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Old 24.11.2014, 05:20
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Orthodontist Insurance for Congenital Birth Defects

Maybe this should be added to a Sticky, in a thread which is closed?

To be eligible and covered by the IV or AI (Invalide Versicherung, l'assurance-invalidité. ) for congenital birth defects including non-straight teeth, cleft palette, the child must be born in Switzerland and be under 21 years of age. Usual accidents and normal dentistry is not covered, otherwise all treatment is covered.

(German Google; IV Zahnbehandlung ) (French Google; AI Suisse soins dentaires )

DF]IV - SSO -> IV is the Swiss Invalid Insurance

www.sso.ch/doc/doc_download.cfm?uuid... Translate this page -> Especially see pages 2, 7, 8 of 14)...
Die IV ist eine allgemeine, obligatorische Volksversicherung wie die AHV. Sie erstrebt, ... Wird eine Zahnbehandlung durch ein in der GgV aufgeführtes.


Behandlung von Geburtsgebrechen
Die einzige Ausnahme von der genannten Regel bilden die ärztlichen und zahnärztlichen Massnahmen für die Behandlung von Geburtsgebrechen bei minderjährigen Versicherten gemäss Artikel 3 ATSG, 13 IVG (siehe Liste im Abschnitt III). In solchen Fällen kommt die IV für die gesamte notwendige Behandlung auf, bis der Versicherte das zwanzigste Lebensjahr vollendet hat. Als Geburtsgebrechen gelten alle Gebrechen, die bei vollendeter Geburt bestehen und in der Liste in Abschnitt III enthalten sind oder vom Eidgenössischen Departement des Innern als solche bezeichnet werden. Die Veranlagung zu einem Leiden gilt nicht als Geburtsgebrechen. Hingegen ist der Zeitpunkt, in dem ein Geburtsgebrechen als solches erkannt wird, unerheblich.

Das Gesetz verfolgt also nicht die Absicht, jedem durch Krankheit Unfall oder Wachstum irgendwie benachteiligten Kind Hilfe zu bieten, wohl aber dem von einem Geburtsgebrechen betroffenen Kind gute ärztliche oder zahnärztliche Hilfe zuzusichern.

Adressen der IV-Stellen
(IV-Stellen der Kantone) IV is the Swiss Invalide Versicherung
Die Adressen der IV-Stellen sind zu finden auf der Website
( http://www.ahv-iv.info/andere/00145/index.html?lang=de <- link broken?)

http://tel.local.ch/en/q?what=IV+stelle&where=&rid=iVnF <- list of IV offices in each Canton

Von der IV für kieferorthopädische Abklärungen anerkannte Fachzahnärztinnen und Fachzahnärzte für Kieferorthopädie
(betr. Ziffer 208, 209, 210, 214 und 218 GgV)
Aktuelle Liste auf der Website der SSO
http://www.sso.ch:80/doc/doc_downloa...5BEF8810B24CC6

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Links in French,

http://www.sso.ch/index.cfm?uuid=05A...d=&o_lang_id=8

l’ordonnance sur les prestations de l’assurance des soins (OPAS) (fichier PDF, 75 Ko).

.

Last edited by Sbrinz; 24.11.2014 at 05:35. Reason: many ...
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Old 24.11.2014, 08:21
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Re: Orthodontist Insurance for Congenital Birth Defects

Two corrections and two clarifications

Corrections

- coverage under this part of the scheme extends until the day before the person turns 20, not 21

- there are other qualifying criteria - not just birth in CH- but principally having had a parent who has paid into the IV scheme for a minimum of 12 months before the birth (or the event that gave rise to the claim). Similarly in the event of children not born CH, a few countries have made separate agreements for these base criteria to be amended. The only way to know for sure is to refer to your local IV/AI office - who even then will take some time to reply as they refer to their in house legal dept.


Clarification

This scheme covers not just dental problems but every condition that a child could be born with ( that is covered by the scheme)- conditions covered are listed in the annexe of congenital defects (some 400 paragraphs long ...). Another part of the same regulations also pulls in illness and accident causing illness or disability being conditions that the child was not born with.

If you are accepted for coverage under this part of the scheme (known as medical measures) then all of the other parts of the disaility scheme become potentially open to you (subject to qualifying criteria being met) including help with travel, carer's allowance, specialised equipment allowances etc
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Old 24.11.2014, 09:28
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Re: Orthodontist Insurance for Congenital Birth Defects

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the child must be born in Switzerland and be under 21 years of age.

.. bis der Versicherte das zwanzigste Lebensjahr vollendet hat.
I thought "under 21" has the same meaning as "not finished their 20th year"
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Old 24.11.2014, 09:57
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Re: Orthodontist Insurance for Congenital Birth Defects

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I thought "under 21" has the same meaning as "not finished their 20th year"
But their 20 th year is the year between 19 and 20 surely?
Their first year being between birth and one year old.
So under 21 would be not finished their 21st year.
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Old 28.11.2014, 17:45
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Re: Orthodontist Insurance for Congenital Birth Defects

Maybe this helps as well ? I worte this for the New Stork Times, hope this may help as well


Cheerio

EE

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When our middle daughter was born 12 weeks premature, having a long stay ahead of her in the ITU ward of our local children’s hospital, one would not think about the costs that would ensue in such an event.
We experienced the same when our youngest daughter was born 4 weeks premature. At the beginning, she seemed to be a perfectly ‘normal’ baby, but when she was about three and a half years old, we realised all was not as it seemed. She has been diagnosed with CAPD (a form of an attention deficit disorder) and dystonia (a form of mild cerebral palsy) in her calves. Since then - only five years ago - she has attended a variety of weekly therapy sessions such as physiotherapy, occupational therapy, and speech therapy. For her legs, she has undergone four sessions of botox injections to paralyse her calves, then her lower legs were put in plaster casts for weeks, followed by intensive physiotherapy twice per week, and she must still wear special braces on her legs.
Again, we want the very best for our children. However, what about the costs? Health insurance more often than not does not cover it all, and certainly not over such a long span of therapy.
Céline’s bill from her stay in ITU followed by 18 months of special physiotherapy and two examinations by the neurologist (to see if she develops well), was several tens of thousands of francs.
Each of Nadine’s treatments of botox/plaster casts/braces and physiotherapy cost between seven and nine thousand francs, not to mention the occupational therapy and ‘regular’ physiotherapy sessions! What parents could pay such huge sums?
I suspect not many, and fortunately, if you live in Switzerland, there is insurance which all of us have, some even without knowing it.
It is called the Invalidenversicherung (invalid’s insurance), abbreviated to IV.
Below is an explanation about what the IV in general is and how to apply for the first time to get registered with them for possible help or benefits. The actual process of how to get specific help, will be outlined in a follow up article''

What is the IV?
The Swiss invalidity insurance (IV) is, like the AHV and the health insurance, a mandatory insurance. The goal is to secure the insured with integration measures or payments in cash (level of basis of existence) if they become invalid.
The IV is part of the Swiss Federal social security net, based on the three-column concept: the national insurance with IV, AHV and the supplementary payments (EL) as the first column, the pension fund as second column, and the self-precaution as the third column. This social security system is made complete by the public social welfare assistance, forming the last of the safety nets.
As is the case for the AHV and the supplementary payments (EL), there is also with the IV a legal claim to help if the exact conditions specified in the law are fulfilled.
The Swiss invalidity insurance has been in existence since 1960. The founding of it dates back to 1925 when the Swiss voted for the creation of a pension and invalidity insurance.

Who is insured with the IV
All persons who live in and/or are employed in Switzerland receive mandatory IV insurance; additionally, citizens of Switzerland, the European Union or EFTA can, upon request, obtain voluntary insurance with the IV if they live outside of these countries!

Disability in the sense of the IV

The IV defines disability as a damage caused by physical, psychological or mental health issues causing a disability to perform employment, or inability to continue work (for example in the household).

This inability must be lasting or last a longer time (at least one year).
It is not important whether the health damage already existed at birth or is a consequence of an illness or an accident. Disability exists thus under the following conditions:
- Health damage/handicap is present;
- There is a lasting or longer time continuing disability to work and/or inability to work; and
- The disability is due to health damage.

How can the insured make claims?
No payments or benefits without registration!
In order to profit from the IV services, the insured person must announce their claims at the IV-office in the canton in which they live in. Almost EVERY town or village hall has an AHV or IV office (called in a phone directory IV or AHV-Stellen or AUSGLEICHSKASSEN) where you can obtain claim forms. It is important to announce immediately, if possible, or at least as soon as the handicap appears and it is almost certain it is lasting. Before making a claim to the IV, it is NOT advisable to wait until health insurance payments or accident insurance (SUVA) payments are exhausted.
The IV will only pay out retroactive benefits for a maximum of ONE YEAR from the time of filing the claim.

What happens after the registration?
The IV checks your claim.
After the insured person submits their application forms at the IV-Office, the clerks check the claim thoroughly, together with external specialists, and clarify what specific benefits or help the insured person will obtain. Primarily, they will require re-integration into the workforce or general integration measures before paying out any benefits.
If an insured person has been approved to receive a monthly benefit, then the IV will order the local ‘Ausgleichskasse’ to calculate said benefit.
As soon as all clarifications are final and the possible benefit is calculated, the IV will then send a letter with its decision, a so-called VERFÜGUNG, which is legally binding.

What obligation to cooperate does the insured person have?
The insured person must try everything (obligation to self-integration) to keep costs within limits. They are obliged to work together with the IV and accept the execution of any reasonable measure. Furthermore, they are obliged to provide all available information regarding their claim to the IV. The IV offices can order a claimant to attend a vocational clarification or a medical examination at the regional medical services attached to the IV.

What can an insured person do if they are not content with the decision the IV takes regarding their claim?
Insured persons who cannot accept the decision made by the IV can appeal the decree at the regional office where ordered.
If the decision upon appeal is still not acceptable, then there exists the possibility to file a complaint with the responsible cantonal insurance court. If the ruling of this court is still not acceptable, they can turn, as a last resort, to the Federal court.

So in our case, when Céline was born, we had to fill out a six-page application form for Invalids Insurance. After being accepted, she got her VERSICHERUNGSAUSWEIS (grey insurance card), and from then on all bills went directly to the IV. When at about eight months old, she was prescribed some special physiotherapy, the hospital could file the claim to cover the costs by the IV, as she was already registered and granted that everything that was in connection with her being a preemie would be covered.
For Nadine, it was a bit of a different story. The registration process was the same: fill in a six-page form and get the insurance card. Her handicaps were not accepted as being birth defects, and coverage for each claim was only granted for two years. After these two years were up, all treating personnel (doctors & therapists) had to re-evaluate her case and file a new claim for coverage of the expenses to the IV; fortunately for us, it was granted every time.
Now I am getting to the reason behind writing this column. Our eldest daughter, Melanie, will need some major orthodontic work done, partly because the regular dentist did not spot and treat the problem in time, and partly because it seems to be a birth defect that needs to be corrected. The first estimate of the orthodontist says it will cost over ten thousand francs. We are not able to afford it, and the health insurance will only pay 70% toward it. Seeing as she has a malformation of her lower jaw, which classifies as a birth defect, our chances are quite good that she will be accepted by the IV, who would then cover the costs entirely, but as I am just in the stage of making the first claim, I won’t know by the time this article goes to print, if it will work out or not.


©sylv07



edit: At the end, back then , we never got the help for the eldest daughter's orthodontic problem, because of 2 MILIMETRES discrepancy between what she had and what the IV required it to be.....

Last edited by EastEnders; 28.11.2014 at 17:49. Reason: Adding updated information
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Old 28.11.2014, 18:14
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Re: Orthodontist Insurance for Congenital Birth Defects

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edit: At the end, back then , we never got the help for the eldest daughter's orthodontic problem, because of 2 MILIMETRES discrepancy between what she had and what the IV required it to be.....
That's right. Even a 0.2 mm discrepancy would have been too much. The IV is pretty generous once a case is approved but very strictly sticks to the rules concerning approval. There's no wiggling room.
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