No matter what age: healthy teeth and gums make a decisive contribution to the quality of life. And not just because well-groomed teeth give an attractive smile – but for another reason as well: the health of your gums and teeth has a significant impact on your whole body. We support you in matters of dental health – with our dental services.
A wide range of services
Depending on the specific condition of your teeth, your dentist uses various dental measures. These include, among other things, preventive examinations, caries treatment, pulling diseased teeth, root canal treatment, periodontal treatment, surgical interventions, treatment of oral and maxillofacial diseases and much more. Your dentist can also carry out orthodontic or implantological treatments if you have certain indications. Basically, these dental services are covered by our basic insurance.
By "dental services" or "dental fee" is meant the treatment itself – for example, examining your teeth, preparing your teeth for a crown and inserting the crown. Added to this are dentures and implants Materials and dental laboratory services – For example, the manufacture of the crown in the laboratory and the cost of the materials required for this. These material and laboratory costs are only partially reimbursable. You can reduce your deductibles with our additional insurance.
Interesting facts for all member groups
No matter which treatment or intervention you are planning: here you can get to know the different services of your dentist in detail.
General dental services
For example, fillings, root canal or periodontal treatment: You do not need to have a dental treatment approved by us in advance. If you are planning a more complex measure or your dentist would like to make dentures or implants for you, we recommend that you submit a medical and cost plan in advance. Your expenses for this are reimbursable. In most cases we can then calculate our estimated reimbursement amount.
We will calculate our exact assumption of costs as soon as we receive your invoice. For general dental services, there are no deductibles or additional payments.
Loose brackets, fixed braces, treatment of misaligned jaws and teeth – no matter what orthodontic service you are planning: before the start of treatment we need a treatment and cost plan. Orthodontic services must therefore be approved by us in advance, as we can only reimburse them for certain indications.
Functional analytical and functional therapeutic services
Your dentist would like to carry out a so-called functional analysis examination? This exam will provide your doctor and dental technician with additional information on how your denture needs to be adjusted to fit properly.
In order for us to recognize functional analytical and functional therapeutic services, you must have at least one of the following indications and be certified by a dentist:
- TMJ and jaw muscle diseases
- Gum disease as part of a systematic periodontal treatment
- Treatments with bite aid with adjuvant surfaces
- extensive orthodontic measures including orthodontic-surgical operations
- Extensive denture restoration: restoration of at least eight posterior teeth in a jaw with dentures, crowns or inlays
General anesthesia as part of dental services
We only cover your costs for general anesthesia in exceptional cases. The same applies to other types of anesthesia such as nitrous oxide sedation or so-called analgesia sedation.
Exceptions are for example:
- a serious mental or physical disability
- a medically confirmed intolerance to local anesthetics
- a medically confirmed serious general illness, so that anesthesia and circulatory monitoring are required during dental treatment
- a pathological phobia confirmed by a specialist before dental treatment
We recommend that you submit your medical and cost plan as well as a dental opinion to us before a planned anesthetic. So we can check whether we can cover the costs.
Digital volume tomography
In principle, digital volume tomography – or DVT for short – is a 3D X-ray image. The DVT has an additional medical benefit when it comes to particularly complicated issues. We will reimburse your costs for a DVT, for example in connection with a sinus lift operation in the upper jaw, in the case of jaw surgery after an accident or in the context of jaw adjustment surgery. We also take on your expenses for orthodontic treatments of tooth anomalies.
Basically, we reimburse dental services for two implants per jaw. If your upper or lower jaw is toothless, we will reimburse you for a maximum of four implants per jaw. If you already have implants for which you have received aid or comparable benefits from public funds, we must include them.
There is no limit to the following clinical pictures – this means that we will cover your dental costs for all necessary implants:
- Major jaw or facial defects, which among other things have the following causes: tumor surgery, inflammation of the jaw, surgery due to large cysts or osteopathies, congenital malformations of the jaw, malformation of the teeth or accidents
- permanent dry mouth
- generalized genetic non-investment of teeth
- Muscular malfunctions in the mouth and face area that cannot be influenced willingly, such as spasticity
Please note that we only cover 40 percent of your material and laboratory costs for implants with our basic insurance. If you have not taken out additional insurance, you will be subject to deductibles.
Our reimbursement services for all member groups
Regardless of which member group you belong to, the basis for our reimbursement is the fee schedule for dentists (GOZ). A distinction is made between dental fees, material and laboratory costs and medical-technical services.
- The dental fee We will reimburse you up to 2.3 times the GOZ rate. In particularly difficult cases, we recognize dental fees up to 3.5 times the rate of increase. For this we need a medical reason: Your doctor has to explain this reason on a case-by-case basis, specifically tailored to your person and formulate it in detail. We do not accept blanket reasons.
- You can also Material and laboratory costs arise. In the case of fillings, dentures and implants, we generally reimburse you for expenses as well as material and laboratory costs by 40 percent. Therefore, you have to pay 60 percent of these costs as a deductible.
- With certain medical-technical services Like X-rays, we reimburse up to 1.8 or 2.3 times the rate for the fee schedule for doctors (GOÄ). In justified exceptions, up to 2.5 times or 3.5 times the increase factor.
Tip: save costs with our additional insurance
Complete the supplementary level with up to 2 steps and the ISH level. In this way you can reduce or even avoid your deductibles for fees, material and laboratory costs and implants for dentures.
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