• 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

503. Responsibilities

State Departments
Each department is responsible for notifying its employees of benefit eligibility guidelines, time constraints for enrollment, changes to benefits resulting from movements in and out of bargaining units, and applicable provisions of Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage. Departments are also responsible for completing enrollment documents and ensuring that documents are forwarded to the SCO in a timely manner. Each department should ensure that a supply of enrollment forms; dental plan information packages and current Evidence of Coverage Booklets for each dental plan are maintained and made available to interested employees. Departments are encouraged to review and refer to the policy and procedures outlined in this section when handling dental eligibility and enrollment issues. If, after thoroughly researching this material, there are issues which cannot be resolved; DPA is available to provide guidance and assistance.

State Controller's Office
The State Controller's Office (SCO), Benefits Unit, is responsible for processing all dental enrollment/change documents, updating the employees' payroll/deduction history and forwarding a copy of each enrollment document to the appropriate dental carrier. SCO is also responsible for auditing enrollment documents to ensure the validity of information. Those documents that require correction are returned to the respective employing department for appropriate action. In addition, on approximately the 5th and 20th of each month, the carriers receive eligibility information from SCO via eligibility file.

California Public Employees' Retirement System
The CalPERS, Health Benefit Services Division (HBSD), is responsible for processing all dental enrollment/change documents for retired State employees. It is the responsibility of each department to complete a STD. 692 for retiring employees and forward to CalPERS for processing. In addition, employees may not change dental plans when they retire unless their dental plan is no longer available to them in their 50 mile service area. Refer to Section 517 of these procedures for detailed information on dental enrollment issues for retiring employees.

Exclusive Representatives for Bargaining Units 5 and 6
The exclusive representatives for Bargaining Units 5, and 6, contract directly with dental carriers for dental coverage for their members and have administrative responsibility for such coverage. Employees in Units 5 and 6 enroll in their respective union-sponsored plan through their Personnel Office using the standard dental enrollment form, STD. 692 and normal enrollment procedures. Once enrolled, employees in these bargaining units should contact their union directly regarding questions or issues regarding their dental coverage. The contact numbers for these bargaining units are provided below: