• 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)

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• Table of Contents

510. Enrollment

Eligible employees appointed permanent, LT or TAU with a time base of half-time or more and six months or more, have 60 days from the effective date of their appointment to complete and submit a STD. 692 form to their departmental Personnel Office. It is the department's responsibility to advise each employee of the 60 day enrollment time limitation and to ensure that employees are provided information on the dental plans available. Eligible employees, who do not wish to enroll in a dental plan within the 60 day limit, must be advised that they will not be able to enroll until the next open enrollment period. These employees must complete Section D, and sign/date the STD. 692. This document, declining coverage, should be retained in the employee's personnel file. No further action is required by the Department. Do not submit documents declining enrollment to SCO or DPA.

Permanent-Intermittent (PI) Employees

A PI employee who meets the eligibility criteria described in Section 505 may enroll in a State-sponsored dental plan. The earliest possible effective dates of enrollment are August 1st or February 1st, based upon the end of the control period, ending June 30th or December 31st. Completed STD. 692 enrollment forms must be submitted to the employing office, within 60 calendar days after the end of the control period.

Permanent-Intermittent (PI) Employees - California Correctional Peace Officers Association - Bargaining Unit 6 Cadet Employees

Bargaining Unit 6 cadet (PI) employees will be eligible for dental benefits following graduation from the Academies of the Department of Corrections and the Department of the Youth Authority. The earliest possible effective date will be the first of the month following submission of the STD. 692 enrollment form to the employing office after their date of graduation. For enrollment use permitting event code 04.

Continuation of Coverage for PI Employees

Eligibility for a PI employee to continue enrollment is based upon qualification at the end of the next control period. To continue enrollment, a PI employee must receive credit for 480 paid hours in the current control period or a total of 960 paid hours in two consecutive (prior and current) control periods. If the employee does not qualify, coverage must be cancelled effective August 1, or February 1, depending on the non-qualifying control period.

An eligible PI employee has 60 days after the end of the qualifying control period to complete and sign a STD. 692 and submit it to the Personnel Office. A PI employee cannot enroll during an open enrollment period unless the open enrollment period corresponds with the completion of a control period and a portion of the 60 day time limit. However, a PI employee enrolled in a dental plan may only add/delete dependents and/or change dental plans during an open enrollment period.

Retired State employees that reinstate as a PI employee and have dental coverage, may reenroll within 60 days after appointment, and do not have to wait until the end of the qualifying control period. However, if the employee does not qualify, coverage must be cancelled effective August 1, or February 1, depending on the non-qualifying control period.