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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2019 State of Wisconsin Group Health Insurance Program
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2019 It's Your Choice - State of Wisconsin Group Health Insurance for Employees and Retirees

Wisconsin Department Of Employee Trust FundsIt's Your Choice 2019


State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

Supplemental Benefits

More choices mean more opportunities for better health and wellness. Check out the supplemental benefits available and if you are eligible, when you can enroll.

The information on these pages will help you compare dental benefit options. The Uniform Dental Benefit offers coverage on routine and basic dental services. If you need additional coverage for major/restorative services, check out the supplemental dental options.

 

Health Insurance Required

Uniform Dental Benefits are only available if you enroll in health insurance under the State of Wisconsin Group Health Insurance Program.

Uniform Dental through Delta Dental is offered to active employees and retirees 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 family dental.

Uniform Dental

Employee - Monthly Payment (Premium)

Added to your health insurance premium

$3 (Individual)

$8 (Family)

Retiree - Monthly Payment (Premium)

Added to your health insurance premium

$30.20 (Individual)

$75.50 (Family)*

*Medicare 1 and Medicare 2 recipients pay a family rate of $60.40

In-Network Providers

No out-of-network coverage

Delta Dental PPO or Premier providers

Annual Deductible

None

Annual Benefit Max

$1,000 / person

Waiting Period

None

Diagnostic & Preventive Services

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

100%

Basic Services

Fillings

100%

Anesthesia (general and IV sedation)

80%

Emergency pain relief

80%

Periodontal Maintenance

80%

Major / Restorative Services

Crowns, bridges, dentures, implants

No coverage

Surgical extraction, root canal (endodontics), periodontics (except maintenance), oral surgery

No coverage

Non-surgical extractions

90%

Orthodontics

Coverage

50% (Under age 19)

Lifetime Maximum

$1,500

Plan Administrator

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

Covered services and coinsurance

All covered services, copays and/or coinsurance are outlined in the Uniform Dental Benefit Certificate of Coverage and at Delta Dental.

Enrollment

Uniform Dental through Delta Dental is offered to active employees and retirees 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.

You can supplement your Uniform Dental Benefit coverage with these additional options. Delta Dental PPO SM - Select Plan and Delta Dental PPO Plus Premier - Select Plus Plan are new offerings for the 2019 plan year. You may only enroll in one of these supplemental dental plan.

Previously Enrolled?

If you were previously enrolled in supplemental dental, you must enroll in a new plan to continue coverage. In future years, your supplemental coverage will continue unless you cancel it during open enrollment.

Select

Select Plus

Employee - Monthly Payment (Premium)

$8.55 (Individual)

$11.54 (Individual + Children)

$17.10 (Individual + Spouse)

$20.52 (Family)

$16.19 (Individual)

$29.95 (Individual + Children)

$32.38 (Individual + Spouse)

$49.38 (Family)

Retiree - Monthly Payment (Premium)

$14.25 (Individual)

$19.24 (Individual + Children)

$28.50 (Individual + Spouse)

$34.20 (Family)

$25.83 (Individual)

$47.79 (Individual + Children)

$51.66 (Individual + Spouse)

$78.78 (Family)

In-Network Providers

No out-of-network coverage

Delta Dental PPO providers

Delta Dental PPO or Premier providers

Annual Deductible

$100 / person

$25 / person

Annual Benefit Max

$1,000 / person

$2,500 / person

Waiting Period

None

None

Diagnostic & Preventive Services

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

No coverage

No coverage

Basic Services

Fillings

No coverage

No coverage

Anesthesia (general and IV sedation)

50%

80%

Emergency pain relief

No coverage

No coverage

Periodontal Maintenance

No coverage

No coverage

Major / Restorative Services

Crowns, bridges, dentures, implants

50%

60%

Surgical extraction, root canal (endodontics), periodontics (except maintenance), oral surgery

50%

80%

Non-surgical extractions

No coverage

No coverage

Orthodontics

Coverage

No Coverage

50%

(Regardless of age)

Lifetime Maximum

No Coverage

$1,500

(in addition to Uniform Dental)


Plan Administrator

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

Enrollment

Supplemental Dental through Delta Dental is offered to active employees and retirees during It’s Your Choice open enrollment.

Active employees: visit the enrollment page for instructions.

Retirees: You have two ways to enroll during open enrollment:

  1. Complete the State of Wisconsin- ETF Supplemental Dental Open Enrollment Form and mail the completed form to Delta Dental at the address on the bottom of the form.
  2. Enroll online.

Summary of Benefits

Handbooks

VSP logo

VSP Vision Care
VSP Vision Care is a national not-for-profit insurance plan, offering personalized eyecare and eyewear services from a diverse network of providers. Members and their covered dependents can receive annual eye exams and coverage allowances towards glasses or contact lenses following a copayment. For more information, please visit VSP's website or call 1-800-400-4569.
UW System employees:  uwsystem.vspforme.com
STAR agency employees: staractives.vspforme.com.
All other employees (non-UW System, non-STAR): stateofwiemployees.vspforme.com.
Retirees: stateofwiretirees.vspforme.com.

Enrollment
VSP will offer open enrollment during It’s Your Choice to active employees and retirees in 2019. If you are currently enrolled with VSP, your enrollment will continue unless you cancel during It’s Your Choice open enrollment.

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

It is important to note:

  • Employers do not contribute to the premiums for this plan.
  • Throughout the year, eligible employees may enroll or make changes to their enrollment based on qualifying events such as marriage, divorce, birth, adoption or loss of other comparable coverage.
  • With few exceptions, once enrolled, you must remain in the plan for the full year. Mid-year cancellation procedures follow those for health insurance—see the Frequently Asked Question “How do I cancel coverage.”
  • You may cancel your new or existing enrollment during the It’s Your Choice Open Enrollment period.

Note: UW System and STAR employees are not eligible to use VSP's Internet or telephone enrollment process. UW System employees should go to UW System Annual Benefit Enrollment (ABE) website at www.wisconsin.edu/abe for enrollment information. Contact your UW institution's payroll and benefits office if you have questions about the enrollment process. STAR employees will make all benefits elections through STAR at ess.wi.gov.

Note: UW System and UW Hospital and Clinics employees may have different optional plans available. Check with your human resources/benefits office for details and instructions for 2019. UW System employees may refer to www.wisconsin.edu/ohrwd/benefits.

 

Zurich logo

Zurich Accidental Death and Dismemberment
Zurich Accidental Death and Dismemberment provides payments for specific amputation injuries, such as loss of a limb, or for accidental death. You choose a coverage level based on multiples of your salary. It also includes travel insurance and insures against identity theft. This benefit is only available to active employees. For enrollment questions, see your payroll/benefits representative; for other questions, please contact Zurich at cms@zurichna.com. For detailed plan information, please visit https://ZurichPlanInfo.qwikcoverage.com.

Enrollment
Zurich will offer open enrollment during It’s Your Choice to active employees. If you are currently enrolled in this plan, your enrollment will continue unless you cancel during It’s Your Choice open enrollment.
New employees may enroll within 30 days of their eligibility throughout the year.

This plan is not available to retirees.

It is important to note:

  • Employers do not contribute to the premiums for this plan.
  • Throughout the year, eligible employees may enroll or make changes to their enrollment based on qualifying events such as marriage, divorce, birth, adoption or loss of other comparable coverage.
  • With few exceptions, once enrolled, you must remain in the plan for the full year. Mid-year cancellation procedures follow those for health insurance—see the Frequently Asked Question “How do I cancel coverage.”
  • You may cancel your new or existing enrollment during the It’s Your Choice Open Enrollment period.

Note: UW System and UW Hospital and Clinics employees may have different optional plans available. Check with your human resources/benefits office for details and instructions for 2019. UW System employees may refer to www.wisconsin.edu/ohrwd/benefits

Zurich has anytime enrollment for UW System employees.

Additional benefits are available to eligible employees, outside of the It's Your Choice open enrollment period. For more information click on the link. If you have questions, contact your human resources/benefits office.

UW System and UW Hospital and Clinics employees may have different supplemental plans available. Check with your human resources/benefits office for details and instructions for 2019. UW System employees may refer to Wisconsin.edu/ohrwd/benefits.

Does your employer offer any supplemental insurance plans?
For a table showing agency names and the insurers available, go to the 2019 Agency/Plan Table.

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: 10/29/2018 10:58:38 AM