State of California M E M O R A N D U M To: PERSONNEL MANAGEMENT LIAISONS Date: August 14, 1992 Reference Code: 92-94 Please distribute this memorandum immediately to all Personnel Officers, Employee Relations Officers and all Personnel Office Transactions staff. From: Department of Personnel Administration Subject: 1992 Dental Open Enrollment Period The following information regarding the 1992 Dental Open Enrollment Period should be distributed to all employees as soon as possible. DENTAL PROGRAM INFORMATION The Department of Personnel Administration (DPA) has current contracts with Delta Dental Plan, California Dental Health Plan, DentiCare and PMI/Delta Care to provide dental insurance for: (1) annuitants; (2) excluded employees; and (3) represented employees in Bargaining Units 1 through 21 with the exception of Unit 5, who are eligible to enroll in the three state-sponsored prepaid plans, and Units 6 and 13 who have their dental insurance provided through their respective union-sponsored trusts. OPEN ENROLLMENT - DENTAL Open enrollment for dental benefits will be from September 1, 1992 through September 30, 1992. Eligible employees may enroll in a dental plan, change dental plans, and add/delete dependents during this period. Employees taking action during this period must sign their enrollment form no later than September 30, 1992. No action is necessary for those employees who are currently enrolled and do not wish to make any changes in their dental coverage. Documentation Please use the following information when completing the dental open enrollment documents: PERMITTING EVENT CODES: 03 - New Enrollment 15 - Add Dependent(s) 28 - Change of Plan 29 - Change of Plan and addition of dependent(s) on one enrollment form PML 92-94 August 14, 1992 Page 2 PERMITTING EVENT DATE: September 1, 1992 For the current dental deduction codes, group numbers, and premium amounts, please refer to Attachment I. EFFECTIVE DATES: If the Form STD-692 reaches the State Controller's by: Effective Date: September 10, 1992 October 1, 1992 October 9, 1992 November 1, 1992 November 10, 1992 December 1, 1992 December 10, 1992 January 1, 1993 December 31, 1992 February 1, 1993 THE STATE CONTROLLER'S OFFICE WILL NOT ACCEPT OPEN ENROLLMENT DOCUMENTS AFTER DECEMBER 31, 1992. NOTE: CURRENT FLEXELECT PARTICIPANTS AND THOSE ELECTING TO ENROLL IN FLEX DURING THE SEPTEMBER FLEX OPEN ENROLLMENT PERIOD MAY MAKE CHANGES TO THEIR DENTAL COVERAGE HOWEVER THESE CHANGES WILL BE EFFECTIVE JANUARY 1, 1993. DENTAL RATES - EMPLOYEE COPAYMENT Recently negotiated collective bargaining agreements have changed the State's contribution for the Delta Dental premium. The chart provided on the following page shows the State contribution and employee copay amount for represented employees effective with the July 1992 pay period (warrants issued July 31, 1992). The employee copay amount applies only to represented employees, as the State will pay the full premium for excluded employee through the remainder of the calendar year. Also reflected are the Delta rates and employee copay which will go into effect January 1, 1993 for all represented and excluded employees. It is important that employees be made aware of both the current and new rates for 1993 as there will not be a special open enrollment period in January to allow current Delta enrollees to elect prepaid coverage because of the increase in the employee copay amount. Therefore, employees who do not want to pay the 1/1/93 copay amount MUST change to one of the available prepaid plans during this open enrollment period. PML 92-94 August 14, 1992 Page 3 DELTA DENTAL PREMIUM - EFFECTIVE JULY 1, 1992 Represented Employees - Basic Plan Party Code State Share Employee Copay Total Premium One Party $24.37 $3.30 $27.67 Two Party 43.82 5.97 49.79 Three Party 63.95 8.74 72.69 DELTA DENTAL PREMIUM - EFFECTIVE JANUARY 1, 1993 Represented Employees - Basic Plan Party Code State Share Employee Copay Total Premium One Party $24.37 $ 6.70 $31.07 Two Party 43.82 12.05 55.87 Three Party 63.95 17.59 81.54 Excluded Employees - Enhanced Plan Party Code State Share Employee Copay Total Premium One Party $26.04 $ 6.70 $32.74 Two Party 55.04 12.05 67.09 Three Party 76.89 17.59 94.48 The following collective bargaining units have agreed to the above listed employee copayments: #1 Administrative, Financial and Staff Services; #4 Office and Allied; #5 California Highway Patrol; #7 Protective Services and Public Safety; #8 Firefighter; #10 Professional Scientific; #12 Craft and Maintenance; #13 Stationary Engineer; #15 Allied Services; #16 Physician, Dentist and Podiatrist; #17 Registered Nurse; #18 Psychiatric Technician; #19 Health and Social Services Professional; #20 Medical and Social Services; and #21 Educational Consultant, Library and Maritime. Until contracts are ratified for Bargaining Units 2, 3, 9, 11 and 14 the State contribution will continue at the current level of $27.67 for an eligible employee, $49.79 for an eligible employee and one dependent, and $72.69 for an eligible employee and two or more dependents. Upon ratification, rates and copays will be implemented. The State contribution for Unit 6 will also remain at the current level. The State sponsored prepaid dental plans continue to be fully State funded with no cost to the employee for the premiums. Employees who do not wish to participate in the Delta Dental premium copayment and want to change to one of the prepaid plans must change plans during the September dental open enrollment period. PML 92-94 August 14, 1992 Page 4 Employees who belong to unions who have negotiated automatic pretax of any out of pocket premiums will be automatically enrolled in the Premium Only Plan (POP). Unit 11 is the only unit which has elected not to provide POP. DENTAL CARRIER INFORMATION Dental carrier addresses and phone numbers are provided below for inquiries regarding claims or complaints. California Dental Health Plan (CDHP) 1-800- 622-6388 P.O. Box 899 Tustin, CA 92681-0899 Delta Dental 1-800- 225-3368 P.O. Box 7736 San Francisco, CA 94120 DentiCare 1-800- 926-7828 28202 Cabot Rd., Suite 600 Laguna Niguel, CA 92607-0019 PMI/Delta Care (North) 1-800-422-4234 5122 Katella Ave., Suite 206 (South) 1-800-325-4529 Los Alamitos, CA 90720 NOTE: The State is currently in a bidding process for the Prepaid Plans. Information regarding any change in carrier(s) or in plan design that may result from this process will be distributed at a later date. If necessary an extended or new open enrollment period will be held to allow employees the opportunity to enroll in any new prepaid plan(s). Until that information is available, employees should make their dental plan choice from the plans listed above. CLAIM FORMS, EVIDENCE OF COVERAGE BOOKLETS, PROVIDER LISTS AND MEMBERSHIP CARDS Claim forms are not required by PMI, CDHP or DentiCare. Blue Cross claim forms are available from the Exclusive Representative(s) for Units 5 and 6. Delta Dental claim forms are available at dental offices. The new Delta Dental Plan Evidence of Coverage booklets are not available at this time. Please refer to Attachment II, which can be copied and used as a handout to employees interested in the information on the coverage under the Delta Dental Plan. PML 92-94 August 14, 1992 Page 5 Blue Cross Evidence of Coverage booklets will be available from the Exclusive Representative(s). To order provider lists and Evidence of Coverage booklets from PMI, CDHP and DentiCare, please call the respective carrier directly at the phone numbers listed above. Membership cards (if appropriate) will be mailed by the carrier(s) after open enrollment. DENTAL PLAN DESCRIPTIONS A brief description of the State sponsored dental plans and a comparison chart is provided on Attachments III and IV. For more detailed information, consult each carrier's Evidence of Coverage booklet. For more detailed information regarding union sponsored plans, please contact the Exclusive Representative. Employees should be directed to contact their Personnel Office if they have any questions regarding this open enrollment period. Personnel Office staff requiring assistance or clarification of the information contained in this memo should call Nicolas Villa, Statewide Dental Coordinator, at (916) 324-9486 or ATSS 454-9486. Patricia Pavone, Chief Benefits and Training Division Attachments cc: Linda Edwards, SCO PERS STRS DEPARTMENT OF THE MILITARY FAIRS AND EXPOSITIONS LOS ANGELES COUNTY SUPERIOR COURT JUDGES ATTACHMENT I STATE DENTAL PLAN DEDUCTION CODES, GROUP NUMBERS & PREMIUM AMOUNTS JULY 1, 1992 Deduction Code Deduction Code Carrier Basic Flex/POP Delta 100-120 351-007 (Represented Employees/ Annuitants) Delta 100-007 351-008 (Non-Represented Employees) CDHP 100-050 351-011 PMI/Delta Care 100-009 351-009 DentiCare 100-070 351-012 Blue Cross (Unit 5) 100-222 351-005 Blue Cross (Unit 6) 100-245 351-006 CDHP (Unit 6) 100-247 351-003 (Unit 5) (Unit 6) (Unit 6) Carriers DentiCare PMI CDHP Blue Cross Blue Cross CDHP Group # 901690 0171 I600 361165A 100-245 100-247 Premiums EE only $10.48 $11.19 $ 11.12 $25.37* $44.73** $44.73** EE + 1 16.97 18.10 17.56 45.32* 44.73** 44.73** EE + 2 23.74 24.89 23.44 65.95* 44.73** 44.73** Delta - Basic Delta - Enhanced (Represented EE's (Excluded EE's) and Annuitants) Group # 9949 9949 Premiums EE only $27.67*** $28.79** EE + 1 49.79*** 58.98** EE + 2 72.69*** 83.06** NOTE: EXCLUDED EMPLOYEES WILL HAVE THEIR FULL DENTAL PREMIUM PAID BY THE STATE UNTIL JANUARY 1, 1993. FOR JANUARY 1, 1993 RATES SEE PAGE 3 OF PML 92-.... ISSUED AUGUST......... * Includes employee copay of $1.00, $1.50 and $2.00 each. ** No employee copay as of January 1, 1992. *** Includes employee copay of $3.30, $5.97 and $8.74. ATTACHMENT III COMPARISON OF DENTAL PLANS PREPAID DENTAL PLANS California Dental Health Plan, DentiCare, Private Medical Care CDHP, DentiCare, and PMI provide dental services through panel member dentists throughout California. Many services are provided at no or little cost to you, there are no deductibles or maximum limitations, as with Delta Dental. Also, many Delta dentists participate as prepaid panel providers to accommodate the State in ensuring affordable dental services at reasonable rates. However, you must enroll with a particular dentist, but you may change dentists if you experience a service plan cut and/or change dental plans if you move and your plan is no longer available. If you need emergency work done and you are outside your service area, you may go to any dentist and be reimbursed up to $400 per year within 90 days from date of treatment. If you are interested in knowing the location of a CDHP, DentiCare, or PMI dentist in your area, call CDHP at 1-800-622-6388, DentiCare at 1-800-999-2848, and PMI at 1-800-422-4234 (NoCal), 1-800-325-4529 (SoCal). INDEMNITY DENTAL PLAN Delta Dental Plan of California - Group #9949 Delta Dental features freedom of choice of dentist, full access to specialty care and guaranteed benefits through member dentists. Your present dentist may be a member of Delta Dental. However, you can see any dentist worldwide and still be covered as costs are assessed on the Usual, Customary and Reasonable (UCR) fees for California. Member dentists will submit your treatment forms to Delta Dental. When you go to a non-participating dentist, either in California or out of state, your reimbursement will be based on the fee charged or the fee which satisfies the majority of Delta Dental's participating dentists, whichever is less. If you are out of state, you can be reimbursed from an itemized receipt or by submitting any standard claim form. Payment for services on non-participating dentists, both in California and out of state, will be made directly to you. For more information, contact Delta Dental at 1-800-225-3368. NOTE: These are brief descriptions and comparisons of the available dental plans. Please consult each carrier's "Evidence of Coverage" booklet or call the carrier for a more detailed explanation. ATTACHMENT IV COMPARISON OF DENTAL PLANS FOR REPRESENTED EMPLOYEES ONLY - BASIC PLAN For these procedures: Employee Pays INDEMNITY PREPAID Self Dependents Diagnostic and Preventive 0 0 0 Basic Benefits (UCR) 10% 20% 0 Crowns 20% 50% $50 Bridges, partial, & dentures 50% 50% $65 and up Annual Deductible & $50 $50 No deductible Maximum Deductible $150 per family Orthodontia (Lifetime) * * $1,000 Annual Maximum $2,000 $1,000 No maximum FOR EXCLUDED EMPLOYEES ONLY - ENHANCED PLAN For these procedures: Employee Pays INDEMNITY PREPAID Self Dependents Diagnostic and Preventive 0 0 0 Basic Benefits (UCR) 10% 10% 0 Crowns 20% 20% $50 Bridges, partial, & dentures 50% 50% $65 and up Annual Deductible & $25 $25 No deductible Maximum Deductible $100 per family Orthodontia (Lifetime) * * $1,000 Annual Maximum $2,000 $2,000 No maximum * Delta will pay up to $1,000 for employee and each dependent for orthodontia. The employee is responsible for any amount over the $1,000 maximum.