Cookies facilitate the provision of our services. By using our services, you agree to our use of necessary cookies. You can refuse the use of optional cookies or only allow certain cookies. You can find further information in our privacy policy.

responsibility finder
Schleswig-Holstein

We only need 2 pieces of information from you.

Where?

Specify your location to receive regionalized information.

What?

You searched in services/administrative services.

Selected service: Submit costs for implants or orthodontic treatment for adults to the statutory health insurance fund in cases of special exceptions
Information about "Submit costs for implants or orthodontic treatment for adults to the statutory health insurance fund in cases of special exceptions" was found.

Enter words here that describe what you are looking for (e.B. cut a tree) or a matter for citizens and companies (e.B. house construction, marriage).
Enter here names or the name of a body, office or authority you are looking for (e.B. Tax Office Kiel, Police Lübeck).

Submit costs for implants or orthodontic treatment for adults to the statutory health insurance fund in cases of special exceptions

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)

Service Description

In special or severe exceptional cases, the statutory health insurance fund will contribute to orthodontic treatment for adults or implants.

If you have statutory health insurance, many services provided by your dentist are free of charge for you and are billed via your electronic health card (eGK): This applies, for example, to the removal of caries and the filling of cavities.

Additional cost regulation for dental fillings

You are entitled to fillings made from the cheapest material. In addition to this standard treatment, you can also choose other materials. In these cases, you only have to pay the additional costs incurred privately.
If you opt for a more expensive material for which you bear part of the costs yourself, you conclude a so-called additional cost agreement with your dentist. Your dentist will bill your health insurance company for the services to which you are entitled according to the standard treatment. You will receive an invoice from your dentist for any additional services.

Subsidy for dentures

For the provision of dentures (e.g. crowns or bridges), you will receive precisely defined amounts as fixed subsidies from your health insurance company. The amount of the fixed subsidy is 60 percent of the average costs for standard care and can rise to 70 or 75 percent if you have had regular check-ups in the last 5 or 10 years before the start of treatment and the check-ups are documented in your bonus booklet.

You must bear any costs that exceed the statutory reimbursement amount yourself. Your health insurance company may cover a further amount of the costs if you only have a low income or receive certain social benefits (e.g. BAföG, social assistance or unemployment benefit II).

If you have private supplementary dental insurance, you may - depending on your policy - be able to submit additional cost invoices, co-payment invoices and private invoices. In any case, it is advisable to inform your private supplementary insurance company before starting treatment and clarify what needs to be taken into account for any reimbursement that may be considered or what documents are required for this.

Orthodontics

You or your child are entitled to orthodontic treatment if there is a medically justified indication and you or your child have not yet reached the age of 18 at the start of treatment. Adults generally have to pay for orthodontic treatment themselves. Only in exceptional medical cases, for example in the case of severe jaw anomalies that also require surgical correction, can insured persons over the age of 18 also be entitled to benefits.

Dental implants

You must also bear the costs of a dental implant and the implant operation yourself. Only in serious and special exceptions does the health insurance company contribute to implants, for example as part of overall medical treatment following tumor surgery.


Process flow

For exceptional indications:

You can submit the treatment and cost plan together with the treatment and cost plan for the prosthetic treatment by post or - in the case of many statutory health insurance companies - in person at the office.

  • In the case of implantology or orthodontic services for exceptional indications, your dentist will prepare a cost estimate.
  • Your dentist will send the cost estimate directly to your statutory health insurance fund.
  • Your statutory health insurance company will check the application and inform you whether it has been approved or rejected.

Additional costs, private billing, own contribution:

  • You will receive an invoice from your dentist and pay the invoice amount.
  • If you have private supplementary insurance, you can ask them whether the costs you have incurred will be reimbursed and which documents are required for this.
  • If your private supplementary insurance requires a letter of rejection from your statutory health insurance fund, submit the invoice to your statutory health insurance fund.
  • Your statutory health insurance company will check the application and send you a rejection notice.
  • You submit the rejection to your private supplementary dental insurance company.
  • Depending on the contract, your private supplementary dental insurance will reimburse you the agreed proportion of the total bill.
Requirements
  • You are a member of a statutory health insurance fund.
  • The treatment and cost plan was approved by your statutory health insurance provider before the start of treatment.
  • The treatment and cost plan or the oral surgery and orthodontic treatment concept has been approved by your statutory health insurance provider.
Which documents are required?

Depending on which dental or orthodontic service you are claiming, your health insurance company may require the following documents before treatment begins:

  • Treatment and cost plan
  • invoice from the dentist including laboratory invoices, if applicable
  • Bonus booklet, if applicable (copy)
  • for particularly serious cases (exceptional indications):
    • Cost estimate
  • for adult orthodontic treatment:
    • oral surgery and orthodontic treatment concept

Please contact your health insurance company to clarify which documents are required.

What are the fees?
  • You will not incur any costs for the application to your statutory health insurance fund.
  • You will have to bear any additional costs yourself.
What deadlines do I have to pay attention to?

You do not have to observe any deadlines.

Processing duration

Processing normally takes 2 to 7 working days.

Your health insurance company must have the necessary information and any required documents in a complete and meaningful form in order to process and decide quickly.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
An expert opinion may have to be obtained. This may take up to 6 weeks.

Legal basis
Appeal
  • Objection
  • Action before the social court
Author

National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)


Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

Teaser

In special or severe exceptional cases, the statutory health insurance fund will contribute to orthodontic treatment for adults or implants.

Process flow

For exceptional indications:

You can submit the treatment and cost plan together with the treatment and cost plan for the prosthetic treatment by post or - in the case of many statutory health insurance companies - in person at the office.

  • In the case of implantology or orthodontic services for exceptional indications, your dentist will prepare a cost estimate.
  • Your dentist will send the cost estimate directly to your statutory health insurance fund.
  • Your statutory health insurance company will check the application and inform you whether it has been approved or rejected.

Additional costs, private billing, own contribution:

  • You will receive an invoice from your dentist and pay the invoice amount.
  • If you have private supplementary insurance, you can ask them whether the costs you have incurred will be reimbursed and which documents are required for this.
  • If your private supplementary insurance requires a letter of rejection from your statutory health insurance fund, submit the invoice to your statutory health insurance fund.
  • Your statutory health insurance company will check the application and send you a rejection notice.
  • You submit the rejection to your private supplementary dental insurance company.
  • Depending on the contract, your private supplementary dental insurance will reimburse you the agreed proportion of the total bill.

Requirements

  • You are a member of a statutory health insurance fund.
  • The treatment and cost plan was approved by your statutory health insurance provider before the start of treatment.
  • The treatment and cost plan or the oral surgery and orthodontic treatment concept has been approved by your statutory health insurance provider.

Which documents are required?

Depending on which dental or orthodontic service you are claiming, your health insurance company may require the following documents before treatment begins:

  • Treatment and cost plan
  • invoice from the dentist including laboratory invoices, if applicable
  • Bonus booklet, if applicable (copy)
  • for particularly serious cases (exceptional indications):
    • Cost estimate
  • for adult orthodontic treatment:
    • oral surgery and orthodontic treatment concept

Please contact your health insurance company to clarify which documents are required.

What are the fees?

  • You will not incur any costs for the application to your statutory health insurance fund.
  • You will have to bear any additional costs yourself.

What deadlines do I have to pay attention to?

You do not have to observe any deadlines.

Processing duration

Processing normally takes 2 to 7 working days.

Your health insurance company must have the necessary information and any required documents in a complete and meaningful form in order to process and decide quickly.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
An expert opinion may have to be obtained. This may take up to 6 weeks.

Legal basis

Appeal

  • Objection
  • Action before the social court

Author

National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)


Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

Further information and offers