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DENTAL ENROLLMENT FORM DENTAL ENROLLMENT FORM

DENTAL ENROLLMENT FORM - PowerPoint Presentation

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Uploaded On 2017-07-10

DENTAL ENROLLMENT FORM - PPT Presentation

TRAINING CALIFORNIA DEPARTMENT OF HUMAN RESOURCES BENEFITS DIVISION Dental Enrollment Form blank sample Allows for New Enrollments Cancellation Changes Dental Enrollment Form Std 692 Revision February 2016 ID: 568863

benefits dental calculator section dental benefits section calculator form date permitting enrollment sco plan code event number box missing

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Presentation Transcript

Slide1

DENTAL ENROLLMENT FORMTRAINING

CALIFORNIA DEPARTMENT OF HUMAN RESOURCES

BENEFITS DIVISIONSlide2

Dental Enrollment Form –

blank sampleSlide3

Allows for:• New Enrollments

• Cancellation

• Changes

Dental Enrollment Form – Std. 692 Revision February 2016Slide4

SECTION A

Section A

Type of Action

New

Cancel – to cancel all dental coverage.

Changes

COBRA – does not get processed by SCOSlide5

SECTION B

1. DENTAL PLAN NAME

– need

full name

of dental plan name, not just Delta Dental.

2. Provider/Facility Number

(if applicable) – please provide the number only.

3. Employee and dependents name –

Legibility is important. 26 yr. olds not allowed, unless disabled, please note in the remarks section.

4. Relationship –

Verify Marital status.

5. Action Code –

A (add) or D (delete) only allowed!Slide6

Prepaid Plans

Box 1: Name of Dental Plan – please make sure the dental plan name matches with the dental code.

Box 2: Provider/Facility Number (if applicable) (prepaid plans only) – This number can be obtained from the employee’s dental office or through the dental carrier directly.Slide7

SECTION CSlide8

1. A box must be checked.

2. Employee’s signature.

3. Date employee signed the Std. 692.

Section DSlide9

Section ESlide10

2-Reminder for the STD 692

Do not forget to put in

permitting

e

vent date, permitting

e

vent

c

ode, and effective

date of action.

Any

information needed to process the

form,

add in the remarks section

.

Section

E, and

box 3 must be accurate.Slide11

Helpful Hints

When deleting twins, deletion can be on one form

.

The Permitting event must happen first.

Always audit the Std. 692 prior to submitting to SCO for processing.

If you can’t read the writing, then the carriers can’t either. This will cause a problem with accuracy.

Make sure the employee list all their dependents on the form, if they are making changes. Slide12

1-Reasons for SCO Enrollment Rejection

Permitting Event Code is missing or invalid.

Plan name and Org Code doesn’t match (Section B and E).

Party Code is missing or invalid.

Permitting event date is missing or invalid.Slide13

2-Reasons for SCO Enrollment Rejection

Event must happen first.

Standard events: date rec’d by employing office cannot be prior to the permitting event date.

Mandatory events: date rec’d at SCO can’t be prior to the permitting event date.

Section D is not checked. Slide14

3-Reasons for SCO Enrollment Rejection

Family member is missing, check against SCO HIST for party code.

When several permitting events are occurring, they must be submitted on separate forms.

All forms are to be signed by authorized agency personnel.Slide15

BENEFITS CALCULATOR

OVERVIEWSlide16

BENEFITS CALCULATOR

Go To:

CalHR

Website (www.calhr.ca.gov)

C

lick on:

State Employees

Scroll down to:

Health, Dental and VisionClick on:

Benefits CalculatorSlide17

Benefits Calculator – Select Year and Bargaining UnitSlide18

Benefits Calculator – Selected Year and Bargaining UnitSlide19

Benefits Calculator Select a Bargaining Unit Slide20

Benefits Calculator – select plan optionsSlide21

Benefits Calculator - Benefits Comparison

con’tSlide22

Benefits Calculator Results – error messageSlide23

Benefits Calculator Results – messageSlide24

Benefits Calculator Application Template – View/PrintSlide25

Dental Form, input required informationSlide26

Dental Form, input required

information,

con’tSlide27

Benefits Calculator - Open Your Benefits FormSlide28

Dental Enrollment Form Populates, Section A and BSlide29

Benefits Calculator Section C,

Section DSlide30

Dental Enrollment Form, Section ESlide31

Dental Program Coordinators

Sandra Lobatos-Chico

Christina Campbell

Anne

Santos

Phone Number: 916-322-0300

Fax: 855-290-0158

Email: dental@calhr.ca.gov