Submit dental supplementary insurance estimate

A larger dental treatment is coming up, and with it the question: How do I submit the cost estimate correctly to my dental supplementary insurance? This article guides you through the process so that you receive the maximum benefit and encounter no unpleasant surprises. Find out why the treatment and cost plan is so important and which deadlines you need to observe.

Understanding the basics: the treatment and cost plan as the basis

The treatment and cost plan (HKP) is a key document for your dental treatment. It sets out the findings, the planned therapy and the estimated costs of more than €1,000 in detail. Since 1 January 2023, the HKP has been transmitted electronically from the dental practice to the statutory health insurance fund (GKV). As a patient, you receive a printed summary of this information. Approval of the HKP by the GKV is a prerequisite for its subsidy. This plan is generally valid for six months. Early clarification with your supplementary dental insurance is crucial for later reimbursement of costs. Understanding these basics helps to shape the дальнейший process optimally.

Optimise the submission process: step-by-step guide

Submitting the estimate to your dental supplementary insurance follows a clear process. First, your statutory health insurer checks the treatment and cost plan drawn up by the dentist. After it has determined the fixed subsidy, you submit the HKP to your private dental supplementary insurance. Many insurers require this once treatment costs reach €1,000. Submission can be made by post, via online portals or special apps. Make sure all documents are complete to avoid delays. Confirmation of cost coverage before treatment begins gives you financial certainty. This proactive step is especially recommended for extensive dental prosthetics, such as implants, which often cost more than €2,000. Following these steps ensures swift processing.

Master deadlines and waiting periods: Don’t miss out on any benefits

When submitting the estimate, deadlines are an important factor. Be sure to submit the treatment and cost plan before treatment begins, especially for costs over €1,000. Approval by statutory health insurance (GKV) usually takes a few days, but can be extended to up to six weeks if an assessment by a medical expert is required. Private dental supplementary insurance providers often review the treatment and cost plan within two weeks. Also note any waiting periods in your contract, which can be up to eight months. Adhering to these deadlines is crucial for full entitlement to benefits. If you fail to submit it in good time, you risk benefit reductions of up to fifty per cent. Dental supplementary insurance without a waiting period can offer advantages here. So clarify all timing aspects at an early stage.

Practical cases and examples: Examining typical scenarios

Imagine you need a dental implant costing 2,500 euros. Your dentist prepares a treatment and cost plan (HKP). You first submit this to your statutory health insurance (GKV), which approves a fixed subsidy of, for example, 400 euros. You then send the approved HKP to your dental supplementary insurance. It checks the plan and informs you of the amount it will cover, which depending on the tariff can be up to ninety percent of the remaining amount. Another example is a crown costing 800 euros. Here too, it is advisable to clarify matters with the insurance in advance, even if some tariffs only require an HKP from 1,000 euros upwards. Our expert tip: also clarify smaller amounts in advance to avoid misunderstandings. These examples show how important the process is for your dental supplementary insurance costs. This way you are prepared for different treatment situations.

What you should pay attention to when submitting:

• Completeness of the treatment and cost plan (all pages).
• Note from the statutory health insurance provider (GKV) on the HKP.
• Compliance with the deadlines set by the insurance company.
• Providing your correct insurance number and contact details.
• Submission before treatment begins, especially in the case of high costs.
• Clarification of whether original documents or copies are required.
• Ask your insurance provider directly if anything is unclear.

Careful attention to these points makes the process much easier.

Using expert knowledge: legal aspects and pitfalls

The Insurance Contract Act (VVG) forms the legal basis. Your dental supplementary insurance may reduce benefits if you breach obligations, such as submitting the HKP. A refusal to cover costs may occur if the treatment was not medically necessary or was recommended before the contract was concluded. You should therefore document all steps and communications carefully. In the event of disputes, the PKV ombudsman can be a point of contact. Please note that the HKP is an estimate; costs can vary by up to fifteen per cent without a new authorisation being required. For private services on the HKP, your signature is often required on page two. This knowledge protects you from unexpected problems.

After treatment: Submit your invoice correctly

After completing dental treatment, you will receive an invoice from your dentist. You usually pay this invoice yourself initially. You then submit the original invoice, together with any other required documents, to your dental supplement insurance. The insurer then transfers 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 options via app or customer portal, which speeds up the process. There may be tax deductibility of the costs under certain circumstances. The correct submission of the invoice is the final step to your reimbursement.

Checklist for submitting an invoice:

• Original invoice from the dentist (including lab costs, if applicable).
• Copy of the approved treatment and cost plan (if not already submitted).
• Statement of benefits from the statutory health insurance provider.
• Your insurance number and bank details.
• Possibly a separate reimbursement form from your insurer.
• Compliance with the submission deadline (often up to three years, but earlier submission recommended).

With these documents, you can ensure prompt processing.

nextsure at your side: support in the event of a claim

As your partner for insurance solutions, nextsure is also at your side when it comes to submitting a cost estimate for dental supplementary insurance. We understand that the process can be complex. Our digital services and experts help you keep track and assert your claims. With a well-chosen dental supplementary insurance and the knowledge of the correct process, you can significantly reduce your out-of-pocket costs. We help you find the right cover for your individual needs. Rely on our expertise in the niche insurance sector. This allows you to focus on your recovery while we take care of the details.