What the national health fund covers at the dentist

Adults over 18

For each calendar year:

• one full examination with a charted dental status;
• up to three treatments — a composite filling and/or extraction of a permanent tooth under anaesthetic, in any combination.

Pregnant patients are entitled to one additional examination during the year. Unused treatments do not carry over to the next calendar year.

What the adult package does not include

The package for over-18s covers an examination, a filling and the extraction of a permanent tooth. Treatment of pulpitis and periodontitis — what patients call root canal treatment — is not included for this age group and is paid for by the patient. For under-18s it is included.

This is frequently reported incorrectly, including in the media. The scope of the package is set out in Annex 3 to Ordinance No. 9 of 2019.

Children under 18

For each calendar year:

• one full examination with a charted dental status;
• up to four treatments, of which at most two may be for pulpitis or periodontitis of a permanent tooth.

The package covers: a composite filling; extraction of a primary tooth under anaesthetic; extraction of a permanent tooth under anaesthetic; treatment of pulpitis or periodontitis of a primary tooth; and the same for a permanent tooth.

Fillings and extractions for children carry no co-payment. Treatment of pulpitis or periodontitis does. A child may be seen either by a general dentist or by a paediatric dental specialist, and no referral is needed.

Oral surgery cover

Some treatments are carried out by an oral or maxillofacial surgeon following a referral. The package covers a specialist examination, incision, extraction of a deeply fractured or badly broken-down tooth, and a follow-up appointment. Co-payments are higher for adults than for children.

Removal of impacted and partially impacted wisdom teeth is not separately included in the outpatient dental package. Depending on complexity, the patient may be referred to a day-case procedure or to hospital treatment.

Dentures for fully edentulous patients

The fund pays for two treatments restoring chewing function in fully edentulous patients — one per jaw — over a four-year period, including follow-up appointments for up to two months after fitting. The manufacture of the denture is also covered.

The visit fee

In addition to any co-payment for the treatment itself, every visit to a dentist carries a statutory visit fee under Article 37 of the Health Insurance Act. The amount is set by government decree and is the same at every practice.

So a “free examination” means there is no co-payment for the examination itself — the visit fee is still payable separately. This is the single most common misunderstanding.

Exemptions include: under-18s; pregnant patients and mothers up to 45 days after birth; war veterans and disabled veterans; patients with conditions on the list annexed to the national framework contract; patients with over 71% reduced working capacity; those on low incomes; and healthcare professionals. You are entitled to a receipt for anything you pay.

What to bring

• a valid health insurance booklet or its supplement — the dentist records each treatment in it;
• up-to-date insurance contributions, which you can check online on the fund's website.

A supplement to the booklet is issued free of charge by the regional fund office once the dental pages are full. Unlike with a GP, there is no registration with a dentist — you may use any dentist in the country who holds a contract with the fund. Treatments already claimed appear in your electronic health record.

Your entitlement expires at year end

The entitlement is counted per calendar year and anything unused is lost. It shows in the fund's own figures: December dental spending runs noticeably above the yearly average, because most people remember their entitlement at the last minute.

December is also the busiest month for appointments. If you plan to use your cover, it is far less stressful to do so earlier in the year.

How you find out the cost

There is no price list on this site. The Bulgarian code of professional ethics for dentists prohibits advertising a practice by quoting specific prices online or in the media, and prohibits promotions and discounts. The cost also depends on what the examination finds, which cannot be established in advance.

That does not mean the cost stays vague. The same code requires the dentist to tell you, before treatment starts and before asking for your consent:

• the investigations needed, the proposed treatment and all reasonable alternatives, including their risks and approximate cost;
• how long treatment will take and what to expect along the way;
• the expected outcome;
• what is likely to happen if the treatment is not carried out;
• how the cost can be met — through the national fund, supplementary insurance, or directly.

In practice you leave the examination with a plan, an approximate cost and the alternatives, and decide on that basis rather than midway through treatment. For complex or expensive treatment, consent is given in writing.