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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2017 Local High Deductible Health Plan Insurance Program
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2017 It's Your Choice - Local High Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2017


Local High Deductible Health Plan
Insurance for Employees
and Retirees
(PO7, PO17)


Uniform Dental Benefitstooth

Your employer may choose to offer Uniform Dental Benefits along with your health insurance coverage. Ask your benefits office about available options.

Uniform Dental

Uniform Dental Benefits are only available if you enroll in a health plan. If you are currently enrolled in the Uniform Dental Benefit, you will continue coverage for 2017. Uniform Dental Benefits are not available through all employers; please contact your benefits office for details.

Premium Contributions

Employee premium contribution amounts are determined by your employer. Contact your benefits office for employee monthly premium contribution rates. The dental premium will be included in your medical health insurance premium.

Medical Coverage with Dental

If you elect family medical coverage with dental, you will be enrolled in the family dental coverage. Similarly, if you elect single medical coverage with dental, you will be enrolled in the single dental coverage.

Search Covered Providers

Delta Dental has two provider networks available under the Uniform Dental Benefit: Delta Dental PPO and Delta Dental Premier. Providers covered under these networks are considered “in-network” under the Uniform Dental Benefit. You may search the Provider Directory at www.deltadentalwi.com/provider-search/ to see if your dental provider is in a Delta Dental network. There is no benefit for out-of-network providers.

No Dental Deductible

Dental expenses covered under the Uniform Dental Benefit, including those for the High Deductible Health Plan, are separate from medical benefits and will not be subject to a deductible.

Covered Services and Coinsurance

All covered services, copayments and/or coinsurance will be outlined in the Uniform Dental Benefit Certificate and on Delta Dental’s website and enrollment materials. Benefits for 2017 remain the same as in 2016.

See more Uniform Dental Benefits (Certificate of Coverage).

Benefit In-Network Coverage Examples and Limitations of Covered Services
Deductible $0  
Annual Benefit Maximum $1,000 per member  
Diagnostic/Preventive/Basic Services 100% Exams, cleanings, X-rays, fluoride, sealants, fillings
Orthodontics 50% Lifetime maximum of $1,500 per member; children under 19 years of age only

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/20/2016 6:31:45 PM