What is dental insurance?: Why subscribe to it?

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A dental health mutual covers dental costs not reimbursed by Social Security. The cost of dental costs (consultations and interventions) can be very expensive, so it is very advantageous to call on health insurance to complete your care. Especially since dental surgeons or stomatologists generally practice excess fees, which are not covered by social security. Dental costs are reimbursed only up to 70% by social security (based on the basis of conventional rates). It is therefore wise to have complementary health insurance. Your mutual health insurance compensates you for:
  • Part or all of the excess fees
  • Certain dental care not covered by health insurance
  • The moderating ticket which constitutes your remaining charge to be paid
Subscribing to Self Assurance dental insurance is an excellent way to preserve your wallet during your visits to the dentist. think about it

What’s orthodontia?

Orthodontics is a medical specialty aimed at correcting an anomaly related to poor dental and bone position. Teeth in the wrong position can lead to certain problems that spoil your daily life, such as headaches, neck and shoulder problems, and pain.

Orthodontic care applies free fees

The price of orthodontic treatments is set freely by the dental surgeon or stomatologist, unlike so-called conventional dental consultations and care. Health insurance, in order to delimit its scope of intervention, asks it to set its fees and to inform the patient via an estimate. This must be detailed and written in a formal manner At the end of the consultation, the orthodontist must establish an estimate presenting the following information:
  • A detailed description of the treatment provided and/or materials used
  • The number of fees corresponding to the treatment;
  • The amount reimbursed by Health Insurance;
  • Any additional supplements
This document must be sent to the mutual insurance company to benefit from reimbursement by the health insurance. It is strongly advised to obtain an estimate from your orthodontist, in order to benefit, if necessary, from the reimbursement of your dental expenses by your mutual health insurance.

Reimbursed care

What does my health insurance reimburse?

Following the reimbursement of part of the dental health costs by the health insurance, a sum remains the responsibility of the insured. Mutual health insurance reimburses the part not covered by social security depending on the formula chosen. There are three types of care performed by a dental surgeon:
  • Conservative care (scaling, cavities)
  • Surgical care (extraction)
  • Preventive care (sealing of furrows)
Routine dental care such as cavities or the devitalization of a tooth or scaling is covered at 70% of the BRSS by Social Security. The dental mutual reimburses you for all your remaining costs and you have nothing more to pay. Some so-called heavy dental care or surgery is very poorly reimbursed or even not reimbursed at all by social security, hence the fact of subscribing to mutual health insurance. These treatments concern:
  • Typical dental prostheses (crowns, bridges). They are classified into three categories: those which are reimbursed at 100% thanks to the reform of the remainder at zero charges (or 1 00% health), those reimbursed by health insurance, those whose tariffs are free, the remainder at for this category is the highest
  • Dental implants correspond to the support of a crown that is implanted in your jawbone. It is never reimbursed by Social Security but can be covered by your complementary health insurance.
  • Orthodontics: Dental appliances are not reimbursed for patients over 16 years old, if you do not have mutual insurance, the rest for children can be very expensive.
For patients over the age of 16, treatment is reimbursed by your complementary health insurance up to your guarantees.
  • Periodontology encompasses the care of the gums. It is never reimbursed by Social Security but can be covered by your mutual health insurance.

Two types of reimbursement are provided by your dental insurance

  • The lump-sum reimbursement corresponds to a sum of money granted monthly or annually to reimburse your dental expenses. On the other hand, the overruns of the envelope are your responsibility
  • The percentage reimbursement is set as a percentage of the health insurance agreement rate. It can reach up to 800% of it. Thus a dental mutual offering for example a rate of 500%, will reimburse you up to 5 times the amount of the part taken by social security.

Reimbursement of prostheses includes the remainder at zero charge

New dental care is now affected by the remainder at zero charges. They concern :
  • Monolithic ceramic crowns (other than zirconia) and ceramic-metallic crowns on visible teeth, monolithic ceramic zirconia crowns (incisors, canines, and 1st premolar);
  • Monolithic zirconia ceramic crowns
  • Metal crowns any location
  • Core inlays and temporary crowns
  • Metal-ceramic bridges (incisors)
  • Metal bridges in any location
  • Resin-based removable prostheses
The choice of a dental mutual is sometimes complex. To find your way, read your health insurance contract carefully, beforehand you must know the reimbursement rate for consultations, and dental care such as scaling, cavities, and others. Similarly, for orthodontic costs and dental prostheses which are very expensive, find out before subscribing to mutual health insurance, this will allow you to benefit from optimal reimbursement of your dental costs. Waiting period
What is the waiting period?
The waiting period corresponds to a period during which the insured will not be compensated. This period varies according to the insurance companies and appears in the terms of the health contract. Find out beforehand to fully understand the waiting periods imposed by your insurer.

Why does the waiting period exist?

The waiting period was introduced by insurers to dissuade policyholders from excessively consuming their healthcare costs.

Mutual without waiting period: does it exist?

Yes, on behalf of Self Assurance we have no waiting period, regardless of the type of your health expenses, so do not hesitate to consult our guarantees. This is a very good solution if you have been canceled by your insurer and you find yourself without complementary health insurance overnight.
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