Guidebook
What exactly is this KIG? And when does statutory health insurance pay for orthodontics and braces?
The statutory health insurance funds (AOK, Techniker Krankenkasse, DAK, BKK, etc.) cover costs in connection with orthodontic treatment under certain circumstances. In the following article, you can find out more about when statutory health insurance covers orthodontic treatment costs.
Author
Dr. Fabian von Rom
Date
Estimated reading time
approx. 5 min
What is KIG
Contents
What determines whether statutory health insurance covers orthodontic treatment costs?
The KIG classification determines whether the statutory health insurance fund will cover orthodontic treatment costs. KIG stands for orthodontic indication groups. This is a classification system consisting of a letter and a number. The letter codes the type of finding. For example, U stands for an undercount of teeth, S for an obstruction of the tooth throughput or P for a lack of space. The numbers 1-5 in the KIG classification determine the severity of the respective finding. P2, for example, stands for a lack of space of up to three millimeters. P3 corresponds to a lack of space of over three and up to four millimeters. A lack of space of more than four millimeters is classified as KIG P4. There are corresponding criteria or limit values for each type of finding, i.e. for each letter.
At which KIG classification does the statutory health insurance fund cover orthodontic treatment costs?
The KIG criteria for reimbursement by statutory health insurance companies depend on the type of orthodontic treatment. A distinction is made between the following types of treatment: Early treatment, early treatment, main treatment and adult treatment.
Early treatment:
Early treatments are treatments that are started during the first tooth change phase. Early treatment is advisable if there is a risk of massive growth retardation, a significant increase in the deviation is imminent or if a delay in the start of treatment is expected to make treatment more difficult and the prognosis worse.
The guidelines of the Federal Committee of Dentists and Health Insurers (as of January 2004) provide for the assumption of costs by statutory health insurance companies for early treatment in connection with the following KIG classifications: D5, K3, K4, B4, M4, M5, P3.
Early treatment:
In the case of cleft lip, jaw, palate or other craniofacial anomalies, the conditions for early treatment are met. Further indications for early treatment under statutory insurance are the presence of an injury-related jaw malposition or a classification in KIG O5, M4 or M5. In contrast to early treatment, early treatment is not limited to six quarters.
Main treatment:
Most orthodontic treatments are started between the beginning of the second tooth change phase and the age of 18. During this phase, the patient must have a KIG of at least three or higher in order for the costs of orthodontic treatment to be covered by the contract dentist.
Adult treatment:
After the age of 18, orthodontics is only covered by health insurance in a few exceptional cases. For this, a severe jaw anomaly must be present, the treatment of which requires a combined orthodontic-jaw surgery procedure. In addition, the malocclusion must be assignable to at least one of the following KIG classes: A5, D4, M4, O5, B4 or K4.
How is the KIG classification made?
In many cases, an orthodontist is able to determine at the first appointment and without further diagnostic aids whether the patient’s KIG classification is sufficient for the costs to be covered by statutory insurance. In some cases, additional diagnostic tools are required for the assessment. For example, an X-ray may be required to diagnose tooth displacement or non-alignment. In borderline cases, models of the teeth and jaws are made for exact measurement.
What happens if there is an indication (KIG) for orthodontic treatment?
Once it has been established that there is an indication for orthodontic treatment under the statutory health insurance scheme and the patient wishes to undergo treatment, complete diagnostic documentation is prepared and evaluated. This includes photos, x-rays and models. A treatment plan is drawn up on this basis, which must be approved by the health insurance company before treatment can begin. In some cases, an assessment is carried out by an expert before approval. Once the orthodontic treatment plan has been approved by the health insurance company, treatment can begin.
No KIG – What options are there for orthodontic treatment outside of statutory health insurance?
If the statutory health insurance does not cover the costs of orthodontic treatment to a sufficient degree of severity (KIG), private treatment can be agreed with the orthodontist. Any existing supplementary dental insurance policies often cover the costs if the statutory health insurance does not. We offer interest-free installment payments at our specialist orthodontic practice in Munich-Unterföhring to patients who have neither a sufficient KIG classification for statutory insurance nor the corresponding supplementary insurance. In this way, the financial burden of private orthodontic treatment can be kept calculable and manageable.
Your expert for orthodontics
Dr. Fabian von Rom
In the specialist practice for orthodontics, Dr. med, dent. Fabian von Rom uses his extensive expertise and many years of experience to offer patients the best possible care. The practice offers the entire spectrum of modern orthodontics and specializes in innovative and advanced treatment methods. In addition to traditional procedures, the focus is on treatment with invisible braces for teenagers and adults – one of the most modern and discreet solutions in orthodontics. Dr. med. dent. Fabian von Rom attaches great importance to ensuring that medical precision goes hand in hand with a high level of patient satisfaction. By equipping the practice exclusively with individual treatment rooms, individual and professional care at the highest level is guaranteed.
Further topics
In our guide you will find lots more information on current, relevant and interesting topics relating to orthodontics. We hope you enjoy reading it!
