{"id":5856,"date":"2016-12-09T05:00:38","date_gmt":"2016-12-09T11:00:38","guid":{"rendered":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/?page_id=5856"},"modified":"2026-01-05T13:37:12","modified_gmt":"2026-01-05T19:37:12","slug":"uniform-dental","status":"publish","type":"page","link":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/uniform-dental\/","title":{"rendered":"Uniform &amp; Preventive 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(\"Uniform &amp; Preventive Dental Insurance\", \"\", \"div.entry-content\" ,1 ,\"true\", \"toc\");\n \t\t\t\t\t });<\/script>\n<h2><strong>Overview<\/strong><\/h2>\n<p>The Uniform and Preventive Dental plans provide coverage for diagnostic, preventive and basic services. You are eligible for either Uniform Dental <strong>or<\/strong> Preventive Dental, based on whether you enroll in State Group Health Insurance. Review the eligibility section of this page for additional information.<\/p>\n<p>Delta Dental is the plan administrator for the dental insurance plans.<\/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>Eligibility<\/h2>\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\"><strong>Uniform Dental: <\/strong>You are eligible if <\/span><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\">you enroll in State Group Health Insurance. If you enroll in <strong>family<\/strong> State Group Health Insurance then you can <\/span><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\">enroll in family Uniform Dental Insurance. If you enroll in <strong>individual<\/strong> State Group Health Insurance<\/span><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\">\u00a0then you can enroll in individual Uniform Dental Insurance.<\/span><\/p>\n<p><strong><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;letter-spacing: normal;text-align: left;text-decoration: none;text-indent: 0px;text-transform: none\">Preventive Dental: <\/span><\/strong>If you decline State Group Health Insurance, you are eligible for Preventive Dental.<\/p>\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 these plans, 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><strong>Coverage<\/strong><\/h2>\n<p>Below is the schedule of benefits for Uniform Dental and Preventive Dental.<\/p>\n<table class=\"table-bordered\" style=\"width: 832px\">\n<thead>\n<tr style=\"height: 39px\">\n<th style=\"width: 602.344px;height: 39px\"><strong>Schedule of Benefits (Uniform and Preventive Dental Insurance plans)<\/strong><\/th>\n<th style=\"height: 39px;width: 217.656px\"><strong>Coverage<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 602.344px\"><strong>Provider Network<\/strong><\/td>\n<td style=\"height: 39px;width: 217.656px\">Delta Dental PPO and<br \/>\nDelta Dental Premier<\/td>\n<\/tr>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 602.344px\"><strong>Deductible<\/strong><\/td>\n<td style=\"height: 39px;width: 217.656px\">None<\/td>\n<\/tr>\n<tr style=\"height: 39px\">\n<td style=\"height: 39px;width: 602.344px\"><strong>Annual Benefit Maximum<\/strong><\/td>\n<td style=\"height: 39px;width: 217.656px\">$1,000 per member<\/td>\n<\/tr>\n<tr style=\"height: 60.1094px\">\n<td style=\"height: 60.1094px;width: 602.344px\"><strong>Diagnostic and Preventive Services<\/strong><\/p>\n<p>Routine evaluations, dental cleanings, sealants*, bitewing and panoramic X-rays,<br \/>\nfluoride treatments*, pulp vitality tests, fillings and periodontal maintenance<\/p>\n<p><em>*for children to age 19<\/em><\/td>\n<td style=\"height: 60.1094px;width: 217.656px\">100%<\/td>\n<\/tr>\n<tr style=\"height: 77px\">\n<td style=\"height: 77px;width: 602.344px\"><strong>Non-Surgical Extractions (above gumline)<\/strong><\/td>\n<td style=\"height: 77px;width: 217.656px\">90%<\/td>\n<\/tr>\n<tr style=\"height: 83px\">\n<td style=\"height: 83px;width: 602.344px\"><strong>Major\/Restorative Services<\/strong><\/p>\n<p>Crowns, bridges, dentures, root canal therapy (endodontics)<\/td>\n<td style=\"height: 83px;width: 217.656px\">Not covered<\/td>\n<\/tr>\n<tr style=\"height: 112px\">\n<td style=\"height: 112px;width: 602.344px\"><strong>Orthodontics (Under Age 19)<\/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: 112px;width: 217.656px\">&nbsp;<\/p>\n<p>50%<\/p>\n<p>$1,500<\/p>\n<p>None<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Dental services covered by Uniform Dental are not subject to the health insurance deductible. See the <strong>Certificate of Coverage <\/strong>available in the Forms &amp; Resources section below\u00a0for a list of covered services and exclusions.<\/p>\n<p>Uniform Dental and Preventive Dental <strong><em>do not<\/em><\/strong> include coverage for major dental services, such as crowns, root canals or implants. If you want coverage for major dental services, you may enroll in a <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/suppdental\/\" target=\"_blank\" rel=\"noopener noreferrer\">supplemental dental plan<\/a>. You do not need to enroll in Uniform Dental or Preventive Dental to enroll in a supplemental dental plan.<\/p>\n<h2><strong>Provider Network<\/strong><\/h2>\n<p>Delta Dental has two provider networks: Delta Dental PPO and Delta Dental Premier. 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 (844) 337-8383. Or 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 Uniform or Preventive Dental. Coverage begins on the first of the month on or following your eligibility date. If you do not enroll in Uniform or Preventive Dental 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, 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 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\/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\/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\/preventivehandbook.pdf\" target=\"_blank\">Dental Insurance Handbook - Preventive Plan<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li>\n<li><a href=\"https:\/\/etf.wi.gov\/its-your-choice\/2026\/health-benefits\/uniform-dental-benefits-certificate-coverage\" target=\"_blank\" rel=\"noopener noreferrer\">Certificate of Coverage &#8211; Uniform Dental<\/a><\/li>\n<li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/terms-conditions\/\" target=\"_blank\" rel=\"noopener noreferrer\">Terms and 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<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Overview The Uniform and Preventive Dental plans provide coverage for diagnostic, preventive and basic services. You are eligible for either Uniform Dental or Preventive Dental, based on whether you enroll in State Group Health Insurance. Review the eligibility section of this page for additional information. Delta Dental is the plan administrator for the dental insurance [&#8230;]<\/p>\n","protected":false},"author":3081,"featured_media":0,"parent":371,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/42.7563.php","meta":{"footnotes":""},"class_list":["post-5856","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/5856","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\/3081"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/comments?post=5856"}],"version-history":[{"count":15,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/5856\/revisions"}],"predecessor-version":[{"id":29660,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/5856\/revisions\/29660"}],"up":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/371"}],"wp:attachment":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/media?parent=5856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}