Dental and Excess Medical Insurance (EPIC)
Description: The plan provides additional dental, excess medical, and accidental death and dismemberment coverage. It also includes the complimentary EyeMed 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
EPIC EyeMed ID: 9238056
Premiums
Dental and Excess Medical Insurance (EPIC) Premiums
Application | Submit to your Payroll & Benefits Office
Dental & Excess Medical Plan Application, E11444
Affidavit for Insurance Purposes | Submit to your Payroll & Benefits Office
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.
Affidavit for Insurance Purposes, UWS 93
Beneficiary Designation | Submit to EPIC
Beneficiary Designation Form
Vendor Web Site
EPIC Life Insurance
EPIC Contact Information: claims, billing, or administration
Dental & Excess Medical Insurance Plan Document
EPIC Dental & Excess Medical Certificate of Coverage
EPIC Publications
EPIC 2009 Insurance Changes, FAQ's
EPIC Supplemental Plan 2009, E11549
EyeMed Vision Discount Program
Phone: (866) 559-5252
EyeMed Provider Locator
EyeMed Discount Summary, E11678-0708
Coverage End Dates for Dependents
Coverage End Dates for Dependents by Plan, UW1150
Disabled Dependent Benefit Coverage
Disabled Dependent Provisions by Plan, UW1009