Does GEMS Cover Implants
What Implant Benefits Are GEMS Patients Entitled To?
Implants are indeed covered.
The above extract from our 2024 Dental Tariffs Pack.
Get your own copy of the Dental Tariffs Pack: Click here
Practice Admin
Momentum Health: Mouthpart Abbreviation Codes
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GEMS Contracted-in Dentist Note
Good afternoon,
The GEMS Dental Management team monitor monthly claims data of dental service providers who form part of the GEMS Dental Network. This is to ensure that the correct rates are charged for applicable dental procedure codes.
Common procedure codes charged above the GEMS Dental Network contract tariff amounts.
We have noted that most dental providers who use your EDI system charge above the contracted rates for mostly restorative procedure codes on the low benefit options. Kindly note the following for members belonging to Tanzanite One for 2024:
Restorative codes for Tanzanite One members are covered as below:
| Procedure codes | Descriptions | Limitations | How GEMS covers the procedure codes |
| 8367 | Resin restoration, one surface posterior | Any four resin fillings per beneficiary per year (posterior); limited to four restorations overall | Procedure codes covered on the benefit option but at the same rand value as surface amalgam filling. |
| 8368 | Resin restoration, two surfaces posterior | ||
| 8369 | Resin restoration, three surfaces posterior | ||
| 8370 | Resin restoration, four and more surfaces |
Please note the tariff amounts quoted below is from the tariff list for Contracted Dental Practitioners only, please refer to the attached list for the tariff amounts for the other Practice types.
The above procedure codes for Tanzanite One members will therefore pay as per below:
| Procedure codes | Descriptions | Tariff amounts |
| 8341 | Amalgam – one surface | R 354.80 |
| 8342 | Amalgam – two surfaces | R 436.70 |
| 8343 | Amalgam – three surfaces | R 532.70 |
| 8344 | Amalgam – four or more surfaces | R 593.50 |
Instead of the below tariff amounts confirmed in the 2022 tariff schedule.
| Procedure codes | Descriptions | Tariff amounts |
| 8367 | Resin – one surface, posterior | R 422.00 |
| 8368 | Resin – two surfaces, posterior | R 521.90 |
| 8369 | Resin – three surfaces, posterior | R 630.80 |
| 8370 | Resin – four or more surfaces, posterior | R 678.40 |
I have attached the 2024 GEMS Tariff Lists for ease of reference. Please feel free to contact me should you need any additional information.
Kind Regards
GEMS medical aid options and prices
Here is what GEMS has in store for 2024
Context: GEMS was registered medical aid scheme, membership restricted to public servants. It offers a wide range of coverage to suite their member’s needs, from basic to extensive cover. GEMS offers six (6) healthcare Benefit Options, namely: Tanzanite One, Beryl, Ruby, Emerald Value, Emerald and Onyx.
GEMS medical aid options and prices
| Tanzanite One
Entry Level Care-coordinated Network Option In-Hospital benefits within a defined hospital network subject to an annual hospital limit. Out-of-Hospital benefits subject to GEMS Network and FP nomination and Specialist rules From R 1363 pm
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BerylEntry Level Network Option
In-Hospital benefits subject to an annual hospital limit. Out-of-Hospital benefits subject to GEMS network
From R 1538 pm
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RubyMid-Level Savings Option
Comprehensive In-Hospital benefits. Out-of-Hospital benefits subject to a Savings account and Block Benefit
From R 3180 pm
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| Emerald Value
High Level Care-coordinated Network Option Comprehensive In-Hospital benefits within a defined hospital network.Comprehensive Out-of-Hospital benefits subject to GEMS network, FP nomination. Day-to-day Block Benefit
From R 2975 pm
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Emerald
High Level Benefit Option
Comprehensive In-Hospital benefits Comprehensive Out-of-Hospital benefits subject to Day-to-day Block Benefit and Primary Care Extender Benefit.
From R 3554 pm
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Onyx
Top Level Benefit Option
Comprehensive In-Hospital benefits Comprehensive Out-of-Hospital benefits subject to a high value Day-to-day Block Benefit
From R 6162 pm
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gems medical aid options and prices
If you are a dental provider click here for GEMS rates
Basic Dental Terminology: Dental Specialists
Types of Dental Specialists:
- Endodontist – Specializes in Root Canal Therapy
- Oral and Maxillofacial Surgeon – Specializes in surgeries of the mouth, jaw and face
- Orthodontist – Specializes in Braces & Alignment of the teeth & jaw
- Pediatric Dentist – Specializes in Children’s Dentistry
- Periodontist – Specializes in Gums and supporting structures
- Prosthodontist – Specializes in Replacement of teeth
Dental Tariffs SA
Basic Dental Terminology: Dental Procedures
Dental procedures and diagnosis can sometimes be referred to with a clinical terminology that not everyone knows prior to working in the dental office. Here are a few of those dental terms:
- Abscess – Acute or chronic localized inflammation, probably with a collection of pus, associated with tissue destruction and, frequently, swelling; usually secondary to infection.
- Biopsy – Process of removing tissue for histologic evaluation.
- Cavity – Missing tooth structure. A cavity may be due to decay, erosion or abrasion
- Crown (Cap) – An artificial replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure, or is placed on a dental implant.
- Dental Implant – A device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing for dental replacement.
- Endo – Endodontic – Root Canal – Root canal treatment is a procedure to relieve dental pain and save your teeth, typically needed when there is inflammation or infection in the roots of a tooth.The procedure removes the pulp inside the tooth, cleans, disinfects and shapes the root canals, and places a filling to seal the space.
- Extraction – removing a tooth (whole or in parts)
- Fracture – The breaking of a part, especially of a bony structure; breaking of a tooth.
- Gingivitis – Inflammation of gingival tissue without loss of connective tissue.
- HX – Hx refers to ‘history’ as in a patient’s medical history.
- Impacted tooth – An unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely.
- Malocclusion – incorrect position of biting or chewing surfaces of the upper and lower teeth
- Maxilla – the upper jaw
- Mandible – the lower jaw.
- Permanent Tooth Numbers – Dental charts are normally arranged from the viewpoint of a dental practitioner facing a patient. The patient’s right side appears on the left side of the chart, and the patient’s left side appears on the right side of the chart. Therefore, teeth numbers 1 – 16 are on the upper jaw, right to left. Teeth numbers 41 – 48 & 31 -38 are in the lower jaw. Teeth numbers 11 – 18 and 21 -28 upper jaw.
- Primary Tooth Letters – These are the first teeth to erupt into the mouth. The primary dentition is comprised of 20 teeth. Often these teeth are referred to as deciduous teeth or baby teeth. The teeth are usually recognized by a letter of the alphabet beginning with “A” (Maxillary right second molar) and ending with “T” (Mandibular right second molar). Upper jaw 51-55 and 61-65. Lower jaw 81-85 and 71-75.