Ontario OHIP dental benefit rules updated: new fee schedule references, revised payment rates for dental surgeons

Plain-language summary · AI-assisted

The regulation governing which dental services OHIP covers and how much it pays has been updated in several practical ways. The definition of insured dental services now points to the dental benefit schedule's named columns ("OHIP," "D.D.S," and "Spec") rather than generic "Column 1/2/3" references, which clarifies how payments are determined for dental surgeons versus oral and maxillofacial surgeons. Two new versions of the Schedule of Benefits for Dental Services are introduced to apply to services performed from October 2026 onward, and certain columns ("INTL") and appendices are explicitly excluded from OHIP coverage. The older one-time lump-sum bonus payment formulas for dental surgeons (covering 2002–2004) have been removed and replaced with percentage increases of 2.8% and 3.83% applied to services rendered in two more recent periods. Dental surgeons and oral and maxillofacial surgeons who bill OHIP for hospital-based dental procedures should confirm which fee schedule version applies to services they render and verify billing columns accordingly. A prior disclaimer about retroactive provisions has also been removed from the consolidated text.

Who this affects
dental surgeons billing OHIP · oral and maxillofacial surgeons · public hospitals providing dental surgical services · health plan administrators