Patients insured with a national health insurance company under 18 years of age

Since 2001, the services offered by the national health insurance companies have been significantly cut. The German Index of Orthodontic Treatment Need (KIG) categorise malocclusions depending on the severity into 5 grades.

For "mild" malocclusions which fall under KIG grades 1 and 2, the treatment is not covered by health insurance. This does not mean that treatment is not needed in this case. In any case you should have a consultation appointment about the advantages and disadvantages of treatment.

For KIG grades 3 to 5, the national insurance company covers 80% of the cost of treatment which are part of the general dental services agreements in Germany. The remaining 20% of the treatment costs are initially borne by the patients themselves. However, these are refunded by the health insurance company after documentation regarding successful completion of treatment is provided.

Upon successful completion of the treatment and compliance with the stabilisation phase, a final certificate is issued. The previously paid co-payment is then refunded by the health insurance company.

Certain services, such as ceramic brackets, special materials, TMJ analyses and hygienic measures, for example are not covered by the national health insurance companies.

Invoices are sent every three months and include the 20% co-payment. The amount depends on the services provided since the last invoice.

Nationally insured patients over 18 years

Orthodontic treatment is only covered by health insurance, if a combined orthodontic-oral surgeon treatment pursuant to German Social Law SGB V, §28, Abs. 2 is necessary.

The health insurance company covers 80% of the cost of treatment which is part of the general dental services agreements. The remaining 20% of the treatment costs are initially borne by the patients themselves. However, these are refunded by the health insurance company after documentation on successful completion of treatment is provided.

Upon successful completion of the treatment and compliance with the stabilisation phase, a final certificate is issued. The previously paid co-payment is then refunded by the health insurance company. This means, however, that an appliance must be worn at night for a specified period.

Certain services, such as ceramic brackets, special materials, TMJ analyses and hygienic measures, for example, are not covered by the national health insurance companies. Invoices are sent every three months and include the 20% co-payment. The amount depends on the services provided since the last invoice.

Privately insured patients

Entitlement for privately insured patients depends on the respective insurance contract. The entire cost of treatment is generally covered. Individual treatment alternatives will be offered and agreed with the patient and his/her parent(s) for any necessary treatment measures which exceed normal treatment. All treatment costs are invoiced according to the statutory German dental fee bands (GOZ=Gebührenordnung für Zahnärzte).

Eligibility for help with costs

Patients who are eligible for help with costs often ask which costs are covered by your responsible centre. There is unfortunately no clear answer to this question. This often leads to discussions and considerable administrative effort. In the orthodontic field, the scope of services covered has approached that of the national health insurance, with only minor differences still in existence. The fees are based on the German dental fee bands (GOZ=Gebührenordnung für Zahnärzte) However "billable" does not always mean "eligible".

Please speak with us about this issue in the practice, and we will be more than happy to explain it to you.

Financing and paying by instalments

We work with the ABZeg billing firm. This allows you to flexibly and efficiently pay your treatment costs in instalments. Just ask us about the patient information leaflet on paying by instalments.

The ABZeg also assists you in making legitimate claims against your insurance company or other paying authorities.

What if the insurance company does not cover the treatment costs?

In this case, the treatment costs must be borne by the patient. The costs depend on the grade of difficulty and the appliances used for treatment. The exact amount can only be estimated after a personal examination. A payment plan is also possible upon request.

Can I take out supplementary private insurance?

Supplementary private insurance is possible in any case. However, you should pay attention to the individual insurance conditions, because often there is a limit to the cost of orthodontic treatment covered. In addition, the need for orthodontic treatment should not have been previously determined before signing the insurance contract. After taking out the insurance, a certain amount of time must elapse before beginning the treatment. This period varies depending on the insurance.

The cost of supplementary private insurance is graded according to the age of the children. A good overview, for example, can be found at www.hanswaizmann.de.