Dental benefit limits: how dental benefits are capped in the first years

In the first year of insurance, benefits for dentures are often reimbursed up to a maximum of €1,000, in the second year up to €2,000 and in the third up to €3,000. From the fourth or fifth year, full reimbursement usually applies. These figures are guide values and vary by plan and insurer.

The dental benefit limits apply to dental benefits, as a rule not to normal check-ups. These are usually reimbursed in full from the start.

Without dental benefit limits, insured people could take out private health insurance shortly before an expensive planned dental treatment, shift the costs to the insurer and then cancel again. The staggering protects the insurance pool from this form of selection. The figures given are guide values. The specific contract details depend on the plan and insurer.

Dental benefit limits are not the same as a waiting period. The dental benefit limits cap the amount reimbursed in the first years. The waiting period is a period in which certain benefits cannot be claimed at all. Some plans have both, for example a waiting period of three months and dental benefit limits for the first years on top. Other plans provide for only one of the two mechanisms or do without both. If you switch from statutory to private health insurance and need dentures, you should check both points.

When you compare plans, check the dental benefit limits explicitly. For how many years does the staggering apply? Which caps apply in each year? And are there plans without limits at a comparable price?

Premium plans often have no dental benefit limits or only very short ones. Entry-level plans, by contrast, have longer staggering periods and often provide for fixed reimbursement caps over the entire term, which can lead to higher own shares. If you expect to need dentures, schedule the planned treatment after the dental benefit limits have run out where possible, or choose a plan with short limits or none from the start. We recommend that you check the rules on staggering specifically in a plan comparison, especially if major dental treatment is due in the near future.