Protection for your child

Braces, glasses, hospital: what the statutory fund does not pay for

The gaps nobody mentions in German children’s healthcare

For mild misalignments the statutory fund pays nothing at all
Grading happens at eight or nine — after that it is too late
Where supplementary cover is worth it and where it is not

45 minutes · free · no obligation · in English

In short

The answer in 30 seconds

Supplementary health insurance makes plannable what statutory insurance does not pay for your child: braces, senior-physician treatment, single rooms, glasses, cover abroad. Braces in particular hit many families with four-figure bills — insured early they become a formality, because you must sign before the need is diagnosed.

Braces: often four figures — insured before the diagnosis exists
Senior physicians and single rooms when it gets serious
Worldwide cover for holidays and exchange years
Signing early = a health check without hurdles

In short

Does my child need supplementary health insurance in Germany?

It depends — and with braces most starkly. Statutory health insurance covers orthodontic treatment only from KIG grade 3. At grades 1 and 2 — mild and slight misalignments — it pays nothing, neither the treatment nor the brace.

And even where the fund does pay, you first carry a 20 percent patient contribution (10 percent if several siblings are treated at the same time). The fund refunds that amount once the treatment is successfully completed. What is not refunded are comfort and material extras: tooth-coloured brackets, titanium wires, sealing.

The catch is the timing: the grading is done by an orthodontist, usually at the age of eight or nine. A supplementary policy taken out after the diagnosis will, as a rule, no longer pay for that treatment — it is then an insured event that has already occurred. Anyone who wants cover has to arrange it beforehand.

Try it yourself

Does the statutory fund pay for a child’s braces?

Orthodontists grade every misalignment into one of five orthodontic indication groups (KIG). Switch the grade and see where statutory cover begins.

What parents want to know

The ticks change with the KIG grade you pick on the right.

Does the statutory fund pay? Does public health insurance cover the treatment at all?
Fixed brace and treatment The medically necessary standard care.
Materials and comfort Tooth-coloured brackets, titanium wires, sealing.
Patient contribution What you have to advance — and whether you get it back.

KIG 1 KIG 2 KIG 3 KIG 4 KIG 5

KIG 1

Mild misalignment

0 of 4 met

The statutory health fund pays nothing — neither treatment nor brace.

Does the statutory fund pay?: Corrections at grades 1 and 2 fall outside the scope of statutory health insurance.
Fixed brace and treatment: Entirely private — a four-figure sum depending on the work involved.
Materials and comfort: Private.
Patient contribution: There is no patient contribution because there is no statutory benefit. You pay everything.

Verbraucherzentrale (German consumer advice centres): patient contribution, statutory cover and additional costs at the orthodontist.

KIG 2

Slight misalignment

0 of 4 met

Also not covered. This is where statutory care ends.

Does the statutory fund pay?: As with KIG 1: outside the scope of statutory health insurance.
Fixed brace and treatment: Entirely private.
Materials and comfort: Private.
Patient contribution: No statutory benefit, no patient contribution — the full cost sits with you.

Verbraucherzentrale (German consumer advice centres): patient contribution, statutory cover and additional costs at the orthodontist.

KIG 3

Pronounced misalignment

2 of 4 met

From here the fund pays — for the medically necessary standard care.

Does the statutory fund pay?: From KIG 3 statutory health insurance covers the treatment.
Fixed brace and treatment: The medically necessary care is covered.
Materials and comfort: Tooth-coloured brackets, titanium wires and sealing count as comfort or cosmetic services and are paid privately.
Patient contribution: You advance 20 percent of the cost. With several siblings treated at the same time it is 10 percent. On successful completion the fund refunds it.

Verbraucherzentrale (German consumer advice centres): patient contribution, statutory cover and additional costs at the orthodontist.

KIG 4

Strongly pronounced misalignment

2 of 4 met

Covered as with KIG 3 — the treatment is usually more involved and longer.

Does the statutory fund pay?: Covered.
Fixed brace and treatment: The necessary care is covered.
Materials and comfort: Still private.
Patient contribution: Advance 20 percent, refunded on successful completion.

KIG 5

Extremely pronounced misalignment

2 of 4 met

Covered. The grading is done by the orthodontist, not by you.

Does the statutory fund pay?: Covered.
Fixed brace and treatment: The necessary care is covered.
Materials and comfort: Still private.
Patient contribution: Advance 20 percent, refunded on successful completion.

The step between KIG 2 and KIG 3 is the most expensive threshold in children’s healthcare here: on one side the fund pays nothing, on the other almost everything. And which grade your child receives is only settled once an orthodontist has examined them — usually at eight or nine. A supplementary policy taken out after that will, as a rule, no longer pay for that treatment.

Is it worth it in your case — or not?

That depends on your children’s ages, your budget and what you already have in place. In the clarity call we also say so when the honest answer is “you do not need this”.

Book your free clarity call

The four components

Which supplementary cover is worth it for a child?

There is no shortage of supplementary policies for children. Only some of them close a gap that actually hurts.

Dental cover including orthodontics

The component with the largest gap — and the narrowest window.

Roughly half of all children need braces during their school years. Whether the fund pays depends on the KIG grading, and nobody knows that in advance.

What to look for

Benefits at KIG 1 and 2 — that is the actual point. Tariffs that only pay from KIG 3 supplement the fund but do not close the gap.
Reimbursement rate and cap, often staggered over the first few policy years.
Waiting periods — many tariffs pay nothing in the first months.
No ongoing treatment, no diagnosis at the time of application. That is the hard line.

In practice: if you want cover, take it out while the child is small and no orthodontist has looked yet.

Verbraucherzentrale (German consumer advice centres): patient contribution, statutory cover and additional costs at the orthodontist.

Glasses and vision aids

For under-18s the fund pays for lenses — but only up to fixed amounts.

Since 2017 people under 18 with statutory insurance are again entitled to a contribution towards spectacle lenses, regardless of the strength of the prescription. What is paid, however, are fixed amounts for the lenses — not the frame, and not the surcharges for thinner, anti-reflective or especially shatterproof lenses.

When a component is worth it

For children who wear glasses permanently and replace them regularly — through growth, breakage or loss — the cost adds up. For a mild prescription that does not change, less so. Honestly: this is the component you can most readily do without.

Inpatient supplementary cover

Private room and senior consultant — the component that costs most and is needed least.

It raises comfort in hospital. For children the practically relevant point is usually a different one: a parent being admitted alongside.

What already applies by law

For children up to a certain age the statutory fund covers a parent staying with them where it is medically necessary. For older children, or where necessity is contested, a supplementary component can make sense.

We regularly advise against this one: for most families the money is better placed in dental cover or in the savings plan than in a two-bed room.

When supplementary cover does not make sense

When it insures a risk you could pay out of pocket — or when the event has already happened.

Insurance is worth it for losses that would hit you seriously. Below that, saving is cheaper than insuring, because otherwise you are paying the insurer’s administration costs for a risk you could carry yourself.

Three cases where we advise against it

The diagnosis already exists. The insured event has occurred and the tariff will not pay for that treatment.
The component only pays from KIG 3. Then it does not close the gap in question.
The premium comes out of basic protection. A missing personal liability policy is a far bigger hole than a missing two-bed room.

Common questions about supplementary health cover for children

At what age should I take out dental cover for my child?

As early as possible, and in any case before an orthodontist has assessed the teeth. Grading usually happens at eight or nine. After that, a misalignment already established counts as an insured event that has occurred, and the tariff will not pay for that treatment.

What is the KIG grading?

Orthodontic indication groups — a scale from 1 to 5 used to assess misalignments since 2002. Statutory health insurance pays from grade 3. At grades 1 and 2 there is no benefit at all. The grading is done by the orthodontist.

Do I get the 20 percent patient contribution back?

Yes, if the treatment is successfully completed — then the fund refunds the amount you advanced. Where several siblings are treated at the same time the contribution drops to 10 percent. If treatment is broken off, the money is gone.

Does the fund pay for my child’s glasses?

For children and young people under 18 there are fixed amounts for the lenses, regardless of the prescription. Not covered are the frame and surcharges for thinner, anti-reflective or especially shatterproof lenses. For children who replace their glasses often, that adds up.

Is private health insurance worth it for my child?

That is a different and far more consequential decision than supplementary cover — it depends on the parents’ status and is hard to reverse. We go through it in the call with your actual circumstances, rather than give a blanket answer here that would be wrong for half the readers.

What matters more: supplementary cover or a savings plan?

First the protection against what would hit you seriously — personal liability and, if you own property, the building. Then long-term wealth-building. Comfort components last. Reverse the order and you end up with a fine savings plan and a large hole.

Context

This page is general information and does not replace advice tailored to your situation. What a specific tariff actually covers is set out in its terms and conditions — the differences between two offers carrying the same name are considerable. Figures and rates quoted are market values as of the stated date and are not a commitment.

ETF4Kids is a licensed insurance broker under § 34d of the German Trade Regulation Act, supervised by the Chamber of Commerce (IHK) Region Stuttgart. As a broker we are legally obliged to advise in our clients’ interest. We are neither legal nor tax advisers; where a question belongs there, we say so.

What do you actually need — and what not?

In the clarity call we go through the order: what belongs first, where supplementary cover closes a real gap, and where it only costs money. 45 minutes, free, in English.

Book your free clarity call