Overview

The Supplemental Dental Plans provide coverage for major services, such as crowns and implants. The primary differences between the plans are the provider networks, premium cost, annual maximums and whether orthodontia is covered (Select Plus Plan only). You may enroll in one supplemental dental plan (Select or Select Plus).

Note: Neither plan covers preventive or basic services, such as cleanings and fillings. If coverage for preventive and/or basic services is needed, consider enrolling in Uniform or Preventive Dental.

Delta Dental is the plan administrator for the dental insurance plans.

For more information, review the Plan Brochure and Dental Comparison Chart located in the Forms & Resources section below.

Eligibility

Eligibility for this plan:

For detailed information on who you can cover on this plan, see the Dependent Eligibility Chart (UWS 25) pdf .

Plan Options

Supplemental Dental plan options are the PPO Select Plan or the PPO plus Premier Select Plus Plan.

Schedule of Benefits Select Plan Select Plus Plan
Deductible $100 per person $25 per person
Annual Benefit Maximum $1,000 per person $2,500 per person
Diagnostic and Preventive Services

Routine evaluations, dental cleanings, sealants, bitewing and panoramic X-rays, fluoride treatments, pulp vitality tests, fillings and periodontal maintenance

No coverage No coverage
Non-Surgical Extractions (above gumline) No coverage No coverage
Major/Restorative Services

Crowns, bridges, dentures, and implants

Surgical extraction, root canal (endodontics), periodontics (except maintenance), oral surgery

 

50%

50%

 

60%

80%

Orthodontics

Coverage

Lifetime Maximum

Waiting Period

 

No coverage

NA

NA

 

50% (any age)

$1,500

None

Provider Network

Delta Dental has two provider networks: Delta Dental PPO and Delta Dental Premier. If you enroll in the Select plan, you must use a provider in Delta Dental’s PPO network. If you enroll in the Select Plus plan, you must use a provider in Delta Dental’s PPO and/or Premier network. To receive coverage for dental services, you must choose a dentist within one of Delta Dental’s networks. Delta Dental’s PPO network provides the deepest discounts for services. There are no dental benefits for out-of-network providers.

Not sure if your dentist is in one of the networks? Call Delta Dental at (800) 236-3712, visit Delta Dental at deltadentalwi.com/state-of-wi or contact your dentist directly.

Enrollment

You have 30 days from your date of employment or your newly benefits-eligible job to enroll in a supplemental dental plan. Coverage begins on the first of the month on or following your eligibility date. If you do not enroll in a supplemental dental plan within your initial 30-day enrollment period or want to add/remove dependents from your plan, your next opportunity to do so is during the Annual Benefits Enrollment period. Otherwise, if/when you have a qualifying life event. See Life Events for more information.

Once enrolled in a supplemental dental plan, you must remain enrolled for the entire calendar year.

Note: ID cards for Supplemental Dental are separate from the ID cards for Uniform/Preventive Dental. If you enroll in more than one dental plan, bring both ID cards with you to your appointment. After you enroll, Delta Dental will mail your ID card. You may also login and print an ID card online at www.deltadentalwi.com/state-of-wi.

Benefit Premiums

For Supplemental Dental Insurance premiums review the Benefit Premiums web page.

Forms & Resources


Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.

Updated: 10/29/2021