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.
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 or one dependent child, or cover yourself, your spouse and your dependent 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 six 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 and stepchildren upon divorce, and for your dependent children at the end of the calendar year in which they turn age 19 (age 25 if full-time students) or on the date they marry or otherwise cease to be dependent.
You and your insured spouse 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
The schedule of premiums. Premiums will not change for 2008.
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.
The EPIC Plan offers the following distinct benefits:
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Dental Benefits
The EPIC Plan does not cover routine dental exams and cleanings. It does cover extractions, crowns, oral surgery, and many other non-routine procedures. Orthodontic services are covered after the insured has been in the plan for 12 months. Most orthodontic services are covered only if they began before the insured reached age 19.
Each insured person pays the first $200 of expenses for covered services. EPIC then pays 50% of charges that your State Group Health Insurance Plan does not pay, up to $750 per person per calendar year. The lifetime limit for orthodontia is $1,200.
You may select any dentist. However, EPIC will not pay charges in excess of the reasonable cost, as determined by EPIC. Dentists who are part of the Delta Dental network have agreed to accept EPIC's price structure.
Note: If you enrolled for the Epic Plan through open enrollment with a coverage effective date of January 1, 2006, your dental benefits are limited for the first two years of coverage. In 2006, the maximum payable for covered dental charges is $350 per person. In 2007, the maximum payable is $500 per person. There is also a waiting period before the orthodontics benefit begins.
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Medical Benefits
You may qualify for medical benefits if you are hospitalized for at least 24 hours or are treated as a surgical patient at a licensed surgical or hospital outpatient treatment center.
Your State Group Health Insurance Plan (your "basic plan") pays first. You must meet a deductible of at least $250 ($500 for family coverage), including any amount that your basic plan paid. The EPIC Plan then pays 100% of all reasonable and customary charges, up to the $250,000 lifetime per participant maximum ($100,000 for annuitants). Additional limits apply to certain services.
EPIC will not duplicate any charges that your basic plan paid, or would have paid, if you had obtained the proper referral. Because the State Group Health Insurance Program offers comprehensive coverage of most medical needs, you may not derive any additional medical benefits from the EPIC Program. If you have specific medical needs, you should carefully compare your coverage under the State Group Health Insurance Program and the EPIC Plan to see whether additional benefits would be payable.
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Accidental Death and Dismemberment Insurance
If you die as a result of an accidental injury, the EPIC Plan will pay your beneficiary $5,000. The accidental death benefit for your spouse, if insured, is $2,500; for your insured child, it is $1,000. The same amounts are payable if an accidental injury results in the loss of both hands or feet, the sight of both eyes, or the loss of two of the following: one hand, one foot, the sight of one eye. One half of these amounts is payable for accidental loss of one hand, one foot, or the sight of one eye.
To make a beneficiary designation for the accidental death benefit, complete the Beneficiary Designation Form and mail it to Epic Life Insurance Company, P O Box 8430, Madison WI 53708-8430.
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EyeMed Vision Care
Effective on January 1 , 2008, EPIC members have free access to the EyeMed Vision Care discount program. EyeMed offers substantial savings on eye care and eyewear at thousands of provider locations nation wide. To receive your discount, simply show your EPIC member ID card when you visit an EyeMed Provider. See the EPIC brochure for more details.