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When does supplementary dental insurance not pay?

In short

The most common reasons: the treatment was already recommended or started before the policy began, the waiting period of often eight months was still running, or the caps of the first four to five years are used up. Missing teeth that are not covered and wrong answers to the health questions come on top.

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When does supplementary dental insurance not pay?

What it costs

What can remain with you in the first policy year, guide values.

Example	Typical range
Implant EUR 3,000 in year one, cap EUR 1,000	about EUR 1,300 to 1,600 own share despite the tariff
Crown recommended before signing, EUR 800	about EUR 560 own share, the tariff pays nothing
Bridge during the waiting period, EUR 1,500	about EUR 800 to 950 own share
Implant EUR 3,000 from year five, tariff 90 percent	about EUR 300 own share

Guide values as of September 2026, calculated with the 2026 public subsidy. The own share examples are guide values from our quoting practice; your tariff terms are what counts.

Worked example

Implant in the second policy year

The policy has been running for 14 months, EUR 300 for fillings was reimbursed in year one. Now an implant is due.

Implant with crown	EUR 3,000
Fixed public subsidy without bonus	about EUR 553
Tariff with 90 percent would pay	about EUR 2,147
Cap up to year two minus EUR 300	EUR 1,700 still available

The tariff pays EUR 1,700 instead of EUR 2,147. You carry about EUR 750. If you can move the implant a few months into year three, you get more.

Recommended means: already too late

Only what was not yet known when you signed is insured. If the dentist has already recommended a crown or implant, it counts as recommended treatment, even if nothing has been done yet.

What counts is the record at the practice. The insurer can request it when you claim. If you sign shortly after a diagnosis, you get nothing for that tooth. The same applies to findings from a dentist in your home country before you moved.

Waiting period and caps at the start

Many tariffs have a waiting period: often three months for treatment, often eight months for prosthetics and orthodontics. Some tariffs have no waiting period, but the caps at the start still apply.

In the first years the reimbursement is capped. A common scale looks like this:

Policy year	Maximum payout in total about
Year 1	EUR 1,000
Up to year 2	EUR 2,000
Up to year 3	EUR 3,000
Up to year 4	EUR 4,000
From year 5	usually unlimited

Missing teeth and gaps

A tooth that is already missing when you sign is usually excluded. Some tariffs accept one to three missing teeth for a surcharge, others none at all.

This also applies to gaps you do not see as a problem yourself. Declare every gap, otherwise there will be a dispute later.

What else is often not paid

Purely cosmetic treatment such as bleaching is usually not insured. Many tariffs only pay for adult orthodontics after an accident or not at all.

If the dentist bills above the maximum rate of the fee schedule for dentists (GOZ), many tariffs do not reimburse the part above it. Ask beforehand whether your tariff covers this.

Treatment abroad is sometimes limited to the EU or to short trips. If you have work done in your home country, check the clause first and have the treatment plan approved in advance.

If the insurer refuses

Ask for the reason in writing and check it against your terms. A statement from your dentist on when the diagnosis was really made often helps.

If the answer is still no, you can turn to the ombudsman for private health and long-term care insurance (Ombudsmann Private Kranken- und Pflegeversicherung). The procedure is free of charge for you.

Step by step

Before treatment, submit the treatment and cost plan and get written approval.
Check which policy year you are in and how much of the cap is used.
If refused, ask for the reason in writing.
Ask your dentist to confirm the date of the first diagnosis.
If the dispute continues, contact the ombudsman.

Checklist

All health questions answered completely and honestly
Missing teeth declared on the application
No treatment recommended before signing, in Germany or abroad
Waiting period and caps of the tariff known
Insurer's approval before treatment starts
Reimbursement above the maximum fee rate clarified

Common mistakes

Signing quickly after a dental visit with a finding
Hiding a gap in your teeth on the application
Leaving out a recommendation from your dentist back home
Scheduling major treatment in year one although it could wait
Accepting a refusal without checking the terms

Questions and answers

Frequently asked

Does it pay if treatment has already started?

No. Started and recommended treatment is excluded in all common tariffs.

Is there dental cover without a waiting period?

Yes, many tariffs do without one. The caps in the first years still apply.

May the insurer see my dental records?

When you claim, yes, with your consent. Without it the insurer can hold back payment until the case is clear.

What if I answered a question wrongly?

Depending on fault, the insurer can withdraw from the contract, contest it or raise the premium retroactively. It is better to report mistakes yourself.

Does it pay at once after an accident?

With many tariffs yes, because accidents are exempt from the waiting period and often from the caps. Check this in your tariff.

When do I not need supplementary dental cover?

If you are happy with the simple standard treatment or can pay a share of a few thousand euros from savings.

Sources

NAMMERT insurance broker

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