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Special dental care

Reimbursement HollandZorg healthcare insurance 2019

  1. What is special dental care?
  2. When will you qualify for reimbursement?
  3. A referral will be required in certain situations
  4. Reimbursement under public healthcare insurance in 2019
  5. Statutory personal contribution
  6. Policy excess
  7. Who may provide this type of care?
  8. Request permission in advance

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 special dental care?

Special dental care falls under oral care. Examples of special dental care are the correction of a cleft palate (harelip) or a very serious overbite. A dentist or a centre for special dentistry may provide this type of care.

2. When will you qualify for reimbursement?

You will qualify for reimbursement for special dental care if:

  • you have a serious development disorder, growth disorder or acquired deformation of the dental and oral system;
  • you have a non-dental physical or mental disorder and the disorder is such that care is necessary to retain your dental function;
  • any medical treatment without this dental care will not have the result required and you need this medical treatment to retain your dental function.

You will require prior written permission from us for the reimbursement of special dental care. Read the Conditions of Insurance (pdf) for more information.

3. Referral required in certain situations

You will require a referral from a general practitioner, dentist or orthodontist for dental care from a dental surgeon. For the care provided by a prosthodontist you need a referral from a dentist.

 

For the care provided in a centre for special dentistry, you need a referral from a general practitioner, dentist  or orthodontist. The referring dentist or orthodontist may not be affiliated to a centre for special dentistry.

4. Reimbursement under public healthcare insurance in 2019

Under HollandZorg public healthcare insurance, you will qualify for the reimbursement of special dental care.

 

Public Healthcare Insurance                                       Reimbursement 2019
HollandZorg public healthcare insurance 100% for contracted care, minus any statutory personal contribution.

    

Supplementary Insurance Reimbursement 2019
Start none
Extra none
Plus none
Top none

5. Statutory personal contribution

There is a statutory personal contribution:

  • for care that falls under the heading 'All ages', if the care in question is not directly related to the referral  for specialist dental care. In that case, the extent of the statutory personal contribution is the maximum  amount that the care provider would have charged if there was no right to reimbursement of the costs under the heading 'All ages'. This means that you are in fact entitled to a reimbursement of only the additional costs associated with that type of care;
  • for a removable full dental prosthesis for the upper or lower jaw, if you are aged 18 or older and the care  does not fall under the heading 'All ages'. In that case, the statutory personal contribution amounts to 25% of the costs of that dental prosthesis. Contrary to the above, the statutory personal contribution for a removable full dental prosthesis secured on dental implants amounts to:

a. 10% of the costs of that dental prosthesis, if it is a denture for the lower jaw;
b. 8% of the costs of that dental prosthesis, if it is a denture for the upper jaw.

  • for repairs or rebasing of a removable full dental prosthesis. In that case, the statutory personal  contribution amounts to 10% of the costs of the repair or rebasing.

6. Policy excess

Are you 18 or older? The costs incurred for special dental care will count towards your compulsory policy excess and any voluntary policy excess.

7. Who may provide this type of care?

  • Dentists and centres for special dentistry can provide this type of care.
  • A dental surgeon may provide surgical dental assistance;
  • An oral hygienist may provide the following care only: preventive oral care (all M codes), non-complex periodontal assistance (T11, T12, T22, T31 to T33, T41 to T43, T60, T61, T91 to T93, T96),  performing simple fillings (V30, V35, V40, V71, V72, V81, V82, V91, V92) and anaesthetic (A10 and A15);
  • Removable (complete) dentures may be made and fitted by a dental prosthetist.

Use our Care Guide to find a (contracted) care provider near you.

 

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.

8. Request permission in advance

You will require our prior written permission for special dental care. 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.

 

Send your request for permission to:

 

HollandZorg
Medical Advisor
Antwoordnummer 30
7400 VB Deventer

No stamp is necessary.


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