What is not covered by my dental insurance?

1. The orthodontic treatments

• Those that do not entitle you to reimbursement from the mandatory health insurance for members of the Belgian statutory health insurance for medical care and benefits.

• Those that do not meet the reimbursement conditions of the Belgian statutory health insurance for those who are not members of the Belgian statutory health insurance for medical care and benefits.

• Those that were started during the waiting period or before joining Dentalia Up (examinations before treatment to define or start the treatment) or started (flat rate for early orthodontic treatment at the beginning of the treatment or flat rate for equipment for regular orthodontic treatment at the beginning of the treatment). These treatments are not covered, even after the waiting period.

2. The dental prostheses and implants

Those that were started during the waiting period or before joining Dentalia Up (examinations before treatment to define or start the treatment) or started (placement of a temporary implant or a temporary prosthesis) are not covered, even after the waiting period, the provisions of Article 14, l) of the annex to the Royal Decree of September 14, 1984, which establishes the nomenclature for medical services under the statutory health insurance for medical care and benefits, where the codes are not followed by a '+' sign.

3. The medications

4. The materials, instruments, devices, medications for dental use or other pharmaceutical supplies and all procedures closely related to the main procedure.

5. The dental prostheses of the types veneers, inlays, onlays, and overlays, regardless of the reason.

6. The deep-drawing plates, regardless of the reason, other than orthodontic retention.

7. The techniques for composite resin infiltration, using an indirectly fabricated brace, aimed at changing the anatomy, volume, or color of one or more teeth.

8. All treatments for ronchopathy (snoring) or sleep apnea, or any other treatment not related to oral health.

9. The costs resulting from an injury sustained during the practice of a sport where wearing face, mouth, or dental protection is customary or mandatory according to the regulations of the relevant sports federation.

10. The costs arising from participation in a fight.

11. Costs that are not related to the provision of the main materials in leasing or subscription type plans.

12. Aesthetic or cosmetic dental care services.

13. The goods and services provided that may be subject to VAT.

14. Costs where the invoicing is contrary to Belgian regulations.

15. Costs that are not necessary from a diagnostic or therapeutic point of view because they are not curative for a disease.

16. Services or treatments that are not medically necessary.

17. Excessive techniques or treatments (over-treatment) in relation to the pathology.

18. Services that are insufficiently therapeutically recognized or that are not taught in at least one of the Belgian faculties granting access to one of the professions listed in Article 4, § 1 of the annex to the Royal Decree of September 14, 1984, establishing the nomenclature for medical services under mandatory health insurance and benefits.

19. Services provided for an insured who refuses to undergo an examination by a dentist expert appointed by the Insurance Mutuality.

20. Services in the case of clear falsification by the healthcare provider and/or the insured or their representative of the dates of service, the requested amounts, or the description of the services.

21. Supplements charged by contracted dentists.