Benefits Administration Manual - Dental Program
2015 Dental Program Changes
The following are highlights of changes in the Dental Program for 2015. These changes will be reflected in the BAM in January, 2015.
501. GENERAL INFORMATION
The California Department of Human Resources (CalHR) - Benefits Division has administrative responsibility for the state's dental insurance program. This administrative responsibility includes securing and administering contracts with dental carriers to provide dental benefits to employees, annuitants/retirees, and their eligible dependents, the development and communication of policies and procedures relating to eligibility and enrollment, the coordination of annual/special open enrollment periods, and providing information and guidance to personnel office staff on issues relating to the state's dental program.
While CalHR sets policy and procedures on enrollment and eligibility, the actual enrollment documents, Attachment A - Dental Plan Enrollment Authorization (STD 692) are reviewed and processed for active employees by the State Controller's Office (SCO) and for annuitants/retirees by the California Public Employees' Retirement System (CalPERS). Only those documents requesting some type of appeal or exception approval are forwarded to CalHR Benefits Division for review.
Government Code 22952, 22953, 22954 and 22955
Memoranda of Understanding (MOUs)
CAHP - California Association of Highway Patrolmen (Unit 5)
CCPOA - California Correctional Peace Officers Association (Unit 6)
CalHR - California Department of Human Resources
CalPERS - California Public Employees' Retirement System
SCO - State Controller's Office
BU - Bargaining Unit
CSU - California State University
UC - University of California
CalHR, SCO and CalPERS Mailing Addresses and Phone Numbers
California Department of Human Resources
Benefits Division - State Dental Program
1515 S Street, North Building, Suite 400
Sacramento, CA 95811-7258
CalHR Statewide Dental Contract Administrator - (916) 445-9795
State Controller's Office
Personnel/Payroll Services Division
P. O. Box 942850
Sacramento, CA 94250-5878
SCO Benefits Liaison Unit - (916) 323-4718
California Public Employees' Retirement System
Health Benefit Services Division
P. O. Box 942715
Sacramento, CA 94229-2715
Toll Free 1-888-225-7377
Currently the State of California has contracts with five dental plans; Delta Dental for an indemnity type plan referred to as Delta Dental PPO plus Premier, and the Delta Preferred Provider Option (PPO) (Delta), and four prepaid plans; DeltaCare USA, SafeGuard, Premier Access, and Western Dental. These five dental plans provide dental insurance for all eligible active and retired employees and their eligible dependents, with the exception of employees in Unit 6 who have their dental insurance provided through their respective union-sponsored trust. In addition, Unit 5 employees who are members of the California Association of Highway Patrolmen (CAHP) have their own indemnity dental plan, but may enroll in any of the four state-sponsored prepaid dental plans.
Delta Dental: 1-800-225-3368
- Delta Dental PPO plus Premier
- Delta PPO
DeltaCare USA: 1-800-632-8555
Premier Access: 1-888-534-3466
Western Dental: 1-866-859-7525
The following provides a brief description of the three types of dental plans available; prepaid, preferred provider option ,and indemnity type:
- A prepaid plan requires that the enrollee choose a dentist from a specific list of dentists who contract with each prepaid dental carrier. These dentists make up what is referred to as the carrier's provider network. Dentists are paid a flat monthly fee by the plan for each member assigned to their offices. Most basic services are covered at no cost to the enrollee.
Delta (PPO), allows enrollees to select any licensed dentist for services. However, enrollees receive the maximum benefit available under the program when they choose one of the plan's in-network dentists. Similar to the indemnity type plan, individuals who enroll in the plan are required to pay a monthly premium co-payment. Represented, excluded, and retired employees have the same coverage under the PPO plan.
Delta PPO plus Premier basic and enhanced, an indemnity type plan does not use a provider network like the prepaid or preferred provider plans. Enrollees are allowed to select the dentist of their choice. With an indemnity type plan there are set limits that the plan will pay for each specific type of dental treatment. Enrollees are responsible for paying any remaining balance that might be due based on the type of dental treatment provided. The state pays a share of the monthly premium with the balance deducted from the monthly pay warrant of the employee.
- SafeGuard (prepaid) plan offers two plans. Represented employees have the standard plan. Excluded employees and retirees have the enhanced plan.
- The monthly premium is fully paid by the state and no premium deduction is taken from the monthly pay warrant of the employee.
Represented employees and retirees have the basic plan. Excluded employees have the enhanced plan.
See Section 521 for more information on the state-sponsored dental plans.
Each department is responsible for notifying its employees of benefit eligibility guidelines, time constraints for enrollment, changes to benefits resulting from movements in and out of bargaining units, and applicable provisions of Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage. Departments are also responsible for completing enrollment documents and ensuring that documents are forwarded to the SCO in a timely manner. Each department should ensure that a supply of enrollment forms; dental plan information packages and current EOC Booklets for each dental plan are maintained and made available to interested employees. Departments are encouraged to review and refer to the policy and procedures outlined in this section when handling dental eligibility and enrollment issues. If, after thoroughly researching this material, there are issues which cannot be resolved; CalHR is available to provide guidance and assistance.
State Controller's Office (SCO)
The SCO Benefits Unit, is responsible for processing all dental enrollment/change documents, updating the employees' payroll/deduction history and forwarding a copy of each enrollment document to the appropriate dental carrier. SCO is also responsible for auditing enrollment documents to ensure the validity of information. Those documents that require correction are returned to the respective employing department for appropriate action. In addition, on approximately the 5th and 20th of each month, the carriers receive eligibility information from SCO via eligibility file.
California Public Employees' Retirement System (CalPERS)
The CalPERS Health Account Services (HAS), is responsible for processing all dental enrollment/change documents for retired state employees. It is the responsibility of each department to complete a STD. 692 for retiring employees and forward to CalPERS for processing. In addition, employees may not change dental plans when they retire unless their dental plan is no longer available to them within a 50 mile service area. Refer to Section 517 of these procedures for detailed information on dental enrollment issues for retiring employees.
Exclusive Representatives for Bargaining (Units 5 and 6)
The exclusive representatives for 5 and 6 contract directly with dental carriers for dental coverage for their members and have administrative responsibility for such coverage. Employees in Units 5 and 6 enroll in their respective union-sponsored plan through their personnel office using the standard dental enrollment form, STD. 692 and normal enrollment procedures. Once enrolled, employees in these bargaining units should contact their union directly regarding questions or issues regarding their dental coverage. The contact numbers for these bargaining units are provided below:
- California Association of Highway Patrolmen (CAHP), Unit 5: 1-800-734-2247
- California Correctional Peace Officers Association (CCPOA), Unit 6: 1-800-468-6486
504. Dental Plan Deduction Codes/Premiums
Each dental plan is assigned a dental plan deduction code by SCO. This code, which is reflected on the employee's monthly statement of earnings, is used to identify deduction premium and enrollment information for each dental plan. Attachment B - Dental Deduction Codes/Premiums provides a chart that lists each dental plan, its respective dental deduction codes and current dental premiums. Additional information on dental deduction codes is also provided in Section 201 of this Manual.
505. Employee Eligibility
Employees Eligible to Enroll or Continue Enrollment in the State's Dental Program:
- Permanent state employees with a time base of half-time or more who are designated Rank and File, Managerial, Supervisory, Confidential, Exempt, Excluded, Constitutional Officers, Employees of the Judicial Council, and all State Superior, Appellate, and Supreme Court Judges.
- An employee appointed to a Limited-Term (LT) or Temporary Authorization (TAU) with an appointment of six months or more, with a time-base of half-time or more.
- Permanent-Intermittent (PI) employees who are credited with a minimum of 480 hours worked each six-month qualifying control period, January 1 - June 30 and July 1 - December 31.
Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU, and Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.
A former retired state employee reinstated to a PI position. However, retirees reinstated to a PI position must requalify during the next control periods.
Hours worked during a qualifying period in a permanent, (TAU) or (LT) appointment may be counted toward the 480 hours if the employee subsequently receives a PI appointment with no break in service.
An employee who permanently separates and reinstates as a PI employee must work the 480 hours in a qualifying control period to be eligible for coverage, regardless of the length of the break in service.
An enrolled employee whose time base changes to PI will have coverage continued until the end of the next control period. At that time, the employee must requalify based on his/her PI status.
A PI employee who transitions into a LT position during a control period, with no break in service, may combine the hours worked as an LT with the PI hours to qualify for dental coverage at the end of that control period. The LT time base must be half-time or more.
A Unit 6 cadet PI employee will be eligible for dental benefits upon graduation from the Academy of the California Department of Corrections and Rehabilitation.
Employees in Bargaining Unit 6 - California Correctional Peace Officers Association (CCPOA) have dental coverage through their union benefit trust and are not eligible to enroll in the state's dental program.
506. State Dental Plan Restriction for Newly Hired State Employees
24-Month Plan Restriction
All eligible newly hired represented employees in Bargaining Units 1 through 21, (except Units 2, 7, 8, 16, 17, 18, 19, and excluded employees), are required to select their dental plan coverage from one of the four available state-sponsored prepaid dental plans. Impacted employees may select only a prepaid plan until they have completed 24 months of employment without a permanent break during the 24-month qualifying period. At the end of the 24-month period, those employees that elected a prepaid plan will have 60 days to change their enrollment to Delta PPO plus Premier or Delta PPO. Those employees that chose not to enroll in a prepaid dental plan may elect Delta Dental, within 60 days after completing the restriction period, unless they enrolled in the FlexElect cash option for dental.
All eligible employees who reinstate after a permanent separation and previously had 24 months of state service (no permanent break in service during the 24 months), may enroll in Delta PPO plus Premier or PPO plan at the time of hire.
All eligible newly hired represented employees in Bargaining Units 2, 7, 8, 16, 17, 18, 19, and excluded employees (non-represented) may elect Delta PPO plus Premier or PPO at the time of hire and are not restricted to state-sponsored prepaid plans.
It is the responsibility of the personnel office to notify all impacted newly hired represented employees of this restriction. Personnel offices should provide the 24-month restriction end date to represented employees affected by this restriction. Personnel offices should also inform employees affected by this restriction that the employee is required to initiate a STD. 692 to enroll or change their dental coverage to a Delta dental plan, within 60 days from the date they complete the required 24 months of state service. Use PEC 08 on the STD. 692 to process the change. Employees that do not take action to either enroll or change dental plans within the 60 day time period, may elect to enroll/change enrollment during the next scheduled dental open enrollment period.
Bargaining Unit 5
All newly hired represented employees in Unit 5 must elect their dental coverage from one of the state-sponsored prepaid dental plans. After completing a 24-month restriction period, Unit 5 employees must change to the CAHP union-sponsored indemnity plan, Blue Cross, as long as they are members of CAHP. Use PEC 08 on the STD. 692 to process the enrollment or change.
Exceptions to the 24-Month Restriction Period
The following provides information on instances when eligible employees will be exempt from the 24-month restriction and allowed to enroll in Delta Dental at the time of hire:
1. Newly Hired Employees with a LT or TAU Appointment
Employees who are hired to state service with a LT or TAU appointment may use time served in those classes (no permanent break in service) to count towards meeting the 24-month restriction period and enroll at the time of hire if they have the necessary months of state service. However, individuals hired as a student assistant, temporary or seasonal employee (with exception of seasonal Firefighters and Lifeguards), may not count time served in those classes towards meeting the 24-month restriction period.
2. Employees Hired to State Service with Current Delta Dental Coverage
Newly hired eligible employees who have their own current state-sponsored dental coverage with Delta dental at the time of hire, will be allowed to enroll in Delta dental and continue their coverage if they meet any of the following conditions:
- CalPERS retiree, enrolled in Delta, who is reinstating from retirement status and eligible as an active employee for state dental coverage.
- New hire or transfer (no break in service) from another state government agency or California State University (CSU) or University of California (UC) systems (if prior coverage was under city, county, federal, private/public sector, or as a dependent on their parent/spouse state-sponsored plan, then the employee is not eligible for this exception).
- For these exceptions, departments must confirm current Delta Dental plan coverage. Indicate the specific exception in the remarks section on the STD. 692: Prior Delta dental coverage with "Another state Government Agency" or "CSU" or "UC".
- Prior state employees, who continued and maintained their state Delta dental coverage through COBRA (COBRA coverage must be current at the time of hire).
3. Excluded Employees
All eligible newly hired excluded employees (non-represented) may elect the Delta PPO plus Premier or Delta PPO at the time of hire and are not restricted to state-sponsored prepaid plans.
4. Represented Employees in Consolidated Benefits (CoBen)
All eligible newly hired represented employees in Units 2, 7, 8, 16, 17, 18, and 19, may elect the Delta PPO plus Premier or PPO at the time of hire and are not restricted to state-sponsored prepaid plans.
5. Prepaid Dental Plan Provider (Dentist) Not Available Within 50 Miles
Newly hired eligible employees who do not have a prepaid dental plan provider available within 50 miles of their residence may enroll in Delta dental at the time of hire. The personnel office must include a statement in the remarks box indicating in quotations "no provider available within 50 miles". The memo must state that none of the available prepaid plans have a dentist within the employee's service area. Upon verification of this information by the appointing authority, forward the document to SCO for processing.
6. Prior State Employees That Worked For 24 Months
All eligible newly hired or current employees that were previously a state employee for 24 months without a permanent break in state service will be allowed to enroll or change to Delta with a current effective date.
For employees participating in Flex/COBEN Cash, the choice made by these employees for dental insurance (enroll in a state-sponsored plan or elect cash in lieu of their dental benefit) will continue to be a three-year commitment, subject to certain limited exceptions.
The STD. 692 for prior state employees being enrolled in Delta dental under a permitting event does not require CalHR approval and should be sent to SCO for processing.
7. Prior State Employees Hired With Mandatory Reinstatement
Eligible employees who have mandatory reinstatement rights to state service may enroll into Delta dental. The personnel office must send a written memo along with a completed STD. 692 to CalHR, Benefits Division. The memo must indicate that the employee has been mandatorily reinstated. Upon verification of this information, CalHR will approve the enrollment to Delta dental and forward the document to SCO for processing.
8. Employees Hired After Layoff
Newly hired eligible employees who were terminated due to layoff from a state-government agency and then re-hired within 36 months will have one of the following conditions apply:
- If the employee was enrolled in Delta dental at the time of layoff, he/she will be allowed to reenroll in Delta dental and will not be required to complete a 24-month restriction period.
- If the employee had served a portion of the 24-month period prior to layoff, then that time may be included with time served upon rehire to meet the 24-month requirement for enrollment into Delta dental.
For enrollment of the rehired employee, the personnel office must send a completed STD. 692 to SCO, and in the remarks section, indicate that the employee is being reinstated after layoff. The personnel office should use PEC 01 when completing the STD 692. The personnel office is charged with the responsibility to certify that the conditions stated in this section are met.
9. Permanent-Intermittent (PI) Employees
Eligible PI employees who have met the required 24-month restriction period may change to Delta dental during their current PI control period. Those PI employees who are not currently enrolled in a prepaid plan after completion of the 24-month restriction period may only elect to enroll in Delta dental after completion of their current PI control period. The 24-months begins at their PI appointment, not when they become benefit eligible.
Enrollment Processing Upon Completion of 24-Month Restriction Period
The personnel office should use PEC 08 when completing the STD. 692. This code will be used to enroll in or change enrollment after completion of the 24-month restriction period. Refer to the Attachment C - Chart for processing cut-off date.
507. CCPOA Benefit Trust Fund Dental Enrollment
CCPOA Benefit Trust Fund 12-Month Dental Plan Restriction
All newly hired Unit 6 employees must enroll and maintain coverage in the CCPOA prepaid dental plan, Western dental plan for a period of twelve (12) consecutive months from the effective date of their enrollment. This stipulation includes state employees who have transferred into Unit 6 and previously satisfied the state's mandated 24-month dental plan restriction. Those employees that chose not to enroll in the Western dental plan will not be allowed to enroll in the Primary dental plan until they have been enrolled in the Western dental plan for 12 consecutive months. At the end of the 12-month period, restricted employees will have 60 days to request a change to the Primary dental plan. Those employees who do not take this action within the 60 day period may do so during an open enrollment period.
These Exceptions Permit the Employee to Enroll in the CCPOA Primary Dental Program:
- If no prepaid dental facility or provider is within (50) miles from the employee's home or work, the employee has the option to enroll in either the prepaid program or the CCPOA Primary dental program;
- The employee has eligible dependents residing in another service area and is unable to obtain services from a prepaid provider;
- The employee is enrolled in the CCPOA prepaid dental program and then promoted within Corrections (promotion resulted in enrollment in a state-sponsored dental plan), and then later demotes back to Unit Six (R06). The employee will not have to meet another 12-month restriction period;
- Two Unit Six (R06) married employees, enrolled in the same dental plan who met the 12-month restriction and later divorce will not have to meet another 12-month restriction period.
Indicate the specific exception in the remarks section on the STD. 692: "No prepaid facility or provider within 50 miles from employee's home or work" or "Employee's eligible dependent resides in another service area" or "Employee previously met CCPOA 12-month restriction".
Enrollment Processing Upon Completion of 12-Month Restriction Period
The personnel office should use PEC 08 when completing the STD. 692. This code will be used to enroll in or change enrollment after completion of the 12-month restriction period. Refer to Attachment C - Permitting Events Code Chart for processing cut-off date.
508. Dependent Eligibility
Dependent Eligibility Definitions for State Employees
Eligible employees may enroll for self only, or self and eligible dependents.
1. Family Member
Means an employee's or annuitant's spouse (legally married), domestic partner (certified by the Secretary of State), and an "eligible child". The state dental program does not allow common law marriage enrollments.
A copy of a marriage certificate or declaration of domestic partnership must be provided at the time of the initial enrollment of the spouse or domestic partner and maintained in the employee's personnel folder. Information regarding the declaration of domestic partnership is located at the Secretary of State's web site.
2. Registered Domestic Partner
If a domestic partner is being claimed as an economic dependent for the purposes of an employee's personal income taxes, the Affidavit for Domestic Partners being claimed as Economic Dependents (CalHR 680) - (Attachment G) must be received by personnel from the employee and maintained in the employee's official personnel file. The completed STD. 692 to add the dependent to coverage with the appropriate party code designation must be sent to the SCO Benefits Unit for processing.
It is the personnel office responsibility to inform employees regarding the requirements of the CalHR 680 form when adding a domestic partner to their benefits, but it is the employee's responsibility to understand their tax situation and submit the CalHR 680 to personnel. Employees who add a domestic partner to their coverage, but do not submit a CalHR 680 to personnel will be subject to the federal imputed tax based on the difference between the one and two party premiums. SCO will apply the tax withholding on the employee's warrant based on the party code designation on the STD. 692. For the addition of domestic partners who are not considered "economic dependents" for federal tax purposes, when the partner is added to benefits, the party code must be shown as "A" for party code 2 and "B" for party code 3.
For the addition of domestic partners who are considered "economic dependents" for federal tax purposes, when the partner is added to benefits, the party code would be shown as 2 or 3. In the remarks section of the STD. 692, should reflect "Economic Dependent Domestic Partner - CalHR 680 on File". This designates to the SCO that no imputed tax is to be withheld.
3. Eligible Dependents/Family Members
Eligible dependents are defined as (1) the legal spouse or domestic partner, and (2) economically dependent children under the age of 26. "Family member" also includes any child for whom the employee or annuitant has assumed a parent-child relationship up to the age of 26. Children include: natural, adopted, stepchildren or a child living in a parent-child relationship who is economically dependent upon the employee, or economically dependent child where economic dependency is created through a change of custody or through a court order.
Employees must complete a State of California Dental Affidavit of Eligibility (CalHR 025) (Attachment D) in order to enroll economically dependent child(ren) who are not their natural, adopted, or stepchild.
CalHR's dental/vision programs reserve the right to request a birth certificate when there is a questionable enrollment of a dependent child.
Multiple STD 692's can be submitted to reflect the names, date of birth and family relationship of an employee's dependent(s) when the maximum number of dependent(s) cannot fit on one form.
In Remarks Section note "form identifies additional dependents enrolled on plan". Write 1 of 2 and 2 of 2 on the two forms being submitted as one document.
Medically Disabled Eligible Dependent Children
An eligible dependent that is under the age of 26 years and that is enrolled as an eligible family member, may continue to be enrolled after attaining age 26 if he/she is incapable of self-support because of physical disability or mental incapacity and if he/she is dependent upon the eligible employee or annuitant for support and care. A disability certification (CalPERS HBD 34) is required to ensure disabled dependent children remain covered after the age of 26.
- The disabled dependent may be continued under such coverage only under the following conditions:
- The dependent was enrolled as a disabled child at the time of the employee's initial enrollment; or
- The dependent became disabled while enrolled as an eligible family member prior to attaining age 26.
- The following disabled dependent children are excluded from coverage:
- Dependent whose disability occurred after age 26.
- Dependents over age 26 who were enrolled in, and later deleted from, any state-sponsored dental plan.
- Dependents over age 26 who are not currently enrolled in any state-sponsored dental plan.
The employee must provide satisfactory evidence of such disability, within the period starting 60 days before and ending 60 days after the initial enrollment or the dependent's 26th birthday. An approved copy of CalPERS Medical Report for Disabled Dependent (HDB-34) (Attachment E) or CalPERS' letter of approval, should be sent to the dental carrier with a copy of the most recent STD. 692 that lists the disabled child to ensure claims are not denied due to the dependent being over age 26. In addition, the employee may want to encourage their dentist to indicate "Disabled dependent over age 26", on any claims documentation when requesting benefits from carriers. Annual certification of continued disability may be required.
"Family Members" who are not Eligible for Coverage include, but are not Limited to:
- A stepchild for whom the employee or annuitant does not provide "parental supervision and substantial financial support" such as in the case of a step-child not living in the employee's or annuitant's household;
- An otherwise eligible dependent who is on active duty, U.S. military service;
- A disabled child whose disability occurred after age 26;
- A child over age 26 who was once certified as eligible and disabled but subsequently is unable to meet certification requirements for continued disability;
- Parents, grandparents, common law marriages, children over age 26 unless medically disabled; and
- Other relatives or persons not identified as a legal spouse, certified domestic partner or eligible child.
Employees may choose to exclude from coverage dependents who meet any of the following conditions:
- A dependent child covered under a non-state-sponsored dental plan.
- A spouse not living in the employee's household, not applicable in the event of a pending divorce, separation, or annulment.
- A certified domestic partner not living in the employee's household.
- A child over age 18 or no longer economically dependent.
Employees on Their Parents Plan When Hired
When the parents delete these children from their state-sponsored dental plans, the children should be offered COBRA, regardless of the fact that the children may be eligible to enroll in their own right.
Dual/Split Dental Coverage
- State employees may not have dual coverage. At the time a spouse or dependent enrolls as a state employee, coverage as a dependent on a spouse's or parent's state dental plan must be terminated on the effective date of the enrollment as an employee.
- There is no split coverage allowed. State employees may not split dependent coverage; all dependent children must be enrolled by one state employee. The department must correct these types of enrollments retroactive to the date they began and notify the employee accordingly. Use PEC 42 (enrolled, but not eligible) on the STD. 692 and submit to SCO for corrective action. Employees will be responsible for dental expenses incurred during a period of ineligibility. Departments should ensure that new employee benefit orientation packages provide information regarding dual/split dental coverage.
Employees (including unmarried employees) and/or dependents may not have dual or split coverage under any dental plan offered by the State of California and/or the California State University (CSU) system, including retirees.
Court Ordered Dental Coverage - Family Code section 3760-3773 and 4726
A court order may be issued which could require a dental enrollment action. Each court order contains specific instructions for both the employer and the employee which must be followed. Orders of this type are generally subject to the program's eligibility rules.
In the event documentation is necessary to add a dependent child or children to an employee's dental plan, complete a STD. 692 using PEC 16. The PED will be the date of the court order.
If a court order is issued and an employee has voluntarily deleted a spouse, the personnel office should reenroll the spouse until the divorce becomes final. When the divorce becomes final, the ex-spouse must be mandatorily deleted from coverage and becomes eligible for COBRA. Use PEC 17a or 21a to reenroll. The PED will be the date of the court order.
When completing a STD. 692 resulting from a court order, indicate in the remarks section "Court Ordered". If an employee refuses to sign the enrollment form, the personnel office should indicate "Administrative Addition of Dependent Child or Spouse" in the employee signature block and submit to SCO for processing.
Court Ordered Dental Coverage - NATIONAL MEDICAL SUPPORT NOTICE - Notice to Withhold for Health Care Coverage
As noted previously, there may be a court order issued which will require a dental enrollment action. A support order known as a National Medical Support Notice (NMSN) is now being used more frequently by the courts to provide coverage for dependent children.
Each NMSN contains specific instructions for both the employer and the employee, which must be followed. Orders of this type are generally subject to the dental program's eligibility rules. However, the NMSNs are structured such that a personnel office may be required to administratively enroll an employee into a dental plan if the employee does not voluntarily enroll. NMSN orders are not contingent on whether employees decline or refuse to enroll themselves and their dependents into a dental plan.
The enrollment document (STD. 692) should be coded using enrollment code 01 (or code 04 for PI employees). Note in the remarks section: "Enrollment based on NMSN". For PI employees, control period requirements for eligibility will still apply. For departments receiving a NMSN for an employee, who is currently enrolled in the FlexElect or CoBen Cash Option, the employee must continue the cash option enrollment unless the employee has experienced a permitting event (e.g., loss of other coverage) to allow cancellation.
The effective date of the enrollment will be the first of the following month after the order is received in the personnel office.
Including children added to group coverage under a Qualified Medical Child Support Order. This is a judgment, decree, or order that requires that a child receive benefits under group coverage regardless of his/her status as a dependent of the covered employee.
Employees Currently Not Enrolled (Excluding Bargaining Units 5 and 6)
If the dependent(s) covered in the NMSN is within the State of California and able to see the same dental provider as the employee, and the employee is willing to make a voluntarily enrollment of him/herself and the dependent(s) to comply with the NMSN, the employee may choose a state-sponsored prepaid plan.
If any of the dependents covered in the NMSN are outside the State of California, and the employee is willing to voluntarily enroll the dependent(s), the employee only has the option of enrolling in either the Delta PPO plus Premier or the Delta PPO.
If the personnel office must enroll the employee and dependent(s) administratively, the personnel office should enroll the employee and dependent(s) in the state-sponsored Delta dental plan.
Employees Currently Enrolled (Excluding Units 5 and 6)
If the employee is already enrolled in a prepaid dental plan, and the dependent(s) covered in the NMSN is within the State of California and able to see the same dental provider as the employee, the employee may add the NMSN covered dependent(s) to his/her current prepaid plan. If all NMSN covered dependents cannot seek services from the same prepaid plan provider or if the NMSN covered dependent(s) resides out-of-state, an employee making a voluntary enrollment of the NMSN dependent(s) may choose between the state-sponsored Delta PPO plus Premier and the Delta PPO. If the personnel office must enroll the dependent(s) administratively and the dependent(s) is unable to see the same prepaid provider as the employee, the personnel office should change the employee's enrollment (now with dependents) into the state-sponsored Delta Dental plan.
When enrollment of dependents onto an employee's existing dental benefits occurs through the authority of a NMSN, and there is no need for the personnel office to administratively change employee's dental plan based on the coverage requirements created by the NMSN, the personnel office should use Permitting Event Code 16 (change of custody) to add the dependent(s).
Employees in Units 5 or 6
For employees in Bargaining Units (BU) 5 or 6, all the conditions stated above apply. For BU 5 employees enrolled in the CAHP Blue Cross dental plan, and Unit 6 employees enrolled in one of the CCPOA benefit trust dental plans, the respective benefit trust must be notified of the NMSN, with a copy of the NMSN sent to the benefit trust administrator, along with a copy of the enrollment document (STD. 692).
For State and Local Plans, sections 401 (e) & (f) of the Child Support Performance and Incentive Act of 1998.
509. Letter Notice - Move out of Household
A move-out-of-household event is not currently considered a COBRA qualifying event, COBRA is not offered. However, personnel offices should send the person or persons being deleted off the employee's dental plan under this event, notice of the cancelation of benefits. Attachment K - Notice of Loss of Employer Sponsored Coverage can be used by personnel offices as a template for this notification. This notification would be sent to the last address on record of your employee taking the action to delete the dependent(s), but addressed to the person(s) being deleted. Consider that further action may be necessary if your office receives a court order to place the dependent(s) back on the employee's plan prior to the finalization of legal action (divorce or separation). Personnel offices may, at the time your employee is taking this action to delete a dependent(s), ask whether there is a pending divorce or legal separation. For anticipation of event rules, please refer to BAM Section 407 on COBRA.
Eligible employees appointed permanent, LT or TAU with a time base of half-time or more and six months or more, have 60 days from the effective date of their appointment to complete and submit a STD. 692 form to their departmental personnel office. It is the department's responsibility to advise each employee of the 60 day enrollment time limitation and to ensure that employees are provided information on the dental plans available. Eligible employees, who do not wish to enroll in a dental plan within the 60 day limit, must be advised that they will not be able to enroll until the next open enrollment period. These employees must complete Section D, and sign/date the STD. 692. This document, declining coverage, should be retained in the employee's personnel file. No further action is required by the department. Do not submit documents declining enrollment to SCO or CalHR.
Permanent-Intermittent (PI) Employees
A PI employee who meets the eligibility criteria described in Section 505 may enroll in a state-sponsored dental plan. The earliest possible effective dates of enrollment are August 1st or February 1st, based upon the end of the control period, ending June 30th or December 31st. Completed STD. 692 enrollment forms must be submitted to the employing office, within 60 calendar days after the end of the control period.
PI Employees - CCPOA - Unit 6 Cadet Employees
Unit 6 cadet PI employees will be eligible for dental benefits following graduation from the Academy of the California Department of Corrections and Rehabilitation. The earliest possible effective date will be the first of the month following submission of the STD. 692 enrollment form to the employing office after their date of graduation. For enrollment, use PEC 04.
Continuation of Coverage for PI Employees
Eligibility for a PI employee to continue enrollment is based upon qualification at the end of the next control period. To continue enrollment, a PI employee must receive credit for 480 paid hours in the current control period or a total of 960 paid hours in two consecutive (prior and current) control periods. If the employee does not qualify, coverage must be cancelled effective August 1, or February 1, depending on the non-qualifying control period.
An eligible PI employee has 60 days after the end of the qualifying control period to complete and sign a STD. 692 and submit it to the personnel office. A PI employee cannot enroll during an open enrollment period unless the open enrollment period corresponds with the completion of a control period and a portion of the 60 day time limit. However, a PI employee enrolled in a dental plan may only add/delete dependents and/or change dental plans during an open enrollment period.
Retired state employees that reinstate as a PI employee and have dental coverage, may reenroll within 60 days after appointment, and do not have to wait until the end of the qualifying control period. However, if the employee does not qualify, coverage must be cancelled effective August 1, or February 1, depending on the non-qualifying control period.
511. Allowable Changes to Enrollment
It is the responsibility of each department to inform employees of the requirements for making changes to their dental enrollment. The rules governing the changes listed below vary in time limits, therefore, employees should be advised to report changes to their personnel office as soon as possible after the event occurs. This means the event must occur first before the employee can file a change to their dental plan.
Dependents must be deleted as follows:
- Divorced spouse must be deleted from coverage even if the divorce settlement requires the employee to provide dental coverage for the spouse. The state is not required to provide coverage for an ex-spouse. However, COBRA (Consolidated Omnibus Budget Reconciliation Act) must be offered.
- Termination of a Domestic Partnership. (Employee must provide copy of notice of termination of the domestic partnership to the personnel office and COBRA must be offered to the terminated domestic partner.)
- Death of a dependent.
- Dependent child reaches age 26 and is not disabled.
- Dependent goes into military.
- Dependent no longer economically dependent/change of custody.
- Dependent enrolled but not eligible.
- Dependent dual or split covered.
Retroactive processing is limited to six months for reimbursement of dental premiums for mandatory cancellations and/or deletions to employees' dental coverage. Please refer to PML 2005-024.
Employees may elect to make any of the following changes to their enrollment:
- Adding a newly acquired spouse, certified domestic partner and/or stepchild to a one, two, or three party enrollment.
- Adding a newborn, adopted child, or child at each birthday through the age of 6 to a one, two, or three party enrollment.
- Adding spouse, certified domestic partner, and/or dependents that lost coverage to a one, two, or three party enrollment. (Must provide proof of loss of coverage - keep in employee's personnel file).
- Adding a dependent due to a change in custody and/or acquiring an economically dependent child.
- Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible) cannot be deleted due to moving out of the household. Excludes employees in process of separation, divorce, or annulment.
- Deleting a dependent who obtains other group coverage (non-state sponsored).
These voluntary additions/deletions not initiated by the employee within 60 days from the PED may be processed only during a subsequent open enrollment period.
The following deletions are processed administratively. The department is responsible for notifying the employee of administrative deletions. An employee signature is not required; enter "Administrative Deletion" on the Employee Signature line of the STD. 692.
- Dependents who reach age 26 and are not disabled.
- Employees and/or dependents enrolled but not eligible or dual/split coverage exists. Delete retroactive to the effective date using PEC the employee is responsible for any costs for dental services that were performed on him/herself or any ineligible dependent.
- Employees that are enrolled but not eligible and refuses to sign the STD. 692 to change dental plans due to bargaining unit change. Cancel retroactive to PED, which caused eligibility to terminate using code 42.
Death of a spouse, domestic partner or child upon receipt of a death certificate.
- The employee must be notified regarding this change and will not be allowed to enroll in a dental plan until the next scheduled open enrollment.
Voluntary Change of Dental Plan
An employee may only change enrollment from one dental plan to another under the following conditions:
- During an open enrollment period;
- Due to a physical move to an area that is not serviced by the current dental carrier; (PEC: 34)
- Due to a physical move to an area where a dental plan was not previously available to the employee; or (PED: 35)
- Due to service plan cut in the employee's service area and/or the employee's current dental plan does not have a dental provider within a 50 mile radius of the employee's residence. (PEC: 34) Attachment C
Changes in Collective Bargaining Designation (CBID) Units 5 or 6
- Unit 5 - California Association of Highway Patrolmen (CAHP): Unit 5 employees who are enrolled in the CAHP dental plan, Blue Cross, are automatically moved to the state-sponsored Delta plan when they move out of Unit 5. The effective date of the dental plan change is based on when the PAR document is keyed. CHP personnel office staff must complete a STD. 692 and forward a copy to Delta dental so it can update its records accordingly. Since SCO processes the plan change automatically, the STD. 692 is not sent to SCO. Those R05 employees who were enrolled in one of the state-sponsored prepaid plans will continue their enrollment but will be allowed to elect to change to Delta dental if eligible if they choose to do so. CHP personnel office staff are responsible for notifying employees of their options.
- Unit 6 - California Correctional Peace Officer's Association (CCPOA): When employees move in or out of Unit 6, a new STD. 692 must be completed to change the employees to the appropriate dental plan based on their new CBID, failure to do so may result in a loss of coverage. STD. 692 should be completed and forwarded to SCO using PEC 40 with a standard effective date.
Enhanced and Basic Dental Coverage - Automatic Conversion
Employees enrolled in either Delta plan or SafeGuard who move from represented to excluded or excluded to represented will automatically have their dental benefit coverage level changed to either the Basic or Enhanced level of coverage. The effective date of the new plan will be contingent upon when the Personnel Action Request is keyed.
Employees moving from represented to excluded will be automatically moved into the enhanced level of coverage effective the first day of the month following their first full month as an excluded employee. For example, if the CBID identifier change over to an excluded designation is effective March 7, coverage would be effective May 1, (April pay period, first full month as excluded). Because this change is processed automatically by SCO, departments are encouraged to process PAR documents as quickly as possible so that employees receive their correct level of dental benefit coverage. The SCO runs a program each month normally two days prior to the master payroll cutoff. Any changes not processed for the current master payroll cutoff will be processed during the next pay period.
Employees moving from an excluded to a represented classification will be automatically moved into the basic level of coverage effective the first day of the month following the change to represented. For example, if the CBID change to represented is effective March 4, coverage would be effective May 2, (April pay period).
Should a Unit 6 employee promote to an excluded classification with Unit 6 affiliation, that employee now has the option of remaining in CCPOA or enrolling in the Delta PPO plus Premier enhanced, Delta PPO plan or one of the state-sponsored prepaid plans. Because of this new option, if your employee chooses to enroll in one of the state-sponsored plans they must complete a new STD. 692.
Unit 6 employees are restricted to enrollment into one of the CCPOA Union Benefit Trust Plans available to them, in accordance with their Memorandum of Understanding (MOU). Should a Unit 6 employee promote to a supervisory classification, (S06, M06, C06, and E06) that employee has the option of enrolling into a state-Sponsored plan or enrolling into CCPOA Benefit Trust union-sponsored Primary Dental Plan. Failure to disenroll after promotion to a supervisory classification will result in SCO automatically disenrolling the employee after 60 days from CCPOA Western Dental (SCO will send a notice to the personnel office). Employees will be identified by the SCO for automatic deletion by their CBID number (S06 or M06 designation). Personnel offices must continue to complete a STD. 692, indicating any plan change.
Represented employees in Unit 5 who are union members are unable to enroll in Delta. Their indemnity dental benefits are provided through their CAHP Union Trust Plan. The effective date of some actions may occur in accordance with bargaining unit MOU requirements.
512. Effective Dates
There are two types of effective date rules that are applied to all dental enrollment transactions: Mandatory and Standard. The type of permitting event determines which effective date rule should be applied. Events, such as loss of coverage, deletion of dependents due to death or marriage, etc., would normally necessitate immediate action and therefore the mandatory effective date rule would apply. Those events that do not require immediate action would come under the standard effective date rule, i.e., initial enrollment, deletion of dependent at age 18, etc.
Attachment C - Permitting Events Code Chart, lists all of the various dental permitting event codes as well as the respective effective date rule that should be applied.
Mandatory Effective Date Rule
First of the month following the permitting event that allows the action to occur.
- Example: Event occurs any time during the month the effective date will be the first day of the month immediately following the event. Employee's date of divorce is 10/23. The effective date is 11/1.
Standard Effective Date Rule
First of the month after the STD. 692 is completed and received by the employing department.
- Example (1): Employee hired 07/14 and submits STD. 692 on 08/11. The effective date is 09/01.
- Example (2): Spouse moves out of household 03/25 and employee submits STD. 692 on 04/02. The effective date is 05/01.
- STD. 692 forms which are submitted to SCO and must be returned to the employing office due to incomplete or incorrect information will maintain the original effective date. Personnel office staff needs to be aware, however, that document processing problems will result in a delay in eligibility information being sent to the dental plans. Employees should be advised accordingly.
Retroactivity/Emergency Plan Change
Except when approved by CalHR Benefits division, retroactivity/emergency plan changes will not be allowed. Employees must be advised not to use their dental plan prior to the effective date shown on the STD. 692 enrollment document, signed by the authorized agency representative or date approved by CalHR. A brief memo along with the completed STD. 692 should be submitted to CalHR for review. CalHR can request other types of documentation to support an appeal.
Revolving Fund Checks
Since deductions are not taken from revolving fund checks, employees who receive a revolving fund salary check will not have dental eligibility established with their respective dental carrier until a regular salary warrant is issued by SCO. Personnel office staff should contact CalHR in instances when an employee receiving a revolving fund check requires emergency dental treatment either for self or an eligible dependent so CalHR can assist in verifying eligibility with the employee's dental carrier.
513. Re-Enrollment of Employees
Reinstatement after Leave of Absence
Coverage in the same dental plan is automatically restored, effective the first of the month after the first pay warrant is issued by SCO, provided no cancellation was processed prior to, or during the leave of absence. However, if the employee cancelled coverage, the employee must wait until the next open enrollment period to re-enroll. In certain situations, if the employee is off pay status for more than one pay period, an enrollment document (STD. 692) may be required to re-enroll the employee when they return to pay status. Departments should check the monthly payroll register to see if the employee's dental deduction is shown. If the deduction is not shown, it will be necessary to contact SCO.
Reinstatement after Appeal
SCO requires that a STD. 674, Payroll Adjustment Notice, (and STD. 692 and/or STD. 700), be submitted to reinstate an employee's benefit deductions (dental and vision), if the employee is mandatorily reinstated after a termination/suspension and had his/her dental coverage terminated. The effective date can be current or retroactive, depending on the direction in the reinstatement stipulation. Coverage continues for an employee who separated from state service, but who is reinstated without a break in service of more than one pay period. The department should confirm that the proper dental deduction is shown on the employee's first payroll warrant issued after reinstatement. If not shown, contact SCO for assistance to reinstate deductions. In certain non-mandatory reinstatements with a break of more than one pay period, the dental deduction may show on the employee's warrant, and the personnel office should ensure that the employee is eligible for the coverage. If not eligible, a STD. 692 should be submitted to SCO to cancel dental and STD. 700 to cancel vision coverage.
Retired annuitants who temporarily return to state employment are not eligible to enroll in a dental plan as active employees; their dental eligibility is established and maintained based on their retirement status through CalPERS.
A retired annuitant who cancels his/her retirement and permanently returns to state employment is eligible to enroll in a dental plan as an active employee based on his/her bargaining unit designation. A new STD. 692 will need to be submitted to SCO for enrollment.
514. Annual Open Enrollment Period
Open enrollment periods are scheduled annually during the month of September through mid-October. Departments will be notified of open enrollment procedures prior to each open enrollment period. Eligible employees may enroll in a dental plan, change plans, and add/delete dependents during an open enrollment period.
Permitting Event Codes
The following permitting event codes should be used when completing the STD. 692 during an open enrollment period:
03 - New enrollment
15 - Addition/Deletion of dependent(s) (may use one form)
28 - Change of dental plan
29 - Change of plan and addition/deletion of dependent(s) (may use one form)
41 - Cancelling health/dental to enroll in cash in lieu of benefits. Forms to SCO must be stapled together.
Employees Off Active Pay Status During Open Enrollment Period
Eligible employees, who are off active pay status during the entire open enrollment period, may contact their personnel office during the open enrollment period to make changes in their dental enrollment or may wait and make changes within 60 days after returning to active pay status.
All correctly completed open enrollment documents that are submitted to the SCO within the prescribed time frames, will be effective January 1 of the following calendar year. CalHR will send a PML memo to departments prior to the scheduled open enrollment period which will contain document processing instructions.
Correcting Open Enrollment Documents
Corrective action is required when an error has been made by the department in completing the STD. 692 as follows:
For errors that do not pertain to a payroll deduction (i.e., name, age of dependent), photocopy the STD. 692, make the necessary corrections in red, indicate "CORRECTED COPY" in red across the top of the form, and submit it to the dental carrier. Do not send a copy to SCO or CalHR.
Cancel or Change Open Enrollment Documents
Employees enrolling or making changes to their dental coverage during the open enrollment period may cancel or change their election until the end of the open enrollment period. In the remarks section of the new STD. 692, indicate the type of action taken and attach a copy of the original form that was previously sent to SCO during the open enrollment period. Employees may not cancel or change a dental election after the end of the open enrollment period unless they experience a valid change in status.
515. Continuation of Coverage While Off Pay Status
Employees on non-pay status may elect to continue dental coverage by paying the total premium directly to the dental carrier. During the period of non-pay status the state contribution towards the dental premium is not paid, therefore, employees must be advised that they can elect to continue their dental coverage through direct payment of the total premium to the dental carrier in order to maintain coverage.
The Dental Plan Direct Payment Authorization (STD. 696)
The Dental Plan Direct Payment Authorization (STD. 696) is used to enroll eligible employees in direct pay for dental benefits. The STD. 696 fill and print form can be located at the CalHR web site. The form can also be ordered through the Department of General Services, Office of State Publishing.
An employee who wishes to continue coverage while off pay status must complete a Dental Plan Direct Payment Authorization (STD. 696), and forward the form directly to the carrier with a check or money order for the full three month premium amount. The employee's enrollment may not exceed the duration of the state's contract or one year, whichever comes first. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period. For employees with an approved leave extension beyond one year, the employing department must notify the carrier that direct payment of premiums will be continuing beyond one-year. Also, another STD. 696 must be completed and submitted to the new carrier if there is a change in dental carriers at the end of the contract period. If an employee on direct pay has a status change, the employing office must complete a STD. 692 and submit the enrollment form to the SCO. SCO will manually update the payroll master file and upon the employee returning to work, the update will be in place.
An employee who does not elect direct payment must complete section B of the STD. 696, to decline continued coverage. If the employee elects not to enroll, he/she will be liable for any dental expenses incurred while off pay status. A copy should be retained in the employee's personnel file. In this instance, do not send a copy of the STD. 696 to the dental carrier.
Instructions for the completion of the STD. 696 are printed on the reverse side of the form. Personnel staff should verify that all information is completed correctly. Do not forward the original document or copies of the STD. 696 to SCO or CalHR.
Absences/Situations Where Coverage Lapses
- Leave of absence for one or more full pay periods other than NDI, IDL, 4800 Time or Workers Compensation with supplementation.
- Appeal of involuntary termination (COBRA provisions apply, direct payment provisions are not applicable).
- Suspension of one or more complete pay periods.
- PI, enrolled but off pay status (Reduction in hours -COBRA provisions apply, direct payment provisions are not applicable).
- Application for disability retirement is pending (employee is off pay status).
- Pending IDL determination when all sick leave and vacation credits have been exhausted (employee is off pay status).
- Death of an employee (120-day death benefit apply, COBRA provisions are applicable after CalPERS' determination of survivor benefits).
- Under approved State Disability Insurance benefits.
Direct Payment of Premiums
- Dental carriers do not send a monthly bill to an employee who elects to pay premiums directly while he/she is off pay status. Therefore, it is the responsibility of each employee to ensure premium payments are paid timely. Direct pay is normally limited to 12 months. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period.
- Payments must be paid in advance and cover a minimum period of three months or the length of the absence whichever is less. The employee's check/money order for the first three months must be attached to the newly completed STD. 696 and sent to the carrier.
- The dental carrier must receive the initial payment by the first day of the month following the first full month the employee is off pay status. Subsequent installments and/or final payment are due to the dental carrier by the first of each subsequent three-month period. STD. 696 forms received by the dental carrier without the required payment attached will be returned to the employee. Failure to pay the required payment in a timely manner will result in the employee's dental coverage being cancelled.
- In the event an employee returns to pay status prior to the end of his/her approved leave of absence, it will be the employee's responsibility to contact his/her dental carrier to request a refund of any direct premium overpayments paid.
Addition or Deletion of Family Members While on Non-Pay Status
An employee who has a permitting event occur while on non-pay status may make changes to his/her dental enrollment as indicated below:
- An employee is responsible for contacting his/her personnel office and completing a new STD. 692 reflecting the enrollment change. The personnel office must forward the document to SCO for processing.
- If an employee is on direct pay and the change results in a change of premium, a new STD. 696 must also be completed.
- If an employee deletes any dependent prior to or during the leave, the dependent may not be re-enrolled until the next open enrollment period.
Return to Pay Status
Upon return to pay status (if an employee is still enrolled), the state premium contributions will commence with the first pay warrant issued by SCO.
The personnel office should check the employee's pay warrant to verify that the dental plan name is reflected. If the dental deduction is not shown, contact SCO to establish.
Dental Benefits for Exempt Employees Separating from state Service
For exempt employees who are separating from state service, and have not reached retirement age, but desire to continue their dental benefits until they reach minimum retirement age, the conditions listed below will be applicable.
Conditions of Eligibility
Exempt employees who have at least ten (10) years of state service which includes at least two (2) years of credited service while an exempt employee, who permanently separate from state service on or after January 1, 1988, and at the time of separation have more than 10 years before they would attain their minimum age for service retirement from state service, may elect to continue or not continue their dental benefits until their date of retirement.
For these employees, the following two options are available at the time of separation:
- An exempt employee may choose not to continue his/her dental benefits at the time of separation. However, the separated exempt employee will be eligible to enroll in a dental plan at the time of his/her future date of retirement.
- An exempt employee may elect to continue his/her dental benefits at the time of separation. The enrollment must be made within sixty (60) days from their date of permanent separation. The premium rate is 102 percent (%) of the current state rate. While this rate is the same as the COBRA rate, continuation of coverage in this instance is not part of COBRA.
Dental Plan Enrollment Form and Premium Payment
Should an exempt employee elect to continue dental benefits at the time of separation, the following information on enrollment procedures is being provided.
Indemnity Type and PPO Plans - Delta Dental
For enrollments in Delta or PPO, exempt employees should complete the "Delta 602A" form. The following statement should be written across the top of each form, "Based on Section 22816.7 of the Government Code". This form can be obtained from Delta Dental's Marketing Administration by calling (415) 972-8300 (ask for the Enrollment and Billing Department). The enrollment form and initial premium payment should be sent to the California Public Employees' Retirement System (CalPERS) for verification of eligibility. CalPERS will forward the enrollment form and initial payment to Delta for processing. The premiums must be paid on a quarterly schedule. After the initial enrollment, subsequent premiums are sent directly to Delta and due by the first day of the month that the quarter begins (January, April, July and October). Non-payment for two (2) consecutive quarters will automatically disqualify the enrollee from this program. To ensure that the quarterly premiums are credited properly, enrollees should write their social security number and group number 9949-8601 (Delta PPO plus Premier) or 9946-8601 on their payment check.
Prepaid Plans - DeltaCare USA, SafeGuard, Premier Access, and Western Dental
For enrollments in DeltaCare USA, SafeGuard, Premier Access, and Western Dental exempt employees should complete the "Dental Plan Direct Payment Authorization (STD. 696)". The following statement should be written across the top of each form, "Based on Section 22816.7 of the Government Code". The enrollment form and the initial payment should be sent to the California Department of Human Resources (CalHR) to the attention of the Dental Coordinator, for verification of eligibility. CalHR will forward the enrollment form and initial payment to the dental carrier for processing.
The premiums will be paid on a monthly schedule. After the initial enrollment, subsequent premiums are sent directly to the carrier and due by the first day of each month (January, February, March, etc.). Non-payment for two (2) consecutive months will automatically disqualify the enrollee from this program. To ensure that the monthly premiums are credited properly, enrollees should write their social security numbers and "state exempt employee" on their payment check.
Reference: Government Code Section 22816.7
Separating Legislative Members
A former Member of the Legislature who has served six or more years as a member of the Legislature may elect, within 60 days after permanent separation from state service, to enroll or continue enrollment in a dental care plan as provided to state annuitants. Upon that election, the former member is required to pay the total premiums related to the coverage and an additional 2 percent for the administrative costs. Should the person electing this benefit subsequently terminate his or her coverage, they may not reenroll in accordance with Government Code Section 22811. Conditions of payment are the same as those separating from state service outlined in this section.
516. 120-Day Death Benefit for Continuation of Benefits
Under the 120-day death benefit, departments are required to continue to pay full premiums to continue coverage for a covered employee's spouse, domestic partner and/or other eligible family members for 120 days following an employee's death. The 120-day period is to provide the family a grace period while CalPERS determines if the spouse, domestic partner or other family members are eligible for a survivor's benefit.
In implementing this benefit, departments will use the process used for an employee on an unpaid leave of absence (STD. 696). Under this process, the deceased employee's department will pay four months of both the employer and employee contributions directly to the dental plans.
An eligible spouse, domestic partner and/or other eligible dependent(s) who is determined to be an eligible survivor and receives a continuing allowance from CalPERS may continue dental coverage as annuitants.
If CalPERS determines that the spouse, domestic partner and/or other eligible family member(s) is not eligible for survivor benefits, then the department should notify the spouse, domestic partner and/or other eligible family member(s) of COBRA eligibility within sixty days from the date CalPERS makes this determination. Upon notice of COBRA eligibility by the department, it is the responsibility of the spouse, domestic partner, or other eligible family member(s) to elect and pay monthly premiums directly to the plan(s) in the manner prescribed in the COBRA Election Notice.
Collective bargaining agreements (all twenty-one bargaining units) Legislation enacted - AB 1639, Chapter 926, 1999
- Personnel Management Liaison Memorandum (PML) 99-066
- DPA Personnel Transaction Supervisors and Personnel Transaction Staff Memorandum dated August 7, 2001.
517. Retiring Employees
When an employee retires, the personnel office must complete and submit a new STD. 692 to CalPERS HAS in order to establish the dental deduction in CalPERS' retirement system. To continue dental coverage into retirement, with no break in coverage, an employee must be enrolled in a dental plan on the day of separation from employment and retire within 120 days following separation. This is not an event to add dependents. An employee who retires within the 120 days but elects not to enroll in dental may do so during any subsequent open enrollment period. All dental coverage enrollments continued into retirement within the required period, will be processed by CalPERS with no break in dental coverage.
Prior to processing their permanent separation personnel specialists can go to the My CalPAYS system to enroll employees that are retiring.
A retiring state employee may enroll self and dependents into a dental plan into retirement, even though they were not enrolled in a dental plan at the time of separation. The enrollment may be completed if the retiree was eligible to enroll as an employee at the time of separation for retirement, retires within 120 days of separation and receives any state retirement allowance. Upon election to enroll by the retiring employee, the personnel office is to complete and submit a new STD. 692 to CalPERS HAS in order to establish the dental deduction in the retirement payroll system. An employee who retires within the 120 days of separation with eligibility to enroll into a dental plan upon retirement, but elects not to enroll in a dental plan may do so during any subsequent open enrollment period by contacting CalPERS HAS, Eligibility and Enrollment Section. All dental coverage enrollments continued into retirement within the required period, will be processed by CalPERS.
Mail or fax STD. 692 to:
CalPERS (Health Account Services)
Attn: Forms and Roll Administration Unit
P.O. Box 942715
Sacramento, CA 94229-2715
Vesting Requirements for Retiring Employees - General Information
Within certain bargaining unit MOUs, there exists vesting requirements for the state's contribution toward the cost of retirees' dental premiums. In general, where vesting requirements exist, a certain length of state service time is needed to receive a state contribution toward the cost of dental premiums. Those units with dental vesting requirements may also have requirements that employees with employment dates starting on or after a certain date are subject to the vesting schedule stated in their bargaining unit's MOU. Please refer to your retiring employee's specific bargaining unit MOU to check for the existence of a vesting schedule and the terms and conditions of that schedule.
Departments are responsible for ensuring that a new STD. 692 is completed and submitted to CalPERS. Departments must instruct retiring employees of the benefit changes to their dental plans. Each retiree is responsible for ensuring that a dental premium is being paid by verifying coverage on his/her monthly CalPERS earnings statement.
CalPERS HAS has responsibility for processing dental enrollments and maintaining dental coverage for each retiree. All inquiries made by a retiree regarding his/her dental plan enrollment or changes should be referred to CalPERS HAS. A retiree who has questions regarding dental plan coverage or claims should be referred to his/her respective dental plan. Requests to change dental coverage outside of open enrollment or issues which cannot be resolved by the dental plan may be referred to CalHR Benefits division for review.
Coverage for Retirees
Coverage for a retiring employee continues or changes under the following conditions:
- A retiring employee, who is enrolled in DeltaCare USA, SafeGuard, Premier Access, or Western Dental and moves into an area where a prepaid plan is not available will be allowed to change dental enrollment to Delta Dental PPO plus Premier or Delta PPO at the time of his/her retirement.
- An excluded employee who is enrolled in the Delta enhanced and receiving the enhanced level of coverage will be automatically moved to the basic level of coverage upon retirement. (After the STD. 692 is processed by CalPERS).
- Employees enrolled in SafeGuard at the time of retirement will have the enhanced level of coverage (After the STD. 692 is processed by CalPERS).
- An employee in Unit 5, CAHP, must make an irrevocable election to either remain in the CAHP indemnity plan for the duration of his/her retirement or select one of the state-sponsored plans. This option is also available to a retiring manager or supervisor who is designated as M05 or S05. If an employee elects one of the State-sponsored plans, he/she may only change to another state-sponsored plan during the normal dental open enrollment period for the duration of his/her retirement. personnel office staff should ensure that a retiring Unit 5 employee makes an election designating his/her choice of dental plan.
An employee in Unit 6, CCPOA, must change to a state-sponsored dental plan when he/she retires.
- If a Unit 5 employee elects not to have dental benefits at the time of retirement, they would still have the one-time election available to them during a future open enrollment period. The employee must remain in good standing and a dues paying member.
Coverage for Survivors of Deceased Retirees
When a retired employee dies and coverage was maintained for eligible dependents, the eligible dependents as survivors of the retiree are entitled to continue dental coverage if they were enrolled on the deceased member's coverage and will receive a continuing monthly benefit from CalPERS. Dependents who do not meet these criteria will be eligible for COBRA coverage.
Questions regarding eligibility as a survivor should be addressed to CalPERS, Post Retirement Division at (888) 225-7377. For additional information, please refer to the CalPERS Health Benefits Procedure Manual.
518. Cancellation/Termination of Dental Enrollment Coverage
Cancellation of Dental Enrollment
- Employees may voluntarily cancel their dental plan enrollment at any time by completing a STD. 692 and submitting it to their personnel office. These employees may not re-enroll in a dental plan until the next scheduled open enrollment period.
- Enrollment for PI employees who do not qualify during a control period must be administratively cancelled. The effective date of cancellation is February 1 for the July 1 - December 31 control period, and August 1 for the January 1 - June 30 control period. These employees may continue coverage through COBRA.
- Employees/dependents that were enrolled but never eligible must be retroactively cancelled back to the effective date of their enrollment.
- Employees who lose eligibility due to a reduction in time base to less than half-time must be administratively cancelled, with the exception of those employees approved for Partial Service Retirement.
Termination of Coverage
An employee's coverage ceases at midnight on the last day of the month following the month in which the last premium was paid.
519. Consolidated Omnibus Budget Reconciliation Act (COBRA)
The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees and dependents to maintain dental benefits for either 18 or 36 months after losing coverage because of certain qualifying events.
Each employing department is responsible to ensure that employees and their eligible dependents that are eligible for COBRA are notified of their rights, responsibilities and notification timeframes for enrollment. Departments failing to properly notify and assist in the processing of COBRA enrollments are subject to audits and fines imposed by the Internal Revenue Service (IRS) Excise Tax and subject to lawsuits under the Employee Retirement Income Security Act (ERISA), and the Public Health Service Act (PHSA) for failure to comply with COBRA notification requirements.
Departments are urged to review in detail the COBRA policy and procedures outlined in Section 400 of this BAM manual in the event an employee or dependent has any of the following events occur:
COBRA Qualifying Events - Benefits Continued for 18 Months
- Voluntary Termination - Covered employee voluntarily terminates or separates from employment (e.g., retires or quits), and the termination/separation will cause a loss of coverage.
- Involuntary Termination - Covered employee is involuntarily terminated from employment (other than for gross misconduct), and the termination will cause a loss of coverage. If the termination is due to "gross misconduct," the state is not obligated to offer COBRA continuation coverage.
- Reduction of time base - Covered employee's work hours are reduced voluntarily or involuntarily, and the reduction of hours will cause a loss of coverage. Reduction of hours may include:
- Full-time to part-time
- Leave of Absence
- Military call-up (24 months of coverage)
- Permanent Intermittent (who loses coverage based on a non-qualifying control period)
COBRA Qualifying Events - Benefits Continued for 36 Months
- Death - Covered employee or retiree dies, and the surviving family member is not eligible for a monthly survivor allowance from CalPERS.
- Medicare coverage begins-Cvered employee or retiree becomes entitled to Medicare benefits.
- Divorce or legal separation-Covered employee or retiree is divorced or legally separated
- Domestic partnership termination-Covered employee or retiree terminates a domestic partnership (registered in the State of California).
Change in dependent status-An eligible child of a covered employee or retiree turns age 26.
520. Document Completion
1. Use of the Dental Plan Enrollment Authorization Form (STD. 692)
- New enrollments or re-enrollments
- Authorized changes to current coverage
- Cancellation of all coverage
- Elections not to enroll in a dental plan
- COBRA continuation (Use STD. 692 for prepaid plans)
The completed STD. 692 is submitted to SCO within the prescribed time limit for normal processing. Do not use the STD. 692 to report any changes regarding the employee that are reported on a STD. 686, Employee Action Request. These would include social security number, date of birth, name, address, or agency and unit changes.
Once an employee is enrolled, any corrections to a dependent name or date of birth should be noted in red on a photocopy of the most recent enrollment form and forwarded directly to the appropriate dental carrier. Do not send a copy to SCO or CalHR. An employee should report address changes directly to their carrier.
If any alterations are made to the wording in Section D of the STD. 692 by either the employee or the personnel staff, the SCO will not process the document and it will be returned to the department.
Attachment H - Instructions for Completion of Dental Plan Enrollment Authorization (STD 692) provides a chart with instructions for the completion of each item on the STD. 692 for active, retired and COBRA enrollments. Refer to Attachment B - Dental Deduction Codes/Premiums for current dental rates information. Personnel office staff are encouraged to make use of these valuable reference tools.
2. Multiple Transactions
When the PEC, effective date, and PED are the same, all transactions can be reported on one form. When any of these items are different it will be necessary to complete a separate STD. 692 to report each change. When submitting more than one STD. 692, each form should be numbered (in remarks section) based on the sequence of each event (i.e., 1 of 3, 2 of 3 and 3 of 3).
3. Ordering Enrollment Forms
Enrollment (STD. 692) and Dental Plan Direct Payment Authorization (STD. 696) forms can be ordered through the Office of State Publishing, Department of General Services.
521. Dental Carriers/Benefit Information
Evidence of Coverage (EOC) Booklets
- Prepaid Plans
- All employees enrolled in a prepaid dental plan should receive an Evidence of Coverage (EOC) booklet from their selected dental carrier when they initially enroll or change to a new carrier
- To order a small supply of EOC booklets and/or current provider lists for the prepaid plans, contact the dental carriers at the following numbers:
Verification of Coverage
- In the event an employee indicates that a dental claim for services has been denied, it is possible that there is a problem with the employee's enrollment and the employee is not reflected on the dental carrier's eligibility files. If this occurs, departments should do the following:
- Verify that the correct dental plan name is reflected on the employee's pay warrant.
- Ensure that the claim denial was not prior to the 5th or the 20th of the month because the carriers receive eligibility information from SCO via electronic download on these dates. The employee may want to have his/her dentist resubmit the claim.
- Confirm with the employee that the correct Social Security Number was entered on the claim form.
- Review the file copy of the STD. 692 for accuracy.
- If the STD. 692 is correct, contact the SCO Deductions Liaison Unit to verify when the document was processed and premiums paid.
- If any of the following items are incorrect on the STD. 692, contact the SCO Deductions Liaison Unit:
- Section A - Items 1, 2 or 4
- Section B - Item 1; Item 3 does not correspond to Section E, Item 4
- Section D - Form not signed/dated
- Section E - Item 1; Item 2 does not correspond to Items 7 and 8 and/or Section B-1
Change of Dentist
Employees enrolled in a state-sponsored prepaid plan (DeltaCare USA, SafeGuard, Premier Access, Western Dental) are allowed to change to a different dentist within the dental plan's provider network. This type of change must be done through the dental carrier. Please refer the employee appropriately.
All the dental carriers have an internal complaint/grievance process in the event an employee is not satisfied with the services or benefits he/she receives. An employee with such a complaint should be advised to contact his/her dental carrier directly.
In addition, all the dental carriers are required to be licensed under the Knox-Keene Health Care Act of 1975, which is now administered by the Department of Managed Health Care. An employee who has exhausted his/her dental carrier's grievance/complaint process and is not satisfied with how the matter has been handled or resolved can contact the Department of Managed Health Care, Complaint Center or Hotline at (888) HMO-2219 or (877) 688-9891 (TDD).
Claim forms are not required by DeltaCare USA or SafeGuard. Claim forms for Delta dental are generally not necessary because of direct claims submission by the provider to Delta dental. For out-of-network claims for reimbursement for services rendered by a non-Delta dental provider, claim forms may be obtained directly from Delta dental. Employees in Units 5 and 6 should contact their respective union for information on how to obtain claim forms.
Dental Carrier Address/Phone Information for State-Sponsored Dental Plans
Delta Dental of California
P.O. Box 429086
San Francisco, CA 94142-9086
FAX: (415) 972-8334
Attn: Enrollment and Billing
P.O. Box 1803
Alpharetta, GA 30023
FAX: (770) 641-5393
FAX: (562) 924-7849
5 Park Plaza, Suite 1850
Irvine, CA 92614
FAX: (949) 471-2288
8890 Cal Center Drive
Sacramento, CA 95826
FAX: (866) 379-3247
Western Dental Benefits Division
530 South Main Street, 6th Floor
Orange, CA 92868
FAX: (714) 571-3605
Dental Carrier Direct Payment Address Information for State-Sponsored Dental Plans (excluding COBRA)
Delta Dental of California
Attn: Cindy Koga MS:6N
P.O. Box 429086
San Francisco, CA 94142-9086
P.O. Box 1803
Alpharetta, GA 30023
FAX: (770) 641-5393
FAX: (562) 924-7849
P.O. Box 13724
Philadelphia, PA 19101
Benefit Questions 1-800-880-1800
Billing Questions (949) 471-2283
FAX (949) 471-2288
8890 Cal Center Drive
Sacramento, CA 95826
Western Dental Benefits Division
530 South Main Street, 6th Floor
Attention Group Services
Orange, CA 92868
Dental Carrier COBRA Payment Address Information for State-Sponsored Dental Plans
For Delta Dental of California, mail STD 692 to:
Wolfpack Insurance Services, Inc.
P.O. Box 833
Belmont, CA 94002-0833
Wolfpack Insurance Services
P.O. Box 833
Belmont, CA 94002
Attn: COBRA Billing
P.O. Box 13724
Philadelphia, PA 19101
Benefit Questions 1-800-880-1800
Billing Questions (949) 471-2283
8890 Cal Center Drive
Sacramento, CA 95826
Attn: Group Services
530 South Main Street, 6th Floor
Orange, CA 92868