State of California M E M O R A N D U M To: PERSONNEL MANAGEMENT LIAISONS Date: August 13, 1993 Reference Code: 93-56 Please distribute this memorandum to all Personnel Officers, Employee Relations Officers and all Personnel Office Transactions Staff. From: Department of Personnel Administration Subject: 1993 Dental Open Enrollment Period The following information regarding the 1993 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, DentiCare of California, Inc., Private Medical Care, Inc. (PMI), and Safeguard Health Plan to provide dental insurance for: (1) annuitants; (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 employees have their own indemnity dental plan, but may enroll in the State- sponsored prepaid plans. OPEN ENROLLMENT - DENTAL Open enrollment for dental benefits will be from September 1, 1993 through September 30, 1993. Eligible employees may enroll in a dental plan, change dental plans, and add/delete dependents during this period. Employees wishing to enroll or make a change to their current dental coverage must sign a Dental Enrollment Authorization (STD. 692) no later than September 30, 1993. 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/Delete Dependent(s) 28 - Change of Plan 29 - Change of Plan and Add/Delete Dependent(s) - one enrollment form PERMITTING EVENT DATE: 9/1/93 PML 93-56 August 13, 1993 Page 2 For the current dental deduction codes, group numbers, and premium amounts, please refer to Attachments I & II. EFFECTIVE DATES: If the STD. 692 reaches the State Controller's by: Effective Date: September 10, 1993 October 1, 1993 October 12, 1993 November 1, 1993 November 10, 1993 December 1, 1993 December 10, 1993 January 1, 1994 December 31, 1993 February 1, 1994 THE STATE CONTROLLER'S OFFICE WILL NOT ACCEPT OPEN ENROLLMENT DOCUMENTS RECEIVED AFTER DECEMBER 31, 1993. NOTE: CURRENT FLEXELECT PARTICIPANTS AND THOSE ELECTING TO ENROLL IN FLEXELECT DURING THE SEPTEMBER FLEXELECT OPEN ENROLLMENT PERIOD MAY MAKE CHANGES TO THEIR DENTAL COVERAGE. HOWEVER, THESE CHANGES WILL BE EFFECTIVE JANUARY 1, 1994. NOTE: REPRESENTED EMPLOYEES WHO ARE RESTRICTED TO A PREPAID PLAN UNTIL THEY HAVE COMPLETED 24 MONTHS OF STATE SERVICE MAY ONLY ELECT OR CHANGE TO A PREPAID PLAN DURING THE OPEN ENROLLMENT PERIOD. AT THE END OF THE 24 MONTHS, THESE EMPLOYEES WILL HAVE 60 DAYS TO ELECT COVERAGE INTO THE STATE'S INDEMNITY PLAN, DELTA DENTAL. DENTAL PREMIUM RATES - EMPLOYEE COPAYMENT Attachment II reflects the State contribution and employee copay amount for represented and excluded employees enrolled in the Delta Dental Plan. It is important that employees be made aware of both the current 1993 and the increased rates which will be effective January 1, 1994. Employees who no longer want to pay the Delta Dental copay amount may change to one of the prepaid plans (DentiCare, PMI, Safeguard) during this open enrollment period. The State contribution for the prepaid plans continues to be 100 percent paid with no cost to the employee. PREMIUM ONLY PLAN (POP) The Premium Only Plan (POP) provides for the automatic pre-tax of any out-of-pocket premium copay for all excluded and rank and file employees (except employees in Unit 11). Under POP, the employees' copay is taken out of their paycheck before federal, state and social security taxes are deducted. Enrollment into POP is automatic. As the insurance premiums increase or decrease, the employees' copay will automatically change and continue to be deducted from their paycheck on a pre-tax basis as long as they are enrolled in POP. PML 93-56 August 13, 1993 Page 3 DENTAL CARRIER INFORMATION Dental carrier addresses and phone numbers are provided below for inquiries regarding claims or complaints. Delta Dental - Claims Delta Dental - Customer Service 1-800-225-3368 P.O. Box 7736 P.O. Box 429086 San Francisco, CA 94120 San Francisco, CA 94142-9086 DentiCare 1-800-999-2848 28202 Cabot Rd., Suite 600 1-800-926-7828 Laguna Niguel, CA 92607-0019 PMI 1-800-422-4234 5122 Katella Ave., Suite 206 1-800-325-4529 Los Alamitos, CA 90720 Safeguard Health Plans, Inc 1-800-352-4341 505 North Euclid Street Anaheim, Ca 92803-3210 CLAIM FORMS, EVIDENCE OF COVERAGE (EOC) BOOKLETS, PROVIDER OFFICE LISTS AND MEMBERSHIP CARDS Claim forms are not required by Dental Net, DentiCare, PMI, or Safeguard. Blue Cross claim forms are available from the Exclusive Representative(s) for Units 5 and 6. Delta Dental claim forms are available at most dental offices. Unit 13 employees should contact their union trust representative(s) for claim forms information. Although the departmental Personnel Office should maintain a small supply of "EOC" booklets and "provider lists", employees should contact the carriers directly at the phone numbers listed above for additional booklets and/or information. Membership cards (if appropriate) will be mailed by the carrier(s) after open enrollment. PML 93-56 August 13, 1993 Page 4 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 "EOC" booklet. For more detailed information regarding union sponsored plans, contact the Exclusive Representative. COBRA Current COBRA rates and the new rates effective January 1, 1994 are provided on Attachment V. Let's make this open enrollment a success; inform all employees; have informational packages available; review all documents before submitting them to SCO; and be aware of the cut-off dates. Employees should check their monthly "Statement of Earnings and Deductions" to ensure correct dental plan coverage. Please instruct your employees "not to use their dental coverage until they see a deduction on their earnings statement. If they do, they will be liable for any expenses incurred for dental services which are performed prior to their actual effective date". Employees should be directed to contact their departmental 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 William Page, Dental Program Analyst, at (916) 324-0525 or ATSS 454-0525. Patricia Pavone, Chief Benefits and Training Division Attachments cc: Del Delgado/Linda Edwards/Laverne Krebs, SCO Mark Quillici, PERS STRS CAHP DENTAL TRUST CCPOA DENTAL TRUST DEPARTMENT OF THE MILITARY FAIRS AND EXPOSITIONS LOS ANGELES COUNTY SUPERIOR COURT JUDGES VENTURA COUNTY SUPERIOR COURT JUDGES ATTACHMENT I STATE DENTAL PLAN DEDUCTION CODES, GROUP NUMBERS & PREMIUM AMOUNTS January 1, 1993 Deduction Code Deduction Code Carrier Basic Flex/POP Delta Dental - Basic 100-120 351-007 (Represented Employees/ Annuitants) Delta Dental - Enhanced 100-007 351-008 (Excluded Employees) DentiCare - Standard 100-070 351-012 (Represented Employees) DentiCare - Enhanced 100-014 351-014 (Excluded Employees/ Annuitants) PMI 100-009 351-009 Safeguard Health Plan 100-016 351-016 CAHP/Blue Cross (R05) 100-013 351-013 CCPOA/Blue Cross (R06) 100-245 351-006 CCPOA/Dental Net (R06) 100-248 351-248 (Unit 5) (Unit 6) (Unit 6) Carriers DentiCare DentiCare PMI Safeguard Blue Cross Blue Cross Dental Net (Standard) (Enhanced) Group # 901690 903042 0171 4039 336817-A 370101-E 1121SA Premiums EE only $11.20 $13.40 $12.05 $10.85 $26.37* $44.73 $44.73 EE + 1 $17.89 $22.40 $19.52 $17.30 $47.82* $44.73 $44.73 EE + 2 $24.95 $32.40 $26.85 $23.65 $69.95* $44.73 $44.73 * Employee Share $2.00/$4.00/$6.00 Note: Delta Dental premium rates are listed on the next page (Attachment II). Vision Vision Service Plan $11.25 - premium rate covers "EE only", "EE+1", and "EE+2". ATTACHMENT II DELTA DENTAL PREMIUMS - EFFECTIVE JANUARY 1, 1993 Group # 9949 Represented Employees - Basic Plan Party Code State Share Employee Copay Total Premium One Party $24.37 $6.85 $31.22 Two Party $43.82 $ 12.39 $56.21 Three Party $63.95 $18.14 $82.09 Excluded Employees - Enhanced Plan Party Code State Share Employee Copay Total Premium One Party $25.63 $6.85 $32.48 Two Party $54.21 $ 12.39 $66.60 Three Party $75.67 $18.14 $93.81 DELTA DENTAL PREMIUMS - EFFECTIVE JANUARY 1, 1994 Group # 9949 Represented Employees - Basic Plan Party Code State Share Employee Copay Total Premium One Party $24.39 $7.99 $32.38 Two Party $43.83 $ 14.47 $58.30 Three Party $63.96 $21.18 $85.14 Excluded Employees - Enhanced Plan Party Code State Share Employee Copay Total Premium One Party $25.79 $7.99 $33.78 Two Party $54.80 $ 14.47 $69.27 Three Party $76.39 $21.18 $97.57 ATTACHMENT III COMPARISON OF DENTAL PLANS PREPAID DENTAL PLANS DentiCare, Private Medical Care, Inc. (PMI), Safeguard DentiCare, PMI, and Safeguard provide dental services through panel member dentists throughout California. Many services are provided at little or no cost to you. There are no deductibles or maximum limitations, as with Delta Dental. You must enroll with a specific dentist, but you may change dentists upon request and/or change dental plans if you move and your plan is no longer available. If you need emergency dental work done and you are outside your service area, you may go to any dentist for the relief of pain and be reimbursed up to $400 per calender year within 90 days from the date of treatment. If you are interested in knowing the location of a prepaid dentist in your area, call DentiCare at 1-800-999-2848 or 1-800-926-7828, and PMI at 1- 800-422-4234 or 1-800-325-4529, and Safeguard at 1-800-352-4341. 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 California, Usual, Customary and Reasonable (UCR) fees. Member dentists will submit your treatment and/or claim 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 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 For these procedures: Employee Pays DENTICARE INDEMNITY PREPAID ENHANCED Self Dependents Diagnostic and Preventive 0 0 0 0 Basic Benefits (UCR) 10% 10% 0 0 Crowns 20% 20% $50 0 Bridges, partial, & dentures 50% 50% $65 and up 0 Annual Deductible & $25 $25 No deductible No deductible Maximum Deductible $100 per family Orthodontia (Lifetime) * * $1,000 $1,000 Annual Maximum $2,000 $2,000 No maximum 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. ATTACHMENT V COBRA DENTAL/VISION GROUP CONTINUATION RATES* Monthly Insurance Premiums Effective January 1, 1993 FAMILY DENTAL PLAN 1 PARTY 2 PARTY 3 OR MORE NAME Delta Dental (Enhanced) $32.72 $67.52 $95.28 Excluded Employees & Dependents Delta Dental (Basic) $31.44 $56.93 $83.32 Represented Employees Delta Dental (Basic) $25.45 $38.73 $51.92 Dependents of Represented Employees Only DentiCare (Standard) $11.02 $17.84 $25.04 DentiCare (Enhanced) $13.26 $22.44 $32.64 PMI $11.88 $19.50 $26.98 Safeguard Health Plan $10.66 $17.24 $23.72 Vision Vision Service Plan $11.17 $11.17 $11.17 DELTA DENTAL COBRA RATES EFFECTIVE JANUARY 1, 1994* Represented Employees: Dependents of Represented Employees: 1 Party 2 Party 3 or More 1 Party 2 Party 3 or More $32.60 $59.03 $86.41 $26.37 $40.16 $53.84 Excluded Employees & Dependents: 1 Party 2 Party 3 or More $34.03 $70.23 $99.09 Note: For Unit 13, Unit 6 and Unit 5 employees/dependents, ALL COBRA administration will be handled through the exclusive representative. Accordingly, please refer parties to IUOE (Unit 13), CCPOA (Unit 6), and CAHP (Unit 5) respectively. All COBRA enrollment documents are sent directly to the Dental/Vision carriers. * These premium rates are 102% of current premium, minus the administrative fee.