State of Wisconsin Employees
Frequently Asked Questions
Q. Who is eligible for this policy?
A. Employees with the State of Wisconsin, State University System and University Hospital. Please contact your payroll department or EPIC for enrollment information.
Q. What is the Dental and Excess Medical Policy?
A. This policy is a three-part policy, which offers an Accidental Death & Dismemberment, excess major medical and dental coverage. Fore more details on coverage, please see our Dental Coverage, Excess Medical and AD&D overviews.
Q. Why should I purchase this policy?
A. Our policy offers affordable protection against covered medical expenses in excess of your medical plan, protection from high cost for major dental services, and provides AD&D benefits. Once EPIC's deductible has been met, medical benefits are payable for eligible deductibles, co-payments and coinsurance not paid by your medical plan as well as eligible services exceeding your medical plan maximums. Dental benefits are payable for eligible dental services even if you do not have a primary dental plan. You can choose from any one of Delta Dental's network providers or choose a provider outside of their network; we will consider eligible services at the same coinsurance and annual maximum of the network provider.
Q. What is the definition of a dependent?
A. A person who is:
- your spouse;
- your unmarried natural child, adopted child, child placed for adoption with you, step-child or legal ward under age 19;
- your unmarried natural child, adopted child, child placed for adoption with you, step-child or legal ward under age 25, if he/she is a full-time student as determined by us; and
- an unmarried natural child of a dependent child (as described in (b) above) until the dependent child is 18 years of age. In the case of a child placed for adoption with you, the meaning of "placed for adoption" is defined in Section 632.896 Wisconsin Statutes, as amended.
A person is not an eligible dependent if he/she is:
- covered under the policy as an insured;
- on active duty with the military service, including national guard or reserves, other than for duty less than 30 days; or
- in the case of a child:
- if such child provides 50% or more of his/her own support, as determined by us; or
- such child is no longer eligible if adopted or placed for adoption and insured under the adopting person's coverage in accordance with Section 632.896, Wisconsin Statutes, as amended.
No person shall be considered as an eligible dependent of more than one employee covered under the policy as an insured.
A dependent child who is over the limiting age stated above may remain insured as a dependent under the policy if he/she meets certain requirements, provided your family coverage remains in force under the policy.
The child must:
- be unable to support himself/herself with a job because of mental retardation or physical handicap;
- have become disabled before he/she reaches the limiting age stated above; and
- be principally supported by you.
Written proof of the child's disabling condition must be given to us within 31 days of the child attaining the limiting age stated above. Failure to provide such proof to us within that 31-day period shall result in the termination of that dependent child's coverage in accordance with Section VII. When Coverage Ends.
Q. Where can I obtain the status of my dental claim?
A. You may contact Delta Dental to obtain online claim status or call Delta Dental at 1-800-236-3712.
Q. How do I obtain a Continuation form?
A. Continuation forms are provided to employees by the respective State Agency. Payroll coordinators may obtain Continuation forms by contacting us.
Q. Can Annuitants enroll in this policy?
A. Upon retirement, if you are currently enrolled in our policy, you may elect to continue coverage as an annuitant. Your application must be received by EPIC within 31 days of your retirement. Review the policy benefits by choosing Dental Coverage, Excess Medical and AD&D or choose to review our rates at How to Enroll.
Q. What is the cost of Continuation coverage?
A. Our current competitive monthly rates are:
| Non-Annuitants | Annuitants | ||
| Single | $12.90 | $16.85 | |
| Insured/Spouse | $25.80 | $33.65 | |
| Insured/Child | $25.80 | $39.00 | |
| Family | $38.70 | $46.40 |
Q. Who would my employees contact for questions on the dental claim?
A. Delta Dental can provide answers related to dental claims questions and status. Benefit Services at Delta Dental can be reached at 1-800-236-3712.
Q. How can employees request new identification cards or a policy certificate?
A. EPIC can be reached at 1-800-520-5750; dial menu option 7. You'll be directed to our Policyholder Services Representatives to assist in your request.
