Voluntary Changes
Employees may elect to make any of the following changes to their enrollment:

1. Adding a newly acquired spouse, certified domestic partner and/or stepchild to a one, two or three party enrollment.

2. Adding a newborn, adopted child, or child at age 3 to a one, two, or three party enrollment.

3. Adding spouse, certified domestic partner and/or dependents that lost coverage to a one, two or three party enrollment. (Must provide proof of loss of coverage-keep in employee's personnel file).

4. Adding a dependent due to a change in custody and/or acquiring an economically dependent child.

5. Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible).

6. Deleting a dependent who obtains other group coverage (non-State sponsored).

7. Deleting a dependent child who reaches age 18.

8. Deleting a child who is under age three.

   Note:

   These voluntary additions/deletions not initiated by the employee within 60 days from the permitting event date may be processed only during a subsequent open enrollment period.

Administrative Deletions
The following deletions are processed administratively. The department is responsible for notifying the employee of administrative deletions. An employee signature is not required; enter "Administrative Deletion" on the Employee Signature line of the STD. 692.

1. Dependents who reach age 23 and are not disabled. The CalPERS HBD 69 form should be used to assist departments in identifying these individuals. Refer to the CalPERS Health Benefits Procedures Manual.

2. Employees and/or dependents enrolled but not eligible. Delete retroactive to the effective date using Permitting Event Code 42.

   Note:

   The employee is responsible for any costs for dental services that were performed on him/herself or an ineligible dependent.

3. Employees that are enrolled but not eligible and refuses to sign STD. 692 to change dental plans due to bargaining unit change. Cancel retroactive to permitting event date, which caused eligibility to terminate using code 42.

   Note:

   The employee must be notified regarding this change and will not be allowed to enroll in a dental plan until the next scheduled open enrollment.

1. During an open enrollment period;

2. Due to a physical move to an area that is not serviced by the current dental carrier;

3. Due to a physical move to an area where a dental plan was not previously available to the employee; or

4. Due to service plan cut in the employee's service area and/or the employee's current dental plan does not have a dental provider within a 50 mile radius of the employee's residence.

Changes in Collective Bargaining Designation (CBID) Units 5 or 6

1. Unit 5 - California Association of Highway Patrolmen (CAHP)
   Unit 5 employees who are enrolled in the CAHP Dental Plan, Blue Cross, are automatically moved to the State-sponsored Delta Dental plan when they move out of Unit 5. The effective date of the dental plan change is based on when the PAR document is keyed. CHP Personnel Office staff must complete a STD. 692 and forward a copy to Delta Dental so it can update its records accordingly. Since SCO processes the plan change automatically, the STD. 692 is not sent to SCO. Those R05 employees who were enrolled in one of the State-sponsored prepaid plans will continue their enrollment but will be allowed to elect to change to Delta Dental if eligible if they choose to do so. CHP Personnel Office staff are responsible for notifying employees of their options.

2. Unit 6 - California Correctional Peace Officer's Association (CCPOA)
   When employees move in or out of Unit 6, a new STD. 692 must be completed to change the employees to the appropriate dental plan based on their new CBID. Documents should be completed and forwarded to SCO using Permitting Event Code 40 with a Standard Effective Date.

1. Employees moving from represented to excluded will be automatically moved into the Enhanced level of coverage effective the first day of the month following their first full month as an excluded employee. For example, if the CBID identifier change over to an excluded designation is effective November 6, 2006, coverage would be effective January 1, 2007, (December 2006 pay period, first full month as excluded). Because this change is processed automatically by SCO, departments are encouraged to process PAR documents as quickly as possible so that employees receive their correct level of dental benefits. The SCO runs a program each month normally two days prior to the master payroll cutoff. Any changes not processed for the current master payroll cutoff will be processed during the next pay period.

2. Employees moving from an excluded to a represented classification will be automatically moved into the Basic level of coverage effective the first day of the month following the change to represented. For example, if the CBID change to represented is effective November 6, 2006, coverage would be effective December 1, 2006, (November 2006 pay period).