CM tooth advantage
CM members receive a reimbursement of up to 1,050 euros for orthodontics and dental prostheses.
CM started a new dental benefit in 2021. This reimbursement is part of the services and benefits available to all CM members who are in compliance with the payment of the CM contribution .
CM benefit orthodontics
This benefit is included as standard in CM membership for everyone, without waiting time. CM members receive a 60% refund (up to 1,050 euros) of the co-payment and supplements. CM members with increased compensation will receive a 75% refund up to 1,050 euros.
Conditions
- Not be older than 22 years.
- The treatment entitles you to reimbursement of the compulsory health insurance (see also page about orthodontics ).
- The treatment starts on or after January 1, 2021. The performance date of the placement of the first appliance (early or classic orthodontics) is decisive (performance code 305631 or 305933).
- You are entitled to compensation for each registered child.
Frequently asked questions about orthodontics
No. The start date is the performance date of the installation of the first device. This can be in the context of classical orthodontics or early orthodontics.
- Was the first device installed before January 1, 2021? Then a CM member is entitled to the orthodontic benefit with the two fixed lump sums: a fixed lump sum of 185 euros at the start and end of the treatment.
- Has a CM member already had early orthodontic treatment or is it still ongoing? You are still entitled to this new benefit if the start of the classic orthodontic treatment is no earlier than January 1, 2021.
The reimbursement only applies to subsequent services during the active treatment. The start of the active treatment is the placement of the first device.
We will reimburse the co-payment and supplements that are certified under the following nomenclature numbers:
- early orthodontics: 305933 and 305955 (two discs)
- classical orthodontics: 305631 (start) + 305675, 305616, 305653, 305734 (follow-up sessions)
The supplements to be taken into account are considered per performance. If these relate to a performance number (and therefore a performance date), they may be indicated as a supplement to that Riziv performance number.
There is therefore no CM allowance for examinations that are carried out in advance (consultations in the context of preliminary examinations, taking impressions, measurements, drawing up a treatment plan, etc.), retention checks and supplements for additional devices (e.g. retention device).
The placement of the first device determines whether the CM member ends up in the old or the new scheme. The services eligible for the calculation of the reimbursement are:
- for early orthodontics: the two fixed reimbursements at the start and end of the treatment (305933-305944 and 305955-305966);
- for classical regular orthodontics: the active treatment, i.e. 1) the placement of the device(s) with performance number and 2) the flat rates for the control sessions.
So both the services before the active treatment (such as examinations, consultations, advice, drawing up a treatment plan) and those after (contention checks) are not counted towards the reimbursement.
To make dental care accessible to everyone, this benefit is part of our additional services and benefits . We finance these benefits from the membership contribution . To keep it affordable, we have to make choices. Orthodontic treatment at a young age prevents many dental problems in the future. So we chose the importance of prevention here. The CM-MediKo Plan reimburses the invoice amount up to 500 euros for orthodontic treatment without reimbursement from health insurance. Starting January 1, 2024 this is up to 600 euros.
The CM benefit provides a reimbursement of 60% or 75% of the orthodontic costs, up to 1,050 euros per person. CM-MediKo Plan goes a step further. Because your remaining orthodontic costs are still eligible for reimbursement from both the statutory co-payment guarantee and the orthodontics guarantee (supplements). In this way, the total reimbursement for orthodontic treatment from CM and CM insurances together can amount to more than 1,550 euros. And CM-MediKo Plan goes even further! Through CM-MediKo Plan you are also more broadly protected for dental care costs: orthodontic costs without reimbursement by health insurance, dental prostheses and implants, periodontics, radiography, preventive and curative dental care, etc. This insurance also offers protection for other outpatient medical costs such as co-payments, eye care, hearing aids, travel vaccines, nutritional and dietary advice and a childbirth allowance.
CM benefit dental prostheses
This benefit is included as standard in CM membership for everyone, without waiting time. CM members will be reimbursed 40%* of the costs, up to 1,050 euros. CM members with increased compensation receive 75% up to 1,050 euros. For prostheses placed before January 1, 2024, the reimbursement is 60% instead of 40%, with the same maximum amount of 1,050 euros.
Conditions
- Be a member of CM on the performance date.
- The reimbursement applies to the placement of new fixed dental prostheses (crowns, bridges, implants on which a fixed prosthetic device is placed), new removable prostheses and for additional placements on existing removable prostheses. The refund does not apply to repairs or rebasing. In the frequently asked questions below you will find an overview of the performances that are or are not eligible.
- The prosthesis is placed by a dentist recognized by the Riziv.
- The (additional) placement will take place from January 1, 2021 .
- The compensation of up to 1,050 euros is possible every two calendar years .
- There is no right to reimbursement under statutory health insurance .
- Under certain conditions, health insurance reimburses removable dental prostheses . This is legally described and differs for children and adults. Is the patient eligible for health insurance reimbursement? Then the statutory rates apply and no compensation is possible from the CM benefit.
- There is no application for reimbursement via the Technical Dental Council.
Frequently asked questions about dental prostheses
The CM benefit applies to the purchase and installation of dental prostheses and implants from January 1, 2021 without (partial) reimbursement from health insurance. Supplements requested on top of a dental prosthesis for which a Riziv reimbursement is possible are therefore not eligible (see below).
The date of placement of the prosthesis is decisive. All preliminary examinations and preparatory treatments may therefore have taken place before January 1, 2021. The placement of a crown, bridge or implant is a separate provision and is not part of the pre-treatment.
When one or more teeth are effectively and completely replaced , we call it a dental prosthesis. Both the prosthesis itself and the costs of placing it are eligible for the CM benefit provided that the placement takes place from January 1, 2021 and that there is no (partial) reimbursement by the health insurance. There is no reimbursement for supplements requested for a dental prosthesis for which reimbursement by statutory health insurance is possible.
Implants that are placed to fix a removable dental prosthesis are excluded, this also applies to an anchorage, an abutment, and an attachment for a removable prosthesis.
Below you will find for the most common services whether or not they are eligible for the CM reimbursement (overview not exhaustive and based on the Riziv harmonization document). Are you unsure whether the performance is eligible for the CM benefit? Please contact us at [email protected] .
| Dental prostheses | |
|---|---|
| Removable prostheses | CM refund applicable? |
| Resin prosthesis | Yes |
| Frame prosthesis | Yes, if there is no reimbursement from the health insurance for the delivery of the dental prosthesis itself |
| Overdenture | Yes |
| Anchorage/abutment/attachment | No |
| Repair | No |
| Replacement of the base | No |
| Additional placement | Yes |
| Fixed prostheses | |
| Crown/Stand crown | Yes, if it concerns a full crown |
| Bridge | Yes |
| Inlay/onlay/overlay | No |
| Abutment | Yes |
| Facet | No |
| Provisional crown | Yes |
| Implant | Yes, if followed by a fixed prosthetic device |
If no teeth are replaced, there is no reimbursement from the CM dental benefit. But possibly through CM-MediKo Plan , for example:
- only material is placed to better bond existing or removable dental prostheses (e.g. abutments and anchors);
- for other medical procedures (e.g. on the gums).
Because there is already a partial reimbursement through the health insurance, we chose not to introduce an additional CM reimbursement, not even for the non-refundable supplements requested on top of this dental prosthesis (e.g. frame, alley - see below). With CM-MediKo Plan, the remaining costs after reimbursement by the health insurance are eligible within the guarantee for dental prostheses and implants, up to a maximum of 600 euros extra per year.
Yes. We keep the maximum of 1,050 euros for the CM member. If it has not reached the maximum when applying, this can be included in a subsequent treatment until a total of 1,050 euros has been reimbursed. See next question for more information.
The CM member receives 40%* (or 75% in case of increased compensation) of the costs for purchase and installation with a maximum of 1,050 euros. For prostheses placed before January 1, 2024, the reimbursement is 60% instead of 40%, with the same maximum amount of 1,050 euros. This reimbursement will be considered over two calendar years. The refund from the previous year is therefore always taken into account (and any refunds for the following year, if there are any).
| Example calculation over two calendar years | |||
|---|---|---|---|
| Performance year | Prosthesis° | Paid | CM refund |
2021 | Crown | 834 euros | 500 euro (60% of the purchase and installation costs) |
2022 | provisional Crown | 250 euros | 150 euros (60% of the purchase and installation costs) |
| Crown | 1,500 euros | 400 euros (60% of the purchase and installation costs, less refunds 2021 and 2022; or 1,050 euros - 500 euros - 150 euros = 400 euros ) | |
2023 | 2 crowns | 1,750 euros | 500 euro (60% of the purchase and installation costs, less refunds 2022; or 1,050 euros - 150 euros - 400 euros = 500 euros ) |
2024 | 3 crowns | 2,700 euros | 550 euros (40% of the purchase and installation costs, limited to 1,050 euros per 2 calendar years and less reimbursements 2023; or 1,050 euros - 500 euros = 550 euros) |
| ° For the CM dental benefit , only fixed and removable dental prostheses are available without a Riziv reimbursement eligible. | |||
The repayment over two years can never be more than 1,050 euros. Multiple payments are still possible within one two-year term until the maximum is reached. This example is merely illustrative. For additional reimbursement for dental care and other outpatient medical costs, members can take out additional insurance with CM-MediKo Plan .
No, because the delivery of the dental prosthesis itself is reimbursed by health insurance. Then the cumulation ban with health insurance applies and there is therefore no reimbursement through the CM benefit. With CM-MediKo Plan, a CM member can additionally insure themselves against additional supplements for dental prostheses with reimbursement from their health insurance.
The CM benefit provides a reimbursement of 40%* (or 75% if increased compensation) of the costs for the purchase and installation of dental prostheses and implants, up to 1,050 euros per two calendar years. For prostheses placed before January 1, 2024, the reimbursement is 60% instead of 40%, with the same maximum amount of 1,050 euros.
CM-MediKo Plan goes a step further. Because the remaining costs are eligible within the guarantee for dental prostheses and implants, up to a maximum of 600 euros extra per year. And CM-MediKo Plan goes even further. With CM-MediKo Plan you are also more broadly protected for dental care costs: dental prostheses with reimbursement by health insurance, orthodontics, periodontics, radiography, preventive and curative dental care, etc. This insurance also offers protection for other outpatient medical costs such as co-payments, eye care, hearing aids, travel vaccines, nutritional and dietary advice and a childbirth allowance.
* Subject to approval by the Health Insurance Fund Control Service.
What to do?
Provide the CM member with the 'harmonization document' as proof of the treatment(s) carried out. It is a uniform document for all additional services and benefits of the health insurance funds, published by the Riziv. You can download this form from the Riziv website .
Do you provide a certificate for assistance provided electronically (e-certificate or third-party payment scheme)? Then provide the 'harmonization document' as legal proof to your patient. You don't have to deliver anything else.
More information
View the general frequently asked questions below or send an email to our professional helpline at [email protected] .
Yes. That is why this is included as standard in CM's additional range of services and benefits . CM is committed to the health and well-being of everyone. Solidarity is the best guarantee to achieve that.
For additional reimbursement for dental care and other outpatient medical costs, CM members can take out additional insurance through the CM-MediKo Plan .
Yes. You can combine a reimbursement for dental prostheses with the reimbursement for orthodontics if both treatments are necessary.
From 2021, CM has opted for a strong and supportive basic package, and the option to take out additional insurance via the CM-MediKo Plan . This offers even better and broader coverage for orthodontics and dental prostheses, and additional reimbursements such as co-payments, eye care, hearing aids, periodontics, nutritional and dietary advice and a childbirth allowance.
No. We opt for a solidarity solution for all our members, but this solution does not cover all dental costs, nor all types of orthodontics and dental prostheses. A CM member who wants to protect himself even more can do so via the CM-MediKo Plan . The remaining costs for the purchase and installation of dental prostheses and implants are reimbursed up to a maximum of 500 euros extra per year. And as a CM member you are also more broadly protected for dental care costs: dental prostheses with reimbursement from health insurance, orthodontics without reimbursement from health insurance, periodontics, radiography, preventive and curative dental care.
The CM reimbursement is made on the basis of the 'harmonization document' as proof of the treatment(s) carried out. It is a uniform document for all additional services and benefits of the health insurance funds, published by the Riziv. Both the document and agreements on how to complete it can be found on the Riziv website . As a dentist, you can provide this via financial settlement with the CM member to make the costs as bearable as possible for the CM member.
In certain situations, this document must be delivered and there are specific formal requirements, which you can find on the Riziv website .
Because the 'harmonization document' was drawn up in the NCTZ to provide a solution to the demand for uniformity and transparency in compensation from supplementary and optional insurance, we promote this as much as possible. If you pay electronically via eAttest, the discharge of the eAttest is sufficient proof.
We always request a separate document for our additional services and benefits because we (must) keep the processes between mandatory and additional insurance strictly separate.
We also temporarily accept other certificates, forms and invoices if the description is complete (nomenclature number or according to the agreed descriptions) and the other necessary information is stated (amount per performance number, performance date, etc.).