Short overview of Helfo

Helfo is the Health Economic Administration under the Directorate of Health in Norway. Here’s a brief overview of its role and how it relates to dental treatment costs. Individuals over the age of 20 are generally responsible for their own dental treatment costs. However, certain exceptions exist for patients with specific diseases, conditions, or injuries. Your dentist or dental hygienist will assess whether you qualify for support from Helfo. Helfo manages around 35 million Norwegian kroner each year, which includes individual reimbursements for private dental expenses.

What is Insurance Reimbursement?

The regulations in the National Insurance Act § 5-6 aim to provide selected groups with reimbursements for dental services.

It's important to note that it is not NAV (the Norwegian Labour and Welfare Administration) that provides this reimbursement; it is Helfo that manages these regulations.

To determine if you belong to a group eligible for reimbursement, you must undergo an examination by a dentist. Dental treatment must be medically necessary to qualify for support from the National Insurance Scheme.

Who Can Get Reimbursement from Helfo?

There are a total of 15 conditions that qualify for reimbursement for dental expenses. Here are some of the groups that can receive partial or full coverage from Helfo:

• Rare medical conditions
• Cleft lip and palate
• Tumors in the oral cavity or surrounding tissues
• Infection-preventive dental treatment due to specific medical conditions
• Diseases and anomalies of the mouth and jaw
• Periodontitis
• Dental developmental disorders
• Bite anomalies
• Pathological loss of tooth substance due to attrition/erosion
• Hyposalivation (dry mouth)
• Allergic reactions to dental restoration materials
• Dental injuries from approved work-related accidents
• Dental injuries from accidents that are not work-related
• Significantly reduced ability to care for oneself due to chronic illness or permanent disability
• Total or partial tooth loss without any teeth in the lower jaw

Your dentist will diagnose and assess whether you fall into one of these categories. It’s not enough for you to simply assume you qualify. During an examination, we will evaluate and inform you of any reimbursements you may be entitled to. Some conditions may require a medical certificate from your general practitioner to be included in your dental record.

Examples of Individuals Typically Eligible for Reimbursement:

• If you grind your teeth and experience significant wear on your teeth, requiring help to restore function.
• If you have three or more baby teeth that have not been replaced by adult teeth (unless they are front teeth, in which case one is sufficient).
• Individuals with gum disease (periodontitis) who are experiencing tooth loss due to this condition will receive reimbursement for replacing teeth, applicable only up to the fifth tooth in the sequence when counting from the front.
• Another example is dental accidents that occur during leisure activities. For instance, if you break a tooth in a fall while biking, you will be reimbursed for the reconstruction of that tooth. You must document the injury, so it's wise to keep any documents from insurance companies or NAV in case of an accident.

Note: If you qualify for dental treatment in the public dental health service, you generally cannot receive reimbursement from Helfo as part of the National Insurance Scheme.

What Does Direct Billing Mean?

Blid Dental Care has a direct billing agreement with Helfo. This means we receive reimbursement directly for the part of the treatment covered by Helfo. With direct billing, you as a patient do not need to apply for reimbursement yourself or do any paperwork. Everything is processed electronically, and we handle the application for you.

Am I Eligible for Exemption Cards?

The Exemption Card for co-payments applies to certain types of dental treatment. The co-payment threshold is 2,176 NOK (as of 2020). Once your expenses exceed this amount, you will receive an exemption card by mail. This process is also automatic when we submit the reimbursement to Helfo for your treatment; you just need to inform us that you have received it. If you exceed the threshold without notifying us or receiving the exemption card, Helfo will still reimburse you to the account you used to pay for the treatment.