Dental Cover - Online Application

Only one spouse can be covered under the policy and a maximum of four children under the age of 21 years (own, step or legally adopted child including your grandchild if a registered dependent on your medical aid).

Family members may only be covered if you have selected the Family Option. If you would like to change your selection from the Individual Option, please return to start and change your selection.

Principal Insured

Spouse

Child #1

Child #2

Child #3

Child #4

I, {Full names:13} {Surname:14}, {ID Number:17}, hereby acknowledge that:

• The information provided in this application is true and I have not withheld any facts. Misrepresentation of non-disclosure may result in us refusing to pay a claim or voiding this policy.
• I understand and agree to abide to the terms and conditions of this policy. Please click here to read the full terms and conditions.
• I will not be entitled to claim a benefit in respect of a medical condition for which in the 12 months preceding the start date of the policy medical advice, diagnosis, care or treatment was received or would reasonably have been recommended.
• I understand that on the Comprehensive Dental Cover and Core Dental Cover a waiting period of 3 months will apply to the Dentistry Treatment benefit and the Oral Cancer benefit.
• I understand that on Comprehensive Dental Cover a waiting period of 6 months will apply to the Removable Denture benefit and the Implant or Bridge benefit.