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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2019 Local High Deductible Health Plan Insurance Program
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2019 It's Your Choice - Local High Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2019


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


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.

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.

Uniform Dental

Monthly Payment (Premium)

See premium rates with dental

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, 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.

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: 9/20/2018 7:37:15 AM