Benefits Administration Manual

Benefits Administration Training

DPA offers Benefits Administration Training for personnel office staff. Learn

• how to use the BAM and other materials as a reference,
• how to fill out forms correctly and code them into the system, and
• the rules, regulations, and procedures of processing benefit enrollment and changes.

Taught by DPA and CalPERS staff.

2012 Program Changes

View highlights of the benefit plan changes effective January 1, 2012 for:

• Consolidated Benefits Program (CoBen)
• FlexElect Program
• Dental

Contents

100. General Information

• 100. General Information
• 101. Manual Revisions
• 102. Communication Methods
• 103. Contact
• View all Section 100

 

200. Deduction Codes

• 201. Dental Codes
• 202a. FlexElect Codes
• 202b. CoBen Codes
• 203. Health Codes
• 204. Legal Service Plan Codes
• 205. Life Insurance Codes
• 206. Long Term Care Code
• 207. Long Term Disability Codes
• 208. Savings Plus Program Codes
• 209. Vision Codes
• 210. Pre-Tax Parking Codes
• 211. Other Deduction Codes
• View all Section 200

 

300. Annual Leave Program

• 301. General Information
• 302. Eligibility
• 303. Enrollment
• 304. Annual Leave Accrual
• 305. Vacation Balance
• 306. Sick Leave Balance
• 307. Non-Industrial Disability Insurance
• View all Section 300
• Attachments
  • A - Sick Leave/Vacation Election Form

 

400. Consolidated Omnibus Budget Reconciliation Act (COBRA)

• 401. General Information
• 402. Qualified Beneficiary
• 403. Initial General COBRA Notice
• 404. COBRA Qualifying Events
• 405. Retiree Benefit Plan Alternate Coverage
• 406. Leaves of Absence
• 407. Loss of Group Coverage in Anticipation of a Qualifying Event
• 408. COBRA Election Notice and Election Form
• 409. COBRA Qualifying Event Notification Responsibilities
• 410. Notice of Unavailability of Continuation Coverage
• 411. Election Period
• 412. Length of COBRA Coverage
• 413. COBRA Premiums
• 414. Gross Misconduct
• 415. Noncompliance Penalties and Fines
• 416. Open Enrollment Period
• 417. COBRA in Retirement
• 418. Loss of COBRA Continuation Coverage
• 419. Completion of COBRA Enrollment Forms
• 420. Dental/Vision COBRA Premiums
• 421. Insurance Plan Addresses
• View all Section 400
• Attachments
  • A - Sample Initial General COBRA Notice
  • B - Sample COBRA Election Notice
  • C - Sample COBRA Continuation Election Form
  • D - Sample Notice of Unavailability of Continuation Coverage
  • E - Initial General COBRA Notice Log
  • F - COBRA Election Notice Log
  • G - Monthly COBRA Status Report
  • H - COBRA Calendar

 

500. Dental Program

• 501. General Information
• 502. Current State-Sponsored Dental Plans
• 503. Responsibilities
• 504. Dental Plan Deduction Codes/Premiums
• 505. Employee Eligibility
• 506. State Dental Plan Restriction for Newly Hired State Employees
• 507. CCPOA Benefit Trust Fund Dental Enrollment
• 508. Dependent Eligibility
• 509. Letter Notice Move out of Household
• 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
  • A - Dental Plan Enrollment Authorization (STD 692)
  • B - Dental Deduction Codes/Premiums
  • C - Permitting Events Code Chart
  • D - Affidavit of Eligibility
  • E - HDB-34
  • F - Dental Plan Direct Payment Authorization
  • G - Affidavit for Domestic Partners or Same-Sex Spouses Being Claimed as Economic Dependents (DPA 680)
  • H - Instructions for Completion of Dental Plan Enrollment Authorization (STD 692)
  • I - Examples of Completed STD 692
  • J - Delta Form 602A (blank form)
  • J1 - Delta Form 602A (example)
  • K - Notice of Loss of Employer Sponsored Coverage

 

600. Employee Assistance Program

• 601. General Information
• 602. Eligibility
• 603. Enrollment
• 604. Extension of EAP Coverage Following Layoff
• 605. Survivor Benefits
• 606. Managed Health Network
• 607. Confidentiality
• 608. Level of Counseling Services/Problem Types
• 609. Referrals
• 610. Critical Incident Stress Debriefing (CISD)
• 611. Cost
• 612. Employee Assistance Program Coordinator (EAPC)
• 613. Internal Programs
• View all Section 600
• Attachments
  • A - Number of Counseling Sessions
  • B - Departments with Internal EAPs

 

700. FlexElect Program

• 701. General Information
• 702. Plan Options
• 703. Premium Only Plan (POP)
• 704. Eligibility for FlexElect
• 705. Election Changes/Change in Status Events
• 706. Reimbursement Account Information and Procedures
• 707. Enrollment Appeal Process
• 708. Open Enrollment Period
• 709. Newly Eligible Enrollments
• 710. Permanent-Intermittent (PI) Enrollment
• 711. Change in Pay Status While Enrolled in FlexElect
• 712. COBRA
• 713. Retiring While Enrolled in FlexElect
• 714. Unit 6 Employees
• 715. Form Completion
• 716. Std. 701C - Cash Option Enrollment Form
• 717. Std. 701R - Reimbursement Account Enrollment
• 718. HBD-12 & Std. 692 - Additional Documentation
• 719. Employee not Re-Enrolling
• 720. Forms Distribution
• 721. Correcting FlexElect Open Enrollment Documents
• 722. Cancellations/Changes to Open Enrollment Documents
• 723. Example of Situations
• View all Section 700
• Appendixes
  • A - Permitting Event Codes/Date Chart
• Attachments
  • A - Cash Option Enrollment Authorization (STD 701C)
  • B - Reimbursement Account Enrollment Authorization (STD 701R)
  • C - COBRA initial Notice
  • D - COBRA Election Notice
  • E - COBRA Election Form (DPA 689)
  • F - COBRA Confirmation Letter
  • G - Premium Only Plan (POP) Disenrollment Form (DPA 006)
  • H - FlexElect Reimbursement Claim Form (DPA 352)
  • I - Qualified Reservist Distribution Request Form (DPA 902)

 

800. Basic Group Term Life Insurance

• 801. General Information
• 802. Eligibility
• 803. Level of Coverage
• 804. Enrollment
• 805. Supplemental Coverage
• 806. Accelerated Benefit Option
• 807. Assignment of Group Term Life Insurance
• 808. Beneficiary Designation
• 809. Reporting a Death
• 810. Continuation of Coverage Upon Loss of Eligibility
• View all Section 800

 

801. Common Carrier Travel and Accident Insurance

• 801.1. General Information
• 801.2. Eligibility
• 801.3. Covered Travel Benefit
• 801.4. Exposure and Disappearance
• 801.5. Level of Coverage
• 801.6. Exclusions
• 801.7. Enrollment
• 801.8. Beneficiary Designation
• 801.9. Reporting a Covered Death/Loss
• View all Section 801

 

900. Long Term Disability

• 901. General Information
• 902. Eligibility
• 903. Definition of Disability
• 904. Level of Benefits
• 905. Disability Claim Elimination Period
• 906. Pre-Existing Condition Limitations
• 907. Maximum Duration of Benefits
• 908. Plan Features
• 909. Benefit Level Plan Options and Rates
• 910. Premium Computations
• 911. Annual Premium Update
• 912. Enrollment
• 913. Ordering of Enrollment Authorization Forms
• 914. Completion of LTD Enrollment Form
• 915. Claims Process/Procedures
• 916. Continuation of Coverage Upon Loss of Eligibility
• 917. Changing Plan Categories
• 918. Cancellation of Coverage
• View all Section 900

 

1000. Savings Plus Program

• 1000. General Information
• 1001. Contact Information
• 1002. Eligibility
• 1003. Rehired Annuitant
• 1004. Enrollment
• 1005. Enrollment/Sign Up
• 1006. Review Program Materials
• 1007. Choosing an Investment Strategy
• 1008. Beneficiary Designation
• 1009. Contribution Limits
• 1010. Fees
• 1011. Address and Name Changes
• 1012. Traditional Catch-Up 457 Plan Only
• 1013. Age-Based Deferral
• 1014. Loans
• 1015. 457 Unforeseeable Emergency
• 1016. 401(K) Hardship Withdrawal
• 1017. Service Credit Purchase
• 1018. Lump Sum Separation Pay
• 1019. Investment Options
• 1020. SCHWAB Personal Choice Retirement Account (PCRA)
• View Section 1000 -1020

 

1021. PST Retirement Program (Part-Time, Seasonal, and Temporary)

• 1021. PST Retirement Program
• 1022. Contact Information
• 1023. Mandatory Coverage
• 1024. Exempt from Coverage
• 1025. Enrollment
• 1026. Address and Name Changes
• 1027. Beneficiary Designation
• 1028. Automatic Payroll Deductions
• 1029. Administrative Fee
• 1030. Semi-Annual Statement
• 1031. Payment/Distributions
• 1032. Payment Methods
• 1033. CalPERS Eligible
• 1034. Investment Help
• 1035. Dormant Accounts
• View Section 1021 - 1035

 

1036. Alternate Retirement Program

• 1036. General Information
• 1037. Employer Contact Information
• 1038. Mandatory Coverage
• 1039. Exempt from Coverage
• 1040. Enrollment
• 1041. Phases of ARP
• 1042. Conversion from ARP to CalPERS
• 1043. Administrative Fee
• 1044. Address and Name Changes
• 1045. Beneficiary Designation
• 1046. Automatic Payroll Deductions
• 1047. Annual Statements
• 1048. Payment/Distributions for Separated Employees
• 1049. Payment Methods
• 1050. Eligibility to Contribute to Retirement Savings
• View Section 1036 - 1050

 

1100. Excluded Employee Leave Buy Back Program

• 1101. General Information and Authority
• 1102. Eligibility
• 1103. Benefit Details
• View all Section 1100

 

1200. Vision Care Program

• 1201. General Information
• 1202. Eligibility
• 1203. Enrollment
• 1204. The Vision Benefit
• 1205. How to Use the Plan
• 1206. Dual Coverage
• 1207. Direct Payment Process
• 1208. 120-Day Survivor Death Benefit for Continuation of Benefits
• 1209. Consolidated Omnibus Budget Reconciliation Act (COBRA)
• 1210. Instructions for Completion of STD. 700
• 1211. Instructions for Completion of STD. 703
• 1212. Instructions for Completion of DPA 695
• 1213. Vision Plan Premiums and Plan Addresses
• View all Section 1200
• Attachments
  • A - Vision Plan Enrollment Authorization (STD. 700)
  • B - Vision Plan Direct Payment Authorization (STD. 703)
  • C - Permitting Event Codes/Effective Dates Chart
  • D - Retiree Vision Plan Enrollment Authorization (DPA 695)
  • E - Permitting Event Codes/Effective Dates Chart - Retirees

 

1300. Worksite Wellness Program

• 1301. General Information
• 1302. Statewide Wellness Steering Committee
• 1303. Resource Guide
• 1304. Website
• View all Section 1300

 

1400. Workers' Compensation

• 1401. General Information
• 1402. Employee's Responsibility
• 1403. Return to Work Coordinator's or Employer's Responsibility
• 1404. Personnel Office's Responsibility
• 1405. State Compensation Insurance Fund Responsibility
• 1406. Benefits
• 1407. Forms and Brochures
• 1408. Step by Step Instructions
• View all Section 1400

 

1500. Group Legal Services Plan

• 1501. General Information
• 1502. Eligibility Criteria
• 1503. Enrollment
• 1504. Ordering of Enrollment Forms
• 1505. Completion of the Enrollment Form
• 1506. Changes in Coverage
• 1507. Cancellation
• 1508. Continuation of Coverage Upon Loss of Eligibility
• View all Section 1500

 

1600. Consolidated Benefits - COBEN

• 1601. General Information
• 1602. Benefit Allowance
• 1603. CoBen Calculator
• 1604. CoBen Cash
• 1605. Premium Only Plan (POP)
• 1606. Eligibility for Consolidated Benefits
• 1607. Change in Status Events (Permitting Events)
• 1608. Enrollment Appeal Process
• 1609. Open Enrollment Period
• 1610. Newly Eligible Employees
• 1611. Permanent-Intermittent (PI) Employees
• 1612. Change In Pay Status While Enrolled in CoBen Cash
• 1613. Retiring While Enrolled in CoBen Cash
• 1614. Employees Listed as Dependents on Parent's State Plan
• 1615. Form Completion
• 1616. Std. 702 - CoBen Cash Enrollment Election
• 1617. HBD 12 & Std. 692
• 1618. Employees not Re-Enrolling
• 1619. Forms Distribution
• 1620. Correcting CoBen Open Enrollment Forms
• 1621. Cancellations/Changes to Open Enrollment Forms
• 1622. Examples of Situations
• View all Section 1600
• Attachments
  • Consolidated Benefits (COBEN) Cash Enrollment Election
• Appendixes
  • CoBen Program Permitting Event Codes

 

1700. Partial Service Retirement

• 1701. General Information
• 1702. Eligibility Criteria
• 1703. Change in Fractional Time Base
• 1704. Employee Benefits
• 1705. Method of Payment
• 1706. Employee Status
• 1707. Applications
• View all Section 1700

 

1800. Family and Medical Leave Act of 1993

• 1801. General Information
• 1802. Eligibility Criteria
• 1803. Employee Coverage
• 1804. Employer Coverage
• 1805. Leave Entitlement
• 1806. Maintenance of Health Benefits
• 1807. Job Restoration
• 1808. Notice And Certification
• 1809. Unlawful Acts
• 1810. Enforcement
• 1811. Other Provisions
• 1812. Further Information
• View all Section 1800

 

1900. Long-Term Care Program

• 1901. General Information
• 1902. Eligibility
• 1903. Application Period
• 1904. Coverage Choices
• 1905. Premium Information
• 1906. Payroll Deductions
• 1907. Premium Waiver
• 1908. Retirement
• 1909. Termination of Coverage
• 1910. Ordering Employer Materials
• 1911. CalPERS Long-Term Care Quick Reference Numbers
• View all Section 1900

 

2000. Health Benefits

• 2001. CalPERS Health Benefits Booklet

 

2100. Merit Award Program

• 2101. General Information
• 2102. Forms Distribution
• 2103. Eligibility
• 2104. Participation
• 2105. Confidential
• 2106. Resource Guide
• 2107. Tax Withholding
• 2108. Contacts
• 2109. Website
• View all Section 2100

 

2200. Pre-Tax Parking Program

• 2201. General Information
• 2202. Authority
• 2203. Benefit/Maximum Deduction
• 2204. Eligibility
• 2205. Effective Date
• 2206. Enrollment
• 2207. Claims Process
• 2208. Changes
• 2209. Cancellations
• 2210. Forfeiture
• 2211. Leave of Absence
• 2212. Employer Transfer
• 2213. Retroactive Enrollment
• 2214. Refunds
• 2215. Separation or Retirement
• 2216. Beneficiary
• 2217. Contact
• 2218. Website

• View all Section 2200

Comments and Suggestions

Any comments and suggestions are invited and gladly welcomed.

Susan Coats - (916) 327-6429

Department of Personnel Administration
1515 S Street, North Building, Suite 400
Sacramento, California 95811-7258

Get a map to DPA

Updated January 11, 2012 at 3:31 PM.