08.04.2025
KIG levels: what statutory health insurance covers – and what it does not
Statutory health insurance pays for orthodontic treatment in children and adolescents when the findings fall into orthodontic indication group 3, 4 or 5. Groups 1 and 2 count as minor deviations; they are not covered, even when they are visible.
Measurement is in millimetres and follows fixed criteria: how far the front teeth protrude, how large the gap or the crowding is, whether teeth are displaced, whether the bite is crossed at the side or open. The classification is made by the practice; it is verifiable and is submitted with the application.
Once treatment is approved, the insurance covers the standard-benefit share, but initially pays out only 80 percent of it; the remaining 20 percent is reimbursed after the treatment is completed. For siblings the personal share drops to 10 percent. Anyone who breaks off the treatment does not get this share back.
Everything that goes beyond the standard benefit – tooth-coloured brackets, aligners, certain retainers – is a private additional service and is agreed in writing beforehand. Have this part itemised separately, then you can see what you are paying for.