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Apply for orthodontic treatment and reimbursement of the own contribution for orthodontic treatment at the statutory health insurance

Statutory health insurance companies pay for orthodontic treatment for insured persons who have not reached the age of 18 at the beginning of treatment if the treatment is medically necessary.

Whether the treatment is medically necessary for your child is assessed by the orthodontist on the basis of so-called orthodontic indication groups (KIG) and their 5 degrees of severity. The statutory health insurance companies pay the costs for your child from grade 3. This means, for example, that a jaw or tooth misalignment already significantly impairs the biting, the mouth closure or the joint function in your child or threatens to affect it in the future.

The orthodontist settles the orthodontic treatment minus your own contribution directly with the Association of Statutory Health Insurance Dentists. Your own contribution amounts to 20 percent of the contractual medical costs. If you have more than one child in orthodontic treatment, your own contribution for the second and each additional child is reduced to 10 percent of the contractual medical costs. The prerequisite is that they live in a common household.

If the treatment has been successfully completed, the statutory health insurance company will pay you back 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, for example the final report of the orthodontist as well as the own contribution invoices with corresponding proof of payment.

Reimbursement for adults

The costs for orthodontic treatment, which is started from the age of 18, can only be covered by the statutory health insurance in very few exceptional cases. These include, for example, severe jaw abnormalities, in which surgical corrections are also necessary. In these cases, your orthodontist will create a coordinated orthodontic and orthodontic treatment concept.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)

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