• 501. General Information
• 502. Current State-Sponsored Dental Plans
• 503. Responsibilities
• 504. Dental Plan Deduction Codes/Premiums
• 505. Employee Eligibility
• 506. Intentionally Unused
• 507. 24 Month Plan Restriction
• 508. Dependent Eligibility
• 509. Intentionally Unused
• 510. Enrollment
• 511. Allowable Changes To Enrollment
• 512. Effective Dates
• 513. Re-Enrollment Of Employees
• 514. Annual Open Enrollment Period
• 515. Continuation of Coverage While Off Pay Status
• 516. 120-Day Survivor Death Benefit For Continuation Of Benefits
• 517. Retiring Employees
• 518. Cancellation/Termination Of Dental Enrollment/Coverage
• 519. Consolidated Omnibus Budget Reconciliation Act (COBRA)
• 520. Document Completion
• 521. Dental Carriers/Benefit Information

• View all Section 500

  Attachments

• Attachment A - Dental Plan Enrollment Authorization (Std. 692)
• Attachment B - Dental Deduction Codes/Premiums
• Attachment C - Permitting Events Code Chart
• Attachment D - Affidavit of Eligibility
• Attachment E - HDB-34
• Attachment F - Dental Plan Direct Payment Authorization (Std. 696)
• Attachment G - Affidavit of Eligibility - Domestic Partner (DPA 680)
• Attachment H - Instructions for Completion of Dental Plan Enrollment Authorization (Std. 692)
• Attachment I - Examples of Completed Std. 692
• Attachment J - Delta Form 602A (blank form)
• Attachment J1 - Delta Form 602A (example)

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• Table of Contents

   Summary of 2007 Program Changes

501. General Information

The Department of Personnel Administration (DPA), Benefits Division has administrative responsibility for the State's Dental Insurance Program. This administrative responsibility includes securing and administering contracts with dental companies to provide dental benefits to employees, annuitants/retirees and their eligible dependents, the development and communication of policies and procedures relating to eligibility and enrollment, the coordination of annual/special open enrollment periods, and providing information and guidance to personnel office staff on issues relating to the State's Dental Program.

While DPA sets policy and procedures on enrollment and eligibility, the actual enrollment documents, Dental Plan Enrollment Authorization, STD. 692 (Attachment A) are reviewed and processed for active employees by the State Controller's Office (SCO) and for annuitants/retirees by the California Public Employees' Retirement System (CalPERS). Only those documents requesting some type of appeal or exception approval are forwarded to DPA for review.

Authority
Government Code 22952, 22953, 22954 and 22955
Memoranda of Understanding (MOUs)

Abbreviations