Dental care up to the age of 18

Reimbursement HollandZorg healthcare insurance 2021

  1. What is dental care?
  2. Reimbursement dental care up to 23 years
  3. Referral required sometimes

  4. Reimbursement under public healthcare insurance in 2021
  5. No statutory personal contribution
  6. No policy excess
  7. Who can you approach?
  8. Request permission

Please note: the information provided on this page is a summary of the reimbursement applicable. You will only be able to derive rights from the HollandZorg Conditions of Insurance (pdf).

1. What is dental care?

Dental care involves caring for and correcting teeth. 

 

If you have a special condition of the mouth, jaw and / or teeth (tooth-jaw-mouth system), you are eligible for special dental care.

2. Reimbursement dental care up to 23 years

An insured party who is younger than 18 will qualify for the reimbursement of the costs of the following under the public healthcare insurance:

  • special dental care;
  • an annual dentist's check-up (more check-ups on indication);
  • an occasional dental examination;
  • the removal of tartar;
  • two fluoride treatments per year (more treatments on indication);
  • the application of a thin protective layer to the top of the molars (sealing);
  • treatment of gum problems (parodontal treatment);
  • anaesthetic
  • root canal treatments (and endodontic treatment);
  • restoration of the dental elements with plastic materials (fillings);
  • help with problems with the jaw or teeth grinding (gnathological treatment);
  • removable dental prosthesis (dentures);
  • surgical dental treatment, with the exception of the fitting of dental implants;
  • x-rays, with the exception of x-rays for orthodontic care;
  • If you are younger than 23 and the care does not fall under the heading 'dental care for all ages', you are entitled to tooth replacement with non-plastic materials and fitting dental implants if this concerns the replacement of one or more missing permanent incisors or canines which have not grown or a tooth or teeth missing as the direct result of an accident. This is subject to the condition that the necessity of the care is established before you reached the age of 18.

You need our permission for a number of types of dental care. Read the insurance conditions (pdf) for the full terms and conditions.

3. Referral required sometimes

  • For the care provided in a centre for special dentistry, you need a referral from a general practitioner, dentist, dental surgeon or orthodontist. The referring dentist, dental surgeon or orthodontist may not be affiliated to a centre for special dentistry.
  • For the care provided by a dental surgeon, you need a referral from a general practitioner, dentist, orthodontist or an other dental surgeon.
  • For measuring, making and fitting removable (full) prostheses for the upper or lower jaw, whether or not secured on dental implants, you need a referral from a dentist, dental surgeon or orthodontist.

4. Reimbursement dental insurance 2021

With dental insurance, the insured person under the age of 18 is entitled to reimbursement of dental care up to the insured amount for various components combined.

 

Dental insurance Reimbursement 
TandExtra 75% up to a maximum of € 250,- per calendar year
TandPlus 75% up to a maximum of € 500,- per calendar year

 

The maximum reimbursement applies to the following elements jointly:

  • general dental care;
  • orthodontic treatment if you are younger than 18;
  • technical costs;
  • statutory personal contribution for dentures;
  • urgent dental treatment outside the Netherlands.

 

Reimbursement general dental care

The reimbursement applies to the various elements mentioned above jointly. Codes are shown after each type of treatment. These have been formulated by the Dutch Healthcare Authority (Nederlandse Zorgautoriteit). You can view them and download the list at www.nza.nl. You are only entitled to reimbursement of the costs of care with those service codes. You are not entitled to reimbursement based on your dental care insurance if the treatment concerned is covered by the public healthcare insurance. In that case, the costs will be reimbursed under the conditions of the public healthcare insurance.

 

Type of treatment Service code
Consultation and diagnostics  All C-codes
Taking and evaluating photos  All X-codes
Preventive oral care  All M-codes
Anaesthesia All A-codes
Anaesthesia (light anaesthetic)  All B-codes
Fillings  All V-codes
Root canal treatments All E-codes
Crowns and bridges  All R-codes
Jaw treatments  All G-codes
Surgery All H-codes
Dentures All P-codes
Gum treatments All T-codes
Implants All J-codes and, for care by dental surgeons, the relevant medical specialistic treatments (other care products)

 

Reimbursement of technology costs
Technology costs are the costs incurred to make a workpiece (or to have a workpiece made), such as a crown or dentures. You are entitled to reimbursement of (a part of) the technical costs for the aforementioned treatments. You can view the maximum of the amount included for the treatment in question in the List of maximum reimbursements of technical costs. The reimbursement to which you are entitled is 75% of the maximum technology costs up to the insured amount per calendar year in accordance with your supplementary policy conditions. 

 

Reimbursement of the statutory personal contribution for dentures
You will qualify for the reimbursement of costs for your statutory personal contribution for a removable complete prosthesis. Is this prosthesis secured on dental implants? Then you can get a reimbursement up to a maximum of € 275,- (TandExtra: up to a maximum of € 250,-).

 

Reimbursement of urgent oral care abroad
With the HollandZorg dental insurance, you qualify for the reimbursement of urgent oral care abroad. Cover is limited to the treatments included in the Urgent Oral Care List (pdf).

 

What is not reimbursed?
Have you failed to attend an appointment and have now received an invoice? We will not reimburse the costs charged for non-attendance of an appointment.

5. No statutory personal contribution

There is no statutory personal contribution for dental care under the public healthcare insurance for insured parties under the age of 18.

6. No policy excess

Insured parties under the age of 18 will not have any policy excess for the cost of care under the public healthcare insurance.

7. Who may provide this type of care?

You may obtain dental care from:

  • a dentist for dental care.
  • an orthodontist for orthodontics.
  • a dental surgeon for implantology.
  • an oral hygienist for oral hygienic care.

Removable (full) prosthetic devices for the upper or lower jaw, whether or not to be placed on dental implants, may also be measured, made and placed by a dental prosthetician. When it comes to fitting, fitting, fitting and fitting by a dental prosthetician of removable (full) prosthetic devices on dental implants, you must have a referral from a dentist.

8. Request permission

You will require our prior written permission for the following treatments:

  • special dental care
  • gnathological care if the insured is younger than 18;
  • taking a jaw overview photo if the insured is younger than 18;
  • the third or fourth fluoride treatment per year from the time the permanent teeth break through if the insured is under 18 years of age;
  • dental replacement care with non-plastic materials if you are under 23 years old;
  • treatments under anesthesia;
  • osteotomy and combined treatment of orthodontics and osteotomy;
  • placing a dental implant;
  • surgical dental care of a specialist nature if this requires residence;
  • making, installing, repairing or rebasing a complete dental prosthesis for the upper or lower jaw, whether or not to place it on dental implants;
  • care by a center for special dentistry.

Include a written and reasoned treatment plan from the care provider with your request. This plan will include the medical diagnosis (or diagnoses) and the care codes, supplemented by x-rays and any dental models.

Please send requests for permission to:

HollandZorg
Medical Advisor
Antwoordnummer 30
7400 VB Deventer

No stamp is necessary.

 

If you have any questions or would like more information, contact customer services on +31(0)570 687 123. We will be happy to answer your questions.


< Back to the reimbursement overview for healthcare insurance