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DENTAL RISK INSURANCE 2017
YOUR SMILE PROTECTOR

What is Dental Risk Insurance?
DRI is a dental solution which fills the gap of medical aid short-falls, to ensure all South Africans can afford dental treatment. The packages cater from BASIC to SPECIALISED dentistry cover at contribution that will make you smile.

HOW DO THE PRODUCTS WORK?
  • Procedures may only be provided by registered general dentists (preferably on the DRC network)
  • The procedure or service being claimed for must be provided while the policy is in force
  • For a list of DRC preferred network providers, please visit their website: www.dentalrisk.co.za
MONTHLY PREMIUMS FOR 2017
Option Main Member Adult Member (>21) Child Dependent (<21)
Prime R31 R27 R23
Bronze R115 R498 R64
Silver R225 R170 R110
Gold R320 R260 R1563

Panoramic scan (PAN scan):
This is a full mouth X-ray that will only be covered when joining the Bronze, Silver and Gold options as an individual, over the age of 18 years; from October 2016 – this is applicable to new dependents on current policies as well. The Panoramic radiograph will only be paid by DRUM once the scan has been received by DRUM via email claims@dentalrisk.com. The cover is limited to Medicross (a list is available on our website) or any other facilities that has a panoramic radiograph machine. A benefit of R300 per nominated beneficiary is available and it is compulsory to submit this X-ray within 3 months of inception date to DRUM for capturing and releasing of future benefits. Should claims for specialised dentistry be submitted prior to the panoramic radiograph received, these claims will not be covered.
  • Once DRUM has received the panoramic scan, DRUM will identify all missing teeth, existing crowns, existing implants and existing temporary crowns. Existing crowns, existing implants and existing temporary crowns will be ruled as pre-existing conditions and will have an additional waiting period applied to them for a period of 5 (five) years. After the additional period of 5 years is completed, the policyholder may apply to have these procedures redone.

HOW DO I UTILISE THE CONCIERGE SERVICE?
Contact the call centre on 0861 843 842  or send the word DENTIST via SMS to 45288 (a call centre agents will call you back) Note: SMS’s are charged at R1 per SMS.
The requested dental service appointment bookings will be made on your behalf. An email / SMS confirmation of the booking and reference number will be sent to you

WHAT IS THE PROCEDURE WHEN CLAIMING?
Once the procedure / service has been completed:
  • If you have paid the provider directly, DRI will refund you up to the maximum benefit allowed according to your option choice, into your bank account on receipt of a provider invoice / statement and proof of payment OR the claim will be paid up to the maximum benefit allowed directly to the provider on receipt of the invoice and a signed payment session form
  • All claims must be submitted within 3 months of the event occurring
  • Claim documentation can be emailed to dri@drcclaims.co.za OR faxed to 086 687 1285
WHEN AM I COVERED?
As soon as any relevant waiting periods expired and all premiums are paid up to date – please refer to the benefit table on the brochure

SNAPSHOT OF EXCLUSIONS:
IMPLANTS: The Insured Member cannot join and receive cover for a previously extracted
tooth. (The Administrator must have the extraction on record as paid for cover to be granted for an implant).

FILLINGS AND CROWNS / CAPS: Changing existing fillings / crowns / caps for reasons
including headaches, fatigue or other conditions not directly related to the tooth structure and for cosmetic reasons is excluded

IMPACTED TEETH: Teeth that are in the process of eruption, but are not impacted are
excluded.

ORTHODONTICS: NOT COVERED

BACK CLAIMING: No dental claims for treatments received during the respective waiting
periods will be paid once the waiting periods are over – all claims need to be dated for
treatments received once the waiting periods are over.

NOTE:
  • Should a debit order be rejected a second time, the policy will automatically be cancelled
  • HealthGroup only provides factual information about this product - it is entirely the choice and decision of the applicant to enter into this contract. We have NOT provided any advice in this regard.

PACKAGES AVAILABLE
THERE ARE 4 UNIQUE OPTIONS

Click on the links below to download the brochures and application forms:


pdf DRI - Policy Wording 2017
pdf DRI Brochure 2018 (updated)
pdf DRI Application Form 2018 (updated)
dri


Please note the following important points:
  •  Maximum entry age is 65
  • Orthodontic treatment is NO LONGER COVERED
  • Specialised dentistry  is subject to authorisation
  • Waiting periods apply as per the plan selected (see the brochure)
  • PRE-AUTHORISATION: all Specialised dental benefits listed must be pre-authorised before the treatment commences! 
    • DRI require a comprehensive quotation + an x-ray to support the treatment. 
    • In the event of Trauma, pre-authorisation must be obtained within 48 working hours of the event occurring. A policy report / emergency room report is required. Further evidence may be requested at the discretion of the Administrator
Please contact info@healthgroup.org.za should you have any questions at all!

Application forms must be scanned and emailed to info@healthgroup.org.za for processing.