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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2018 Local Health Plan Insurance Program
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2018 It's Your Choice - Local Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2018


Local Health Plan
Insurance for Employees
and Retirees
(PO6, PO16)


Supplemental Benefits

Your employer may choose to offer Uniform Dental Benefits along with your health insurance coverage. Ask your benefits office about available options.  The chart lists the most commonly used benefits. Review complete information, including limitations and benefit exclusions in the covered services and coinsurance section below.

Health Insurance Required

The Uniform Dental Benefit is only available if you enroll in health insurance under the WPE Group Health Insurance Program.

Your dental coverage will mirror your health coverage; if you elect family health insurance with dental, you will be enrolled in family dental coverage. If you elect individual health insurance with dental, you will be enrolled in individual dental coverage.

Delta Dental Logo

Monthly Payment (Premium)

Contact Your Employer

In-Network Providers

Delta Dental PPO or
Premier providers
No out-of-network coverage

Deductible

None
Annual Benefit Max $1,000 / person
Diagnostic & Preventive Services


Routine evaluations, dental cleanings, sealants, bitewing and panoramic X-rays, fluoride treatments, fillings
100%

Basic Services
Local anesthesia, emergency pain relief

80%

Major / Restorative Services
Crowns, bridges, dentures, root canal therapy (endodontics)

Not covered

Waiting Period

None

Orthodontics (Under Age 19)
Coverage
Lifetime Maximum
Waiting Period


50%
$1,500
None

Contact

1-844-337-8383
deltadentalwi.com/state-of-wi

Covered Services And Coinsurance:
All covered services, copayments and/or coinsurance are outlined in the Uniform Dental Benefit Certificate of Coverage and at Delta Dental.

Enrollment
If your employer offers Uniform Dental, active employees and retirees may choose to elect dental during It’s Your Choice open enrollment as part of your health insurance coverage. Your coverage level will mirror your health insurance coverage. For instance, if you elect individual medical coverage, you will be enrolled in individual dental coverage. If you elect family medical coverage, you will be enrolled in family dental.

New employees may enroll within 30 days of their eligibility throughout the year.

Go to Delta Dental and create an account to:

  • Find in-network providers
  • Print ID cards
  • View your benefits and claims
  • Find valuable dental health resources
  • Ask questions

Additional benefits are available to eligible employees, for more information click on the link. If you have questions, contact your human resources/benefits office.

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: 10/3/2017 11:58:38 AM