Zahnärztliche Behandlung für Krankenversicherte Finanzierung

People with statutory health insurance are entitled to dental and orthodontic treatment.

Dental treatment consists of

• diagnostic measures,
• conservative, surgical and orthodontic treatment,
• systematic treatment of periodontal diseases (diseases of the periodontium)
• other treatment measures
• prescription of medicines.

For dental prostheses, the health insurance company covers 60 percent of the costs, which are determined for the so-called standard care according to a certain finding.

• When visiting the doctor: electronic health card.
• For dental prostheses: treatment and cost plan from the treating dentist.

Benefits that exceed adequate, appropriate and economical care must be paid by the insured person.

A hardship provision for dental prostheses applies to low-income recipients. Reimbursement of up to 100 percent of the costs is possible.

• Entitled are
  • People with low income
  • Recipients of BAföG, social assistance, Hartz IV, war victims' welfare and basic security in old age.
  • Residents of homes whose accommodation is paid for by social welfare or war victims' welfare.

The health insurance fund must decide on applications for dental prostheses within a period of 3 weeks (up to 6 weeks in the case of expert involvement) from receipt of the application.

You can appeal against the decision of the health insurance fund. If the appeal is not upheld, you can file a lawsuit with the competent social court.

Dental treatment consists of

• diagnostic measures
• conservative, surgical, orthodontic treatment
• systematic treatment of periodontal diseases (diseases of the periodontium)
• dentures (fixed allowance)
• other treatment measures
• and the prescription of medicines.

The responsibility lies with the respective health insurance company.