Vision Plan Enrollment Authorization (STD. 700)
Premier Vision Enrollment Authorization (CalHR 774)
Permitting Event Codes/Effective Dates Chart - Basic Plan | C - Permitting Event Codes/Effective Dates Chart - Basic Plan - Text Only (RTF)
D - Vision Plan Direct Payment Authorization (STD 703)
Retiree Vision Plan Enrollment Authorization (CalHR 695)
Permitting Event Codes/Effective Dates Chart - Retirees | F - Permitting Event Codes/Effective Dates Chart - Retirees - Text Only (RTF)
Permitting Event Codes/Effective Dates Chart - Premier Plan | Permitting Event Codes/Effective Dates Chart - Premier Plan - Text Only (RTF)
If you are an active state employee, please contact your department's personnel/human resources' office. For Personnel Office Staff requiring assistance or clarification regarding active employees or retired/annuitants in the State's vision program, please email Vision at
There will be no premium increases, increase in employee contributions, or benefit changes for the Premier Vision Plan. Retirees now have the option of the Premier Vision Plan.
The state’s Basic Vision Plan moved from the existing Regional Network Plan (RNP) structure to the VSP Advantage network structure effective January 1, 2015. This network change was done as VSP will be sunsetting the current VSP RNP network.
The state now offers retirees the Premier Vision plan into retirement. All Premier Vision Plan benefits remain the same as the active plan, but as with the retiree Basic VIsion Plan, the retiree pays the full premium amount cost for this plan.
The California Department of Human Resources (CalHR) administers the State's Vision Care Program and maintains the contract between the state and the carrier. The current carrier, Vision Service Plan (VSP), provides vision coverage plans (State of California Plan group number - Basic Plan 30052011), (State of California Plan group number - Premier Plan 30034581) (State of California Retiree Vision Plan group number 30052010 - for retirees/annuitants).
CalHR Rule 599.927 - Non-Represented Employees
Memoranda of Understanding - Rank and File Employees
Government Code 22959.1 - 22959.6 - Retirees/Annuitants
State employees designated rank and file, managerial, supervisory, confidential, and all other employees excluded from collective bargaining, Constitutional Officers, employees of the Judicial Council, Supreme, Appellate, and Superior Court Judges who meet the following criteria:
A permanent employee appointed half-time or more.
An employee appointed limited-term (LT) or temporary authorization (TAU) for six months or more with a time base of half-time or more.
A permanent intermittent employee who works a minimum of 480 hours in a six-month qualifying control period (January 1-June 30 and July 1-December 31).
A former retired state employee who is currently enrolled in state COBRA vision benefits and/or Retiree Vision Program and reinstates as a permanent intermittent.
An employee appointed under Government Code Section 21228.
Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU
Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.
Employees in Bargaining Unit 6 - California Correctional Peace Officers Association (CCPOA) have vision coverage through their union benefit trust and are not eligible to enroll in the state's Vision Program as an active employee; however, upon retirement, they're eligible for the state Retiree Vision Program. The personnel office should offer these individuals the state Retiree Vision Program at retirement. Any questions regarding BU 6 Non-Supervisor (CCPOA) member information should be directed to CCPOA.
All active state employees (with the exception of rank and file BU 6 employees, as their vision benefits are provided by their union trust) are eligible to enroll in the Premier Plan.
Employeeste who are retiring from the state may enroll in the Retiree/Annuitant Vision Program. They must meet the requirements of Government Code Section 22959.4 at the time of retirement (as reflected below).
A civil service employee of the state.
An elected member of the Legislature.
A legislative employee.
A constitutional officer.
An employee, judge, or justice of the judicial branch of state government.
When an employee retires, personnel office MUST offer retiree vision or COBRA continuation of active state coverage.
Currently there is not a Premier vision (enhanced) plan for retirees/annuitants. However, if a retiring employee is already enrolled in the Premier vision plan for active employees at the time of retirement, then the retiring employee may continue the Premier through COBRA only up to 18 months by completing the CalHR 774 Premier Vision Form and checking the "New COBRA Enrollment" box.
Retirees/Annuitants of the California State University (CSU) and University of California (UC) systems may not participate in this vision program.
Eligible survivors (survivorship as determined by CalPERS), may enroll in the Retiree/Annuitant Vision Program.
Retirees/Annuitants Eligibility (G.C. Sec. 22959.4 requirements)
state retirees/annuitants are eligible for enrollment into the Retiree Vision Program if any of the following apply:
(a.) The retiree/annuitant was enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation for retirement, and retired within 120 days of the date of separation from the state. (b.) The retiree/annuitant was not enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation or retirement, but was eligible for enrollment as an employee at the time of separation for retirement, and retired within 120 days of the date of separation from the state.
The annuitant is part of the Legislators' Retirement System receiving an allowance pursuant to Article 6 (commencing with Section 9359) of Chapter 3.5 of Part 1 of Division 2.
An annuitant is part of the Judges Retirement System I or II, and receiving an allowance from either system.
A person who was enrolled in a vision care plan at the time he or she became an annuitant under state or federal provisions, may continue his or her enrollment, including eligible family members, without discrimination as to benefit coverage as an enrolled person within this program.
Note to Personnel:
To enroll a survivor and dependents into the retiree vision program, before the 120 day benefit is completed, please send a fax a completed CalHR 695 Retiree Vision Form to CalHR Fax 916.322.3769. PLEASE INDICATE "Survivor Benefit" at the top of the CalHR 695. In the remarks section, please include the deceased employee's full name, dob and full ssn for reference. Be sure to complete the party code, retiree vision premium amount, effective date, agency contact information and necessary signatures.
Enrollment into the state's Basic Vision Plan for eligible employees and their eligible dependents is automatic. The effective date of enrollment is based on when the Personnel Office keys an employee's Personnel Action Request (PAR) document into the State Controller's Office (SCO) payroll system. Eligible dependents are automatically enrolled at the same time that an employee's enrollment becomes effective. (Note: STD. 700 must be completed for Permanent Intermittent employees' enrollments.)
The following situations will require completion of a Vision Plan Enrollment Authorization, STD. 700 to enroll in or cancel coverage. See
Attachment C - Permitting Event Codes/Effective Dates Chart - Basic Vision Plan for information regarding permitting event codes.
For permanent intermittent employees wanting to enroll into the Premier Vision Plan, the STD. 700 needs to be completed in order to process the employer's contribution and deduction. In addition to the STD. 700, the CalHR 774 MUST ALSO be completed in order to enroll a member into Premier Vision. The STD. 700 should be sent to SCO and the CalHR 774 is to be sent to VSP's mailing address.
The completion of a STD.700 or CalHR 774 is required for deleting ineligible dependents off an active employee’s vision plan. Deletion documents will need to be sent to Vision Service Plan with a copy retained in the employee’ s personnel file. The CalHR 695 is not required for deletion of ineligible dependents. Employees who have dependents should be advised that ineligible dependents are not permitted to use the state's vision plan. Employees and retirees will be held liable for payment of services that are provided to ineligible dependents.
Standard Eye Examination and Glasses:
Employees/retirees/dependents may obtain covered services or materials from any other licensed optometrist, ophthalmologist, or optician of their choice. Services obtained through non-member doctors are subject to the same deductibles and limitations as services through VSP member doctors. The doctor must be paid in full and an itemized receipt is submitted to VSP. VSP will reimburse the employee/retiree/dependent up to the amounts allowed under the state plan's non- member doctor schedule. The reimbursement schedule does not guarantee full payment nor can VSP guarantee patient satisfaction when services are received from a non-member doctor.
Mark the form for the plan selection (Basic or Premier Vision plan). Please mail completed CalHR 695 form to VSP's mailing address or fax to VSP at (916) 463-9031 for processing. See
Section 1214 for address to send the