Edgars dental insurance is a brand-new concept created with our Edgars customers in mind. We incorporate your premiums in your Edgars payment so you don’t have to add another payment to your budget.
We Offer More than you’d Ever Expect
Throughout the years, Edgars have been known for our apparel and fashion sense; however, we are much more than that.
We’ve enlisted the help of the most experienced consultants to aid us with our insurance side of the business, transforming us into a genuinely diverse retail firm that not only looks nice on the outside, but also has an amazing grin to match.
Cover your Dental Health Needs
We conducted extensive research into what clients desire from an insurance provider and developed a solution that addresses those concerns.
Our dental insurance covers all of your basic and extensive dental needs. We have a plan that will work for you and your family.
Our rates are very reasonable, so there’s no reason why you shouldn’t maintain your teeth healthy for years to come.
What does dental insurance really cover?
Preventive care, fillings, crowns, root canals, and oral surgery, such as tooth extractions, are usually covered in part by dental insurance. Orthodontics, periodontics (the structures that support and surround the tooth), and prosthodontics (dentures and bridges) may also be covered. Two preventive visits are normally covered each year. Further reading: Is teeth straightening covered by dental insurance?
Periodontics and prosthodontics may not be provided in the first year of coverage if you purchase an individual policy. For any type of policy, orthodontics frequently requires a rider, for which you must pay an additional premium.
The most common coverage structure is 100-80-50. That implies they cover 100 percent of preventative care, 80 percent of basic operations, and 50 percent of big procedures, or a higher co-payment. However, other procedures, including tooth sealants, may not be covered at all by a dental plan.
Can I use my Edgars card at a dentist?
The Edcon group in South Africa provides you with Edgars dental insurance. We’ve created dental coverage with a twist because we know that medical aid sometimes only covers an annual check-up.
Edgars account holders can take advantage of a streamlined and rapid membership option that will provide them with a cheap and convenient insurance cover to help with their dental expenditures.
Access to a World of Benefits
Edcon has been one of the top leaders in the garment industry since 1929, and has expanded our market through inventive innovations throughout the years, including the addition of insurance coverage alternatives.
We have a large footprint in South Africa, allowing our clients to use our services from anywhere in the country.
We got he Extra Mile
We go above and beyond for our Edgars customers, and we treat your health as seriously as any other service we offer.
Our insurance process is straightforward and cost-effective, and we also provide instant online insurance quotes. Customers can join at any of our locations across the country.
What’s more, your premiums will be added to and deducted from your Edgars account, allowing you to continue paying your Edgars account on a monthly basis as usual.
Settled in just 48 Hours!
Any claims filed to us by our clients are resolved within 48 hours, making us one of the country’s fastest paying dental insurers.
Clients simply pay their dental bill at the practice and submit a claim to us with the correct invoice information (ICD codes, membership number, member name, and dental practitioner details).
It’s now more affordable than ever to have a beautiful smile, and Edgars can help!
Take Care of your Teeth Stress Free!
Clients of Edgars no longer have to be concerned about dental hygiene checkups, consultations, root canals, or fillings. You can now take care of your teeth while also claiming reimbursement from your dental insurance.
When you join the Edgars dental insurance plan, we will give you a complete breakdown of what your dental insurance covers.
We also give a toll-free number for members to call if they have any questions about their insurance premiums, dental coverage, or service providers to use.
Why does my dental insurance not cover anything?
The best approach to conceive of dental insurance is to think of it as a benefit rather than an insurance policy. So, instead of dental insurance, it’s a dental benefit plan. You don’t have any insurance against loss. Consider dental insurance as a benefit plan that pays for a portion of your treatment and allows you to pay a lower charge. Dental insurance is not the same as medical insurance. Annual maximums for dental policies are usually between $1000 and $1500. You insure the value of your home, for example, with home insurance. If your house is worth $150,000, you may insure it for nearly the entire amount. Only a percentage of the cost of your dental health and needs is covered by dental benefits. If your treatment costs $5500, your plan will only cover up to $1000.
Restrictions and exclusions may apply to dental plans. They may not be able to afford veneers, implants, or other cosmetic operations. They can also impose up to a year-long waiting period before covering some operations. These limitations are dependent on pricing, with more comprehensive programs typically costing more.
Most dental insurance do not cover all procedures equally. Fillings can be covered up to 80%, while crowns can be covered up to 50%. Apart from cleanings, dental insurance seldom, if ever, pays for the entire cost of a service. The remainder or co-pay is the portion for which the patient is responsible. Some plans have a deductible that must be satisfied before any treatment can be paid for.
The decreased cost schedule might be a significant benefit of the dental plan. A cost schedule with providers will be negotiated by a dental plan business. The dental clinic takes a lower price in exchange for patients being referred to them from a list of providers. You are in network if you opt to see a dentist who is a plan provider. You may not obtain the same low rates or have a procedure paid at the same rate if you choose a provider outside of the network. Some plans are so exclusive that patients can only see a certain provider, which means your plan can’t be utilized at an out-of-network facility. Benefit plans can also refuse to cover a procedure or downcode it to a lower-cost option. This down coding does not imply that the procedure is unnecessary; rather, it is a lower-cost payment option offered by the insurance carrier.
Dental insurance isn’t free. They’re usually covered by an employer, a group plan, or an individual policy. The cost of a plan is frequently deducted from an employee’s pay. Consider the entire benefit to be the annual maximum minus the annual cost.
$1250 yearly maximum – $480 plan cost – $50 deductible = $720 total benefit
If the entire cost of the dental benefit plan is too high, it may not be worth it to pay for one if your dental needs are minimal. If only routine cleanings, radiographs, and exams are required, more money could be spent on the treatment plan rather than the treatment itself.
Engaging with your HR professional to understand the cost of the plan to employees and the constraints that have been chosen might be beneficial. If you have an individual plan, it is a good idea to examine your dental needs to see if the expenses of coverage outweigh the advantages. Your dentist should be able to provide you with a comprehensive dental history as well as a forecast of future needs. They can also recommend plans that have the fewest limits and are the most cost-effective.
Which medical aid covers dental implants in South Africa?
Consider how the second-largest medical aid system in South Africa, Bonitas Medical Scheme, pays for dental care.
The Bonitas dental tariff is used to calculate dental benefits. Pre-authorization is required for hospitalization and certain specialized operations.
Co-payments for orthodontics are required on the Standard and Standard Select plans. Members must use dentists who are part of the scheme’s network of designated service providers for crown and bridge work.
Bonitas: co-payments, managed care protocols and exclusions
Dental benefits under the primary plan are limited to the DSP network of the plan. Managed care guidelines regulate all dental coverage, and scheme exclusions apply.
On the BonCom option, specialized dental benefits are paid from available savings and/or the Above Threshold limit.
Pre-authorization is necessary for hospital admissions and some operations, like as implants, crowns, and orthodontics, and benefits are subject to managed care regulations.
Which of the following is not covered under a dental insurance plan?
In a dental insurance plan, which of the following is not covered? A dental plan’s coverage for lost dentures is specifically excluded.
Does insurance cover cavity fillings?
Most dental insurance policies include fillings as a regular service. The amount of coverage they provide, however, is determined by a number of criteria, including your deductible and coverage level. Having dental insurance can help you save money on dental fillings and other dental procedures.
Does medicross accept Edgars cards?
Edgars Club, a South African shopping club, has partnered with a hospital and an optometry company to provide health care benefits and discounts to its Classic members.
Edgars Club has partnered with the SDK Organization of optometrists and Netcare, a large South African hospital group. The initiative will be a key component of the Edgars Club Classic option, and members will be able to save money on essential healthcare services such as doctor visits, dental exams, optometry, emergency room facility fees, and maternity services.
Edgars Club Classic members can use the healthcare suite to get preferential and reduced rates at participating establishments.
- At selected clinics, you can save up to R48 (about US$6.50) by paying a fixed charge for a consultation with a general practitioner, which includes three items of medication.
These perks will be promoted to the Club’s one million members across the country and will be redeemable at Netcare Group enterprises. Medicross and Prime Cure Medi-Clinics, Netcare Hospital Emergency Rooms, Storks Nest Clinics, as well as Stanley & de Kock and Millers Optometrists, are among those participating.
Elaine Holmes-Coetzee, Manager of Edgars Club and Financial Services Marketing at Edgars, believes that “Given the social issues surrounding access to high-quality, low-cost health care in South Africa, a venture like this adds even more value to all parties involved, including members, Edgars, and benefit providers.”
Support on a strategic level LifeWorld Relationship Management, Edgars Club’s strategic support partner, developed the strategy and negotiated the benefits, which are the first of their kind in the present offering of customer clubs and loyalty programs.
LifeWorld has worked with Edgars Club for over four years, and has been involved in the club’s strategic development as well as benefit negotiation and management. According to LifeWorld’s CEO, Rebecca Eliot: “LifeWorld wanted to provide Edgars Club Classic members with a variety of high-value, real-life advantages that would complement the club’s existing entertainment, travel, and leisure offerings. We concentrated on essential necessities that cut across all customer target groups, and we anticipate that, given the present rise in health-care expenditures in South Africa, they will be favorably appreciated by members.”
Cards that are sophisticated To track and authenticate eligibility to receive their benefits, Edgars Club Classic members will be given a member benefit card based on advanced gift card technology provided by Tutuka.
New credit card machines have also been installed at participating Netcare and SDK Group locations. These were provided by Altech Card Solutions, a subsidiary of listed Allied Technologies, and customized by Tutuka to enable for membership authentication and tracking of health care benefit redemption at the appropriate benefit providers.
Visit Edgars at http://www.edgars.co.za for more information. Visit http://www.lifeworld.co.za for more information.
Is dental insurance useless?
A toothache sent me back to the dentist’s office last October. I was able to receive the care I required, but my fear of returning to the dentist’s chair was nearly matched by anxiety about the cost and how I would pay for it.
I wasn’t one of the many Americans who ended up in the emergency room for dental care, which costs ten times as much as preventive care. According to the American Dental Association’s Health Policy Resources Center, there were 2.1 million dental-related ER visits in 2010, costing the health-care system between $867 million and $2.1 billion.
I wasn’t one of the nearly 50 million Americans who live in areas where dentists are scarce or nonexistent. Thousands of people waited for hours in the rain for medical attention in barns and animal stalls on a Virginia carnival during a three-day Remote Area Medical health care expedition, according to Potter. The majority of the people were there to visit a dentist, not a doctor. Some people traveled from as far as Florida and Wisconsin in search of dental care they couldn’t get or afford back home.
I discovered a dentist who could see me right immediately near my office in downtown Washington. She took an x-ray and determined that I required an emergency root canal. She scheduled an appointment with an endodontist and provided me with a referral. I’d have to come back for tooth restoration and a dental crown.
I wasn’t one of the estimated 130 million people in the United States who didn’t have dental coverage. My company provided dental care, which I used little. Otherwise, I might have ended myself in an emergency room, in far more anguish, and in grave danger to my health.
However, I was one of many Americans who had no idea how much some dental operations cost. The cost of dental treatment has risen faster than the cost of medical care overall, according to the Bureau of Labor Statistics. Only hospital and adult day care prices increased faster between 2008 and 2012, while annual dental spending caps remained same from the Watergate era, ranging between $1,000 and $2,000.
Many Americans, including myself, were unaware of how little dental insurance covered. The dental office employees informed me that my dental insurance was “extremely good.” Nonetheless, the cost of a root canal, repair, and dental crown came close to my coverage’s $1,500 yearly spending limit.
When I went back to the dentist for a restoration and a temporary crown, I received more awful news. She took many x-rays and determined that I required another root canal. Unbeknownst to me, bruxism had broken a tooth, allowing disease to set in.
My dental insurance covered two root canals per year, but the cost of only one together with the necessary reconstruction and crown was less than the annual cap on my dental insurance. The second root canal, repair, and crown would not be covered.
There isn’t such a thing as true dental coverage. When you have major medical problems, traditional health insurance actually pays you back more than you paid in premiums. With dental insurance, however, this is not the case.
If you ever require major dental work, you’ve probably paid more in dental insurance premiums than you’ll get back. Your annual dental coverage will expire well before you require treatment. You’ll have to come up with the difference yourself. You go without dental treatment or put it off as long as you can if you don’t have it and can’t borrow the money or locate a better deal.
That’s exactly what I did. I didn’t book another appointment after my second root canal. I knew that starting in January, when I was finally covered by my husband’s insurance, I’d have better dental coverage. If I’d used the family plan that covered my husband and our kids before the Supreme Court threw down DOMA, I would have owed thousands of dollars in taxes since it would have been considered a “gift.”
Now I have a new dentist. He’s well aware of my childhood trauma and strives to make my visits as pain-free and anxiety-free as possible. The two permanent crowns have been completed. I’ll be returning this week for a cleaning and checkup, and will do so every six months going forward. I’m hoping that the monthly checkups, as well as my own dental hygiene routine, will help me avoid another dental emergency.
As I already stated, I am lucky. I neglected my dental care as a result of childhood trauma, but I was eventually able to seek the help I needed. Millions of Americans are unable to do so due to no fault of their own.
The Affordable Care Act, which only guarantees dental coverage for almost 5.3 million children eligible for other government programs but not adults, turns four this week. Perhaps it’s time for a “Affordable Dental Care Act,” as one reader on Potter’s original post suggested.
Why do dentist charge more than insurance allows?
When the insurance company authorizes the claim, dentists who are in-network with a PPO or EPO plan cannot charge more than the contractual amount. This is the contractual limit on how much they can charge patients for covered treatments.
Expect to spend more than your copayment for approved treatments, and you may have to pay higher prices if your insurer refuses claims for one of three reasons.
Excluded Services
When your insurance doesn’t cover a certain service, in-network dentists may charge you more. Every recommended or requested procedure will not be approved by your plan. As a result, the agreed-upon amount may not be applicable in all circumstances.