Free dental care for disability pensioners depends on certain criteria

Since 2019, the EHIF has expanded free dental care for people with severe physical and mental disabilities, who are unable to take care of their oral hygiene. The Health Insurance Fund will compensate disability pensioners for their dental care in full amount, if the patient has been diagnosed with a need for life-long dental care.

Külli Fridemann, Head of the Primary Care Package Division of the Health Insurance Fund, points out that free dental care does not apply to all disabled individuals. "The Health Insurance Fund has set certain criteria that a condition of a disability pensioner has to meet in order to qualify for free dental care. It is important to note that the right to free dental care is determined by the patient's doctor, not by their dentist. People should first consult with the patient’s attending physician and make sure that such diagnosis has been made, "explains Friedemann. 

Criteria for free dental care for disability pensioners

Criteria to be used by an attending physician or family physician to determine the need for life-long dental care:

Psychic peculiarities of personality that are independent of direct nosology of the disease, and which makes a patient unable to take care of their oral hygiene even with adequate instruction:

• Intellectual disability (profound mental retardation)
• Autism spectrum disorder
• Dementia
• Other psychiatric abnormalities (such as chronic severe psychosis).

Physical, disease-related conditions due to which a person is unable to perform oral hygiene procedures

• Paralysis that involve both upper extremities and is caused by central nervous system or neuromuscular unit disease
• Movement disorders such as Parkinson's syndrome, generalized dystonia, severe chorea
• Congenital or acquired physical peculiarities, such as lack of a limb or its significant part due to underdevelopment or amputation due to which the person is unable to take care of their oral hygiene

If, based on the said criteria, a family physician or a medical specialist finds it necessary to prescribe a disabled person life-long dental care, the physician will indicate the statistical code (9072) on the medical bill in the system, based on which the Health Insurance Fund will compensate for the dental care of the patient.

Friedemann explained that this year, the service is still in a testing phase, and initial criteria have been set for the reasons why disability pensioners might need fully paid life-long dental care. "If necessary, these criteria will be supplemented once it has become clear to which patients, according to the doctors' opinion, free dental care should be extended", she adds.

It may take up to two months for free scheduled dental care to become effective for a disability pensioner. According to Fridemann, the delay is due to the data exchange between the information systems, which is necessary for having an entry in the system that verifies a patient’s need for life-long dental care. She adds that if a person cannot wait that long and his/her health problem is urgent then he/she will be provided free emergency medical care.

If a patient's life-long dental care indication can be seen in the system, the person can contact their dentist to see if the health care institution has signed a health insurance agreement with the Health Insurance Fund and book a dentist appointment.

There are a number of factors to consider when booking a dentist appointment for a disabled person. "The caller must be prepared to provide information about the condition of the disabled person. For example, the dentist must be informed whether a disabled person is able to sit in a dentist's chair, open his/her mouth, and whether he/she is able to understand dentist’s instructions. They must also point out when was the last time the disabled person visited a dentist and what was his/her previous experience like," explains Friedemann.

Booking a dentist appointment

There are a number of factors to consider when booking a dentist appointment for a disabled person:

• Find out whether the health care institution has signed an agreement (pediatric dentistry insurance) with the Health Insurance Fund.
• You have to provide the patient’s personal identification code to book an appointment.
• The caller must be prepared to provide information about the condition of the disabled person:
  • description of the disability (physical, mental)
  • Does a person move independently or uses a wheelchair?
  • Is a person able to sit in a dental chair by him/herself?
  • Is a person able to understand a dentist’s instructions and what is happening?
  • Can a person describe, for example, the nature of his/her toothache?
  • Is the person able to keep the mouth open and, if necessary, stay still?
  • For how long is the patient able to lie on a dentist chair? Is a visit that lasts more than half an hour too exhausting for the patient?