Employee Benefits

EPIC Benefits+

Background

The EPIC Benefits+ plan is an insurance plan that provides the following benefits:

  • Dental benefit - partial coverage for non-routine dental services
  • Vision benefit - discount vision plan through regular Benefits+ coverage or vision insurance for an additional premium
  • Hospital and Surgery benefit - you will receive $100 for each day of hospitalization in excess of three days or following an outpatient surgery performed at a hospital or ambulatory center
  • Accidental death and dismemberment benefit

The EPIC Life Insurance Company is a wholly owned subsidiary of Wisconsin Physicians Service Insurance Corporation (WPS).

Plan Information


General Plan Information

Eligibility

Classified and unclassified employees are eligible when they become covered by the Wisconsin Retirement System.

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). 

Your spouse, domestic partner and unmarried children under age 26 are eligible for coverage (age 27 in 2011). Your children must also be covered by your State Group Health Insurance policy in order to be eligible for coverage under this plan. You may elect single, two-person or full family coverage (you and two or more family members).

Enrollment

Classified employees must file an application with the institution 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 (six months for LTEs) of WRS-covered employment for coverage to be effective at the same time your State Group Health Insurance coverage becomes effective.

Unclassified employees must file an application with the institution 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 or domestic partner by filing an application with the institution benefits office within 30 days after the marriage or establishment of a domestic partnership for benefit purposes.  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 Benefits+ Plan.  From time to time a special enrollment opportunity may be offered to employees who missed their initial enrollment deadline.  

Coverage and Continuation

Coverage is effective on the first of the month following receipt of your application. 

You and your insured family members may be eligible to continue your coverage for up to 18 months after your employment ends under COBRA provisions. If a dependent loses coverage due to a loss of eligibility (divorce, child turns 26...), the dependent is eligible to continue coverage for up to 36 months.  Conversion to an individual policy is not available.

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. Your premium costs will be slightly higher as an annuitant.

Coverage ends for your spouse/domestic partner and stepchildren/domestic partner's children upon divorce/termination of domestic partnership.

Premiums

EPIC Benefits+ Premium Chart

Program Features

The EPIC Benefits+ Plan is designed to supplement the benefits you receive from your primary state group health insurance plan.  EPIC Benefits+ 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 four components to the EPIC Benefits+ coverage: Dental, a Hospital/Surgical benefit, Accidental Death and Dismemberment (AD&D) and a vision discount plan.

  • 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.
  • Effective January 1, 2012, Benefits+ will pay you $100 if you have outpatient surgery at a hospital or ambulatory treatment facility or $100 for each day of hospital confinement after the first three days. For claims prior to January 1, 2012, upon satisfaction of an annual deductible, excess major medical benefits are payable following an outpatient surgery or in-patient stay for non-covered costs such as prescription drug copayment 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..
  • Davis Optical offers substantial savings on eye care, eyewear, and laser vision correction procedures. A vision discount plan is included in the EPIC Benefits+ basic plan. For an additional premium, you may elect the Vision Benefit Extension which provides vision insurance rather than just a vision discount plan. Both the Vision Discount Extension and the vision discount program use the Davis Vision network. Once you elect the Vision Benefit Extension, you cannot drop it without canceling your EPIC Benefits+ plan entirely.

Benefits are outlined in EPIC's Enrollment Brochure. See the Vision Discount Program section in the plan brochure for more information about vision discounts associated with the EPIC Benefits+ basic plan through Davis Optical. Davis Optical utilizes private practice doctors and optical retail chains, such as Walmart Vision Centers, Shopko, Visionworks, Stein Optical and Wisconsin Vision.

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.

Upon termination of employment or retirement, you may elect to continue the coverage by completing a continuation form.

 

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This document was last revised on April 15, 2013

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