Dental Program California Department of Human Resources - PowerPoint Presentation

Slide1

Dental Program

California Department of Human ResourcesSlide2

OBJECTIVES

Your Responsibilities

24- Month Restriction

Imputed Tax Situations

Mandatory/Standard Rules Slide3

Benefits Administrative Manual

Location

:

www.CalHR.ca.gov

Click

on:

State HR

Professionals

Click on:

Dental Program

box

or

Click

on:

Benefits

Administration -

Dental Program

Slide4

Direction to the PMLs

Location:

CalHR

website

Click on

State HR Professionals

Scroll down to

Click on: Policy Memos boxSlide5

Dental Program Coordinator

Sandra Lobatos-Chico

Christina Campbell

Anne Santos

Phone: (916) 322-0300

Fax 855-290-0158

Email: dental@calhr.ca.govSlide6

Eligibility List for Updating Dental

If you would like to be added to our list that allows you to call the carrier and update your employees dental eligibility or personal information, have your manager or supervisor send an email to Penny Jones:

at

penny.jo

nes@calhr.ca.govSlide7

Eligibility List for Updating Dental cont. 2

All updates are due before the 10

th

of the month. If the updates are not received before the 10

th

, they will have to wait until the following month to get updated.

When someone who is on this list leaves the department, make sure you delete them from this listing ASAP. This is to assure there is no confusion between you and the carrier. We don’t want them to be on the list twice under two different departmentsSlide8

Current State-Sponsored Dental Plans BAM Section 502

Four prepaid plans: DeltaCare USA, Premier Access, SafeGuard, and Western Dental

.

Delta Dental Indemnity type plan referred to as Delta Dental PPO plus Premier, and the Delta Preferred Provider Option (PPO).Slide9

Dental Options

Section 502

These plans provide dental benefits for:

All eligible active and retired employees

and their eligible dependents;

With the exception of employees in Bargaining Units 5 and 6 which have their own Union sponsored plans. Slide10

Prepaid PlansBAM Section 502

Requires that the enrollee choose a dentist from a specific list of dentists.

These dentists make up what is referred to as the dental carrier’s provider network.

The monthly premium is fully paid by the state and no premium deduction is taken from employees payroll.Slide11

Your ResponsibilitiesSection 503

You are responsible for notifying employees of:

Benefit eligibility guidelines and timeframes for enrollment

. Completing enrollment documents and submitting to SCO in a timely manner.

Applicable provisions of Consolidated Omnibus Budget Reconciliation Act (COBRA).Slide12

24 Month Plan RestrictionBAM Section 506

All

eligible newly hired represented employees in BU’s 1-21 (except Units 2, 7, 8, 16, 17, 18,

19

, and excluded employees) are required to select from one of the prepaid plans.

All impacted employees must complete 24 months of employment with

no permanent break in service.Slide13

24 Month RestrictionSection 506

It’s your responsibility to notify impacted newly hired employees of this

restriction

and to

give these employees an end date to this restriction.

At that point, it’s their responsibility to initiate a new STD. 692 to change their dental plan. Slide14

1-24 Month Plan RestrictionBAM Section 506 -

Use PEC: 08

At the end of the 24-month restriction, employees will have 60 days to change their enrollment, unless they enrolled in the FlexElect cash option for dental.

Once

an employee reinstates after a permanent separation and

*previously

had 24-months of

state

service may enroll in Delta

Dental PPO plus Premier or Delta PPO

Plan at the time of

hire.

*Make a note of it in the remarks box.Slide15

2-24 Month Plan RestrictionBAM Section 506

All eligible newly hired represented employees in BU’s 2, 7, 8, 16, 17, 18, 19, and excluded (non-represented/CoBEN) may elect Delta Dental PPO plus Premier or PPO Plan. They are not restricted to state-sponsored prepaid plans.Slide16

Exceptions to 24-Month Restriction Period BAM Section 506

Employees who are hired to state service with a LT or TAU appointment may use time served in those classes –

no permanent break in service

to count towards meeting the 24-month restriction.

Including employees

hired to s

tate service

with their own current

s

tate

sponsored Delta

dental

.Slide17

Exceptions to 24 Months Restriction BAM Section 506

CalPERS retiree – reinstating from retirement status and eligible as an active employee for dental coverage.

New hire or transfer (no break in service) from another agency or CSU.

Time not counted

: Student assistants, temporary or seasonal employees (with the exception of Seasonal Firefighters and Lifeguards). Slide18

Dependent EligibilityBAM Section 508

Eligible dependents are defined as:

Spouse, domestic partner (certified by the Secretary of State)

An eligible child/stepchild/economically dependent child.

Common law marriage not allowed.Slide19

Domestic Partnerships

Stop Imputed Tax

If your employee is claiming their Domestic Partner as an economic dependent for Federal Income Tax purposes as authorized by the Internal Revenue Service, they will need to fill out the form CalHR 680.

Use Party Code 2 or Party Code 3 when filling out the STD 692. Indicate in box 18 (remarks section)

CalHR 680 on file

.

Slide20

Domestic Partners

Imputed Tax Applies Here

If they are claiming them as a dependent for dental benefits this form does not need to be filled out and the Party Code would say “A” (party code 2) or “B” for a (party code 3).

SCO will apply the imputed tax.Slide21

Medically Disabled Dependent Children Section

508

A disability certification is required to ensure disabled dependent children remain covered after the age of 26.

(CalPERS HBD 34)Slide22

Eligible Medically Disabled Dependent Children

Eligible Medically Disabled Dependent

Children over age 26 can remain covered if:

The dependent was enrolled as a disabled child at the time of the employee’s initial enrollment; or

The

dependent became disabled while enrolled as an eligible family member prior to attaining the age of 26. Slide23

1-Ineligible Medically Disabled Dependent Children

The following disabled dependent children are excluded from coverage:

Dependent whose disability occurred after age 26.

Dependents over age 26 who were enrolled in, and later deleted from, any State-sponsored dental plan. Slide24

2- Ineligible Medically Disabled Dependent Children

continued:

Dependents over age 26 who are not currently enrolled in any State-sponsored dental plan.Slide25

Employees on Their Parents Plan When Hired BAM Section 508

When dependent children of state employees who are under the age of 26 become state employees, they can remain on their parents plan until the age of 26.

If the dependent children do not qualify for state dental benefits as state employees they may remain on their parent's state-sponsored plan, provided they are under age 26. Slide26

1-Dual/Split CoverageBAM Section 508

Dual coverage not allowed.

Split coverage not allowed.Slide27

2-Dual/Split CoverageBAM Section 508

All dependent children must be enrolled by one State employee if both parents are state employees.

Departments must correct these enrollments retroactive to the date they began and notify the employee and submit to SCO for corrective action.Slide28

1-Court Ordered Dental CoverageBAM Section 508

Court orders are generally subject to program’s eligibility rules.

In adding a child/children complete the STD. 692, using Permitting Event Code 16. Slide29

2-Court Ordered Dental CoverageBAM Section 508

If a court order is issued and your employee has voluntarily deleted a spouse you must reenroll the spouse until the divorce is final, at that point it’s mandatory that the ex-spouse be deleted from coverage and now eligible for COBRA. (PEC 17a or 21a).Slide30

3-

Court Ordered Dental Coverage

BAM Section 508

When completing the STD. 692 resulting from the court order indicate in the Remarks Section “Court Ordered”.Slide31

1-Mandatory DeletionsBAM Section 511

Dependents that

must

be deleted:

Divorced. (However, COBRA must be offered.)

Termination of a Domestic Partnership. (Employee must provide copy of notice of termination and COBRA must be offered to terminated domestic partner.)Slide32

2-Mandatory Deletions BAM Section 511

Death of a dependent (maybe done administratively upon seeing death certificate – note it in the remarks box).

Dependent child reaches age of 26.

Dependent goes into military.Slide33

3-Mandatory DeletionsBAM Section 511

Dependent no longer economically dependent or change of custody.

Dependent enrolled but never eligible.

Dependent dual or split covered.Slide34

1-Voluntary Changes BAM Section 511

Adding new spouse, certified domestic partner and/or stepchild to a one, two, or more party enrollment. (PEC 17a or 21a)

Adding newborn, adopted child, or child at each birthday until the age of 6. (PEC 19 or 22a)Slide35

2-Voluntary Changes BAM Section 511

Adding spouse, certified domestic partner and/or dependents that lost coverage. (PEC 17b - Must provide proof of loss of coverage.)Slide36

3-Voluntary ChangesBAM Section 511

Adding a dependent due to a change in custody and/or acquiring an economically dependent child. (PEC 16)

Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible).

(PEC 24b – not applicable in the event of a pending divorce, separation or annulment)Slide37

4-Voluntary ChangesBAM Section 511

Deleting a dependent who obtains other group coverage (non-State sponsored). (PEC 23b)Slide38

1-Administrative DeletionsBAM Section 511

Dependent who reaches age 26 and not disabled. (PEC 26d)

Employees and/or dependents enrolled but not eligible. Must be deleted retroactive to the effective date. (PEC 42)

Employees enrolled, but not eligible due to bargaining unit change and the employee refuses to sign. Delete retroactive to the effective date. (PEC 42)Slide39

2-Administrative Deletions

Death of a

S

pouse, domestic partner or child

Must see the death certificate and make a note in the remarks section of the 692.Slide40

1-Effective DatesBAM Section 512

Mandatory Effective Date Rule:

First of the month following the permitting event that allows the action to occur.

Example: Event occurs any time during the month, the event will be the first day of the month immediately following the event. Divorce final 10/31. Effective 11/1.Slide41

2-Effective DatesBAM Section 512

S

tandard Effective Date Rule:

First of the month after STD. 692 is completed and received by the employing department.

Example - EE hired 1/14 and submits the 692 on 2/11 the effective date is 3/1.Slide42

1-Re-Enrollment of EmployeesBAM Section 513

Reinstatement after a Leave of Absence:

Coverage in the same dental plan is automatically restored. Effective the first of the month after the first pay warrant is issued by SCO. Slide43

2-Re-Enrollment of EmployeesBAM Section 513

Reinstatement after Appeal:

SCO requires that a STD. 674 Payroll Adjustment Notice, be submitted to reinstate an employee’s benefit deductions.

The effective date can be current or retroactive.Slide44

Continuation of Coverage While Off Pay Status BAM Section 515

Employees on non-pay status may continue dental coverage, by paying the total premium directly to the carrier.

Employees must complete the STD 696 and forward to the carrier with a check for three months premium amount. The carrier will not send a bill.

It does not come to CalHR.Slide45

Dental Carrier Information

Delta

Dental: 1-800-225-3368

www.deltadentalins.com/state/

DeltaCare USA

:

1-800-422-4234

www.deltadentalins.com/state

Premier Access: 1-888-534-3466

http://

www.socdhmo.com

SafeGuard: 1-800-880-1800

www.SafeGuard.net

Western Dental: 1-866-859-7525

www.westerndental.com/stateofca Slide46

Personnel Staff YOU

Rock!!

Thank you for all that you do!