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.

Reimbursements

The disorder or deformation must be of such a serious nature, that without that care you are unable to retain or acquire dental function equal to that which you would have had if the disorder or deformation had not occurred.

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.

Referral required in certain situations

  • You will require a referral from a general practitioner, dentist, orthodontist or an other dental surgeon for dental care from a dental surgeon.
  • For the care provided by a prosthodontist you need a referral from a dentist.
  • You need a referral from a dentist, dental surgeon or an orthodontist for the measuring, production, fitting and installation of removable (full) prostheses on dental implants by a prosthodontist.
  • 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.

Reimbursement under public healthcare insurance

Under HollandZorg public healthcare insurance, you will qualify for the reimbursement of special dental care.
Public Healthcare Insurance Reimbursement
HollandZorg public healthcare insurance
100% for contracted care, minus any statutory personal contribution.

Statutory personal contribution

There is a statutory personal contribution:

  • for care that falls under the heading 'All ages' in our conditions, 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' in our conditions. 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 our conditions. 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.

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.

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, whether or not affiliated to a centre for special dentistry, may provide the care that oral hygienists tend to provide;
  • 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.

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.

Reimbursements 2021

Also view the Reimbursements 2021.

Note

The information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions (PDF).

More information

Use our Care Guide to find a (contracted) care provider near you. For more information, contact customer services on +31(0)570 687 123. Our expert employees will be pleased to help you.