EPIC Benefits+
Plan Overview
Description: The plan provides additional dental, excess medical, accidental death and dismemberment, and optional vision coverage. It also includes a complimentary vision discount program. There is no coverage for routine dental services. You have the flexibility to choose any dentist. The plan pays 50% of covered, non-routine dental charges, up to $1000 per year after a $75 per person annual deductible is satisfied. Orthodontic lifetime maximum is $1,200 per member. Orthodontic services have a 12 month waiting period and are for eligible children under 19. This plan is not intended to replace your health insurance.
EPIC Group Number: 3180
Premiums
EPIC Benefits+ PremiumsLearn More
- 2012 Benefits+ Brochure
- 2011 Benefits+ Brochure
- EPIC Benefits+ Vision Benefit Frequently Asked Questions
- Dental Plan Comparison Chart
- Vision Plan Comparison Chart
- Coverage End Dates for Dependents
Dental Providers
EPIC Benefits+ uses the Delta Dental provider network. You can see any dentist if you have EPIC Benefits+ coverage but you will receive the best value if you choose a Delta Dental provider. You are able to search Delta Dental's online provider directory or you can contact Delta Dental customer service at 1-800-236-3712.
Vision Providers
Vision benefits under the plan are provided by the Davis Vision Network. To find a vision care provider in your area, call Davis Vision toll-free at 1-888-825-8390 or go to the online provider directory at www.davisvision.com (click on "members", enter client code 7748, and click on "Find a Provider").
Vendor Web Site
- EPIC Life Insurance
- EPIC Contact Information: Claims, Billing, Administration
- Delta Dental
- Davis Vision Network
Send questions to: benefits@ohr.wisc.edu
Forms
Note: Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview", a PDF reader.
Application | Submit to your Payroll & Benefits Office
- Benefits+ Enrollment Form, E11444
- Adding a domestic partner and his/her eligible dependents
- Adding eligible adult children under age 27
Affidavit for Insurance Purposes | Submit to your Payroll & Benefits Office
Affidavit for Insurance Purposes, UWS 93
Complete this form if you are unable to provide a Social Security Number for a non-citizen spouse or non-citizen eligible dependent. Submit the Affidavit with your application.