Many children and youth have malpositioned teeth or teeth that should be treated orthodontically. From a defined severity, health insurance companies pay for the entire treatment. If you want more than regular care, you have to pay privately. As a parent, be well informed by your orthodontist.
The essentials in brief:
- Misaligned teeth are divided into five orthodontic groups (KIG).
- Children and adolescents up to the age of 18 are entitled to a free of charge orthodontic treatment – in case of severity (KIG 3-5).
- Orthodontists have a duty to inform parents about the free treatment option for your To inform children.
- Orthodontists may not refuse to pay benefits or make them dependent on private co-payments.
Your child is entitled to cash benefits!
Treatment with braces is fully paid for by many health insurers up to the age of 18. The severity of the deformity is decisive. If there is a medical need, children and adolescents are entitled to free treatment and dentists must also point this out! Orthodontists may not refuse treatment at the till or make them dependent on additional private benefits.
How does the orthodontist measure a tooth misalignment?
Since 2002, tooth positions have been divided into five degrees of severity, the so-called orthodontic indication groups (KIG). How are the individual degrees of severity divided? There are very precise definitions, measurements are made in millimeters.
Severity 1 (KIG 1): describes a slight misalignment of the teeth, e.g. the upper incisors protrude up to three millimeters in front of the lower ones. At best there is an aesthetic problem, not a medical one.
Severity 2 (KIG 2): there is a slight manifestation of a misaligned tooth, e.g. a lack of space in the teeth, where the space requirement is up to three millimeters. Correction may make medical sense, but must be paid for privately.
Severity 3 (KIG 3) includes pronounced misalignments that require treatment for medical reasons, e.g. a double-sided cross bite or a significant tightness of the teeth.
Severity 4 (KIG 4) describes pronounced misaligned teeth. For these malpositions, treatment is urgently required for medical reasons, e.g. in the absence of teeth or an open bite.
Severity 5 (KIG 5): this is a very pronounced malposition of the teeth, e.g. with an extreme bite or overbite of up to nine millimeters.
When does health insurance pay for treatment in children?
The orthodontist measures the deformities in the jaw, such as a constriction, lack of space, breakthrough disorders or a number of teeth. The result, measured in millimeters, can be assigned to the five orthodontic indication groups (KIG). The decisive factor is the deformity with the highest-rated treatment need.
While KIG 1 is usually only an aesthetic problem, the orthodontist at KIG 2 can already advise treatment for medical reasons. With KIG 1 and 2 she sees statutory health insurance however, no cash benefits yet. In both cases, treatment would have to be paid for privately by the parents.
The health insurance fund covers the entire treatment costs only for KIG 3, 4 and 5 and only until the end of the 17th year of life. Treatment is carried out as standard care and includes the standard benefits of the health fund. Extra services have to be paid privately.
Treatment always makes sense?
In many cases, the line between medical necessity and aesthetic reasons is blurred. Dentists are increasingly pointing out that misaligned teeth and jaws endanger oral health and the functionality of the dentition. Scientific knowledge leaves at least doubts about these statements. Braces do not always lead to improved dental health. It has not been proven that malpositions increase the later risk of tooth decay, periodontitis or jaw pain, nor that braces keep teeth longer. Feel free to ask the orthodontist what happens if your child is not being treated.
What own contribution do parents pay?
Parents are required to pay 20% of their own cash during treatment, which will be paid back after the therapy has been successfully completed. If several children are treated at the same time, the patient’s contribution is reduced to 10%.
Paid extras are voluntary services
If orthodontists also offer methods and equipment that have to be paid for, such as tooth-colored brackets, the patient is free to choose. These private additional services, if requested by the patient, should be agreed on separate, understandable forms.
In our info area you can download our free brochure "Orthodontics in children" download.
more on the subject
Orthodontic agreement and other sample forms – on the website of the National Association of Statutory Health Insurance Dentists (KZBV)
Orthodontics: More clarity and more patient protection – on the website of the National Association of Statutory Health Insurance Dentists (KZBV)
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