Epic Dental and Excess Major Medical Coverage
2009 Benefit and Premium Information
2009 Premiums for new enrollees and current subscribers
Summary of benefits for those who enroll during special enrollment period
The EPIC Dental and Excess Major Medical Plan is voluntary, supplemental insurance that pays for covered dental and medical expenses that remain after your primary insurance policy pays. It also provides a small benefit in case of accidental death or certain accidental injuries. The EPIC Life Insurance Company is a wholly owned subsidiary of Wisconsin Physicians Service Insurance Corporation (WPS).
The summary below is not a detailed description of the EPIC
Plan. Do not use it as your only reference on eligibility
and plan benefits. Review the contract carefully and
consult your staff benefits office about your specific
circumstances.
Eligibility
Classified and unclassified employees
are eligible when they become covered by the Wisconsin
Retirement System (WRS).
Short-term academic staff, graduate student assistants, and
employees-in-training are eligible if their appointment is
at least one-third of full time for at least one semester
(six months for twelve-month positions).
You may enroll for yourself only for 'Single coverage'.
You may choose two-person or "Limited Family coverage" for
yourself and either your spouse or one dependent child, or
cover yourself, your spouse and your dependent children with
'Family Coverage.'
Enrollment
Classified employees must file an application with the
campus benefits office within 30 days after the first day of
WRS-covered employment OR any time before the first of the
month following completion of six months of WRS-covered
employment for coverage to be effective with your State
Group Health Insurance Plan.
Unclassified employees must file an application with the
campus benefits office within 30 days after the first day of
WRS-covered employment.
Short-term academic staff, student assistants, and
employees-in-training must file an application within 30
days after the beginning of their first eligible appointment.
If you have single coverage, you may add coverage for your
spouse by filing an application with the campus benefits
office within 31 days after the marriage. If you have
single coverage, you may add coverage for a newborn or
adopted child by applying within 60 days of the birth or
adoption. If you have family coverage in effect, a newborn
or adopted child is covered automatically.
Late enrollment via evidence of insurability is not
available in the EPIC Plan. From time to time a
special enrollment opportunity may be offered to employees
who missed their initial enrollment deadline.
Coverage
Coverage is effective on the first of the month following
receipt of your application.
You may keep your coverage in retirement if you take an
immediate annuity from the WRS or have 20 years of EPIC
coverage at the time you terminate employment. Your premium
costs will be slightly higher as an annuitant. Coverage
terminates when you lose eligibility for the State Group
Health Insurance Program. Coverage ends for your
spouse and stepchildren upon divorce, and for your dependent
children at the end of the calendar year in which they turn
age 19 (age 25 if full-time students) or on the date they
marry or otherwise cease to be dependent.
You and your insured spouse and dependent children may be
eligible to continue your coverage for 36 months after
employment ends under the provisions of COBRA.
Conversion to an individual policy is not available.
Premiums
The schedule of premiums. Premiums
will not change for 2008.
Your Epic insurance premium qualifies as a pre-tax payroll
deduction for the Employee
Reimbursement Account(ERA) Program's automatic premium
conversion feature, which reduces your taxable gross pay.
Program Features
The EPIC Plan is designed to supplement the benefits you
receive from your primary state group health insurance plan.
Epic will not duplicate payment for any dental or medical
services that you are eligible to receive under the
State Group Health Insurance Program or other insurance
such as Medicare or Workers Compensation.
The EPIC Plan offers the following
distinct benefits:
Dental Benefits
The EPIC Plan does not cover routine dental exams and
cleanings. It does cover extractions, crowns, oral surgery,
and many other non-routine procedures. Orthodontic services
are covered after the insured has been in the plan for 12
months. Most orthodontic services are covered only if they
began before the insured reached age 19.
Each insured person pays the first $200 of expenses for
covered services. EPIC then pays 50% of charges that
your State Group Health Insurance Plan does not pay, up to
$750 per person per calendar year. The lifetime limit for
orthodontia is $1,200.
You may select any dentist. However, EPIC will not pay
charges in excess of the reasonable cost, as determined by
EPIC. Dentists who are part of the Delta Dental network have
agreed to accept EPIC's price structure.
Note: If you enrolled for the Epic Plan through open
enrollment with a coverage effective date of January 1,
2006, your dental benefits are limited for the first two
years of coverage. In 2006, the maximum payable for covered
dental charges is $350 per person. In 2007, the maximum
payable is $500 per person. There is also a waiting period
before the orthodontics benefit begins.
Medical Benefits
You may qualify for medical benefits if you are hospitalized
for at least 24 hours or are treated as a surgical patient
at a licensed surgical or hospital outpatient treatment
center.
Your State Group Health Insurance Plan (your "basic plan")
pays first. You must meet a deductible of at least $250
($500 for family coverage), including any amount that your
basic plan paid. The EPIC Plan then pays 100% of all
reasonable and customary charges, up to the $250,000
lifetime per participant maximum ($100,000 for annuitants).
Additional limits apply to certain services.
EPIC will not duplicate any charges that your basic plan
paid, or would have paid, if you had obtained the proper
referral. Because the State Group Health Insurance Program
offers comprehensive coverage of most medical needs, you may
not derive any additional medical benefits from the EPIC
Program. If you have specific medical needs, you should
carefully compare your coverage under the State Group Health
Insurance Program and the EPIC Plan to see whether
additional benefits would be payable.
Accidental Death and Dismemberment
Insurance
If you die as a result of an accidental injury, the EPIC
Plan will pay your beneficiary $5,000. The accidental
death benefit for your spouse, if insured, is $2,500; for
your insured child, it is $1,000. The same amounts are
payable if an accidental injury results in the loss of both
hands or feet, the sight of both eyes, or the loss of two of
the following: one hand, one foot, the sight of one
eye. One half of these amounts is payable for accidental
loss of one hand, one foot, or the sight of one eye.
To make a beneficiary designation for the accidental death
benefit, complete the Beneficiary
Designation Form and mail it to Epic Life Insurance
Company, P O Box 8430, Madison WI 53708-8430.
EyeMed Vision Care
Effective on January 1 , 2008, EPIC members have free access
to the EyeMed Vision Care discount program. EyeMed offers
substantial savings on eye care and eyewear at thousands of
provider locations nation wide. To receive your discount,
simply show your EPIC member ID card when you visit an
EyeMed Provider. See the EPIC
brochure for more details.
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