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. State Dental Plan Restriction for Newly Hired State Employees 507. CCPOA Benefit Trust Fund Dental Enrollment 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 502. Current State-Sponsored Dental Plans Currently the State of California has contracts with four dental carriers; Delta Dental for an indemnity plan referred to as Delta Dental Premier, and the Delta Preferred Provider Option (PPO) plan which is the preferred provider option plan, and two prepaid plans; DeltaCare USA, and SafeGuard. These four plans provide dental insurance for all eligible active and retired employees and their eligible dependents, with the exception of employees in Unit 6 that have their dental insurance provided through their respective union-sponsored trust. In addition, Unit 5 employees that are also members of the California Association of Highway Patrolmen (CAHP) have their own indemnity dental plan, but may enroll in any of the four State-sponsored prepaid plans. Delta Dental: 1-800-225-3368 Delta Premier Delta PPO 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. See Section 521 for more information on the State-sponsored dental plans. Back to Top