Dental Scale

The dental tier limits the reimbursable amount for dental services during the first few years of the contract and gradually increases it. This is why a newly introduced plan initially provides less coverage for major dental treatments than the budget tier would suggest.

What a typical season looks like

The maximum reimbursable amount increases over several years, for example:

• First year of the contract: a limited portion of the full amount
• Second year of the contract: higher percentage, cumulative with the previous year
• Starting in the third or fourth year: full range of services

Whether a waiting period applies, how many years it lasts, and how restrictive it is varies significantly depending on the insurer and the plan. Some plans do not include a waiting period at all.

Why the season exists

Dental prosthetics is the service for which demand is easiest to predict. Anyone facing major treatment would benefit particularly from taking out a new policy without a waiting period—the waiting period helps balance out this disparity.

However, in group health insurance (bKV) under a collective bargaining agreement, this argument holds less weight than in individual insurance: The employer enrolls the entire workforce, regardless of individual medical needs. For this reason, many group plans do not include tiered coverage or have shorter coverage periods than comparable individual policies.

What this means for the rollout

A phase-in works best when attention is at its peak—during the first year after implementation. Anyone who submits a claim for dental treatment and receives less reimbursement than expected will draw conclusions about the entire supplementary health insurance plan.

Two consequences:

• When choosing a plan: For a workforce with a higher average age and corresponding dental needs, a flat-rate plan is often worth the extra cost.
• In communication: If a phase is in effect, it must be clearly stated. Nothing undermines acceptance more than a rejection that no one has announced.

Distinction from Similar Restrictions

• Waiting period: a time-based exclusion prior to the first entitlement to benefits—the sliding scale, on the other hand, limits the amount; benefits are available immediately.
• Sublimit: permanent, area-specific limit—the sliding scale expires after a few years.
• Reimbursement rate: percentage of the invoice amount — applies regardless of the contract term.

In practice, several of these limits overlap. A dental bill is first reduced by the reimbursement rate, then checked against the sliding scale and sublimit, and finally against the remaining budget.

What to Look for When Comparing Options

• Is there even a pay scale —and if so, over how many years?
• Are prior periods of insurance taken into account, for example, when changing insurers or employers?
• Are the annual amounts cumulative, or is there a separate maximum amount for each year?
• Does the plan cover only dentures, or does it also cover dental treatment and orthodontics?

Conclusion

The dental tier system is a temporary restriction with a lasting effect on how it is perceived: it affects the most expensive service at the worst possible moment. Whether it is acceptable depends on the workforce structure—and whether it is communicated determines the overall acceptance of the supplementary health insurance plan.