Benefits - Benefits Administration Manual

	Department of Personnel Administration
	Benefits Administration Manual
	Section 500 501. 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) Navigation Table of Contents	Dental Program 504. Dental Plan Deduction Codes/Premiums Each dental carrier is assigned a dental plan deduction code by SCO. This code, which is reflected on the employee's monthly statement of earnings, is used to identify deduction premium and enrollment information for each dental carrier. Attachment B provides a chart that lists each dental plan, its respective dental deduction code and the current dental premium. Additional information on dental deduction codes is also provided in Section 201 of this Manual.