Children’s braces insurance

A brace for children can quickly cost several thousand euros, especially if modern methods are desired. Statutory health insurers often cover only a fraction. Suitable children's braces insurance protects you from unexpected costs and ensures your child receives the best possible treatment.

Dental brace cost trap: What statutory health insurance really pays

Statutory health insurance (GKV) only covers the costs of braces for children under 18 under certain conditions. [1]

The classification into the orthodontic indication groups (KIG) is decisive. These five severity levels define the medical necessity of treatment. [1]

The GKV generally only pays for KIG 3 to 5. [3]

Parents must initially pay a 20% co-payment of the treatment costs. [4]

For a second child undergoing treatment at the same time, it is 10 per cent. [4]

This amount is reimbursed by the insurer after successful completion of the treatment. [1]

Treatment in KIG 1 and 2 is often considered cosmetic and is usually not paid for by the GKV. [8]

Understanding KIG classification: The key to cost coverage

The KIG system was introduced on 1 January 2002. It is intended to objectively assess the need for orthodontic treatment. [8]

There are five levels that describe the severity of a dental or jaw misalignment. KIG 1 are minor misalignments, KIG 5 are extremely severe. [1]

The orthodontist makes the classification on the basis of precise measurements.

Cost coverage by the statutory health insurance scheme usually applies from KIG 3 onwards. [5]

This means that for less severe misalignments (KIG 1 and 2), the costs must be paid entirely privately.

Many parents are surprised that even medically advised corrections in KIG 2 are often not paid for by the insurer.

A private dental supplementary insurance policy can be an important financial support here.

The precise KIG classification is therefore the first step in clarifying the question of costs.

Additional costs in focus: where private co-payments may be lurking

Even for KIG 3 to 5, the GKV only covers the costs of a “sufficient, appropriate and economical” standard treatment. [1]

Modern and more aesthetically pleasing treatment methods often lead to significant additional costs. These can easily amount to more than one thousand euros. [2]

The most common additional services include:

• Discreet brackets (e.g. ceramic or plastic)
• Lingual braces fitted on the inside of the teeth
• Transparent aligners, which can cost up to six thousand euros [3]
• Shorter treatment times thanks to special techniques
• Professional dental cleanings during treatment
• Retainers to stabilise the result

These additional services often significantly improve comfort and the aesthetic result.

Without children’s braces insurance, parents have to cover these costs entirely themselves.

It is therefore advisable to think about cover at an early stage.

Optimal cover: The role of supplementary dental insurance

A children’s braces insurance policy fills the gap in statutory health insurance. It can cover the costs of treatments in KIG 1 and 2. [1]

It also covers the additional costs for KIG 3 to 5. [1]

Tariffs are available from just a few euros per month. However, premiums rise with the child’s age. [7]

Key features of a good supplementary dental insurance policy for children are:

• Coverage of costs even for KIG 1 and 2
• High reimbursement rates for additional benefits (ideally eighty to one hundred per cent)
• Cover for prophylaxis and fissure sealing
• Benefits for retainers
• No long waiting periods or benefit limits in the first years

The policy should definitely be taken out before the dentist or orthodontist has diagnosed a misalignment. [1]

A supplementary dental insurance policy for the whole family can also be an option.

Careful review of the contract terms is crucial.

Practical tips: avoid cost traps and secure grants

To keep the cost of braces within limits, parents should bear a few points in mind.

First, a detailed treatment and cost plan from the orthodontist is essential.

This should clearly show which services are covered by the GKV and which are billed as private services.

If in doubt, seek a second opinion, especially if high additional costs are incurred.

Keep all invoices and the orthodontist’s final certificate carefully.

You will need these to obtain reimbursement of your out-of-pocket contribution from the GKV. [4]

Make sure your child wears the braces as instructed and attends all follow-up appointments, otherwise the right to reimbursement may lapse. [1]

Information on the tax deductibility of medical expenses may also be relevant.

Early and comprehensive information helps to minimise the financial burden.

Expert depth: Legal foundations and current rulings

The legal basis for the statutory health insurance (GKV) obligation to cover orthodontic treatment can be found in Section 29 of Book Five of the Social Code (SGB V). [1]

It establishes the entitlement to orthodontic care for medically justified indication groups.

The exact guidelines, in particular the KIG classifications, are set by the Joint Federal Committee (G-BA).

Recent court rulings continue to confirm the GKV’s limitation of benefits to what is medically necessary in the sense of standard care.

Our expert tip: Before starting treatment, clarify exactly which services your health insurance fund covers and which it does not.

If costs are rejected or there is uncertainty regarding the KIG classification, an objection or an expert assessment procedure may be considered.

A correct submission of the cost estimate is crucial in this regard.

nextsure will be happy to advise you on your options and support you in choosing the right insurance cover.