If you are a student and need dental prosthetics (Zahnersatz), you will quickly notice that statutory health insurance does not cover everything. Dental prosthetics are supported by a fixed subsidy (Festzuschuss) that is based on the standard treatment. This guide explains what your fund pays, how the treatment and cost plan works and why the bonus booklet can be worth money.
Short answer: For dental prosthetics, statutory health insurance pays a fixed subsidy towards the standard treatment (section 55 SGB V). If you choose a higher-value treatment, you pay the difference yourself. If you document regular check-ups, the bonus booklet increases the subsidy. Status October 2026.
The most important points
- For dental prosthetics, statutory health insurance pays a fixed subsidy, not full reimbursement of costs.
- The subsidy is based on the standard treatment, that is the medically sufficient basic treatment.
- Before treatment, the dentist prepares a treatment and cost plan (Heil- und Kostenplan), which the fund checks.
- Regular preventive check-ups, documented in the bonus booklet (Bonusheft), increase the subsidy.
- You pay the difference between the chosen treatment and the subsidy yourself.
What your fund pays for dental prosthetics
The statutory entitlement to dental prosthetics is set out in the Social Code Book V. The basis is section 55 SGB V. The table explains the terms you will meet on the way to treatment.
| Term | What it means | Where you find it |
|---|---|---|
| Fixed subsidy (Festzuschuss) | A fixed share of the costs of the standard treatment, regardless of the final bill | Treatment and cost plan |
| Standard treatment (Regelversorgung) | The standard dental prosthetic that is medically sufficient | Treatment and cost plan |
| Bonus booklet (Bonusheft) | Proof of regular preventive check-ups, which can increase the subsidy | Bonus booklet at the dental practice |
| Treatment and cost plan (Heil- und Kostenplan) | A plan with findings, treatment and costs, which the fund checks before treatment starts | Prepared by the dentist, submitted to the fund |
Since the reform, the fixed subsidy depends on the findings. The amount depends on which finding is present and which treatment is provided for it. Two students with similar needs can therefore receive different amounts. Do not compare your figures with those of friends, but read your own plan.
The subsidy does not depend on your preferred solution, but on the standard treatment. This is the point many students overlook at the first cost estimate.
Why the treatment and cost plan matters
The treatment and cost plan is the most important document before dental prosthetics treatment. It shows which treatment the dentist considers medically necessary, which standard treatment the fund subsidises and what you pay yourself. Always ask for a written version before you agree.
- Ask for the treatment and cost plan before treatment and find out which treatment counts as the standard treatment.
- Check which additional costs arise for the materials or methods you want, and whether you want to bear them.
- Submit the plan to your statutory health insurance fund. The fund checks it and tells you the subsidy.
- If you have not received a reply in time, ask in writing. For a dental expert procedure, the fund has six or four weeks under section 13 para. 3a SGB V.
An important point is in the same provision: if the fund does not respond within the deadline without a sufficient reason, the benefit is considered approved after the deadline has expired. In that case, ask in writing so that you can document the status. The deadlines follow the statutory rules, status October 2026, as set out in section 13 SGB V.
The bonus booklet: preventive care pays off
The bonus booklet is an underrated document for many students. If you go to dental preventive check-ups regularly and have the dates recorded in the booklet, you receive a higher subsidy for later dental prosthetics. The bonus depends on uninterrupted check-ups, so gaps in the proof can put it at risk.
The exact levels of the bonus and the requirements for proof are set out in the bonus booklet itself and in the rules on subsidies. Check the percentages there before treatment, because they can change. If you are unsure, ask your health insurance fund or the dental practice.
What you pay yourself: a calculation example
Your own share results from the difference between the total costs and the fixed subsidy. The following example uses freely chosen figures so that the calculation is easy to follow.
- Assumption: The treatment you want costs 1,200 euros in total.
- Assumption: The fixed subsidy of the fund is 500 euros.
- Your share without the bonus: 1,200 minus 500 equals 700 euros.
- Assumption: With a bonus booklet, the subsidy rises to 560 euros.
- Your share with the bonus: 1,200 minus 560 equals 640 euros.
The difference in the example is 60 euros. The real figures are in your treatment and cost plan. The calculation shows, however, that a complete bonus booklet makes a noticeable difference for any larger treatment.
Studies, moving and changing funds
Changing your health insurance fund does not change the statutory subsidies, because they apply to all statutory members. Still, take your documents with you so that the bonus booklet stays complete. If you move to another university, you can change the dental practice or keep going there. What matters is that the bonus booklet is continued.
Plan larger treatments as early as possible. If you need dental prosthetics in the middle of a semester or shortly before an exam period, appointments can quickly clash. A treatment and cost plan takes time, and so does the fund. A buffer of time helps to avoid stress.
Frequently asked questions
Does the fund pay a crown in full?
No. The fund pays the fixed subsidy towards the standard treatment. If you choose a higher-value treatment, you pay the difference yourself. Ask your dentist explicitly about the standard treatment and have the additional costs itemised separately.
Do I have to get dental prosthetics approved in advance?
Yes, a treatment and cost plan is submitted before treatment starts. The fund checks it and communicates the fixed subsidy. Only then do you decide whether to go ahead with the treatment in the planned form.
What if the dentist suggests a more expensive solution?
You can ask questions, take time to think and get a second opinion. The standard treatment remains the basis for the fixed subsidy. If you want a more expensive solution, ask for the costs in writing and compare them with the plan for the standard treatment.
Does a dental supplementary insurance help?
Additional cover can reduce your own share. Whether it is worth it depends on benefits, waiting periods, contributions and your personal situation. Compare the conditions carefully and read the small print before you sign anything. A personal assessment can help you check tariffs against your needs.
How do I recognise a good dental practice?
Look for clear information about alternatives and costs. A reputable practice explains the standard treatment, shows the advantages and disadvantages of materials and gives you time to decide. Have the cost plan explained to you before you sign. A second opinion is common for larger treatments and can remove uncertainty.
What to do now
- Keep a bonus booklet from the start of your studies and have the preventive dates recorded.
- For larger treatments, ask for the treatment and cost plan in writing.
- Submit the plan to your health insurance fund and wait for the notice of the fixed subsidy.
- Compare your share with your budget before you agree to the treatment.
Related reading
- Was zahlt die gesetzliche Krankenkasse nicht? Die wichtigsten Lücken (in German)
- Krankenkassen mit Zahnreinigung für Studierende
- Zahnarztkosten in der PKV: Beispiele und Erstattung im Studium (in German)
- Kassenwechsel Schritt für Schritt: Kündigungsvorlage und Fristen
Sources: Section 55 SGB V, fixed subsidy for dental prosthetics (retrieved October 2026), Section 13 SGB V, reimbursement and deadlines (retrieved October 2026), Federal Joint Committee (G-BA), rules on fixed subsidies (status October 2026).
Last updated: October 2026. This guide is general information, not individual advice.
