits for specialised dentistry and orthodontic treatment.

Ruby, Emerald and Onyx options

These options have a broad range of dental benefits. Procedures that require pre-authorisation:

• Fixed and removable orthodontic treatments;
• Conscious sedation;
• Intravenous sedation;
• Surgical removal of impacted third molars/wisdom teeth; and
• Procedures performed in hospitals and day facilities.

Exclusions

• Orthodontic treatment is only covered for members under the age of 21 years;
• Placement of implants and related restorative procedures are excluded; and
• Frenectomy procedures (removal of tissue in the frenulum or adjacent large gaps in the teeth) in members over eight years of age are excluded.

If you are unsure about benefits, contact the GEMS on 0860 00 4367.