Employee Benefits
Epic Dental and Excess Major Medical Coverage
EPIC Dental and Excess Major Medical Coverage
The EPIC Dental and Excess Major Medical Plan is voluntary, supplemental insurance that pays for covered dental and medical expenses that remain after your primary insurance policy pays. It also provides a small benefit in case of accidental death or certain accidental injuries. The EPIC Life Insurance Company is a wholly owned subsidiary of Wisconsin Physicians Service Insurance Corporation (WPS).
The summary below is not a detailed description of the EPIC Plan. Do not use it as your only reference on eligibility and plan benefits. Review the contract carefully and consult your staff benefits office about your specific circumstances. Please review the EPIC FAQ for additional information about the plan.
Eligibility
Classified and unclassified employees are eligible when they become covered by the Wisconsin Retirement System (WRS).
Short-term academic staff, graduate student assistants, and employees-in-training are eligible if their appointment is at least one-third of full time for at least one semester (six months for twelve-month positions).
You may enroll for yourself only for 'Single coverage'. You may choose two-person or "Limited Family coverage" for yourself and either your spouse, domestic partner or one dependent child, or cover yourself, your spouse/domestic partner and your dependent children/domestic partner's children with 'Family Coverage.'
Enrollment
Classified employees must file an application with the campus benefits office within 30 days after the first day of WRS-covered employment OR any time before the first of the month following completion of two months of WRS-covered employment for coverage to be effective with your State Group Health Insurance Plan.
Unclassified employees must file an application with the campus benefits office within 30 days after the first day of WRS-covered employment.
Short-term academic staff, student assistants, and employees-in-training must file an application within 30 days after the beginning of their first eligible appointment.
If you have single coverage, you may add coverage for your spouse by filing an application with the campus benefits office within 31 days after the marriage. If you have single coverage, you may add coverage for a newborn or adopted child by applying within 60 days of the birth or adoption. If you have family coverage in effect, a newborn or adopted child is covered automatically.
Late enrollment via evidence of insurability is not available in the EPIC Plan. From time to time a special enrollment opportunity may be offered to employees who missed their initial enrollment deadline.
Coverage
Coverage is effective on the first of the month following receipt of your application.
You may keep your coverage in retirement if you take an immediate annuity from the WRS or have 20 years of EPIC coverage at the time you terminate employment. Your premium costs will be slightly higher as an annuitant. Coverage terminates when you lose eligibility for the State Group Health Insurance Program. Coverage ends for your spouse/domestic partner and stepchildren/domestic partner's children upon divorce/termination of domestic partnership. Effective January 1, 2010, unmarried dependent children are eligible for coverage until the end of the month they turn 27, provided the child is covered under the parent's health insurance policy. Please see EPIC's FAQ for more information about dependent eligibility.
You and your insured spouse, domestic partner and dependent children may be eligible to continue your coverage for 36 months after employment ends under the provisions of COBRA. Conversion to an individual policy is not available.
Premiums
Your EPIC insurance premium qualifies as a pre-tax payroll deduction for the Employee Reimbursement Account (ERA) Program's automatic premium conversion feature, which reduces your taxable gross pay.
Program Features
The EPIC Plan is designed to supplement the benefits you receive from your primary state group health insurance plan. EPIC will not duplicate payment for any dental or medical services that you are eligible to receive under the State Group Health Insurance Program or other insurance such as Medicare or Workers Compensation.
There are three components to the EPIC coverage: Dental, Excess Major Medical, Accidental Death and Dismemberment (AD&D) and a vision discount plan through EyeMed.
- The excess dental benefit covers major dental services at 50% following an annual $75 deductible and up to an annual maximum benefit of $1,000. It also includes an orthodontic benefit of $1,200 for dependents under age 19.
- Upon satisfaction of an annual deductible, the Excess Major Medical benefits are payable following an outpatient surgery or inpatient stay for non-covered costs such as prescription drug copayments or durable medical equipment coinsurance.
-
A small AD&D policy pays your beneficiary(ies) $10,000 should you die accidentally while an active employee and also provides coverage for your dependents. It will pay a lump sum benefit if you or your dependents lose your eye sight or suffer a dismemberment due to an accident. To request benefits, you must complete the required claim form and submit it to Epic..
- EyeMed offers substantial savings on eye care, eyewear, and laser vision correction procedures.
Benefits are outlined in EPIC's Enrollment Brochure. See the EyeMed Vision Discount Program plan brochure for more information about vision discounts associated with the EPIC Plan.
Employees who enrolled in coverage during the 2008 special enrollment period for coverage effective January 1, 2009, will continue to have the graduated dental benefits outlined in the EPIC special enrollment brochure.
If you would like to designate a beneficiary for the accidental death benefit associated with the EPIC Plan, complete the Beneficiary Designation Form and send it to the address listed on the form.
This document was last revised on January 21, 2010
