Statutory health insurance companies pay for orthodontic treatment for insured persons who have not reached the age of 18 at the start of treatment, if the treatment is medically necessary.
The orthodontist will assess whether the treatment is medically necessary for your child based on so-called orthodontic indication groups (KIG) and their 5 degrees of severity. The statutory health insurance companies will pay for your child's orthodontic treatment from severity level 3, which means, for example, that a jaw or tooth misalignment already significantly impairs your child's biting, mouth closure or joint function, or threatens to do so in the future.
The orthodontist will bill the Kassenzahnärztliche Vereinigung directly for the orthodontic treatment, minus your own contribution. Your co-payment amounts to 20 percent of the SHI-accredited costs. If you have more than one child undergoing orthodontic treatment, your co-payment for the second and each additional child is reduced to 10 percent of the SHI-accredited costs. The prerequisite is that they live in the same household.
Once the treatment has been successfully completed, the statutory health insurance will reimburse your own contribution. To do this, you must submit an application to your health insurance company or your child's health insurance company and submit some documents, such as the final report from the orthodontist or orthodontist and the co-payment invoices with corresponding proof of payment.
Cost absorption for adults
The costs for orthodontic treatment started at the age of 18 can only be covered by the statutory health insurance in very few exceptional cases. These include, for example, severe jaw anomalies where surgical corrections are also necessary. In these cases, your orthodontist will create a coordinated oral surgery and orthodontic treatment concept.