Assurance santé News

Are implants reimbursed by dental insurance?

For major dental procedures, the use of artificial teeth may be necessary. As not all implants are covered by the social security system, it is necessary to join a mutual insurance company to benefit from compensation. However, there are many rumors about the quality of reimbursement of certain mutuals. Are dental implants reimbursed?

What should I know about the Reimbursement of implants by mutual insurance companies?

From now on, the majority of dental mutuals have adopted a special coverage for dental implants. Generally, the latter is in the form of an annual package. Some of the more popular mutual insurance companies offer different levels of coverage for implants.

It is recommended, before starting treatment, to contact your health insurance fund to find out the level of cover you have. Implants can be covered in two different ways. On the one hand, this is possible by the level of reimbursement (percentage) specified in the contractual dental insurance. On the other hand, coverage is provided for a certain annual fee. The insured and his family are then entitled to benefits.

a woman at the dentist
A woman at the dentist

Reimbursement of defective implants: is this possible within the framework of mutual insurance?

If the implant is defective and needs to be replaced with a new one, the mutual reimburses you. It provides for an annual limit specific to this type of device. However, the company offers a legal assistance clause in the health contract. This measure allows insured persons to obtain compensation or to receive treatment free of charge.

In addition, any freshly placed implant is examined by an oral surgeon. He is appointed by the health insurance fund to assess compliance with social security criteria. If the insured develops sequelae (eg abscesses, cysts, etc.), the health insurance fund will cover all medical and dental costs before and after the implantation. In addition, she can advise a partner dentist for the continuation of the necessary treatment.

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How to find a health insurance that offers good reimbursement for dental implants?

Please make use of the “comparator of dental insurance formulas” to choose a good dental insurance plan. Choosing the right one is essential to being reimbursed and minimizing the cost of implants. This is why it is important to find out beforehand on the insurance with your mutual insurance company.

It is possible to consider several treatments during the same year. You can then ask yourself the following key questions:

  • does your current plan offer a package of implants?
  • if yes how much ?
  • are they limited by year or by the number of implants?
  • is there a limit to the number of teeth per year?

If you do not get satisfactory answers, you must first contact your health insurance fund. The goal is to see if you can benefit from better implant coverage. It is therefore important to reconcile the additional cost of the contribution with the actual amount of the reimbursement.

On the other hand, if you are not satisfied with the proposal of the mutual, you can also change insurer at the end of your contract. To help you choose, there are a number of comparison tools online. The majority are free. After a few questions, they offer you a health insurance that best suits your needs and your budget.

How are implants paid for?

Specialists or experts can help you deal with social security schemes and mutuals. The purpose is to facilitate the reimbursement of expenses. To benefit from the latter abroad, certain documents must be presented to the social security office. It’s about :

  • panoramic dental x-rays before and after treatment,
  • the written complaint form or an invoice including (the number of teeth treated, dental work carried out and their value, “…”),
  • form S3125,
  • proof of accommodation (e.g. flight ticket invoice and/or accommodation invoice).
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These are the components of the dental care reimbursement file. Finally, you can submit a request for additional cover to your health insurance fund. You are thus reimbursed for the remaining cost of the crown and the body of the implant.