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.


An insured person who lives alone has a monthly gross income of 1250 euros. The basic care for the required denture costs 800 euros. The statutory health insurance company therefore subsidizes the denture to the amount of 400 euros.

The hardship limit for single people is 1162 euros. The acceptable liability is then calculated as following:
(1250 euros – 1162 euros) x 3 = 264 euros

The actual liability is 400 euros.

The actual liability thus exceeds the acceptable liability by 136 euros.

The statutory health insurance company therefore increases its subsidy by 136 euros to a total of 536 euros.


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