Patient finance
Does medical aid cover clear aligners?
Medical aid clear aligner cover in South Africa is more common than most people expect, and many members are surprised to learn their plan can go towards clear aligner treatment. Here is how to check what you are covered for, and how to claim.
Many people do not realise they are covered.
Depending on your scheme, plan and available funds, your medical aid may cover part of your orthodontic or clear aligner treatment. Many members simply do not realise the benefit is there, or that their plan includes a dental or orthodontic allowance they can put towards a straighter, healthier smile.
Members usually draw on one of a few benefit categories. The first is your medical savings account, the flexible funds you can spend as you choose during the year. The second is a day-to-day or above-threshold benefit, which some plans apply once your everyday spending passes a set limit. The third is a dedicated dental or orthodontic sub-limit, a capped amount your plan sets aside specifically for orthodontic work. Which of these applies to you depends entirely on your scheme and plan tier, so it is worth checking all three when you call.
How to check your cover
Ask your provider for the codes
Your Active Aligners provider can give you the procedure codes for your treatment, which you submit to your medical aid for a quote or a claim.
Call your medical aid
Ask whether your plan includes a dental or orthodontic benefit, and how much of it is still available for this year.
Check your savings or day to day funds
Some members use their medical savings account or day to day benefit to cover part of the cost. Confirm what is available before you start.
Good to know
Cover varies from scheme to scheme and plan to plan. Some plans cover a portion, others none, so always confirm directly with your medical aid first. If your plan does not cover treatment, ask your provider about other ways to spread the cost, such as applying for finance.
It helps to be realistic about how much your plan is likely to put in. In practice most members find their medical aid covers a portion rather than the full cost, and the exact amount comes down to your plan tier and how much of your benefit is still available for the year. A higher tier plan with a dedicated orthodontic benefit may cover a meaningful share, while an entry-level or hospital-only plan may cover little or nothing. Because schemes set their own rules and limits, the only way to know your real figure is to confirm it directly, then treat anything your plan does not cover as the balance you plan for.
Common questions about claiming
Which procedure codes do I submit?
Your Active Aligners provider gives you the procedure codes that match your specific treatment. You submit these to your medical aid, either upfront for a quote or afterwards as a claim. Codes differ from one case to the next, so always use the ones your provider supplies rather than a general figure you find online.
Can I claim after treatment has already started?
In most cases yes, though it is best to check with your scheme before you begin. Some schemes prefer to see the codes or a treatment quote before treatment starts, while others let you claim as you go. Confirming the process early means there are no surprises when you submit.
What if my funds run out mid-year?
If your dental or savings funds are used up before your treatment finishes, your plan may not pay the remaining amount until your benefits reset in the new year. Ask your provider about spreading the balance over time, or look at applying for finance so treatment can carry on without a gap.
Ready to start?
Find an Active Aligners provider near you and ask about using your medical aid.