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Dental for Excluded Employees who Separate

Dental Benefits for Exempt Employees who Separate

If you meet these conditions and you don't retire within 120 days of separating, you can continue your dental benefits.

  • You are an exempt employee

  • You have ten or more years of CalPERS service credit

  • At least two years of your CalPERS service was in an exempt position

  • You leave your retirement contributions with CalPERS

  • You separate before age 60

  • You're enrolled in a CalHR-sponsored dental plan when you separate

 

If you don't meet these conditions, you can still continue benefits for up to 18 months under COBRA. You must submit the forms within 60 days of separation. See below for how to enroll. Contact your personnel office if you have questions. 

Your premiums

Your premiums depend on your age and your CalPERS retirement tier.

  • If you are you are at least 40 (or 45 for Tier Two): You pay the employee contribution only. You can discontinue coverage and reenroll when you retire.

  • If you are under 40 (or under 45 for Tier Two): You pay both the employee and the employer contribution, and a 2% administrative fee. If you discontinue coverage, you can't reenroll when you retire. If you continue coverage until you retire, you will receive the employer contribution to your dental coverage after retirement.

How to sign up

If you're enrolled in Delta Dental PPO plus Premier or Delta Preferred Provider Option

  • Complete form Delta 602A. Contact Delta Dental at(415) 972-8300 to get the form. Write "Based on Section 22816.7 of the Government Code" at the top of each page.

  • Send the completed form and your initial premium payment to CalPERS.

  • Send your premium payments to Delta Dental. Submit payments so they're received on the first day of every quarter (January 1, April 1, July 1, and October 1). If you miss two consecutive payments, you'll be disqualified.

  • When you pay your premiums, you may want to write on the check your Social Security number and the group number for the dental plan (Delta Dental PPO plus Premier: 9949-8601; Delta Preferred Provider Option: 9946-8601).

 

If you're enrolled in DeltaCare USA or Safeguard

  • Complete the Dental Plan Direct Payment Authorization (STD 696). Write "Based on Section 22816.7 of the Government Code" at the top of each page.    (To read this file, you’ll need Adobe Reader – get a free download.)

  • Send the completed form and your initial payment to CalHR.

  • Send your premium payments to your provider. Submit payments so they're received on the first day of each month. If you miss two consecutive payments, you'll be disqualified.

  • When you pay your premiums, you may want to write on the check your Social Security number and "State exempt employee."

  Updated: 4/30/2014
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