State of Wisconsin Employees

Excess Medical Coverage

An umbrella of protection over your base medical coverage

It's no secret medical care is expensive, and getting more so every year. Excess Medical Coverage from The EPIC Life Insurance Company will help ease the financial burden brought on by extensive medical treatment.

Excess Medical coverage "fills the gap" in your primary health care plan by rounding out the benefits offered if you're hospitalized for at least 24 hours, or you have outpatient surgery performed in a hospital setting or licensed surgical center. Procedures falling under Wisconsin state mandates, noted in the following benefits grid, are considered for coverage without meeting the outpatient surgery or inpatient requirements.

First, your primary coverage processes your medical claims. Then, the following benefits kick in after you meet your annual deductible.

Annual Deductible	$250 Individual / $500 Family
Individual Lifetime Maximum	Non-Annuitant $250,000 / Annuitant $100,000
Professional Services Surgical Services Medical Services Anesthesia Services Maternity Services Diagnostic Radiology and Laboratory Services	Deductible, then 100% of covered charges
Hospital Services Room and Board Charges including Nursing Services and Private Room (up to primary room rate) Room and Board in an Intensive Care Unit Miscellaneous Hospital Expenses	Deductible, then 100% of covered charges
Other Treatments, Services, and Supplies Outpatient Physical Therapy Professional Licensed Ambulance Service Blood and Blood Plasma Initial Artificial Limbs and Eyes Casts, Splints, Strapping, Orthopedic Braces, and Crutches Oxygen and Respiratory Therapy Equipment, Subject to our Approval Rental or Purchase of Durable Medical Equipment, Subject to our Approval Dental Repair to Natural Teeth within 180 Days of the Injury Nursing Services, as Defined in the Policy Prescription Legend Drugs	Deductible, then 100% of covered charges
Treatment of Alcoholism, Drug Abuse, and Mental or Nervous Disorders (Wisconsin State Mandate) Inpatient Hospital Services Outpatient Services Transitional Treatment	100% to a maximum of $7,000 per year, where the maximum is a combination of benefits paid by your primary health plan and the EPIC plan
Kidney Disease, as Described in the Policy (Wisconsin State Mandate)	Deductible, then 100% to a $30,000 maximum per participant per calendar year
Transplants -- Heart • Lung • Heart/Lung • Pancreas • Liver • Bone Marrow	Deductible, then up to 50% of covered charges to a $30,000 lifetime maximum per participant for the listed transplants
Skilled Nursing Care (Wisconsin State Mandate) Up to 30 Days per Confinement in a Licensed Skilled Nursing Facility at a Daily Rate Set by the State of Wisconsin	Deductible, then 100% of covered charges
Home Care Services (Wisconsin State Mandate) Up to 40 Visits per Participant in any 12-month Period under an Approved Home Care Plan	Deductible, then 100% of covered charges
Additional Wisconsin State Mandates Mammography Screening Diabetes Treatment, Including One Pump per Calendar Year, Insulin, and Self-management Education Programs Blood Lead Tests to Age Five Temporomandibular Joint Disorder (TMJ), as Defined in the Policy Breast Reconstruction Following a Covered Mastectomy Immunizations	Deductible, then 100% of covered charges