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 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 507. CCPOA Benefit Trust Fund Dental Enrollment CCPOA Benefit Trust Fund 12-Month Dental Plan Restriction All newly hired Unit 6 employees must enroll and maintain coverage in the CCPOA prepaid dental plan, Western Dental Plan for a period of twelve (12) consecutive months from the effective date of their enrollment. This stipulation includes State employees who have transferred into Unit 6 and previously satisfied the State’s mandated 24-month dental plan restriction. Those employees that chose not to enroll in the Western Dental Plan will not be allowed to enroll in the Primary Dental Plan until they have been enrolled in the Western Dental Plan for 12 consecutive months. At the end of the 12-month period, restricted employees will have 60 days to request a change to the Primary Dental Plan. Those employees who do not take this action within the 60 day period may do so during an open enrollment period. These exceptions permit the employee to enroll in the CCPOA Primary Dental Program: If no prepaid dental facility or provider is within (50) miles from the employee’s home or work, the employee has the option to enroll in either the prepaid program or the CCPOA Primary Dental program; The employee has eligible dependents residing in another service area and is unable to obtain services from a prepaid provider; The employee is enrolled in the CCPOA prepaid dental program and then promoted within Corrections (promotion resulted in enrollment in a State-sponsored dental plan), and then later demotes back to Bargaining Unit Six (R06). The employee will not have to meet another 12-month restriction period; Two Bargaining Unit Six (R06) married employees, enrolled in the same dental plan who met the 12-month restriction and later divorce. The employee will not have to meet another 12-month restriction period. Indicate the specific exception in the remarks section on the STD. 692: “No prepaid facility or provider within 50 miles from employee’s home or work” or “Employee’s eligible dependent resides in another service area” or “Employee previously met CCPOA 12-month restriction”. Enrollment Processing Upon Completion of 12-Month Restriction Period The Personnel Office should use Permitting Event Code 08 when completing the STD. 692. This code will be used to enroll in or change enrollment after completion of the 12-month restriction period. Refer to the Permitting Event Code Chart (Attachment C) for processing cut-off date. Back to Top