Samsung Electronics of America (SEA) Benefits Overview - Base plan
PPO Network
Using a PPO provider is considered in network and will offer you the greatest savings on dental services which will spread your annual maximum further.
Premier Network
Using a Premier provider is considered in network but will not offer as robust savings as the PPO network. It is the largest network.
| In-Network | ||
|---|---|---|
| Service | If a Delta Dental PPO Network Dentist is used | If a Delta Dental Premier Dentist is used |
| Annual maximum (per person) | $1,000 | $1,000 |
| Annual deductible (waived for Preventive & Diagnostic) | ||
| Per person | $50 | $100 |
| Family aggregate | $150 | $300 |
| Preventive & Diagnostic | ||
| Exams (Frequency limitations apply) | 100% | 100% |
| Cleanings (Frequency limitations apply) | 100% | 100% |
| Bitewing X-Rays | 100% | 100% |
| Fluoride Treatment (Frequency limitations apply) | 100% | 100% |
| Sealants, Space Maintainers | 100% | 100% |
| Periodontal Maintenance | 100% | 100% |
| Basic Services | ||
| Fillings (composite fillings on all teeth) | 80% | 80% |
| Simple Extractions | 80% | 80% |
| Root Canals (Endodontics) | 80% | 80% |
| Periodontics (Surgical), Oral Surgery | 80% | 80% |
| Repair of dentures | 80% | 80% |
| Major Services | ||
| Crowns & Gold Restorations | 50% | 50% |
| Bridgework, Full & Partial Dentures | 50% | 50% |
| Implants | Not covered | Not covered |
| Orthodontics (Adult and Child) | ||
| Co-insurance | Not covered | Not covered |
| Lifetime maximum | Not covered | Not covered |
Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out of pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out of network dentists, you will pay the most out of pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.
