Submit a dental insurance quote: How to secure your cost reimbursement
7 Apr 2025
10
Minutes
Katrin Straub
CEO at nextsure
A major dental treatment is scheduled, raising the question: How do I correctly submit the cost estimate to my supplementary dental insurance? This article guides you through the process to ensure you receive the maximum benefits and avoid any unpleasant surprises. Learn why the treatment and cost plan is so important and which deadlines you need to observe.
The topic in brief and concise terms
Always submit the treatment and cost plan (HKP) to your dental insurance before beginning treatment, especially for costs over €1,000, to avoid reductions in benefits.
The treatment plan is first reviewed and approved by the statutory health insurance before being submitted to the private dental supplementary insurance; this process has been digitised since 2023.
After the treatment, submit the original invoice to your dental supplement insurance to receive the agreed reimbursement into your account; digital submission is often possible.
Understanding the Basics: The Treatment and Cost Plan as a Foundation
The treatment and cost plan (HKP) is a central document for your dental treatment. It details the diagnosis, the planned therapy, and the estimated costs of over 1,000 Euros. Since the first of January 2023, the transmission of the HKP from the dental practice to the statutory health insurance (GKV) has been carried out electronically. As a patient, you receive a printed summary of this information. The approval of the HKP by the GKV is a prerequisite for their subsidy. This plan is generally valid for six months. Early clarification with your dental supplemental insurance is crucial for the subsequent reimbursement of costs. Knowledge of these fundamentals helps to optimally shape the further process.
Optimize the submission process: Step-by-step guide
The submission of the cost estimate to your supplementary dental insurance follows a clear procedure. First, your statutory health insurance checks the treatment and cost plan created by the dentist. After they determine the fixed subsidy, you submit the treatment and cost plan to your private supplementary dental insurance. Many insurers require this for treatment costs exceeding 1,000 euros. The submission can be done by post, via online portals, or special apps. Ensure all documents are complete to avoid delays. A confirmation of cost coverage before treatment begins provides financial security. This proactive step is particularly recommended for extensive dental prostheses, such as implants, which often cost over 2,000 euros. Following these steps ensures prompt processing.
Managing deadlines and waiting times: Don’t miss out on any benefits
Deadlines are a crucial factor when submitting a cost estimate. Ensure that you submit the treatment and cost plan before the treatment starts, especially for costs exceeding €1,000. Approval by the statutory health insurance typically takes a few days but can extend up to six weeks if there is a review by the expert. Private dental supplemental insurance usually checks the treatment and cost plan within two weeks. Also, be mindful of any waiting periods in your policy, which can be up to eight months. Compliance with these deadlines is essential to ensure full entitlement to benefits. Failure to submit on time risks reductions in benefits of up to fifty percent. A dental supplementary insurance without a waiting period can offer advantages here. Therefore, clarify all timing aspects early on.
Case studies and examples: Exploring typical scenarios
Imagine you need a dental implant costing €2,500. Your dentist creates a treatment and cost plan (HKP). You first submit this to your statutory health insurance (GKV), which grants a fixed subsidy of, for example, €400. You then send the approved HKP to your supplementary dental insurance. They review the plan and inform you of the amount they will cover, which can be up to ninety percent of the remainder depending on the tariff. Another example is a crown costing €800. Here, it is also advisable to clarify details with the insurance beforehand, even though some tariffs only require an HKP for amounts exceeding €1,000. Our expert tip: Clarify even smaller amounts in advance to avoid misunderstandings. These examples show the importance of the process for your supplementary dental insurance costs. This way, you are prepared for various treatment situations.
What you should pay attention to when submitting:
Completeness of the treatment and cost plan (all pages).
Notation from the statutory health insurance (GKV) on the HKP.
Adherence to the deadlines set by the insurance.
Providing your correct insurance number and contact details.
Submission before the start of treatment, especially for high costs.
Clarification whether original documents or copies are required.
Direct inquiries with your insurance in case of uncertainties.
Careful attention to these points greatly facilitates the handling process.
Leverage expert knowledge: Legal aspects and pitfalls
The Insurance Contract Act (VVG) serves as the legal basis. Your supplementary dental insurance may reduce benefits if you violate obligations, such as submitting the treatment and cost plan (HKP). A refusal of cost coverage may occur if the treatment was not medically necessary or was recommended before the contract was signed. Therefore, document all steps and communications carefully. In case of disagreements, the PKV Ombudsmann can be a point of contact. Note that the HKP is an estimate; costs can vary by up to fifteen percent without requiring new approval. For private services listed on the HKP, your signature is often required on the second page. This knowledge protects you from unexpected problems.
After the treatment: Submit the invoice correctly
After completing your dental treatment, you will receive an invoice from your dentist. Generally, you will pay this invoice yourself initially. You then submit the original invoice, along with any additional required documents, to your dental supplementary insurance. The insurance company will transfer the reimbursement amount to your account, usually within three to four weeks. Keep copies of all submitted documents for your records. Most insurers now offer digital submission methods via app or customer portal, which speeds up the process. Tax deductibility of the costs may sometimes be possible. Correct submission of the invoice is the final step towards your cost reimbursement.
Checklist for submitting your invoice:
Original invoice from the dentist (including any lab costs, if applicable).
Copy of the approved treatment and cost plan (if not already submitted).
Benefits statement from your statutory health insurance.
Your insurance number and bank account details.
Possibly a separate reimbursement form from your insurance company.
Compliance with the submission deadline (often up to three years, but early submission is recommended).
With these documents, you ensure prompt processing.
nextsure by your side: Support in case of a claim
As your partner for insurance solutions, nextsure is here to support you with submitting a dental supplementary insurance cost estimate. We understand that the process can be complex. Our digital services and experts assist you in staying organized and making your claims. With a well-chosen dental supplementary insurance and knowing the correct procedures, you can significantly minimize your personal share. We help you find the right coverage for your individual needs. Rely on our expertise in niche insurances. This way, you can focus on your recovery while we take care of the details.
More useful links
Bundesgesundheitsministerium offers comprehensive information about dental treatment in Germany.
Bundesgesundheitsministerium explains the reimbursement process in statutory health insurance (GKV).
Verwaltung.Bund.de provides information on dental services in the German public service.
Verbraucherzentrale offers information on personal shares and fixed subsidies for dental prostheses and health insurance benefits.
Verbraucherzentrale discusses whether taking out supplemental dental insurance is worthwhile.
Kassenzahnärztliche Bundesvereinigung (KZBV) provides information about dental care within the statutory health insurance framework.
Gemeinsamer Bundesausschuss (G-BA) provides information on the topic of dental prostheses.
gesund.bund.de, a government portal, offers information about dental services.
PKV (Verband der Privaten Krankenversicherung) publishes a press release on the strong growth of supplemental dental insurance in Germany.
FAQ
What documents do I need to submit an estimate?
You need the complete treatment and cost plan (HKP), ideally with the authorization note from your statutory health insurance, as well as your insurance number.
How quickly does the dental insurance process my submitted cost estimate?
The processing time may vary, but many insurers review the treatment plan (Heil- und Kostenplan) within two weeks. In complex cases or if there are follow-up questions, it may take longer.
What is the difference between standard care and private service in the HKP?
Standard care is the standard therapy subsidized by statutory health insurance. Private services extend beyond this (e.g., higher quality materials) and are listed on a separate part of the treatment plan, often with GOZ codes.
Can I also submit a quote for a professional dental cleaning?
A professional dental cleaning usually doesn't require an estimate beforehand. You submit the invoice after the treatment. Check your plan as the reimbursement amount can vary.
My dental insurance has only partially approved the estimate – what now?
Check the justification of the insurance. Certain services may not be included in your policy, or there may be limits. Contact your insurance for clarification or seek advice.
Does the dentist have to adhere exactly to the costs in the treatment plan?
The HKP is an estimate. Cost overruns of up to fifteen percent are often unproblematic. If deviations exceed this, the dentist should inform you and possibly create a new HKP.
