This plan will end on December 31, 2012. Members wanting dental insurance for 2013 should consider enrolling in Dental Wisconsin during the Annual Benefit Enrollment Period that runs from October 8 - November 2, 2012.

Anthem DentalBlue is an optional dental plan for which you pay the entire premium (there is no employer contribution). Effective January 1, 2011, only classified employees represented by a union are eligible for coverage.

2012 Plan Information

• Frequently Asked Questions
  
  
• 2012 Summary of Anthem DentalBlue plans and premiums
  
  
• Compare 2012 Anthem DentalBlue dental benefits and premium to Dental Wisconsin and EPIC Benefits+ dental benefits.

Eligibility

You and your dependents must be enrolled for coverage prior to January 1, 2012. Newly added dependents during the year may be added to coverage within 30 days of the event (60 days for newborn or adopted children).

WRS annuitants must be covered under Anthem DentalBlue at the time of retirement to be eligible to maintain dental coverage indefinitely after retirement.

Enrollment

Enrollment is closed to new employees.

NOTE: Once enrolled, you must remain in this dental plan for the full calendar year unless employment terminates.

Program Features

2012 Anthem DentalBlue Plan and Premium Summary

2011 Anthem DentalBlue Plan and Premium Summary

With the Dentacare HMO option, you must use the Dentacare HMO dental providers to receive benefits. You may change Dentacare centers twice per calendar year if you desire.

• Review the Dentacare HMO Provider Directory
• Review the Dentacare HMO Benefit Handbook
• Instructions for navigating the Anthem DentalBlue On-Line Provider Directory Guide

The Preferred PPO option allows you to see the dentist of your choice. However, your out-of-pocket costs will be lower if you select a dental provider who is affiliated with DentalBlue as you will receive a higher level of coverage.

• Review the Preferred PPO Provider Directory
• Review the Preferred PPO Benefit Handbook
• Instructions for navigating the Anthem DentalBlue On-Line Provider Directory Guide

The Supplemental Plan is specifically designed to wrap around your health plan's dental benefits. To be eligible for the Supplemental Plan, your health plan must provide routine diagnostic and preventative coverage. If you change health plans and your new health plan does not cover diagnostic and preventative dental services, you must submit an application to cancel your coverage or change to the Dentacare HMO or Preferred PPO. The application must be submitted to your Staff Benefits office within 30 days of your change in health plans.

The Supplemental Plan does not cover annual cleanings or x-rays as these are typically covered by those specific health plans that provide routine dental coverage. Fillings are covered, as are services such as crowns, bridges, complex endodontics and periodontics. While not required, selecting a PPO provider may provide a lower employee "out of pocket" cost after co-insurance is applied. Please check what your health plan provides prior to enrolling.

• Review the PPO Provider Directory
• Review the Supplemental Plan Benefit Handbook
• Instructions for navigating the Anthem DentalBlue On-Line Provider Directory Guide

Premium

You can select the Dentacare HMO, Preferred PPO or the Supplemental Plan. The benefits vary between the options so consider the provider restrictions, office visit copayments, coverage levels and annual maximums of each option.

2012 comparison chart and premium information

2011 comparison chart and premium information

There is a 3-month waiting period before basic and major services are covered for new enrollees under the Preferred PPO or the Supplemental Plan.

Application

Print the application and submit the completed application to your staff benefits office within 30 days of eligibility.

Upon termination, you may be able to continue your Anthem DentalBlue coverage. If you retire on an immediate Wisconsin Retirement System (WRS) annuity or have 20 years of WRS service at termination, you and your covered family members may continue coverage indefinitely. You can request a continuation form from your staff benefits office.

Other Information about the Anthem DentalBlue plans:
Frequently Asked Questions
Domestic Partner Affidavit
OSER's website

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This document was last revised on September 11, 2012