The Cap Hiding Behind the Headline Percentage
Your tariff says "90% for dentures" — but if you sign today and need two implants next year, you may discover the insurer pays far less than 90% of the bill. The reason is the Zahnstaffel (dental benefit scale): a cap on total dental reimbursement during the first years of the contract, built into almost every PKV tariff.
Why it exists: without the scale, people could delay expensive dental work, take out top dental cover, have the work done and cancel. The Zahnstaffel protects the insured collective against exactly this — at the price of patience for genuine newcomers.
How a Typical Scale Looks
| Contract year | Typical cumulative cap |
|---|---|
| Year 1 | €1,000 – €1,500 |
| Years 1–2 | €2,000 – €3,000 |
| Years 1–3 | €3,000 – €4,500 |
| Years 1–4/5 | €4,000 – €6,000, then unlimited |
Exact figures vary widely between tariffs — premium lines run higher scales, budget lines lower ones. After the scale period (usually 4–5 years, sometimes 3 in strong tariffs), the tariff's normal percentages apply without an annual cap.
The Crucial Exception: Accidents
Nearly all tariffs waive the Zahnstaffel for dental work made necessary by an accident. Break a tooth in a fall in year one, and reimbursement follows the normal tariff percentages immediately. Some tariffs also waive the scale where the need for treatment demonstrably arose only after the policy began.
Planning Around the Scale
- Compare scales, not just percentages: two "90% dentures" tariffs can differ by thousands of euros in the early years
- Time major work realistically: known implant or orthodontic plans may be excluded anyway as pre-existing treatment needs — declared honestly, the insurer decides how to handle them
- Spread treatments: where medically sensible, staging work across contract years uses each year's headroom
- Get a treatment and cost plan (Heil- und Kostenplan): submit it before starting; the insurer's written response tells you exactly what the scale leaves you to pay
The Bottom Line
The Zahnstaffel is not a trick — it is a standard, openly documented feature that keeps dental tariffs affordable. Know your tariff's figures, use the accident exception when it applies, and always send a cost plan before major work so the numbers hold no surprises.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
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