An overview of all cash benefits in dentistry

The essentials in brief:

With a few exceptions, there is always a possible dental treatment that is 100% financed by the statutory health insurance funds.
The statutory health insurance companies pay for what is medically necessary. Additional offers that are subject to a fee often only include an aesthetic added value and less an additional medical benefit.
Some health insurance benefits must be requested in writing from the health insurance company before treatment begins.

dental care

For adults, the statutory health insurance companies pay two dental check-ups a year and one tartar removal, i.e. the removal of hard and soft plaque. Every two years, health insurance companies cover the costs of early diagnosis of periodontitis.

In children between the ages of 6 and 18, two dental check-ups are paid for, as well as caries prophylactic filling of furrows (fissure sealing) of the two permanent molars in front of the wisdom teeth. Between the third and sixth year of life, the statutory health insurance companies undertake three early dental examinations.

Many health insurance companies also took part in subsidized professional dental cleaning.

dental fillings

The statutory health insurance companies reimburse so-called composite fillings made of tooth-colored plastic in the anterior region and amalgam fillings in the posterior region. Anyone who can detect an amalgam allergy also receives a free plastic filling in the posterior region.

Even if patients opt for a fee-based filling, the statutory health insurance companies still cover the costs of the legal alternative, i.e. the patient only has to pay the difference between the cashier variant free of charge and the fee-based service.

In the event of defects in the fillings, for which the patient is not to blame, the statutory health insurers assume a two-year warranty period. The dentist has to correct the error free of charge or use a completely new filling.

root canals

The scope of services of the health insurance company includes root canal treatment and the removal of root tips (resection) in the anterior and posterior region, provided that the tooth concerned is classified as worth preserving. The cleaning, filling and closing of the root canals are reimbursable services of a root canal treatment.

A prerequisite for successful root canal treatment is that the root canal is measured precisely before the actual treatment. The standard method that is paid for by the cash registers is to determine the length using X-rays.

Treatment of periodontitis

The health insurance companies cover the costs if periodontitis requiring treatment is present. This means that there is a gum pocket depth of 3.5 mm or more. Prerequisite for the assumption of costs is pre-treatment and a written application to the health insurance company. For this purpose, the dentist draws up a treatment and cost plan, which the patient submits to his cash register for examination and approval. As part of the pre-treatment, health insurance companies cover the cost of removing tartar and other irritant factors, unless this service has already been performed by the dentist in the current calendar year. Patients have to pay for the instructions for proper oral care, which is also part of the mandatory pretreatment.

Treatment of misaligned teeth (orthodontics)

In children up to the age of 18, the orthodontist uses five orthodontic indication groups, or KIG for short, to check the severity of the misaligned teeth. From KIG 3, the statutory health insurance companies bear the costs of the treatment. Depending on the need, the concrete scope of services includes either a removable plastic clip with metal brackets or a fixed clip with stainless steel brackets.

The health insurance company also assumes the costs for the so-called retention phase ("stabilization phase"), that is, when it comes to securing the achieved result for the future. In adults, orthodontic treatment is only provided for severe jaw misalignments, which must also be treated with jaw surgery.

In the case of children, parents must initially pay 20% of the cost of the statutory treatment themselves, but will also be reimbursed if the treatment is successfully completed. If two or more children are undergoing orthodontic treatment at the same time, the parents only have to make an advance payment of 10%.

dentures

Different rules apply to dentures than to other dental care.

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