Bonus booklet
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The bonus booklet has been used in Germany since 1989 as part of dental care by statutory health insurance companies. It serves as evidence for regular preventive examinations in order to receive entitlement to increased subsidies for dentures . Insured persons receive a personal bonus booklet, which they should show at every dental health examination (check-up or prophylaxis session) in order to be able to provide the necessary evidence as completely as possible.
For 12 to 17-year-old insured persons, the date of the assessment of the oral hygiene status as part of the individual dental prophylaxis in accordance with Section 22 of the Social Code Book V is entered for every six - month calendar . After reaching the age of 18, the date of the annual dental check- ups is entered in the bonus booklet .
Goal setting
The 1989 Health Reform Act limited the reimbursement of statutory health insurance costs for dentures to 50%. At the same time, a bonus scheme was introduced as an incentive for regular individual prophylaxis. This is intended to strengthen the personal responsibility of the insured. Insured persons should practice regular oral hygiene and regularly visit the dentist for an examination at least once a year. This is intended to avoid tooth damage or to detect it at an early stage in order to avoid dentures as much as possible or to reduce their scope and thus limit the expenses of the health insurance companies.
Bonus scheme
In principle, those insured in statutory health insurance companies receive a fixed allowance of 50%. Patients whose condition of the teeth reveals regular dental care and who regularly take advantage of dental check- ups , receive a bonus in the form of 10 for medically necessary care with dental prostheses such as crowns , bridges and removable prostheses in accordance with Section 55 (1) SGB V or 15 percentage points higher fixed allowance to the fixed amounts for the respective standard care. The bonus is not granted on the additional costs that go beyond the costs of the “ standard care ” - so-called “similar care” and “different care”.
45% of those with statutory health insurance cannot claim the bonus because they do not provide evidence or do not provide it completely.
20% bonus
The subsidy for the contractual service increases by 20% of the basic amount (i.e. from 50 percentage points to 60 percentage points) if people with statutory health insurance who have reached the age of 18 have been to the dentist for a detailed examination at least once a calendar year in the past five years Regular dental care reveals the teeth. Children and adolescents from the age of 12 must have taken part in the individual prophylaxis at least once per calendar half year. The remaining portion must be paid by the patients themselves. Your own contribution can be fully or partially insured through a private supplementary dental insurance .
30% bonus
In the case of seamless provision over a period of ten years, the subsidy for the health insurance benefits increases by a further 10% to 30% (based on the subsidy of 50%). This increases the subsidy to a total of 65% of the costs of standard care.
Changes due to the Appointment Service and Supply Act
As a result of the Appointment Service and Supply Act passed on March 14, 2019, the diagnosis-related fixed grants, which previously covered around 50 percent of the costs of standard care, will be increased to 60 percent from January 1, 2021 in accordance with Section 55 new SGB V. As a result, the bonuses that those insured receive who can prove that they regularly use dental check-ups with their bonus booklet also increase from 60 or 65 percent to 70 or 75 percent.
In justified exceptional cases, the one-time failure of a preventive examination (five times in five years or ten times in ten years) should have no consequences for the bonus scheme for dentures.
Hardship regulation
Unreasonable burden
People with statutory health insurance are largely exempt from their own contributions for dentures if they are unreasonably burdened.
An unreasonable burden exists if the monthly gross income for the subsistence of the insured person does not exceed 40% of the monthly reference value according to § 18 SGB IV. In 2019, this limit is 1,246 euros (with one family member 1,713.25 euros, with two family members 2,024.75 euros and with three family members 2,336.25 euros). The exemption is also granted to insured persons who receive certain social benefits. These are support for subsistence according to SGB XII or according to the Federal Pension Act, benefits according to the law of needs-based basic security, benefits to secure a livelihood according to SGB II, training support according to the Federal Training Assistance Act or SGB III or if the costs of accommodation in a home or a similar institution are funded by a social welfare or war victims' agency.
Insured persons who fall under the hardship regulation receive double the fixed allowance for standard dental prosthesis care, even if they did not keep the bonus booklet in full. (§ 55 Abs. 2 SGB V). If the insured have chosen the standard pension, there is no co-payment.
Sliding hardship rule
The hardship limit is not rigid, but provides for a sliding clause. The health insurance company reimburses the insured person the amount by which the simple fixed allowance - without bonus - exceeds three times the difference between the gross monthly income for living expenses and the income limit ("hardship limit") that is decisive for granting the double fixed allowance. This additional contribution to the costs does not exceed an amount equal to twice the fixed allowance and no more than the costs actually incurred (Section 55 (3) SGB V). The remaining balance must be borne by the insured.
Missing bonus booklet entry
If an entry is missing in the bonus book, the counting of the years required for a bonus starts from the beginning.
If the insured person has lost their bonus booklet, they may have to pay a fee for the dentist to collect all appointments from the past and stamp a new bonus booklet accordingly. The fee according to GOÄ No. 70 can be between € 2.33 and € 8.15, depending on the effort. If the dentist refuses to confirm in the bonus booklet (examination and proof of regular oral care provided), he may be liable for the amount that the patient does not receive or less from the health insurance company due to the missing bonus booklet proof. As a dentist, you also have to stamp a paper printout, there is no noticeable less work involved. Bonus booklets are still available unchanged. They have to be requested by the dentist from his dental association.
In some cases, individual health insurance companies already have an insured person-related machine data exchange with the statutory health insurance associations on preventive examinations. With these health insurers, proof of later dentist visits is no longer required since a certain key date.
Request
The application for the double fixed allowance can be omitted from the health insurance company for certain social benefits (e.g. unemployment benefit II), since the health insurance company can recognize this benefit directly. Otherwise and in the case of sliding hardship, the insured person must fill out an application form from the health insurance company. It makes sense to submit the form together with the HKP to the health insurance company.
The amount of the double fixed allowance is set by the health insurance company on the treatment and cost plan (HKP) in a separate field.
Other bonus books
Not to be confused with the bonus booklet dealt with here are evidence of other bonus programs with different content orientations, which are used by companies, but also by health insurances, for various purposes. Some health insurance companies offer bonus programs for health-conscious behavior on the basis of Section 65a (1) SGB V and their respective statutes, for example , and require the maintenance of a bonus booklet as proof.
Individual evidence
- ↑ Individual prophylaxis guidelines of the Federal Committee of Dentists and Health Insurance Companies on Measures to Prevent Dental Diseases (PDF; 45 kB) from June 4, 2003. B. 13, Federal Gazette No. 226 (p. 24 966) from December 3, 2003.
- ^ Law on structural reform in the health system (Health Reform Act - GRG; PDF; 48 kB) of December 20, 1988 ( Federal Law Gazette I p. 2477 ).
- ↑ Bundestag printed matter 200/88 (PDF; 27.3 MB), p. 2.
- ↑ kzvb-TRANSPARENT 7/2009, Around 60% of Germans give away grants
- ↑ bill TSVG , BMG. Retrieved March 14, 2019.
- ↑ T. Blöß, Collecting Points Deutsches Ärzteblatt, March 2004, page 108.
Web links
- Bonus smile , information page on standard care and fixed subsidies from the dental associations, Kdö.R.
