Hardship provision for those in poverty, low-earners and students

What is hardship provision?

Patients who are socially deprived receive a 100% bonus regardless of the bonus booklet. This means double the fixed subsidy with regards to the provision of dentures. Whether there is a hardship case depends above all on the level on monthly income, and this must be clarified before application for dentures.

The health insurance company will always request proof of the financial situation of the insured person.

The following groups of people can make use of the hardship provision regarding dentures:

• Policyholders with a gross income of under 1134 euros
• Policyholders who live together with a relative and make less than 1559.25 euros gross income per month
• Recipients of unemployment benefits (Hartz IV)
• Recipients of basic income support for the elderly
• Recipients of basic income support for persons with reduced earning capacity
• Those covered by statutory insurance who live in a home the costs of which are covered by a social agency
• Welfare recipients
• Recipients of governmental funding for students and trainees (BAFöG)

If the 100% bonus is not sufficient to pay the actual costs of dentures in a case of hardship, the health insurances company must also pay the costs which exceed the doubled fixed subsidy. However, this only applies within a standard care treatment (in other words, basic care). If a treatment is desired which exceeds basic care, the health insurance company will not pay the additional costs.

Applicable hardship provisions

If your personal gross income does not significantly exceed the income limits, you may also be able to benefit from the hardship provisions. The following special legal arrangement applies here: The co-payment which must be paid by the patient may not exceed three times the total of the excesses.