In short: Before any major dental work, German dentists must give you a written treatment and cost plan. It goes to your insurer for approval before treatment starts. Statutory insurance pays a fixed subsidy based on your diagnosis — not a percentage of the bill — so choosing a more expensive solution does not increase the subsidy. You do not have to sign immediately. Take it home.
For patients arriving from another healthcare system, this document causes more anxiety than the drill. It is written in administrative German, it contains numbers that appear to contradict each other, and it is usually handed over at the end of an appointment. Here is how to read it.
What the document is
Before any major restorative work — crowns, bridges, dentures, implants — the practice creates a plan listing the diagnosis, the proposed treatment and the expected costs. It is submitted to your statutory insurer, which approves the subsidy. Only then does treatment begin. This exists for your protection: there should be no invoice whose size you did not know in advance.
The fixed subsidy, and why it is fixed
German statutory insurance does not pay a percentage of your bill. It pays a fixed amount (Festzuschuss) determined by your diagnosis. The benchmark is the Regelversorgung — the standard solution considered medically adequate for that diagnosis. If you choose something more elaborate, the subsidy stays the same and you carry the difference.
This is the single most misunderstood point in German dentistry: a more expensive treatment does not attract a larger subsidy.
The three categories
- Regelversorgung — exactly the standard solution for your diagnosis. The subsidy covers the largest share; a co-payment remains.
- Gleichartige Versorgung — the standard solution plus extras, for example a ceramic facing where the standard does not include one. Subsidy unchanged, extras charged privately.
- Andersartige Versorgung — a different concept from the standard, typically an implant instead of a bridge. You still receive the subsidy for your diagnosis; the rest is invoiced privately.
What reduces the amount you pay
The Bonusheft: if you can show documented annual check-ups over five or ten years, the subsidy increases in steps. It is the cheapest way to make dentures less expensive and it costs nothing but two appointments a year. There is also a hardship provision (Härtefallregelung) for low incomes, which can cover the co-payment for standard treatment entirely.
If you hold supplementary dental insurance (Zahnzusatzversicherung), submit the plan to them before treatment begins. Many policies reimburse only if the plan was submitted in advance. Note also that treatment already diagnosed cannot usually be insured retrospectively — a policy taken out after a plan exists will not cover that work.
What to check before you sign
- Are the alternatives listed, or only the recommended solution? For almost every diagnosis there is more than one route
- Which items are medically necessary, and which are a choice?
- Are material and laboratory costs itemised separately?
- Is a bone graft, a temporary restoration or follow-up care included, or invoiced separately later?
- Does the total match the sum of the parts? Ask about anything you cannot follow
Take your time. A plan is equally valid a week later, and a second opinion is your right rather than a vote of no confidence. We go through your plan with you line by line in German, Spanish, English or Portuguese, and you take it home. Nothing is signed at the first appointment.
If you cannot pay it in one sum
Ask about instalments early — ideally during the consultation, before the plan is finalised. When you sign the plan digitally you can choose to pay in instalments and set the amount, term and start date yourself. Interest- and fee-free instalments are possible over a period of up to 36 months.
Frequently asked questions
Do I have to sign the plan straight away?
No. Take it home, read it, and ask questions. For larger treatments a second opinion is explicitly sensible.
What happens if treatment turns out more expensive than planned?
If changes become necessary during treatment, a new or supplementary plan is drawn up and discussed with you before any cost arises.
I have only been in Germany a short time and have no Bonusheft. Does that matter?
It affects only the subsidy level for dentures, and only after five documented years. Start the booklet now — it matters for treatment later, not today.
Does the plan apply to implants too?
Yes. Implants normally count as andersartige Versorgung: you receive the fixed subsidy for your diagnosis and the remainder is invoiced privately, itemised in the plan.
Can I get the plan in English?
We go through it with you in your language and explain each item. The official document itself is issued in German, because that is the version your insurer processes.
This article provides general information and does not replace a dental examination. Medically reviewed by Dr. F. J. Rodríguez Ruíz, MSc., dentist at A+ Dental, Düsseldorf-Oberkassel.