COSTS AND COVERAGE

COVERAGE OF COSTS RELATING TO ORTHODONTIC CARE UNDER HEALTH INSURANCE

Orthodontic treatments are covered by the state sickness benefits fund in France (Assurance Maladie) if they begin before the patient’s 16th birthday and providing the prior agreement of the sickness benefits fund to which the patient is affiliated has been obtained.

In certain circumstances, children over 16 years of age and adults can benefit from coverage by the sickness benefits fund for six months of treatment prior to a surgical intervention on the jaws. This six-month period is non-renewable.

Once a patient has reached 16 years of age, orthodontic care is no longer covered by the sickness benefits fund.

PRIOR APPROVAL REQUESTS

A form requesting prior approval for treatment (CERFA form no. S3150) will be filled in by the patient’s orthodontist, completed by the insured party, signed and then submitted to the sickness benefits fund to which the patient is affiliated.

After a 15-day period, if the patient has not heard back from the sickness benefits fund to which the request was submitted, their request can be considered as having been approved.

Patients should be aware that approval granted by the sickness benefits fund is valid for a period of 6 months.

It is, therefore, necessary to start treatment within 6 months of approval being granted.

Costs incurred for any treatment starting after expiry of that period will not be covered.

TARIFFS AND REIMBURSEMENT FOR ORTHODONTIC TREATMENTS

Tariffs for orthodontic treatments are unrestricted.

 

The difference between the amount of fees paid and the amount reimbursed by the sickness benefits fund may be covered by your complementary healthcare insurance provided that your policy covers the treatment delivered.

Do not hesitate to contact your complementary healthcare insurance provider for more specific information.

 

 

DID YOU KNOW?

 

Prior to commencing treatment, your orthodontic specialist will give you a detailed estimate to sign to show your agreement.