Your Uniform Dental Benefits
May 2, 2014
In 2014, all health plans except the Standard Plan and SMP offer a uniform dental benefit. The dental provider networks vary by health plan but the benefits are the same. For some employees this means a reduction in the dental benefits you had in the past. For others, this means an increase to your dental benefits and for some, there is no change from past coverage. A summary of the Uniform Dental Benefit is below.
Uniform Dental is part of the health insurance contract and is included as part of your health insurance plan. Uniform Dental is not the sameas the supplemental dental plans that are also offered (Dental Wisconsin PPO or Select or EPIC Benefits+).
| In-Network Provider | Designated Out-of-Network Provider* | Covered Services (Examples) | |
|---|---|---|---|
| Deductible | $0 | $0 | |
| Annual Benefit Maximum (per person) | $1,000 | $1,000 | |
| Diagnostic/Preventive | 100% | 50% |
|
| Restorative | 100% | 50% |
|
| Periodontal | 80% | 50% |
|
| Adjunctive Services | 80% | 50% |
|
| Orthodontia (under 19) | 50% | 50% | |
| Orthodontia Lifetime Maximum (per child) | $1,500 | $1,500 |
*A health plan may designate and authorize out-of-network providers so that at least one dentist is available in each county or major city, if applicable.
For a complete list of benefits, see the Certificate of Coverage.
Before making an appointment always check your health insurance provider’s website to make sure that your dentist is included as either an “In-Network” or “Designated Out-of-Network” dentist. This information will not only assist you in finding a dentist, but help to determine if the services you receive will have additional charges. Remember that dentists come in and drop out of dental networks on a regular basis. Even if your dentist used to be in your network, there are no guarantees that your dentist will remain in the network.
Review the chart above and the certificate of coverage to confirm what services are covered. If you carry Dental Wisconsin or EPIC Benefits+, you should review your coverage under these plans and confirm that your dental office is aware of all of your dental plans. Services not covered by any dental plan are the member’s responsibility. If you enrolled in the Employee Reimbursement Account (ERA) for 2014, these expenses may be eligible for reimbursement through this program.
Source: UW System Administration
Categories: Insurance