DeltaCare USA: 1-800-422-4234

SafeGuard: 1-800-880-1800

The following provides a brief description of the three types of dental plans available; prepaid, preferred provider option and indemnity:

A prepaid plan requires that the enrollee choose a dentist from a specific list of dentists who contract with each prepaid dental company. These dentists make up what is referred to as the dental carrier's provider network. Dentists are paid a flat monthly fee by the plan for each member assigned to their offices. Most basic services are covered at no cost to the enrollee.

SafeGuard (prepaid) plan offers two plans. Represented employees have the standard plan. Excluded employees and retirees have the enhanced plan.

The monthly premium is fully paid by the State and no premium deduction is taken from the monthly pay warrant of the employee.

Delta Preferred Provider Option (PPO), a preferred provider option plan allows enrollees to select any licensed dentist for services. However, enrollees receive the maximum benefit available under the program when they choose one of the plan's in-network dentists. Similar to the indemnity plan, individuals who enroll in the plan are required to pay a monthly premium co-payment. Represented, excluded, and retired employees have the same coverage under the PPO plan.

Delta Dental Premier, an indemnity plan does not use a provider network like the prepaid or preferred provider plans. Enrollees are allowed to select the dentist of their choice. With an indemnity plan there are set limits that the plan will pay for each specific type of dental treatment. Enrollees are responsible for paying any remaining balance that might be due based on the type of dental treatment provided. The State pays a share of the monthly premium with the balance deducted from the monthly pay warrant of the employee.

Represented employees and retirees have the basic plan. Excluded employees have the enhanced plan.

24-Month Plan Restriction

All eligible newly hired represented employees in Bargaining Units 1 through 21, (except Units 2, 7, 8, 16, 17, 18, 19, and excluded employees), are required to select their dental plan coverage from one of the two available State-sponsored prepaid dental plans. Impacted employees may select only a prepaid plan until they have completed 24 months of employment without a permanent break during the 24-month qualifying period. At the end of the 24-month period, those employees that elected a prepaid plan will have 60 days to change their enrollment to Delta Dental Premier or Delta Dental PPO. Those employees that chose not to enroll in a prepaid dental plan may elect Delta Dental, within 60 days after completing the restriction period, unless they enrolled in the FlexElect cash option for dental.

Dental Premier or Delta Dental PPO. Those employees that chose not to enroll in a prepaid dental plan may elect Delta Dental, within 60 days after completing the restriction period, unless they enrolled in the FlexElect cash option for dental.

All eligible employees who reinstate after a permanent separation and previously had 24 months of State service (no permanent break in service during the 24 months), may enroll in the DeltaPremier or PPO Plan at the time of hire.

All eligible newly hired represented employees in Bargaining Units 2, 7, 8, 16, 17, 18, 19, and excluded employees (non-represented) may elect the DeltaPremier or PPO Plan, at the time of hire and are not restricted to State-sponsored prepaid plans.

It shall be the responsibility of the Personnel Office to notify all impacted newly hired represented employees of this restriction. Personnel Offices should provide the 24-month restriction end date to represented employees effected by this restriction. Personnel offices should also inform employees affected by this restriction that the employee is required to initiate a STD. 692 to enroll or change their dental coverage to a Delta Dental Plan, within 60 days from the date they complete the required 24 months of State service. Use Permitting Event Code 08 on the STD. 692 to process the change. Employees that do not take action to either enroll or change dental plans within the 60 day time period, may elect to enroll/change enrollment during the next scheduled dental open enrollment period.

Bargaining Unit 5

All newly hired represented employees in Bargaining Unit 5 must elect their dental coverage from one of the State-sponsored prepaid dental plans. After completing a 24-month restriction period, Unit 5 employees may enroll or change to the CAHP union-sponsored indemnity plan, Blue Cross, as long as they are members of CAHP. Use Permitting Event Code 08 on the STD. 692 to process the enrollment or change.

Exceptions to the 24-Month Restriction Period

The following provides information on instances when eligible employees will be exempt from the 24-month restriction and allowed to enroll in Delta Dental at the time of hire:

1. Newly Hired Employees with a LT or TAU Appointment

   Employees who are hired to State service with a LT or TAU appointment may use time served in those classes (no permanent break in service) to count towards meeting the 24-month restriction period and enroll at the time of hire if they have the necessary months of state service. However, individuals hired as a Student Assistant, Temporary or Seasonal employee (with exception of Seasonal Firefighters and Lifeguards), may not count time served in those classes towards meeting the 24-month restriction period.

2. Employees Hired to State Service with Current Delta Dental Coverage

   Newly hired eligible employees who have their own current State-sponsored dental coverage with Delta Dental at the time of hire, will be allowed to enroll in Delta Dental and continue their coverage if they meet any of the following conditions:

   1. CalPERS retiree, enrolled in Delta Dental, who is reinstating from retirement status and eligible as an active employee for State dental coverage.

   2. New hire or transfer (no break in service) from another State government agency or California State University (CSU) or University of California (UC) systems (if prior coverage was under city, county, federal, private/public sector, or as a dependent on their parent/spouse state-sponsored plan, then the employee is not eligible for this exception).

      Important Note: For these exceptions, departments must confirm current Delta Dental Plan coverage. Indicate the specific exception in the remarks section on the STD. 692: Prior Delta Dental coverage with “Another State Government Agency” or “CSU” or “UC”.

   3. Prior State employees, who continued and maintained their State Delta Dental coverage through COBRA (COBRA coverage must be current at the time of hire).

3. Excluded Employees

   All eligible newly hired excluded employees (non-represented) may elect the DeltaPremier or PPO Plan, at the time of hire and are not restricted to State-sponsored prepaid plans.

4. Represented Employees in Consolidated Benefits (CoBen)

   All eligible newly hired represented employees in Bargaining Units 2, 7, 8, 16, 17, 18, and 19, may elect the DeltaPremier or PPO Plan, at the time of hire and are not restricted to State-sponsored prepaid plans.

5. Prepaid Dental Plan Provider (Dentist) Not Available Within 50 Miles

   Newly hired eligible employees who do not have a prepaid dental plan provider available within 50 miles of their residence may enroll in Delta Dental at the time of hire. The Personnel Office must send a written memo along with a completed STD. 692 to the SCO Benefits Unit. The memo must state that none of the available prepaid plans have a dentist within the employee's service area. Upon verification of this information by the appointing authority, forward the document to SCO for processing.

6. Prior State Employees that Worked For 24 Months

   All eligible newly hired or current employees that were previously a State employee for 24 months without a permanent break in state service will be allowed to enroll or change to Delta Dental with a current effective date.

   Important Note: For employees participating in Flex/COBEN Cash, the choice made by these employees for dental insurance (enroll in a State-sponsored plan or elect cash in lieu of their dental benefit) will continue to be a three-year commitment, subject to certain limited exceptions.

   The STD. 692 for prior State employees being enrolled in Delta Dental under a permitting event does not require DPA approval and should be sent to SCO for processing.

7. Prior State Employees Hired With Mandatory Reinstatement

   Eligible employees who have mandatory reinstatement rights to State service may enroll into Delta Dental. The Personnel Office must send a written memo along with a completed STD. 692 to DPA, Benefits Division. The memo must indicate that the employee has been mandatorily reinstated. Upon verification of this information, DPA will approve the enrollment to Delta Dental and forward the document to SCO for processing.

8. Employees Hired After Layoff

   Newly hired eligible employees who were terminated due to layoff from a State-government agency and are then re-hired within 36 months will have one of the following conditions apply:

   1. If the employee was enrolled in Delta Dental at the time of layoff, he/she will be allowed to reenroll in Delta Dental and will not be required to complete a 24-month restriction period.

   2. If the employee had served a portion of the 24-month period prior to layoff, then that time may be included with time served upon rehire to meet the 24-month requirement for enrollment into Delta Dental.

   For enrollment of the rehired employee, the Personnel Office must send a completed STD. 692 to SCO, and in the remarks section, indicate that the employee is being reinstated after layoff. The Personnel Office should use Permitting Event Code 01a when completing the STD 692. The Personnel Office is charged with the responsibility to certify that the conditions stated in this section are met.

9. Permanent-Intermittent (PI) Employees

   Eligible PI employees who have met the required 24-month restriction period may change to Delta Dental during their current PI Control Period. Those PI employees who are not currently enrolled in a prepaid plan after completion of the 24-month restriction period may only elect to enroll in Delta Dental after completion of their current PI Control Period.

Enrollment Processing Upon Completion of 24-Month Restriction Period

Enrollment Processing Upon Completion of 12-Month Restriction Period

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.

An employee may only change enrollment from one dental plan to another under the following conditions:

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.

Employees enrolled in either Delta Premier or SafeGuard who move from represented to excluded or excluded to represented will automatically have their dental benefit coverage level changed to either the Basic or Enhanced level of coverage. The effective date of the new plan will be contingent upon when the PAR is keyed.

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, 2008, coverage would be effective January 1, 2009, (December 2008 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 benefit coverage. 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, 2008, coverage would be effective December 1, 2008, (November 2008 pay period).

Employees Off Active Pay Status During Open Enrollment Period

Eligible employees, who are off active pay status during the entire open enrollment period, may contact their Personnel Office during the open enrollment period to make changes in their dental enrollment or may wait and make changes within 60 days after returning to active pay status.

Effective Dates

All correctly completed open enrollment documents that are submitted to the SCO within the prescribed time frames, will be effective January 1 of the following calendar year. DPA will send a PML memo to departments prior to the scheduled open enrollment period which will contain document processing instructions.

Correcting Open Enrollment Documents

Corrective action is required when an error has been made by the department in completing the STD. 692 as follows:

For errors that do not pertain to a payroll deduction (i.e., name, age of dependent), photocopy the STD. 692, make the necessary corrections in red, indicate "CORRECTED COPY" in red across the top of the form, and submit it to the dental carrier. Do not send a copy to SCO or DPA.

Cancel or Change Open Enrollment Documents

Employees enrolling or making changes to their dental coverage during the open enrollment period may cancel or change their election until the end of the open enrollment period. In the remarks section of the new STD. 692, indicate the type of action taken and attach a copy of the original form that was previously sent to SCO during the open enrollment period. Employees may not cancel or change a dental election after the end of the open enrollment period unless they experience a valid change in status.

1. Dental carriers do not send a monthly bill to an employee who elects to pay premiums directly while he/she is off pay status. Therefore, it is the responsibility of each employee to ensure premium payments are paid timely. Direct pay is normally limited to 12 months. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period.

2. Payments must be paid in advance and cover a minimum period of three months or the length of the absence whichever is less. The employee's check/money order for the first three months must be attached to the newly completed STD. 696 and sent to the carrier.

3. The dental carrier must receive the initial payment by the first day of the month following the first full month the employee is off pay status. Subsequent installments and/or final payment are due to the dental carrier by the first of each subsequent three-month period. STD. 696 forms received by the dental carrier without the required payment attached will be returned to the employee. Failure to pay the required payment in a timely manner will result in the employee's dental coverage being cancelled.

4. In the event an employee returns to pay status prior to the end of his/her approved leave of absence, it will be the employee's responsibility to contact his/her dental carrier to request a refund of any direct premium overpayments paid.

An employee who has a permitting event occur while on non-pay status may make changes to his/her dental enrollment as indicated below:

1. An employee is responsible for contacting his/her Personnel Office and completing a new STD. 692 reflecting the enrollment change. The Personnel Office must forward the document to SCO for processing.

2. If an employee is on direct pay and the change results in a change of premium, a new STD. 696 must also be completed.

3. If an employee deletes any dependent prior to or during the leave, the dependent may not be re-enrolled until the next open enrollment period.

Return to Pay Status

Upon return to pay status (if an employee is still enrolled), the State premium contributions will commence with the first pay warrant issued by SCO.

The Personnel Office should check the employee's pay warrant to verify that the dental plan name is reflected. If the dental deduction is not shown, contact SCO to establish.

Dental Benefits for Exempt Employees Separating from State Service

For exempt employees who are separating from State service, and have not reached retirement age, but desire to continue their dental benefits until they reach minimum retirement age, the conditions listed below will be applicable.

Conditions of Eligibility

Exempt employees who have at least ten (10) years of State service which includes at least two (2) years of credited service while an exempt employee, who permanently separate from State service on or after January 1, 1988, and at the time of separation have more than 10 years before they would attain their minimum age for service retirement from State service, may elect to continue or not continue their dental benefits until their date of retirement.

For these employees, the following two options are available at the time of separation:

1. An exempt employee may choose not to continue his/her dental benefits at the time of separation. However, the separated exempt employee will be eligible to enroll in a dental plan at the time of his/her future date of retirement.

2. An exempt employee may elect to continue his/her dental benefits at the time of separation. The enrollment must be made within sixty (60) days from their date of permanent separation. The premium rate is 102 percent (%) of the current State rate. While this rate is the same as the COBRA rate, continuation of coverage in this instance is not part of COBRA.

Dental Plan Enrollment Form and Premium Payment

Should an exempt employee elect to continue dental benefits at the time of separation, the following information on enrollment procedures is being provided.

Indemnity and PPO Plans - Delta Dental

For enrollments in Delta Dental (Delta), exempt employees should complete the "Delta 602A" form. The following statement should be written across the top of each form, "Based on Section 22816.7 of the Government Code". This form can be obtained from Delta Dental's Marketing Administration by calling (415) 972-8300 (ask for Account Services). The enrollment form and initial premium payment should be sent to the California Public Employees' Retirement System (CalPERS) for verification of eligibility. CalPERS will forward the enrollment form and initial payment to Delta for processing. The premiums must be paid on a quarterly schedule. After the initial enrollment, subsequent premiums are sent directly to Delta and due by the first day of the month that the quarter begins (January, April, July and October). Non-payment for two (2) consecutive quarters will automatically disqualify the enrollee from this program. To ensure that the quarterly premiums are credited properly, enrollees should write their social security number and group number 9949-8601 (Delta Premier) or 9946-8601 (PPO) on their payment check.

Prepaid Plans - DeltaCare USA and SafeGuard

For enrollments in DeltaCare USA and SafeGuard, exempt employees should complete the "Dental Plan Direct Payment Authorization (STD. 696)". The following statement should be written across the top of each form, "Based on Section 22816.7 of the Government Code". The enrollment form and the initial payment should be sent to the Department of Personnel Administration (DPA) to the attention of the Dental Coordinator, for verification of eligibility. DPA will forward the enrollment form and initial payment to the dental carrier for processing.

The premiums will be paid on a monthly schedule. After the initial enrollment, subsequent premiums are sent directly to the carrier and due by the first day of each month (January, February, March, etc.). Non-payment for two (2) consecutive months will automatically disqualify the enrollee from this program. To ensure that the monthly premiums are credited properly, enrollees should write their social security numbers and "state exempt employee" on their payment check.

Reference:  Government Code Section 22816.7

Termination of Coverage

An employee's coverage ceases at midnight on the last day of the month following the month in which the last premium was paid.

Verification of Coverage

In the event an employee indicates that a dental claim for services has been denied, it is possible that there is a problem with the employee's enrollment and the employee is not reflected on the dental carrier's eligibility files. If this occurs, departments should do the following:

1. Verify that the correct dental plan name is reflected on the employee's pay warrant.

2. Ensure that the claim denial was not prior to the 5th or the 20th of the month because the carriers receive eligibility information from SCO via electronic download on these dates. The employee may want to have his/her dentist resubmit the claim.

3. Confirm with the employee that the correct Social Security Number was entered on the claim form.

4. Review the file copy of the STD. 692 for accuracy.
   • If the STD. 692 is correct, contact the SCO Deductions Liaison Unit to verify when the document was processed and premiums paid.
   • If any of the following items are incorrect on the STD. 692, contact the SCO Deductions Liaison Unit:

     Section A -	Items 1, 2 or 4
     Section B -	Item 1; Item 3 does not correspond to Section E, Item 4
     Section D -	Form not signed/dated
     Section E -	Item 1; Item 2 does not correspond to Items 7 and 8 and/or Section B-1

Change of Dentist

Employees enrolled in a State-sponsored prepaid plan (DeltaCare USA or SafeGuard) are allowed to change to a different dentist within the dental plan's provider network. This type of change must be done through the dental carrier. Please refer the employee appropriately.

Employee Complaints

All the dental carriers have an internal complaint/grievance process in the event an employee is not satisfied with the services or benefits he/she receives. An employee with such a complaint should be advised to contact his/her dental carrier directly.