• 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

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.