An investment account reserved for dental expenses will keep you smiling

Question: My friend’s son has had braces fitted to his teeth. I was shocked to hear what it cost and that it was not covered by their medical aid. What do I do now to ensure that if my son needs braces, I will be able to pay for them?

Answer: Medical scheme plans are modular: you select a basic hospital plan or compre­hensive cover, and you carry more of the day-to-day costs through your medical savings account.

Modern medical schemes are designed to pool risk for unpredictable, catastrophic events such as heart attacks, accidents and cancer.

Dentistry is different: much of it is predictable maintenance, including check-ups and fillings, or elective, planned interventions such as orthodontics and implants.

Covering a benefit that most members will predictably use pushes premiums sky-high. Funds, therefore, cap or exclude much of dentistry to keep contributions affordable for the wider pool.

You do have options, though, and the key is to understand the rules of the game, then build a plan to fit your family’s likely needs.

The Medical Schemes Act requires schemes to fund a list of prescribed minimum benefits (PMBs) in full. These are life-threatening or chronic conditions. Ordinary dental issues – including braces and implants – are not PMBs. Unless the oral condition is part of a PMB diagnosis (say, oral cancer or a severe infection that becomes systemic), your scheme is allowed to limit payment.

Depending on what option you choose, your scheme may pay for routine dentistry such as check-ups, basic fillings and simple extractions. This will typically come out of your medical savings account. Oral surgery in hospital for trauma or impacted teeth may be covered as part of an in-hospital cost, but there may be restrictions in terms of needing authorisation.

Orthodontics, implants and dentures are usually not paid once your medical savings account is depleted.

I would suggest you audit your current benefits and answer the following questions:

• What is the annual dental sub-limit (if any)?
• Are orthodontics covered? At what percentage and with what maximum?
• Are there network restrictions (using designated dentists/orthodontists)?
• What authorisation or clinical motivation is required?

If your answers amount to “limited” or “mostly from savings”, you’re carrying the risk yourself.

Medical aids are currently publishing their benefit options and premiums for next year. I would suggest that you look at the options, and see if the additional premiums are more costly than the additional dental benefits you will receive.

If this is the case, then you should open a separate investment account for your dental savings. You can fund this with a monthly debit order so that when the inevitable happens, you will have a financial cushion.

Something else that you can speak to your financial adviser about is dental gap cover. This is a supplementary insurance that helps cover shortfalls on certain dental procedures. It’s not a replacement for medical aid, and there are waiting periods and exclusions that you need to be aware of.

Dental care has become one of those expenses that requires planning rather than relying solely on your medical aid. DM

Kenny Meiring is an independent financial adviser. Contact him on 082 856 0348 or at financialwellnesscoach.co.za. Send your questions to kenny.meiring@sfpwealth.co.za.

Did you find this article useful? Read more business and personal finance articles here.

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.