If you need dentures, your dentist will advise you on the most suitable treatment. He or she will draw up a treatment and cost plan for dentures required for dental treatment. This documents the expected material and laboratory costs as well as the dentist's fee. The treatment and cost plan also serves as an application to your statutory health insurance provider for reimbursement of the costs of dentures.

Subsidy for dentures

Your statutory health insurance company will provide you with fixed subsidy amounts for your dentures. These are called fixed allowances based on the diagnosis, because their amount depends on the diagnosis - for example: "missing tooth". The amount of the subsidy is the same for all insured persons with the same diagnosis. The subsidy from your health insurance company is 60 percent and can increase if you have had regular check-ups and the check-ups are documented in your bonus booklet.

The amount of the subsidy is based on the so-called standard care. Standard care is something like standard or basic treatment.

• The subsidy from the health insurance company can increase to 70 or 75 percent if you have had regular dental check-ups in the last 5 or 10 years before the start of treatment and can prove this with your bonus booklet.
• Depending on the amount of the treatment costs, the co-payment may represent an unreasonable burden for you. People with a low income then have the option of applying to their health insurance provider to have a case of hardship assessed. If the hardship case is approved, the subsidy from the health insurance companies can increase to up to 100 percent of the costs of standard care.

Costs that exceed the statutory fixed reimbursement amount must be borne by you as your own contribution.

Similar and different dentures

If your treatment differs from the standard treatment, this is referred to as similar or dissimilar dentures.

A "similar restoration" is when additional elements are added to the actual standard restoration. These can be additional ceramic veneers, for example. These elements are not included in the fixed allowance. You must therefore pay for the additional services yourself.

The fixed allowance system also includes the term "different treatment". This refers to a deviation from the standard treatment. Here is an example: If you have 5 missing teeth in the upper jaw, the standard treatment includes a partial denture. If you opt for two bridges instead of the partial denture, this is considered a different type of restoration.

Billing is then carried out as follows: Your dentist will invoice you for the dentures based on the scale of fees for dentists (GOZ). Your health insurance company will then pay you the subsidy on application, which is based on the costs of standard care.

Exceptional indications

The statutory health insurance companies will cover the costs of a dental implant and the implant operation for so-called exceptional indications in particularly severe cases. These are severe jaw diseases such as jaw defects caused by accidents or cancerous tumors as well as genetically caused missing teeth. In order to check whether such an exceptional case exists and whether the costs can be covered as part of overall medical treatment, the health insurance company must have an assessment carried out.