Overview

EPIC Benefits+ is a supplemental insurance plan that offers dental, hospital and surgery, accidental death and dismemberment coverage, and a vision discount program, along with the option to purchase additional vision insurance. EPIC Benefits+ is offered through EPIC Specialty Benefits.

EPIC Benefits+ coverage includes:

Dental

    • Partial coverage for fillings, crowns, implants, and bridges with an annual benefit maximum of $1,500/person
    • Orthodontia services are covered at 50% for children under 19, up to a lifetime benefit maximum of $1,200, after a 12-month waiting period. This does not apply towards the annual benefit maximum
    • May see the dentist of your choice, however, you will have lower out-of-pocket costs if you see a Delta Dental Premier provider.

Not sure if your dentist is a Delta Dental Premier provider? Call Delta Dental at 800-236-3712 or visit Delta Dental on the web at www.deltadentalwi.com/state-of-wi or contact your dentist directly.

Vision

    • Automatic enrollment in the Affinity Vision Discount Program which offers members discounts on professional vision services and products
    • You have the option of adding supplemental vision insurance for an additional cost. The optional vision insurance provides coverage for vision materials (e.g., glasses or contacts); there is no coverage for routine vision exams.

Hospital/Surgery

    • You will receive $200 for each outpatient surgery performed at an approved facility or $200 for each day of hospital confinement starting on the third day of confinement and continuing through day 365 of the hospitalization. Confinement in a skilled nursing facility does not qualify for this benefit.

Accidental Death and Dismemberment

    • Coverage ranges from $1,500 to $15,000 paid to you or the beneficiary of your choice.
See the  Plan Brochure for plan details and list of exclusions.

Eligibility

You must meet the following requirements to be eligible for this plan:

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

Enrollment

You have 30 days from your date of employment or your newly benefits-eligible job to enroll yourself and eligible family members in EPIC Benefits+. Your coverage will begin on the first of the month on or following your eligibility date.

If you do not enroll in EPIC Benefits+ or did not include dependents on your plan during your initial 30-day enrollment period, you may enroll when offered during the Annual Benefits Enrollment period or if you have a qualifying life event. See Life Events for more information.

Once you are enrolled in EPIC Benefits+, you must remain enrolled for the calendar year.

Premiums

For EPIC Benefits+ premiums, see the Premiums page.

Beneficiary Information

EPIC Benefits+ plan includes accidental death and dismemberment coverage. You are strongly encouraged to designate a beneficiary(ies) to ensure benefits are paid according to your wishes. To designate a beneficiary(ies), complete the Beneficiary Designation Form form and mail or fax directly to EPIC.

In the event there is no eligible beneficiary on record, or you do not submit a designation either electronically or on paper, benefits will be paid in the following order:

  • Your surviving spouse or domestic partner, otherwise;
  • Your surviving children equally, otherwise;
  • Your surviving grandchildren equally, otherwise;
  • Your surviving parents equally, otherwise;
  • Your surviving siblings equally, otherwise;
  • Your estate.

For more information, see Beneficiary.

Forms & Resources


last updated: 12/9/16