Dental Program California Department of Human Resources

OBJECTIVES Dental Form Your Responsibilities 24- Month Restriction Imputed Tax Situations Mandatory/Standard Rules

Eligibility List for Updating Dental If you would like to be added to our list that allows you to call the carrier and update your employees dental eligibility or personal information, have your manager send an to:

Benefits Administrative Manual Location: Click on: State HR Professionals Click on:Benefits Administration Manual Click on: Dental Program

Direction to the PMLs Location: CalHR website Scroll down Resources for State HR Professionals Click on: Policy Memos

Dental Program Staff Sandra Lobatos-Chico (916) / Fax Linda McCarthy (916) / Fax

Current State-Sponsored Dental Plans BAM Section 502 Delta Dental Indemnity type plan referred to as Delta Dental PPO plus Premier, and the Delta Preferred Provider Option (PPO). Four prepaid plans: DeltaCare USA, SafeGuard, Premier Access, and Western Dental.

Dental Options Section 502 These plans provide dental benefits for: All eligible active and retired employees and their eligible dependents; With the exception of employees in Bargaining Units 5 and 6 which have their own Union sponsored plans.

Prepaid Plans BAM Section 502 Requires that the enrollee choose a dentist from a specific list of dentists. These dentists make up what is referred to as the dental carrier’s provider network. The monthly premium is fully paid by the state and no premium deduction is taken from employees payroll.

Prepaid Plans Only To assist your employees that are enrolling in a prepaid plan, be sure they fill in section B, box # 2 of the dental enrollment form STD Do not insert the name of the dental office selected, the carriers want the numbers only. Numbers are located at the carriers website.

Your Responsibilities Section 503 You are responsible for notifying employees of: Benefit eligibility guidelines and timeframes for enrollment. Completing enrollment documents and submitting to SCO in a timely manner. Applicable provisions of Consolidated Omnibus Budget Reconciliation Act (COBRA).

Comparison of Benefits and Covered Services for Prepaid Plans CalHR website Scroll down: Comparison of Benefits and Covered Services Scroll down to: Click on: Procedures Prepaid Plans

Cost Comparison Chart for Indemnity and PPO CalHR website Scroll Down: Click on: Find Dental Benefits Scroll down to: Comparison of Benefits and Covered Services Click on: Procedures Indemnity and PPO

24 Month Plan Restriction BAM Section 506 All eligible newly hired represented employees in BU’s 1-21 (except Units 2, 7, 8, 16, 17, 18, 19, and excluded employees) are required to select from one of the prepaid plans. All impacted employees must complete 24 months of employment with no permanent break in service.

24 Month Restriction Section 506 It’s your responsibility to notify impacted newly hired employees of this restriction and to give these employees an end date to this restriction. At that point, it’s their responsibility to initiate a new STD. 692 to change their dental plan.

1-24 Month Plan Restriction BAM Section Use PEC: 08 At the end of the 24-month restriction, employees will have 60 days to change their enrollment, unless they enrolled in the FlexElect cash option for dental. Once an employee reinstates after a permanent separation and previously had 24-months of state service may enroll in Delta Dental PPO plus Premier or Delta PPO Plan at the time of hire. Make a note of it in the remarks box.

2-24 Month Plan Restriction BAM Section 506 All eligible newly hired represented employees in BU’s 2, 7, 8, 16, 17, 18, 19, and excluded (non- represented/CoBEN) may elect Delta Dental PPO plus Premier or PPO Plan. They are not restricted to state-sponsored prepaid plans.

Exceptions to 24-Month Restriction Period BAM Section 506 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. Including employees hired to state service with their own current state sponsored Delta dental.

Exceptions to 24 Months Restriction BAM Section 506 CalPERS retiree – reinstating from retirement status and eligible as an active employee for dental coverage. New hire or transfer (no break in service) from another agency or CSU. Time not counted: Student assistants, temporary or seasonal employees (with the exception of Seasonal Firefighters and Lifeguards).

Dependent Eligibility BAM Section 508 Eligible dependents are defined as: Spouse, domestic partner (certified by the Secretary of State) An eligible child/stepchild/economically dependent child. Common law marriage not allowed.

Dependent Eligibility No pets allowed – no matter how much you love them and feel they are like your family/kids.

Domestic Partnerships Stop Imputed Tax If your employee is claiming their Domestic Partner as an economic dependent for Federal Income Tax purposes as authorized by the Internal Revenue Service, they will need to fill out the form CalHR 680. Use Party Code 2 or Party Code 3 when filling out the STD 692. Indicate in box 18 (remarks section) CalHR 680 on file.

Domestic Partners Imputed Tax Applies Here If they are claiming them as a dependent for dental benefits this form does not need to be filled out and the Party Code would say “A” (party code 2) or “B” for a (party code 3). SCO will apply the imputed tax.

Medically Disabled Dependent Children Section 508 A disability certification is required to ensure disabled dependent children remain covered after the age of 26. (CalPERS HBD 34)

Eligible Medically Disabled Dependent Children Eligible Medically Disabled Dependent Children over age 26 can remain covered if: The dependent was enrolled as a disabled child at the time of the employee’s initial enrollment; or or The dependent became disabled while enrolled as an eligible family member prior to attaining the age of 26.

1-Ineligible Medically Disabled Dependent Children 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.

2- Ineligible Medically Disabled Dependent Children continued: Dependents over age 26 who are not currently enrolled in any State-sponsored dental plan.

Employees on Their Parents Plan When Hired BAM Section 508 When dependent children of state employees who are under the age of 26 become state employees, they can remain on their parents plan until the age of 26. If the dependent children do not qualify for state dental benefits as state employees they may remain on their parent's state-sponsored plan, provided they are under age 26.

1-Dual/Split Coverage BAM Section 508 Dual coverage not allowed. Split coverage not allowed.

2-Dual/Split Coverage BAM Section 508 All dependent children must be enrolled by one State employee if both parents are state employees. Departments must correct these enrollments retroactive to the date they began and notify the employee and submit to SCO for corrective action.

1-Court Ordered Dental Coverage BAM Section 508 Court orders are generally subject to program’s eligibility rules. In adding a child/children complete the STD. 692, using Permitting Event Code 16.

2-Court Ordered Dental Coverage BAM Section 508 If a court order is issued and your employee has voluntarily deleted a spouse you must reenroll the spouse until the divorce is final, at that point it’s mandatory that the ex-spouse be deleted from coverage and now eligible for COBRA. (PEC 17a or 21a).

3-Court Ordered Dental Coverage BAM Section 508 When completing the STD. 692 resulting from the court order indicate in the Remarks Section “Court Ordered”.

1-Mandatory Deletions BAM Section 511 Dependents that must be deleted: Divorced. (However, COBRA must be offered.) Termination of a Domestic Partnership. (Employee must provide copy of notice of termination and COBRA must be offered to terminated domestic partner.)

2-Mandatory Deletions BAM Section 511 Death of a dependent (maybe done administratively upon seeing death certificate – note it in the remarks box). Dependent child reaches age of 26. Dependent goes into military.

3-Mandatory Deletions BAM Section 511 Dependent no longer economically dependent or change of custody. Dependent enrolled but never eligible. Dependent dual or split covered.

1-Voluntary Changes BAM Section 511 Adding new spouse, certified domestic partner and/or stepchild to a one, two, or more party enrollment. (PEC 17a or 21a) Adding newborn, adopted child, or child at each birthday until the age of 6. (PEC 19 or 22a)

2-Voluntary Changes BAM Section 511 Adding spouse, certified domestic partner and/or dependents that lost coverage. (PEC 17b - Must provide proof of loss of coverage.)

3-Voluntary Changes BAM Section 511 Adding a dependent due to a change in custody and/or acquiring an economically dependent child. (PEC 16) Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible). (PEC 24b – not applicable in the event of a pending divorce, separation or annulment)

4-Voluntary Changes BAM Section 511 Deleting a dependent who obtains other group coverage (non-State sponsored). (PEC 23b)

1-Administrative Deletions BAM Section 511 Dependent who reaches age 26 and not disabled. (PEC 26d) Employees and/or dependents enrolled but not eligible. Must be deleted retroactive to the effective date. (PEC 42) Employees enrolled, but not eligible due to bargaining unit change and the employee refuses to sign. Delete retroactive to the effective date. (PEC 42)

2-Administrative Deletions Death of a Spouse, domestic partner or child Must see the death certificate and make a note in the remarks section of the 692.

1-Effective Dates BAM Section 512 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 event will be the first day of the month immediately following the event. Divorce final 10/31. Effective 11/1.

2-Effective Dates BAM Section 512 Standard Effective Date Rule: First of the month after STD. 692 is completed and received by the employing department. Example - EE hired 1/14 and submits the 692 on 2/11 the effective date is 3/1.

1-Re-Enrollment of Employees BAM Section 513 Reinstatement after a 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.

2-Re-Enrollment of Employees BAM Section 513 Reinstatement after Appeal: SCO requires that a STD. 674 Payroll Adjustment Notice, be submitted to reinstate an employee’s benefit deductions. The effective date can be current or retroactive.

Continuation of Coverage While Off Pay Status BAM Section 515 Employees on non-pay status may continue dental coverage, by paying the total premium directly to the carrier. Employees must complete the STD 696 and forward to the carrier with a check for three months premium amount. The carrier will not send a bill. It does not come to CalHR.

1-Reasons for SCO Enrollment Rejection Permitting Event Code is missing or invalid. Plan name and Org Code doesn’t match (Section B and E). Party Code is missing or invalid. Permitting event date is missing or invalid.

2-Reasons for SCO Enrollment Rejection Event must happen first. Standard events: date rec’d by employing office cannot be prior to the permitting event date. Mandatory events: date rec’d at SCO can’t be prior to the permitting event date. Section D is not checked.

3-Reasons for SCO Enrollment Rejection Family member is missing, check against SCO HIST for party code. When several permitting events are occurring, they must be submitted on separate forms. All forms are to be signed by authorized agency personnel.

1-Reminder for the STD 692 Section B box 1 must match section E box 2. Prepaid plans only Section B, box 2 should be filled out. Section B, box 3 must match Section E - box 3 and add family relationships.

2-Reminder for the STD 692 Do not forget to put in permitting event date, permitting event code, and effective date of action. Any information needed to process the form add in the remarks section. Section E, and box 3 must be accurate.

Dental Carrier Information Delta Dental: DeltaCare USA: SafeGuard: Premier Access: Western Dental:

Personnel People ROCK!! Thank you for attending the dental portion of BAM training.