Cancellation of EPIC Benefits+ for 2016 (complete cancellation of all coverage under this plan for 2016)
Must be submitted via paper application to your Institution’s benefit office by 4:30pm on December 1st, 2015
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 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, up to a lifetime benefit maximum of $1,200, after a 12-month waiting period. This does not apply towards the annual benefit maximum.
- Vision Benefits
- Automatic enrollment in the Davis Affinity Vision Discount Program.
- Optional vision insurance for additional premium.
- Hospital/Surgery Benefits – 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.
- Accidental death and dismemberment coverage – coverage ranges from $1,500 to $15,000 paid to you or the beneficiary of your choice.
See thefor detailed coverage information.
|You must meet the following requirements to be eligible for this plan:
||An eligible dependent includes:
For detailed information regarding dependent eligibility, see UWSA’s.
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, either through eBenefits or paper .
- Coverage is effective on the first of the month on or following your benefits eligibility date.
- University Staff 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 after completion of two months of WRS service if the application is received by your employer, either eBenefits or via paper application prior to meeting the WRS service requirement .
- 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 dependents, you may enroll your dependents for coverage 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 a child due to birth or adoption.
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.
Find 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 Premier 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.