Plan Summary

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:

  • PPO Plan
  • Select Plan

You may enroll in either the PPO or the Select Plan – not both.

Dental Wisconsin is offered through EPIC Life Insurance Company.

The plan administrator is Delta Dental.


 

Dental Wisconsin coverage includes:

  • 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 Affinity Vision Discount Program.

Select Plan

PPO 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).
  • Annual deductible of $50/person.
  • 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 Plan Brochure for detailed coverage information.
epic life insurance co.
  • Website
  • Customer Service: 1-800-520-5750
delta dental
  • Website
  • Customer Service: 1-800-236-3712
davis vision
  • Website
  • Customer Service: 1-800-282-4471
  • Client Code: 7748

Eligibility

Employee
Dependents
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:

  • Spouse
  • Domestic partner
  • Children
    • Your, 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 turn 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 (UWS 25).

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, either through eBenefits or paper application.
  • Coverage is effective on the first of the month on or following your benefits eligibility date.
  • 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.
  • An open enrollment for this plan is offered at least every two years during the Annual Benefit Enrollment period each fall.

Dependents

  • 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 institution by December 1st.

Premiums

Monthly Premiums
 Plan Employee Only Employee + Spouse/DP Employee + Child(ren) Family
Select Plan $20.52 $42.19 $48.68 $71.59
PPO Plan $25.49 $53.96 $60.34 $91.21

The University does not contribute toward the premium.

Find a Provider

Dental Providers

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.

Present your Dental Wisconsin card to your provider when you receive dental services. The provider will bill EPIC directly. You may have to pay your portion of charges when you receive services.

Find a Provider
Select Plan

Locating a Delta Dental Premier Provider

PPO Plan

Locating a Delta Dental PPO Provider

  • You may 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 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.
  • You may 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 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 do not use a Delta Dental PPO provider, benefits will be paid according to the out-of-network benefit schedule.
  • If you use a Delta Dental Premier provider, 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 1-888-825-8390 to find a provider.

When you receive vision services, present your Dental Wisconsin card to your provider to receive your discount.

Forms & Resources