Dental
Your best smile starts here. All our dental plans cover 100% of in-network preventive care.
Dental Coverage Options
You have two dental plans to choose from:
- PPO Base Dental Plan
- PPO Buy-up Dental Plan
BlueCross BlueShield of Texas (BCBSTX) administers both plans, which include a broad network of providers.
Cost for coverage
You pay for dental coverage through paycheck contributions. The amount you pay depends on the plan you choose and who you cover.
Dental Bi-Weekly Contribution Rates
| BCBSTX PPO Base Plan | BCBSTX PPO Buy-up Plan | |
|---|---|---|
| You only | $0.00 | $6.04 |
| You + Spouse | $3.64 | $18.15 |
| You + Child(ren) | $3.63 | $14.52 |
| You + Family | $6.05 | $25.41 |
Compare dental plans
In-Network
|
PPO Base Plan (in-network) |
PPO Buy-up Plan (in-network) |
|---|---|
| Annual Maximum | $1,500 per person |
| Annual deductible |
$50 per person $150 per family |
|
Preventive Care Exams, Cleanings |
Plan pays 100% for 4 cleanings |
|
Basic Care Anterior fillings, Extractions |
90% after deductible |
| Posterior White Fillings | Not covered |
|
Major Care Inlays, Crowns |
80% after deductible |
|
Orthodontia Adults & Children |
50% after deductible, up to $1,500 lifetime maximum per person |
| Implants |
80% after deductible $1,500 annual maximum |
Out-of-Network
|
PPO Base Plan (out-of-network) |
PPO Buy-up Plan (out-of-network) |
|---|---|
| Annual Maximum | $1,500 per person |
| Annual deductible |
$100 per person $300 per family |
|
Preventive Care Exams, Cleanings |
Plan pays 100% for 4 cleanings |
|
Basic Care Anterior fillings, Extractions |
90% after deductible |
| Posterior White Fillings | Not covered |
|
Major Care Inlays, Crowns |
80% after deductible |
|
Orthodontia Adults & Children |
50% $1,500 lifetime maximum per member |
| Implants |
80% after deductible $1,500 annual maximum |
Understanding your dental plan
All the plans we offer include:
- In-network preventive care, such as exams and cleanings
- Reduced rates for in-network providers
For non-preventive dental care, the deductible is the amount you pay before the plan starts to pay. Some plans don’t have a deductible, so the plan starts paying right away.
Once you meet the deductible, the plan shares the cost of care with you. You’ll pay a percentage of the cost, called coinsurance. The amount of coinsurance depends on the plan you choose and the care you receive.
The annual maximum is the most the plan will pay for dental expenses in one calendar year. Once you meet the annual maximum, the plan won’t pay benefits for the rest of the year.
Your Dental ID Card
Your BlueCross BlueShield of Texas dental plan ID card will arrive at the address you have provided to mysamsungbenefits.com within 7 to 10 business days after you enroll in coverage. Your BCBSTX dental card is a separate card from your medical ID card.
Important notes about deductibles
Your deductible and out-of-pocket maximum reset each year on January 1. Out-of-pocket expenses you paid in the previous year don’t carry over, no matter when you enrolled.
Any charges by an out-of-network provider or facility that are higher than the plan’s “covered expense” amount won’t count toward your deductible. Your out-of-network provider or facility may bill you for the difference between what they charge and what your insurance pays.
Contact
BlueCross BlueShield of Texas (BCBSTX)
- bcbstx.com
- 1-888-258-0310
- Group #: 372194
Log into your BCBSTX account to:
- Find a dentist
- Print additional ID cards
- Review claims information
Locate in microsite here: https://yoursamsungbenefits.com/physical-health/dental/