Submit costs for implants or orthodontic treatment for adults to the statutory health insurance in cases of special exceptions Unfortunately this specification of service has not yet been completely translated.
In special or severe exceptional cases, the statutory health insurance contributes to orthodontic treatment of 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 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 allowance 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.
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.
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 following tumor surgery.
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
in case of orthodontic adult treatment:
- orthodontic and maxillofacial treatment plan
Please contact your health insurance company to clarify which documents are required.
- Forms: yes
- Online procedure possible: Many statutory health insurers offer an online procedure.
- Written form required: yes
- Personal appearance required: no
Zum Einreichen der Kosten von Implantaten oder kieferorthopädische Behandlungen bei Erwachsenen über den Kassen-Navigator des GKV-Spitzenverbands
- 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.
§ 28 Absatz 2 Fünftes Buch Sozialgesetzbuch (SGB V)
§ 8 Zweites Gesetz über die Krankenversicherung der Landwirte (KVLG 1989)
Informationen zur zahnärztlichen Behandlung als gesetzlich Versicherte auf der Internetseite des Bundesgesundheitsministeriums
For exceptional indications:
You can submit the treatment and cost planning together with the treatment and cost plan for prosthetic treatment by mail and - for many statutory health insurance companies - in person at the office or online.
- 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.
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Federal Ministry of Health
Last update or date of publication