Dentures: Gap in the bonus booklet partly without consequences
Lisa Weidner studied German and sociology and completed several journalistic internships. She is a volunteer at Hubert Burda Media Verlag and writes for the "Meine Familie und Ich" magazine and on nutrition and health topics.
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Good news for cash patients: The fixed subsidies for dentures are increasing. And not only that - if you missed the retirement appointment, you may still be able to keep your bonus claim.
Up until now, a complete bonus booklet was the prerequisite for an increased health insurance subsidy for dentures. But that will change on October 1st - in part: For example, at least for the highest grant, for which patients have to prove the necessary check-up appointments for ten years without interruption, the one-time failure of an examination can be without consequences. This is indicated by the National Association of Statutory Health Insurance Dentists (KZBV).
However, patients must be able to conclusively explain to the health insurance fund why they could not go to the dentist in the relevant year or - for children between 6 and 18 years of age - in the six months. The legislature does not give concrete examples of exceptional cases.
At the discretion of the health insurance company
Thus, it is at the discretion of the individual health insurers whether they consider a case to be justified or not, the umbrella association of statutory health insurers (GKV) announced. Good to know for parents: According to the KZBV, children and adolescents who were unable to get dental care in the first half of 2020 due to Corona keep their full bonus entitlement, provided they otherwise always go to the dentist twice a year.
In general, the following applies: If an entry is missing in the bonus booklet because patients have not been to the examination for no particular reason, the bonus rule no longer applies. The KZBV explains that entitlement to a bonus only exists again when the inspection dates for the past five years can be proven without gaps.
Increased fixed grants
From October, patients will also benefit more from a completely filled bonus booklet: Those who can prove the required check-up appointments for five years without interruption will receive 70 percent instead of the previous 60 percent fixed subsidy for a denture. At ten years it will be 75 percent instead of the previous 65 percent. The fixed grants for those who cannot provide proof of this in the bonus book will also increase: from 50 percent to 60 percent.
Important detail: According to KZBV information, the previous calendar years count for the calculation of the higher subsidy. The stamp for the current year does not count, if it already exists.
The basis for calculating the fixed allowance are the average costs of standard care. Depending on the amount of the bonus percentage and the scope of the necessary dentures, you can save more than a hundred euros. Those who prefer a different treatment also receive the fixed allowance for standard care and have to bear the extra costs themselves. (lw / dpa)
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