Dental implant: what reimbursement by Social Security?

Dental implant: what reimbursement by Social Security?

To fully understand how the reimbursement of a dental implant works, you should know that an implant consists of three parts:

  • The implant itself replaces the root: it is not funded at all by Social Security.
  • The prosthetic abutment links with the crown or the bridge which covers it: The prosthetic abutment (or inlay-core) with free support can be reimbursed up to 70% of the BRSS (the basis for reimbursement by Social Security: €90) or €63.
  • The crown covers the whole: the crown with free coverage is reimbursed at 70% of the BRSS, ie €75.25 provided that it is carried out on a dilapidated tooth. The BRSS is €107.50 in 2020, then it will be increased to €120 in 2021.

Note: Bridges on implants are not covered by Social Security. At least one abutment tooth of the bridge must be dilapidated for 70% of the BRSS of €279.50 to be reimbursed, ie a reimbursement of €195.65.

Reimbursement of dental implants with the MMA dental mutual

Your MMA mutual can reimburse you for all or part of your remaining charge. The portion funded, for dental implants, by MMA Health Insurance is expressed as a flat rate. The Comfort Level 4 formula allows you, for example, to be reimbursed up to €300 for implants not covered by Social Security.

The +: if you do not use your plan for three years, with the responsible consumption bonus, you can be reimbursed up to €600, under the conditions, limits, and exclusions of guarantees set out in the contract.

Example of reimbursement of a dental implant by the mutual health insurance MMA

Example with MMA comfort level 4 health insurance :

Your dental surgeon places an implant in you. The invoice amounts to €2,000 (abutment at €550, free-of-charge crown at €650, and implant at €800)

  • Social Security only covers the costs for the crown up to 70% of the BRSS (€107.50) or €75.25 of the crown
  • MMA completes this reimbursement of the crown up to 300% of the BRSS, ie €247.25. This reimbursement does not include the Partner Consulting reinforcement (4).
  • To this, MMA adds a flat rate of €300 on the non-reimbursed implant
  • Rest at your expense: 1377.5 €. This reimbursement does not include the Conso-Responsible bonus.

Example for an expense of €2,000 with MMA comfort level 4 health insurance

Details of refunds:

Social Security mma Remains dependent

Rising:

€75.25 €547.25 €1377.50

Sinclair (2) MMA partner allows you to benefit from services and advantageous rates

2 Dental estimate analysis services:

Before incurring major healthcare expenses, from your Customer Space, you have the option of:

  • to send an estimate to have it analyzed within 72 hours by an adviser.
  • This allows you to know the number of reimbursements from Social Security and your mutual health insurance and to obtain an estimate of your remaining charge.
  • If you wish to consult a dental surgeon who is not a Santéclair partner, an adviser checks that the service offered is adapted to your needs and that the price corresponds to that usually practiced in your region.
  • If necessary, Santéclair brings you its expertise to reduce your expenditure by communicating to you, in particular, the remaining charge that you would have by going to one of its partners.
  • to analyze your estimate whenever you want with an immediate result, by using the service “analyze my dental estimate in a few minutes”.
  • The Santéclair partner dental surgeons and general practitioners provide you with quality care at negotiated rates (3) for the most frequent free-of-charge procedures (prostheses and orthodontics).
  • With dental surgeons qualified in dental implantology, you benefit from negotiated rates of up to -40% on acts related to implantology.

A traceability certificate indicating the origin of the prosthesis is given to you on request: the crowns placed are of French manufacture, a guarantee of quality.

 Illustration of the reduction in your dental costs with Santéclair partners:

An adult residing in Marseille, placement of an implant:

Thanks to third-party payment (4), you do not make any upfront costs.

Compared to average market prices. Comparison between the rates negotiated with Santéclair partner health professionals and the quotes analyzed by Santéclair in 2019.

More info on health insurance

Optical refund

  • Coverage of optical expenses depends on the vision defect and the nature of the lenses prescribed by the ophthalmologist. Security support.

Dental reimbursement

  • If Social Security pays dental care like any medical procedure, it only finances a small part of dental prostheses.

Orthodontic reimbursement

  • Yet essential, orthodontic costs are funded by Social Security up to 25 to 30% of their actual cost. MMA Health Insurance can take…

Health reimbursement

Our coverage takes place within the limits of the expenses incurred and under the conditions, limits, and exclusions of the guarantees which are specified in the General Conditions (No. 381 and 379) and the Special Conditions of the MMA Health Insurance contract.

(1) Reinforcement allocated for the reimbursement of dental prostheses which have been subject to a prior assessment by the MMMA Santé Partner.

(2) Santéclair (SA with a capital of €3,834,029 registered with the Nantes RCS under number 428 704 977 – Head office at 7 Mail Pablo Picasso – 44 046 NANTES CEDEX 1) partner of MMA santé. Santéclair services are subject to change over time. Santéclair(3) partner health professionals are selected according to criteria defined by Santéclair(2) and accessible according to the location of Santéclair partners (opticians, ophthalmology centers, refractive surgery centers, dental surgeons, dieticians, osteopaths, and chiropractors).

Access to Santéclair partners and services is reserved for MMA policyholders holding an MMA Health Insurance contract in force. Please note, depending on the age of the contract taken out, the service offer may differ. For more information contact a GPS health adviser*. Your MMA General Agent has a list of Santéclair partner health professionals near you. You can also find the contact details of the partners closest to you on your mma.fr customer area via the “Santclair services” section.

(3) Negotiated prices lower than average market prices according to a study carried out by Santéclair in 2019, on a sample of quotes made throughout France, with healthcare professionals who are partners and non-partners of Santéclair.

(4) Third-party payment is possible with healthcare professionals with whom MMA has signed an agreement and with the following Santéclair partners: opticians, centers specializing in refractive surgery, dental surgeons (including those qualified in dental implantology), and audio prosthetists

*For any subscription/membership with an MMA Agent, between February 28 and April 30, 2022, inclusive:

  • a Health contract (CG 381), excluding Vitale formula and Frontaliers Health Insurance, 20% reduction on your annual contribution the first year,
  • a Life Accident Guarantee (CG 088) or Life Accident Protection (CG 089) contract, 20% reduction on your annual premium for the first year,
  • an Assurance Revenus MMA contract (CG 714) or an Assurance Revenus Pros contract (CG 715), 20% reduction on your annual premium for the first year,
  • to a term death insurance contract Death Capital MMA, 20% reduction on your annual premium for the first year.
By aamritri

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