Statutory health insurance for orthodontics
The cost coverage of the statutory health insurance (GKV) for orthodontic treatment measures depends on the classification of the patient in a so-called orthodontic indication group (KIG). Basically, it must be differentiated whether the patient in question belongs to the group of children and adolescents (up to the age of 18) or whether it is an adult. The following explains exactly how it is with the benefits of the statutory health insurance.
What happens if you are classified in KIG 1 or 2
In the case of children and adolescents, the statutory health insurance covers the treatment costs if the findings show a severity of at least KIG3. In adults, the whole thing looks a little different. Here, costs for services are only covered if there are severe malformations of the jaw that require orthodontic and orthodontic measures. These include in particular tooth position anomalies and anomalies of the bite position.
In the following, KIG 1 and 2 are defined in order to provide an opportunity for orientation:
- KIG 1: Classification into KIG 1 takes place when a slight tooth misalignment is diagnosed. Although this can be treated, it must be done without the existence of adequate private dental supplement insurance, which includes the component of orthodontic treatment measures at KIG1. It is always important to ensure that only a few dental insurance policies cover this component for adults.
- KIG2: If it is classified in the KIG2, it is a misaligned tooth, which, from a medical point of view, requires the anomaly to be corrected. Since the costs of tooth and jaw misalignments of this severity are also not covered by the statutory health insurance, any costs for treatment measures must be borne if a supplementary dental insurance has not been taken out in good time beforehand.
The special features of the KIG 3 to 5
Even if the costs of the treatment are borne by the SHI in diagnosed KIG 3 to 5 (they are considered to be in need of treatment in the sense of the SHI service catalog), patients cannot assume that the resulting bills will be paid immediately. Rather, the reimbursement of costs takes place through a two-stage system. An initial personal contribution of 10 – 20%, which depends on the number of children in a household to be treated at the same time, should motivate parents to adhere to and check the measures recommended by the doctor. Only if the treatment has been successfully completed will the self-paid portion be reimbursed by the SHI.
But when exactly are jaw indication groups 3-5 diagnosed? The following are the definitions for these three KIG:
- KIG 3: In order for the KIG 3 to be diagnosed, there must be a pronounced tooth and / or jaw misalignment, which requires medical treatment.
- KIG 4: If the orthodontist treating the patient detects a pronounced tooth and / or jaw misalignment that makes treatment measures urgently necessary from a medical perspective, the patient is classified in KIG 4.
- KIG 5: The classification of the patient in the KIG 5 is an extremely pronounced tooth and / or jaw misalignment, which from a medical point of view absolutely requires a treatment measure.
Then why a dental supplement insurance – if there is a classification in the KIG 3-5
In principle, the SHI covers the costs for all medically necessary services that are provided as part of the contractual dental care. This sentence already suggests why it can lead to financial contributions that are not covered by the SHI. These are listed and explained in more detail below:
- Additional orthodontic services: Additional services are often offered and carried out by the orthodontist, which increase wearing and cleaning comfort, but are purely cosmetic in terms of SHI and are therefore not reimbursable expenses.
- Private dental billing of some orthodontists: The basic prerequisite for reimbursement by the SHI is the statutory dentist’s statement. Here, patients have to make sure that the selected orthodontist not only accounts for the services provided, but also has a health insurance license.
Not every dental insurance covers orthodontics
With the dental supplementary insurance product, too, it is like with other private forms of insurance, the benefits covered are very different. Only a few additional dental insurance policies also cover orthodontic services. Especially when it comes to adult orthodontics, there are very few offers on the market. A detailed comparison is therefore recommended. You can therefore compare over 200 different tariffs on our website. The rating system designed by us gives points for the individual features. Among other things, you can easily see how a particular dental insurance in the field of orthodontics performs.
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