01Why dental care can be covered by indemnity insurance — 3 key principles
In short, the copay for dental treatments that are 'covered by Korean NHIS'can be claimed under indemnity insurance. The following three conditions are key.
1) Enrollment date: baseline is October 2009
Indemnity health insurance standardization in October 2009 was the turning point when coverage changed significantly. For plans enrolled after standardization, the NHIS-covered treatment copayare included within the coverage scope, but most products issued before then excluded dental treatment itself (some rider exceptions apply).
② Diagnosis: Dental disease codes (K00~K08)
For a claim to be approved, it must not be for simple cosmetic or preventive care, but for treatment of a disease to qualify. Under the Korean Standard Classification of Diseases, the relevant tooth and supporting-structure codes K00~K08(e.g., Cavity K02, pulpitis K04, periodontal disease K05, etc.) apply to eligible treatments.
③ Items: Only treatments covered by Korean NHIS; non-covered (out-of-pocket) are generally excluded
Even for the same dental treatment, Korean NHIS covered items (Wisdom Tooth extraction, Root Canal Treatment, Gum (Periodontal) Treatment, etc.) are claimable only for your co-pay portion. Treatments such as Dental Implant, Composite Resin, Crown, and Orthodontics are non-covered (out-of-pocket) itemsexcluded from coverage under the standard policy terms.
Quick summary
Enrolled after October 2009 + K00–K08 diagnosis + covered treatment = Potential eligibility to claim reimbursement of your co-pay. However, the final decision follows your policy and the insurer’s review.
02Dental treatments you can claim (covered by Korean NHIS)
Below are representative treatments covered by Korean NHIS. For covered treatments, your co-payis what can be reviewed for reimbursement claims.
| Treatment item | Claim eligibility | Notes |
|---|---|---|
| Wisdom Tooth treatment/extraction | ○ Eligible | Includes impacted Wisdom Tooth extraction; co-pay for covered treatment |
| Root Canal Treatment (endodontic therapy) | ○ Eligible | The Root Canal Treatment itself is covered. The subsequent Crown is non-covered and excluded |
| Scaling (Dental Cleaning) for treatment purposes · Gum (Periodontal) Treatment | ○ Eligible | When performed for treatment under a diagnosis of gingivitis/Periodontitis (K05) |
| Cavity treatment (using covered materials such as amalgam) | ○ Eligible | When covered materials are used. Composite Resin and inlays are non-covered |
| Covered X-ray exams such as panoramic X-rays | ○ Eligible | Covered tests performed during the course of treatment |
| Korean NHIS-covered treatments related to tooth fractures | ○ Eligible | If associated with trauma or an accident, coverage may expand depending on policy terms. |
Most commonly missed case: Wisdom Tooth
Impacted Wisdom Tooth extraction is a covered treatment, and your out-of-pocket copay can reach the tens of thousands of won; many people don’t file claims because they think "dental isn’t reimbursable under indemnity plans." If you enrolled in an indemnity plan in or after October 2009, keep your receipt and itemized statement and consider filing a claim.
03Treatments that are difficult to claim (non-covered items)
Because the treatments below are non-covered under Korean NHIS, standard indemnity plans in principle exclude them from coverageThe belief that "dental isn’t reimbursable" mostly stems from these items.
| Treatment type | Claim potential | Reason |
|---|---|---|
| Dental Implant | × Generally not reimbursable | Non-covered (out-of-pocket) (separate Korean NHIS benefit for ages 65+ — see 04 below) |
| Composite Resin · Inlay (cavity restorative treatment) | × Generally not reimbursable | Non-covered materials |
| Crown (Gold · Ceramic) | × Generally not reimbursable | Non-covered prosthetics |
| Orthodontics · Invisalign | × Generally not reimbursable | Non-covered (out-of-pocket) + cosmetic/functional improvement |
| Preventive Scaling (Dental Cleaning) | × Generally not reimbursable | Preventive, not disease treatment (one Korean NHIS-covered session per year applies separately) |
| Teeth Whitening · Laminate Veneer | × Generally not reimbursable | Cosmetic purpose |
Note: Don’t confuse this with "dental insurance"
Sold separately from indemnity insurance, dental insurancepays fixed benefits for prosthetic treatments such as Crowns, Dental Implants, and Dentures. Even the items marked "not reimbursable" above may be paid under your dental insurance, so review all the plans you hold.
04Dental Implants — how to use Korean NHIS instead of indemnity insurance
Dental implants are generally not reimbursable under indemnity insurance, but if you meet certain conditions, Korean NHIScan significantly reduce your out-of-pocket cost.
| Category | Details |
|---|---|
| Eligibility | Age 65 or older, partial tooth loss (some teeth remaining) |
| Patient copay | of the Dental Implant cost 30% |
| Number limit | Per person Lifetime: 2 |
| Exclusions | Bone Graft (GBR) is non-covered (out-of-pocket)charged separately |
If tooth fracture or loss was caused by an accident, coverage may be possible under accident riders or certain policy terms; contact your insurer with the accident details for an accurate determination.
Wondering whether Dental Implants for age 65 or older are covered by Korean NHIS?
The Seoul BD Dental Implant Center will clearly explain NHIS coverage eligibility and costs.
05Check your indemnity health insurance generation (1~5 generations)
Indemnity health insurance is divided into "generations" by enrollment date, with different copay rates and claim conditions. Confirming which generation you are inis the starting point for a claim.
| Generation | Sales period | Key points for dental coverage |
|---|---|---|
| 1st generation | ~2009.9 | Pre-standardization. Most dental treatments excluded from coverage (some rider exceptions) |
| 2nd generation (standardized) | 2009.10~2017.3 | Begins covering the patient copay for NHIS-covered dental care |
| 3rd generation | 2017.4~2021.6 | Covers NHIS copays; copay structure changed |
| 4th generation | 2021.7~ | Covered and non-covered split; premiums vary based on non-covered usage |
| 5th generation | Launches 2026.5 | Latest revised product. Check each policy’s coverage structure |
How to check your generation (1 min)
- Find My Insurance (cont.insure.or.kr) or confirm your enrollment date in your insurer’s app
- Compare your enrollment date with the table above to identify your generation
- Call your insurer’s call center and ask directly whether your plan covers the patient copay for NHIS-covered dental treatment
06Claim documents and process — what to obtain from the dental clinic
If you prepare the documents properly, submitting the claim via your insurer’s app takes about 5 minutes.
Basic documents
- Treatment fee invoice/receipt — showing covered by Korean NHIS vs non-covered (out-of-pocket)
- Itemized statement of treatment charges — lets you check, by item, which treatments are covered by Korean NHIS
- Medical certificate or outpatient visit confirmation — if required by your insurer (with diagnosis code)
Simplified small-amount claims
If your outpatient medical expense falls within the small-amount range (thresholds vary by insurer/policy, commonly 30,000–100,000 KRW), many insurers allow a simplified claim without a diagnosis certificate—using just the receipt and prescription. Check your insurer’s app or call center for the exact criteria.
How to file a claim
- At the front desk "Please give me the documents for a reimbursement claim" request (invoice + itemized statement)
- Go to the claim menu in your insurer’s app/website
- Take photos of the documents and upload → submit
- Payment after insurer review (usually within a few business days)
Seoul BD Dental issues claim documents on the same day
We can issue at the front desk, on the spot, the itemized statement of treatment charges, medical certificate (with diagnosis code), and other documents needed for a reimbursement claim. Even if you’re not sure which ones you need, just say "I’d like to file a reimbursement claim."
07Pre-claim self-checklist
Checking the four items below before you claim can save you an unnecessary trip.
- Enrollment date — Is my indemnity plan enrolled in October 2009 or later (2nd generation or newer)?
- Diagnosis code — Is the treatment diagnosed as a dental condition (K00~K08)? (Check on the itemized statement/medical certificate)
- NHIS coverage status — Does the receipt mark the treatment as "급여" (covered by Korean NHIS)?
- Confirm with your insurer — Even if the three items above fit, final coverage depends on policy terms and review—did you check with your insurer in advance?
08Frequently Asked Questions (FAQ)
Q.Can I claim reimbursement for dental treatment too?
Some treatments, yes. For policies enrolled after October 2009 standardized indemnity plan policyholders who received care under a dental diagnosis (K00~K08) the patient co-pay for covered treatments may be eligible to claim. Typical examples include Wisdom Tooth extraction, Root Canal Treatment, and medically necessary Scaling (Dental Cleaning). On the other hand, Dental Implant, Composite Resin, Crown, and Orthodontics are non-covered and generally not eligible.
Q.Are Dental Implants not reimbursable at all?
Under the standard policy, Dental Implants are non-covered, so claims are generally not allowed. Instead, Age 65 or older, coverage may be available through Korean NHIS Up to 2 in a lifetime; 30% patient co-payDental implants can be covered (bone graft (GBR) is non-covered and billed separately). Tooth damage from an accident may be covered under an accident rider, so please check with your insurer.
Q.Is Scaling (Dental Cleaning) covered or not?
It depends on the purpose. For gingivitis or periodontitis For treatment Scaling (covered by Korean NHIS) is eligible for claim review, but the once-per-year NHIS-covered For prevention Scaling is not for disease treatment, so it is not eligible under indemnity insurance. Check whether the itemized statement includes a periodontal disease diagnosis code.
Q.Can the Crown placed after a Root Canal Treatment be claimed together?
No, they must be handled separately. Root Canal Treatment itself is covered by Korean NHIS so your co-pay can be reviewed for reimbursement, but the Crown is non-covered (out-of-pocket) and is generally excluded. Even for treatment on the same tooth, covered and non-covered items are listed separately on the receipt, so be sure to check the itemized statement.
Q.I have an older policy (before 2009). Is there any way to claim?
In principle, it’s difficult, but some first-generation plans include dental coverage as a rider. Check your policy terms (certificate) from when you enrolled, or call your insurer’s call center and directly ask, "Are covered dental treatments included?" That’s the most accurate way.
Q.How do I request the documents from the dental clinic?
At the front desk "For an indemnity claim, please give me the medical receipt and the itemized statement."—that’s all you need to say. If your insurer requires a medical certificate, we can also issue one with the diagnosis code. At Seoul BD Dental, all of these can be issued the same day.
Reimbursement claim documents, ready on the day of treatment
Seoul BD Dental issues claim documents such as an itemized statement and medical certificate on the same day. Your first consultation is free.
Don’t just read—check for yourself
Free self-check tools made by Seoul BD Dental. No sign-up required; done in 1 minute.
On this topic, a column written by the Director
We’ve compiled the questions we’re asked most often in the clinic.