Medical College of Wisconsin Affiliated Hospitals, Inc.
Your Delta Dental Insurance Plan
Delta Dental Customer Service ………1-800-236-3712
Delta Dental Website ……………………www.deltadentalwi.com
SUMMARY OF BENEFITS
· Immediate coverage upon effective starting date in MCWAH program.
· Housestaff pay 50% of the premium equal to a PRE-TAX monthly payroll deduction of $9.71 single or $31.13 family.
· Open enrollment every July.
FROM THE DELTA DENTAL WEBSITE:
TO FIND A DENTIST – CLICK ON "DENTIST SEARCH"
· If you have enrolled in the "Freedom of Choice" Plan, you can select a dentist from either the "Delta Dental PPO" or "Delta Dental Premier" network.
o See "SUMMARY OF OPTIONS" and "YOUR DENTAL BENEFITS" to determine the deductibles, limits and co-pays that apply to each network. Under this plan option, dentists can also be selected outside of these networks, but out of pocket cost may be higher. [Group #10302]
· If you have enrolled in the "EPO-Exclusive Provider Option" Plan, you can ONLY select a dentist from the "Delta Dental PPO" category.
o See "SUMMARY OF OPTIONS" and "YOUR DENTAL BENEFITS" to determine the deductibles, limits and co-pays, and restrictions that apply to this plan option. Note that if you enroll in this plan option and obtain services from a Dentist outside of this network, there will be NO benefits for these services. [Group #03905]
o Once you chose a provider, you are urged to CONFIRM WITH THE PROVIDER THAT THEY PARTICIPATE IN YOUR PLAN before having services performed.
TO ACCESS YOUR INDIVIDUAL MEMBERSHIP INFORMATION – CLICK ON "SUBCRIBERS" then "SUBSCRIBER CONNECTION" to
· Check the Status of a Claim
· Review your Benefits
· Update your Contact Information
· Replace Lost ID Cards and More