Gingival and dental care and extractions

Coverage rates

Beyond an annual amount of 60,00 €, a flat rate paid in full by the health insurance, these treatments are covered at the rate of eighty-eight per cent (88%) of the standard rates.

For children under 18 years, these treatments are covered at the rate of hundred per cent (100%) of the standard rates.

It can therefore happen that reimbursement for one treatment may differ in percentage according to the amount payable on the balance payable, as noted above.

Exemple

Rates Date Price Reimbursement Comment
DS16 03.10.13 50,30 50,30 Reimbursement at 100 % (Balance 60 – 50,30 = 9,70)
 
DS16 08.10.13 50,30 45,43

Reimbursement of 9,70 at 100% = 9,70

Reimbursement of 50,30 – 9,70 = 40.60 at 88% = 35,73
TOTAL : 45,43

DS16 15.10.13 50,30 44,27 Reimbursement at 88 %

If in the course of the same session several technical actions are carried out on the same person by the same dentist, the dentist is entitled to charge the rate for which the coefficient is the highest, as well as to calculate 50% of the rate for a second and if necessary, for a third action. Subsequent actions do not give rise to additional charging.

The aforesaid notwithstanding, charges for actions other than surgical extractions may be accrued at the full rate regardless of number. They are to be regarded as a single technical action. In the case of the pooling of the total for one kind of action with other technical actions, the reduction of fifty per cent as laid down in the provisions given in the preceding paragraph cannot be applied to this group as though it were one action. The other actions can be reckoned separately, the first at 100% and the second at 50%.

Example (For the sake of this example we are assuming that the flat rate reimbursement of 60,00 € has already been paid and the person is aged over 18).

Rates Date Price Reimbursement Comment
21-DS61 03.10.13 17,50 15,40 This action falls under the accumulated charge.
Reimbursement is therefore 88%
21-DS20 03.10.13 10,50 9,24 This action falls under the accumulated charge.
Reimbursement is therefore 88%
28-DS88 03.10.13 178,00 156,64 This refers to a surgical action; it is therefore not part of the accumulated charge.
As it refers to the first action not falling under the accumulate charge, the reimbursement is 88%
28-DS20 03.10.13 10,50 9,24 This action falls under the accumulated charge.
Reimbursement is therefore 88%
38-DS88 R 03.10.13 178,00 78,32 This refers to a surgical action; it is therefore not part of the accumulated charge.
As it refers to the second action not falling under the accumulated charge, the reimbursement is 50% of 88%
38-DS20 03.1013 10,50 9,24 This action falls under the accumulated charge.
Reimbursement is therefore 88%
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