/depts/,/depts/uwhealth/,/depts/uwhealth/benefits/,/depts/uwhealth/benefits/open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/supplemental-delta-dental/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/supplemental-delta-dental/resources/,

/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/supplemental-delta-dental/resources/2018-Combined-Dental-Comparison-Grid-09.25.18-KAS.pdf

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UWHC,UWMF,

Departments & Programs,UW Health,Benefits,UW Health Open Enrollment,UWHC Open Enrollment,Supplemental Delta Dental,Resources

2018 Dental Comparison

2018 Dental Comparison - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, UWHC Open Enrollment, Supplemental Delta Dental, Resources


2018 Dental
State Uniform Dental
(Combined with Health Ins.)
Network
Delta Dental PPO and Delta
Dental Premier provider
networks
Delta Dental PPO Delta Dental Premier Non-contracted
2018 Premium Rates Optional for 2018* Without Vision With Vision
Employee $3.00* $21.38 $25.02
Employee + Spouse or Domestic Partner n/a $42.76 $49.16
Employee + Child(ren) n/a $42.76 $49.16
Family $8.00* $64.14 $73.58
Provider Network In-network ONLY Delta Dental PPO Delta Dental Premier Non-contracted
Deductible
(must be met before benefits are covered)
$0 $25 per member
Calendar Benefit Max $1,000
2018 Max $750
2019 Max $1,000
2020 (and later) Max $1,500
Diagnostic & Preventative 100% 100% 100% 80%
Routine Evals 2 per year
Cleanings 2 per year
Bitewing X-rays 1 set per year
Panoramic X-rays Once every 60 months
Fluouride 2 per year up to age 19
Basic See specific services
Fillings 100% 80% 80% 50%
Extractions (non-surgical) Not covered 80% 80% 50%
Local Anesthesia 80% 50% 50% 50%
Emergency Palliative Care 80% 80% 80% 50%
X-rays (limited) 100% 100% 100% 80%
Oral Surgery
Not covered, but may be covered
under medical plan
50% 50% 50%
Major/Restorative See specific services
Implants 50% 50% Not covered
Crowns 50% 50% Not covered
Bridges 50% 50% Not covered
Dentures 50% 50% Not covered
Endodontic 50% 50% 50%
Periodontic
80%: Limited to Periodontal
Maintenance
50% 50% 50%
Dental Waiting Period None None None None
Claim Filing Timeline 12 months
Orthodontia 50% (under 19 only) 50% (under 19 only) 50% (under 19 only) Not covered
Ortho Lifetime Max $1,500 $1,250 $1,250 Not covered
Ortho Waiting Period None None None Not covered
Website
deltadentalwi.com/state-of-wi
Updated 09.26.17
2018 UWHC Dental Benefits Plans Comparison
epiclife.com/wi-state-employees/
$1,200
See specific services
None
120 days
50% (under 19 only)
24 months
$20.92
EE + 2 or more = $64.54
$1,000
EE + 1= $40.86
50% on covered procedures as
related to Major Services only
Open Network
$75
Not Covered
$1,500. / For new enrollees, if
See specific services
See specific services
$1,000
Not covered
Not Covered
See specific services
50% on covered procedures as
related to Major Services only
DISCLAIMER: Every effort has been made to ensure that this information is correct and current. However, the terms and conditions of UWHC’s benefit programs are established by state and federal laws and regulations
and the relevant contracts. These sources of authority have control over the information to the extent there are any differences or conflicts.
*Must be enrolled in state group health insurance to be enrolled in Uniform Dental. Premiums listed represent the additional cost to the employee to add Uniform Dental coverage to their
health insurance. The $3 or $8 is added to the health insurance premium for health insurance + uniform dental.
15 months
Once every 6 months
Once every 6 months
EPIC Benefits +
Delta Dental nationwide: Member
responsible for charges over the
allowable amount unless a Delta Premier
Provider is used.
UWHC Supplemental Delta Dental
$50 per member
deltadentalwi.com
Once every 6 months
Once every 3 years
2 per year up to age 19
$1,000