Using additional dental insurance: a guide for policyholders
You have purchased additional dental insurance — what to do next? In this article, we will examine how to use your additional dental insurance policy, pay for it, and receive the necessary high-quality medical care.
We will look at the key points and provide step-by-step instructions on how to use Zahnzusatzversicherung.
Do you already have supplementary dental insurance?
Step 1
I have recently entered into a Zahnzusatzversicherung agreement. What should I do next?
The agreement enters into legal force after the deduction of the first payment under the contract. It is recommended to install the insurance company's mobile application (if they have one) or set up a Personal Account on your insurance company's website. After registration, some companies send a password for access by regular post.
Step 2
What do I need to show the doctor during my visit? Do I need to report having additional dental insurance?
You are under no obligation to disclose whether you have private medical insurance. Moreover, if you do not trust the doctor, we do not recommend to report this information. There are cases where, knowing about the existence of extra dental insurance, dishonest dentists might «treat» healthy teeth.
Step 3
How can I get a filling made from modern, high-quality material?
It is recommended to inform your dentist about your wish to have a high-quality filling; they will offer a «free» option under the statutory health insurance (GKV) and high-quality options for an additional fee, which will be covered by supplementary dental insurance. Choose a high-quality material!
Step 4
After the appointment you will receive an invoice (Rechnung),
Sometimes it is sent by post, with varying payment terms. You pay the bill yourself and send a photo of the bill to the insurance company (via the app or your personal account). The insurance company reimburses your medical expenses to your account.
If the payment term is, for example, 30 days, the reimbursement from the insurance company usually arrives faster than the payment is due to the doctor. For cleanings and fillings, the money usually arrives within a week, and for something more serious — 2-3 weeks.
Step 5
Should the treatment plan be sent to the insurance company?
If it is a matter of expensive treatment (usually over 1000 euros), it is strongly recommended to send the treatment plan to the insurance company for its approval.
Step 6
Do I need to send the treatment plan to my statutory health insurance company?
Yes, absolutely, as some supplemental dental insurance policies have a penalty for refusing to pay the part of the bill not covered by the state insurance.
Please check, as the doctor may have already sent your treatment plan to the state health insurance.
Everything about insurance payment
- How does the payment process work? In most cases, it was necessary to sign a SEPA mandate, which involves automatic debiting from your account. Sometimes, payment by PayPal or on invoice (Rechnung) is permitted.
- Will the tariff price change? Most often, the cost changes every 10 years – at ages 21, 31, 41, 51, and 61. Sometimes the increase occurs every 5 years.
- If the insurance company unexpectedly raises the price, what can I do? You have the right to terminate the contract under a special procedure - Sonderkündigung, within 30 days of the price increase.
- Is there a family dental plan available? No, a separate tariff is concluded and paid for each person.
Frequently asked questions
From what point can I go to the doctor?
There are no waiting periods in our offers, you can go for an appointment immediately after taking out the insurance.
What does «tariff 80% or 90%» mean?
These rates usually apply only to prosthetics. This means that statutory health insurance (GKV), together with supplementary health insurance, will cover 80% or 90% of the invoice amount. Your contribution will be 20% or 10% respectively.
What does «tariff 100%» mean?
This means that the insurance company covers 100% of the costs — for doctors’ services: up to 3.5 times the fee rate; for laboratory services: up to 1.3 times the fee rate; and for medical-technical services: up to 2.5 times the fee rate.
What is the GOZ coefficient/factor?
Dental services are charged in accordance with the chosen tariff and the current standards for charging for medical services in Germany, as set out in the schedule of fees for dentists (GOZ) and/or physicians (GOÄ). The multiplier for calculating the cost of services is increased from 1 upwards in cases of complex treatment, high qualification of the doctor, the use of special equipment, etc.
Usually, insurance companies cover medical services up to 3.5 times the basic tariff, laboratory services up to 1.3 times, and medical-technical services up to 2.5 times the tariff.
Calculation example:
You have undergone a procedure with a base cost of 280 euros. However, due to the difficulty of access, increased bleeding and complications, the doctor applied a multiplier of 4.2. The total cost of the procedure will be €280 × 4.2 = €1,176. If your policy provides cover under code 100% and pays up to a multiplier of 3.5, the insurance company will cover an amount of 280 euros * 3.5 = 980 euros.
How can a contract be terminated?
Any insurance policy can be cancelled without giving a reason within 14 days of conclusion. You need to write a Widerruf. Next, cancellation (Kündigung) can be carried out in accordance with the terms of the contract. Usually, the minimum contract term is 1-2 years. If the contract is not cancelled, renewal happens automatically.
If I am leaving Germany?
Definitely Notify the insurance company of your departure! You have the right to cancel, as the supplementary medical insurance is only valid if you have state insurance.
Insurance coverage limit
The insurance coverage limit increases annually, approximately for 1000-1500 euros. It is recommended to enter into a contract with an annual limit increase of 1,500 euros.
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If dental treatment has already been scheduled
As a rule, insurance companies refuse payouts for treatment that has already been prescribed or started. We recommend taking out insurance before visiting the dentist, but the need for additional dental insurance often arises only after a visit to the doctor.
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