High cost protection at a certain threshold
In order to ensure that dental care does not cost too much, there is a high cost protection to support you after you have paid a certain amount for your dental care. This high cost protection is somewhat different from the high cost protection for healthcare, as the threshold is higher and the insurance only covers parts of your additional expenses.
Financial support for more expensive dental care
Somewhat simplified, the high cost protection means that you pay the total cost for all dental care up to SEK 3,000, and then receive financial support that cover parts of your additional expenses. The more expensive the procedure, the greater the financial support. You will receive a price reduction of
- 50 percent for expenses between SEK 3,001 and SEK 15,000
- 85 percent for expenses over SEK 15,000
Dental care costs
Up to SEK 3,000
You paid the entire cost
Between SEK 3,001 and SEK 15,000
You pay 50% - the Swedish Social Insurance Agency pays 50%
You pay 15% - the Swedish Social Insurance Agency pays 85%
Your dental care costs are accumulated over a 12-month period, after which they are reset. If your treatment is not completed within a 12-month period, you will start a new period and start paying your normal rate again. You are responsible for keeping track of the dates for these periods.
It is possible to reset the period and start a new one within less than twelve months. This might be beneficial if you, for example, have already started a period but will be soon undergo an expensive dental procedure that will continue past the final date of your current period. You cannot change the start date retrospectively.
Your dental clinic receives information from the Swedish Social Insurance Agency on how much of the dental care will by counted towards your high cost protection. If you switch dental care provider, your new provider will be able to see the current status of your high cost protection.
You can use your high cost protection as from 1 January of the year you turn 20 years old.
The more expensive, the greater the financial support
Below are two examples of how the high cost protection affects how much you pay in the end.
You receive check-ups and treatments for a cost of SEK 10,000.
First, you pay SEK 3,000 yourself.
Then, you pay 50% of the cost between SEK 3,001 and SEK 15,000, which in this case is 50% of SEK 7,000 = SEK 3,500.
In total, you pay SEK 3,000 + SEK 3,500 = SEK 6,500.
Thanks to the high cost protection, you pay SEK 6,500 instead of SEK 10,000.
You receive check-ups and treatments for a cost of SEK 24,000.
First, you pay SEK 3,000 yourself.
Then, you pay 50% of the cost between SEK 3,001 and SEK 15,000, which in this case is 50% of SEK 12,000 = SEK 6,000.
Finally, you pay 15% of the cost that exceeds SEK 15,000, which in this case is 15% of SEK 9,000 = SEK 1,350.
In total, you pay SEK 3,000 + SEK 6,000 + SEK 1,350 = SEK 10,350.
Thanks to the high cost protection, you pay SEK 10,350 instead of SEK 24,000.
Not everything is covered
There are rules that determine which check-ups, procedures and materials are covered by the high cost protection. If you choose a dental procedure that is not covered by the high cost protection at all, then you will have to pay for all the costs yourself. Sometimes, you can receive financial support for parts of the treatment.
Your dentist or dental hygienist has an obligation to inform you about which parts of the procedure are covered.
Which check-ups and procedures are covered?
The mouth is divided into four parts. Part one is the right side of the upper jaw, part two is the left side of the upper jaw, part three is the left side of the lower jaw and part four is the right side of the lower jaw. The teeth in each part are numbered from 1 to 8. Procedures involving tooth 1 to 6 are more or less always covered by the high cost protection.
Each tooth has a unique number based on in which part of the mouth it is located. For example, the teeth in part 3 are numbered 31, 32 ,33, 34 and so on. You have the right to financial support for all check-ups and most dental procedures. However, you do not receive financial support for cosmetic procedures that only improve the appearance of your teeth.
You will always have the right to receive treatment if you are in pain or suffer from illness, but you will not receive financial support for a root filling of a wisdom tooth.
If the ailment involves any of the twelve front teeth in the upper and lower jaw, then more or less all procedures are covered. If you need to fill a cavity, then the procedure is covered regardless of which tooth it is.
Removable dentures are always covered by the high cost protection.
Dental crowns are covered by high cost protection for tooth 1-6, if the tooth is seriously damaged. Tooth 7 is also covered if tooth 6 on the same side is missing.
When it comes to ‘bridges’ and implants, there are many in-depth rules that determine which teeth and which types of material are covered by the high cost protection. Therefore, we recommend that you ask your dentist.
A dental procedure consists of several parts
A check-up or dental procedure usually consists of several different parts. For example, if you need to extract a tooth, then you will also need anaesthesia, antihaemorrhagic agents and possibly stitches in addition to the extraction. Check-ups and follow-up, such as removing stitches, are also part of the procedure.
Anaesthesia is always included when needed.
Sometimes it gets more expensive
If you need a comprehensive dental procedure, it can sometimes be difficult for the dentist to estimate exactly how much dental care will be needed and how much it will cost. The suggested price may change if the procedure goes on for longer than initially planned. This could happen if there are complications or if the healing takes longer than expected, for example.
In these cases, you will have to pay for the additional dental care, but you have the right to receive this information as soon as the dentist finds out that your procedure will become more expensive.
Reference prices are the basis of the protection threshold against high costs
The price charged by the dentist is not always the same as the amount that will be counted towards your high cost protection. The amount of financial support the you will receive is determined by ‘reference prices’.
The reference price is a set price that determines how much will be counted towards your high cost protection. It is not an average price or a recommended price that a dentist must charge.
All dentists and dental hygienists are permitted to set their own prices. If you use a dental clinic that charges a higher price than the reference price, then only the reference price will count towards your high cost protection. You will have to pay for the additional cost yourself. When a dentist or dental hygienist charges a price that is lower than the reference price, then it is always the lower price that will count towards your high cost protection.
Clinics will often charge a higher price for emergency dental care, but reference prices will still be the same as for scheduled dental care.
Reference prices are revised and changed every year.
The price list must be clearly displayed
Even before visiting a dental clinic, you have the right to know the prices. There must also be a price list in the waiting room. The clinics are to show clearly the reference prices and their own prices, so that you can compared them.
If you have been examined and need several dental procedures, then you have the right to be informed, in writing, of what the procedures will cost and whether they will count towards your high cost protection. If it is difficult to state an exact price for a procedure, then you still have the right to an approximate price, or an estimation of the minimum and maximum price.