University of Wisconsin–Milwaukee

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Step 3

Optional Dental and Vision Insurances Breakdown

30 day enrollment or change deadline
Dental and Vision Insurances Most of the State Group Health Plans provide some level of dental benefits (refer to the individual Health Plan, under the Dental Benefits section for details). You can enhance your benefits with additional dental and/or vision coverage as described below.
DENTAL
  • Side by Side Comparison of All Supplemental Dental Plans
  • Dental Wisconsin: Provides two different levels of dental coverage as a supplement to or instead of your State Group Health Plan dental through Delta Dental of Wisconsin.
    • Dental Wisconsin Select: Provides additional coverage for your current dental plan or may cover services that are not included.
    • Dental Wisconsin PPO: Provides coverage for all phases of dental care to include cleaning and x-rays.
  • EPIC Benefits+: Provides supplemental dental coverage that works with your State Group Health Plan dental. Also includes hospital/surgery, accidental death and dismemberment insurance and a vision discount plan for glasses and/or contacts.
    • Additional vision insurance can be purchased with this plan to provide coverage for frames, lenses and/or contacts.
  • Anthem DentalBlue: Only available to classified represented employees. Coverage will cease for all employees effective 01/01/2013. Please see the FAQ for additional information.
VISION
  • VSP: This plan provides supplementary vision coverage to include an annual eye exam, lenses, and/or contacts. Frames can be purchased every other year.


Dental Wisconsin Program
 Preferred Provider Plan (PPO) Select Plan
In-Network Out-of-Network
Diagnostic/Preventative 100% 75% No Coverage
Basic 75% 55% 75%
Major/Restore - includes implants 50% 25% 50%
Ortho – for children under the age of 19 50% 50% 50%
Ortho Lifetime Maximum $1,000 $1,000
Annual Deductible $25 $50 $50
Office Visit Copay None None
Annual Benefit Maximum $1,000 $1,000
Endodontic & Periodontic Both Under Major/Restore Both Under Major/Restore
Waiting Period (if no prior dental insurance)
    Basic Services
    Major Services
    Ortho		 Prior Similar Coverage Credited:
3 months
3 months
12 months		 Prior Similar Coverage Credited:
3 months
3 months
12 months
Network Dental PPO Providers Any Dentist Any Dentist
WI Providers $1,698 $3,899 $3,899

Dental Wisconsin 2013 Monthly Rates
 PPO Plan Select Plan
Employee $28.32 $20.52
Employee + Spouse/Domestic Partner $59.96 $42.19
Employee + Child(ren) $67.04 $48.68
Family $101.34 $71.59
Provider Directory can be accessed at http://www.epiclife.com, click on the Wisconsin map for State of Wisconsin Employees, and click on the Dental Wisconsin link.


EPIC Benefits+ Dental
Annual Deductible $75 Per Member
Dental Services
  • Extractions
  • Therapeutic injections
  • Periodontics
  • Anesthesia services, as defined in the policy
  • Endodontics
  • Restorations, as defined in the policy
  • Alveolectomy
  • Prosthetics including dentures and bridges and their repair
  • Crowns, as defined in the policy
  • Inlays and onlays
  • Dental implants
  • Orthodontic services and supplies, as defined in the policy*
 Deductible, then 50% of covered charges up to a calendar-year maximum, of $1,000 per member
Orthodontic Lifetime Maximum* $1,200 per member
Provider Directory for Delta Dental available at http://www.deltadentalwi.com or by calling 800-236-3712.
*For eligible children under 19. All appliances must be in place before the eligible child’s 19th birthday. There is a 12-month waiting period from the dependent’s effective date for benefits for orthodontic services and supplies.

EPIC Benefits+ 2013 Monthly Rates
 With Vision Without Vision
Employee $24.02 $19.77
Employee + Spouse/Domestic Partner $47.04 $39.54
Employee + Child $47.04 $39.54
Family $70.34 $59.31
Provider Directory can be accessed at http://www.epiclife.com, click on the Wisconsin map for State of Wisconsin Employees, and click on the EPIC Benefits+ link.


VSP Vision
BENEFITS DESCRIPTION COPAY FREQUENCY
Your Coverage with a VSP Doctor
WellVision Exam
  • focuses on your eyes and overall wellness
 $10 Every calendar year
Prescription Glasses $25 See frame and lenses
Frame
  • $130 allowance for a wide selection of frames
  • 20% off amount over your allowance
 Included in Prescription Glasses Every other calendar year
Lenses
  • Single vision, lined bifocal, and lined trifocal lenses
  • Polycarbonate lenses for dependent children
 Included in Prescription Glasses Every calendar year
Lens Options
  • Scratch-resistant coating
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average 20-25% off other lens options
 $0
$55
$95 - $105
$150 - $175
 Every calendar year
Contacts
(instead of glasses)
  • $105 allowance for contacts and contact lens exam (fitting and evaluation)
  • 15% off contact lens exam (fitting and evaluation)
 $0 Every calendar year
Extra Savings
and Discounts		 Glasses and Sunglasses
  • 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last WellVision Exam.
Laser Vision Correction
  • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
Your Monthly
Contribution		 $5.24 Employee only  $10.49 Employee + spouse  $11.23 Employee + child(ren)
$17.93 Employee + family
Your Coverage with Other Providers
Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.
  • Exam up to $40
  • Single Vision Lenses up to $33
  • Lined Trifocal Lenses up to $66
  • Contacts up to $105
  • Frame up to $45
  • Lined Bifocal Lenses up to $50
  • Progressive Lenses up to $50
Provider
Directory		 Visit vsp.com/go/uwsystem or call 800-877-7195
Please note: VSP does not issue cards to members. Simply inform the provider that you are with VSP when obtaining services.

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