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10-01-2022

Dental prosthetics: CHIF funds have dissolved the queues

Iliustracija

There are no more queues for waiting dentures reimbursed by the Compulsory Health Insurance Fund (CHIF). In recent years, sufficient CHIF funds have been allocated for these purposes and a significant number of contracts have been concluded with dental prosthetic institutions. Thus, patients can get reimbursable services much faster. With no more queues, there was no point in getting prosthetic teeth at one’s own expense, as was the case before, and then apply to the health insurance fund for compensation.

"As much as 16.4 times more funds have been allocated since 2006 to compensate for dental prosthesis services. If in 2006 2.5 million was allocated from the CHIF for these needs, in 2021 - as much as 40.9 million euros. Also, the availability of services for patients has increased significantly in recent years, as significantly more dental institutions have contracts with health insurance funds. If in 2006 there were only 83 of them, then last year there were already 963 of them, which is 11.6 times more, says Rasa Valinskaitė-Barščevičienė, Head of the Population Service Division of Kaunas Territorial Health Insurance Fund (THIF).

Pensioners, the disabled, children, patients who have received treatment for oncological disease of the mouth, face and jaws are entitled to CHIF-reimbursed dental prosthetics.

"It is important to mention that at the beginning of last year, the path from submitting an application for prosthetic teeth to providing a service to a patient was significantly shortened. Patients entitled to dental prosthesis must consult a dentist who has a contract with the THIF for the provision of dental care. This may be the institution to which the patient is enrolled, or another contract with the health insurance fund (in which case a referral is required for the service to be paid for from the CHIF budget). If the doctor determines that the patient needs a dental prosthesis and can be reimbursed for these services, the doctor registers him/her in the information system. As soon as the patient is registered by the dentist, he/she immediately acquires the right to have dentures. There is no need to wait for any notifications from the health insurance funds as before,” says R. Valinskaitė-Barščevičienė.

A person registered in the information system can apply to any institution in the country with which the THIF has a contract for dental prosthetics. These services must be provided within 3 years of the patient's registration in the information system. If the prosthetic teeth are not fitted within this period, the patient will be removed from the lists and will have to consult a dentist again for establishing the right to have prosthetic teeth.

Again, a person can receive dental prosthesis services paid from the CHIF budget 3 years after the previous reimbursement of dental prosthesis services. This 3-year period does not apply to children and patients who have been treated for oncological disease of the mouth, face and jaw and therefore no longer have minimal chewing function. For example, a retiree or disabled person with dentures this year has developed oral cancer. He underwent surgery that resulted in the loss of his teeth. For this reason, he can reapply for dentures, even though 3 years have not passed since the fitting of dentures.

When going to a medical institution, it is necessary to find out whether it has a contract with the THIF for the provision of these services. The costs of providing dental prosthesis services are paid to the institution that provided the services.

The health insurance funds recall that pensioners, the disabled and those who have received treatment for oral, maxillofacial oncology are currently reimbursed up to € 620.92 from CHIF and up to € 316.88 for children. When more complex treatment is needed (decided by the dental council), the reimbursable amount can be as high as € 1,910.49.

In all cases, if the actual cost of the dental prosthesis exceeds the reimbursable amount, the remaining part must be paid by the person. This happens when the patient wishes to have dentures using more sophisticated technologies and more expensive materials. By December 2021, more than 50,000 residents of the country had received dental prosthesis services reimbursed from the CHIF.

More information about dentures is available here.

The NHIF invites you:

Your questions are welcome by email [email protected] or phone: local (8 5) 232 2222, international +370 5 232 222

Last updated: 25-02-2022

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