Special dental care
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 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.
Who may provide this type of care?
You may obtain dental care from a dentist (whether or not working in a centre for special dentistry). You may also obtain certain dental care from the following care providers:
- a dentist, whether or not affiliated to a centre for centre special dentistry or a youth dental care institution, is permitted to provide all care;
- a dental hygienist, whether or not affiliated to a centre for special dentistry or an institution for youth dentistry, may provide the care insofar as it concerns care that dental hygienists tend to provide;
- an orthodontist may only provide orthodontic treatment;
- a dental surgeon can only provide implantology;
- a prosthodontist may only provide prosthodontic treatments and measure, make, fit and place removable (full) dental prosthetics for the upper or lower jaw, whether or not secured on dental implants.
You must have a referral from a dentist for the measuring, making, fitting and placing of a removable (full) prosthetic provision for the upper or lower jaw by a dental prosthodontist, secured on dental implants. The reimbursement of the fitting of dental implants is subject to our written consent before you receive the care.
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.
Please note:
The information on this page is a brief outline of the reimbursements. No rights can be derived from this page. You can only derive rights from our insurance conditions.
Your health insurance
In My HollandZorg you will find all information about your health insurance policy.
Maximum rates for a non-contracted care provider
Have you chosen a healthcare provider with whom we have no contract? Then, we will reimburse according to our maximum rates. If the rate invoiced by the non-contracted care provider is higher than our maximum rates, you will have to pay the difference yourself. You will be able to find contracted care providers with our Care finder.
Reimbursements, conditions and regulations 2023
