DENTAL INSURANCE:
Dentacare HMO, PPO, & Supplemental Plans

Frequently Asked Questions

1. Who is eligible for these plans?
Unclassified faculty, academic staff and short-term academic staff appointees, non-represented classified employees (including LTEs covered by the retirement system), non-represented graduate assistants, fellows and scholars and employees in-training are eligible to enroll for single or family coverage.  Employees must be eligible to enroll in the State of Wisconsin group health insurance program with either an immediate or future state share contribution. Rehired annuitants are not eligible.

2. How do I decide which plan to choose?
Review the Plan Summary on this web site for details about the benefits and out-of-pocket costs, including premiums, office visit co-pays and coinsurance.  If your health plan provides some routine dental benefits, such as cleanings, x-rays and fillings, you may want to select the Supplemental Plan which was designed to “wrap-around” the dental benefits some health plans provide. You can see the dentist of your choice.  If your HMO does not cover any routine dental benefits, you may not select the Supplemental Plan but might consider the Dentacare HMO or PPO.  Check the Provider Directories to see if your dentist is listed as a Dentacare HMO or PPO provider.  If you select the HMO, you must use a Dentacare provider to receive benefits. If you select the PPO, you will receive a higher level of benefits when you use a Dentacare provider but you can see any dental provider. This may be better suited if you have covered family members living in another area (such as a dependent student) or travel frequently.

3. How often can I change clinics?
You may change the Dentacare center twice per calendar year. Complete a new application and return it to your staff benefits office.

4. How do I choose a clinic or dentist?
The current provider directories for the HMO and PPO plans can be viewed on this web site. The HMO and the PPO have separate directories. Note: There is no provider directory for the Supplemental Plan as you can see the dentist of your choice.

5. What about my annual maximums and deductibles?
The annual maximums and deductibles are applied on a calendar year basis.

6.  Rates will now be based on employee plus 1 dependent and employee plus 2 or more dependents. How will Dentacare determine which rate I will be charged?
Coverage will be based on the information you provide on the application.  If the rate is incorrect based on the number of dependents you believe are covered, please see your staff benefits office.

7. Is there a waiting period before services are covered?
There is a waiting period of 90 days before basic services (e.g., fillings) or major services (e.g., crowns, bridges, dentures) are covered under the Preferred PPO or the Supplemental Plan.

The Dentacare HMO has no waiting periods for coverage.

8. Are domestic partners covered?
Yes. Domestic partners and their dependent children are eligible dependents under this dental program. To enroll a domestic partner, an Affidavit of Domestic Partnership must be on file with your staff benefits office.

9. What if my dentist leaves the plan during the year?
It depends on which plan you have selected. If you have selected the Dentacare HMO, you must use a dentist listed in the current Dentacare Primary Care Provider Directory in order to receive benefits. With the Dentacare PPO plan, you may continue to see your dentist; however, you will incur higher out-of-pocket costs. The Supplemental Plan has no provider restrictions so this situation would have no impact on the benefits provided.

10. My dentist is not currently a participating dentist but would like to be. Who should he/she contact?
Providers should contact DentalBlue’s provider relations if they are interested in contracting to be participating dental providers 

11. Why is the Dentacare HMO less expensive in the Milwaukee area?
Dentacare is better able to negotiate lower fees with providers in the Milwaukee area than they are in other areas of the state and that is reflected in the premium. The premiums are shown on the Plan Summary as Region 1. The rates for the Dentacare PPO and Supplemental Plan are the same statewide.  The “Milwaukee area” includes Milwaukee, Waukesha, Ozaukee, Washington, Racine and Kenosha counties. The premium is determined by the county in which the selected Dentacare clinic is located.

12. Why are unions offering these benefits at a lower cost?
While this dental program is offered only to University employees, the union dental plans are offered to represented employees statewide. This allows the union plans to have a greater number of insured.  Typically, the larger the group, the lower the cost to insure it. In addition, University employees tend to be more informed and knowledgeable about offered benefits and are more likely to use the benefits once they are enrolled.

13. Are premiums taken pre-tax?
Premiums are deducted pre-tax for all eligible employees, except LTEs.

14. Is the Epic deductible satisfied by charges paid under the DentalBlue plan?
No. While the Epic plan does provide dental coverage in addition to Excess Medical coverage, it is in no way associated with Dentacare. If you have coverage under both Epic and a Dentacare plan, Epic will pay last and you must still meet the $200 per person deductible for benefits to be payable by Epic.

15. If I have some dental coverage through my health plan and one of the Dentacare plans and am also enrolled in Epic, in what order will the plans pay my claims?
The health plan will pay its benefits first. The Dentacare plan will then pay according the benefits of the plan you selected. Epic will always consider the charges last and you must satisfy the $200 Epic deductible before it will pay benefits. For example:

􀂃 The insured receives 4 crowns at $700 each. Total charges are $2800.

􀂃 The HMO denies the claim as it does not provide coverage for crowns.

􀂃 The Insured has the Supplemental Plan which pays %50 for crowns, subject to the $1000 annual benefit maximum. The Supplemental Plan pays $1000, leaving a balance of $1800.

􀂃 The insured pays the $200 annual deductible under Epic, leaving a $1600 balance. Epic then pays 50% of crowns, up to its annual maximum of $750.

􀂃 Total Paid by Insured: $1050; Total Paid by Health Plan: $0

􀂃 Total Paid by Dentacare: $1000; Total Paid by Epic: $750

16. Can I make ERA changes now if I enroll in Dental Blue during the open enrollment?
No. Federal IRS regulations prohibit changes to the ERA program after the start of the benefit year, which was January 1, 2004. 

17. What is the orthodontic benefit?
The orthodontic benefit is the same for all three plans. If you use a DentalBlue Preferred Orthodontist, you will receive a 20% discount off of billed charges, subject to a lifetime maximum of $1000. There is no age limit for the orthodontic benefit.

18. Will there be other open enrollment opportunities in the future?
It is likely that there will be open enrollment opportunities in the future but there is no guarantee of when they will be offered. There will not be another open enrollment opportunity in 2004.

19. Can I continue coverage if I terminate employment or retire?
Yes. Coverage may be continued by completing a continuation form (UWS-8). Coverage may be continued for 18 months in the event of termination of employment or for up to 36 months if coverage is lost to due to death of the employee, divorce or legal separation, eligibility for Medicare or lose of eligibility for a dependent.

20. How can I contact Dentacare if I have questions?
Questions about the Dentacare HMO or PPO should be directed to 1-888-223-9575. Questions about the Dentacare HMO should be directed to 1-800-307-4414. The DentalBlue Open Enrollment Home is located at:

http://www.uwsa.edu/hr/benefits/ins/dopenrll.htm