State of California M E M O R A N D U M To: PERSONNEL MANAGEMENT LIAISONS Date: August 10, 1994 Reference Code: 94-44 Please distribute this memorandum to all Personnel Officers, Personnel Transactions Supervisors and Personnel Transactions Staff. From: Department of Personnel Administration Subject: 1994 Dental Open Enrollment Period The following information regarding the 1994 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; (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, 1994 through September 30, 1994. All actions taken during this open enrollment period will become effective January 1, 1995. 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, 1994. 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) - may use one form 28 - Change of Plan 29 - Change of Plan and Add/Delete Dependent(s) - may use one form PERMITTING EVENT DATE: 9/1/94 PML 94-44 August 10, 1994 Page 2 Effective Date All documents that are submitted to the State Controller's Office (SCO) during the open enrollment period will have an effective date of January 1, 1995. The STD. 692 must reach SCO no later than December 12, 1994, in order to be effective January 1, 1995. This effective date will allow sufficient time for submission and processing of all enrollment actions. Current FlexElect participants and those electing to enroll in FlexElect during the September FlexElect Open Enrollment Period may make changes to their dental coverage. These changes will also be effective January 1, 1995. THE STATE CONTROLLER'S OFFICE WILL NOT ACCEPT OPEN ENROLLMENT DOCUMENTS RECEIVED AFTER DECEMBER 12, 1994. DELTA DENTAL RESTRICTION Represented employees who are restricted to a prepaid plan until they have completed 24 months of State service will not be allowed to enroll in Delta Dental during the Open Enrollment Period. At the end of the 24 months, these employees will have 60 days to elect coverage into Delta Dental, should they wish to do so. DENTAL PREMIUM RATES - EMPLOYEE COPAYMENT - CARRIER INFORMATION Attachment I reflects the State contribution, employee premium copay amount for represented and excluded employees enrolled in the State-sponsored Dental Plans, and carrier information. The Delta Dental rates shown are the same as the current 1994 rates. As a result, there will be no employee dental premium copay increase January 1, 1995. The State contribution for the prepaid plans continues to be 100 percent paid with no cost to the employee. DENTAL PLAN DESCRIPTIONS, CLAIM FORMS, EVIDENCE OF COVERAGE (EOC) BOOKLETS, PROVIDER OFFICE LISTS AND MEMBERSHIP CARDS, A brief description of the State-sponsored dental plans and a comparison chart is provided on Attachments II and III. For more detailed information, consult each carrier's EOC booklet. For more information regarding union sponsored plans, Units 5, 6, and 13 employees should be advised to contact their Exclusive Representative. Claim forms are not required by DentiCare, PMI, or Safeguard. Delta Dental claim forms are available at most dental offices. Although the departmental Personnel Office should maintain a small supply of EOC booklets and provider lists, employees should contact the carriers directly for additional booklets and/or information. Membership cards (if appropriate) will be mailed by the carrier(s) after open enrollment. PML 94-44 August 10, 1994 Page 3 COBRA RATES Current COBRA rates are provided on Attachment IV. DENTAL PROGRAM BOOKLET We have recently completed a Dental Program Booklet, which will provide active State employees with eligibility and enrollment information. In addition, the booklet contains a description of the State-sponsored dental plans. A copy of the booklet will be sent to the home of all eligible State employees during the latter part of August. In addition all Personnel Offices will be mailed a booklet. Information regarding the availability of additional booklets will be provided at a later date. Also, we plan to have the revised Dental Procedures Manual completed in early 1995. DEPARTMENT ROLE IN THE OPEN ENROLLMENT PROCESS Your assistance in making this open enrollment a success will be appreciated. Personnel offices are being asked to inform all employees; have informational packages available; review all documents before submitting them to SCO; and be aware of the cut-off date. All employees electing to enroll or change their dental enrollment should be advised to check their December "Statement of Earnings and Deductions" to ensure correct dental plan coverage. Please instruct your employees "not to use their dental coverage until they see the appropriate 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 CalNet 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, 1995 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 $13.42 $12.07 $10.87 $29.39* $47.25** $47.25** EE + 1 $17.91 $22.42 $19.54 $17.32 $50.83* $47.25** $47.25** EE + 2 $24.97 $32.42 $26.87 $23.67 $73.96* $47.25** $47.25** * Employee Share $5.00/$7.00/$10.00 ** Employee Share $2.50 (SCO/DPA administrative fee of $.42 is included in the total premium amount) ATTACHMENT II DELTA DENTAL PREMIUMS - EFFECTIVE JANUARY 1, 1995 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 II 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 calendar 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 1-800-750-4303. 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 your reimbursement is 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, 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 III 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 IV COBRA DENTAL GROUP CONTINUATION RATES* Monthly Insurance Premiums Effective January 1, 1995 FAMILY DENTAL PLAN 1 PARTY 2 PARTY 3 OR MORE NAME Delta Dental (Enhanced) $34.03 $70.23 $99.09 Excluded Employees & Dependents Delta Dental (Basic) $32.60 $59.03 $86.41 Represented Employees Delta Dental (Basic) $26.19 $39.89 $53.48 Dependents of Represented Employees Only DentiCare (Standard) $11.99 $19.44 $27.30 DentiCare (Enhanced) $14.45 $24.46 $35.58 PMI $12.95 $21.26 $29.41 Safeguard Health Plan $11.62 $18.79 $25.85 Note: For Unit 5, Unit 6 and Unit 13 employees/dependents, ALL COBRA administration will be handled through the exclusive representative. Accordingly, please refer parties to CAHP (Unit 5), CCPOA (Unit 6), IUOE (Unit 13). All COBRA enrollment documents are sent directly to the dental carriers. * These premium rates are 102% of current premium, minus the administrative fee.