{"id":10511,"date":"2018-11-26T08:26:24","date_gmt":"2018-11-26T14:26:24","guid":{"rendered":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/?page_id=10511"},"modified":"2026-01-05T13:37:58","modified_gmt":"2026-01-05T19:37:58","slug":"suppdental","status":"publish","type":"page","link":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/suppdental\/","title":{"rendered":"Supplemental Dental Insurance"},"content":{"rendered":"<div id=\"toc\" class=\"uwsa-toc callout hidden-print\"><\/div><style>@media (min-width: 768px) {#toc { max-width: 40%} <\/style><script>jQuery(document).ready(function() {\n \t\t\t\t\tgenerateTOC(\"Supplemental Dental Insurance\", \"\", \"div.entry-content\" ,1 ,\"true\", \"toc\");\n \t\t\t\t\t });<\/script>\n<h2><strong>Overview<\/strong><\/h2>\n<p>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).<\/p>\n<p><strong>Note: <\/strong>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 <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/uniform-dental\/\" target=\"_blank\" rel=\"noopener noreferrer\">Uniform or Preventive Dental<\/a>.<\/p>\n<p style=\"background: white;margin: 0in 0in 8.25pt 0in\"><span style=\"font-size: 10.5pt;font-family: 'Open Sans',sans-serif;color: #333333\">Delta Dental is the plan administrator for the dental insurance plans.<\/span><\/p>\n<p>For more information, review the Plan Brochure and Dental Comparison Chart located in the Forms &amp; Resources section below.<\/p>\n<h2><strong>Eligibility<\/strong><\/h2>\n<p>Eligibility for this plan:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/#eligibility\" target=\"_blank\" rel=\"noopener noreferrer\">Eligible for State Group Health Insurance<\/a>, and<\/li>\n<li>Are not receiving a Wisconsin Retirement System (WRS) annuity.<\/li>\n<\/ul>\n<p><span style=\"float: none;background-color: transparent;color: #333333;cursor: text;font-family: 'Open Sans','Helvetica Neue',Helvetica,Arial,sans-serif;font-size: 14px;font-style: normal;font-variant: normal;font-weight: 400;letter-spacing: normal;text-align: left;text-decoration: none;text-indent: 0px;text-transform: none\">For information on who you can cover on this plan, review the <span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/Dependent-Eligibility-Chart-UWS-25.pdf\" target=\"_blank\">Dependent Eligibility Chart (UWS 25)<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n.<\/span><\/p>\n<h2>Plan Options<\/h2>\n<p>Supplemental Dental plan options are the PPO <strong>Select Plan<\/strong> or the PPO plus Premier <strong>Select Plus Plan<\/strong>.<\/p>\n<table class=\"table-bordered\" style=\"width: 895px\">\n<tbody>\n<tr style=\"height: 39px\">\n<th style=\"width: 538px;height: 39px\"><strong>Schedule of Benefits<\/strong><\/th>\n<th style=\"height: 39px;width: 234.047px;text-align: center\"><strong>Select Plan<\/strong><\/th>\n<th style=\"height: 39px;width: 247.953px;text-align: center\"><strong>Select Plus Plan<\/strong><\/th>\n<\/tr>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 538px\"><strong>Provider Network<\/strong><\/td>\n<td style=\"height: 39px;width: 234.047px;text-align: center\">Delta Dental PPO<\/td>\n<td style=\"height: 39px;width: 247.953px;text-align: center\">Delta Dental PPO and<br \/>\nDelta Dental Premier<\/td>\n<\/tr>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 538px\"><strong>Deductible<\/strong><\/td>\n<td style=\"height: 39px;width: 234.047px;text-align: center\">$100 per person<\/td>\n<td style=\"height: 39px;width: 247.953px;text-align: center\">$25 per person<\/td>\n<\/tr>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 538px\"><strong>Annual Benefit Maximum<\/strong><\/td>\n<td style=\"height: 39px;width: 234.047px;text-align: center\">$1,000 per person<\/td>\n<td style=\"height: 39px;width: 247.953px;text-align: center\">$2,500 per person<\/td>\n<\/tr>\n<tr style=\"height: 83px\">\n<td style=\"height: 83px;width: 538px\"><strong>Diagnostic and Preventive Services<\/strong><\/p>\n<p>Routine evaluations, dental cleanings, sealants, bitewing and panoramic X-rays, fluoride treatments, pulp vitality tests, fillings and periodontal maintenance<\/td>\n<td style=\"height: 83px;width: 234.047px;text-align: center\">No coverage<\/td>\n<td style=\"height: 83px;width: 247.953px;text-align: center\">No coverage<\/td>\n<\/tr>\n<tr style=\"height: 42px\">\n<td style=\"height: 42px;width: 538px\"><strong>Non-Surgical Extractions (above gumline)<\/strong><\/td>\n<td style=\"height: 42px;width: 234.047px;text-align: center\">No coverage<\/td>\n<td style=\"height: 42px;width: 247.953px;text-align: center\">No coverage<\/td>\n<\/tr>\n<tr style=\"height: 83px\">\n<td style=\"height: 83px;width: 538px\"><strong>Major\/Restorative Services<\/strong><\/p>\n<p>Crowns, bridges, dentures, and implants<\/p>\n<p>Surgical extraction, root canal (endodontics), periodontics (except maintenance), oral surgery<\/td>\n<td style=\"height: 83px;width: 234.047px;text-align: center\">&nbsp;<\/p>\n<p>50%<\/p>\n<p>50%<\/td>\n<td style=\"height: 83px;width: 247.953px;text-align: center\">&nbsp;<\/p>\n<p>60%<\/p>\n<p>80%<\/td>\n<\/tr>\n<tr style=\"height: 114px\">\n<td style=\"height: 114px;width: 538px\"><strong>Orthodontics<\/strong><\/p>\n<p style=\"text-align: right\">Coverage<\/p>\n<p style=\"text-align: right\">Lifetime Maximum<\/p>\n<p style=\"text-align: right\">Waiting Period<\/p>\n<\/td>\n<td style=\"height: 114px;width: 234.047px;text-align: center\">&nbsp;<\/p>\n<p>No coverage<\/p>\n<p>NA<\/p>\n<p>NA<\/td>\n<td style=\"height: 114px;width: 247.953px;text-align: center\">&nbsp;<\/p>\n<p>50% (any age)<\/p>\n<p>$1,500<\/p>\n<p>None<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><strong>Provider Network<\/strong><\/h2>\n<p>Delta Dental has two provider networks: Delta Dental PPO and Delta Dental Premier. If you enroll in the <strong>Select plan,<\/strong> you must use a provider in Delta Dental&#8217;s <strong>PPO network<\/strong>. If you enroll in the <strong>Select Plus plan<\/strong>, you must use a provider in <strong>Delta Dental&#8217;s PPO and\/or Premier network<\/strong>. To receive coverage for dental services, you must choose a dentist within one of Delta Dental\u2019s networks. Delta Dental&#8217;s <strong>PPO network provides the deepest discounts<\/strong> for services. There are no dental benefits for out-of-network providers.<\/p>\n<p>Not sure if your dentist is in one of the networks? Call Delta Dental at (800) 236-3712, visit Delta Dental at <a href=\"http:\/\/www.deltadentalwi.com\/state-of-wi\" target=\"_blank\" rel=\"noopener noreferrer\">deltadentalwi.com\/state-of-wi<\/a> or contact your dentist directly.<\/p>\n<h2><strong>Enrollment<\/strong><\/h2>\n<p>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 enrollment period each fall for coverage effective the following January 1. Otherwise, if\/when you have a qualifying life event. See <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life-events\/\" target=\"_blank\" rel=\"noopener noreferrer\">Life Events<\/a> for more information.<\/p>\n<p><strong>Once enrolled in a supplemental dental plan, you must remain enrolled for the entire calendar year.<\/strong><\/p>\n<h2><strong>ID Cards<\/strong><\/h2>\n<p>If you enroll in dental insurance, you will receive an ID card from Delta Dental, the dental insurance carrier. For each dental insurance plan (Uniform, Preventive, Select, Select Plus), there are separate ID cards. Present both of your Delta Dental ID cards at your dental appointments if you enroll in more than one plan. To print your dental insurance ID cards, go to the Delta Dental website (linked in the &#8220;Plan Administrators&#8221; section below). To request that Delta Dental send you new ID cards via U.S. Mail, contact Delta Dental at 1-844-337-8383.<\/p>\n<h2><strong>Benefit Premiums<\/strong><\/h2>\n<p>For Supplemental Dental Insurance premiums review the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/premiums\/\" target=\"_blank\" rel=\"noopener\">Benefit Premiums web page<\/a>.<\/p>\n<h2><strong>Forms &amp; Resources<\/strong><\/h2>\n<ul>\n<li><a href=\"https:\/\/etf.wi.gov\/publications\/et-2339\/download?inline=\" target=\"_blank\" rel=\"noopener\">Supplemental Insurance (dental, vision, accident) Application\/Change Form (ET-2339)<\/a><\/li>\n<li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/dentalinsbrochure.pdf\" target=\"_blank\">Dental Insurance Brochure<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li>\n<li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/dentalcomp.pdf\" target=\"_blank\">Dental Comparison Chart<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li>\n<li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/selecthandbook.pdf\" target=\"_blank\">Dental Insurance Handbook - Select Plan<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li>\n<li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/selectplushandbook.pdf\" target=\"_blank\">Dental Insurance Handbook - Select Plus Plan<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li>\n<li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/terms-conditions\/\" target=\"_blank\" rel=\"noopener noreferrer\">Terms &amp; Conditions<\/a><\/li>\n<\/ul>\n<h2>Plan Administrator<\/h2>\n<ul>\n<li><a href=\"http:\/\/www.deltadentalwi.com\/state-of-wi\/\" target=\"_blank\" rel=\"noopener noreferrer\">Delta Dental<\/a> | (<span style=\"float: none;background-color: transparent;color: #333333;font-family: 'Open Sans','Helvetica Neue',Helvetica,Arial,sans-serif;font-size: 14px;font-style: normal;font-variant: normal;font-weight: 400;letter-spacing: normal;line-height: 22px;text-align: left;text-decoration: none;text-indent: 0px;text-transform: none\">844) 337-8383 | <a href=\"https:\/\/www.deltadentalwi.com\/s\/find-a-provider\" target=\"_blank\" rel=\"noopener\">Find a Dental Insurance Provider<\/a><\/span><\/li>\n<\/ul>\n<hr \/>\n<p style=\"text-align: right\">\n","protected":false},"excerpt":{"rendered":"<p>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 [&#8230;]<\/p>\n","protected":false},"author":1612,"featured_media":0,"parent":7394,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/42.7563.php","meta":{"footnotes":""},"class_list":["post-10511","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/10511","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/users\/1612"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/comments?post=10511"}],"version-history":[{"count":9,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/10511\/revisions"}],"predecessor-version":[{"id":29661,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/10511\/revisions\/29661"}],"up":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/7394"}],"wp:attachment":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/media?parent=10511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}