What Is the NHIS Dental Benefit?

The NHIS provides health insurance benefits for prevention, diagnosis and treatment of disease, injury or rehabilitation.

When it comes to dentistry, the coverage is more limited than general medical care — some basic care is insured, while many cosmetic or elective treatments are not.

Key Dental Treatments Covered by NHIS

Here are some major categories of dental treatments that the NHIS covers, and the conditions under which they apply:

• Dental scaling (professional cleaning for periodontal health)
  The NHIS covers one annual scaling for adults (age criteria apply) to remove tartar/plaque buildup and help prevent periodontal disease.

• Dental sealants (children & adolescents)
  Sealants for first/second molars have been added to insurance for children/adolescents. For example: first molar covered from Dec 2009 for ages 6-14; second molar added 2012; coverage extended under 18 in 2013.
• Extractions, fillings, basic restorations
  Basic treatments like tooth removal, diagnosis, X-rays, and some fillings are generally covered under NHIS for necessary medical reasons.
• Dentures & dental implants for older adults
  NHIS expanded to cover prosthetic treatments for certain age groups:
• Complete dentures for edentulous patients aged 75+ from July 2012; then aged 65+ from July 2016.
• Dental implants for older adults: coverage began 2014 for 75+; age threshold lowered to 65 in 2016; with lifetime limits and conditions.

Important Limitations & Exclusions

• Many treatments considered cosmetic (e.g., crowns made of premium materials, veneers, aesthetic implants) are not covered or only partially covered.
• Age, eligibility, number of lifetime uses and co-payments change depending on treatment type. For example, implants covered under NHIS for elderly have lifetime limits (e.g., only two implants per person) and higher out-of-pocket share.
• Coverage for children/adolescents is more generous for preventive treatments (sealants) than for adults for some services.
• Even when a treatment is “covered”, the patient usually pays a co-payment (often 30-50% of cost) and may pay extra for non-covered materials or premium options.

What This Means for Patients (Including Foreign Residents)

• If you are enrolled in NHIS (which includes citizens and long-term foreign residents) you are eligible for the same benefits as Korean citizens.
• Before any dental treatment: ask the clinic whether the procedure is fully covered under NHIS, or only partly, or whether premium material costs will be extra.
• For elective or cosmetic dentistry you should budget for non-covered costs.
• For older adults (65+) there is help with dentures/implants under NHIS but conditions apply.
• Preventive care (scaling annually, sealants for children) is a cost-effective benefit under NHIS — good to utilise.

Tips for Using This in Your Website

• Use this page under a “Dental Services & Insurance” section to help patients understand what is covered.
• Include a checklist summarising “What is typically covered / What is not covered”
• Add a FAQ section (e.g., “Is a crown covered?”, “What about implant materials?”, “Do I still pay extra?”)
• Highlight any special categories of patients (children, seniors, foreign residents) and age/eligibility thresholds.
• Consider linking to official NHIS pages (in English) for current updates.