print logo
Main Content Anchor

Consolidated Benefits

 CoBen Changes for 2017

  • Some employer health benefit contributions will decrease for the 2017 Plan Year.

Content 

Attachments

Appendixes

1601. General Information

The Consolidated Benefits (CoBen) Program, is administered by the California Department of Human Resources (CalHR) Benefits Division. Departments are responsible for ensuring that all employees are provided information on the CoBen benefit. The following instructions provide the information required to assist departments in accomplishing that task. This manual will provide departments with information regarding eligibility, enrollment, and available benefits under the CoBen program. The two types of benefits presented under the CoBen program are:
  • The Consolidated Benefits (CoBen) Program Benefit Allowance, is automatically established in the State Controller’s Office (SCO) payroll system to offset eligible employees’ health, dental, and state-sponsored basic vision total benefits cost.
  • The Consolidated Benefits (CoBen) Program Cash Option is a cash payment option, in lieu of maintaining State-sponsored health or health and dental benefits, which is available to eligible State employees. Departments are responsible for assisting those employees who wish to enroll in CoBen Cash, by ensuring that all the appropriate documents are completed correctly and timely. This manual provides the information required to assist departments in accomplishing that task.
This manual provides an explanation of the CoBen Benefit Allowance and instructions on how to complete the Consolidated Benefits (CoBen) Cash Enrollment Election (STD. 702) for enrollment in CoBen Cash. For complete instructions on how to complete the Health Benefits Enrollment Form (HBD-12) and/or my|CalPERS health enrollment system, please refer to the CalPERS Health Benefits Manual; for complete instructions on how to complete the Dental Plan Enrollment Authorization (STD. 692), please refer to the Dental Procedures Manual. The examples of completed forms required for CoBen Cash enrollments that are provided in this manual include the STD. 702, HBD-12, and STD. 692.
 
The CoBen Handbook, which provides an overview of the program and how it works, should be made available to eligible employees. Personnel Offices may go to the CalHR Benefits Division website to download unlimited copies of the CoBen handbook for employees who do not have internet access.
 
CalHR Benefits Division
(916) 322-0300
 

Authority

Internal Revenue Code Sections 125 and 129
Section 599.956 through 599.959 of Title 2 of the California Administrative Code
State Consolidated Benefits Program
 

1602. Benefit Allowance

“Benefit Allowance”

The State will establish one “combined” employer contribution amount for an employee’s health, dental, and state-sponsored basic vision benefits. The employees’ benefit allowance is automatically established in the SCO payroll system, therefore, no enrollment form is required. Based on the health, dental, and vision plans an eligible employee chooses, the full premium cost is deducted from the employee’s benefit allowance. Eligible employees are automatically enrolled in the State’s vision plan. The vision benefit is mandatory under CoBen and eligible employees may not cancel their State-sponsored vision coverage.
 
The amount of employees’ benefit allowance will depend on the number of dependents that employees choose to cover. If employees are enrolled in both a State-sponsored health and dental plan, their health benefit enrollment party code will determine the amount of the benefit allowance they will receive.
 
If the total cost of the plans employees choose is less than their benefit allowance, they receive the difference as taxable cash (excess cash) in their paycheck. The excess cash amount will be subject to state, federal, and social security taxes. In order to receive excess cash, employees must be enrolled in health, dental, and state-sponsored basic vision. If employees are not enrolled in all three benefits, then they will not be eligible to receive excess cash.
 
If the total cost of the plans employees choose is more than their benefit allowance, they pay the difference (out-of-pocket) with pre-tax dollars automatically deducted from their paycheck. The out-of-pocket amount will not be subject to state, federal, and social security taxes.
 
If employees enrolled in health and state-sponsored basic vision only, they will receive the lesser of the total premium cost or the CoBen allowance amount.
 
If employees elect to receive cash in lieu of their State-sponsored health plan but enroll in a State-sponsored dental plan, then the benefit allowance will be the amount of their dental and state-sponsored basic vision premium. In this situation, employees will receive cash in lieu of qualifying group health coverage, and the employees’ dental and vision premium will be fully paid. The employee will not have an out-of-pocket dental and vision premium cost.
 
Employees benefit allowance will automatically stop at the time of retirement, separation, benefits are canceled for non-eligibility, or there is a change in their eligibility for Consolidated Benefits. At retirement, their health and dental deduction (if any) will be shown as the State share and retiree share of the applicable premiums. The Personnel Office is required to offer employees COBRA continuation if they want to continue their state-sponsored vision coverage at the time of retirement. The state will continue to fully pay the state-sponsored basic vision premium for eligible active employees.
 

Represented Employee CoBen Allowance

The CoBen allowance for represented employees is determined through collective bargaining.
 
New employees who have never had state health benefit eligibility may be subject to health dependent vesting. Employees in bargaining units that have contracted for health dependent vesting are provided with 50 percent of the employer dependent contribution the first 12 months, and 75 percent of the employer dependent contribution for months 13 through 24. After 24 months, these employees will receive the full employer dependent contribution applicable to their bargaining unit. Please refer to the appropriate collective bargaining agreement for specific criteria for determining if an employee is subject to health dependent vesting.
 
The following CoBen allowance amounts will be effective January 1, 2017. However, the collective bargaining process is fluid and changes may be agreed to which alter these amounts. CalHR will notify departments if there are subsequent changes to these rates. Rates may be subject to change through the collective bargaining process and are subject to Budget approval. Any future changes will be posted to CalHR web site.
 

2017 CoBen Allowances

The CoBen allowance for Rank and File employees is determined through collective bargaining. As of the date of this publication, the following rates will be effective April 1, 2017.
 
Bargaining UnitSingle
​2-Party
50%
Dep.
Vesting
​2-Party
75%
Dep.
Vesting
​2-Party

100%
Dep.
Vesting

​Family

50%
Dep.
Vesting

​Family

75%
Dep.
Vesting

​Family

100%
Dep.
Vesting

​2​$606​N/A​N/A​$1,201​​N/A​​N/A​​$1,568
​7$609​​N/A​​​N/A$1,204​N/A​​N/A​​$1,575​
​8$641​​N/A​​​N/A$1,236​​N/A​​N/A​$1,603​
​16$606​$918​$1,060​​$1,201​$1,117​​$1,342​$1,568​
​17$606​​N/A​N/A$1,201​​N/A​​N/A​$1,568​
​18$609​​N/A​N/A$1,204​​N/A​​N/A​$1,575​
​19$606​​N/A​N/A​$1,201​N/A​​N/A​​$1,568​
​Excluded​$643​N/A​N/A​$1,248​N/A​​N/A​​​​$1,617
 
Note: Due to the nature of the collective bargaining process, changes may alter contribution amounts and dependent vesting levels.

1603. Benefits Calculator

The Benefits Calculator helps employees in CoBen determine how much will be deducted from their paycheck, or added to it, based on which health and dental plans they choose. State vision coverage is mandatory under CoBen; therefore, the vision amount is automatically added into the calculation.
 
The CoBen handbook includes a worksheet that employees may fill out to help them calculate their benefit costs. However, the CoBen calculator has the advantage of being easier to use and allowing employees to try different scenarios. An employee simply clicks on his or her health and dental plan choices, and how many dependents will be covered. The calculator automatically computes the total cost of the benefits and subtracts from the CoBen allowance. The result shows whether the employee will have a monthly benefit deduction or receive extra cash, and the amount of the deduction or cash.  
 

1604. CoBen Cash

“Cash Option”

Employees may elect to receive cash in lieu of their own State- sponsored health insurance or health and dental insurance plan. Employees may not elect to receive cash in lieu of dental coverage only. Employees must certify that they have qualifying group health and/or dental coverage through a spouse, domestic partner, or another source to be eligible for cash option.
 
Group coverage is typically maintained by an employer or employee organization and must conform to the federal Affordable Care Act's (ACA's) minimum value standards.  The ACA establishes a minimum value standard of benefits of a health plan.  For a qualifying group health plan to meet the ACE's minimum value standards, the plan must cover at least 60 percent of the total allowed costs of benefits provided under the plan.
 
All CalPERS-sponsored health plans meet the minimum value standards.  Employees covered under individual coverage, such as Tricare, Medicare, Medi-Cal, and Covered California are not eligible for the CoBen Cash, even if they meet the minimum value standards.
 
Cash Option payments are taxable and the amounts are listed below:
  • $155 per month in lieu of health and dental insurance
  • $130 per month in lieu of health only
Employees in CoBen are eligible for the CoBen Cash Option in lieu of health or health and dental benefits, therefore, they are not eligible for the State’s FlexElect Cash Option Program. Retired employees are not eligible for CoBen Cash.
 
Employees who are not currently enrolled in the CoBen Cash Option and wish to enroll in the Cash Option for the next Plan Year, must complete a Consolidated Benefits (CoBen) Cash Enrollment Election (STD. 702) during an open enrollment period or as newly eligible. The CoBen Cash Plan Year is from January 1 through December 31.
 
Employees who are currently enrolled in the Cash Option will be automatically reenrolled into the Cash Option for the next plan year. It is not necessary for these employees to complete a Consolidated Benefits (CoBen) Cash Enrollment Election (STD. 702) during a CoBen Cash Open Enrollment Period, unless they wish to cancel or change their Cash Option Enrollment.
 
Under the Internal Revenue Code governing the CoBenProgram, employees who enroll or make changes to their Cash Option during an Open Enrollment Period may cancel or change their election through December 31. This rule also applies to employees who are automatically reenrolled in the Cash Option. Accordingly, if employees wish to cancel their automatic Cash Option reenrollment after the Open Enrollment Period has ended, they may do so, provided it is done on or before December 31 in the same year.
 
  • Eligible employees enrolled in CoBen Cash may also enroll in the State’s FlexElect Program’s, Dependent Care Reimbursement Account and/or Medical Reimbursement Account. Departments should reference the Benefits Administration Manual (BAM) Section 700 for the FlexElect Reimbursement Accounts eligibility/enrollment criteria.
  • Permanent-Intermittent (PI) employees wishing to participate in the Cash Option, will not have their enrollment automatically continued. PI employees are required to complete a STD. 702 each year they wish to receive the Cash Option.
  • If the employee is not enrolled in a state-sponsored health and/or dental plan at the time of his/her death, then the surviving spouse and dependents can’t enroll in a medical or dental plan unless the California Public Employees’ Retirement System (CalPERS) determines they’re eligible for survivor benefits.
  • Employees who are eligible to receive survivor benefits after the death of the spouse or domestic partner can continue to receive CoBen Cash.

Dental Plan Three-Year Commitment

For dental insurance, remember that the choice employees make for dental insurance is a three-year (plan year) commitment. It is very important that employees who enroll in the cash option are made aware of the three-year dental commitment. The Personnel Office should take steps to monitor the 3-year commitment and ensure compliance when employees request cash option enrollment changes during or after the open enrollment period. After completing the three-year commitment, employees may enroll in a dental plan during the open enrollment period. There is no three-year commitment for employees who are not enrolled in the Cash Option.
 
If employees enroll in the Cash Option for health and dental, they may not cancel their dental Cash Option for three years unless the following occurs:
  1. Lose their other dental coverage;
  2. Cancel both their health and dental CoBen Cash during an open enrollment period; or
  3. Due to a valid permitting event under the CoBen Program.
If one of these events occurs, then the employee may enroll in a dental plan prior to the end of the three-year commitment period.
 

Delta Dental Plan 24-Month Restriction

Employees in CoBen do not serve the State Dental Program’s Delta Dental 24-month restriction period. Newly hired employees and those employees who transfer from a Bargaining Unit that is not eligible for CoBen to a Bargaining Unit that is eligible for CoBen, including those employees who are currently serving the 24-month restriction will be allowed to enroll or change to a Delta Dental plan.
 

Administrative Fee

Those employees who enroll in the CoBen Cash Option only in lieu of enrolling in State-sponsored benefits, will not pay a monthly administrative fee. Those employees enrolled in CoBen Cash and also enrolled in a FlexElect Program Medical and/or Dependent Care Reimbursement Account will pay a $1.00 monthly administrative fee. The administrative fee will be deducted from their after tax salary each month. The administrative fee will be determined each year by the CalHR.
 

1605. Premium Only Plan (POP)

Under the State’s Premium Only Plan any out-of-pocket premium cost to employees for their State-sponsored health, dental, and vision insurance cost (in excess of their CoBen allowance) is taken out of their paycheck before federal, state, and social security taxes are deducted (pre-tax basis). This tax savings helps to offset some of their insurance premium cost. All employees in CoBen who pay an out-of-pocket share for their State-sponsored health, dental, and vision premiums are automatically enrolled into Premium Only Plan.
 
In addition, as the employees’ CoBen allowance and/or insurance premiums increase or decrease, the employees’ share will automatically change and continue to be deducted from their paycheck as long as they are enrolled in POP.
 

Enrollment into POP

Enrollment into Premium Only Plan is automatic for all employees in CoBen who pay an out-of-pocket amount for health, dental, and vision premiums. Premium Only Plan is mandatory under CoBen and employees may not disenroll. There is not a monthly administrative fee for Premium Only Plan participants.
 

Benefit Allowance - Out of Pocket Cost

If the total cost of the plans employees choose is more than their CoBen allowance, they pay the difference (out-of-pocket) with pre-tax dollars automatically deducted from their paycheck. The out-of-pocket amount will not be subject to state, federal, and social security taxes.
 
Should an employee only enroll into one of the benefits (dental or health), along with the mandatory vision plan enrollment, the employee’s allowance will be the sum of premium cost only, or the maximum contribution amount, based on the dental or health party code (based on the actual enrollment), whichever is less.
 

1606. Eligibility for Consolidated Benefits

Employees eligible for the CoBen Benefit Allowance and also eligible to enroll in the CoBen Cash Option and FlexElect Dependent Care and/or Medical reimbursement accounts, but they must be paid by SCO through the State Uniform Payroll System or by the District Agricultural Associations and meet the eligibility criteria listed below:
  1. Employees in Bargaining Units 2, 7, 8, 16, 17, 18, and 19, managerial, supervisory, exempt (except Judicial Council employees, Judges and Justices), confidential, and all other permanent employees excluded from collective bargaining.
  2. Limited-Term (LT) or Temporary Authorization (TAU) employees appointed six months or more - no mandatory right of return to a permanent position required (for appointments in item 1).
  3. 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.
  4. All eligible employees must work half-time or more.
  5. Permanent-Intermittent (PI) employees may participate in the Cash Option but have limited eligibility. Specific PI eligibility and enrollment procedures are contained in this manual. Prior to enrolling a PI employee in the CoBen Cash Option, please read this information carefully.
  6. Employees may have more than one appointment, as long as the combined time base is half-time or more.

Eligibility Restrictions:

  • Permanent-Intermittent (PI) employees may only participate in the Cash Option and the Premium Only Plan (POP). Specific PI eligibility and enrollment procedures are contained within this manual. Prior to enrolling a PI employee in CoBen Cash Option, please read this information carefully.
  • Correctional Supervisors (S06) and managers (M06) may use any of the options within CoBen including CoBen Cash Option in lieu of their dental insurance. However, cash in lieu of the dental benefit only is not allowed under the CoBen program.
  • Employees who are maintaining coverage as a dependent on their parent’s State-sponsored health and/or dental benefits ARE eligible for the Cash Option.
  • Units 2, 7, 8, 16, 17, 18, and 19, and excluded employees are in the Consolidated Benefits (CoBen) Program. These employees are eligible for the CoBen Cash Option and therefore, are not eligible for the FlexElect Cash Option. Eligible employees enrolled in CoBen may enroll in the FlexElect Program Dependent Care Reimbursement Account (DCRA) and/or Medical Reimbursement Account (MRA).
  • Employees who are eligible to receive survivor benefits after death of a spouse or domestic partner can newly enroll into the CoBen Cash benefit if not already enrolled, or continue to receive CoBen Cash if currently enrolled into CoBen Cash.
  • Employees who are maintaining their own coverage on any state-sponsored health and/or dental benefits (including CSU system) ARE NOT eligible for the Cash Option.
 Newly eligible employees may enroll in the CoBen Cash Option during the Plan Year. The effective date of enrollment will be based on the appropriate effective date rule as described on the CoBen Permitting Event Chart (Appendix A). Newly eligible employees must enroll in CoBen Cash within 60 days of becoming eligible. All newly eligible employees must meet the eligibility criteria outlined above. Newly eligible employees are:
  1. New State employees hired after the open enrollment period;
  2. Employees whose time base/employee designation changes from one that was not eligible to one that is eligible or a PI employee who changes to a permanent position with a time base of half-time or more;
  3. Employees who were on an approved leave of absence during the entire open enrollment period may enroll upon return to work within the specified time period;
  4. Employees not currently enrolled in CoBen Cash, who experience a valid change in status event as reflected in Section 1607. In addition, if the employee’s change in status event results in a concurrent approved leave of absence (e.g. birth of child/maternity leave), the employee may enroll upon return to work within the specified time period.

Enrollment Effective Date

Correctly completed Cash Option enrollment forms for newly eligible employees received at SCO by the 10th of the month will be effective the first of the following month. The last possible “effective date” of enrollment during the plan year as a newly eligible employee in CoBen Cash is December 1. In order to receive a December 1 effective date, correctly completed enrollment documents must be received at SCO by November 10th. Enrollment documents received after November 10th will be processed for the next Plan Year.
 
When the 10th is on a weekend or holiday, the cut-off date will be on the next regular workday.
 

1607. Change in Status Events (Permitting Events)

The CoBen Cash enrollment is in effect for the entire Plan Year, January 1 through December 31. Employees may not change or cancel their CoBen Cash election during the Plan Year, except for allowable changes in status events as defined by Internal Revenue Service (IRS) regulations.
Allowable status changes are:
  • Initial appointment (Includes reinstatement following a permanent break in service);
  • Change in time base/designation from one that was not eligible to one that is eligible or a PI who changes to a permanent position with a time base of half-time or more;
  • Marriage, divorce, commencement or termination of domestic partnership, legal separation, or annulment;
  • Loss or commencement of health and/or dental coverage provided through spouse, domestic partner, or other source;
  • Loss or commencement of employee’s, spouse’s, or domestic partner’s employment;
  • Move out of group practice plan service area;
  • New health and/or dental plan(s) in area where none was previously available;
  • Change in bargaining unit or employee designation.
 
Valid permitting events for the CoBen Cash Option Program are listed in the permitting event table (Section 1607). These events include enrollment at the time of initial appointment and those events allowed as the result of a valid change in status event as reflected above. Please note that action must be taken (enroll, cancel, change) within 60 days from the date the change in status event occurs.
 
For further information on permitting event codes and effective dates please refer to the CoBen Program Permitting Event Codes. THESE PERMITTING EVENTS APPLY TO THE COBEN CASH OPTION PROGRAM. PLEASE REFER TO THE HEALTH BENEFITS, FLEXELECT AND/OR DENTAL PROCEDURE MANUALS FOR ALLOWABLE PERMITTING EVENTS FOR THOSE BENEFITS.
 

Initial appointment (Includes reinstatement following a permanent break in service)

May enroll as a newly eligible.
 

Change in time base/designation from one that was not eligible to one that is eligible or a PI who changes to a permanent position with a time base of half-time or more

May enroll as a newly eligible.
 

Marriage or commencement of domestic partnership

May enroll as newly eligible, or if currently enrolled may cancel/change Cash elections.
 

Divorce (date of final divorce), termination of domestic partnership, legal separation, or annulment

May enroll as newly eligible, or if currently enrolled may cancel/change Cash elections.
 
 

Death of spouse or domestic partner

If currently enrolled may cancel/change Cash elections. New enrollments not allowed.
 

Loss of health/dental coverage provided through spouse, domestic partner, or other source

May enroll as newly eligible, or if currently enrolled may cancel/change Cash elections.
 

Commencement of health/dental coverage provided through spouse, domestic partner, or other source (due to an employment status change) or survivor benefit

May enroll as newly eligible, or if currently enrolled may cancel/change Cash elections.
 

Move out of group practice plan service area

May enroll in a new plan, if your plan is no longer available. May cancel/change Cash elections. New enrollments not allowed.
 

New health and/or dental plan(s) in area where none was previously available

Change to new plan(s). May cancel/change Cash elections. New enrollments not allowed
 

Change in bargaining unit or employee designation

If currently enrolled may change health/dental plan(s) or cancel/change Cash elections per union requirements. New enrollments not allowed.
 

Loss of health/dental coverage provided through spouse, domestic partner, or other source

Re-enroll in prior health/dental plan(s).

Court Ordered Health/Dental Coverage which impacts FlexElect/CoBen Cash

Occasionally an employee receiving FlexElect/CoBen Cash will be issued a court order regarding the provision of benefits for their dependent(s).  The court order will specify that the dependent be enrolled into benefits.  The employee receiving FlexElect/CoBen Cash must be covered elsewhere for health and/or dental benefits and the dependent(s) should be added to those benefits to comply with the court order.  A court order is not always a permitting event to allow an employee to cancel the FlexElect/CoBen cash.
 

1608. Enrollment Appeal Process

Under the policies and procedures of the CoBen Program there are established timeframes for the completion and processing of the CoBen Cash enrollment form. The Personnel Office is responsible for the timely submission of enrollment forms. In situations when there has been a discrepancy in document processing, CalHR will consider an appeal, upon request.
 
The appeal should be sent to CalHR at the following address:
 
California Department of Human Resources
Benefits Division - CoBen Program
1515 “S” Street, North Building, Suite 500
Sacramento, CA 95811-7258
 
Following are some situations that typically occur with enrollments and should be used as a guide prior to submitting any appeal to CalHR for consideration.
  • Employee claims he/she was not informed of the CoBen Cash Open Enrollment Period and wishes to enroll after open enrollment has ended but before the beginning of the next plan year.
    • Employee will not be able to enroll unless the department certifies in writing that the employee was not notified of the CoBen Cash Open Enrollment Period and provides an explanation. The department must send the enrollment form and all other necessary forms to the CalHR, Benefits Division for consideration. CalHR will consider the facts presented and may allow enrollment on a prospective basis within IRS regulations.
  • Employee claims he/she was not informed of the CoBen Cash Open Enrollment Period and wishes to enroll after January 1, the beginning of the next plan year.
    • Employee will not be able to enroll unless the department certifies in writing that the employee was not notified of the CoBen Cash Open Enrollment Period and provides an explanation as to why. The department must send the enrollment form and all other necessary forms to CalHR, Benefits Division. CalHR will consider the facts presented and may allow enrollment on a prospective basis within IRS regulations.
  • Employee submitted an incorrectly completed form. Errors were not detected by the Personnel Office which resulted in the form being rejected by SCO and returned.
    • Departments may submit a written explanation of the facts in cases where they believe they caused processing delays by making an error or not catching errors the employee made in completing the form. CalHR will consider the facts presented and may allow enrollment on a prospective basis within IRS regulations.
  • Employee submitted a correctly completed CoBen Cash enrollment form, however, the Personnel Office did not submit the form to SCO in a timely manner and the deduction did not take effect.
    • Departments must submit an explanation in writing as to why the CoBen Cash form did not get processed timely to CalHR, Benefits Division with all necessary enrollment forms. CalHR will consider the facts presented and may allow enrollment on a prospective basis within IRS regulations.
  • Personnel Office submitted an incorrectly completed form to SCO during the open enrollment period. SCO begins system processing of the form. Subsequently, SCO discovers an error on the document and returns the form to the Personnel Office for correction.
    • Departments must submit an explanation in writing as to why the CoBen Cash form did not get processed timely to CalHR, Benefits Division with all necessary enrollment forms. CalHR will consider the facts presented and may allow enrollment on a prospective basis within IRS regulations. 

In accordance with Internal Revenue Service (IRS) regulations which prohibit the deferral of income; under no circumstances will retroactivity into a prior plan year be allowed. In those instances where CalHR approves retroactivity it will only be approved for the current plan year.

In cases where the department feels that the employee is not at fault, and employees are not being allowed to enroll or make changes, or are not being enrolled on the earliest possible effective date, the department may send CalHR an appeal and ask for an exception on a case by case basis.
 

1609. Open Enrollment Period

The Open Enrollment Period to enroll in CoBen Cash is held in the fall and coincides with the Dental and Health open enrollment period. Employees must sign and submit their CoBen Cash form, including HBD-12’s and STD. 692’s to their Personnel Office no later than the last day of the open enrollment period (as shown on enrollment forms). Any change in the open enrollment period dates will be communicated to departments prior to the beginning of the open enrollment period. The effective date of action during open enrollment is January 1, of the following year.
 
A memo that includes specific open enrollment information regarding permitting event date, effective date, permitting event code, and cutoff dates for submission of CoBen forms to the State Controller’s Office (SCO) will be sent by CalHR to departments prior to the beginning of the open enrollment period.
 

Cash Option Enrollments/Reenrollments

Employees currently enrolled in the Cash Option will be automatically reenrolled into CoBen Cash for the next Plan Year. It is not necessary for these employees to complete a Consolidated Benefits Cash Enrollment Election (STD. 702) during the Open Enrollment Period, unless they wish to cancel or change their Cash Option Enrollment.
 
Employees who are not currently enrolled in the CoBen Cash Option, and wish to enroll in the Cash Option for the next Plan Year, must complete a STD. 702 during the CoBen Open Enrollment Period.
 
After employees enroll (per IRS regulations), they may change or rescind their open enrollment election through December 31. Employees cannot change or rescind their election after December 31, unless they experience a valid change in status event as described in the Permitting Events Table.
Once new enrollees have initially enrolled in the CoBen Cash Option, their enrollment will automatically continue in future plan years and it will not be necessary for them to reenroll. If these employees wish to cancel or change their Cash Option enrollment as the result of a change in status event or during open enrollment, they must complete a STD. 702.
 

Exception to Automatic Reenrollment

Permanent-Intermittent (PI) employees, wishing to participate in the Cash Option, must reenroll each CoBen Open Enrollment Period in order to receive the Cash Option. The automatic enrollment continuation does not apply to PIs because part of their eligibility requires completion of a specific number of work hours each plan year and a separate payment process.
 
If enrollment forms (i.e., HBD-12 and/or STD. 692) are also being submitted for the spouse/ domestic partner of an employee, they must be coordinated and submitted as a package, along with the employee’s STD. 702 form. The department with the employee who is enrolling in CoBen must assume the responsibility of coordinating all of the forms. All forms should be reviewed by the Personnel Office to ensure that they are completed accurately.
Forms should be submitted to SCO at the address listed below:
 
State Controller’s Office
Division of Personnel/Payroll Services
Benefits Unit
P.O. Box 942850
Sacramento, CA 94250-5878
 
SCO Benefits Unit:
(916) 372-7200
 

1610. Newly Eligible Employees

Employees become newly eligible for CoBen Cash due to their initial appointment, change in their eligible time base, marriage, commencement of domestic partnership, divorce, termination of domestic partnership, legal separation or annulment, birth or adoption of a child, death of a spouse or domestic partner, loss or commencement of spouse’s or domestic partner’s employment, or loss of spouse’s or domestic partner’s health and/or dental coverage. Newly eligible employees must enroll within 60 days of becoming eligible. The effective date of enrollment will be based on the appropriate permitting event. The last possible effective date for enrollment as a newly eligible during the plan year is December 1.
 
Employees may make certain changes to their health/dental insurance for purposes of enrolling in CoBen Cash. The type of change is based on the permitting event. Refer to the CalPERS Health Benefits and the Dental Procedure Manuals to determine if the event is one that will allow employees to make a change and for the appropriate reason codes, etc.
 
To enroll in CoBen Cash as a newly eligible employee, employees must complete all of the appropriate forms which must be submitted as a package. In completing the STD. 702, the following information should be entered on the form(s) by the Personnel Office:
  • Effective Date: Current or prospective basis (i.e., First of the following month when correctly completed enrollment form is received at SCO by the10th AND does not have to be returned to the agency for correction).
  • Permitting Event Date: Date employee became newly eligible.
  • Permitting Event Code: 01
  • Remarks: Provide a brief explanation of how employee became newly eligible (i.e., new hire, change in status event, etc.)

Personnel Action Request (PAR) Keying

The effective date for employees moving into or out of CoBen is on a prospective basis. For CoBen to be effective on the first of the following month after the PAR is keyed, the PAR must be keyed at least one cycle prior to SCO’s monthly master cut-off date (exception: PAR’s for Bargaining Unit 18 employees only, must be keyed at least three cycles prior to SCO’s monthly master cutoff date). PAR’s keyed timely will result in the employee’s deductions being converted to the appropriate benefit plans on the first of the following month. Deductions for PAR’s not keyed timely will not be effective until the first of the second month.
You should contact SCO’s Benefits Unit, at the number listed in this manual for questions regarding the monthly cycle date.  In situations where the employees' CoBen Allowance is delayed due to Personnel Office error, the Personnel Office can send CalHR an appeal explaining the situation and CalHR may make an exception on a case by case basis.
 

Loss of Eligibility - CoBen Cash Option

Employees lose eligibility for CoBen Cash option when they:
Change to a time base that is less than half-time; Change to a Permanent Intermittent position (may possibly reenroll as a newly eligibility PI - please see Permanent-Intermittent (PI) Employees in Section 1611 for PI enrollment information and eligibility requirements).
 
An employee in the cash-option who changes classification, which changes his/her eligibility into or out of CoBen, does not require a new form to change the cash amount. This is done automatically through the State Controller’s payroll system.
 

Personnel Office Responsibility When Employee Loses Eligibility

When an employee loses eligibility CoBen Cash due to one of the above event, his/her enrollment must be cancelled. The effective date of the cancellation must be the first of the second month following the date of the event (the date of time-based/appointment change). For example, an employee enrollment in the Cash Option transfers to a PI position effective July 13th. The Cash option enrollment must be cancelled effective September 1.
 
Cancellation of the CoBen Cash enrollment due to loss of eligibility (as shown above) may be processed administratively. The Personnel Office is responsible for notifying the employee when an administrative CoBen Cash cancellation is done.
 
The Personnel Office should indicate the following information on the form(s) and submit to SCO for processing:
  • Effective Date: 1st of the second month following the date of the event.
  • Permitting Event Date: Date of time base and/or appointment change.
  • Permitting Event Code: 41 Clarify how employee lost eligibility for CoBen Cash.
In cases where employees feel that through no fault of their own the PAR was not keyed timely, and as a result they are not in CoBen with the earliest possible effective date, the employee may seek financial remedy by filing a claim through the Victim Compensation and Government Claims Board against their department for the amount of money and/or tax savings they believe they did not receive.
 

1611. Permanent-Intermittent (PI) Employees

Permanent-Intermittent (PI) employees may enroll in CoBen Cash, but have limited eligibility. PI employees are not eligible to enroll in a Medical and/or Dependent Care Reimbursement Account under the State FlexElect Program.
 
All PI employees who either qualify or expect to qualify for CoBen Cash during the next plan year must make an election to enroll in the Cash Option during the CoBen Open Enrollment Period by completing a Consolidated Benefits Cash Enrollment Election (STD. 702). Actual participation in CoBen Cash will be contingent on meeting the required eligibility criteria. In the event PIs who have enrolled during the open enrollment period do not qualify, their STD. 702 form, which was retained by the Personnel Office during the open enrollment period, should not be sent to SCO for processing. The employees will have another opportunity to enroll in CoBen Cash during the next open enrollment period.
 
PI employees hired after the open enrollment period should enroll in CoBen Cash during the next open enrollment period, however, they must meet the eligibility criteria for the Cash Option as outlined in this manual before their enrollment can become effective.
 
PI employees who enroll in CoBen Cash may not cancel or change their election, including their choice of State-sponsored health and/or dental plans, during the plan year unless they experience a valid change in status event as defined by the Internal Revenue Service (IRS) regulations.
 
Valid changes in status events are:
  • Marriage, commencement of domestic partnership, divorce, termination of domestic partnership, legal separation, or annulment;
  • Loss or commencement of employee’s, spouse’s, or domestic partner’s employment or loss of employee’s, spouse’s, or domestic partner’s health or dental coverage;
  • Move out of group practice plan service area;
  • Change in bargaining unit or employee designation.
In addition to changes or cancellations that PI employees may initiate as a result of the above changes in status events, their continued participation in CoBen Cash is contingent on meeting the specific eligibility criteria for the Cash Option as outlined in PI Eligibility for Cash Option of Section 1611.
 

PI Employees Pre-Tax Benefits

With the pre-tax benefits, the employees’ share of their health, dental, and state-sponsored basic vision insurance premiums (in excess of their CoBen allowance) is deducted from their paycheck before federal, state, and social security taxes are withheld.
 

PI Eligibility for Pre-Tax Benefits

In order to participate in benefits, PI employees must qualify for health/dental/vision benefits by earning at least 480 paid hours during each control period (January through June and July through December) or at least 960 paid hours during two consecutive control periods (prior and current). If after enrolling in a health, dental, and state-sponsored basic vision plan, PI employees pay an out-of-pocket premium deduction, it will automatically be deducted on a pretax basis. Since enrollment in pre-tax benefits is automatic there are no enrollment forms required.
 

Cash Option - PI Employees

Cash Option payments are taxable and available to PI employees as follows:
  • $930 lump-sum payment in lieu of health and dental insurance
  • $780 lump-sum payment in lieu of health only
The lump-sum cash payment is for the January through June control period for the plan year in which the PI is enrolled. PI employees are not eligible to receive cash for the July through December control period because such payment would not be made until the next plan year. Such payments made in a subsequent plan year are considered a deferral of income which is strictly prohibited by IRS.
 

PI Eligibility for Cash Option

In order to participate and receive the CoBen Cash payment, a PI employee must meet ALL of the criteria specified below:
  • must have completed a STD. 702 during the open enrollment period, or as newly eligible after open enrollment, but prior to January 1 AND
  • must have been eligible to be enrolled in health or health and dental insurance for the entire January through June control period (eligibility gained as of January 1 but not effective until February 1 meets this criteria) AND
  • must be paid for at least 480 hours worked during the January through June control period (*see notes on the next page regarding multiple PI positions and NDI time) AND
  • have a PI appointment from January 1 through June 30 of the Plan Year for which they have enrolled (with no break in service).
*In situations where an employee maintains multiple PI appointments during the January through June control period, the department may count the hours worked from the multiple positions regardless of whether the multiple positions are within one department or multiple departments.
 
*PI’s may not use NDI or SDI time to count towards their 480 qualifying hours in a control period to qualify for the lump-sum cash payment.
 

Form Submission for Cash Option - PI Employees

The following information covers the types of actions, which can occur during the open enrollment period.
 
  1. Employees who were eligible for health and/or dental but were not currently enrolled and were electing the Cash Option in lieu of health or health and dental.
    • These employees must have completed a STD. 702 during the open enrollment period. On or after July 1, Personnel Offices will verify the qualifying hours during the January-June control period. For those employees who worked the required 480 hours AND meet the other eligibility criteria, the STD. 702 should be forwarded along with a STD. 674 to SCO to request the cash option payment. In the Remarks section of the STD. 674 put the following language:  I certify this PI employee has worked 480 hours during the January – June YEAR Control Period and meets all other eligibility criteria for the CoBen Cash Option payment of $xxx.00.
  2. Employees who cancelled their health and/or dental benefits effective January 1 in order to obtain the Cash Option in lieu of health or health and dental.
    • During the open enrollment period, these employees would have completed a STD. 702 AND in addition an HBD-12 and/or a STD. 692 to cancel their current benefits effective January 1. The HBD-12 and/or STD. 692 should have been forwarded immediately to SCO as instructed below:
      • Permitting Event Code: 36a (For STD. 692)
      • Reason Code: 503 (For HBD-12)
      • Remarks Section for both HBD-12 and STD. 692: “PI canceling benefits to enroll in CoBen Cash Option”
      • Personnel Office forwards HBD-12 and STD. 692 to SCO.
      • Personnel Office retains the STD. 702 until completion of the January through June control period.
      • If employee meets Cash Option eligibility the STD. 702 is sent to SCO with a STD. 674 requesting the cash option payment.

Form Submission Deadline for Cash Option Payment

The STD. 702 and STD. 674 for PI employees who qualify for a six-month lump sum cash payment must be received at SCO by September 1st. All requests received at SCO after the cut-off date will be returned unprocessed to the Personnel Office.
 
Note: When the 1st is on a weekend or holiday, than the cut-off date will be on the next regular workday.
 

Impact of Time Base Changes on CoBen Cash Eligibility for PI employees

PI employees who are appointed to a Permanent, LT, or TAU position with a time base of half-time or more, lose eligibility for the PI cash payment, and MUST complete a new STD. 702 within 60 days after their appointment to enroll as newly eligible for monthly CoBen Cash payments. Additionally, they become newly eligible to enroll into a Medical and/or Dependent Care Reimbursement Account under the State FlexElect Program. Permitting Event Code 01 should be used on the STD. 702 and/or STD. 701R.
 
CoBen Cash participants with a time base of half-time or more who change to PI status MUST CANCEL their participation effective the first of the month following their first full pay period as a PI. Those employees who meet all of the PI eligibility criteria for the Cash Option must wait until the next open enrollment period to enroll.
 

Cancellation of CoBen Cash as a Result of a Time Base Change from Permanent Half-Time or More to Permanent-Intermittent

Employees canceling their CoBen Cash as a result of a time base change to PI must complete a new Consolidated Benefits Cash Enrollment Election (STD. 702) as follows:
  • Effective Date: First of the month following their first full pay period as a PI.
  • Permitting Event: 41
  • Permitting Event Date: Date of time base change
  • Remarks Section: Enter - “CoBen Cash Cancellation Time Base Change to Intermittent.”

PI Eligibility Audit

Since PI eligibility in CoBen Cash is based on eligibility for health/dental benefits and completion of the required number of paid hours worked within a control period, the State Controller’s Office will verify the paid hours worked by the employee prior to issuing the cash payment.
 

1612. Change in Pay Status while Enrolled in CoBen Cash

Non-Industrial Disability (NDI)

If employees go on NDI and they elected to receive the CoBen Cash Option in lieu of health or health and dental, their cash elections will remain in effect. and will be reflected on their NDI check.  

Industrial Disability Leave (IDL) and Temporary Disability (TD)

If employees go on IDL or TD while enrolled in CoBen Cash, and they elected to receive CoBen Cash for health or health and dental, their cash election will remain in effect. Employees will receive a separate check for the Cash Option, which will be issued approximately one week after their IDL or TD paycheck is issued.

State Disability Insurance (SDI)

For employees in Bargaining Unit 17 (only): If a Unit 17 employee goes on SDI while enrolled in the CoBen cash option, their enrollment will stop while they are on leave, unless they supplement their SDI payments. If they return to pay status in the same CoBen plan year, their enrollment will resume.

Unpaid Leave of Absence

If employees leave “pay status” while enrolled in CoBen Cash, their CoBen Cash election will stop for as long as they continue to remain on unpaid leave. If they return to pay status in the same plan year, then their enrollment will resume.

Military Leave

Pursuant to Government Code Section 19755.18, state employees called to active military duty for the War on Terrorism are eligible to retain their State benefits for up to 365 calendar days above the 180 calendar days provided by GC Section 19755.17. If an employee is currently receiving CoBen Cash in lieu of qualifying group health and/or dental benefits, he/she may continue to receive the cash for the duration of their military leave, not to exceed the time limits mentioned above. Military Leave is not a permitting event to newly enroll into the CoBen Cash Program. Employees enrolled in the medical reimbursement account may elect to continue their coverage via COBRA or their deduction will stop for the duration of their leave.
 

1613. Retiring while Enrolled in CoBen Cash

Retired employees are not eligible for CoBen Cash. Accordingly, there are several different situations that may apply to employees who retire while enrolled in CoBen Cash. The following gives examples of these situations and the appropriate action that should be taken.
 
If employees retire and;
  1. They have chosen the Cash Option instead of their own health insurance plan;
    • Employees have 30 days prior to or 60 days following the date of their retirement to enroll in a California Public Employees’ Retirement System (CalPERS) health insurance plan.
 
    • Form processing:
      • Reenrolls in a health plan 30 days prior to retirement: Employees must complete an HBD-12 and a STD. 702 to cancel their CoBen Cash enrollment. The Permitting Event Code to be used on the STD. 702 is 88, and the Permitting Event Date is the date the HBD-12 is received in the employing office (as shown on the form). Both forms should be submitted as a package to SCO for processing.
      • Reenrolls in a health plan 60 days after retirement: The Personnel Office must complete an HBD-12 to be submitted to CalPERS for processing. It is not necessary for employees to complete a STD. 702 to cancel their CoBen Cash as their enrollment will be automatically terminated upon their retirement and cancel as an active employee on SCO’s payroll system.

     2.    They have chosen the Cash Option instead of their own dental insurance plan;

    • Employees have 30 days prior to or 60 days following the date of their retirement to enroll in a dental insurance plan.
 
    • Form processing:
      • Reenrolls in a dental plan 30 days prior to retirement: Employees must complete a STD. 692 and a STD. 702 to cancel their CoBen Cash enrollment. The Permitting Event Code to be used on the STD. 702 is 88, and the Permitting Event Date is the date the STD. 692 is received in the employing office (as shown on the form). Both forms should be submitted as a package to SCO for processing.
      • Reenrolls in a dental plan 60 days prior to retirement: The Personnel Office must complete a STD. 692 to be submitted to CalPERS for processing. It is not necessary for employees to complete a STD. 702 to cancel their CoBen Cash as their enrollment will be automatically terminated upon their retirement and cancel as an active employee on SCO’s payroll system.
If employees fail to reenroll into a health and/or dental plan within the specified timeframes they must wait until the next health and/or dental open enrollment period. The enrollment at that point would be handled through CalPERS.
 

1614. Enrollment When Both Husband and Wife or Domestic Partners Work for the State

In cases of two married or two domestic partner State employees, where more than one employing department is involved and both employees are making changes in their health and/or dental insurance for purposes of enrolling in CoBen Cash, the departmental Personnel Office with the employee enrolling in CoBen Cash, should assume the responsibility of coordinating all forms. These forms could include the spouse’s or domestic partner’s Health Benefits Enrollment (HBD-12) or Health Benefit and Enrollment History page after confirmation from My|CalPERS and/or the Dental Plan Enrollment Authorization (STD. 692) forms. All forms must be submitted as a package to SCO with the Consolidated Benefits (CoBen) Cash Enrollment Election (STD. 702). In the event both employees enroll in CoBen Cash, one departmental Personnel Office should assume responsibility to coordinate all the forms and send them to the SCO as a package. Include the spouse’s or domestic partner’s SSN on all forms.
 

1615. STD 702 - CoBen Cash Enrollment Election

The three-part, color-coded Consolidated Benefits Cash Enrollment Election (STD. 702) form is available for ordering through the Office of State Publishing (OSP). Additionally, the CoBen Handbook contains a link to the STD. 702. The Personnel Office should review each enrollment form to ensure that it has been completed correctly by the employee. The Personnel Office should then complete the “Agency Use Only” section of the form, Sections 8-21. Specific instructions for completion of the document are outlined below:
 
Section 1- Enrollment - If employees are:
  • enrolling during the open enrollment period, check Item A.
  • enrolling as “newly eligible” (i.e. enrolling outside an open enrollment period due to a permitting event), check Item B.
  • changing their CoBen Cash enrollment because they have experienced a valid change in status event (permitting event), check Item C.
  • canceling their enrollment as the result of a valid change in status event, check Item D.
Section 2 - Social Security Number:
 
Section 3 - Name: First name, middle initial, and last name of employee.
 
Section 4 - Cash Option:
  • Health Only: If employees are electing to receive the Cash Option in lieu of their health coverage, then enter $130.00 in Item A. If they do not want to receive the cash in lieu of health only, they must enter “N/A” in Item A.
  • Health and Dental: If employees are electing to receive the Cash Option in lieu of their health and dental coverage, then enter $155.00 in Item B. If they do not want to receive the cash in lieu of health and dental, they must enter “N/A” in Item B.
Section 5 - SCO Use Only: FOR SCO USE ONLY
 
Section 6 - Statement of Other Qualifying Group Health or Qualifying Group Health and Dental Coverage: If employees want the Cash Option in lieu of their health or health and dental coverage, they must complete Item 6. In Item A and/or B they must indicate the carrier name of their other qualifying group health and/or dental insurance. In Item C they check the appropriate box showing whom they have other coverage through. If their health and/or dental insurance are through their spouse or domestic partner, they must complete Item D indicating whether their spouse’s or domestic partner’s employer is the State or other and enter their spouse’s or domestic partner’s social security number.
 
Section 7 - Important Program Information and Employee Signature/Date: This section contains important information that employees should be aware of when enrolling in CoBen Cash. Their signatures certify that they have other health and/or dental coverage and that they have read the information and agree to the terms and conditions of the CoBen Program as outlined on the STD. 702 and by CalHR.
 
Section 8 - Effective Date of Action: The effective date of action during open enrollment. The three-part, color-coded Consolidated Benefits Cash Enrollment Election (STD. 702) form is available for ordering through the Office of State Publishing (OSP). Additionally, the CoBen Handbook contains one copy of the STD. 702.
 
A sample of the STD. 702 is contained in this manual. The Personnel Office should review each enrollment form to ensure that it has been completed correctly by the employee. The Personnel Office should then complete the “Agency Use Only” section of the form, Sections 8-21. Specific instructions for completion of the document are outlined below:
 
Section 1- Enrollment: - If employees are:
  • enrolling during the open enrollment period, check Item A.
  • enrolling as “newly eligible” (i.e. enrolling outside an open enrollment period due to a permitting event), check Item B.
  • changing their CoBen Cash enrollment because they have experienced a valid change in status event (permitting event), check Item C.
  • canceling their enrollment as the result of a valid change in status event, check Item D.
 
Section 2 - Social Security Number:
 
Section 3 - Name: First name, middle initial, and last name of employee.
 
Section 4 - Cash Option:
  • Health Only: If employees are electing to receive the Cash Option in lieu of their qualifying group health coverage, then enter $130.00 in Item A. If they do not want to receive the cash in lieu of health only, they must enter “N/A” in Item A.
  • Health and Dental: If employees are electing to receive the Cash Option in lieu of their health and dental coverage, then enter $155.00 in Item B. If they do not want to receive the cash in lieu of health and dental, they must enter “N/A” in Item B.
Section 5 - SCO Use Only: FOR SCO USE ONLY
 
Section 6 - Statement of Other Qualifying Group Health or Qualifying Group Health and Dental Coverage: If employees want the Cash Option in lieu of their qualifying group health coverage or health and dental coverage, they must complete Item 6. In Item A and/or B they must indicate the carrier name of their other qualifying group health and/or dental insurance. In Item C they check the appropriate box showing whom they have other coverage through. If their health and/or dental insurance are through their spouse or domestic partner, they must complete Item D indicating whether their spouse’s or domestic partner’s employer is the State or other and enter their spouse’s or domestic partner’s social security number.
 
Section 7 - Important Program Information and Employee Signature/Date: This section contains important information that employees should be aware of when enrolling in CoBen Cash. Their signatures certify that they have other qualifying group health and/or dental coverage and that they have read the information and agree to the terms and conditions of the CoBen Program as outlined on the STD. 702 and by CalHR.
 
Section 8 - Effective Date of Action: The effective date of action during open enrollment is January 1, of the following year. For forms processed outside the open enrollment period you should refer to the effective date rule for the appropriate permitting event on chart (Appendix A).
 
Section 9 - Employee CBID: For represented employees enter their Collective Bargaining Designation and Unit (e.g., R07, R08, R18). For excluded employees enter (e.g., E-99, S07, C01, or M09).
 
Section 10 - Time Base/Tenure:  Indicate the time base/tenure of employee to establish eligibility.
 
Section 11 - Permitting Event Date: This section does not need to be completed during open enrollment. The Permitting Event Date refers to the effective date of an enrollment change during the plan year due to an allowable change in status event (permitting event).
 
Section 12 - Permitting Event Code: This section does not need to be completed during open enrollment. The Permitting Event Code refers to an enrollment change during the plan year due to an allowable change in status event (permitting event).
 
Section 13 - Health Form Attached (HBD-12): If employees are making any changes to their current health insurance plan, attach the HBD-12 or Health Benefit and Enrollment History page after confirmation from My|CalPERS to the STD. 702 enrollment form and check box “Yes”. If employees are not making any changes to their current health insurance plan, do not attach an HBD-12 to the STD. 702 enrollment form, and check box “No”.
 
Section 14 - Dental Form Attached (STD. 692): If employees are making any changes to their current dental insurance plan, attach the STD. 692 to the STD. 702 enrollment form and check box “Yes”. If employees are not making any changes to their current dental insurance plan, do not attach a STD. 692 to the STD. 702 enrollment form and check box “No”.
 
Section 15 - Permanent Intermittent: Indicate if the employee is Permanent- Intermittent.
 
Section 16 - Agency Code: Enter the employee’s agency code.
 
Section 17 - Unit Code: Enter the employee’s reporting unit code.
 
Section 18 - Remarks: Complete this section to provide additional information to clarify the action being taken. If the employee is also enrolling in a reimbursement account, please indicate “STD. 701R attached”.
Important Note: For new enrollments, describe the permitting event that makes the employee newly eligible.
 
Section 19 - Agency Name: Enter the name of the employee’s department or agency.
 
Section 20- Authorized Agency Signature: The signature of the individual in the Personnel Office who is authorized to complete the STD. 702 enrollment form.
 
Section 21 - Email Address:  Indicate email address for Personnel Office staff signing form.
 
Section 22 - Telephone Number: Enter the telephone number of the individual signing the “Authorized Agency Signature”.
 
Section 23 - Date Received in Employing Office: Enter the date the STD. 702 enrollment form was received in the employing office.
 
Important Note: The Personnel Office is responsible for confirming with the employee the accuracy of all information provided on CoBen Enrollment Election form and any supporting documents.
 

1616. HBD 12 or Health Benefit and Enrollment History Page after confirmation from My|CalPERS and STD 692

 
In addition to the STD. 702, a Health Benefits Enrollment Form (HBD-12) or Health Benefit and Enrollment History Page after confirmation from My|CalPERS and/or Dental Plan Enrollment Authorization (STD. 692) are required if employees are:
  • Enrolling in or Changing their current health and/or dental plan to different carriers. Changing the number of dependents on their health and/or dental plan.
  • Canceling their health and/or dental plan. Remember, those employees who cancel and become a dependent on their spouse’s or domestic partner’s plan must also submit their spouse’s or domestic partner’s HBD-12 and/or STD. 692 if the spouse or domestic partner is a State employee. Also, the effective date of the employee’s cancellation must be the same date that the spouse or domestic partner added them as a dependent.
 If employees do not make any health or dental insurance plan changes, then a HBD-12 and/or STD. 692 will not be required as a part of the CoBen package.
 
CalHR and CalPERS require that a marriage certificate be submitted when a spouse is added. For a domestic partner, the Declaration of Domestic Partnership and Statement of Financial Liability must be submitted. These documents should be maintained in the employee’s Personnel file. This requirement applies at the time of a new enrollment, a new marriage, domestic partnership, during the open enrollment period, or through the Health Statement Application process. CalHR and CalPERS also require an Affidavit of Eligibility to enroll an economically dependent child who resides with the employee in a regular parent/child relationship. Please refer to the CalPERS Health Benefits Procedures Manual and the CalHR State Dental Program Procedures Manual for instructions on these requirements. Failure to submit these documents with the CoBen package when required, may delay the processing of all forms in the CoBen package and thereby impact the effective date of an eligible enrollment.
 
Double coverage and split coverage of spouses, domestic partners, and dependent children is not permitted. Upon discovery, the Personnel Office must coordinate deletions/cancellations on a retroactive basis
 

Completion of Health Benefits Enrollment Form (HBD-12)

  • Effective Date: The effective date of action during open enrollment is January 1, of the following year. For forms processed outside the open enrollment period you should refer to the effective date rule for the appropriate reason code in the Health Benefits Procedures Manual.
  • Permitting Event Date: Date of event that makes the employee eligible
  • Reason Code: Use appropriate code for action
  • Remarks: Provide a brief explanation of the event.
    • i.e. CoBen - employee adding dependents, spouse, domestic partner, taking Cash Option
    • i.e. CoBen - employee canceling coverage, enrolling in Cash Option
    • i.e. CoBen - employee enrolling in or changing plans
 Please refer to the Health Benefits Procedures Manual for detailed instructions when completing the HBD-12. Any questions regarding health benefits or completion of the HBD-12, should be directed to CalPERS, Health Benefit Services Division at 1 (888) 225-7377.
 

Completion of Dental Plan Enrollment Authorization (STD. 692)

  • Effective Date: The effective date of action during open enrollment is January 1, of the following year. For forms processed outside the open enrollment period you should refer to the effective date rule for the appropriate permitting event in the Dental Procedures Manual.
  • Permitting Event Code: Date of event that makes the employee eligible
  • Permitting Event Code: Use appropriate code for action
  • Remarks: Provide a brief explanation of the event.
    • i.e. CoBen - employee adding dependents, spouse, domestic partner, taking Cash Option
    • i.e. CoBen - employee canceling coverage, enrolling in Cash Options
    • i.e. CoBen - employee enrolling in or changing plans
 Please refer to the Dental Program Procedures Manual for detailed instructions when completing the STD. 692. Any questions regarding dental benefits or completion of the STD. 692 should be directed to the CalHR, Benefits Division at (916) 322-0300.
 

1617. Employees Not Re-Enrolling

Employees who were enrolled in the Cash Option and do not want to be automatically reenrolled will need to cancel their enrollment. In addition, in order to obtain their own State-sponsored benefits they MUST enroll in a health and/or dental insurance plan. Enrollment or Reenrollment into traditional health and/or dental is NOT automatic for Cash Option participants who elect to cancel their CoBen Cash.
 
If employees do not wish to reenroll in CoBen Cash for the next Plan Year and wish to enroll in or make changes to their health and/or dental insurance, they MUST complete an HBD-12 and/or STD. 692 reflecting the changes. The HBD-12 should be sent to CalPERS for processing and the STD. 692 should be sent to SCO for processing.
 
The HBD-12 and/or STD. 692 must be completed during the CoBen open enrollment period. Use the following information when completing these forms:
  • Effective Date: January 1 (following year)
  • Permitting Event Date: September 1 (current year)
  • Reason Code: 104 (HBD-12) Health
  • Permitting Event Code: 03 (STD. 692) Dental
  • Remarks: Enter “Employee canceling CoBen Cash and enrolling in traditional State-sponsored health (or dental) insurance.”
For dental insurance, remember that the choice employees made for dental insurance is a three-year commitment. Accordingly, if employees opted out of dental and received cash, they cannot reenroll in a State-sponsored dental plan, for three years, unless they lose their coverage under their spouse, domestic partner, or other coverage; cancel both their health and dental CoBen Cash during an open enrollment period; or due to a valid permitting event under the CoBen Program.
 

1618. Forms Distribution

The CoBen Handbook contains a link to the Consolidated Benefits Cash Enrollment Election (STD. 702). If employees enroll by using the form, two additional copies of the form must be photocopied. Send the original to SCO, return one copy to the employee for his/her personal records, and retain one copy in the Personnel Office. Be sure to attach all other appropriate forms (i.e. HBD-12, STD. 692) to the original. If employees use the three-part, color-coded enrollment form the distribution is as follows:
  • Original - SCO
  • Pink Copy - Agency
  • Goldenrod - Employee
Send completed enrollment forms to:
 
State Controller's Office
Division of Personnel/Payroll Services
Benefits Unit
P.O. Box 942850
Sacramento, CA 94250-5878
 
SCO Benefits Unit Phone Number:
(916) 372-7200 
 

1619. Correcting CoBen Open Enrollment Forms

CoBen packages will be audited by SCO staff to ensure that all forms are completed correctly. If an HBD-12 or Health Benefit and Enrollment History page after confirmation from My|CalPERS and/or STD. 692 are included, those forms will be audited as well. This audit includes ensuring that:
  • the employee is eligible to enroll in CoBen Cash; and
  • signatures are completed; and
  • dollar amounts are correctly reflected.
If errors are found during processing, SCO will return the package to the Personnel Office with a Discrepancy Notice (PR 250J). If no errors are found, the forms will be processed. Forms should be corrected immediately and returned to SCO along with the discrepancy notice. The corrected form(s) MUST note at the top of the form(s) “CORRECTED DOCUMENT”. Please Note: CalPERS has requested that the reference to “CORRECTED DOCUMENT” be placed in the Remarks Section of the HBD-12 and not across the top of the form. It is important that returned forms be given priority and are corrected and resubmitted to SCO immediately. This will ensure that the transactions are processed so that the employees’ CoBen Cash election remains in effect on their paycheck dated January 1 (following year).
 Corrected or new enrollment forms “replace” the preceding forms, so it is important that ALL information be provided, not just those items that need corrections.
 

1620. Cancellations and Changes to Open Enrollment Forms

Employees who enroll or make changes to their CoBen Cash election during the open enrollment period and employees who are automatically reenrolled into CoBen Cash Option will be allowed to cancel or change their elections through December 31 (current year). A new STD. 702 must be completed AND signed by the employee by December 31 (current year).
 

Form Completion

Cancellations - STD. 702

  • Employee completes a new STD. 702. If an enrollment document was actually completed indicate at the top “Canceling Open Enrollment Document”. If employee is completing a STD. 702 to cancel his/her automatic reenrollment, indicate at the top “Canceling Automatic Reenrollment”.
  • Items 1, 2, and 3, must be completed and the employee must sign and date in Item 7.
  • On the STD. 702, Sections 4A or 4B must also be completed to indicate what Cash Option amount is to be cancelled.
  • The Personnel Office must complete their appropriate sections and forward to SCO.

Changes - STD. 702

  • Employee completes a new STD. 702. Indicate at the top “Changing Open Enrollment Document.”
  • All sections on the form must be completed just as if the election had been made during the open enrollment period.
  • The Personnel Office will complete their appropriate sections and forward to SCO.
 
Reminder: If the HBD-12 (Health) and STD. 692 (Dental) forms were completed canceling coverage and employee now wants to maintain State-sponsored coverage, new forms enrolling or reenrolling the employee must be completed and forwarded along with the STD. 702.
 

1621. Example Situations

Following are some examples of different scenarios of CoBen Cash options employees may choose. With every different situation and dates involved, the form(s) will be completed differently.
 
Each example begins with an explanation of the employee’s current status, his/her desired CoBen election, and the actions required by the Employee, his/her Spouse or Domestic Partner, and the Personnel Office.
 
In all examples, the “employee” is the State employee and is the principal figure in the scenario. The “employee’s spouse or domestic partner” in some examples is a State employee or may be employed by private industry.
 
The explanation of each scenario is followed by a correctly completed sample of every enrollment form required to complete the employee’s desired elections.
The examples in this manual do not reflect every possible type of enrollment within the CoBen Cash Option but hopefully do provide a broad enough basis to guide the Personnel Office through typical enrollment situations.
 
The health and dental premium amounts are not shown in the examples. Instead, we have inserted TBA (to be announced). When completing the HBD-12 and STD. 692, please show the appropriate premium amounts.
 

Examples: 1 - Open Enrollment, Cash Option For Health and Dental - New Enrollment, Spouse or Domestic Partner also a State Employee

  • SITUATION: Open Enrollment, Cash Option For Health and Dental - New Enrollment, Spouse or Domestic Partner also a State Employee
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Jill A. Gordon (also a State employee) 
  • CURRENT STATUS
    • Employee is currently enrolled in his own State-sponsored health and dental insurance plans.
    • Employee’s spouse or domestic partner, who is also a State employee, is currently enrolled in her own State-sponsored health and dental insurance plans. Spouse or domestic partner is not currently covering any dependents. 
  • DESIRED COBEN ELECTION
    • Employee wants to enroll in the CoBen Cash Option in lieu of his own State-sponsored health and dental insurance plan. 
  • FORMS REQUIRED
    • Employee: STD. 702, HBD-12 or Health Benefit and Enrollment History Page after confirmation from MyCalPERS, STD. 692
    • Spouse/Domestic Partner: HBD-12 Health Benefit and Enrollment History Page after confirmation from MyCalPERS and STD. 692 
  • ACTION REQUIRED

    • Employee must complete a STD. 702 to enroll in the Cash Option. Employee must also complete an HBD-12 and STD. 692 to cancel his own health and dental insurance.
    • Spouse/Domestic Partner must complete an HBD-12 and STD. 692 to add employee plus any dependents on her health and dental insurance.
    • Employee’s Personnel Office must coordinate the employee’s STD. 702, HBD-12, and STD. 692 and his spouse’s/domestic partner’s HBD-12 and STD. 692. Spouse’s/Domestic Partner’s Personnel Office must complete the “Agency Use Only” section of the spouse’s/domestic partner’s forms and send the forms to the Employee’s Personnel Office.
    • Employee’s Personnel Office must complete the “Agency Use Only” section of the employee’s forms; receive and review spouse’s/domestic partner’s forms to ensure that all forms are completed accurately and submit them as a package to SCO. The package should be assembled so that the STD. 702 is on top with all other forms clipped behind it.
 

Examples: 2 - Open Enrollment, Cash Option for Health, Maintaining State-Sponsored Dental Insurance, Enrolling In Both a FlexElect Medical and Dependent Care Reimbursement Account, Spouse/Domestic Partner Is Not a State Employee

  • SITUATION: Open Enrollment, Cash Option for Health, Maintaining State-Sponsored Dental Insurance, Enrolling In Both a FlexElect Medical and Dependent Care Reimbursement Account, Spouse/Domestic Partner Is Not a State Employee
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Yes (not a State employee) 
  • CURRENT STATUS

    • Employee is currently not enrolled in his own State-sponsored health insurance plan but he is currently enrolled in his own State-sponsored dental insurance plan. Employee is covering his dependent on his dental plan.
    • Employee’s spouse/domestic partner, who is employed by private industry (not a State employee) is currently enrolled in her own private industry sponsored health and dental insurance plans and is covering the employee and their dependent. 
  • DESIRED COBEN AND FLEXELECT ELECTION
    • Employee wants to enroll in the CoBen Cash Option in lieu of his own state-sponsored health insurance plan and keep his dental insurance as it is. Employee also wants to put $100 per month ($1,200 per year) into a State FlexElect Program Medical Reimbursement Account and $300 per month ($3,600 per year) into the Dependent Care Reimbursement Account. 
  • DOCUMENTS REQUIRED
    • Employee: STD. 702 and STD. 701R
    • Spouse/Domestic Partner: None 
  • ACTION REQUIRED

    • Employee must complete a STD. 702 to enroll in the Cash Option and a STD. 701R to enroll in the Medical and Dependent Care Reimbursement Accounts.
    • Employee’s Personnel Office must complete the “Agency Use Only” section of the STD. 702 and STD. 701R and ensure the rest of the form is completed accurately and submit to SCO.
 

Examples: 3 - Open Enrollment, Two State Employees, One Employee CoBen Cash - One Employee FlexElect Reimbursement Account

  • SITUATION: Open Enrollment, Two State Employees, One Employee CoBen Cash - One Employee FlexElect Reimbursement Account
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Jill A. Gordon (also a state employee)
  • CURRENT STATUS

    • Employee is currently enrolled in his own state-sponsored health and dental insurance plans; employee covers his dependent on both plans. Spouse/Domestic Partner currently is enrolled in her own State-sponsored health and dental insurance plans and does not cover any dependents.
  • DESIRED COBEN ELECTION

    • Employee wants to enroll in the CoBen Cash Option in lieu of his own health and dental insurance. Spouse/Domestic Partner wants to enroll in the State FlexElect Program and put $100 per month ($1,200 per year) into a Medical Reimbursement Account and $200 per month ($2,400 per year) into a Dependent Care Reimbursement Account. In addition, spouse/domestic partner wants to enroll employee and her dependent on her health and dental insurance plans.
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, HBD-12, STD. 692
    • Spouse/Domestic Partner - STD. 701R, HBD-12, STD. 692 - Marriage Certificate Required or Declaration of Domestic Partnership and Statement of Financial Liability
  • ACTION REQUIRED

    • Employee must complete a STD. 702 and spouse/domestic partner must complete a STD. 701R to enroll in a FlexElect Reimbursement Account. In addition the employee must also complete an HBD-12 and STD. 692 to cancel his own medical and dental insurance; spouse/domestic partner must also complete an HBD-12 and STD. 692 to add employee and their dependent to both her medical and dental insurance.
    • Employee’s Personnel Office must assemble the employee’s STD. 702, HBD-12 and STD. 692; complete the “Agency Use Only” section of each form; and ensure that all documents are completed accurately. Spouse’s/Domestic Partner’s Personnel Office must assemble the spouse’s/domestic partner’s STD. 701R, HBD-12, and STD. 692; complete the “Agency Use Only” section of each form; and ensure that all documents are completed accurately. One Personnel Office must coordinate submission of both the employee’s and the spouse’s/domestic partner’s documents to SCO. The package should be assembled so that the STD. 702 and STD. 701R are on top with all other forms clipped behind them.
 

Examples: 4 - Open Enrollment, Cancellation of Automatic CoBen Cash Option

  • SITUATION: Open Enrollment, Cancellation of Automatic CoBen Cash Option
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Jill A. Gordon (not a State employee)
  • CURRENT STATUS

    • Employee is currently enrolled in the CoBen Cash Option in lieu of health insurance and dental insurance for the current Plan Year. Employee is enrolled on spouse’s/domestic partner’s health and dental plan. Spouse/Domestic Partner works for private industry.
  • DESIRED COBEN ELECTION

    • Employee does not want to be automatically reenrolled into the Cash Option for the next plan year, but instead wants to enroll in a State-sponsored health and dental plan.
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, HBD-12, STD. 692
  • ACTION REQUIRED

    • If employee has met the three-year dental cash commitment, employee must complete a STD. 702 to cancel his automatic reenrollment into the Cash Option for the next Plan Year. In addition, the employee must also complete an HBD-12 and STD. 692 to enroll in a State-sponsored health and dental plan.
 

Examples: 5 - Open Enrollment, Change of Automatic CoBen Cash Option

  • SITUATION: Open Enrollment, Change of Automatic CoBen Cash Option
    • Employee: Jill A. Gordon
    • Spouse/Domestic Partner: Jack A. Gordon (not a state employee)
  • CURRENT STATUS

    • Employee is currently enrolled in the CoBen Cash Option in lieu of both health insurance and dental insurance for the current Plan Year.
    • Employee has been receiving CoBen Cash in lieu of dental insurance for three years. Spouse/Domestic Partner works for private industry.
  • DESIRED COBEN ELECTION

    • Employee wishes to maintain CoBen Cash in lieu of health insurance, cancel CoBen Cash in lieu of dental insurance, and enroll in a state-sponsored dental plan.
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, STD. 692
  • ACTION REQUIRED

    • Employee must complete a STD. 702 to change her automatic reenrollment into the Cash Option for the next Plan Year. In addition, the employee must also complete a STD. 692 to enroll in a State-sponsored dental plan.
 

Examples: 6 - Open Enrollment, Reenrolling in Medical Reimbursement Account and Automatic Cash Option

  • SITUATION: Open Enrollment, Reenrolling in Medical Reimbursement Account and Automatic Cash Option
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: None 
  • CURRENT STATUS

    • Employee is currently enrolled in the CoBen Cash Option for the 2001 Plan Year and is also enrolled in the FlexElect Program Medical Reimbursement Account. 
  • DESIRED COBEN ELECTION AND FLEXELECT ELECTION

    • Employee wants to continue the CoBen Cash Option and wants to reenroll in the Medical Reimbursement Account with a monthly deduction of $50.00. 
  • DOCUMENTS REQUIRED

    • Employee: STD. 701R 
  • ACTION REQUIRED

    • Employee must complete a STD. 701R to reenroll into a Medical Reimbursement Account for the next FlexElect Plan Year. Because the employee will be automatically reenrolled into the CoBen Cash Option for the next Plan Year, he is not required to complete a STD. 702.
 
 

Examples: 7 - Permanent-Intermittent Enrollment/Cash Option

  • SITUATION: Permanent-Intermittent Enrollment, Cash Option
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Yes (not a State employee) 
  • CURRENT STATUS

    • Employee is currently enrolled in his own state-sponsored health and dental insurance plans. Employee has his dependent enrolled under both his health and dental plans.
    • Employee’s spouse/domestic partner, who is not a state employee, is currently enrolled in her own private industry sponsored health and dental insurance and currently does not cover the employee and their dependent on her plans. 
  • DESIRED COBEN ELECTION

    • Employee wants to enroll in CoBen Cash for the cash in lieu of his own state-sponsored health and dental insurance plan. 
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, HBD-12, STD. 692, STD. 674 Spouse/Domestic Partner - None 
  • ACTION REQUIRED

    • Employee must complete a STD. 702 to enroll in CoBen Cash. Employee must also complete an HBD-12 and a STD. 692 to cancel his own health and dental insurance. Employee’s spouse/domestic must add employee and their dependent on her private industry health and dental insurance plans. Employee is responsible for ensuring that his dependent and he are added to his spouse’s/domestic partner’s health and dental insurance plans no later than January 1.
    • Employee’s Personnel Office will complete the “Agency Use Only” section of each form; and ensure that all documents are completed accurately and submit only the HBD-12 and STD. 692 to SCO to cancel employee’s health and dental coverage. Personnel Office will retain the STD. 702. After completion of the January through June control period, if the employee has been paid the required 480 hours and met all other eligibility criteria, the Personnel Office should submit the STD. 702 and STD. 674 to SCO to request the cash payment.
 

Examples: 8 - Newly Eligible After Open Enrollment

  • SITUATION: Newly Eligible After Open Enrollment
    • Employee: Jill A. Gordon
    • Spouse/Domestic Partner: Jack A. Gordon (also a State employee) 
  • CURRENT STATUS

    • Employee is a new hire to state service, appointed February 24 (current year), to a permanent full-time position. Employee is covered under her spouse’s/domestic partner’s health and dental plans. Employee has declined enrollment into her own state-sponsored health plan, but wants her own state-sponsored dental plan. 
  • DESIRED COBEN AND FLEXELECT ELECTION

    • Employee wants to enroll in CoBen Cash for cash in lieu of a state-sponsored health plan. Employee wants her own state-sponsored dental plan.
      • Employee could also enroll into the FlexElect Program Medical and/or Dependent Care Reimbursement Accounts, if she so desires. 
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, HBD-12, STD. 692
    • Spouse/Domestic Partner: STD. 692 
  • ACTION REQUIRED

    • Employee must complete a STD. 702 (within 60 days of her appointment) to enroll in CoBen Cash. Employee must also complete a STD. 692 to enroll in a state-sponsored dental plan. Employee must complete an HBD-12 to decline enrollment in a state-sponsored health plan.
    • Spouse/Domestic Partner must complete a STD. 692 to delete employee from his dental plan. (Dual coverage not allowed)
    • Employee’s Personnel Office must assemble the employee’s STD. 702, HBD-12 and STD. 692 and his spouse’s/domestic partner STD. 692. Spouse’s/Domestic Partner’s Personnel Office must complete the “Agency Use Only” section of the spouse’s/domestic partner’s form and send the form to the employee’s Personnel Office.
    • Employee’s Personnel Office must complete the “Agency Use Only” section of the employee’s forms; receive and review spouse’s/domestic partner’s form to ensure that it is completed accurately and submit the entire package to SCO.
 

Examples: 9 - Cancellation Due to Change in Status Event (Divorce)

  • SITUATION: Cancellation - Due to Change in Status Event (Divorce)
    • Employee: Jack A. Gordon
    • Spouse/Domestic Partner: Yes (not a State employee)
  • CURRENT STATUS

    • Employee is currently enrolled in the CoBen Cash Option in lieu of health insurance and enrolled in the FlexElect Dependent Care Reimbursement Account. Employee has his dental plan enrolled under CoBen. Employee is enrolled under spouse’s health plan. Employee is covering spouse/domestic partner under his dental plan. Employee and spouse have divorced or domestic partnership terminated effective October 29 (current year).
  • DESIRED COBEN AND FLEXELECT ELECTION

    • Employee wants to cancel CoBen Cash and enroll in his own health insurance plan. Employee wants to delete spouse/domestic partner from dental plan, which is mandatory in the case of divorce or termination of domestic partnership.
      • Employee can only take action to cancel his CoBen Cash and FlexElect Reimbursement Account within 60 days after the date of divorce or termination of domestic partnership. Employee could have continued CoBen Cash and kept his Dependent Care Reimbursement Account, but in this case chose to cancel all CoBen and FlexElect elections.
  • DOCUMENTS REQUIRED

    • Employee: STD. 702, STD. 701R, HBD-12, STD. 692 Spouse/Domestic Partner - none
  • ACTION REQUIRED

    • Employee must complete a STD. 702 to cancel the CoBen Cash and STD. 701R to cancel FlexElect. Employee must also complete an HBD-12 to enroll into a health plan and a STD. 692 to delete spouse/domestic partner from his dental plan. (Remember to offer spouse/domestic partner “COBRA” for dental and vision).
    • Employee’s Personnel Office must complete the “Agency Use Only” section of the STD. 702, STD. 701R, HBD-12 and STD. 692 and ensure accuracy, then submit to SCO.
  Updated: 3/20/2017
One Column Page
Link Back to Top