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2011 Comparison of Dental Wiscon

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					                                                    2011 Comparison of Dental Wisconsin, Anthem DentalBlue and EPIC Benefits+ Dental Benefits

                                          DENTAL WISCONSIN                     DENTAL WISCONSIN                       ANTHEM                       ANTHEM                           ANTHEM                                  EPIC
           PLAN NAME                              PPO                             Dental Select                   DENTACARE - HMO             PREFERRED - PPO                      Supplemental                            Benefits+
                                                      Out-of-                                                                                   In-     Out-of-
                                         In-Network
                                                      Network                                                                                 Network  Network
                                                                                      No coverage,                                                                            No coverage. Must select
 Diagnostic / Preventative                  100%                   75%         free to choose any health                    100%                80%                 75%        health plan w/ diag/prev                  No coverage
                                                                                          plan                                                                                          dental
 Basic                                       75%                   55%                     75%                              80%                 60%                 50%                   75%                            No coverage

 Major/Restore (Includes                     50%                   25%                                                                          40% –              25% –
                                           – includes            – includes      50% – includes implants                    60%                includes            includes               50%                       50% - includes implants
 Endodontic and Periodontic)                implants              implants                                                                     implants            implants
                                                $1,000 Benefit                       $1,000 Benefit                  20% discount at              20% discount at                  20% discount at             $1200 for children under age
 Orthodontia (Lifetime Benefit)          – for children under the age         – for children under the age             participating                participating             participating ortho/$1000        19 after a 12-month waiting
                                                     of 19.                               of 19.                   ortho/$1000 Benefit          ortho/$1000 Benefit                    Benefit                            period
 Annual Deductible Per Person                $25                   $50                      $50                              $0                  $25                $50                   $50                                  $75

 Office Visit Copay                                     None                               None                       $10 per visit                       None                           None                                 None
                                                                                                                                                                                                                             $1,000
                                                                                                                                                                                                               If enroll during special enrollment:
                                                                                                                                                                                                                           Year 1: $500
 Annual Benefit Maximum                                 $1,000                            $1,000                  $750 + add’l $500 for                   $1,000                        $1,000
                                                                                                                                                                                                                           Year 2: $750
                                                                                                                       endo/perio                                                                                         Year 3: $1,000
                                                                                                                                                                                                                24-month waiting period for otho

 Waiting Period (if no prior coverage)    Prior coverage credited              Prior coverage credited                                        Prior coverage credited         Prior coverage credited          Prior Coverage not credited
   Basic Services                                    3 Months                             3 Months                                                     3 Months                        3 Months                            Not covered
   Major Services                                    3 Months                             3 Months
                                                                                                                            None                       3 Months                        3 Months                               None
   Orthodontia                                      12 Months                            12 Months                                                     12 Months                       12 Months                            12 months

                                                                                                                                                                                                                 Without
 2011 RATES                                                                                                       Region 1         Region 2                                                                                  With Vision
                                                                                                                                                                                                                 Vision
 Employee                                               $25.54                            $16.99                   $23.27      $28.78                 $23.51                           $16.59                    $16.70        $20.70
 Employee + Spouse or                                                                                                  EE + 1 Dep                   EE + 1 Dep                       EE + 1 Dep                       EE + 1 Dep
                                                        $54.08                            $34.93
 Domestic Partner                                                                                                  $46.55      $57.56                 $47.01                           $33.19                    $33.40        $40.47
                                                                                                                                                                                                                     EE & 2+ Deps
 Employee + Child(ren)                                  $60.47                            $40.30                     EE & 2+ Deps                 EE & 2+ Deps                      EE & 2+ Deps
                                                                                                                                                     $77.56                            $49.80                     $50.10                 $60.49
 Family                                            $91.41                                 $59.28                   $74.47           $92.10
                                                       Delta Dental                        Any                                                                                           Any                                  Any
                                          Uses the        Premier                                                                                                                                                            Dentist
                                         Delta Dental                                     Dentist                                                                                       Dentist
                                                         Providers                                                                                                                                             This is an excess coverage plan that
                                                                              Utilization of a Premier provider                                                               Utilization of a Preferred PPO
 Network Requirements                        PPO       (Out of network                                              DentaCare HMO             Preferred PPO Providers                                          includes dental benefits, not a dental
                                                                              will eliminate any excess charges                                                                 provider will eliminate any
                                          Provider     providers with a                                                Providers                                                                                 insurance plan. It always pays its
                                                                               over maximum plan allowable                                                                    excess charges over maximum
                                                         participating                                                                                                                                           benefits after all other plans have
                                          Network                                            cost.                                                                                 plan allowable cost.
                                                               agreement)                                                                                                                                                       paid.
 WI Providers                                1417                 2344            3761 (participating)                       760                          1642                         1642 (?)                                N/A

Prepared by UWSA Office of Human Resources Services

				
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