Implant expenses and health insurance

Comprehensive dental-implantological care can be time-consuming and demanding. Sometimes the efforts continue when the standard reimbursements for treatment costs have to be claimed from payors. Supplementary dental insurance, which is based on monthly contributions from 9.00 EUR for adults, is not uncontroversial. In this context, it may be appropriate to ask how private health insurers in this area estimate their outgoings, given that cost of treatment and restorative care in this area may be well be in the five digit range. Those who have full private health insurance have been exposed to steadily rising contributions for many years.

Frankfurter Allgemeine Zeitung recently reported about the option for those who have held full private health insurance for many years to change to a cheaper plan, without having to subject themselves to renewed underwriting. The reports states that policy holders who are younger than 55 can switch to statutory health insurance, though obviously this entails a loss of the provisions for old age that have accumulated in the private health insurance. A change into another private health insurance was said to be possible with transfer of these old age provisions. But above all the report highlights a change of plan with the same insurance company, in particular to a plan that accordingly reckons with lower risk-adjusted health care costs, which overall makes for cheaper calculated contributions. FAZ reports that this would allow to reduce monthly contributions by up to 50 % while benefits would remain the same. Advice with this aim is provided by the financial service company www.widge.de.

In the area of dental supplementary insurance for patients with statutory health insurance it is noticeable that insurers not infrequently unilaterally rescind a contract as soon as a new customer submits a treatment and expense plan for a comprehensive implantological-prosthetic care. The rescission is justified through the violation of pre-contractual duties of disclosure, in particular with respect to the state of one's teeth at the time of contract formation. Pre-existing periodontitis as well as an unerupted primary tooth have been given as reasons for rescinding a contract. In the latter case juridical review found against the private health insurance, finding that such an unerupted primary tooth is not be regarded as as dental anomaly that would prompt the realisation in a patient that this fact needs to be disclosed when entering into a health insurance contract (LG Düsseldorf, Judgem. dated 28.07.2010, 11 O 410/08).