You are eligible to enroll in, make changes and cancel coverage for Dental Wisconsin during the Annual Benefit Enrollment period from October 6 to October 31, 2014. Visit the Annual Benefit Enrollment (ABE) website for more information on upcoming changes and enrollment opportunities for 2015.
The Dental Wisconsin Insurance plan is a stand-alone dental insurance plan that offers comprehensive dental coverage. There are two benefit plans from which to choose: the PPO and the Select Plan (you may enroll in either the PPO or the Select Plan – not both). Dental Wisconsin is offered through EPIC Life Insurance Company.
Dental Wisconsin coverage includes:
- Coverage under both Select and PPO Plans:
- You may see the dentist of your choice. If you see an in-network dentist, you will have lower out-of-pocket costs.
- Partial coverage for fillings, crowns, implants, bridges complex endodontics and periodontics, with an annual benefit maximum of $1,000/person.
- Orthodontia services are covered at 50% for children under 19 years old, up to a lifetime benefit maximum of $1,000. This does not apply towards the annual benefit maximum.
- You and your covered dependents must serve a 3 month waiting period for basic and major services and a 12 month waiting period for orthodontic services (unless you have prior creditable dental coverage).
- Automatic enrollment in the Davis Vision Affinity Discount Program.
- Select Plan
- Wraps around dental benefits offered by your State Group Health Insurance plan.
- Does not cover annual cleanings or x-rays (these services are typically covered by the State Group Health plans with the exception of the Standard Plan).
- Annual deductible of $50/person.
- The PPO Plan
- Coverage for annual cleanings and x-rays with no waiting period.
- Annual deductible of $25/person for in-network services and $50/person for out-of-network services.
See the Dental Wisconsin brochure for detailed coverage information.
You must meet the following requirements to be eligible for this plan:
- Eligible for State Group Health Insurance; and
- Are not receiving a Wisconsin Retirement System (WRS) annuity.
An eligible dependent includes:
- Domestic partner
- Your or your spouse’s or domestic partner’s unmarried or married children under age 26. Children remain eligible for coverage until the end of the month in which they are 26 years old.
- Your child may remain eligible beyond age 26 if he/she is incapable of self-support due to a physical or mental disability.
- If born to a covered child under age 18.
- Grandchildren remain eligible for coverage until the end of the month in which the grandchild’s parent turns 18.
For detailed information regarding dependent eligibility, see UWSA’s Dependent Eligibility Grid.
Eligibility to Continue Coverage when Employment Ends
You and your family members may be eligible to continue coverage when eligibility or employment ends. See Employment Changes for additional information.
- You may enroll within 30 days of the start of your first benefits-eligible appointment. Coverage is effective on the first of the month on or following receipt of your application, either through eBenefits or paper application.
- You may enroll within 30 days of a change in family status (ex. marriage or domestic partnership) or loss of other comparable group dental coverage.
- You may enroll within 60 days of the birth or adoption of a child.
- If you were initially eligible for coverage when you were not covered by the Wisconsin Retirement System (WRS), you may enroll within 30 days of your WRS coverage begin date.
- If you have eligible dependents when you enroll in coverage, you may enroll your dependents at the same time.
- You may add a spouse or domestic partner within 30 days of marriage or establishing a domestic partnership for benefit purposes (may add spouse’s or domestic partner’s children at same time).
- You may add a child within 60 days of gaining an eligible child due to birth or adoption.
- You may add a spouse, domestic partner, or child within 30 days of their loss of coverage under a comparable group dental plan.
Note: Once you are enrolled in Dental Wisconsin, you must remain enrolled for the calendar year. You may cancel coverage or remove dependents for the following year by submitting an application to your benefits office by December 1st.
Selecting a Provider
You may see the dental provider of your choice but you will have lower out-of-pocket costs if you see a dental provider in your plan’s network. Prices for dental services received in-network are negotiated for your benefit. Providers in the network will not bill you for any charges in excess of the negotiated fee.
When you receive dental services, present your Dental Wisconsin card to your provider. The provider will bill EPIC directly. You may have to pay your portion of charges when you receive services.
Select Plan – Locating a Delta Dental Premier Provider
You can see the provider of your choice under the Select Plan, but you will have lower out-of-pocket costs if you use a provider in the Delta Dental Premier Provider network.
You can use the Delta Dental Provider Online Provider Search (click the button next to “Delta Dental Premier” under Network Selection) to find a Delta Dental Premier Provider. You may also call Delta Dental at 800-236-3712 to find a provider.
PPO Plan – Locating a Delta Dental PPO Provider
You can see the provider of your choice under the PPO Plan, but you will have lower out-of-pocket costs if you use a provider in the Delta Dental PPO network.
You can use the Delta Dental Provider Online Provider Search (click the button next to “Delta Dental PPO” under Network Selection) to find a Delta Dental PPO Provider. You may also call Delta Dental at 800-236-3712 to find a provider.
If you are covered by the PPO Plan and use a Delta Dental Premier provider who is not part of the Delta Dental PPO network, your benefits will be paid according to the out-of-network benefit schedule, but you will not be billed for any charges in excess of the in-network negotiated fee.
Locating a Davis Vision Provider
You can use the Davis Vision Online Provider Search (Go to the Open Enrollment box and enter Client Code 7748) to find a Davis Vision Provider. You may also call Davis Vision at 888-825-8390 to find a provider.
When you receive vision services, present your Dental Wisconsin card to your provider to receive your discount.
Forms & Publications
Dental WI Select Plan Certificate - Amended Benefits Endorsement 2013
Dental WI PPO Plan Certificate - Amended Benefits Endorsement 2013 (Annuitants)
Dental WI Select Plan Certificate - Amended Benefits Endorsement 2012
Dental WI PPO Plan Certificate - Amended Benefits Endorsement 2012 (Late Enrollees)
- Application - Complete and submit to your institution’s benefits office to enroll in the plan.