The new reform 100 % Santé gives you access to a large range of dental treatment including a large choice of crowns, bridges, and dentures, fully reimbursed:
- Crowns in ceramic-metal and fully ceramic for teeth that are visible.
- Metallic crown for all the other teeth.
- Replacement of bridges céramo-métalliques for replacement of incisors teeth & canines.
- Metallic bridges for all other teeth.
- Resin dentures (removable prosthesis) for all or part of the teeth.
- The repairs and change of elements in the dentures.
The teeth in light pink and green (teeth called 1st & 2nd premolar, 1st & 2nd molar & wisdom teeth) are what is called non-visible teeth so crowns in metal.
Visible teeth are in red and blue (front teeth called central incisors, canines & lateral incisors)
The 100 % Santé is available with all dentists.
Your dentist will propose a quote showing the treatment and cost with precise description.
Every act is mentioned in the quote and refers to a type of treatments defined in the new law 100 % Santé.
It exists 3 types of treatments for prostheses:
- le panier 100 % Santé: Crowns, bridges and dentures are fully reimbursed as long as you have a top up that includes the 100% santé cover. With us-Allianz, only Hospital only cover, or ECO cover do not include it. The top up contract which includes the 100% santé are called« contrat responsable».
- le panier aux tarifs maîtrisés: This is medium price so for a crown for instance, it would be 371 euro left to be paid by you and top up instead of 694 for the one below. So, crown is not fully ceramic but has metal in it.
- le panier aux tarifs libres: High price and of course according to dentist better quality or better looking so mostly fully ceramic.
Since 1st of January 2020, all the dentists must include systematically in their quote the 100% santé treatment when it is possible. In fact, you must get at least two quotes and one of them must include the 100% santé.
The quote shows the treatment plan and the material used.
If he proposes some treatment or acts which leave you an amount to pay yourself (reste à charge or montant non remboursé) after the reimbursement done by CPAM, he must also do a quote 100% santé so nothing for you to pay or if not possible with moderate costs (panier aux tariffs maitrisés showed above).
I went to the dentist and my husband needed a crown on tooth 15 which is pre-molar. They gave us a quote. Guess what! They did not give him a quote 100% santé. So, I politely inquire, and the secretary told me 100% santé do not apply for those teeth!! I insisted and then she said yes but it is a metal crown. Ah! So, you do it but do not quote it!! Which is illegal. Note that the French government is lenient now but if they carry on not playing fair, it will be a fine of 1 500 euro per patients!! Please note that the majority of dentist do play fair.
Below is the first page of the quote which explains the type of materials, type of treatments (between the 3 I explained above).
The quote shows the teeth number which in this case is 1st premolar, the type fo treament 3 which is free pricing for the dentist!! The materials, etc. You can see the total amount, the amount set by cpam, amount reimbursed by Cpam and what is left for me to pay!!
The second quote was included but the secretary did not mention it and surprise, the total amount and type of treatment (which in this case is medium-between 100% santé and free price) is not on it!!I guess it made it harder for me to realise it is cheaper!!
General things to know about dentists in France:
Do not wait to have tooth ache to register with a dentist. Do it now and even before you get your carte vitale. Most of them have a waiting list of 6 Months or more and some even refuse to get you on the waiting list!!
The dentist must inform the patient of the treatment included in the 100% santé but he is not obliged to do the treatment. In this case he must refer you to one of his colleagues.
Do insist for the 100% santé. Especially if you are on a budget!! I have a metal crown on my premolar, and I can live with it, and nobody has noticed.
Please do visit your dentist at least once a year as it has been proven that bad teeth are a cause to heart problems!! Bacteria go into your blood stream and affect your heart.
When you need to have heart surgery, it is now an obligation to visit the dentist before the operation.
Please feel free to contact me for a quote for a top up insurance. Note that the law has changed now, and we can cancel your existing top up contract at anytime as long as you have had the contract for at least one year so please do not hesitate and contact me for a quote. You probably have a contract with extra level of cover for teeth where now it is not necessary as 100% is enough so you could have a cheaper contract! Plus, with Allianz, you can choose better cover for hospital while staying on low level for teeth or glasses, etc. Most companies have level 1, 2, 3 etc. so if you want best cover for hospital, you have no choice but have best cover for all the rest as well.
Conclusion: The new law is fantastic and means you can get treatment covered fully by your top up as long as you have the proper contract (Contrat Responsable). But you need to know the law before you visit your dentist!! Now you do!!
And remember to check out our web site www.bh-assurances.fr/en for all my previous articles and register to receive our monthly Newsletter. You can also follow us on Facebook: “Allianz Jacques Boulesteix et Romain Lesterps”
And don’t hesitate to contact me for any other information or quote on subject such as Funeral cover, inheritance law, investments, car, house, professional and top up health insurance, etc…
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