Administrative services A-Z

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 holes.

Additional cost regulation for dental fillings

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

Allowance for dentures

For dental prostheses (e.g. crowns or bridges), your health insurance fund will provide you with precisely defined amounts as fixed allowances. The amount of the fixed subsidy is 60 percent of the average costs for standard care and can increase to 70 or 75 percent if you have had regular checkups in the last 5 or 10 years before treatment begins and the checkups are documented in your bonus booklet.

Costs that exceed the legally regulated reimbursement amount must be borne by you. Your health insurance company may cover a further amount of the costs if you have only a low income or receive certain social benefits (for example, BAföG, social assistance or unemployment benefit II).

If you have private supplementary dental insurance, you may - depending on the contract - be able to submit additional cost invoices, co-payment invoices and private invoices there. In any case, it is recommended that you inform your private supplementary insurance company before treatment begins and clarify what must be taken into account for any possible reimbursement or which 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 when treatment begins. Adults usually have to pay for orthodontic treatment themselves. Only in medically justified exceptional cases, for example in the case of severe jaw anomalies where surgical corrections are also necessary, 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 surgery yourself. Only in severe and special exceptions does the health insurance fund contribute to implants, for example as part of an overall medical treatment after a tumor operation.

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

Depending on the dental or orthodontic service you are receiving, your health insurance company may require the following documents in certain cases before treatment can begin:

• Treatment and cost plan
• Invoice from the dentist, if applicable, including laboratory invoices
• If applicable, a copy of your bonus booklet
• in particularly severe cases (exceptional indications):
  • Cost estimate
• for adult orthodontic treatment:
  • maxillofacial and orthodontic treatment concept

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

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

For exceptional indications:

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

• In the case of implantological or orthodontic services for exceptional indications, your dentist will prepare a cost estimate.
• Your dentist sends the cost estimate directly to your statutory health insurance fund.
• Your statutory health insurance fund reviews the application and informs you of approval or rejection.

Additional costs, private billing, co-payment:

• 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 rejection letter from the statutory health insurance fund, submit the invoice to your statutory health insurance fund.
• Your statutory health insurance fund will review the application and send you a rejection notice.
• You submit the rejection to your private supplementary dental insurance.
• Depending on the contract, your private supplementary dental insurance will reimburse you for the agreed share of the total bill.

You do not have to observe any deadlines.

The responsibility lies with the respective health insurance company.

• § Section 28 (2) of the Fifth Book of the Social Code (SGB V)
• § Section 8 of the Second Act on Health Insurance for Farmers (KVLG 1989)

• Information on dental treatment for people with statutory health insurance on the website of the Federal Ministry of Health
• For further information and, if necessary, forms for submitting the costs of implants or orthodontic treatment for adults via the health insurance navigator of the GKV-Spitzenverband

Federal Ministry of Health (BMG)