Apply for orthodontic treatment and reimbursement of the co-payment for orthodontic treatment at the statutory health insurance

For the reimbursement of co-payments for orthodontic treatment, proceed as follows:

Standard care for children and adolescents:

• The orthodontist detects a malocclusion in your child from severity 3 and draws up an orthodontic treatment plan. The orthodontic treatment plan includes
  • the planned therapeutic measures,
  • the expected duration of treatment, and
  • the estimated costs.
• The orthodontic practice submits the findings and the treatment plan to your statutory health insurance company or to the health insurance company with which your child is insured.
• Treatment begins when the competent health insurance fund has approved the treatment plan.
• During the treatment, the orthodontic practice settles 80 percent of the contract medical costs (for several children from the 2nd and for each additional child 90 percent) directly with the responsible health insurance company. The practice will send you an invoice per quarter for the remaining 20 percent (or 10 percent if there are several children).
• You pay the invoice amount to the orthodontic practice.
• Keep the invoices of the orthodontic practice as well as the corresponding payment receipts.
• The orthodontic practice will issue a certificate of completion for you after successfully completing the treatment.
• You apply for reimbursement of the co-payment paid to the competent health insurance fund and submit the necessary documents. You can submit the application by post and – with many statutory health insurance companies – in person at the office.
• Your statutory health insurance company will transfer your own contributions.

Exceptional indications in adults:

• Your orthodontist transmits the coordinated oral surgery and orthodontic treatment concept directly to your statutory health insurance company.

• You are a member of a statutory health insurance fund.
• For the reimbursement of the co-payment, your child must have successfully completed the treatment.

• Orthodontic treatment plan
• For the reimbursement of the own contribution, the certificate of completion of the orthodontist or the orthodontist as well as the invoices for your own contribution are also required.
   

• You will not incur any costs for the application to the statutory health insurance company.
• If your child is treated with services that go beyond what is medically necessary, you will have to pay for it yourself. This applies, for example, to tooth-colored brackets, smooth surface sealing or highly elastic wires made of special alloys.

As a rule, you do not have to observe any deadlines.

Processing usually takes about 2 to 5 business days.

For a quick processing and decision, the health insurance company must have the necessary information and, if necessary, necessary documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed to protect patients' rights.

Please note that the stated processing time is an average value of all health insurance companies. It may vary in individual cases. The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or documents are sent by post to you or the health insurance company. Where appropriate, an expert opinion is required. This takes up to 6 weeks in addition.

• Forms available: yes
• Written form required: no
• Informal application possible: no
• Personal appearance required: no
• Online service available: no

• Contradiction
• Complaint

The text was automatically translated based on the German content.

Federal Ministry of Health (BMG)