Bonitas Dental Benefit Tables 2024

BONCOMPREHENSIVE Dental Benefit Table 2024 ..................................................................................... 2

BONCLASSIC Dental Benefit Table 2024..................................................................................................... 7
STANDARD Dental Benefit Table 2024 ...................................................................................................... 12
STANDARD SELECT Dental Benefit Table 2024 ....................................................................................... 12
BONCOMPLETE Dental Benefit Table 2024 .............................................................................................. 12
PRIMARY Dental Benefit Table 2024 ......................................................................................................... 21
PRIMARY SELECT Dental Benefit Table 2024 .......................................................................................... 21
BONSAVE Dental Benefit Table 2024 ........................................................................................................ 27
BONFIT SELECT Dental Benefit Table 2024.............................................................................................. 32
BONCAP Dental Benefit Table 2024 .......................................................................................................... 37
HOSPITAL STANDARD Dental Benefit Table 2024 ................................................................................... 40
BONESSENTIAL Dental Benefit Table 2024 .............................................................................................. 43
BONESSENTIAL SELECT Dental Benefit Table 2024 ............................................................................... 43
BONSTART Dental Benefit Table 2024 ...................................................................................................... 46
BONSTART PLUS Dental Benefit Table 2024 ............................................................................................ 46
Additional Scheme Exclusions (All Options) ............................................................................................... 48

Get in touch
For assistance with Dental pre-authorisations, queries on your claims, or benefit information, contact DENIS:

Members: 0860 336 346 | Providers: 0861 033 647

www.denis.co.za

1 Bonitas Dental Benefit Tables 2024

BONCOMPREHENSIVE Dental Benefit Table 2024

Dental Benefits** Pre-authorisation*

The dental benefits of the BonComprehensive option Hospitalisation, and certain dentistry procedures and
will be paid from the member’s available Savings and/or treatments must be pre-authorised. Pre-authorisation
Threshold Limit. is required for: Dentures, Crown & Bridge, Implants,
Orthodontics, Periodontics, Hospital Admissions and
Dental benefits are paid at the Bonitas Dental Tariff
Moderate / Deep Sedation in the Dental Rooms.
(BDT).
Procedures and treatments not pre-authorised will not
The dental benefits as published below will apply,
attract a benefit, with the exception of Crown & Bridge
subject to DENIS managed care protocols and
procedures where a 20% penalty will apply if
managed care interventions which may include the
authorisation is applied for after the treatment is
requirement of treatment plans and/or radiographs prior
clinically indicated.
to benefit application.
Failure to pre-authorise orthodontic treatment will result
Scheme Exclusions apply to dental benefits.
in a payment only from date of authorisation for the
In the event of a dispute, the registered Rules of the remaining months of treatment, provided that the
Scheme will prevail. treatment is clinically indicated.
Penalties do not apply to emergency hospital
admission.
** Please note that Medscheme will be responsible
for the payment of all dental related claims on the
BonComprehensive option.

CONSERVATIVE
BONCOMPREHENSIVE
DENTISTRY

Consultations Two check-ups per beneficiary per year (once every 6 months)
Benefit subject to managed care protocols
Covered at the BDT

X-rays: Intraoral Benefit subject to managed care protocols

Covered at the BDT

X-rays: Extraoral One per beneficiary in a 3-year period

Additional benefit may be considered where specialised dental treatment is
required.
Benefit subject to managed care protocols
Covered at the BDT

Preventative Care Two scale and polish treatments per beneficiary per year (once every 6 months)
Benefit for fissure sealants:
Limited to beneficiaries younger than 16 years of age
Benefit for fluoride:
Limited to beneficiaries from age 5 and younger than 16 years of age
Benefit subject to managed care protocols
Covered at the BDT

2 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
BONCOMPREHENSIVE
DENTISTRY

Scheme Exclusions:
• Oral hygiene instruction
• Oral hygiene evaluation
• Professionally applied fluoride for beneficiaries younger than 5, and 16 years and
older
• Tooth whitening

Fillings Benefit for fillings:

Granted once per tooth in 720 days
Benefit for re-treatment of a tooth:
Subject to managed care protocols
Multiple fillings:
A treatment plan and X-rays may be required for multiple fillings
Covered at the BDT
Scheme Exclusions:
• Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion
and fluorosis
• Resin bonding for restorations that are charged as a separate procedure to the
restoration
• The polishing of restorations
• Gold foil restorations
• Ozone therapy

Root Canal Therapy Benefit subject to managed care protocols

and Extractions
Covered at the BDT
Scheme Exclusions:
• Root canal therapy on primary (milk) teeth
• Root canal therapy on third molars (wisdom teeth)
• Direct and indirect pulp capping procedures

Plastic Dentures* Pre-authorisation required for Dentures

and Associated
One set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
Laboratory Costs
Benefit not available for the clinical fee of denture repairs, denture tooth
replacements and the addition of a soft base to new dentures; the laboratory fee will
be covered (no pre-authorisation required).
Benefit for a mouth guard: Benefit available for both the clinical and the associated
laboratory fee for a mouth guard (no pre-authorisation required).
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Diagnostic dentures and associated laboratory costs
• Snoring appliances and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees
• Provisional dentures and associated laboratory costs

3 Bonitas Dental Benefit Tables 2024

 SPECIALISED
BONCOMPREHENSIVE
DENTISTRY

Partial Chrome Cobalt Pre-authorisation required

Frame Dentures*
Two partial frames (an upper and a lower) per beneficiary in a 5-year period
and Associated
Laboratory Costs Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• The metal base to full dentures and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Crown & Bridge* Pre-authorisation required

and Associated
Three crowns per family per year
Laboratory Costs
Benefit for crowns will be granted once per tooth in a 5-year period
A bridge comprises two or
more crown units. Each A treatment plan and X-rays may be requested
crown is payable from the
Benefit subject to managed care protocols
available Crown & Bridge
benefit. A pontic on a 2nd molar, where the 3rd molar is a crown retainer, is subject to
managed care protocols
Covered at the BDT
Scheme Exclusions:
• Crowns on third molars
• Crown and bridge procedures for cosmetic reasons and associated laboratory
costs
• Occlusal rehabilitations and associated laboratory costs
• Laboratory fabricated temporary crowns
• Provisional crowns and associated laboratory costs
• Porcelain veneers and inlays, and associated laboratory costs
• Emergency crowns that are not placed for the immediate protection in tooth
injury
and associated laboratory costs
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Implants* Pre-authorisation required

and Associated
Two implants per beneficiary in a 5-year period
Laboratory Costs
Cost of implant components limited to R3 387 per implant
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Implants on third molars (wisdom teeth)
• Laboratory delivery fees

Orthodontics* Pre-authorisation required

and Associated
Benefit for orthodontic treatment granted once per beneficiary per lifetime
Laboratory Costs
Only one family member may commence orthodontic treatment in a calendar year
On pre-authorisation, cases will be clinically assessed by using an orthodontic
needs analysis. Benefit allocation is subject to the outcome of the needs analysis
and funding can be granted up to 100% of the BDT.

4 Bonitas Dental Benefit Tables 2024

 SPECIALISED
BONCOMPREHENSIVE
DENTISTRY

Benefit for orthodontic treatment will be granted where function is impaired.

Benefit will not be granted where orthodontic treatment is required for cosmetic
reasons. The associated laboratory costs will also not be covered.
Benefit for fixed comprehensive treatment:
Limited to individuals from age 9 and younger than 18 years of age
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Orthognathic (jaw correction) and other orthodontic related surgery, and any
associated hospital and laboratory costs
• Orthodontic re-treatment and any related laboratory costs
• Invisible retainer material
• Laboratory delivery fees

Periodontics* Pre-authorisation required

Benefit will only be applied to members registered on the Periodontal Programme
Benefit limited to conservative, non-surgical therapy only
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Surgical periodontics which includes gingivectomies, periodontal flap surgery,
tissue grafting and the hemisection of a tooth
• PerioChip placement

Maxillo-facial Surgery Surgery in the dental chair:

and Oral Pathology Benefit subject to managed care protocols
Covered at the BDT
Temporo-mandibular joint (TMJ) therapy:
Benefit limited to non-surgical intervention/treatments
Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of
the jaw and soft tissue tumours): Claims will only be covered if supported by a
laboratory report that confirms diagnosis.
Benefit for the closure of an oral-antral opening (code 8909):
Subject to motivation and managed care protocols
Surgery in hospital: See Hospitalisation* below
Scheme Exclusions:
• Orthognathic (jaw correction) surgery
• Sinus lifts
• Bone augmentations
• Bone and tissue regeneration procedures
• The cost of bone regeneration material
• The auto-transplantation of teeth

5 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
BONCOMPREHENSIVE
ANAESTHETICS

Hospitalisation Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply
Benefit subject to managed care protocols
General anaesthetic benefit available for children under the age of 5 years for
extensive dental treatment
General anaesthetic benefit available for the removal of impacted teeth
The hospital and anaesthetist claims for the procedures listed below will not be
covered when performed under general anaesthesia. The payment of the dental
procedure will be dependent on available benefits, and payable at the BDT:
• Apicectomies
• Dentectomies
• Frenectomies
• Implantology and associated surgical procedures
• Conservative dental treatment (fillings, extractions and root canal therapy) for
adults
• Professional oral hygiene procedures
• Surgical tooth exposures for orthodontic reasons
Scheme Exclusions:
• Where the only reason for admission to hospital is dental fear and anxiety
• Multiple hospital admissions
• Where the only reason for the admission request is for a sterile facility
• The cost of dental materials for procedures performed under general anaesthesia

Inhalation Sedation Benefit subject to managed care protocols

in the Dental Rooms
Covered at the BDT

Moderate/Deep Sedation Pre-authorisation required

in the Dental Rooms*
Benefit limited to extensive dental treatment
Benefit subject to managed care protocols
Covered at the BDT

6 Bonitas Dental Benefit Tables 2024

BONCLASSIC Dental Benefit Table 2024

Dental Benefits Pre-authorisation*

Dental benefits are paid at the Bonitas Dental Tariff Hospitalisation, and certain dentistry procedures and
(BDT) subject to the available financial limit. treatments must be pre-authorised. Pre-authorisation is
required for: Dentures, Crown & Bridge, Orthodontics,
Dental benefits are subject to managed care protocols
Periodontics, Hospital Admissions and Moderate/Deep
and managed care interventions which may include the
Sedation in the Dental Rooms.
requirement of treatment plans and/or radiographs prior
to benefit application. Procedures and treatments not pre-authorised will not
attract a benefit, with the exception of Crown & Bridge
Scheme Exclusions apply to dental benefits.
procedures where a 20% penalty will apply if
In the event of a dispute, the Rules of the Scheme will authorisation is applied for after the treatment has been
prevail. clinically indicated.
Co-payments Failure to pre-authorise orthodontic treatment will result
in a payment only from date of authorisation for the
On the BonClassic option a co-payment is levied on
remaining months of treatment, provided that the
the hospital account.
treatment is clinically indicated.
Hospital account: The co-payments on BonClassic to
Penalties do not apply to emergency hospital
be waived if the cost of the service falls within the co-
admission.
payment amount.

Bonitas BonClassic Hospital Network

Members on the BonClassic option must use a hospital
within the Bonitas BonClassic Hospital Network.
Should a member on the BonClassic option make use
of a non-network hospital for an elective procedure, a
30% co-payment will be applicable on the hospital
account.

CONSERVATIVE BONCLASSIC
DENTISTRY Conservative Dentistry limit of R5 812 per family per year

Consultations Two check-ups per beneficiary per year (once every 6 months)
Benefit subject to managed care protocols
Covered at the BDT

X-rays: Intraoral Benefit subject to managed care protocols

Covered at the BDT

X-rays: Extraoral One per beneficiary in a 3-year period

Additional benefit may be considered where specialised dental treatment is
required.
Benefit subject to managed care protocols
Covered at the BDT

7 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE BONCLASSIC
DENTISTRY Conservative Dentistry limit of R5 812 per family per year

Preventative Care Benefit for scale and polish:

Two scale and polish treatments per beneficiary per year (once every 6 months)
Benefit for fissure sealants:
Limited to beneficiaries younger than 16 years of age
Benefit for fluoride:
Limited to beneficiaries from age 5 and younger than 16 years of age
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Oral hygiene instruction
• Oral hygiene evaluation
• Professionally applied fluoride for beneficiaries younger than 5, and 16 years and
older
• Tooth whitening

Fillings Benefit for fillings:

Granted once per tooth in 720 days
Benefit for re-treatment of a tooth:
Subject to managed care protocols
Multiple fillings:
A treatment plan and X-rays may be required for multiple fillings
Covered at the BDT
Scheme Exclusions:
• Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion
and fluorosis
• Resin bonding for restorations that are charged as a separate procedure to the
restoration
• The polishing of restorations
• Gold foil restorations
• Ozone therapy

Root Canal Therapy Benefit subject to managed care protocols

and Extractions
Covered at the BDT
Scheme Exclusions:
• Root canal therapy on primary (milk) teeth
• Root canal therapy on third molars (wisdom teeth)
• Direct and indirect pulp capping procedures

Plastic Dentures* Pre-authorisation required for Dentures

and Associated
One set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
Laboratory Costs
Limit: Benefit for Plastic Dentures and Associated Laboratory Costs is payable from
the available Conservative Dentistry limit.
• Benefit not available for the clinical fee of denture repairs, denture tooth
replacements and the addition of a soft base to new dentures; the laboratory fee will
be covered (no pre-authorisation required).
• Benefit for a mouth guard: Benefit available for both the clinical and the associated
laboratory fee for a mouth guard (no pre-authorisation required).
Benefit subject to managed care protocols | Covered at the BDT

8 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE BONCLASSIC
DENTISTRY Conservative Dentistry limit of R5 812 per family per year

Scheme Exclusions:
• Diagnostic dentures and associated laboratory costs
• Snoring appliances and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees
• Provisional dentures and associated laboratory costs

SPECIALISED BONCLASSIC
DENTISTRY Specialised Dentistry limit of R6 997 per family per year

Partial Chrome Cobalt Pre-authorisation required

Frame Dentures*
Two partial metal frames (an upper and a lower) per beneficiary in a 5-year period
and Associated
Laboratory Costs Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• The metal base to full dentures and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Crown & Bridge* Pre-authorisation required

and Associated
One crown per family per year
Laboratory Costs
Benefit for crowns will be granted once per tooth in a 5-year period
A bridge comprises two or
more crown units. Each A treatment plan and X-rays may be requested
crown is payable from the
Benefit subject to managed care protocols
available Crown & Bridge
benefit. A pontic on a 2nd molar, where the 3rd molar is a crown retainer, is subject to
managed care protocols
Covered at the BDT
Scheme Exclusions:
• Crowns on third molars
• Crown and bridge procedures for cosmetic reasons and associated laboratory
costs
• Laboratory fabricated temporary crowns
• Occlusal rehabilitations and associated laboratory costs
• Provisional crowns and associated laboratory costs
• Porcelain veneers and inlays, and associated laboratory costs
• Emergency crowns that are not placed for the immediate protection in tooth injury
and associated laboratory costs
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Implants* No benefit
and Associated
Laboratory Costs

9 Bonitas Dental Benefit Tables 2024

 SPECIALISED BONCLASSIC
DENTISTRY Specialised Dentistry limit of R6 997 per family per year

Orthodontics* Pre-authorisation required

and Associated
Benefit for orthodontic treatment granted once per beneficiary per lifetime
Laboratory Costs
Only one family member may commence orthodontic treatment in a calendar year
On pre-authorisation, cases will be clinically assessed by using an orthodontic
needs analysis. Benefit allocation is subject to the outcome of the needs analysis
and funding can be granted up to 100% of the BDT.
Benefit for orthodontic treatment will be granted where function is impaired.
Benefit will not be granted where orthodontic treatment is required for cosmetic
reasons. The associated laboratory costs will also not be covered.
Benefit for fixed comprehensive treatment:
Limited to individuals from age 9 and younger than 18 years of age
Benefit subject to managed care protocols
Scheme Exclusions:
• Orthognathic (jaw correction) and other orthodontic related surgery, and any
associated hospital and laboratory costs
• Orthodontic re-treatment and any related laboratory costs
• Invisible retainer material
• Laboratory delivery fees

Periodontics* Pre-authorisation required

Benefit will only be applied to members registered on the Periodontal Programme.
Benefit limited to conservative, non-surgical therapy only
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Surgical periodontics which includes gingivectomies, periodontal flap surgery,
tissue grafting and the hemisection of a tooth
• PerioChip placement

Maxillo-facial Surgery Surgery in the dental chair:

and Oral Pathology Benefit subject to managed care protocols
Covered at the BDT
Temporo-mandibular joint (TMJ) therapy:
Benefit limited to non-surgical intervention/treatments
Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of
the jaw and soft tissue tumours): Claims will only be covered if supported by a
laboratory report that confirms diagnosis.
Benefit for the closure of an oral-antral opening (code 8909):
Subject to motivation and managed care protocols
Surgery in hospital: See Hospitalisation* below
Scheme Exclusions:
• Orthognathic (jaw correction) surgery
• Sinus lifts
• Bone augmentations
• Bone and tissue regeneration procedures
• The cost of bone regeneration material
• The auto-transplantation of teeth

10 Bonitas Dental Benefit Tables 2024

 HOSPITALISATION AND
BONCLASSIC
ANAESTHETICS

Hospitalisation Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply
Benefit subject to managed care protocols
General anaesthetic benefit available for children under the age of 5 years for
extensive dental treatment:
• A co-payment of R3 500 per hospital OR day clinic admission applies.
General anaesthetic benefit available for the removal of impacted teeth:
• A co-payment of R5 000 per hospital admission applies for the removal of
impacted teeth and any other medical admission other than children younger
than 5 years of age.
• A co-payment of R2 500 per day clinic admission applies for the removal of
impacted teeth and any other medical admission other than children younger
than 5 years of age.
The hospital and anaesthetist claims for the procedures listed below will not be
covered when performed under general anaesthesia. The payment of the dental
procedure will be dependent on available benefits, and payable at BDT:
• Apicectomies
• Dentectomies
• Frenectomies
• Implantology and associated surgical procedures
• Conservative dental treatment (fillings, extractions and root canal therapy) for
adults
• Professional oral hygiene procedures
• Surgical tooth exposures for orthodontic reasons
Scheme Exclusions:
• Where the only reason for admission to hospital is dental fear and anxiety
• Multiple hospital admissions
• Where the only reason for the admission request is for a sterile facility
• The cost of dental materials for procedures performed under general anaesthesia

Inhalation Sedation Benefit subject to managed care protocols

in the Dental Rooms
Covered at the BDT

Moderate/Deep Sedation Pre-authorisation required

in the Dental Rooms*
Benefit limited to extensive dental treatment
Benefit subject to managed care protocols
Covered at the BDT

11 Bonitas Dental Benefit Tables 2024

STANDARD Dental Benefit Table 2024
STANDARD SELECT Dental Benefit Table 2024
BONCOMPLETE Dental Benefit Table 2024

Dental Benefits Pre-authorisation*

Dental benefits are paid at the Bonitas Dental Tariff Hospitalisation, and certain dentistry procedures and
(BDT). treatments must be pre-authorised. Pre-authorisation is
required for Dentures, Crown & Bridge, Orthodontics,
Dental benefits are subject to managed care protocols
Periodontics, Hospital Admissions and Moderate/Deep
and managed care interventions which may include the
Sedation in the Dental Rooms.
requirement of treatment plans and/or radiographs prior
to benefit application. Procedures and treatments not pre-authorised will not
attract a benefit, with the exception of Crown & Bridge
Scheme Exclusions apply to dental benefits.
procedures where a 20% penalty will apply if
In the event of a dispute, the registered Rules of the authorisation is applied for after the treatment has
Scheme will prevail. clinically indicated.
Co-payments Failure to pre-authorise orthodontic treatment will result
in a payment only from date of authorisation for the
On the Standard, Standard Select and BonComplete
remaining months of treatment, provided that the
options:
treatment is clinically indicated.
• Co-payments are levied for orthodontics
Penalties do not apply to emergency hospital
• Co-payments are levied on the hospital account
admission.
DSP Network: Standard Select
Benefits payable on the Bonitas Standard Select
option are subject to the use of a Designated Service
Provider (DSP) on the DENIS Dental Network.

Hospital Network: Standard Select &

BonComplete
Members on the Standard Select option must use a
hospital within the Bonitas Standard Select Hospital
Network.
Members on the BonComplete option must use a
hospital within the Bonitas BonComplete Hospital
Network.
Hospital account: The co-payments on BonComplete,
Standard and Standard Select Options to be waived
if the cost of the service falls within the co-payment
amount.
Should a member on these two options make use of a
non-network hospital for an elective procedure, a 30%
co-payment will be applicable on the hospital account.

12 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Consultations Two check-ups per Two check-ups per Two check-ups per
beneficiary per year beneficiary per year beneficiary per year
(once every 6 months) (once every 6 months) (once every 6 months)
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT

X-rays: Intraoral Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT

X-rays: Extraoral One per beneficiary in One per beneficiary in One per beneficiary in
a 3-year period a 3-year period a 3-year period
Additional benefit may be Additional benefit may be Additional benefit may be
considered where considered where considered where
specialised dental specialised dental specialised dental
treatment is required. treatment is required. treatment is required.
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT

Preventative Care Benefit for scale and polish: Benefit for scale and polish: Benefit for scale and polish:
Two scale and polish Two scale and polish Two scale and polish
treatments per beneficiary treatments per beneficiary treatments per beneficiary
per year (once every 6 per year (once every 6 per year (once every 6
months) months) months)
Benefit for fissure sealants: Benefit for fissure sealants: Benefit for fissure sealants:
Limited to beneficiaries Limited to beneficiaries Limited to beneficiaries
younger than 16 years of younger than 16 years of younger than 16 years of
age age age
Benefit for fluoride: Benefit for fluoride: Benefit for fluoride:
Limited to beneficiaries Limited to beneficiaries Limited to beneficiaries
from age 5 and younger from age 5 and younger from age 5 and younger
than 16 years of age than 16 years of age than 16 years of age
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Oral hygiene instruction • Oral hygiene instruction • Oral hygiene instruction
• Oral hygiene evaluation • Oral hygiene evaluation • Oral hygiene evaluation
• Professionally applied • Professionally applied • Professionally applied
fluoride for beneficiaries fluoride for beneficiaries fluoride for beneficiaries
younger than 5, and 16 younger than 5, and 16 younger than 5, and 16
years and older years and older years and older
• Tooth whitening • Tooth whitening • Tooth whitening

13 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Fillings Benefit for fillings: Granted Benefit for fillings: Granted Benefit for fillings: Granted
once per tooth in 720 days once per tooth in 720 days once per tooth in 720 days
Benefit for re-treatment of a Benefit for re-treatment of a Benefit for re-treatment of a
tooth: Subject to managed tooth: Subject to managed tooth: Subject to managed
care protocols care protocols care protocols
Multiple fillings: A treatment Multiple fillings: A treatment Multiple fillings: A treatment
plan and X-rays may be plan and X-rays may be plan and X-rays may be
required for multiple fillings required for multiple fillings required for multiple fillings
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Fillings to restore teeth • Fillings to restore teeth • Fillings to restore teeth
damaged due to damaged due to damaged due to
toothbrush abrasion, toothbrush abrasion, toothbrush abrasion,
attrition, erosion and attrition, erosion and attrition, erosion and
fluorosis fluorosis fluorosis
• Resin bonding for • Resin bonding for • Resin bonding for
restorations that are restorations that are restorations that are
charged as a separate charged as a separate charged as a separate
procedure to the procedure to the procedure to the
restoration restoration restoration
• The polishing of • The polishing of • The polishing of
restorations restorations restorations
• Gold foil restorations • Gold foil restorations • Gold foil restorations
• Ozone therapy • Ozone therapy • Ozone therapy

Root Canal Therapy Benefit subject to managed Benefit subject to managed Benefit subject to managed
and Extractions care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Root canal therapy on • Root canal therapy on • Root canal therapy on
primary (milk) teeth primary (milk) teeth primary (milk) teeth
• Root canal therapy on • Root canal therapy on • Root canal therapy on
third molars (wisdom third molars (wisdom third molars (wisdom
teeth) teeth) teeth)
• Direct and indirect pulp • Direct and indirect pulp • Direct and indirect pulp
capping procedures capping procedures capping procedures

Plastic Dentures* Pre-authorisation required Pre-authorisation required Pre-authorisation required

and Associated for Dentures for Dentures for Dentures
Laboratory Costs
One set of plastic dentures One set of plastic dentures One set of plastic dentures
(an upper and a lower) per (an upper and a lower) per (an upper and a lower) per
beneficiary in a 4-year beneficiary in a 4-year beneficiary in a 4-year
period period period
Benefit not available for the Benefit not available for the Benefit not available for the
clinical fee of denture clinical fee of denture clinical fee of denture
repairs, denture tooth repairs, denture tooth repairs, denture tooth
replacements and the replacements and the replacements and the
addition of a soft addition of a soft addition of a soft
base to new dentures; base to new dentures; base to new dentures;
the laboratory fee will be the laboratory fee will be the laboratory fee will be
covered (no pre- covered (no pre- covered (no pre-
authorisation required). authorisation required). authorisation required).

14 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Benefit for a mouth guard: Benefit for a mouth guard: Benefit for a mouth guard:
Benefit available for both Benefit available for both Benefit available for both
the clinical and the the clinical and the the clinical and the
associated laboratory fee associated laboratory fee associated laboratory fee
for a mouth guard (no pre- for a mouth guard (no pre- for a mouth guard (no pre-
authorisation required). authorisation required). authorisation required).
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Diagnostic dentures and • Diagnostic dentures and • Diagnostic dentures and
associated laboratory associated laboratory associated laboratory
costs costs costs
• Snoring appliances and • Snoring appliances and • Snoring appliances and
associated laboratory associated laboratory associated laboratory
costs costs costs
• High impact acrylic • High impact acrylic • High impact acrylic
• The cost of gold, • The cost of gold, • The cost of gold,
precious metal, semi- precious metal, semi- precious metal, semi-
precious metal and precious metal and precious metal and
platinum foil platinum foil platinum foil
• Laboratory delivery fees • Laboratory delivery fees • Laboratory delivery fees
• Provisional dentures and • Provisional dentures and • Provisional dentures and
associated laboratory associated laboratory associated laboratory
costs costs costs

SPECIALISED
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Partial Chrome Cobalt Pre-authorisation required Pre-authorisation required Pre-authorisation required

Frame Dentures*
One partial metal frame (an One partial metal frame (an One partial metal frame (an
and Associated
upper or a lower) per upper or a lower) per upper or a lower) per
Laboratory Costs
beneficiary in a 5-year beneficiary in a 5-year beneficiary in a 5-year
period period period
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• The metal base to full • The metal base to full • The metal base to full
dentures and associated dentures and associated dentures and associated
laboratory costs laboratory costs laboratory costs
• High impact acrylic • High impact acrylic • High impact acrylic
• The cost of gold, precious • The cost of gold, precious • The cost of gold, precious
metal, semi-precious metal, semi-precious metal, semi-precious
metal and platinum foil metal and platinum foil metal and platinum foil
• Laboratory delivery fees • Laboratory delivery fees • Laboratory delivery fees

15 Bonitas Dental Benefit Tables 2024

 SPECIALISED
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Crown & Bridge* Pre-authorisation required Pre-authorisation required Pre-authorisation required

and Associated
One crown per family One crown per family One crown per family
Laboratory Costs
per year per year per year
A bridge comprises two or
Benefit for crowns will be Benefit for crowns will be Benefit for crowns will be
more crown units. Each
granted once per tooth in a granted once per tooth in a granted once per tooth in a
crown is payable from the
5-year period 5-year period 5-year period
available Crown & Bridge
benefit. A treatment plan and X-rays A treatment plan and X-rays A treatment plan and X-rays
may be requested may be requested may be requested
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
A pontic on a 2nd molar, A pontic on a 2nd molar, A pontic on a 2nd molar,
where the 3rd molar is a where the 3rd molar is a where the 3rd molar is a
crown retainer, is subject to crown retainer, is subject to crown retainer, is subject to
managed care protocols managed care protocols managed care protocols
Covered at the BDT Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Crowns on third molars • Crowns on third molars • Crowns on third molars
• Crown and bridge • Crown and bridge • Crown and bridge
procedures for cosmetic procedures for cosmetic procedures for cosmetic
reasons and associated reasons and associated reasons and associated
laboratory costs laboratory costs laboratory costs
• Laboratory fabricated • Laboratory fabricated • Laboratory fabricated
temporary crowns temporary crowns temporary crowns
• Occlusal rehabilitations • Occlusal rehabilitations • Occlusal rehabilitations
and associated laboratory and associated laboratory and associated laboratory
costs costs costs
• Provisional crowns and • Provisional crowns and • Provisional crowns and
associated laboratory associated laboratory associated laboratory
costs costs costs
• Porcelain veneers and • Porcelain veneers and • Porcelain veneers and
inlays, and associated inlays, and associated inlays, and associated
laboratory costs laboratory costs laboratory costs
• Emergency crowns that • Emergency crowns that • Emergency crowns that
are not placed for the are not placed for the are not placed for the
immediate protection in immediate protection in immediate protection in
tooth injury and tooth injury and tooth injury and
associated laboratory associated laboratory associated laboratory
costs costs costs
• The cost of gold, precious • The cost of gold, precious • The cost of gold, precious
metal, semi-precious metal, semi-precious metal, semi-precious
metal and platinum foil metal and platinum foil metal and platinum foil
• Laboratory delivery fees • Laboratory delivery fees • Laboratory delivery fees

Implants* No benefit No benefit No benefit

and Associated
Laboratory Costs

16 Bonitas Dental Benefit Tables 2024

 SPECIALISED
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Orthodontics* Pre-authorisation required Pre-authorisation required Pre-authorisation required

and Associated
Benefit for orthodontic Benefit for orthodontic Benefit for orthodontic
Laboratory Costs
treatment granted once per treatment granted once per treatment granted once per
beneficiary per lifetime beneficiary per lifetime beneficiary per lifetime
Only one family member Only one family member Only one family member
may commence orthodontic may commence orthodontic may commence orthodontic
treatment in a calendar year treatment in a calendar year treatment in a calendar year
On pre-authorisation, cases On pre-authorisation, cases On pre-authorisation, cases
will be clinically assessed will be clinically assessed will be clinically assessed
by using an orthodontic by using an orthodontic by using an orthodontic
needs analysis. needs analysis. needs analysis.
Benefit allocation is subject Benefit allocation is subject Benefit allocation is subject
to the outcome of the needs to the outcome of the needs to the outcome of the needs
analysis and funding can be analysis and funding can be analysis and funding can be
granted up to 80% of the granted up to 80% of the granted up to 65% of the
BDT. BDT. BDT.
Benefit for orthodontic Benefit for orthodontic Benefit for orthodontic
treatment will be granted treatment will be granted treatment will be granted
where function is impaired where function is impaired where function is impaired
Benefit will not be granted Benefit will not be granted Benefit will not be granted
where orthodontic treatment where orthodontic treatment where orthodontic treatment
is required for cosmetic is required for cosmetic is required for cosmetic
reasons. reasons. reasons.
The associated laboratory The associated laboratory The associated laboratory
costs will also not be costs will also not be costs will also not be
covered. covered. covered.
Benefit for fixed Benefit for fixed Benefit for fixed
comprehensive treatment: comprehensive treatment: comprehensive treatment:
Limited to individuals from Limited to individuals from Limited to individuals from
age 9 and younger than 18 age 9 and younger than 18 age 9 and younger than 18
years of age years of age years of age
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Orthognathic (jaw • Orthognathic (jaw • Orthognathic (jaw
correction) and other correction) and other correction) and other
orthodontic related orthodontic related orthodontic related
surgery, and any surgery, and any surgery, and any
associated hospital and associated hospital and associated hospital and
laboratory costs laboratory costs laboratory costs
• Orthodontic re-treatment • Orthodontic re-treatment • Orthodontic re-treatment
and any related and any related and any related
laboratory costs laboratory costs laboratory costs
• Invisible retainer material • Invisible retainer material • Invisible retainer material
• Laboratory delivery fees • Laboratory delivery fees • Laboratory delivery fees

17 Bonitas Dental Benefit Tables 2024

 SPECIALISED
STANDARD STANDARD SELECT BONCOMPLETE
DENTISTRY

Periodontics* Pre-authorisation required Pre-authorisation required Pre-authorisation required

Benefit will only be applied Benefit will only be applied Benefit will only be applied
to members registered on to members registered on to members registered on
the Periodontal Programme the Periodontal Programme the Periodontal Programme
Benefit limited to Benefit limited to Benefit limited to
conservative, non-surgical conservative, non-surgical conservative, non-surgical
therapy only therapy only therapy only
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols | Covered at care protocols | Covered at care protocols | Covered at
the BDT the BDT the BDT
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Surgical periodontics • Surgical periodontics • Surgical periodontics
which includes which includes which includes
gingivectomies, gingivectomies, gingivectomies,
periodontal flap surgery, periodontal flap surgery, periodontal flap surgery,
tissue grafting and the tissue grafting and the tissue grafting and the
hemisection of a tooth hemisection of a tooth hemisection of a tooth
• PerioChip placement • PerioChip placement • PerioChip placement

Maxillo-facial Surgery Surgery in the dental chair: Surgery in the dental chair: Surgery in the dental chair:
and Oral Pathology Covered at the BDT Covered at the BDT Covered at the BDT
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Temporo-mandibular joint Temporo-mandibular joint Temporo-mandibular joint
(TMJ) therapy: Benefit (TMJ) therapy: Benefit (TMJ) therapy: Benefit
limited to non-surgical limited to non-surgical limited to non-surgical
intervention/ treatments intervention/ treatments intervention/ treatments
Oral pathology procedures Oral pathology procedures Oral pathology procedures
(cysts and biopsies, the (cysts and biopsies, the (cysts and biopsies, the
surgical treatment of surgical treatment of surgical treatment of
tumours of the jaw and soft tumours of the jaw and soft tumours of the jaw and soft
tissue tumours): Claims will tissue tumours): Claims will tissue tumours): Claims will
only be covered if supported only be covered if supported only be covered if supported
by a laboratory report that by a laboratory report that by a laboratory report that
confirms diagnosis. confirms diagnosis. confirms diagnosis.
Benefit for the closure of an Benefit for the closure of an Benefit for the closure of an
oral-antral opening (code oral-antral opening (code oral-antral opening (code
8909): Subject to motivation 8909): Subject to motivation 8909): Subject to motivation
and managed care and managed care and managed care
protocols protocols protocols
Surgery in hospital: Surgery in hospital: Surgery in hospital:
See Hospitalisation* below See Hospitalisation* below See Hospitalisation* below
Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:
• Orthognathic (jaw • Orthognathic (jaw • Orthognathic (jaw
correction) surgery correction) surgery correction) surgery
• Sinus lifts • Sinus lifts • Sinus lifts
• Bone augmentations • Bone augmentations • Bone augmentations
• Bone and tissue • Bone and tissue • Bone and tissue
regeneration procedures regeneration procedures regeneration procedures
• The cost of bone • The cost of bone • The cost of bone
regeneration material regeneration material regeneration material
• The auto-transplantation • The auto-transplantation • The auto-transplantation
of teeth of teeth of teeth

18 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
STANDARD STANDARD SELECT BONCOMPLETE
ANAESTHETICS

Hospitalisation Pre-authorisation required Pre-authorisation required Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply Admission protocols apply Admission protocols apply
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
General anaesthetic benefit General anaesthetic benefit General anaesthetic benefit
available for children under available for children under available for children under
the age of 5 years for the age of 5 years for the age of 5 years for
extensive dental treatment: extensive dental treatment: extensive dental treatment:
• A co-payment of R3 500 • A co-payment of R3 500 • A co-payment of R3 500
per hospital OR day per hospital OR day per hospital OR day
clinic admission applies. clinic admission applies. clinic admission applies.
General anaesthetic benefit General anaesthetic benefit General anaesthetic benefit
available for the removal of available for the removal of available for the removal of
impacted teeth: impacted teeth: impacted teeth:
• A co-payment of R5 000 • A co-payment of R5 000 • A co-payment of R5 000
per hospital admission per hospital admission per hospital admission
applies for the removal of applies for the removal of applies for the removal of
impacted teeth and any impacted teeth and any impacted teeth and any
other medical admission other medical admission other medical admission
other than children other than children other than children
younger than 5 years of younger than 5 years of younger than 5 years of
age. age. age.
• A co-payment of R2 500 • A co-payment of R2 500 • A co-payment of R2 500
per day clinic admission per day clinic admission per day clinic admission
applies for the removal of applies for the removal of applies for the removal of
impacted teeth and any impacted teeth and any impacted teeth and any
other medical admission other medical admission other medical admission
other than children other than children other than children
younger than 5 years of younger than 5 years of younger than 5 years of
age. age. age.
The hospital and The hospital and The hospital and
anaesthetist claims for the anaesthetist claims for the anaesthetist claims for the
procedures listed below will procedures listed below will procedures listed below will
not be covered when not be covered when not be covered when
performed under general performed under general performed under general
anaesthesia. anaesthesia. anaesthesia.
The payment of the dental The payment of the dental The payment of the dental
procedure will be procedure will be procedure will be
dependent on available dependent on available dependent on available
benefits, and payable at the benefits, and payable at the benefits, and payable at the
BDT: BDT: BDT:
• Apicectomies • Apicectomies • Apicectomies
• Dentectomies • Dentectomies • Dentectomies
• Frenectomies • Frenectomies • Frenectomies
• Implantology and • Implantology and • Implantology and
associated surgical associated surgical associated surgical
procedures procedures procedures
• Conservative dental • Conservative dental • Conservative dental
treatment (fillings, treatment (fillings, treatment (fillings,
extractions and root extractions and root extractions and root
canal therapy) for adults canal therapy) for adults canal therapy) for adults
• Professional oral hygiene • Professional oral hygiene • Professional oral hygiene
procedures procedures procedures
• Surgical tooth exposures • Surgical tooth exposures • Surgical tooth exposures
for orthodontic reasons for orthodontic reasons for orthodontic reasons

19 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
STANDARD STANDARD SELECT BONCOMPLETE
ANAESTHETICS

Scheme Exclusions: Scheme Exclusions: Scheme Exclusions:

• Where the only reason • Where the only reason • Where the only reason
for admission to hospital for admission to hospital for admission to hospital
is dental fear and anxiety is dental fear and anxiety is dental fear and anxiety
• Multiple hospital • Multiple hospital • Multiple hospital
admissions admissions admissions
• Where the only reason • Where the only reason • Where the only reason
for the admission request for the admission request for the admission request
is for a sterile facility is for a sterile facility is for a sterile facility
• The cost of dental • The cost of dental • The cost of dental
materials for procedures materials for procedures materials for procedures
performed under general performed under general performed under general
anaesthesia anaesthesia anaesthesia

Inhalation Sedation Benefit subject to managed Benefit subject to managed Benefit subject to managed
in the Dental Rooms care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT

Moderate/Deep Sedation Pre-authorisation required Pre-authorisation required Pre-authorisation required

in the Dental Rooms*
Benefit limited to extensive Benefit limited to extensive Benefit limited to extensive
dental treatment dental treatment dental treatment
Benefit subject to managed Benefit subject to managed Benefit subject to managed
care protocols care protocols care protocols
Covered at the BDT Covered at the BDT Covered at the BDT

20 Bonitas Dental Benefit Tables 2024

PRIMARY Dental Benefit Table 2024
PRIMARY SELECT Dental Benefit Table 2024

Dental Benefits DSP Network: Primary and Primary Select

Dental benefits are paid at the Bonitas Dental Tariff Benefits payable on the Primary and Primary Select
(BDT). options are subject to the use of a Designated Service
Provider (DSP) on the DENIS Dental Network.
Dental benefits are subject to managed care protocols
and managed care interventions which may include the Out-of-Network Emergency Consultation
requirement of treatment plans and/or radiographs prior
There is a benefit for one out-of-network emergency
to benefit application.
consultation (tariff code 8104) per beneficiary per year
Scheme Exclusions apply to dental benefits. on the Primary and Primary Select options.
In the event of a dispute, the registered Rules of the The following treatment is covered when charged with
Scheme will prevail. code 8104: extractions (code 8201 – max of 2); a
pulpotomy (8307 – max of 2) or a pulpectomy (8132 –
Pre-authorisation*
max of 2). No benefit for other out-of-network visits.
Hospitalisation and Dentures must be pre-authorised.
Bonitas Primary Select Hospital Network
Procedures and treatments not pre-authorised will not
attract a benefit. Members on the Primary Select option must use a
hospital within the Bonitas Primary Select Hospital
Penalties do not apply to emergency hospital Network.
admission.
Should a member on the Primary Select option make
Co-payments use of a non-network hospital for an elective procedure,
On the Primary and Primary Select options: a 30% co-payment will be applicable on the hospital
account.
• Co-payments are levied for plastic dentures
• Co-payments are levied on the hospital account
• Hospital account: The co-payments on Primary
and Primary Select to be waived if the cost of the
service falls within the co-payment amount.

CONSERVATIVE
PRIMARY PRIMARY SELECT
DENTISTRY

Consultations Two check-ups per Two check-ups per

beneficiary per year beneficiary per year
(once every 6 months) (once every 6 months)
Benefit subject to managed care Benefit subject to managed care protocols
protocols
Covered at the BDT
Covered at the BDT

X-rays: Intraoral Benefit subject to managed care Benefit subject to managed care protocols
protocols
Covered at the BDT
Covered at the BDT

X-rays: Extraoral One per beneficiary in One per beneficiary in

a 3-year period a 3-year period
Benefit subject to managed care Benefit subject to managed care
protocols. Covered at the BDT protocols. Covered at the BDT

21 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
PRIMARY PRIMARY SELECT
DENTISTRY

Preventative Care Benefit for scale and polish: Benefit for scale and polish:
Two scale and polish treatments per Two scale and polish treatments per
beneficiary per year (once every 6 beneficiary per year (once every 6
months) months)
Benefit for fissure sealants: Benefit for fissure sealants:
Limited to beneficiaries younger than 16 Limited to beneficiaries younger than 16
years of age years of age
Benefit for fluoride: Benefit for fluoride:
Limited to beneficiaries from age 5 and Limited to beneficiaries from age 5 and
younger than 16 years of age younger than 16 years of age
Benefit subject to managed care Benefit subject to managed care protocols
protocols | Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions:
• Oral hygiene instruction • Oral hygiene instruction
• Oral hygiene evaluation • Oral hygiene evaluation
• Professionally applied fluoride for • Professionally applied fluoride for
beneficiaries younger than 5, and beneficiaries younger than 5, and
16 years and older 16 years and older
• Tooth whitening • Tooth whitening

Fillings Benefit for fillings: Granted once per Benefit for fillings: Granted once per tooth
tooth in 720 days in 720 days
Benefit for re-treatment of a tooth: Benefit for re-treatment of a tooth: Subject
Subject to managed care protocols to managed care protocols
Multiple fillings: A treatment plan and X- Multiple fillings: A treatment plan and X-
rays may be required for multiple fillings rays may be required for multiple fillings
Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions:
• Fillings to restore teeth damaged due • Fillings to restore teeth damaged due to
to toothbrush abrasion, attrition, toothbrush abrasion, attrition, erosion
erosion and fluorosis and fluorosis
• Resin bonding for restorations that are • Resin bonding for restorations that are
charged as a separate procedure to charged as a separate procedure to the
the restoration restoration
• The polishing of restorations • The polishing of restorations
• Gold foil restorations • Gold foil restorations
• Ozone therapy • Ozone therapy

Root Canal Therapy Benefit for root canal therapy includes all Benefit for root canal therapy includes all
and Extractions teeth except primary teeth and teeth except primary teeth and permanent
permanent molars. molars.
Benefit subject to managed care Benefit subject to managed care protocols
protocols
Covered at the BDT
Covered at the BDT
Scheme Exclusions:
Scheme Exclusions: • Root canal therapy on primary (milk)
• Root canal therapy on primary (milk) teeth
teeth • Root canal therapy on third molars
• Root canal therapy on third molars (wisdom teeth)
(wisdom teeth)
• Direct and indirect pulp capping • Direct and indirect pulp capping
procedures procedures

22 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
PRIMARY PRIMARY SELECT
DENTISTRY

Plastic Dentures* Pre-authorisation required for Dentures Pre-authorisation required for Dentures
and Associated
One set of plastic dentures One set of plastic dentures
Laboratory Costs
(an upper and a lower) in a 4-year period (an upper and a lower) in a 4-year period
for beneficiaries 21 years and older. A for beneficiaries 21 years and older. A
20% co-payment applies. 20% co-payment applies.
The appropriate laboratory codes will be The appropriate laboratory codes will be
covered with a 20% co-payment. covered with a 20% co-payment.
Benefit not available for the clinical fee of Benefit not available for the clinical fee of
denture repairs, denture tooth denture repairs, denture tooth
replacements and the addition of a soft replacements and the addition of a soft
base to new dentures; the laboratory fee base to new dentures; the laboratory fee
will be covered (no pre-authorisation will be covered (no pre-authorisation
required). required).
Benefit for a mouth guard: Benefit Benefit for a mouth guard: Benefit
available for both the clinical and the available for both the clinical and the
associated laboratory fee for a mouth associated laboratory fee for a mouth
guard (no pre-authorisation required). guard (no pre-authorisation required).
Benefit subject to managed care Benefit subject to managed care
protocols protocols
Covered at the BDT Covered at the BDT
Scheme Exclusions: Scheme Exclusions:
• Diagnostic dentures and associated • Diagnostic dentures and associated
laboratory costs laboratory costs
• Snoring appliances and associated • Snoring appliances and associated
laboratory costs laboratory costs
• High impact acrylic • High impact acrylic
• The cost of gold, precious metal, • The cost of gold, precious metal, semi-
semi-precious metal and platinum foil precious metal and platinum foil
• Laboratory delivery fees • Laboratory delivery fees
• Provisional dentures and associated • Provisional dentures and associated
laboratory costs laboratory costs

SPECIALISED
PRIMARY PRIMARY SELECT
DENTISTRY

Partial Chrome Cobalt No benefit No benefit

Frame Dentures*
and Associated
Laboratory Costs

Crown & Bridge* No benefit No benefit

and Associated
Laboratory Costs
A bridge comprises two or
more crown units. Each
crown is payable from the
available Crown & Bridge
benefit.

23 Bonitas Dental Benefit Tables 2024

 SPECIALISED
PRIMARY PRIMARY SELECT
DENTISTRY

Implants* No benefit No benefit

and Associated
Laboratory Costs

Orthodontics* No benefit No benefit

and Associated
Laboratory Costs

Periodontics* No benefit No benefit

Maxillo-facial Surgery Surgery in the dental chair: Covered at Surgery in the dental chair: Covered at the
and Oral Pathology the BDT | Benefit subject to managed BDT | Benefit subject to managed care
care protocols protocols
Temporo-mandibular joint (TMJ) therapy: Temporo-mandibular joint (TMJ) therapy:
Benefit limited to non-surgical Benefit limited to non-surgical
intervention/treatments intervention/treatments
Oral pathology procedures (cysts and Oral pathology procedures (cysts and
biopsies, the surgical treatment of biopsies, the surgical treatment of
tumours of the jaw and soft tissue tumours of the jaw and soft tissue
tumours): tumours):
Claims will only be covered if supported Claims will only be covered if supported
by a laboratory report that confirms by a laboratory report that confirms
diagnosis. diagnosis.
Benefit for the closure of an oral-antral Benefit for the closure of an oral-antral
opening (code 8909): Subject to opening (code 8909): Subject to
motivation and managed care protocols motivation and managed care protocols
Surgery in hospital: Surgery in hospital:
See Hospitalisation* below See Hospitalisation* below
Scheme Exclusions: Scheme Exclusions:
• Orthognathic (jaw correction) surgery • Orthognathic (jaw correction) surgery
• Sinus lifts • Sinus lifts
• Bone augmentations • Bone augmentations
• Bone and tissue regeneration • Bone and tissue regeneration
procedures procedures
• The cost of bone regeneration • The cost of bone regeneration
material material
• The auto-transplantation • The auto-transplantation
of teeth of teeth

24 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
PRIMARY PRIMARY SELECT
ANAESTHETICS

Hospitalisation Pre-authorisation required Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply Admission protocols apply
Benefit subject to managed care Benefit subject to managed care
protocols protocols
General anaesthetic benefit available for General anaesthetic benefit available for
children under the age of 5 years for children under the age of 5 years for
extensive dental treatment: extensive dental treatment:
• A co-payment of R3 500 per hospital • A co-payment of R3 500 per hospital
OR day clinic admission applies. OR day clinic admission applies.
General anaesthetic benefit available for General anaesthetic benefit available for
the removal of impacted teeth: the removal of impacted teeth:
• A co-payment of R5 000 per hospital • A co-payment of R5 000 per hospital
admission applies for the removal of admission applies for the removal of
impacted teeth and any other medical impacted teeth and any other medical
admission other than children younger admission other than children younger
than 5 years of age. than 5 years of age.
• A co-payment of R2 500 per day • A co-payment of R2 500 per day clinic
clinic admission applies for the admission applies for the removal of
removal of impacted teeth and any impacted teeth and any other medical
other medical admission other than admission other than children younger
children younger than 5 years of age. than 5 years of age.
The hospital and anaesthetist claims for The hospital and anaesthetist claims for
the procedures listed below will not be the procedures listed below will not be
covered when performed under general covered when performed under general
anaesthesia. anaesthesia.
The payment of the dental procedure will The payment of the dental procedure will
be dependent on available benefits, and be dependent on available benefits, and
payable at the BDT: payable at the BDT:
• Apicectomies • Apicectomies
• Dentectomies • Dentectomies
• Frenectomies • Frenectomies
• Implantology and associated surgical • Implantology and associated surgical
procedures procedures
• Conservative dental treatment (fillings, • Conservative dental treatment (fillings,
extractions and root canal therapy) for extractions and root canal therapy) for
adults adults
• Professional oral hygiene • Professional oral hygiene
procedures procedures
• Surgical tooth exposures • Surgical tooth exposures
for orthodontic reasons for orthodontic reasons
Scheme Exclusions: Scheme Exclusions:
• Where the only reason for admission • Where the only reason for admission
to hospital is dental fear and anxiety to hospital is dental fear and anxiety
• Multiple hospital admissions • Multiple hospital admissions
• Where the only reason for the • Where the only reason for the
admission request is for a sterile admission request is for a sterile
facility facility
• The cost of dental materials for • The cost of dental materials for
procedures performed under general procedures performed under general
anaesthesia anaesthesia

Inhalation Sedation Benefit subject to managed care Benefit subject to managed care
in the Dental Rooms protocols | Covered at the BDT protocols | Covered at the BDT

25 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
PRIMARY PRIMARY SELECT
ANAESTHETICS

Moderate/Deep Sedation Pre-authorisation required Pre-authorisation required

in the Dental Rooms*
Benefit limited to extensive dental Benefit limited to extensive dental
treatment treatment
Benefit subject to managed care Benefit subject to managed care
protocols | Covered at the BDT protocols | Covered at the BDT

26 Bonitas Dental Benefit Tables 2024

BONSAVE Dental Benefit Table 2024

Dental Benefits Out of Hospital Bonitas BonSave Hospital Network

Preventative dental benefits are managed by DENIS Members on the BonSave option must use a hospital
and paid at the Bonitas Dental Tariff (BDT) from risk. within the Bonitas BonSave Hospital Network.
Only the preventative dental codes listed in the table
Should a member on the BonSave option make use of
below will be covered from risk for out of hospital dental
a non-network hospital for an elective procedure, a 30%
services.
co-payment will be applicable on the hospital account.
All other out of hospital conservative and specialised
Pre-Authorisation*
dental services will be interfaced by DENIS to the
Scheme’s administrator for payment from the member’s Dental treatment in hospital and Moderate/Deep
positive savings account. Sedation in the Dental Rooms is limited to the removal
of impacted teeth ONLY and must be pre-authorised.
Dental benefits are subject to managed care protocols.
Procedures and treatment not pre-authorised will not
In the event of a dispute, the registered Rules of the attract a benefit.
Scheme will prevail.
Penalties do not apply to emergency/PMB hospital
Co-payments admissions.
On the BonSave option a co-payment is levied on the
hospital account.
Hospital account: The co-payments on BonSave to be
waived if the cost of the service falls within the co-
payment amount.

PREVENTATIVE
CODE PAYABLE BY DENIS FROM RISK
DENTISTRY

Consultations 8101 Two consultations per beneficiary per year (once every 6 months)

Polishing of Teeth 8155 Two scale and polish treatments per beneficiary per year (once every 6
months)

Scaling and Polishing 8159 Code 8155 and/or 8159 (max of 2 in total per year)

Fluoride Treatment Two treatments per year, limited to beneficiaries from age 5 and younger
than 16 years of age

8161 5 to 12 years of age

8162 13 to 15 years of age

Fissure Sealant 8163 One per tooth in a 3-year period for beneficiaries younger than 16 years of
age

Infection Control 8109 One set per beneficiary per visit

(One set = 8109 x 2, 8110 x 1)
Instrument Sterilisation 8110

27 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

X-rays: Intraoral Benefit subject to managed care protocols

Covered at the BDT

X-rays: Extraoral One per beneficiary in a 3-year period

Additional benefit may be considered where specialised dental treatment is required.
Benefit subject to managed care protocols
Covered at the BDT

Fillings Benefit for fillings:

Granted once per tooth in 720 days
Benefit for re-treatment of a tooth:
Subject to managed care protocols
Multiple fillings:
A treatment plan and X-rays may be required for multiple fillings
Covered at the BDT
Scheme Exclusions:
• Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion
and fluorosis
• Resin bonding for restorations that are charged as a separate procedure to the
restoration
• The polishing of restorations
• Gold foil restorations
• Ozone therapy

Root Canal Therapy Benefit subject to managed care protocols

and Extractions Covered at the BDT
Scheme Exclusions:
• Root canal therapy on primary (milk) teeth
• Root canal therapy on third molars (wisdom teeth)
• Direct and indirect pulp capping procedures

Plastic Dentures* Pre-authorisation required for Dentures

and Associated One set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
Laboratory Costs
Benefit not available for the clinical fee of denture repairs, denture tooth
replacements and the addition of a soft base to new dentures; the laboratory fee will
be covered (no pre-authorisation required).
Benefit for a mouth guard: Benefit available for both the clinical and the associated
laboratory fee for a mouth guard (no pre-authorisation required).
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Diagnostic dentures and associated laboratory costs
• Snoring appliances and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees
• Provisional dentures and associated laboratory costs

28 Bonitas Dental Benefit Tables 2024

 SPECIALISED
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

Partial Chrome Cobalt Pre-authorisation required

Frame Dentures* Two partial frames (an upper and a lower) per beneficiary in a 5-year period
and Associated
Benefit subject to managed care protocols
Laboratory Costs
Covered at the BDT
Scheme Exclusions:
• The metal base to full dentures and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Crown & Bridge* Pre-authorisation required

and Associated Three crowns per family per year
Laboratory Costs
Benefit for crowns will be granted once per tooth in a 5-year period
A bridge comprises two or
A treatment plan and X-rays may be requested
more crown units. Each
crown is payable from the Benefit subject to managed care protocols
available Crown & Bridge A pontic on a 2nd molar, where the 3rd molar is a crown retainer, is subject to
benefit. managed care protocols
Covered at the BDT
Scheme Exclusions:
• Crowns on third molars
• Crown and bridge procedures for cosmetic reasons and associated laboratory
costs
• Occlusal rehabilitations and associated laboratory costs
• Laboratory fabricated temporary crowns
• Provisional crowns and associated laboratory costs
• Porcelain veneers and inlays, and associated laboratory costs
• Emergency crowns that are not placed for the immediate protection in tooth
injury
and associated laboratory costs
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Implants* No benefit
and Associated
Laboratory Costs

Orthodontics* Pre-authorisation required

and Associated Benefit for orthodontic treatment granted once per beneficiary per lifetime
Laboratory Costs
Only one family member may commence orthodontic treatment in a calendar year
On pre-authorisation, cases will be clinically assessed by using an orthodontic
needs analysis. Benefit allocation is subject to the outcome of the needs analysis
and funding can be granted up to 100% of the BDT.
Benefit for orthodontic treatment will be granted where function is impaired.
Benefit will not be granted where orthodontic treatment is required for cosmetic
reasons. The associated laboratory costs will also not be covered.
Benefit for fixed comprehensive treatment:
Limited to individuals from age 9 and younger than 18 years of age
Benefit subject to managed care protocols
Covered at the BDT

29 Bonitas Dental Benefit Tables 2024

 SPECIALISED
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

Scheme Exclusions:
• Orthognathic (jaw correction) and other orthodontic related surgery, and any
associated hospital and laboratory costs
• Orthodontic re-treatment and any related laboratory costs
• Invisible retainer material
• Laboratory delivery fees

Periodontics* Pre-authorisation required

Benefit will only be applied to members registered on the Periodontal Programme
Benefit limited to conservative, non-surgical therapy only
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Surgical periodontics which includes gingivectomies, periodontal flap surgery,
tissue grafting and the hemisection of a tooth
• PerioChip placement

Maxillo-facial Surgery Surgery in the dental chair:

and Oral Pathology Benefit subject to managed care protocols
Covered at the BDT
Temporo-mandibular joint (TMJ) therapy:
Benefit limited to non-surgical intervention/treatments
Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of
the jaw and soft tissue tumours): Claims will only be covered if supported by a
laboratory report that confirms diagnosis.
Benefit for the closure of an oral-antral opening (code 8909):
Subject to motivation and managed care protocols
Surgery in hospital: See Hospitalisation* below
Scheme Exclusions:
• Orthognathic (jaw correction) surgery
• Sinus lifts
• Bone augmentations
• Bone and tissue regeneration procedures
• The cost of bone regeneration material
• The auto-transplantation of teeth

30 Bonitas Dental Benefit Tables 2024

HOSPITALISATION AND
PAYABLE FROM RISK, UNLESS SPECIFIED FROM SAVINGS
ANAESTHETICS

Hospitalisation Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply
General anaesthetic benefit ONLY available for the removal of impacted teeth -
payable from Risk:
• A co-payment of R5 000 per hospital admission applies.
• A co-payment of R2 500 upfront co-payment to apply for the removal of
impacted teeth if performed in a Day Clinic.
Benefit subject to managed care protocols
Scheme Exclusions:
• Where the only reason for admission to hospital is dental fear and anxiety
• Multiple hospital admissions
• Where the only reason for the admission request is for a sterile facility
• The cost of dental materials for procedures performed under general anaesthesia

Inhalation Sedation in Payable from available Savings

the Dental Rooms
Benefit subject to managed care protocols
Covered at the BDT

Moderate/Deep Pre-authorisation required

Sedation in the Dental
For the removal of impacted teeth – payable from Risk
Rooms*
For any other extensive dental treatment, payable from Savings
Benefit subject to managed care protocols
Covered at the BDT

31 Bonitas Dental Benefit Tables 2024

BONFIT SELECT Dental Benefit Table 2024

Dental Benefits Out of Hospital Hospitalisation

Preventative dental benefits are managed by DENIS PMB treatment is the only dental treatment covered in
and paid at the Bonitas Dental Tariff (BDT) from risk. hospital on the BonFit Select option.
Only the preventative dental codes listed in the table Pre-authorisation by DENIS is required for any dental-
below will be covered from risk for out of hospital dental related PMB hospitalisation, subject to the BonFit
services. Select Hospital Network.
All other out-of-hospital conservative and specialised Should a member on the BonFit Select option make
dental services will be interfaced by DENIS to the use of a non-network hospital for a PMB procedure, a
Scheme’s administrator for payment from the member’s 30% co-payment will be applicable on the hospital
positive savings account. account.
Dental benefits are subject to managed care protocols. Emergencies require authorisation within 48 hours of
the first working day after admission.
In the event of a dispute, the registered Rules of the
Scheme will prevail.

PREVENTATIVE
CODE PAYABLE BY DENIS FROM RISK
DENTISTRY

Consultation 8101 Two consultations per beneficiary per year (once every 6 months)

Polishing of Teeth 8155 Two scale and polish treatments per beneficiary per year (once every 6
months)

Scaling and Polishing 8159 Code 8155 and/or 8159 (max of 2 in total per year)

Fluoride Treatment Two treatments per year, limited to beneficiaries from age 5 and younger
than 16 years of age

8161 5 to 12 years of age

8162 13 to 15 years of age

Fissure Sealant 8163 One per tooth in a 3-year period for beneficiaries younger than 16 years of
age

Infection Control 8109 One set per beneficiary per visit

(One set = 8109 x 2, 8110 x 1)
Instrument Sterilisation 8110

32 Bonitas Dental Benefit Tables 2024

 CONSERVATIVE
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

X-rays: Intraoral Benefit subject to managed care protocols

Covered at the BDT

X-rays: Extraoral One per beneficiary in a 3-year period

Additional benefit may be considered where specialised dental treatment is required.
Benefit subject to managed care protocols
Covered at the BDT

Fillings Benefit for fillings:

Granted once per tooth in 720 days
Benefit for re-treatment of a tooth:
Subject to managed care protocols
Multiple fillings:
A treatment plan and X-rays may be required for multiple fillings
Covered at the BDT
Scheme Exclusions:
• Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion
and fluorosis
• Resin bonding for restorations that are charged as a separate procedure to the
restoration
• The polishing of restorations
• Gold foil restorations
• Ozone therapy

Root Canal Therapy Benefit subject to managed care protocols

and Extractions Covered at the BDT
Scheme Exclusions:
• Root canal therapy on primary (milk) teeth
• Root canal therapy on third molars (wisdom teeth)
• Direct and indirect pulp capping procedures

Plastic Dentures* Pre-authorisation required for Dentures

and Associated One set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
Laboratory Costs
Benefit not available for the clinical fee of denture repairs, denture tooth
replacements and the addition of a soft base to new dentures; the laboratory fee will
be covered (no pre-authorisation required).
Benefit for a mouth guard: Benefit available for both the clinical and the associated
laboratory fee for a mouth guard (no pre-authorisation required).
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Diagnostic dentures and associated laboratory costs
• Snoring appliances and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees
• Provisional dentures and associated laboratory costs

33 Bonitas Dental Benefit Tables 2024

 SPECIALISED
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

Partial Chrome Cobalt Pre-authorisation required

Frame Dentures* Two partial frames (an upper and a lower) per beneficiary in a 5-year period
and Associated
Benefit subject to managed care protocols
Laboratory Costs
Covered at the BDT
Scheme Exclusions:
• The metal base to full dentures and associated laboratory costs
• High impact acrylic
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Crown & Bridge* Pre-authorisation required

and Associated Three crowns per family per year
Laboratory Costs
Benefit for crowns will be granted once per tooth in a 5-year period
A bridge comprises two or
A treatment plan and X-rays may be requested
more crown units. Each
crown is payable from the Benefit subject to managed care protocols
available Crown & Bridge A pontic on a 2nd molar, where the 3rd molar is a crown retainer, is subject to
benefit. managed care protocols
Covered at the BDT
Scheme Exclusions:
• Crowns on third molars
• Crown and bridge procedures for cosmetic reasons and associated laboratory
costs
• Occlusal rehabilitations and associated laboratory costs
• Laboratory fabricated temporary crowns
• Provisional crowns and associated laboratory costs
• Porcelain veneers and inlays, and associated laboratory costs
• Emergency crowns that are not placed for the immediate protection in tooth
injury
and associated laboratory costs
• The cost of gold, precious metal, semi-precious metal and platinum foil
• Laboratory delivery fees

Implants* No benefit
and Associated
Laboratory Costs

Orthodontics* Pre-authorisation required

and Associated Benefit for orthodontic treatment granted once per beneficiary per lifetime
Laboratory Costs
Only one family member may commence orthodontic treatment in a calendar year
On pre-authorisation, cases will be clinically assessed by using an orthodontic
needs analysis. Benefit allocation is subject to the outcome of the needs analysis
and funding can be granted up to 100% of the BDT.
Benefit for orthodontic treatment will be granted where function is impaired.
Benefit will not be granted where orthodontic treatment is required for cosmetic
reasons. The associated laboratory costs will also not be covered.
Benefit for fixed comprehensive treatment:
Limited to individuals from age 9 and younger than 18 years of age
Benefit subject to managed care protocols
Covered at the BDT

34 Bonitas Dental Benefit Tables 2024

 SPECIALISED
PAYABLE FROM AVAILABLE SAVINGS
DENTISTRY

Scheme Exclusions:
• Orthognathic (jaw correction) and other orthodontic related surgery, and any
associated hospital and laboratory costs
• Orthodontic re-treatment and any related laboratory costs
• Invisible retainer material
• Laboratory delivery fees

Periodontics* Pre-authorisation required

Benefit will only be applied to members registered on the Periodontal Programme
Benefit limited to conservative, non-surgical therapy only
Benefit subject to managed care protocols
Covered at the BDT
Scheme Exclusions:
• Surgical periodontics which includes gingivectomies, periodontal flap surgery,
tissue grafting and the hemisection of a tooth
• PerioChip placement

Maxillo-facial Surgery Surgery in the dental chair:

and Oral Pathology Benefit subject to managed care protocols
Covered at the BDT
Temporo-mandibular joint (TMJ) therapy:
Benefit limited to non-surgical intervention/treatments
Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of
the jaw and soft tissue tumours): Claims will only be covered if supported by a
laboratory report that confirms diagnosis.
Benefit for the closure of an oral-antral opening (code 8909):
Subject to motivation and managed care protocols
Surgery in hospital: See Hospitalisation* below
Scheme Exclusions:
• Orthognathic (jaw correction) surgery
• Sinus lifts
• Bone augmentations
• Bone and tissue regeneration procedures
• The cost of bone regeneration material
• The auto-transplantation of teeth

35 Bonitas Dental Benefit Tables 2024

 HOSPITALISATION AND
ANAESTHETICS

Hospitalisation No benefit for In Hospital (General Anaesthetic) dentistry,

(General Anaesthetic)* except for PMBs.
Subject to BonFit Select Hospital Network
Subject to pre-authorisation

Inhalation Sedation in the Payable from available Savings

Dental Rooms
Benefit subject to managed care protocols
Covered at the BDT

Moderate/Deep Sedation Pre-authorisation required

in the Dental Rooms*
Payable from Savings
Benefit limited to extensive dental treatment
Benefit subject to managed care protocols
Covered at the BDT

36 Bonitas Dental Benefit Tables 2024

BONCAP Dental Benefit Table 2024

Dental Benefits DSP Network

Dental benefits are managed by DENIS and paid at the Benefits payable for Conservative Out-of-hospital
Bonitas Dental Tariff (BDT). services on the BonCap option are subject to the use
of a Designated Service Provider (DSP) on the DENIS
There is no overall annual limit on BonCap for 2024.
Dental Network. No benefit for out-of-network visits.
Only the dental codes listed in the table below will be
If there is no DSP in the member’s area, the member
covered under this option, except in the case of
needs to contact DENIS prior to treatment.
authorised Prescribed Minimum Benefit (PMB) events.
This option does not provide benefits for any Pre-authorisation*
Specialised Dentistry. Dentures must be pre-authorised on the BonCap
Dental benefits are subject to managed care protocols option. A 20% penalty will apply if authorisation is
and managed care interventions which may include the applied for after the treatment is clinically indicated.
requirement of treatment plans and/or radiographs prior PMB treatment is the only dental treatment covered in
to benefit application. hospital on the BonCap option. Pre-authorisation by
In the event of a dispute, the registered Rules of the DENIS is required for any dental related PMB
Scheme will prevail. hospitalisation.

Please note that Medscheme will be responsible for the Emergencies require authorisation within 48 hours of
payment of all dental claims (Out-of-hospital dentistry, the first working day.
In-hospital PMB dentistry and related anaesthetics) on
the BonCap option.

BENEFIT CODE DENIS BENEFIT INFORMATION

Consultation 8101 One check-up per beneficiary per year (Once every 365 days)

Specific Consultation 8104 One specific consultation (emergency) for pain and sepsis per
(Emergency) beneficiary per year

Intraoral X-rays 8107 Four X-rays in total per beneficiary per year
and/or
NOTE: X-rays Extraoral – NO Benefit
8112

Polishing of Teeth 8155 One polish (8155) or one scaling and polishing (8159)
per beneficiary per year
Scaling and Polishing 8159

Fluoride Treatment One treatment per year for beneficiaries under 16 years of age

8161 5 to 12 years of age

8162 13 to 15 years of age

Fissure Sealant 8163 One per tooth in a 3-year period for beneficiaries younger than 16
years of age

37 Bonitas Dental Benefit Tables 2024

 BENEFIT CODE DENIS BENEFIT INFORMATION

Infection Control 8109

One set per beneficiary per visit

Instrument Sterilisation 8110
(One set = 8109 x 2, 8110 x 1, 8145 x 1)

Local Anaesthetic 8145

Inhalation Sedation Inhalation Sedation is limited to extensive conservative dental

in the Dental Rooms treatment only

8141 First 15 minutes

8143 Each additional 15 minutes

Emergency Pulp 8131 Benefit for emergency treatment only

removal for the relief of
8132 Pulp Removal (Pulpectomy)
acute pain prior to root
canal therapy

Pulp Treatments 8307 Benefit for amputation of pulp of primary teeth

Extractions 8201 Extraction of tooth or exposed roots

(Removal of Teeth)
8935 Treatment of septic socket

Dental Fillings 8341 Benefit for 4 fillings per beneficiary per year
8342
Benefit for fillings are granted once per tooth in 720 days
8343
8344 Benefit for re-treatment of a tooth subject to managed care protocols
8351
8352
8353
8354
8367
8368
8369
8370

Plastic Dentures* 8231 Pre-authorisation required

8232
One set of plastic dentures (an upper and a lower) per family in a 2-
8233
year period for beneficiaries 21 years and older. 20% co-payment
8234
applies.
8235
8236 The appropriate laboratory codes will be covered. 20% co-payment
8237 applies.
8238
8239
8240
8241

38 Bonitas Dental Benefit Tables 2024

 BENEFIT CODE DENIS BENEFIT INFORMATION

Denture Rebase 8259 Rebase of denture once per family per year for beneficiaries 21 years
and older. 20% co-payment applies
The appropriate laboratory codes will be covered. 20% co-payment
applies.

Denture Repairs 8263 Repairs to existing dentures twice per family per year for beneficiaries
21 years and older. 20% co-payment applies.
8269
The appropriate laboratory codes will be covered. 20% co-payment
8271
applies.
8273

Maxillo-facial Surgery in Surgery in the dental chair subject to the use of a DENIS designated
Dental Chair service provider, and only PMB and the 2 codes listed below will be
covered.

8937 Surgical removal of tooth

8213 Surgical removal of residual roots

Cover for PMB treatment

Moderate/Deep Sedation 8144 Pre-authorisation required

in the Dental Rooms*
Benefit limited to extensive conservative dental treatment

Hospitalisation No benefits for in hospital (general anaesthetic) dentistry, except for

(General Anaesthetic)* PMBs.
Pre-authorisation required

39 Bonitas Dental Benefit Tables 2024

HOSPITAL STANDARD Dental Benefit Table 2024

Dental Benefits Hospital Standard Hospital Network

Dental benefits are paid at the Bonitas Dental Tariff Members on the Hospital Standard option must use a
(BDT). hospital within the Bonitas Hospital Standard Hospital
Network.
Dental benefits are subject to managed care protocols
and managed care interventions which may include the Should a member on the Hospital Standard option
requirement of treatment plans and/or radiographs prior make use of a non-network hospital for an elective
to benefit application. procedure, a 30% co-payment will be applicable on the
hospital account.
Scheme Exclusions apply to dental benefits.
In the event of a dispute, the Rules of the Scheme will Pre-authorisation*
prevail.
Dental treatment in hospital and Moderate/Deep
Co-payments Sedation in the Dental Rooms must be pre-authorised.
Procedures and treatments not pre-authorised will not
On the Hospital Standard option a co-payment is
attract a benefit.
levied on the hospital account.
Penalties do not apply to emergency/PMB** hospital
Hospital account: The co-payments on Hospital
admissions.
Standard to be waived if the cost of the service falls
within the co-payment amount. ** PMB = Prescribed Minimum Benefits

CONSERVATIVE
HOSPITAL STANDARD
DENTISTRY

Consultations No benefit

X-rays: Intraoral No benefit

X-rays: Extraoral No benefit

Preventative Care No benefit

Fillings No benefit

Root Canal Therapy and No benefit

Extractions

Plastic Dentures No benefit

40 Bonitas Dental Benefit Tables 2024

 SPECIALISED
HOSPITAL STANDARD
DENTISTRY

Partial Chrome Cobalt No benefit

Frame Dentures
and Associated
Laboratory Costs

Crown & Bridge No benefit

and Associated
Laboratory Costs

Implants No benefit
and Associated
Laboratory Costs

Orthodontics No benefit
and Associated
Laboratory Costs

Periodontics No benefit

Maxillo-facial Surgery* Maxillo-facial surgery in hospital:

- Pre-authorisation required
- Services included are surgery as a result of tumours, neoplasms, sepsis, trauma
and congenital birth defects.
- Benefit subject to managed care protocols and payable to the specialist up to 100%
of the BDT
Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of
the jaw and soft tissue tumours):
- Claims will only be covered if supported by a laboratory report that confirms
diagnosis.
Benefit for the closure of an oral-antral opening (code 8909):
- Subject to motivation and managed care protocols
Other surgery in hospital:
- See Hospitalisation* below
Scheme Exclusions:
• Osseo-integrated implantation
• Orthognathic (jaw correction) surgery
• Sinus lifts
• Bone augmentations
• Bone and tissue regeneration procedures
• The cost of bone regeneration material
• The auto-transplantation of teeth

41 Bonitas Dental Benefit Tables 2024

 HOSPITALISATION AND
HOSPITAL STANDARD
ANAESTHETICS

Hospitalisation Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply
Benefit subject to managed care protocols
General anaesthetic benefit available for children under the age of 5 years for
extensive dental treatment:
• A co-payment of R3 500 per hospital OR day clinic admission applies.
General anaesthetic benefit available for the removal of impacted teeth:
• A co-payment of R5 000 per hospital admission applies for the removal of
impacted teeth and any other medical admission other than children younger than
5 years of age.
• A co-payment of R2 500 per day clinic admission applies for the removal of
impacted teeth and any other medical admission other than children younger than
5 years of age.
Scheme Exclusions:
• Where the only reason for admission to hospital is dental fear and anxiety
• Multiple hospital admissions
• Where the only reason for the admission request is for a sterile facility
• The cost of dental materials for procedures performed under general anaesthesia

Inhalation Sedation No benefit

in the Dental Rooms

Moderate/Deep Sedation Pre-authorisation required

in the Dental Rooms*
Benefit subject to managed care protocols
Covered at 100% of BDT
Only applicable in lieu of GA for the benefits described under Hospitalisation.

42 Bonitas Dental Benefit Tables 2024

BONESSENTIAL Dental Benefit Table 2024
BONESSENTIAL SELECT Dental Benefit Table 2024

Dental Benefits BonEssential Select Hospital Network

Dental benefits are paid at the Bonitas Dental Tariff Members on the BonEssential Select option must use
(BDT). a hospital within the Bonitas BonEssential Select
Hospital Network.
Dental benefits are subject to managed care protocols
and managed care interventions which may include the Should a member on the BonEssential Select option
requirement of treatment plans and/or radiographs prior make use of a non-network hospital for an elective
to benefit application. procedure, a 30% co-payment will be applicable on the
hospital account.
Scheme Exclusions apply to dental benefits.
In the event of a dispute, the Rules of the Scheme will Pre-authorisation*
prevail. Dental treatment in hospital and Moderate/Deep
Co-payments Sedation in the Dental Rooms must be pre-authorised.
Procedures and treatments not pre-authorised will not
On the BonEssential and BonEssential Select attract a benefit.
options a co-payment is levied on the hospital account.
Penalties do not apply to emergency/PMB** hospital
Hospital account: The co-payments on BonEssential admissions.
and BonEssential Select options to be waived if the
cost of the service falls within the co-payment amount. ** PMB = Prescribed Minimum Benefits

CONSERVATIVE
BONESSENTIAL & BONESSENTIAL SELECT
DENTISTRY

Consultations No benefit

X-rays: Intraoral No benefit

X-rays: Extraoral No benefit

Preventative Care Fissure sealants (tariff code 8163) are available for beneficiaries younger than 16
years of age and limited to one per tooth in 3 years
Benefit for fissure sealants subject to managed care protocols
Covered at 100% of BDT

Fillings No benefit

Root Canal Therapy No benefit

and Extractions

Plastic Dentures No benefit

43 Bonitas Dental Benefit Tables 2024

 SPECIALISED
BONESSENTIAL & BONESSENTIAL SELECT
DENTISTRY

Partial Chrome Cobalt No benefit

Frame Dentures
and Associated
Laboratory Costs

Crown & Bridge No benefit

and Associated
Laboratory Costs

Implants No benefit
and Associated
Laboratory Costs

Orthodontics No benefit
and Associated
Laboratory Costs

Periodontics No benefit

Maxillo-facial Surgery* Surgery in the dental chair:

Benefit subject to managed care protocols
Covered at the BDT
Benefit ONLY available for the removal of impacted teeth:
Code 8941

Surgery in hospital:
• See Hospitalisation* below

HOSPITALISATION AND
BONESSENTIAL & BONESSENTIAL SELECT
ANAESTHETICS

Hospitalisation Pre-authorisation required

(General Anaesthetic)*
Admission protocols apply
Benefit subject to managed care protocols
BonEssential Select is subject to the use of a hospital on the BonEssential Select
Hospital Network.
General anaesthetic benefit available for the removal of impacted teeth ONLY:
• A co-payment of R5 000 per hospital admission applies.
• A co-payment of R2 500 upfront co-payment to apply for the removal of impacted
teeth if performed in a Day Clinic.
Scheme Exclusions:
• Where the only reason for admission to hospital is dental fear and anxiety
• Multiple hospital admissions
• Where the only reason for the admission request is for a sterile facility
• The cost of dental materials for procedures performed under general anaesthesia

44 Bonitas Dental Benefit Tables 2024

 HOSPITALISATION AND
BONESSENTIAL & BONESSENTIAL SELECT
ANAESTHETICS

Inhalation Sedation in No benefit

the Dental Rooms

Moderate/Deep Sedation Pre-authorisation required

in the Dental Rooms*
Benefit subject to managed care protocols
Covered at 100% of BDT
Only applicable in lieu of GA for the benefits described under Hospitalisation.

45 Bonitas Dental Benefit Tables 2024

BONSTART Dental Benefit Table 2024
BONSTART PLUS Dental Benefit Table 2024

Dental Benefits Hospitalisation

Preventative dental benefits are managed by DENIS PMB treatment is the only dental treatment covered in
and paid at the Bonitas Dental Tariff (BDT). hospital on these options.
Only the dental codes listed in the table below will be Pre-authorisation by DENIS is required for any dental
covered under this option. related PMB hospitalisation. Subject to BonStart and
BonStart Plus Hospital Network.
Dental benefits are subject to managed care protocols.
A R12 050 co-payment to apply to all non-network
In the event of a dispute, the registered Rules of the
admissions, subject to Regulation 8 (3).
Scheme will prevail.
Emergencies require authorisation within 48 hours of
the first working day.

BENEFIT CODE BONSTART BONSTART PLUS

Consultation 8101 One consultation per beneficiary One consultation per beneficiary per
per year (not within 6 months from year (not within 6 months from the
the previous year’s consultation) previous year’s consultation)
R120 co-payment applies to the R65 co-payment applies to the
charged code 8101 charged code 8101

Polishing of Teeth 8155 One scale and polish treatment per One scale and polish treatment per
beneficiary per year (not within 6 beneficiary per year (not within 6
months from the previous year’s months from the previous year’s
Scaling and Polishing 8159
scale and polish) scale and polish)
Code 8155 or 8159 (max of 1 in Code 8155 or 8159 (max of 1 in total
total per year) per year)

Fluoride Treatment One treatment per year, limited to One treatment per year, limited to
beneficiaries from age 5 and beneficiaries from age 5 and
younger than 16 years of age younger than 16 years of age

8161 5 to 12 years of age 5 to 12 years of age

8162 13 to 15 years of age 13 to 15 years of age

Fissure Sealant 8163 One per tooth in a 3-year period for One per tooth in a 3-year period for
beneficiaries younger than 16 beneficiaries younger than 16 years
years of age of age

Infection Control 8109

One set per beneficiary per visit One set per beneficiary per visit
Instrument 8110
(One set = 8109 x 2, 8110 x 1, (One set = 8109 x 2, 8110 x 1,
Sterilisation
8145 x 1) 8145 x 1)

Local Anaesthetic 8145

46 Bonitas Dental Benefit Tables 2024

 BENEFIT CODE BONSTART BONSTART PLUS

Hospitalisation* No benefit for In-hospital (General No benefit for In-hospital (General

(General Anaesthetic) Anaesthetic) dentistry, except for Anaesthetic) dentistry, except for
PMBs. PMBs.
Subject to BonStart Hospital Subject to BonStart Plus Hospital
Network Network
Subject to pre-authorisation Subject to pre-authorisation

47 Bonitas Dental Benefit Tables 2024

Additional Scheme Exclusions (All Options)
• Electrognathographic recordings, pantographic recordings and other such electronic analyses
• Nutritional and tobacco counseling
• Caries susceptibility and microbiological tests
• Pulp tests
• Cost of Mineral Trioxide
• Cost of prescribed toothpastes, mouthwashes (e.g. Corsodyl) and ointments
• Appointment not kept
• Special report
• Dental testimony including dento-legal fees
• Treatment plan completed
• Enamel microabrasion
• Behaviour management
• Intramuscular or subcutaneous injection
• Procedures that are defined as unusual circumstances and procedures that are defined as unlisted procedures

48 Bonitas Dental Benefit Tables 2024