Dental care: Basic characteristics, 2013

Transcription

1 Austria Belgium Bulgaria Croatia Dental treatment is granted according to the statues. Medical treatment includes conservative, surgical and orthodontic treatments. The patient's or family member's contribution towards orthodontic treatment is between 25% and 50%. The entitlement is proven towards the dentists by e-card, an electronic sickness insurance card. The annual fee is EUR (with the exception of relatives, pensioners and the needy). Comprising preventive and conservative treatment, extractions, dental prosthesis, and orthodontic treatment. Refund: of cost of treatment: See medical care, of cost of dental plates, etc., subject to sickness fund doctor's approval, up to 100% if patient is over 50, or if younger, affected by specific complaints justifying the intervention of the insurance. Children under 18 years of age: free dental care (except orthodontic treatment and nonreimbursable care). Patient charges of up to 25% for ordinary insured persons over 18 years of age. All health insured persons are entitled to receive the following dental treatment: Persons under 18: 1 diagnostic examination and up to 4 dental interventions per calendar year; Persons over 18: 1 diagnostic examination and up to 2 dental interventions per calendar year. The National Health Insurance Fund pays for this treatment fully or partially as contracted in the National Framework Contract and depending on the kind of the treatment and the age of the person. Preventive and curative dental treatment: Insured persons are obliged to participate to the amount of HRK 10 (EUR 1.34) for health protection (examination and issued drugs) at contracted dentists. They participate in specialist-consultation dental protection to the amount of HRK 25 (EUR 3.35). (Indispensable) dental prosthesis is granted according to the statutes. The patient's or family member's contribution towards removable dental prosthesis such as braces is between 25% and 50%. Health insurance does not cover removable dental prosthesis except for patients aged at least 50. Exceptions are possible, notably as regards the age limit of 50 years. Reimbursement of 75% for ordinary insured persons and of 95% for beneficiaries of the preferential scheme. Not covered. Partially covered. Coverage of stomatological aids depends upon the age of the insured persons. Patient participation of 20% of the cost, but minimum HRK 1,000 (EUR 134) for patients aged 18 to 65 and HRK 500 (EUR 67) for patients aged 65 or over. The cap of participation costs is HRK 2,000 (EUR 269) per issued receipt. Cyprus Not applicable. is provided for certain low-income groups, as follows: transitional removable full or partial dentures (acrylic), at EUR per item, casted framework removable full or partial dentures, at EUR per item, and Page 1 of 8

2 Cyprus (cont.) Czech Republic Denmark Dental services are reimbursed according to a special price list and a patient does not bear the costs himself, unless the law provides otherwise. The law determines frequencies of the prophylactic dental examinations which are not paid by a patient so these are reimbursed by the public health insurance system. However there are regulatory charges: see Table II, Benefits Payment of doctor and Exemption or reduction of patient s participation. Procedures using materials above the standard in accordance with patient wish that are not reimbursed by the public health insurance system as well as procedures which are laid down by the law as a non-reimbursable are paid entirely by patient. Residents are entitled to public subsidies covering expenses for dental care. These subsidies comprise prevention as well as certain treatments. For residents below the age of 18 all dental care is provided free of charge. Special subsidies are provided to groups of patients with extraordinary needs for dental care as a result of certain diseases. The municipalities are bound to provide and extensively subsidise dental care for residents who, as a consequence of reduced mobility or considerable physical or mental disabilities are having difficulties using the regular dental care services. Estonia Health Insurance Act guarantees free dental care for children and adolescents up to 19 years old, including preventive and curative services. Adult dental care must be paid for out-of-pocket, but is subject to partial reimbursement by the Health Insurance Fund for certain pensioners and for insured persons aged over 63 (EUR per year). A higher rate of benefit (EUR per year) shall be established by a regulation of the Minister of Social Affairs for: Pregnant women; mothers of children under 1 year of age; persons who have an increased need for dental treatment services as a result of health services provided to them (e.g. surgical treatment of face traumas). Nevertheless, the Health Insurance Fund covers the costs of adult emergency dental care, such as abscess incision and excision of teeth or root treatment in case of periodontitis or abscesses. interocclusal appliances (splints) at EUR per item. Partial metallic dentures are offered to groups entitled to treatment free of charge (see "Field of application, 1. Beneficiaries" above), at the cost of EUR 75 per item. Additionally, the patients have to pay EUR 75 per item at a dental laboratory for the construction of the metallic frame. Dental prostheses are available to all insured persons. The law defines the amount of reimbursement by the public health insurance system according to the use of various materials. Selected materials may be fully reimbursed from the public health insurance system. All the costs above the standard amount of a reimbursement from the public health insurance system are borne by patient. For pensioners: depending on their financial situation and medical condition, the municipalities can cover 85% of the participation to the expenses by means of the Health allowance. In the case of dentures, the Health Insurance Fund compensates, once every 3 years, the amount paid for dentures by insured individuals who are at least 63 years old or who receive an old-age pension. The amount is up to EUR Page 2 of 8

3 Finland France Germany Greece Hungary Health centre: The patient normally pays a fee according to a basic fee and a fixed tariff for each intervention. Health centres are allowed to fix their tariff within certain limits. They are all lower than those by private dentists. Persons under the age of 18 and war veterans receive dental treatment free of charge. Sickness insurance: Dental expenses are partly refunded. The system allows the patient to directly know the reimbursement amount. The patient is reimbursed part of the private dentist s fee and the examination and treatment charges according to a schedule of fixed charges. No refund is provided in respect of ortho- and prosthodontic treatment. General scheme for employees: Comprising preventive and conservative treatment, extractions and (submit to approval) orthodontic treatment. Refund according to fixed rate as for medical care. Share borne by the insured person: 30%. Full compensation of medically necessary conservative and surgical dental treatment. Full compensation of necessary orthodontist care for insured persons aged less than 18. A system for persons up to 18 years of age of prophylactic measures designed to prevent dental disease. In Health Units of the National Organisation for Healthcare Services Provision, prevention and treatment services are provided obligatory once a year and free of charge for minors up to 13 years old. Co-payments made with respect to the costs of certain materials used and to certain treatments. is free of charge for: Patients under 18 years of age, patients studying at secondary school or training school, pregnant patients (from the date of recognition of pregnancy until 90 days after the birth), except: technical costs, e.g. dental prosthesis, patients above 18 years: emergency treatment; dental surgery; plaque removal and treatment of gum deformity, Health centre: Only for war veterans (full coverage). Sickness insurance: Refunded for war veterans. General scheme for employees: Refund according to fixed rates. Share borne by the insured person: 30%. Since 1 January 2005 the insured person is entitled to receive diagnosis-related fixed subsidies, which correspond to 50% of the costs of the fixed standard care determined by the Joint Federal Committee. No contribution for medically conservative treatment and for denture radiography. When the insured person takes measures to maintain healthy teeth, the benefit is increased by a bonus of 20% or 30%. In Health Units of the National Organisation for Healthcare Services Provision, partial dentures and complete dentures are provided every 5 years, as well as intermediary services whenever they are needed. For dental prosthesis necessary to restore the patient's ability to chew, co-payments are charged. Amounts are fixed by service providers. Page 3 of 8

4 Hungary (cont.) Ireland Italy Latvia patients above 60 years: emergency treatment; dental surgery; plaque removal and treatment of gum deformity plus full scale of basic and specialized treatment, (except: technical costs), without age limit: dental and dental surgical treatment relating to a basic medical problem and search for the origin of dental infection (referral is required), dental protection (according to a special regulation). Co-payments are charged in the following circumstances: orthodontic brace (under age 18), dental prosthesis (needed to restore the patient's ability to chew). Amounts are fixed by service providers. No charge for persons with full eligibility, children under 6 years of age and persons up to the age of 16 years who are attending or have attended primary school or who are/have been taught at home. For adults with full eligibility the range of treatments is limited since April 2010 due to the introduction of measures to contain expenditure on dental treatment under the Dental Services Scheme. For persons who pay pay-related social insurance contributions and their spouses the range of treatments provided are now limited due to the introduction of measures to contain expenditure on dental treatment. Patients in neither of the above categories pay full fees. Except for the payment of a small charge to be paid by those people whose income is above a given ceiling, free treatment is provided in the National Health Service centres or at registered dentists surgery. Free of charge for children up to 18 years; For children (up to 22 years) with orofacial clefts orthodontic treatment free of charge; Victims of the Chernobyl accident receive 50% coverage by the National Health Service. Lithuania Dental treatment is partially covered for adults. is free for children under 18 years. Luxembourg Comprising preservative treatment, extractions, orthodontic treatment, and prostheses. Reimbursement according to tariffs set by collective agreements. 88% reimbursement in excess of an annual sum of EUR 60 which is fully covered. Prosthetics will only be allowed in emergency circumstances approved by the Health Service Executive (HSE) due to the introduction of measures to contain expenditure on dental treatment. Paid by the beneficiary. Full price. Exception: prosthetics of partial acrylic dentures for victims of Chernobyl accident is free of charge. expenses are covered for children, disabled persons and retired persons. The level of coverage depends on the status of the patient and may vary from LTL 1,157 (EUR 335) to LTL 3,560 (EUR 1,031). Prostheses are 100% covered, unless the insured person did not regularly consult a dentist as a matter of prevention, in which case patient's participation is 80%. Supplements for prostheses and benefits which go beyond what is useful and needed are not covered. Page 4 of 8

5 Malta Free for persons suffering from a list of prescribed conditions including tuberculosis, leprosy, poliomyelitis and diabetes mellitus. In addition the following population groups are entitled to these services free-of-charge: Members of religious orders, inmates of charitable institutions, certain grades of employees in the Health Division, certain grades of employees in the police and armed forces, prisoners, persons injured on government duty (for a condition resulting from the injury). Those who satisfy a means and asset test are entitled to a Pink card and may obtain dental treatment free of charge. Asset Test: The total capital assets of the applicant should not exceed EUR 14,000 for a single person and EUR 23,300 for a married or cohabiting couple. If the head of household is selfoccupied or employed the capital assets of the whole household are assessed. However, half of the property belonging to children is excluded. If the children's property is the future home of any child who is about to marry it is totally excluded. If the head of the household is not in insurable employment or self-occupation, any member of that household who has means of his/her own which would disqualify him/her personally are excluded from the composition of the household provided that such assistance is not required for himself, in which case the assets of the whole household are taken into account. The assets do not include the house of permanent residence, the summer residence, a car and garage for personal use. Means Test includes the: total income from employment of the head of the household and his/her spouse (excl. social security contributions), 15.7% of the net wages of children, any income derived from any investments or rents (less the first EUR 95 per annum) and estimated income from property, which is not being made use of (estimated using 5% per annum after deducting EUR 585 from such capital). Exempted from the means test are Social Assistance, Sickness Assistance, Tuberculosis Assistance, Leprosy Assistance, Milk Grant, and the equivalent to the rate of National Minimum Pension. All health care beneficiaries are covered for full dental examination, investigations, preventive treatment, emergency treatment and surgery requiring general anaesthesia. This is provided to this specific group without a means test. Comprehensive dental services are offered to Pink Card holders, special population groups described above and persons suffering from coagulation disorders, valvular heart disease, physical or mental disability and head and neck cancer. The Pink Card is issued as the Medical Aids Grant under the Social Security Act and is based on an assessment of total household income which must fall below a certain threshold. School children are offered preventive care, restorative dentistry and orthodontic care. Page 5 of 8

6 Netherlands Poland Portugal Dental care for children up to 18 years of age including preventive maintenance work, fluoride applications up to twice a year from the age of 6, sealing, periodontal care and surgical treatment are included in the legally defined coverage; Adult dentures and specialist surgical treatments are only covered if it concerns a serious development disorder, growth disorder or an acquired defect of the dental/jaw/ mouth system. Other dental treatments are only covered through voluntary supplemental insurance. Basic treatment and materials included in the official list drawn up by Minister of Health are free of charge for all insured persons. Free choice among the specialists of the private sector. Reimbursement according the scale fixed by government. Romania No coverage for any dental treatment starting from 1 April Not covered. Slovak Republic Slovenia Spain Sweden Free choice among contracted doctors. Dental services are reimbursed according to prices agreed between health insurance agencies and providers. Dental examination is not paid for by the patient. The use of materials above the prescribed standard is paid for entirely by the patient. Dental care provided by a non-contracted doctor is paid for by the patient him-or herself. Free dental treatment for children and students, for others 20% additional payment. Dental prosthetic treatment of adults: 90% additional payment. Voluntary supplementary insurance for co-payments is available. Comprising extractions and certain types of treatment. In case of an accident or illness, oral and facial surgeries are also covered. Up to and including the calendar year in which a person reaches the age of 19, the person receives free dental care, which is financed by the county councils or regions. From the calendar year in which a person reaches the age of 20, the person is covered by dental care insurance. The insurance includes a high-cost protection scheme combined with a dental care voucher to encourage regular dental care check-ups. The compensation in the high-cost protection scheme is based on reference prices - 50% of the patient s costs between SEK 3,000 (EUR 345) and SEK 15,000 (EUR 1,723) and 85% of the patient s costs exceeding SEK 15,000 (EUR 1,723). Dentures: Patient's participation of 25%. The cost of dental prosthesis is covered by insurance once every 5 years. Fees paid by patient. Refund of 75% of the fee according to official scale. Certain additional co-payments (according to list of health devices). The average patient's participation is about 35%, depending on the type and the material of the dental prosthesis. The cost for a complete dental prosthesis ranges between EUR 165 and EUR 829. See dental treatment. Certain financial aids for dental prosthesis. Dental care includes dental prosthesis. See dental treatment. Page 6 of 8

7 United Kingdom There are three standard charges for NHS dental treatment GBP (EUR 21), GBP (EUR 57) or GBP (EUR 250), depending on treatment required. No charge for: women who are pregnant, or who have had a baby in the preceding 12 months, when the course of treatment starts, people under 18, those aged 19 or under and in full-time education, people and their partners who are receiving Income-related Employment and Support Allowance (ESA), Income Support or Income-based Jobseekers' Allowance, or Pension Credit Guarantee Credit, people named on a Tax Credit NHS Exemption Certificate or a valid HC2 certificate. People on a low income may be able to get help with the cost of treatment. Dental treatment in the hospital and Community Dental Services may incur a charge depending on the type of treatment carried out. See dental treatment. Iceland Dental care is fully or partially covered for children under the age of 18 as well as for national old-age and invalidity pension recipients. Dental care is not covered for the rest of the population except for treatment due to serious consequences of congenital defects, accidents or illness. A new system for children under the age of 18 is gradually being implemented and will be fully in force as from January 2017 for all age groups. According to the new system, apart from an annual co-payment of ISK 2,500 (EUR 15) paid at the beginning of the 12-month period, dental care provided to children under the age of 18 will be paid in full by the Icelandic Health Insurance provided the dentist works under a contract with the Icelandic Health Insurance and the child is registered with that dentist. Pensioners receiving national old-age or invalidity pension supplement are entitled to 75% coverage and other pensioners are entitled to 50% coverage of costs. In case of serious consequences of congenital defects, accidents or illness, the rate of coverage is 80%. If dentists do not work under a contract with the Icelandic Health Insurance, the insured patient pays in full but he/she can receive the same amount as would have been paid by the Icelandic Health Insurance as a refund. The payments or the refunds in the absence of a contract are calculated in accordance with a tariff set by the Icelandic Health Insurance. Costs of fixed prostheses and implants and full and partial dentures are covered for old-age and invalidity pensioners according to the same rules as those applying to dental treatment, subject to certain conditions. Page 7 of 8

8 Norway Switzerland Children up to 20 years of age are entitled to public basic dental care, free of charge up to 18, and against a limited charge for the remaining 2 years. Orthodontic treatment can be paid for fully or partially according to the gravity of the condition. For adults the dental care coverage is limited. Some coverage exists for dental surgery and treatment of patients carrying certain diseases or in particular need of free treatment (nursing home and long term hospital patients). Surgical interventions and cleansing in the case of gum disease/periodontitis are covered. Payment limited to cases: Caused by a serious and unavoidable disease of the mastication system, caused by any other serious illness or its after-effects (e.g. leukaemia, AIDS), necessary for the treatment of a serious illness or its after-effects, where injuries of the mastication system are caused by an accident not covered by the accident insurance. Source: MISSOC Comparative Tables Database: 1 July 2013, accessed 25 June Generally not covered. Some coverage for persons not developing teeth as they grow up and for persons having lost their teeth traumatically as a consequence of certain diseases. Replacement of teeth lost in periodontitis is paid for according to fixed tariffs. Under the same conditions as dental treatment. Page 8 of 8