State of California M E M O R A N D U M To: PERSONNEL MANAGEMENT LIAISONS Date: January 22, 1993 Reference Code: 93-11 THIS MEMORANDUM SHOULD BE DISTRIBUTED TO ALL PERSONNEL OFFICERS, PERSONNEL TRANSACTIONS SUPERVISORS AND PERSONNEL TRANSACTIONS STAFF From: Department of Personnel Administration Subject: Special Dental Open Enrollment for Prepaid Plans This memorandum primarily deals with issues related to a special dental open enrollment because of changes to the State of California's prepaid (capitation) dental program. Other than the 1993 increase to the employee/retiree premium copayment amounts, there has been no changes to the State's Indemnity (fee-for-service) dental program, Delta Dental. Prepaid plans have been available under the State's Dental program for ten years. In light of the premium copayment under Delta Dental, we believe some employees may now wish to examine the benefits which are available under the prepaid plans as a less costly alternative for meeting the dental needs of themselves and their eligible dependents. Under prepaid dentistry, employees should be aware that they must use "panel" dentists. Thus, these plans do not have the flexibility of the Delta Dental plan, where virtually any dental office can be used. As with any "preferred provider" (PPO) or "health maintenance organization" (HMO) there are some trade offs involved in saving money. For this reason, the choice of plans is highly individualized. SUMMARY OF ENROLLMENT Effective January 1, 1993, Private Medical-Care, Inc. (PMI), DentiCare, and Safeguard are the three state-sponsored prepaid dental carriers. These companies are available for : (1) retirees; (2) excluded employees; and (3) represented employees in Bargaining Units 1 through 21 with the exception of Units 6 and 13 who have their dental insurance provided through their respective union-sponsored trusts. Unit 5 (CAHP) employees will also be allowed to participate in this special prepaid open enrollment process. Also, in addition to the regular DentiCare plan, a new DentiCare Enhanced Plan will be available April 1, 1993, for excluded and retired employees only. Represented employees are not eligible for the DentiCare Enhanced Plan. A separate enrollment for retired employees is already underway. In order to allow employees the opportunity to enroll or change their enrollment to one of the available prepaid plans, a special prepaid dental open enrollment period will be held during the month of February. This memo will provide you important information regarding this special enrollment process. To assist you in notifying your employees, we are attaching a letter which should answer any questions they may have. This letter should be duplicated and distributed to all eligible employees as soon as possible. PML 93-11 January 22, 1993 Page 2 DOCUMENT PROCESSING This special open enrollment period will be from February 1 through February 26, 1993. During this period, eligible employees will only be allowed to enroll or change their enrollment in one of the available prepaid plans. Please note that enrollments into Delta Dental will not be allowed during this special open enrollment period. However, employees currently enrolled in Delta may elect to change their enrollment to one of the prepaid plans. Excluded employees currently enrolled in DentiCare will automatically be transferred into the new DentiCare Enhanced Plan and receive the higher level of benefits effective April 1, 1993. It is therefore, not necessary for these employees to complete a dental enrollment form during this open enrollment process. Personnel Offices should audit all enrollments to ensure that only eligible (excluded) employees enroll in the new DentiCare Enhanced Plan. Effective Date All documents processed during this special open enrollment period will be effective April 1, 1993. Completed documents must be received at the State Controller's Office (SCO) by March 10, 1993. Documents received after the March 10th cutoff will be returned and the employee will be required to make their change during the annual dental open enrollment period scheduled for September, 1993. The following information should be used on all STD-692, Dental Enrollment documents: Permitting Event Date - 2/1/93 Permitting Event Code - 03 Effective Date - 4/1/93 Flex Participants As you are all aware, employees enrolled in the traditional FlexElect Program are not normally allowed to change their health and/or dental plans during the Flex Plan Year. In light of the increased out-of-pocket premiums for Delta Dental, we believe that some employees enrolled in FlexElect may wish to enroll in a prepaid plan which is fully funded by the State with no out-of-pocket premium deduction. As a result, we will allow Flex participants to change to a prepaid dental carrier during this special enrollment process. If a Flex participant who is currently enrolled in a State sponsored dental plan wishes to change to one of the available prepaid plans they will need to complete a STD-701, FlexElect Enrollment Form and submit it along with the required STD-692. The following information should be used on the STD-701: Permitting Event Date - 2/1/93 Permitting Event Code - Leave Blank Effective Date - 4/1/93 PML 93-11 January 22, 1993 Page 3 Please note that in addition to indicating the new dental code information, all other items on the Flex enrollment form must be completed exactly like the employee's original Flex document. The reason for this is that SCO has to reenter all of the Flex election information, not just the information that is changing. Also, please remember that the STD-701 will only be necessary for those employees who elected to enroll in the traditional Flex Program. Employees in POP (Premium Only Plan) will not be required to submit a STD-701 with their dental enrollment change. Dental Rates and Codes Attachment I provides a listing of all dental plans, along with their appropriate codes and rates. In addition, the address and phone number of each dental carrier is listed. Since premium rates will remain in effect until January of 1994, this Attachment should be maintained for use in completing all your dental documents in 1993. DENTAL PLAN COMPARISON Attachment II provides a summary description of the prepaid plans and Delta Dental. Effective April 1, 1993, a new prepaid enhanced plan, DentiCare Enhanced, will be available to all excluded employees, as well as retirees. Like the regular prepaid plans, the general services under the DentiCare Enhanced Plan are provided at no charge to the member and eligible dependents. These services included preventive and diagnostic services, fillings, oral surgery, root canals, crowns, bridges and dentures. The plan features enhanced benefits for: Teeth Cleaning - Three per year are covered at no charge and the fourth cleaning is covered for a $30 co-payment. General Anesthesia Treatment of Temporomandibular Joint Dysfunction (TJM) Cosmetic Bonding Periodontics Endodontics Like the standard prepaid plans, the DentiCare Enhanced Plan requires no claim forms, no deductibles and no annual maximum of dental benefits provided by the general practitioner. Attachment III provides a benefit comparison chart which outlines the various dental benefits available under both the prepaid and indemnity plans. We are including this chart as an attachment to the letter to all eligible employees. Accordingly, please ensure that this chart is duplicated with the employee letter. For more detailed benefit information the employees should be instructed to refer to the respective coverage booklets. Employees should also be advised to review the provider lists for the prepaid plan they are considering prior to making their election change. We are aware that in some areas of the State, particularly, Northern California, there are limited providers. We continue to work with all of the prepaid plans in their efforts to expand their provider network. PML 93-11 January 22, 1993 Page 4 The prepaid plans providers are only located in California, with the exception of DentiCare who has limited providers in the States of Arizona, Oregon and Washington. Accordingly, eligible employees who reside in Chicago, Dallas or New York will not be able to enroll in any of the state-sponsored prepaid plans. All prepaid plans continue to be fully funded by the State with no out-of-pocket premium deduction required. Prepaid Carrier Benefit Booklets and Provider Lists We have been advised that PMI distributed their benefit booklets/provider lists to all departments last September. Those booklets can be used for this special open enrollment process. Departments should also have a supply of the regular DentiCare benefit booklets; booklets/provider lists for the DentiCare Enhanced Plan should be received prior to February 1. Safeguard has indicated that their booklets/provider lists are also being mailed and should be delivered shortly. Should you need additional booklets/provider lists please contact the carriers directly at the 800 numbers listed on Attachment I. Please ensure that the attached letter to all eligible employees and the comparison chart are duplicated and distributed to all eligible employees as soon as possible. Employees should be advised of any internal dates your department may wish to establish to ensure that documents are received, processed and forwarded to SCO by the March 10, 1993 deadline. Please note that there will be no retroactive enrollment. Documents not processed within the required timeframes will be returned and employees will be required to wait until the annual dental open enrollment period in September in order to make a plan change. Should you have any questions regarding this enrollment process, please contact Nicolas Villa, Statewide Dental Coordinator, at (916) 324-9486 or CalNet 8-454-9486. Patricia Pavone, Chief Benefits and Training Division Attachments cc: Linda Edwards - SCO PERS STRS Department of the Military Fairs and Exposition CAHP Dental Trust CCPOA Dental Trust Los Angeles County Superior Court Judges Ventura County Superior Court Judges