We decided to outline how our practice handles PSMAS dental patients. The information is based on our internal billing policy and not on PSMAS’s advertised limits. This policy may change from time to time based on reviews of our relationship with the provider.
1. USD Plans (Public Sector)
| Plan | Dental (Basic) | Prosthetics (Crowns, Dentures) | Orthodontics | Practice Policy |
|---|---|---|---|---|
| Executive | Accepted – up to $700 | Subject to pre-authorisation & review | Under Review | Basic dentistry honoured across this plan. Prosthetics only if approved. |
| Optimum | Accepted – up to $350 | Subject to pre-authorisation & review | Under Review | Basic dentistry honoured across this plan. Prosthetics only if approved. |
| Standard | Accepted – up to $235 | Under Review (currently not accepted) | Under Review | Basic dentistry honoured across this plan. Prosthetics not accepted at this time. |
2. ZWL Plans
| Plan | Dental (Basic) | Prosthetics | Orthodontics | Practice Policy |
|---|---|---|---|---|
| Standard | Covered | Under Review | Under Review | Patient pays 50% of our cash fee as copayment. |
| Optimum | Covered | Under Review | Under Review | Patient pays 50% of our cash fee as copayment. |
| Executive | Covered | Under Review | Under Review | Patient pays 50% of our cash fee as copayment. |
3. Copayment Rule for ZWL Plans
All patients on ZWL-based PSMAS plans are required to pay 50% of our cash fee upfront.
This measure was created to allow the surgery to fund its daily operations in an environment of unpredictable inflation, especially as medical aid providers may sometimes take long to settle payments.
- The copayment helps us maintain quality services and retain staff even when settlements are delayed.
- It is a practice requirement regardless of how the funder reimburses.
- A consultation fee of $10 is always required before any treatment and remains valid for 12 months.
4. Cash Prices & Copayments (Both Practices)
| Service | Highfield Cash | Highfield Copay (50%) | Avonlea Cash | Avonlea Copay (50%) |
|---|---|---|---|---|
| Consultation (valid 12 months) | $10 | $10 (always paid in full) | $10 | $10 (always paid in full) |
| Extraction (simple) | $20 | $10 | $30 | $15 |
| Filling – Front teeth | $50 | $25 | $50 | $25 |
| Filling – Other teeth | $30 | $15 | $40 | $20 |
| Scaling & Polishing | $30 | $15 | $30 | $15 |
| Root Canal – Front teeth | $80 | $40 | $100 | $50 |
| Root Canal – Back teeth/molars | $100 | $50 | $120 | $60 |
| Wisdom Teeth (normally erupted) | $50 | $25 | $50 | $25 |
| Impacted Wisdom Teeth | $150 | $75 | $150 | $75 |
Perfect 👍🏽 — here’s a clean section you can slot into your WordPress page that clearly defines Basic Dentistry for your patients, using only the treatments your practice actually offers (excluding prosthetics and orthodontics).
What We Mean by “Basic Dentistry”
At our practice, basic dentistry refers to the essential day-to-day dental treatments that maintain oral health and manage common problems. Under PSMAS, the following services are covered as part of basic dentistry:
- Consultation / Examination – includes diagnosis, treatment planning, and record keeping (mandatory once per year at $10, valid for 12 months).
- Tooth Extractions (simple) – removal of teeth that can be taken out without surgical intervention.
- Fillings – restoring teeth damaged by decay:
- Front teeth fillings
- Other teeth fillings
- Scaling & Polishing – cleaning to remove tartar and stains, and polishing to prevent plaque build-up.
- Root Canal Treatments – saving teeth with infected or damaged nerves:
- Front teeth root canals
- Back teeth/molars root canals
- Wisdom Tooth Extractions (normally erupted) – removal when there is pain or overcrowding.
- Impacted Wisdom Teeth Removal – removal of teeth that have not erupted properly and require minor surgery.
- X-rays (where necessary) – diagnostic imaging to support treatment decisions.
Would you like me to weave this directly into the main article (maybe after the “Summary of Practice Policy”), or should it stand alone as a separate section on the page?
5. Summary of Practice Policy
- Basic Dentistry (consultation, fillings, extractions, scaling, root canal, X-rays, wisdom teeth) → Accepted across all USD and ZWL plans.
- Prosthetics (crowns, dentures):
- ❌ Under Review on ZWL plans.
- ✅ Accepted on USD Executive and Optimum plans if pre-authorised.
- ⚠️ USD Standard plan: Under Review (currently not accepted).
- Orthodontics: Not accepted on any plan.
- ZWL Members: Must pay 50% copayment of cash prices (to sustain operations in the face of inflation and delayed settlements).
- USD Members: Basic dentistry accepted across all plans; prosthetics only case-by-case.
- Consultation Rule: $10 fee required before any treatment; valid for 12 months.
- Disclaimer: This policy may change from time to time based on reviews of our relationship with PSMAS.
You may also find our policies with regards to other Medical Aid insurances by clicking here.
Related Search Terms
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