§ 8 Regulations on the reimbursement of sickness and disability costs for supplementary benefits (RKEL) - Dental Treatment Costs

1. Costs for simple, economical, and appropriate dental treatments are reimbursed according to the treatment recommendations of the Swiss Cantonal Dentists. Additionally, the conditions outlined in paragraphs 4 to 8 must be met.

2. The tariff for accident, military, and disability insurance (UV/MV/IV tariff) concerning the remuneration of dental services and the UV/MV/IV tariff for dental technical work is decisive for the reimbursement.

3. Cost estimates and invoices must be submitted according to the tariff positions of the UV/MV/IV tariff and must be conclusive.

4. Costs under 1,000 francs can be submitted without a cost estimate if the treatment is conclusive. If treatment over 3,000 francs is carried out without an approved cost estimate, EL covers a maximum of 1,000 francs.

5. If the costs of a dental treatment, including the dental technical laboratory, are expected to exceed 1,000 francs, a cost estimate and the X-rays must be submitted to the AKSO before treatment.

6. If the costs of a dental treatment exceed 3,000 francs, before treatment, the clarification form, a cost estimate for the dental services as well as any possible dental technical laboratory, and the X-rays must be submitted to the AKSO.

7. To confirm coverage of anesthesia costs, a medical certificate must be presented. The necessity of a general anesthesia must be related to a physical or mental disability. Additional costs of up to 2,000 francs can be reimbursed. Priorly, a contribution from disability insurance or health insurance should be considered.

8. For orthodontic treatments, the clarification form, treatment plan, as well as the orthopantomography (OPT/OPG) and the study model must be submitted to the AKSO before the start of treatment. If this procedure is not followed, the total costs for orthodontic treatment will not be reimbursed.

9. The AKSO may arrange for an assessment directly with a trusted dentist.

← § 7 RKEL Regulations on the reimbursement of sickness and disability costs for supplementary benefits (RKEL) - Principle § 9 RKEL - Diet Costs →