Heil- und Kostenplan - Cost Estimate and Prosthetic Treatment Plan for German Krankenkasse.
Patients insured in Germany settle for dental services (prosthetics) with their health insurance funds (Krankenkasse) based on a form called Heil- und Kostenplan (translated: treatment and cost plan). Dental procedures are also covered if the patient decides to undergo treatment in Poland, provided that the appropriate formal procedures are followed.
The treatment and cost plan for individuals with statutory health insurance in Germany (e.g., AOK, BKK, VIACTIV) is prepared by a dentist in the case of prosthetic treatment. The specialist completes the Heil- und Kostenplan, thereby documenting the current dental condition (B), the procedures to be performed (R - standard treatments reimbursed by Krankenkasse and TP, i.e., those that are supplementary), and the probable costs of such treatment. Polish doctors may not always have the knowledge to complete a treatment plan for the German Krankenkasse, and these plans are not intended for patients, as the document must be properly filled out by the person responsible for the treatment. The preparation of the cost estimate itself can take some time (consultation with the doctor, dental examination, correct completion of the estimate according to procedure), followed by approval and authorization by Krankenkasse.
The first part of the treatment and cost plan (Heil- und Kostenplan) includes consultation findings, which encompass:
BEFUND (B): The patient's current dental condition. After an examination, the dentist assesses the precise state of the patient's oral cavity and enters the results using appropriate abbreviations from the legend into the HKP card. The size of the letters plays an important role. In the B section, lowercase letters are used, for example, "f" indicating a missing tooth, "x" indicating a damaged and non-salvageable tooth.
Regelversorgung (R): Standard care, which Krankenkasse covers according to patient rights, for example, full-metal crowns.
Therapieplanung (TP): Planned therapy, but supplementary, not covered by Krankenkasse by default, for instance, implants. The size of letters is significant, and the dentist also uses special abbreviations to precisely describe each element of the Heil- und Kostenplan, explained in the legend in the document. In the B section, lowercase letters are used, such as "f" for a missing tooth, "x" for a damaged and non-salvageable tooth. Standard care is then recorded in the R row. If a tooth is missing, this corresponds to the letter B, along with additional elements included in basic care. However, if the patient prefers supplementary care not covered by insurance, such as a dental implant, the TP column is filled with the letter "S," signifying "restoration supported by implants." Of course, the treatment plan includes more than just implants, such as crowns.
The dentist always enters standard care (R) into the plan, based on the dental examination (B), regardless of the actual prostheses used. The TP line of the treatment and cost plan is only filled out when other or additional services beyond standard care are planned (e.g., implant, veneer). Since Krankenkasse pays the dentist for preparing the Heil- und Kostenplan, patients do not incur any fees for receiving it. In the case of visits to Poland, the dentist may charge a consultation fee, which is not reimbursed by Krankenkasse.
After preparing the dental treatment plan, it must be submitted to the health insurance fund for evaluation, during which the necessity of treatment is checked, and a decision is made on approval and fixed funding. The health insurance fund has the right to employ an expert to determine if the statements specified in the treatment and cost plan are accurate, if prosthetic care is needed, and if the planned care is in line with dental knowledge. REMEMBER: The Heil- und Kostenplan is an estimate, but the costs resulting from it must be as accurately determined as possible.
Frequently Asked Questions:
How long is the treatment and cost plan estimate valid?
The estimate based on the completed Heil- und Kostenplan is valid for six months, so the proposed treatment must be completed within this period. If treatment does not take place within this timeframe, a new application must be submitted to the health insurance fund for cost coverage. If you cannot meet this deadline, you can also apply to your health insurance fund for an extension.
When is the HKP approved?
The health insurance provider has 3 weeks to review the Heil- und Kostenplan. If an expert is commissioned to review the Heil- und Kostenplan, the decision period extends to 6 weeks from receiving the application. If the health insurance fund considers an expertise necessary, they must inform you immediately whether the 3-week or 6-week period applies. If the health insurance fund cannot meet these deadlines, they must inform you in due time in writing, stating the reason.
When is a treatment and cost plan needed?
Before commencing prosthetic treatment, the dentist must complete the treatment and cost plan. Dentists or patients send the plan to the health insurance fund, preferably along with a premium booklet. The fund checks whether the conditions for financial support are met and determines the fixed subsidy.
Can I complete the Heil- und Kostenplan myself?
The cost estimate for prosthetic treatment for the health insurance fund must be completed by a specialist doctor who is proficient in dental terminology. In our team, we have an experienced specialist in oral and maxillofacial surgery who, based on photos sent by the patient and the treatment plan prepared by the chosen facility, drafts the Heil- und Kostenplan for the German health insurance fund.
Our team is happy to assist you with formalities related to dental treatment in Poland.
+ 48 607 871 284/e-mail: kontakt@medicaladvisor.pl
