Law (2008:145) On State Dental Care

Original Language Title: Lag (2008:145) om statligt tandvårdsstöd

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Read the untranslated law here: http://rkrattsbaser.gov.se/sfst?bet=2008:145

Chapter 1. Introductory provisions



The law's scope and purpose



section 1 of this Act contains provisions on the compensation of

caregivers for performed dentistry (State dental care).



State dental care is provided in the form of General

Dental contributions, particularly dental contributions and

dental health care. Law (2011:1189).



2 for the purposes of this Act, section



1. dental care: measures to prevent, investigate and treat

diseases and lesions in the oral cavity,



2. health care provider ' means the natural or legal person who professionally

engaged in dental care.



section 3 of the insurance fund leaving State dental care for



1. preventive dental care, and



2. dental treatment that the patient needs and aimed at

achieve



-freedom from pain and disease,



-ability to eat, Chew and talk without major obstacles, or



-an appearance acceptable results.



Dental care shall aim to preserve as far as possible in the mouth

tissues. The quality and durability of the treatment should be weighed against the

costs.



Government, or the Government authority determines,

Announces rules on what dental measures that can

be eligible for compensation under this Act and under what

conditions may be reimbursed for these measures

(eligible dental procedures).



General provisions concerning the right of State dental care



section 4 of the State dental care may be provided for dental measures

completed from the year in which the patient turns 20 years old.

Provisions on free dental care for children and young people

and with the year in which they turn 19 years of age, see 7 § 1 and § 15 a

first subparagraph dental Act (1985:125).



paragraph 5 of the State dental care may be provided if the patient, when

Dental operation begins;



1. are insured for residence-based benefits under 4

and Chapter 5. the social security code, or



2. without being a resident here are entitled to benefits

following a decision of the European Parliament and Council Regulation (EC) no

883/2004 of 29 april 2004 on the coordination of social

security systems. Law (2010:1322).



section 6 of the State dental care support shall not be granted for such dental care

referred to in the sixth paragraph 15 a of the dental Act (1985:125).

Law (2010:251).



Chapter 2. General and particular dental contributions and

dental health care



General dental premiums



§ 1 General Dental grants may be used for payment of

eligible dental measures during a period

of a maximum of two years from 1 July each year,

If the patient is on that date fulfil the requirements in Chapter 1. 5 § 1

or 2.



Each submission may be used for payment at only one

opportunity. Law (2011:1189).



Especially dental premiums



1 a of the Particular Dental grants may be used for payment

by reimbursable preventive dental measures

during the two periods each of not more than six months each year,

counting from 1 January and 1 July,

If the patient



1. that date fulfil the requirements in Chapter 1. 5 § 1 or 2,

and



2. when dental task starts with a disease or

disability that causes risk for impaired

dental health.



The Government or the authority, as the Government determines

Announces rules those diseases and

disabilities referred to in the first subparagraph of paragraph 2.

Law (2011:1189).



Common provisions on dental premiums



2 § dental contribution may also be used for payment in accordance with

a contract for the subscription agreement means that dental care, if

the health care provider for a period of three years at a fixed price

to perform the dental patient needs in the form of



1. surveys and investigations;



2. health promotion,



3. treatment of sickness and pain, as well as



4. restorative care.



The agreement may also cover other dental care than is said in

the first paragraph. Law (2011:1189).



section 3 of the Government Announces rules on dental benefits

size. Law (2011:1189).



Dental health care



4 § For eligible dental measures

completed during the replacement period of one year, provided

dental health care with a certain percentage of the patient's total

costs, insofar as these exceed the amount

determined in accordance with paragraph 6 of the 1.



The cost is calculated on the basis of the reference rates for

eligible dental operations. The cost of a

action taken must not, however, be estimated higher than an amount

the corresponding healthcare provider's price for the operation for the current

the patient.



Benefit period referred to in the first subparagraph begins when a

the first eligible action is completed.

The caregiver can notify the patient's request in

The social insurance office to a new replacement period shall begin

before the previous benefit period has expired.



Government, or the Government authority determines,

Announces rules on notification referred to in the third subparagraph and on

When a new replacement time shall begin to run.



4 a of for the calculation of the dental compensation under paragraph 4 shall

the costs for dental services, drugs, or other

care products adopted decision on compensation

According to section 10 of the Act (2013:513) for reimbursement of costs to the

due care in another country within the European economic

area is included. Team (2013:517).



section 5 Dental care payments may not be made for such

dental measures falling within the scope of an agreement

subscription dentistry under.



Dental health care may not be submitted for

dental measures to the extent that these are paid by

dental benefits. Law (2011:1189).



section 6 of the Government, or the Government authority determines,

Announces rules on



1. the amount of the patient's total dental care costs

during the benefit period must exceed in order to

dental health care should be provided,



2. what proportion of the total costs

excess of the amount provided for in paragraph 1 that dental reimbursement shall

be provided, as well as



3. reference prices for reimbursable

Dental operations.



Chapter 3. Health care providers



Conditions for obtaining State dental care



(1) to a health care provider should be able to receive compensation under this

law, the caregiver must be connected to the Swedish social insurance agency

electronic systems for State dental care.



The Government, or Government authority determines,

provide for the requirements of and termination of connection

to the electronic system for State dental care.



Healthcare provider's obligation to



section 2 of the health care provider is at the request of the health insurance fund or

the Court shall, in matters concerning State dental care leave

information, as well as showcase the journal and other materials relating to the

examination or treatment of a patient.



section 3 of the health care provider shall provide information to the Swedish social insurance agency

If



1. performed dental services, and



2. the content of agreements about subscription dentistry

According to Chapter 2. 2 § and if such an agreement has expired,

apply early.



The health care provider should provide information on the National Board of health and welfare

his patients ' dental health.



The Government or the authority, as the Government determines

may provide for the caregiver

obligation in relation to the Swedish social insurance agency

and the National Board of health and the health care provider information

must provide to a patient. Law (2011:1189).



Chapter 4. Other provisions



Insurance obligation



section 1 of the health insurance fund shall, at the request of a health care provider

provide the information the healthcare provider needs to

be able to calculate a patient's cost for dental care.



The repayment obligation



section 2 If a caregiver has received compensation under this Act

with an excessive amount, insurance agency require

back the benefit incorrectly paid.

Insurance agency may, instead of requiring

refund, counting of the amount from another claim which

the health care provider has for compensation under this Act.



The first subparagraph shall not apply to particular dental contribution, if

the caregiver has had reasonable grounds to believe that

the patient was eligible for such grants.

Law (2011:1189).



section 3 of the health insurance fund shall reclaim the consideration

provided to a health care provider who has performed a prosthetic

treatment needs to be done if, provided that the

new treatment



1. is not eligible as defined in

regulations issued pursuant to Chapter 1. paragraph 3 of the third

subparagraph, and



2. performed by another health care provider than the one that carried out the

treatment needs to be done.



Insurance agency may, instead of demanding repayment,

count of amount from another claim that the health care provider has to

compensation under this Act.



The insurance fund may provide remuneration to the healthcare provider

Repeat the treatment.



section 4 If the patient has provided incomplete or incorrect

information which led to the health care provider has not received the requested

compensation from the social insurance agency, the health care provider may require

the patient on the amount representing the difference between the requested and

the resulting compensation.



Prior authorisation



§ 5 in the case referred to in paragraph 3 of the first paragraph, the need to

do if the prosthetic treatment förhandsprövas of

The insurance fund before the new treatment.



5 a of the health insurance fund shall, at the request of a patient or

a health care provider make a preliminary determination as to whether the

the conditions for special dental contribution according to

Chapter 2. (1) (a) paragraph 2 is met.

Law (2011:1189).



section 6, If a health care provider



1. materially has breached the provisions of


This law, or in the regulations, adopted pursuant

the law, if the provider's obligations or conditions for

compensation, and



2. There is reason to believe that the health care provider will continue

to materially override provisions,



get insurance agency decide that the healthcare provider, to get

remuneration of certain dental tasks, in each case

shall request the prior authorisation of the insurance fund. Such a

decision shall be valid for a maximum of one year.



section 7 of the Government or the authority that the Government

determines Announces rules on when prior authorisation

in cases other than those referred to in paragraphs 5 and 6.

Law (2011:1189).



Application for and payment of State dental care



section 8 Of the health care provider should be able to receive compensation under this

law, the application for compensation be submitted to the social insurance Office

within two weeks of the dental action for which

reimbursement is requested has been completed. If there are special reasons,

can insurance agency pay compensation even if the application has

come in too late.



Insurance Fund shall pay compensation within two weeks from the

the application came in. If there are special reasons,

compensation will be paid later. Insurance agency may withhold

payment of compensation pending healthcare provider fulfils

their obligation under Chapter 3. section 3.



Appeal, etc.



subject to section 9 of this Act, apply, mutatis

parts of the following provisions of the social security code for

cases concerning State dental care:



-107 Cape. 9, 10, 12, 17 and 18 of the seizure, statute of limitations

and damages etc.,



-108. 2, 11, 15, 16, 19 and 21 sections and section 22 of the first

the paragraph on the repayment obligation and interest, etc.,



-110 Cape. section 13, section 14 (1) and (2) and section 31 and 115. 4 § about

obligation to provide accommodation,



-113 Cape. 2-17, 19, 20 and 21 of the amending, rethinking and

appeal.



The provisions of chapter 108. 2, 11, 15, 16, 19 and 21 sections and section 22

the first subparagraph shall not apply in the social code

relation to caregivers. Team (2013:110).



section 10 of the health care provider may not appeal against other decisions of the

The social insurance agency in cases where prior authorisation, other than those

referred to in paragraph 6. Decisions in cases of prior authorisation in accordance with paragraph 5 of

may, however, be appealed by the health care provider who has carried out the

treatment needs to be done.



section 11 of the Government, or the Government authority determines,

Announces rules on



1. application for and the calculation and payment of compensation

under this Act,



2. subscription dental care, as well as



3. prior examination.



Transitional provisions



2008:145



1. this law shall enter into force on 1 July 2008.



2. For dental measures that have been initiated before the entry into force

for older replacement provisions.



3. If prior authorisation has been requested before entry into force, the

older provisions on prior authorisation and reimbursement of the

Dental operations subject to preliminary examination.



4. A prerequisite for being able to receive compensation under the older

provisions is that the health care provider within four months from the

Dental operation completed successfully applying for compensation of

The social insurance agency. However, this does not apply to dental operations

subject to a prior examination as requested before the

July 1, 2008. For dental operations completed before the

september 1, 2009, applications for compensation made in

The social insurance office until september 1, 2011.

Law (2010:336).



5. The general dental care allowance must not be used for

payment under subscription dental care, if the patient

upon entry into force already covered by an existing agreement on

subscription dentistry. Older provisions on compensation in case of

subscription agreements entered into before the dental care

the entry into force.



2010:1322



1. this law shall enter into force on 1 January 2011.



2. Older provisions as regards section 2 applies

still for those covered by Council regulation

(EEC) No 1408/71 of 14 June 1971 on the application of

social security schemes to employed persons, self-employed

or members of their families moving within the community.



2011:1189



This law shall enter into force on 1 January 2012 in the case of Chapter 3.

paragraph 3 and the remainder on 1 January 2013.



2013:110



1. this law shall enter into force on 1 July 2013.



2. Older regulations apply for decisions rendered

before the entry into force.