• Introduction

100.  General Information

• 100. General Information
• 101. Manual Revisions
• 102. Communication Methods
• 103. Contact
• View all Section 100

200.  Deduction Codes

• 201. Dental Codes
• 202. FlexElect Dental Codes
• 203. Health Codes
• 204. Legal Service Plan Codes
• 205. Life Insurance Codes
• 206. Long Term Care Code
• 207. Long Term Disability Codes
• 208. Savings Plus Program Codes
• 209. Other Deduction Codes
• View all Section 200

300.  Annual Leave Program

• 301. General Information
• 302. Eligibility
• 303. Enrollment
• 304. Annual Leave Accrual
• 305. Vacation Balance
• 306. Sick Leave Balance
• 307. Non-Industrial Disability Insurance
• View all Section 300

  Attachments

• Attachment A - Sick Leave/Vacation Election Form

400.  Consolidated Omnibus Budget Reconciliation Act (COBRA)

• 401. General Information
• 402. Qualified Beneficiary
• 403. Initial General COBRA Notice
• 404. COBRA Qualifying Events
• 405. Retiree Benefit Plan Alternate Coverage
• 406. Leaves of Absence
• 407. Loss of Group Coverage in Anticipation of a Qualifying Event
• 408. COBRA Election Notice and Election Form
• 409. COBRA Qualifying Event Notification Responsibilities
• 410. Notice of Unavailability of Continuation Coverage
• 411. Election Period
• 412. Length of COBRA Coverage
• 413. COBRA Premiums
• 414. Gross Misconduct
• 415. Noncompliance Penalties and Fines
• 416. Open Enrollment Period
• 417. COBRA in Retirement
• 418. Loss of COBRA Continuation Coverage
• 419. Completion of COBRA Enrollment Forms
• 420. Dental/Vision COBRA Premiums
• 421. Insurance Plan Addresses
• View all Section 400

  Attachments

• Attachment A - Sample Initial General COBRA Notice
• Attachment B - Sample COBRA Election Notice
• Attachment C - Sample COBRA Continuation Election Form
• Attachment D - Sample Notice of Unavailability of Continuation Coverage
• Attachment E - Initial General COBRA Notice Log
• Attachment F - COBRA Election Notice Log
• Attachment G - Monthly COBRA Status Report
• Attachment H - COBRA Calendar

500.  Dental Program

• 501. General Information
• 502. Current State-Sponsored Dental Plans
• 503. Responsibilities
• 504. Dental Plan Deduction Codes/Premiums
• 505. Employee Eligibility
• 506. Intentionally Unused
• 507. 24 Month Plan Restriction
• 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)

600.  Employee Assistance Program

• 601. General Information
• 602. Eligibility
• 603. Enrollment
• 604. Extension of EAP Coverage Following Layoff
• 605. Managed Health Networ
• 606. Confidentiality
• 607. Level of Counseling Services/Problem Types
• 608. Referrals
• 609. Critical Incident Stress Debriefing (CISD)
• 610. Cost
• 611. Employee Assistance Program Coordinator (EAPC)
• 612. Internal Programs
• View all Section 600

  Attachments

• Attachment A - Number of Counseling Sessions
• Attachment B - Departments with Internal EAPs

700.  FlexElect Program

• 701. General Information
• 702. Plan Options
• 703. Premium Only Plan (POP)
• 704. Eligibility for FlexElect
• 705. Election Changes/Change in Status Events
• 706. Reimbursement Account Information and Procedures
• 707. Enrollment Appeal Process
• 708. Open Enrollment Period
• 709. Newly Eligible Enrollments
• 710. Permanent-Intermittent (PI) Enrollment
• 711. Change in Pay Status While Enrolled In FlexElect
• 712. COBRA
• 713. Retiring While Enrolled in FlexElect
• 714. Unit 6 Employees
• 715. Form Completion
• 716. Std. 701C - Cash Option Enrollment Form
• 717. Std. 701R - Reimbursement Account Enrollment
• 718. HBD-12 & Std. 692 - Additional Documentation
• 719. Employee not Re-Enrolling
• 720. Forms Distribution
• 721. Correcting FlexElect Open Enrollment Documents
• 722. Cancellations/Changes to Open Enrollment Documents
• 723. Example of Situations
• View all Section 700

  Appendixes

• Appendix A - Permitting Event Codes/Date Chart

  Attachments

• Attachment A - Cash Option Enrollment Authorization (STD. 701C)
• Attachment B - Reimbursement Account Enrollment Authorization (STD. 701R)
• Attachment C - COBRA Initial Notice
• Attachment D - COBRA Election Notice
• Attachment E - COBRA Election Form (DPA 689)
• Attachment F - COBRA Confirmation Letter
• Attachment G - Premium Only Plan (POP) Disenrollment Form (DPA 006)
• Attachment H - FlexElect Reimbursement Claim Form (DPA 352)

800.  Basic Group Term Life Insurance

• 801. General Information
• 802. Eligibility
• 803. Level of Coverage
• 804. Enrollment
• 805. Supplemental Coverage
• 806. Accelerated Benefit Option
• 807. Assignment of Group Term Life Insurance
• 808. Beneficiary Designation
• 809. Reporting a Death
• 810. Continuation of Coverage Upon Loss of Eligibility
• View all Section 800

801.  Common Carrier Travel and Accident Insurance

• 801.1. General Information
• 801.2. Eligibility
• 801.3. Covered Travel Benefit
• 801.4. Exposure and Disappearance
• 801.5. Level of Coverage
• 801.6. Exclusions
• 801.7. Enrollment
• 801.8. Beneficiary Designation
• 801.9. Reporting a Covered Death/Loss
• View all Section 801

900.  Long Term Disability

• 901. General Information
• 902. Eligibility
• 903. Definition of Disability
• 904. Level of Benefits
• 905. Disability Claim Elimination Period
• 906. Pre-Existing Condition Limitations
• 907. Maximum Duration of Benefits
• 908. Plan Features
• 909. Benefit Level Plan Options and Rates
• 910. Premium Computations
• 911. Annual Premium Update
• 912. Enrollment
• 913. Ordering of Enrollment Authorization Forms
• 914. Completion of LTD Enrollment Form
• 915. Claims Process/Procedures
• 916. Continuation of Coverage Upon Loss of Eligibility
• 917. Changing Plan Categories
• 918. Cancellation of Coverage
• View all Section 900

1000.  Savings Plus Program

• 1001. General Information
• 1002. Contact Information
• 1003. Eligibility
• 1004. Enrollment
• 1005. Enrollment/Sign Up
• 1006. Review Program Materials
• 1007. Choosing an Investment Strategy
• 1008. Complete the Beneficiary Designation Form
• 1009. Contribution Limits
• 1010. Fees
• 1011. Address and Name Changes
• 1012. Catch-Up Deferral
• 1013. Age-Based Deferral
• 1014. 401(K) and 457 Loans
• 1015. 457 Unforeseeable Emergency
• 1016. 401(K) Hardship Withdrawal
• 1017. Service Credit Purchase
• 1018. Lump Sum Separation Pay
• 1019. Investment Options
• 1020. SCHWAB Personal Choice Retirement Account (PCRA)
• View Section 1000 -1020

1021.  PST Retirement Program (Part-Time, Seasonal, and Temporary)

• 1021. PST Retirement Program
• 1022.00Contact Information
• 1023.00Mandatory Coverage
• 1024.00Exempt From Coverage
• 1025. Enrollment
• 1026. Address Changes
• 1027. Beneficiary Designation
• 1028. Automatic Payroll Deductions
• 1029. Administrative Fee
• 1030. Semi-Annual Statement
• 1031. Payment/ Distributions
• 1032. Payment Methods
• 1033. CalPERS Eligible
• 1034. Investment Help
• 1035. Dormant Accounts
• View Section 1021 - 1035

1036.  Alternate Retirement Program

• 1037. General Information
• 1038. Employer Contact Information
• 1039. Mandatory Coverage
• 1040. Exempt from Coverage
• 1041. Enrollment
• 1042. Administrative Fee
• 1043. Address and Name Changes
• 1044. Beneficiary Designation
• 1045. Automatic Payroll Deductions
• 1046. Annual Statements
• 1047. Payment/ Distributions
• 1048. Payment Methods
• 1049. Direct Payment
• 1050. Direct Rollover to Another Entity
• 1051. Conversion of ARP to CalPERS Eligibility
• 1052. Eligibility to Contribute to Retirement Savings
• View Section 1036 - 1052

1100.  Excluded Employee Leave Buy Back Program

• General Information and Authority
• 1102. Eligibility
• 1103. Benefit Details
• View all Section 1100

1200.  Vision Care Program

• 1201. General Information
• 1202. Eligibility
• 1203. Enrollment
• 1204. The Vision Benefit
• 1205. How to Use the Plan
• 1206. Dual Coverage
• 1207. Direct Payment Process
• 1208. Consolidated Omnibus Budget Reconciliation Act (COBRA)
• 1209. Vision Plan Premium Rates and Address
• 1210. Instructions for Completion of Std. 700
• 1211. Instructions for Completion of Std. 703
• View all Section 1200

  Attachments

• Attachment A - Sample Vision Plan Enrollment Authorization (STD. 700)
• Attachment B - Sample Vision Plan Direct Payment Authorization (STD. 703)
• Attachment C - Permitting Event Codes/Effective Dates Chart

1300.  Worksite Wellness Program

• 1301. General Information
• 1302. Statewide Wellness Steering Committee
• 1303. Resource Guide
• 1304. Website
• View all Section 1300

1400.  Workers' Compensation

• 1401. General Information
• 1402. Employee's Responsibility
• 1403. Supervisor's Responsibility
• 1404. Reviewing Supervisor/ Management's Responsibility
• 1405. Personnel Office's Responsibility
• 1406. State Compensation Insurance Fund Responsibility
• 1407. Forms and Brochures
• 1408. Benefit Options
• View all Section 1400

  Attachments

• Attachment A - SCIF 3301
• Attachment B - SCIF SCIF 13546
• Attachment C - I've Just Been Injured on the Job, What Happens Now?
• Attachment D - SCIF 3067
• Attachment E - Witness Contact Sheet
• Attachment F - STD. 618S-IDL/S
• Attachment G - SCIF 3290
• Attachment H - First Aid vs Medical Treatment

1500.  Group Legal Services Plan

• 1501. General Information
• 1502. Eligibility Criteria
• 1503. Enrollment
• 1504. Ordering of Enrollment Forms
• 1505. Completion of The Enrollment Form
• 1506. Changes In Coverage
• 1507. Cancellation
• 1508. Continuation of Coverage Upon Loss of Eligibility
• View all Section 1500

  Attachments

• Attachment A - Plan Features at a Glance
• Attachment B - Leave of Absence Notification
• Attachment C - Group Legal Services Insurance Plan Form

1600.  Consolidated Benefits - COBEN

• 1601. General Information
• 1602. Benefit Allowance
• 1603. CoBen Calculator
• 1604. CoBen Cash
• 1605. Premium Only Plan (POP)
• 1606. Eligibility for Consolidated Benefits
• 1607. Change in Status Events (Permitting Events)
• 1608. Enrollment Appeal Process
• 1609. Open Enrollment Period
• 1610. Newly Eligible Employees
• 1611. Permanent-Intermittent (PI) Employees
• 1612. Change In Pay Status While Enrolled in CoBen Cash
• 1613. Retiring While Enrolled in CoBen Cash
• 1614. Employees Listed as Dependents on Parent's State Plan
• 1615. Form Completion
• 1616. Std. 702 - CoBen Cash Enrollment Election
• 1617. HBD 12 & Std. 692
• 1618. Employees not Re-Enrolling
• 1619. Forms Distribution
• 1620. Correcting CoBen Open Enrollment Forms
• 1621. Cancellations/Changes to Open Enrollment Forms
• 1622. Examples of Situations
• View all Section 1600

  Attachments

• Consolidated Benefits (COBEN) Cash Enrollment Election

  Appendixes

• CoBen Program Permitting Events Codes

1700.  Partial Service Retirement

• 1701. General Information
• 1702. Eligibility Criteria
• 1703. Change in Fractional Time Base
• 1704. Employee Benefits
• 1705. Method of Payment
• 1706. Employee Status
• 1707. Applications
• View all Section 1700

1800.  Family and Medical Leave Act of 1993

• 1801. General Information
• 1802. Eligibility Criteria
• 1803. Employee Coverage
• 1804. Employer Coverage
• 1805. Leave Entitlement
• 1806. Maintenance of Health Benefits
• 1807. Job Restoration
• 1808. Notice And Certification
• 1809. Unlawful Acts
• 1810. Enforcement
• 1811. Other Provisions
• 1812. Further Information
• View all Section 1800

1900.  Long-Term Care Program

• 1901. General Information
• 1902. Eligibility
• 1903. Application Period
• 1904. Coverage Choices
• 1905. Premium Information
• 1906. Payroll Deductions
• 1907. Premium Waiver
• 1908. Retirement
• 1909. Termination of Coverage
• 1910. Ordering Employer Materials
• 1911. CalPERS Long-Term Care Quick Reference Numbers
• View all Section 1900

2000.  Health Benefits

• 2001. CalPERS Health Benefits Booklet

2100.  Merit Award Program

• 2101. General Information
• 2102. Forms Distribution
• 2103. Eligibility
• 2104. Enrollment
• 2105. Participation
• 2106. Confidential
• 2107. Resource Guide
• 2108. Tax Withholding
• 2109. Website
• View all Section 2100

2200.  Pre-Tax Parking Program

• 2201. General Information
• 2102. Authority
• 2103. Benefit/Maximum Deduction
• 2204. Eligibility
• 2205. Effective Date
• 2206. Enrollment
• 2207. Claims Process
• 2208. Changes
• 2209. Cancellations
• 2210. Forfeiture
• 2211. Leave of Absence
• 2212. Employer Transfer
• 2213. Retroactive Enrollment
• 2214. Refunds
• 2215. Separation Or Retirement
• 2216. Beneficiary
• 2217. Contact
• 2218. Website
• View all Section 2200

Comments, suggestions, or questions - Please write to Susan Coats.