EPIC Benefits+

You are eligible to enroll in, make changes and cancel coverage for EPIC Benefits+ 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.

Plan Summary

The EPIC Benefits+ Insurance plan offers supplemental dental and vision coverage, as well as a hospital/surgery benefit and an accidental death and dismemberment benefit. EPIC Benefits+ is is offered through EPIC Life Insurance Company.

EPIC Benefits+ coverage includes:

  • Supplemental dental coverage - fillings, crowns, implants, and bridges are partially covered with an annual benefit maximum of $1,500/person after a $75 deductible.
  • Orthodontia coverage - services are covered at 50% for children under 19 after a 12-month waiting period, up to a lifetime benefit maximum of $1,200. This does not apply towards the annual benefit maximum.
  • Vision Benefits
  • Hospital/Surgery Benefits - you will receive $100 for each outpatient surgery performed at an approved facility or $100 for each day of hospital confinement starting on the third day of confinement.
  • Accidental death and dismemberment coverage – coverage ranges from $1,000 to $10,000 paid to you or the beneficiary of your choice.

See the EPIC Benefits+ brochure for detailed coverage information.

Eligibility

Employee

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.

Dependents

An eligible dependent includes:

  • Spouse
  • Domestic partner
  • Children
    • 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.
  • Grandchildren
    • 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.

Enrollment

Employee

  • 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.
  • Classified employees may also choose to have coverage effective when you become eligible for the employer contribution towards your State Group Health coverage. Coverage is effective the 1st of the month following completion of 2 months of WRS service (after 6 months for LTE's).
  • 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.

Dependents

  • If you have dependents when you enroll in coverage, you may enroll your dependents at the same time you enroll.
  • 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 a child child due to birth or adoption.

Note: Once you are enrolled in EPIC Benefits+, 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.

Premiums

Monthly Premiums
 Employee
Only
Employee
+ Spouse/DP
Employee
+ Child
Family
Without Vision
Insurance
$19.77 $39.54 $39.54 $59.31
With Vision
Insurance
$24.02 $47.04 $47.04 $70.34

The University does not contribute toward the premium.

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 who is in the Delta Dental Premiere network.

Delta Dental Premier Network

EPIC Benefits+ uses the Delta Dental Premier 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.

Locating a Delta Dental Premier Provider

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.

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 dental or vision services, present your EPIC Benefits+ card to your provider. The provider will bill EPIC directly. You may have to pay your portion of charges when you receive services.

Forms & Publications

  • Application - Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation - Complete and submit to EPIC Life Insurance Company to name who you would like to receive benefits payable upon your death under the Accidental Death and Dismemberment provision.
  • Hospital/Surgery Claim Form & Instructions - Complete and submit to EPIC Life Insurance Company to file a claim for an outpatient surgery or hospital confinement.
  • Life and AD&D Claim Form - Complete and submit to EPIC Life Insurance Company to file a claim for a death or dismemberment.
  • Davis Vision Claim Form - Complete and submit to Davis Vision to file a claim for vision services received out of the Davis Vision network.