UW Benefit Enrollment Opportunities for 2011

As employees consider their options for dental insurance for 2011, we have received questions about the specific services that will be covered under the new Dental Wisconsin plan.  The level of benefits payable under the PPO and Select plans is determined by the type of service received:  Preventive (not covered under the Select plan), Basic or Major Restorative.  Below is a general list of the services that fall under each category of service.

Preventive Services 
        Routine Oral Exam
        Prophylaxis
        Fluoride Treatment
        Emergency Palliative
        Xrays
        Sealants
Basic Services
        Laboratory Tests & other Diagnostic Exams
        Oral Surgery
        Anesthesia
        Routine/Surgical Extractions
        Therapeutic Injections
        Restorations
        Alveolectomy
        Denture and Bridgework repair 
        Stainless Steel Crowns 
        Space Maintainers
Major Restorative Services
        Inlays, Onlays, Crowns
        Implants
        Periodontics
        Endodontics
        Dentures
        Bridges

Are you having a hard time deciding whether to elect the Dental Wisconsin PPO or the Select plan?  Here are some things to consider:

Coverage Differences 

The PPO plan provides immediate coverage for diagnostic and preventive dental services (cleaning, x-rays).  The Select plan does not provide any coverage for diagnostic and preventive dental services.  If you do not have coverage for diagnostic and preventative dental services through your health insurance plan, you will be responsible for any costs related to these services if you enroll in the Select plan.  All State Group Health Insurance plans, except the Standard Plan, include some level of basic dental benefits. 

You should determine if paying for preventive and diagnostic services yourself will be more or less costly than the premium difference between the Dental Wisconsin PPO and Select plans.  Remember that you can use the ERA medical account program to contribute pre-tax dollars to pay for non-covered preventive and diagnostic dental services, as well as to reimburse you for your coinsurance costs under either plan.

The level of benefits is the same between the PPO and the Select plans provided you use a Delta Dental PPO provider.  However, if you use a provider who is not listed in the Dental Dental PPO provider directory, your benefits will be paid at a lower level. 

Premium Differences 

The premiums for the PPO plan are higher than those for the Select plan.  This is because the PPO plan covers preventive and diagnostic dental services and the Select plan does not.

Provider Access 

If you enroll in the Select plan, you can see any dental provider.  If you enroll in the PPO plan, you must use a Delta Dental PPO provider to receive the in-network level of benefits.  You can see any dentist and still receive benefits, but they will be paid at a lower level.  For orthodontia under either the PPO or the Select plan, your child who is under age 19 can see any orthodontist and the benefit will be 50% of covered charges, up to a lifetime maximum of $1,000.  You do not need to use a Delta Dental orthodontist.

Regardless of whether you enroll in the Dental Wisconsin PPO or Select plan, if you use a provider who is listed in the Dental Dental Premier network you will have lower out-of-pocket costs because Delta Dental Premier providers have agreed not to bill you for any costs that exceed the maximum billable amount for a particular service.  Other providers may bill you for charges that exceed the maximum billable amount.

See the Dental Wisconsin Plan Brochure for more details.