Kolik dostane zubař od pojišťovny za kompozitní onlay?

When you get a kompozitní onlay, you might wonder: how much does the dental insurance actually pay? It’s not magic, and it’s not the same everywhere. In the Czech Republic, the reimbursement rules are clear, but often confusing. Let’s cut through the noise.

Co je kompozitní onlay?

A kompozitní onlay is a type of dental restoration. It’s not a filling, and it’s not a crown. Think of it as a middle ground. It’s made of composite resin - the same tooth-colored material used for fillings - but it’s custom-made in a lab to fit precisely into a damaged part of your tooth. Unlike a regular filling, which is molded directly in your mouth, an onlay is bonded in place after being shaped to match your tooth’s natural contours. It’s used when the damage is too big for a simple filling but not bad enough to need a full crown.

It’s popular because it preserves more of your natural tooth than a crown, and it looks just like real enamel. It’s also strong enough to handle chewing forces in back teeth. But here’s the catch: insurance doesn’t always cover it the same way as a traditional amalgam filling.

Jak pojišťovna určuje výši náhrady?

The Czech public health insurance system - mostly through VZP (Všeobecná zdravotní pojišťovna) and its regional branches - sets fixed reimbursement rates. These are updated annually and published in the official ceník zdravotních služeb. For a kompozitní onlay, the reimbursement is based on the cost of a standard amalgam (silver) filling.

As of 2026, the reimbursement for a standard amalgam filling in a molar is 370 Kč. That’s the benchmark. Even if your dentist charges 3,500 Kč for a high-quality composite onlay, the insurance will only pay 370 Kč. The rest is your responsibility.

This is where people get frustrated. They think, “I’m paying for a better material, so why don’t I get better coverage?” But the system doesn’t work that way. Insurance pays for the minimum clinically acceptable treatment - not the premium upgrade.

Proč se kompozitní onlay neplatí plně?

Public health insurance in the Czech Republic is designed to cover basic, functional restorations. That means: the tooth must be restored, it must be durable, and it must prevent further decay. Color matching, aesthetics, and longevity beyond 5-7 years are considered extras.

Amalgam fillings last 10-15 years. Composite onlays can last 10-15 years too - sometimes longer. But insurance doesn’t recognize that. They only see the cost of the basic option.

There’s also a bureaucratic reason: the reimbursement system is based on procedure codes. The code for an onlay (7311) is listed under “restoration with composite material,” but the payment cap is still tied to the amalgam rate. There’s no separate code for “premium composite onlay.” So, no matter how advanced the technique, the payout stays the same.

Kolik skutečně zaplatíte?

Let’s break it down with real numbers. A typical composite onlay in Brno costs between 2,800 Kč and 4,200 Kč, depending on the dentist’s experience, lab quality, and complexity of the case. The insurance pays 370 Kč. That means you pay the difference: between 2,430 Kč and 3,830 Kč.

Some dentists offer a “partial discount” - they might reduce their fee by 10-15% if you’re using insurance. But that’s not a rule. It’s up to the practice. Others charge the full price and just file the insurance claim for you.

Important note: If your tooth needs a root canal before the onlay, that’s a separate reimbursement. Root canal treatment is reimbursed at 1,200 Kč. So your total out-of-pocket cost could be even higher.

Co říkají soukromé pojišťovny?

If you have private dental insurance (like those offered by Česká pojišťovna, Union, or Dětská pojišťovna), the rules change. Some plans cover up to 80% of the cost of composite restorations. Others have annual limits - say, 5,000 Kč per year - and you need to choose between crowns, onlays, or orthodontic work.

Always check your policy. Some private plans require pre-approval. Others only cover onlays if they’re deemed medically necessary - not just for aesthetics. A few even cover the full cost if the tooth is in the front area. But for molars? Most private insurers still cap it around 1,500-2,000 Kč.

Když si necháte onlay, co je důležité vědět?

• Asking your dentist for a detailed quote before treatment - including the insurance reimbursement estimate - is not rude. It’s smart.
• Make sure the invoice clearly states “kompozitní onlay” and the procedure code (7311). That’s what the insurance needs to process the claim.
• Some dentists use cheaper composite materials to cut costs. Ask: “Je to kvalitní kompozit, jako Filtek Supreme nebo GrandioSO?” - those brands last longer and look better.
• If you’re getting multiple onlays, ask if the dentist offers a package deal. Many do - especially if you’re paying out of pocket.

Je to vůbec stojí za to?

Yes - if you care about your tooth’s long-term health and appearance. Composite onlays don’t just look better. They bond to the tooth, which strengthens it. Amalgam fillings just sit there. Over time, they can cause micro-fractures. Composite onlays seal the tooth better and reduce the risk of future decay.

Studies from the University of Prague’s Dental Faculty (2024) show that composite onlays have a 92% survival rate after 8 years. Amalgam fillings? 85%. That’s not just aesthetics - it’s function.

And let’s not forget: if you’re paying out of pocket anyway, you might as well get the best result. A well-made onlay can last 15+ years. That’s less than 200 Kč per year. Compare that to replacing a crown later - which could cost 7,000 Kč.

Co dělat, když vám pojišťovna odmítnula náhradu?

If your claim was rejected, it’s usually because:

• The dentist used the wrong procedure code.
• The claim was filed after the 30-day deadline.
• The tooth wasn’t properly diagnosed (e.g., no X-ray attached).

You can appeal. Submit a written request to your insurance provider. Include:

• A copy of the invoice
• The dentist’s treatment plan
• Any X-rays or scans

Some patients succeed - especially if they can prove the onlay was medically necessary (e.g., large cavity, cracked tooth). But don’t expect miracles. Most appeals fail unless there’s clear clinical justification.

Závěr: Jak na to?

Here’s the bottom line: insurance pays 370 Kč for a kompozitní onlay. That’s it. The rest is up to you. But that doesn’t mean you should skip it. If you need a restoration, go for the composite onlay. It’s the best balance of durability, aesthetics, and tooth preservation. Pay the difference - it’s an investment. A good onlay might save you from a root canal, a crown, or even an extraction down the road.

And if you can afford it, consider a private dental plan. Even a basic one with 1,500 Kč annual coverage for restorations can cut your out-of-pocket cost by nearly half.