When is treatment considered to have started, all information

When is treatment considered to have started, all information

When does treatment begin??

Better safe than sorry. Insurance should be taken out if the damage has not yet occurred. If you only sign a policy when your house has already burned down, you cannot count on payments. The insurer only pays for damage that occurred after the contract was concluded. This principle guarantees survival for economically oriented companies. Dental insurance is also not exempt. Only after the insurance cover comes into force can the consumer receive benefits for dental treatment.

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Treatment only begins after the waiting period

Many people start thinking about taking out dental insurance when it’s too late. Teeth and tooth retention apparatus are sometimes seriously damaged at this point. The treatment costs skyrocket. Most insurance companies only pay for treatments that are started after the contract is signed. A distinction is made between the "technical start of insurance" and the "material start of insurance". The technical start of insurance is the date on which the contract enters into force, but the insured person is not yet entitled to the entire range of services. Only after a waiting period stipulated in the tariff does full insurance coverage begin and the company pays for any damage incurred. The waiting time is 0 to 8 months depending on the policy [1].

Unfavorable: Treatment needs in the patient file

Independent experts always warn that treatment is considered to have started when the dentist has identified a need for treatment. This can mean that a treatment and cost plan has been drawn up, or that the dentist has only noted the need for treatment in the patient record. The patient is not always informed of such a note. If the patient submits dental invoices after the insurance cover has been applied, the insurer can use the patient file to check when exactly the damage was found. If damage occurs during the waiting period, it is sufficient to delay the actual start of treatment until the insurance cover starts. If measures are necessary, the findings can be made easily by a dentist during the waiting period.

Special case of missing teeth

Missing teeth are a special case of a need for treatment. A replacement for tooth loss is not covered by private dental insurance. Closing a gap, a missing milk tooth or wisdom tooth, however, are not considered "missing teeth". Those who want to take out dental insurance usually fill out a health questionnaire. This also asks about previous, untreated tooth loss. If there are gaps in the teeth, the insurer has the option of rejecting the patient as a customer. In some tariffs, the missing teeth can also be insured against a risk surcharge. Other tariffs work with extended waiting times for a material start of insurance [2]. An example: A 25-year-old man comes to his dentist for an annual check-up. This detects serious damage from caries. One molar has to be crowned and two fillings in the visible area are due. The young man is a student and is frightened by the costs that will arise. If he tries to get additional dental insurance, it will hardly be possible for him to find a good tariff with acceptable conditions. Some insurance companies reject him as a customer, while others completely exclude the cost of the treatment. Ergo Direkt Versicherung offers the ZAHN-ERSATZ-SOFORT (ZEZ) tariff for customers like him who are only looking for additional insurance when it is too late. This tariff does not provide for a waiting period until full insurance coverage is in place. The costs for the treatment of damage, the need for treatment of which was determined up to 6 months before the start of the insurance, will be borne. However, insurance experts are warning of this Ergo Direkt offer. The resulting costs are offset with increases in premiums over the years and the insurance only pays for a small proportion of the treatment costs. [3] [4] Another case would have been if the student had delayed his visit to the dentist until after the start of the contract. He has to wait until the treatment is completed. However, the insurance will pay for the damage ascertained after the contract has been signed. [3]


This example shows: Dental insurance should best be taken out before serious health problems arise. Patients who can demonstrate good health are preferred by the insurance companies as customers. They also get significantly better benefits with lower premiums. Anyone who suspects damage due to discoloration or toothache should try to find a policy before visiting the dentist. After that, it might be too late.

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Christina Cherry
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