Jaw and tooth misalignments have been divided into five different degrees of severity since 2002, the “orthodontic indication groups” (KIG). The health insurers are obliged to bear the costs for the severity grades KIG 3, 4 and 5. However, this only applies to children and adolescents, whereby the parents must pay their own contribution of 20 percent. Parents make an advance payment for the 20 percent co-payment. At the end of the treatment, this portion will be reimbursed by the health insurances on presentation of a proper invoice. Cosmetic corrections and comfort services are therefore not included in the services of the health insurers. For each further sibling treated at the same time, the co-payment is 10 percent.
The health insurance treatment may not be made dependent on or withheld from additional services that the parents agree with the practitioner. The assumption of costs by the health insurance company only includes standard benefits or the standard benefits of the health insurance company. Metal brackets, for example, have to take care of the cash register, whereas the optically more attractive and inconspicuous ceramic brackets or highly elastic arches do not, as this is a purely cosmetic additional service. The health insurance companies expressly only assume medically necessary services.
The boundaries between medically necessary and aesthetically recommendable orthodontic treatments can, however, be fluid in individual cases. For example, it must be discussed in the individual case whether fixed or removable braces are used or recommended. This is not a binding rule. In addition, with loose braces, factors must also be taken into account, such as the fact that such a utensil can easily be misplaced or lost, so that the costs can ultimately add up again. The health insurers are also obliged to take over a stabilization phase with so-called retainers for two years after successful treatment so that the teeth can be permanently held in the new position.
The takeover of professional tooth cleaning are regulated differently. Here you should inquire with your health insurance company whether it will cover the costs, as there is a clear medical benefit in terms of caries and periodontitis prophylaxis. However, the health insurance companies react differently in this regard.
The above regulations do not apply to adults over the age of 18. Here, the health insurers only pay for severe jaw anomalies and severe misalignments of the teeth, which are “of a magnitude that requires combined oral surgery and orthodontic treatment measures”. Orthodontic treatments in our practice for orthodontics in Berlin Mitte in adulthood are therefore almost always carried out by the patients themselves.
But how are children and adolescents classified in the KIG? After an in-depth examination, the dentist or orthodontist is obliged to document all malpositions in the jaw, measuring in millimeters. If the misalignments are classified under KIG 3, 4 or 5, then the health insurance company can apply for the costs to be covered. An orthodontic treatment plan must be drawn up, which must be approved by the health insurance fund before treatment begins.
It is highly recommended that you keep all treatment documents and invoices carefully, as these must be submitted to the health insurance company. You can also apply to the health insurance company for the corresponding repayment forms for the co-payment and the issuance of a certificate of completion . We will be happy to issue these to you in our orthodontic practice in Berlin Mitte and will also provide you with all the other necessary documents . You will also receive a proper list of all additional services from us.