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Vision Care Program

​​​​​​​​​​​​​​​​​​​​​​​​​​​​Important Policy Updates

 

Vision Changes for 2022

Content

Attachments​​​​

Questions Regarding the State Vision Program for Actives and Retirees

If you are an active state employee, please contact your department's personnel office. Personnel office staff requiring assistance or clarification regarding active employees or retirees enrolled in the state's vision program, please send an email to the Vision program at Vision@calhr.ca.gov.

2022 VISION Program

Premier Vision Plan

The Premier Vision Plan is available to eligible state employees and retirees. Retiree vision benefits are the same as active employee benefits, except retirees pay the full premium.

Plan Premiums

Vision Plan Deduction Codes and Premiums PDF ​​​​​​​

Basic Vision Plan

The state’s basic vision plan is part of the VSP Advantage network and is an automatic benefit provided by the State of California for eligible state employees and their dependents.

1201. General Information

The California Department of Human Resources (CalHR) administers the state's Vision Care Program and maintains the contract between the state and the carrier. The current carrier, Vision Service Plan (VSP), provides vision coverage plans

Plan                         Group Number

Basic Plan             30052011​​

Premier Plan        30034581

Retiree Basic        30052010

Retiree Premier  30058000

Authority

CalHR Rule 599.927  Non-Represented Employees

Memoranda of Understanding  Rank and File Employees

Government Code 22959.1 - 22959.6  Retirees

1202. Eligibility - BASIC and PREMIER

Employees

State employees designated rank and file, managerial, supervisory, confidential, and all other employees excluded from collective bargaining, Constitutional Officers, employees of the Judicial Council, Supreme, Appellate, and Superior Court Judges who meet the following criteria:

  1. A permanent employee appointed half-time or more.
  2. An employee appointed limited-term (LT) or temporary authorization (TAU) for six months or more with a time base of half-time or more.
  3. A permanent intermittent employee who works a minimum of 480 hours in a six-month qualifying control period (January 1-June 30 and July 1-December 31).
  4. A former retired state employee who is currently enrolled in state COBRA vision benefits and/or Retiree Vision Program and reinstates as a permanent intermittent.
  5. An employee appointed under Government Code Section 21228.
  6. Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU
  7. Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.

Employees in Bargaining Unit 6  California Correctional Peace Officers Association (CCPOA) have vision coverage through their union benefit trust and are not eligible to enroll in the state's vision program as an active employee; however, upon retirement, they're eligible for the state Retiree Vision Program. The personnel office should offer these individuals the state Retiree Vision Program benefit at retirement. Any questions regarding BU 6 Non-Supervisor (CCPOA) member information should be directed to CCPOA.

Eligible active state employees (with the exception of rank and file BU 6 employees, as their vision benefits are provided by their union trust)  may enroll in the Premier Vision Plan.

Employees who are retiring from state civil service may enroll in the Retiree Vision Program. They must meet the requirements of Government Code Section 22959.4 at the time of retirement (as reflected below).

The following retiring employees are eligible to enroll:

  1. A civil service employee of the state.
  2. An elected member of the Legislature.
  3. A legislative employee.
  4. A constitutional officer.
  5. An employee, judge, or justice of the judicial branch of state government.

Retiring Employees

When an employee retires, the personnel office MUST offer the choice of retiree vision and/or COBRA continuation of active state coverage. Retirees have the option of choosing the Basic Vision Plan, the Premier Vision Plan or continuing their vision coverage into retirement through COBRA for 18 months. The personnel office must complete and submit a new CalHR 695 Retiree Vision Enrollment Authorization form within 60 days to Vision Service Plan (VSP) in order to establish the vision deduction in CalPERS' retirement system.

To continue vision coverage into retirement, with no break in coverage, an employee must be enrolled in a vision plan on the day of separation from employment and retire within 120 days following separation. An employee who retires within the 120 days but elects not to enroll in vision care may do so during any subsequent open enrollment period. All vision coverage enrollments continued into retirement within the required period, will be processed by VSP with no break in vision coverage.

Retiring state employees may enroll themselves and their dependents into a vision plan into retirement, even though they were not enrolled in a vision plan at the time of separation. The enrollment may be completed if the retiree was eligible to enroll as an employee at the time of separation for retirement, retires within 120 days of separation and receives any state retirement allowance.

Do not send the CalHR 695 form to CalPERS. The CalHR 695 is not intended for open enrollment use. Retirees will receive annual open enrollment information in the mail from the vision plan carrier or they can make changes during open enrollment at stateofcaretiree.vspforme.com or by calling 1-800-877-7195. VSP will no longer accept any CalHR 695 forms submitted for open enrollment purposes.

 

Mail, Email, or fax completed CalHR 695 to:

VSP–Attn: Client Services, MS 229

PO Box 997100, Sacramento, CA 95899-7100

Email: stateofca@vsp.com

Fax: 916.389.8304

 

Retirees of the California State University (CSU) and University of California (UC) systems may not participate in this vision program.

FOR SURVIVORS

Eligible survivors (survivorship as determined by CalPERS), may enroll in the Retiree Vision Program

Retiree Eligibility (G.C. Sec. 22959.4 requirements)

State retirees are eligible for enrollment into the Retiree Vision Program if any of the following apply:

  1. (a.) The retiree was enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation for retirement, and retired within 120 days of the date of separation from the state. (b.) The retiree was not enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation or retirement, but was eligible for enrollment as an employee at the time of separation for retirement, and retired within 120 days of the date of separation from the state.
  2. The retiree is part of the Legislators' Retirement System receiving an allowance pursuant to Article 6 (commencing with Section 9359) of Chapter 3.5 of Part 1 of Division 2.
  3. A retiree is part of the Judges Retirement System I or II, and receiving an allowance from either system.

A person who was enrolled in a vision care plan at the time he or she became a retiree under state or federal provisions, may continue his or her enrollment, including eligible family members, without discrimination as to benefit coverage as an enrolled person within this program.

Note to personnel offices: To enroll a survivor and dependents into the retiree vision program, before the 120-day benefit is completed, please send a completed CalHR 695 Retiree Vision Form to CalHR at vision@calhr.ca.gov. PLEASE INDICATE "Survivor Benefit" at the top of the CalHR 695. In the remarks section, please include the deceased employee's full name, date of birth and full social security number for reference. Be sure to complete the party code, retiree vision premium amount, effective date, agency contact information and necessary signatures.

Dependents of Employees and Retirees Eligibility

Eligible Dependents include

  1. Spouse or Domestic Partner.
  2. Dependent children under the age of 26. Children include: natural, adopted or step children or a child living in a parent-child relationship who is economically dependent upon the employee (until the end of the month in which they reach age 26).

Ineligible Dependents

A covered spouse, domestic partner, or dependent children lose vision coverage when any of the following occurs:

  1. An employee permanently separates from employment or reduction of hours (which causes loss of coverage).
  2. The death of employee.
  3. Divorce or termination of domestic partnership from employee.
  4. Child ceases to be a dependent (e.g., child turns age 26).

Disabled Dependent Children

An eligible dependent who is under the age of 26 years and who is enrolled as an eligible family member, and living in the employee's or retiree's household, may continue to be enrolled after attaining age 26 if he/she is incapable of self-support because of physical disability or mental incapacity and if he/she is dependent upon the eligible employee or retiree for support and care.

The disabled dependent may be continued under such coverage only under the following conditions:

  1. The dependent was eligible as a disabled child at the time of the employee's initial enrollment; or
  2. The dependent became disabled while enrolled as an eligible family member prior to attaining age 26.

The employee must provide satisfactory evidence of the disability, within a period starting 60 days before and ending 60 days after the employee's initial enrollment or the dependent's 26th birthday. An approved copy of a CalPERS Medical Report for Disabled Dependent (HBD-34) must be sent to the vision carrier. Annual certification of continued disability may be required.

The following disabled dependents are excluded from coverage:

  1. Dependent whose disability occurred after age 26.
  2. Dependents over age 26 who were not enrolled at the initial enrollment of the employee.

Retiree Vision Program Only:

Dependents over age 26 who were enrolled in, and later deleted from the Retiree Vision Program are excluded from coverage.

1203. Enrollment and Changes to Enrollment

Basic Vision Plan

Enrollment into the state's Basic Vision Plan for eligible employees and their eligible dependents is automatic. The effective date of enrollment is based on when the personnel office keys an employee's Personnel Action Request (PAR) document into the State Controller's Office (SCO) payroll system. Eligible dependents are automatically enrolled at the same time that an employee's enrollment becomes effective. (Note: STD. 700 must be completed for Permanent Intermittent employees' enrollments.)

The vision coverage will be effective the first of the following month if the employee's PAR document is keyed into the SCO system prior to the 10th of the month (see Example 1 below). The vision coverage will be effective the first of the following second month if the employee's PAR document is keyed into the SCO system after the 10th of the month (see Example 2 below).

  • Example 1: An employee is appointed on the 3rd and the PAR document is keyed prior to the 10th of the month. The coverage is effective on the first of the following month.
  • Example 2: An employee is appointed on the 3rd and the PAR document is keyed after the 10th of the month. The coverage is effective on the first of the following second month.

Vision Plan Enrollment Authorization Form (STD. 700)

The Vision Plan Enrollment Authorization (STD. 700) is used in certain situations to enroll eligible employees in the state Vision Program. See Attachment A - Vision Plan Enrollment Authorization (STD. 700) for a copy of the STD. 700 and Section 1210 for completion instructions.

SITUATIONS THAT REQUIRE THE COMPLETION OF A STD. 700

The following situations will require completion of a Vision Plan Enrollment Authorization, STD. 700 to enroll in or cancel coverage. See Attachment C - Permitting Event Codes/Effective Dates Chart - BasicAttachment C - Permitting Event Codes/Effective Dates Chart - Basic - Text Only (RTF)​ ​for information regarding permitting event codes.

  1. An employee who is eligible, but did not enroll, prior to implementation of the automatic enrollment.
  2. A permanent-intermittent employee who works a minimum of 480 hours in a six-month qualifying control period (January 1-June 30 and July 1-December 31).
  3. A former retired state employee who is currently enrolled in state COBRA vision benefits and reinstates as a permanent intermittent.
  4. A permanent-intermittent employee cancellation due to loss of eligibility.
  5. An employee who declines or cancels coverage may do so by completing a STD. 700 form. If later the employee decides to re-enroll, another STD. 700 must be completed. The vision benefit is mandatory under the Consolidated Benefits Program (CoBen), and employees in CoBen may not cancel their state-sponsored vision coverage.
  6. An employee and/or eligible dependent who elects to continue the vision coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) Program. (see Benefits Administration Manual (BAM) COBRA Section 400).
  7. A permanent intermittent employee in BU 6 who is eligible following graduation from the academies of the California Department of Corrections and California Youth Authority.

PERMANENT INTERMITTENT EMPLOYEE ENROLLMENT into the PREMIER VISION PLAN

The Basic Vision Plan Enrollment Authorization (STD 700) form must be completed for eligible Permanent Intermittent employees (PI’s) and sent to SCO in order to process the employer’s contribution and deduction. Additionally, the CalHR 774 must be sent to VSP at the same time to the following address:

VSP–Attn: Client Services, MS 229
PO Box 997100
Sacramento, CA  95899-7100

or

Email to: stateofca@vsp.com
Or fax to:
(916) 389-8304

Premier Vision Plan

All active state employees (with the exception of rank and file BU6 employees, whose vision benefits are provided by their union trust) are eligible to enroll in the Premier Vision Plan. See Attachment B - Premier Vision Enrollment Authorization (CalHR 774) for a copy of the CalHR 774 and Section 1211 for completion instructions. Eligible state employees enrolled in this plan shall be required to pay a minimal premium. When the employee enrolls in the Premier Vision Plan, they can also add their dependents to their Premier Vision Plan, but they cannot leave their dependents in the Basic Vision plan if they choose the Premier Vision Plan. Employees may add dependents after open enrollment only if family status changes (permitting event), as defined by the state, have occurred.

The CalHR 774 form is not for open enrollment use! Employees will receive annual open enrollment information in the mail from the vision plan carrier that provides contact information and updated plan premiums if they need to make changes to their vision plan. Employees can also log onto stateofcaemployee.vspforme.com or call VSP at (800) 877-7195 to make changes. The CalHR 774 form is intended to be completed for newly eligible employees, Permanent Intermittent employees and for permitting events, as defined by the state. VSP no longer accepts any CalHR 774 forms submitted for open enrollment purposes.

12-Month Minimum Enrollment Period for Premier Vision

For employees wanting to enroll into the Premier Vision Plan, they must positively elect to enroll. Once enrolled into the Premier Vision Plan, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. An employee enrolled in this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). An employee that decides to disenroll from the Premier Vision Plan after their minimum 12-month enrollment period may do so during open enrollment. Employees disenrolling may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment).

Note: The required enrollment period can extend beyond 12 months. Example; a new employee enrolled in the Premier Vision Plan on June 1. As long as they are eligible for benefits, they will be required to maintain their enrollment into the next calendar year. The next point they could disenroll would be open enrollment with an effective date of the first of the next year.

Changes to Enrollment

It is the responsibility of each department to inform employees of the requirements for making changes to their vision enrollment. The rules governing the changes listed below vary in time limits, therefore, employees should be advised to report changes to their personnel office as soon as possible after the event occurs. This means the event must occur first before the employee can file a change to their vision plan. 

Mandatory Deletions

Dependents must be deleted as follows:

  1. Divorced spouse must be deleted from coverage even if the divorce settlement requires the employee to provide vision coverage for the spouse. The state is not required to provide coverage for an ex-spouse. However, COBRA (Consolidated Omnibus Budget Reconciliation Act) must be offered.
  2. Termination of a Domestic Partnership. (Employee must provide copy of notice of termination of the domestic partnership to the personnel office and COBRA must be offered to the terminated domestic partner.)
  3. Death of a dependent.
  4. Dependent child reaches age 26 and is not disabled.
  5. Dependent goes into the military.
  6. Dependent no longer economically dependent/change of custody.
  7. Dependent enrolled but not eligible.
  8. Dependent dual or split covered.

Retroactive processing is limited to six months for reimbursement of vision premiums for mandatory cancellations and/or deletions to employee vision coverage. Please refer to the Human Resources Manual, Section 1404 for more information.

Voluntary Changes

Employees may elect to make any of the following changes to their enrollment:

  1. Adding a newly acquired spouse, certified domestic partner and/or stepchild to a one-, two-, or three- party enrollment.
  2. Adding a newborn, adopted child, or child at each birthday through the age of 6 to a one-, two-, or three- party enrollment.
  3. Adding spouse, certified domestic partner, and/or dependents that lost coverage to a one-, two-, or three-party enrollment (Must provide proof of loss of coverage - keep in employee's personnel file).
  4. Adding a dependent due to a change in custody and/or acquiring an economically dependent child.
  5. Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible) cannot be deleted ​due to moving out of the household.  Excludes employees in process of separation, divorce, or annulment.
  6. Deleting a dependent who obtains other group coverage (non-state sponsored).

    Retroactive processing is limited to six months for reimbursement of vision premiums for mandatory cancellations and/or deletions to employees' vision coverage. Please refer to the Human Resources Manual, Section 1404.

The employee may seek financial remedy by filing a governmental claim with ​the Department of General Services against his/her department for the amount of money they believe they did not receive. For additional information regarding the filing of a governmental claim, please visit the following link:  File-a-Government-Claim

Administrative Deletions

The following deletions are processed administratively. The department is responsible for notifying the employee of administrative deletions. An employee signature is not required; enter "Administrative Deletion" on the Employee Signature line of the STD. 700, CalHR 774 or CalHR 695.

  1. Dependents who reach age 26 and are not disabled.
  2. Employees and/or dependents enrolled but not eligible or dual/split coverage exists. Delete retroactive to the effective date using the Permitting Event Code (PEC). The employee is responsible for any costs for vision services that were performed on him/herself or any ineligible dependent.
  3. Employees that are enrolled but not eligible and refuse to sign the STD. 700, CalHR 774 or CalHR 695 to change vision plans due to bargaining unit change. Cancel retroactive to permitting event date.

    *The employee must be notified regarding this change and will not be allowed to enroll in a   vision plan until the next scheduled open enrollment.
  4. Death of a spouse, domestic partner or child upon receipt of a death certificate. 

Voluntary Change of Vision Plan

An employee may only change enrollment from one vision plan to another during open enrollment, or if a valid permitting event occurs.

COBEN EMPLOYEES

The $8.27 state contribution is part of the CoBen allowance. When an employee is enrolled in the Premier Vision Plan, the $8.27 is still present in the allowance and $8.27 is still paid to VSP as the employer share of this plan. The balance or employee share (PC1 $8.46, PC2 $16.92, or PC3 $27.24) is reported as a separate miscellaneous deduction. Both deductions are itemized on the warrant stub to verify the deductions occurred and were paid to VSP.

NON-COBEN EMPLOYEES

The $8.27 state contribution is still paid for by the state for non-Coben employees. When an employee is enrolled in the Premier Visin Plan, the $8.27 is still present as the employer contribution and $8.27 is still paid to VSP as the employer share of this plan. The balance or employee share (PC1 $8.46, PC2 $16.92, or PC3 $27.24) is reported as a separate miscellaneous deduction.

Both deductions are itemized on the warrant stub to verify the deductions occurred and were paid to VSP.

CoBen Cash

Employees in CoBen cash, will see a -$8.27 on the warrant itemization (right side on the warrant stub) to show the payment of the state share for the vision plan, but it will show in the lower left the employer contribution in total (CoBen Cash amount plus the $8.27 for the vision as part of the total). CoBen cash is paid as a component of taxable salary. Payment amount of the CoBen cash is shown on the left side of the warrant stub.

Enrollment into Retiree Vision Plan

When an employee retires, they must be offered COBRA continuation for the state active employee vision coverage (please see BAM COBRA Section 400 for information on "Retiree Benefit Alternate Coverage"). Retiring employees must also be offered the Retiree Vision Program at the time of retirement. If the retiring employee elects the Retiree Vision Plan, they will need to complete a CalHR 695 then return it to their personnel office. See  Attachment E - Retiree Vision Plan Enrollment Authorization (CalHR 695) for a copy of the CalHR 695 and Section 1213 for completion instructions. Offer of the Retiree Vision Program should be made along with the offer of continuation of other benefits into retirement. All eligibility and enrollment information should be sent to deceased employees' eligible survivors, including COBRA notices.

The CalHR 695 is not intended for open enrollment use! Retirees will receive annual open enrollment information in the mail from the vision plan carrier or they can make changes during open enrollment at stateofcaretiree.vspforme.com or by calling (800) 877-7195. This form is intended to be completed for newly eligible retirees and for permitting events, as defined by the state. VSP will no longer accept any CalHR 695 forms submitted for open enrollment purposes.

Departments with CCPOA employees must continue to offer COBRA to retiring CCPOA employees to continue their active employee vision coverage (if not available through CCPOA trust into retirement) along with offering the Retiree Vision Program. CCPOA covered employee should contract the CCPOA benefits trust for more information on the CCPOA sponsored vision plan.

CONTINUATION OF the PREMIER VISION PLAN THROUGH COBRA 

Retiring employees who are already enrolled in the Premier Vision Plan and wish to continue their enhanced vision benefit, may continue Premier Vision through COBRA for up to 18 months. A CalHR 695 Retiree Vision Enrollment form must be completed and the New COBRA enrollment box would need to be checked on the form. See Section 1214 for COBRA Premier Vision premiums.

The personnel office must offer COBRA for employees who are retiring and are enrolled in the Premier Vision Plan. Retirees may enroll into the Retiree Vision Plan upon the end of their Premier Vision Plan through COBRA continuation.

The personnel office will need to advise the employee at the time of retirement about the Retiree Vision Program and assist them with the enrollment process. After the initial enrollment is processed by the vision plan, the retiree should contact VSP directly to report applicable permitting events. Once enrolled in the Retiree Vision Program they do not have to re-enroll each year.

PLEASE REMEMBER that while CalHR sets policy and procedures on enrollment and eligibility, the actual enrollment form, Vision Plan Enrollment Authorization (STD. 700) is reviewed and processed for active employees by the State Controller's Office (SCO). The Premier Vision Enrollment Authorization (CalHR 774) and the Retiree Vision Plan Enrollment Authorization (CalHR 695) are reviewed and processed by VSP, with deductions taken by the applicable retirement system for retirees (California Public Employees' Retirement System, and Judges' Retirement System or Legislators Retirement Systems). Only those forms requesting some type of appeal or exception are forwarded to CalHR for review.

12-Month Minimum Enrollment Period for Premier Vision

Once enrolled into the Retiree Vision Program, the retiree will be required to maintain their enrollment for a 12-month minimum enrollment period. Retirees enrolled into this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). A retiree that decides to disenroll from the Premier Vision Plan may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment).

OPEN ENROLLMENT

Basic Vision Plan

Eligible active employees enrolled in the Basic Vision Plan do not have an open enrollment period because the enrollment in the state's basic vision coverage is automatic. Employees who are eligible, but did not enroll, prior to implementation of the automatic enrollment may enroll outside of the open enrollment period. Permanent Intermittent (PI) employees may not enroll during an open enrollment period because they must complete a PI control period in order to be eligible for enrollment in the vision plan.

Premier Vision Plan

An employee must elect to enroll into the Premier Vision Plan. Once enrolled into the Premier Vision Plan, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. An employee enrolled into this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). An employee that decides to disenroll from the Premier Vision Plan may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment).

Retiree Vision Plan


Retirees  will receive annual open enrollment information from VSP. The effective date of any action during open enrollment is January 1, of the following year.

MONTHLY PREMIUMS

Basic Vision Plan


The state is responsible for the monthly premium to VSP for eligible active employees enrolled in the Basic Vision Plan. The state contribution amount appears on covered employees' statements of earnings and deductions. The monthly premium covers the employee and all eligible dependents (see Section 1214 for premiums and vision plan address).

Employees in Consolidated Benefits (CoBen) will have the monthly premium amount deducted from their monthly CoBen allowance (as shown on their monthly statement of earnings and deductions). The monthly premiums for the Retiree Vision Program are fully paid by the retiree. Once enrolled, CalPERS will make a monthly deduction from their warrant. If there are insufficient funds to make a deduction, VSP will direct bill the retiree for the cost of the monthly premiums.

California State Teachers' Retirement System (CalSTRS) retirees will be direct-billed for their monthly premium.

Direct-Billed enrollment length is still the same; failure to continue payment will mean the retiree and any enrolled dependents will become ineligible and the retiree will be disenrolled until the next open enrollment period and plan year. The grace period is 60 days, upon which the retiree will be dropped from the plan. This payment failure is considered a voluntary action.

Premier Vision Plan

The state will continue to pay the employer share per month per eligible enrolled employee for those employees enrolled in the state Premier Vision Plan.

EFFECTIVE DATES

Effective dates for the Completed STD. 700 for Active Employees – Basic Vision Plan​

Enrollment documents received at SCO will be effective with a standard or mandatory effective date. Attachment C - Permitting Event Codes/Effective Dates Chart (PDF) – Basic Plan for effective date information.

Effective dates for the Completed CalHR 774 for Active Employees – Premier Vision Plan

Enrollment documents received at VSP will be effective with a standard or mandatory effective date. See  Attachment G - Permittin​g Event Codes/Effective Dates Chart (PDF) Premier Plan for effective date information.

Effective Dates for the Completed CalHR 695 for Retirees​​

Enrollment documents received at VSP will be effective with a standard or mandatory effective date. See Attachment F - Permitting Event Codes/Effective Dates Chart - Retirees (PDF) - for effective date information. After the initial enrollment is processed by the vision plan, then the retiree should contact the vision plan to report applicable permitting events.

Deletion of Ineligible Dependents

The completion of a STD.700 or CalHR 774 is required for deleting ineligible dependents off an active employee’s vision plan. Deletion documents will need to be sent to VSP with a copy retained in the employee’ s personnel file. The CalHR 695 is not required for deletion of ineligible dependents. Employees who have dependents should be advised that ineligible dependents are not permitted to use the state's vision plan. Employees and retirees will be held liable for payment of services that are provided to ineligible dependents.

1204. The Vision Benefit - Basic and Premier - Active Employees and Retirees

For information about your vision plan, please visit the VSP website:

Active Members​

Retired Members​

1205. How to Use the Plan - BASIC & PREMIER

An eligible employee/dependent may choose to receive vision care services from a VSP Member Provider or any other licensed optometrist, ophthalmologist, or optician.

Steps when using a VSP Doctor

  1. Select a VSP doctor. If employees/retirees/dependents need help locating one, call VSP at (800) 877-7195 or access the VSP websi​te.
  2. The employee/retiree/dependent should call the VSP doctor for an appointment and indicate that they are enrolled under the VSP plan. Simply provide the employee's name and social security number. Active employees and eligible dependents are under plan group number 12020000 (State of California). Retirees and eligible dependents are under plan group number 12294067 (State of California).
  3. The doctor and VSP will handle the rest. The doctor will contact VSP to verify eligibility and plan coverage. If the employee/retiree/dependent is not eligible at the time, then the doctor will inform the employee/retiree/dependent. If the employee/retiree/dependent is eligible, then payment for any applicable copayments is required at the time of the appointment. VSP will pay the doctor directly for covered services.

When Not Using a VSP Doctor

Employees/retirees/dependents may obtain covered services or materials from any other licensed optometrist, ophthalmologist, or optician of their choice. Services obtained through non-member doctors are subject to the same deductibles and limitations as services through VSP member doctors. The doctor must be paid in full and an itemized receipt is submitted to VSP. VSP will reimburse the employee/retiree/dependent up to the amounts allowed under the state plan's non- member doctor schedule. The reimbursement schedule does not guarantee full payment nor can VSP guarantee patient satisfaction when services are received from a non-member doctor.

All claims must be filed within six months of the date services were completed. Reimbursement benefits are made directly to the covered employee/retiree/dependent and are not payable to the doctor.

EXCLUSIONS AND LIMITATIONS - Basic Plan

The Basci Vision Plan is designed to cover visual needs rather than cosmetic eyewear. If you select any of the following extras, the plan will pay the basic cost of the allowed lenses and you will be required to pay any additional costs associated with these extras:

  1. Blended lenses
  2. Contact lenses
  3. Oversize lenses
  4. Progressive multifocal lenses
  5. Coated or laminated lenses
  6. Frame costing more than plan allowance
  7. UV protected lenses
  8. Other optional cosmetic processes

The following services or eyewear are excluded under your plan:

  1. Orthoptics; vision training; any associated
  2. Supplemental testing
  3. Plano lenses
  4. Two pairs of glasses in lieu of bifocals
  5. Replacement or repair of lost or broken lenses or frames prior to service eligibility
  6. Medical or surgical treatment of the eyes
  7. Services or eyewear covered under Worker’s Compensation
  8. Eye exams required as a condition of employment
  9. Services or eyewear provided by any other group benefit vision care program

EXCLUSIONS AND LIMITATIONS - Premier Plan


The Premier Vision Plan is designed to cover visual needs rather than cosmetic eyewear. If you select any of the following extras, the plan will pay the basic cost of the allowed lenses and you will be required to pay any additional costs associated with these extras:

  1. Contact lenses
  2. Oversize lenses
  3. Coated or laminated lenses
  4. Frame costing more than plan allowance
  5. UV protected lenses
  6. Other optional cosmetic processes

  The following services or eyewear are excluded under your plan:

  1. Orthoptics; vision training; any associated supplemental testing
  2. Plano lenses
  3. Two pairs of glasses in lieu of bifocals
  4. Replacement or repair of lost or broken lenses or frames prior to service eligibility
  5. Medical or surgical treatment of the eyes
  6. Services or eyewear covered under Worker’s Compensation
  7. Eye exams required as a condition of employment
  8. Services or eyewear provided by any other group benefit vision care program

NON-VSP PROVIDER REIMBURSEMENT SCHEDULE

Availability of services under the reimbursement schedule is subject to the same time limits and copays as those described for VSP network doctor services. Services obtained from a non-VSP provider are in lieu of obtaining services from a VSP network doctor. Reimbursement benefits are not assignable.

* Determination of “necessary” versus “elective” contact lenses under the non-VSP reimbursement schedule will be consistent with VSP network doctor services. Reimbursement for contact lenses is in lieu of all benefits, including exam and eyewear services.

1206. Coordination of Benefits - Dual Coverage

Coordination of Benefits


Covered Persons who are covered under two or more insurance plans that include vision care benefits may be eligible for Coordination of Benefits (“COB”). VSP will combine other insurance plans’ claim payments or reimbursements, if any, with benefits available under Covered Person’s VSP Plan, which may reduce or eliminate covered person’s out-of- pocket expense. Covered persons covered under more than one VSP Plan may also be able to take advantage of COB.

Dual Coverage

A married enrollee whose spouse is also an enrollee under his/her own VSP Plan may coordinate benefits between their respective VSP Plans. Such “dual coverage” will be subject to the same procedures and limitations applicable to coordination of benefits with non-VSP plans.

Eligible married state employees or those state employees with eligible domestic partners may co- cover each other under the state’s Vision Program. This option also applies to their dependent children, including dependents of domestic partners. The procedure for coordination of dual coverage benefits will be as follows:

a) Eligible married state employees or those state employees with eligible domestic partners can receive benefits under each other’s plan and receive two pairs of eyeglasses subject to the independent deductibles and all other plan limitations. Dependent children can receive one pair of eyeglasses under either their parents plan, or both, subject to the deductible and plan limitations. In both instances, this provision applies to the active basic and retiree plans, as well as the Premier Vision Plan.

b) Eligible married state employees or those state employees with eligible domestic partners cannot use their secondary coverage to cover the cost of extras.

c) If an eligible employee receives only one pair of eyeglasses, the deductible may be paid by the secondary coverage. In order to process claims involving COB, VSP may need to share personal information regarding Covered Persons with other parties (such as another insurance company). When this is necessary, VSP will only share such information with those persons or organizations having a legitimate interest in that information and only where such sharing is not prohibited by law.

Retirees

Married retirees and registered domestic partners have dual coverage under the state Vision Program if they are enrolled as a dependents on each other's plan. Dual vision coverage also applies to dependent children if they are enrolled as a dependent on each eligible retiree's plan (either married or registered domestic partnership).

To utilize this feature of the Vision Program, verification of eligibility must be obtained from VSP for the retiree. One verification will authorize coverage as the retiree and the other verification will authorize coverage as a spouse/domestic partner. Verification of eligibility for retirees should be obtained by the member provider on the initial visit. When services are obtained from a non-member provider, an itemized receipt must be returned to VSP and verification of eligibility should be obtained by the provider.

Dual coverage is permitted for the following scenarios:

  1. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee, enrolled in the state active vision plan.
  2. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee, enrolled in the state active vision plan, and they also have a dependent child.
  3. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee (who is also a dependent child on the Retiree Vision plan), enrolled in the state active vision plan.
  4. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active (non-state) employee, enrolled in a non-state vision plan.
  5. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of a retiree, enrolled in a non-state vision plan.
  6. Retired member is enrolled in the Retiree Vision Program, and they are the spouse of an active (non-state) employee, enrolled in a non-state vision plan, and they have a dependent child.

Coordination of Benefits

When an eligible employee or retiree has coverage through the state's Vision Program and the spouse or domestic partner has coverage through an employer other than the state of California, the procedure for coordination of benefits will be as follows:

  1. When one pair of glasses is obtained from a member doctor, the benefits can be coordinated to pay for the deductible, if any, plus some cosmetic extras. The secondary plan can be utilized to reimburse deductibles and overages, up to the limit of that plan.
  2. Two pairs of glasses may be received from a member doctor when the benefits are coordinated. The deductible, if any, will apply to the second pair of glasses. However, the first deductible and some cosmetic extras, will be paid for by the eligible employee or dependent obtaining the glasses. If the patient is eligible for an exam under both benefits, then the secondary exam benefit can be used to pick-up the deductibles and overages from the primary benefit, up to the limit of the secondary exam benefit.
  3. When services for one pair of glasses are received from a non-member doctor, VSP will reimburse the patient up to the combined scheduled allowance, not to exceed the actual examination fee and the cost of the materials.
  4. An individual may choose to receive glasses and contact lenses from either a member or non-member doctor and the normal deductible and limitations will apply. If only elective contact lenses are selected, the combined schedule of allowances will apply, not to exceed the actual charges.

When spouses or domestic partners both have coverage through the state's Vision Program,the Retiree Vision Program, or a combination thereof, procedures for coordination of benefits will be as follows:

  1. Employee and spouse/domestic partner can receive benefits under each other's plan and receive two pair of glasses subject to the independent deductibles and all other plan limitations.
  2. Employee and spouse/domestic partner can use their secondary coverage to cover the cost of extras.
  3. If an employee receives only one pair of glasses, the deductible may be paid by the secondary coverage.
  4. Dependent children can receive one pair of eyeglasses under either their parents plan, or both, subject to the deductible and plan limitations. In both instances, this provision applies to the active Basic and retiree plans, as well as the Premier Vision Plan. When an eligible employee or retiree has coverage through the state's Vision Program or Retiree Vision Program and the spouse/domestic partner has coverage through another insurance company, the state's Vision Program or Retiree Vision Program will be the primary coverage unless the request for payment is submitted with a paid statement from the other insurance carrier. The state's carrier will then pay the deductible, if any, and services not covered under the other plan, subject to the carrier's plan provisions and limitations.

1207. Direct Payment Process

An active employee on non-pay status may elect to continue vision coverage by paying the total premium directly to the vision carrier. During the period of non-pay status, the state contribution towards the vision premium is not paid, therefore, an employee must be advised that they can elect to continue their vision coverage through direct payment in order to maintain coverage.

The Vision Plan Direct Payment Authorization (STD. 703)

The Vision Plan Direct Payment Authorization (STD. 703) is used to enroll eligible employees in Direct Pay. See Attachment D - Vision Plan Direct Payment Authorization (STD. 703) for a copy of the STD. 703 and Section 1212 for completion instructions.

An employee who wishes to continue coverage while off pay status must complete a STD. 703 and forward the form directly to the carrier with a check or money order for a full three-month premium amount. The employee's enrollment may not exceed the duration of the state's contract or one year, whichever comes first. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period. A newly completed STD. 703 must be completed and submitted to the vision carrier.

An employee who does not elect direct payment must complete Part B of the STD. 703, to decline continued coverage. If the employee elects not to enroll he/she will be liable for any vision expenses incurred while off pay status (vision premiums will not be paid by the state during this period). A copy should be retained in the employee's personnel file. In this instance, do not send a copy of the STD. 703 to the vision carrier.

Instructions for the completion of the STD. 703 are printed on the reverse side of the form. Personnel staff should verify that all information is completed correctly. Do not forward copies of the STD. 703 to SCO or CalHR.

Absences/Situations Where Coverage Lapses

  1. Leave of absence for one or more full pay periods, but other than NDI, IDL, 4800 Time or Workers Compensation with supplementation.
  2. Appeal of involuntary termination. (COBRA provisions apply; direct payment provisions are not applicable).
  3. Suspension of one or more complete pay periods.
  4. Permanent-Intermittent, enrolled but off pay status (reduction in hours - COBRA provisions apply, direct payment provisions are not applicable).
  5. Application for disability retirement is pending (employee is off pay status).
  6. Pending IDL determination when all sick leave and vacation credits have been exhausted (employee is off pay status).
  7. Death of an employee (120-day death benefit apply, COBRA is applicable after CalPERS' determination of survivor benefits).
  8. Under approved SDI benefits.

Direct Payment of Premiums

  1. The vision carrier will not send a monthly bill to an employee who elects to pay premiums directly while he/she is off pay status. Therefore, it is the responsibility of each employee to ensure premium payments are paid timely. Direct pay is normally limited to 12 months. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period.
  2. Payments must be paid in advance and cover a minimum period of three months or the length of the absence whichever is less. The employee's check/money order for the first three months must be attached to the newly completed STD. 703 and sent to the carrier.
  3. The vision carrier must receive the initial payment by the first day of the month following the first full month the employee is off pay status. Subsequent installments and/or final payment are due to the vision carrier by the first of each subsequent three-month period. STD. 703 forms received by the vision carrier without the required payment attached will be returned to the employee. Failure to pay the required payment in a timely manner will result in the employee's vision coverage being cancelled.
  4. In the event an employee returns to pay status prior to the end of his/her approved leave of absence, it will be the employee's responsibility to contact the vision carrier to request a refund of any direct premium overpayments paid.

Return to Pay Status

Upon return to pay status (if an employee is still enrolled), the state premium contributions will commence with the first pay warrant issued by SCO.

1208. 120-Day Survivor Death Benefit for Continuation of Benefits

Under the 120-day death benefit, departments are required to continue to pay the employer and employee contributions for a covered employee's spouse, domestic partner and/or other eligible family members for up to 120 days following an employee's death. This means if an employee was in the Premier Vision Plan at the time of death, the department is responsible for paying the full premier premium for 120 days. The 120-day period is to provide the family a grace period while the California Public Employees' Retirement System (CalPERS) determines if the spouse or other family members are eligible for a survivor's benefit.

In implementing this benefit, departments will use the process used for an employee on an unpaid leave of absence (STD. 703). Under this process, the deceased employee's department will pay four months of both the employer and employee contributions directly to the vision carrier.

An eligible spouse and/or other eligible dependent(s) who is determined to be an eligible survivor through CalPERS and receives a continuing allowance from CalPERS may continue vision coverage as a retiree.

If CalPERS determines that the spouse and/or other eligible family member(s) are not eligible for a continuing allowance, then the department should notify the spouse and/or other eligible family member(s) of COBRA eligibility within sixty days from the date CalPERS makes this determination. Upon notice of COBRA eligibility by the department, it is the responsibility of the spouse or other eligible family member(s) to pay monthly premiums directly to the carrier(s) in the manner prescribed in the COBRA notice.

Authority:

Collective bargaining agreements (all twenty-one bargaining units) Legislation enacted - AB 1639, Chapter 926, 1999

Reference:

  1. Personnel Management Liaison Memorandum (PML) 99-066
  2. DPA Personnel Transaction Supervisors and Personnel Transaction Staff Memorandum dated August 7, 2001.

1209. Consolidated Omnibus Budget Reconciliation Act (COBRA)

The state does not continue paid vision coverage for employees into retirement. Each department is required to offer retiring employees the option to enroll in the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) Program. COBRA allows employees and dependents the option to maintain vision benefits for either 18 or 36 months after losing coverage because of certain COBRA qualifying events.

Departments are responsible for ensuring that covered employees and their covered dependents are provided with COBRA information, required COBRA notices, and for assisting those employees and dependents that elect to enroll by ensuring all forms are completed and submitted timely.

Departments should review the COBRA policy and procedures outlined in the Benefits Administration Manual (BAM) - COBRA Section 400 in the event an employee or dependent has any of the following COBRA qualifying events:

COBRA Qualifying Events and Length of Eligibility

  • Voluntary or Involuntary Termination (other than for Gross Misconduct), Reduction of Hours: 18 months
  • Death of Employee, Divorce, Termination of Domestic Partnership, Legal Separation, Employee's Entitlement to Medicare, or Dependent Child Ceases to be a Dependent: 36 Months
  • Military call-up: 24 Months

For a leave of absence, the vision benefits may be continued through Direct Payment, not COBRA (see Section 1207 for direct payment information).

1210. Instructions for Completion of STD. 700

The STD. 700 can be ordered through the Department of General Services (DGS), Office of State Publishing and also available as fill and print on their web site. The form is also available as fill and print on CalHR web site.

1.Section A:

  • A1: Enter employee's social security number
  • A-2: Check appropriate box designating employee's marital status
  • A-3: Check Male or Female
  • A-4: Enter employee's name
  • A-5: Enter employee's mailing address
  • A-6: Enter employee's date of birth
  • A-7: Check appropriate action type
  • A-8: Enter spouse's or domestic partner's name
  • A-9: Enter spouse's or domestic partner's social security number
  • A-10: Enter spouse's or domestic partner's date of birth
  • A-11: Enter family member's name
  • A-12: Enter family member's relationship to employee
  • A-13: Enter family member's social security number
  • A-14: Enter family member's date of birth

(For additional family members, enter information on sections A-15 through A-22)

2. Section B:

  • B-1: Enter name of vision plan being authorized
  • B-2: Enter provider/facility number (if applicable)

3. Section C: For cancellations only

4. Section D: Check one box and Employee's/Retiree's/ signature/date required

5. Section E:

  • E-2: Enter 001 for employees not in CoBen. Enter 002 for employees in CoBen
  • E-4: Enter deduction amount
  • E-5: Enter state share amount (N/A for Retiree)
  • E-6: Enter effective date of action
  • E-7: Enter employee designation (N/A for Retiree)
  • E-8: Enter employee bargaining unit (N/A for Retiree)
  • E-9: Enter the total monthly premium
  • E-10: Enter the date of the permitting event (e.g. new enrollment, PI enrollment, voluntary cancellation) Note: active employees in CoBen may not cancel vision coverage
  • E-11: Enter permitting event code
  • E-12: Enter agency code (N/A for Retiree)
  • E-13: Enter unit code (N/A for Retiree)
  • E-14: Enter agency name
  • E-16: Check if PI employee
  • E-17: Signature of authorized agency representative
  • E-18: Telephone number of authorized agency representative
  • E-19: Enter date received in Personnel Office

Make two copies of the completed form, one for the amployee's official personnel file and one for the employee. The original must be sent to SCO for final processing (see Section 1214 for address to send the STD. 700).

1211. INSTRUCTIONS FOR COMPLETION OF CalHR 774


The CalHR 774 is available as fill and print in the Attachments Section at the top of this page.

The CalHR 774 form is not for open enrollment use. VSP mails out open enrollment packets that contain open enrollment forms with unique identifiers for all eligible employees to complete and return to VSP during open enrollment if they need to make changes to their vision plan. This form is intended to be completed for newly eligible employees, PermanentiIntermittent employees and for permitting events, as defined by the state. VSP will no longer accept any CalHR 774 forms submitted for open enrollment purposes.

  1. Complete Section A: Enter the name, social security number, date of birth, phone number, email and mailing address of the eligible employee.
  2. Complete Section B: Enter dependent information including whether dependent is being added or deleted; if there are no dependents, skip Section B and go to Section C.
  3. Complete Section C: Check the appropriate box to elect to enroll. Employee must sign and date the bottom of Section C.
  4. Complete Section D: This section to be completed by Employing Agency only.
  • D-1: Enter the deduction code (N/A if completing new COBRA enrollment for retiring employee)
  • D-2: Enter party code (1-member only, 2-member plus one dependent, 3-member plus two or more dependents).
  • D-3: Enter premium deduction amount.
  • D-4: Enter effective enrollment. (as a rule: first day of second month.)
  • D-5: Enter BU/CBID.
  • D-6: Enter permitting event date.
  • D-7: Enter permitting event code.
  • D-8: Enter agency name, unit code, and agency code.
  • D-9: Enter any remarks.
  • D-10: Enter agency area code and telephone number.
  • D-11: Enter date of agency signature.
  • D-12: Enter agency phone number, email, and signature of authorized agency representative.
  • D-13: One copy should be retained in agency file, and one copy should go to the employee

Please mail completed CalHR 774 form to VSP at:​

VSP–Attn: Client Services, MS 229
PO Box 997100
Sacramento, CA 95899-7100
Email to: stateofca@vsp.com
Or fax to:
(916) 389-8304

DO NOT SEND CalHR 774 FORMS TO SCO!

1212. Instructions for Completion of STD. 703

The STD. 703 can be ordered through the Department of General Services (DGS), Office of State Publishing and also available as fill and print on their web site. The form is also available as fill and print on the CalHR web site.

  1. Complete Part A: Enter the name and social security number of the eligible employee
  2. If the employee does not wish to retain vision coverage, then complete Part B - employee's signature/date required in Part B or C
  3. Part C: Enter payment amounts
  4. Complete Part D as follows:
  • D-10: Enter agency name
  • D-11: Enter agency address
  • D-12: Enter employee position number
  • D-13: Enter reason (e.g., leave of absence, survivor benefits, IDL, awaiting disability determination)
  • D-14: Enter the dates of absence
  • D-15: Enter pay period of last deduction
  • D-16: Signature of authorized agency representative
  • D-17: Telephone number of authorized agency representative
  • D-18: Enter date received in personnel office

Retain a copy the in the employee's personnel file and send the original to VSP (retain the carrier copy if the employee declines direct payment). Provide a copy to the employee (see Section 1214 for address to send the STD. 703)

1213. Instructions for Completion of CalHR 695

The form is available on the CalHR web site

The CalHR 695 form is not for open enrollment use. VSP mails out open enrollment packets that contain open enrollment forms with unique identifiers for all eligible retirees to complete and return to VSP during open enrollment if they need to make changes to their vision plan. This form is intended to be completed for newly eligible retirees and for permitting events, as defined by the state. VSP will no longer accept any CalHR 695 forms submitted for open enrollment purposes.

  1. Complete Section A: Enter the name, social security number, date of birth, and address of the eligible retiree
  2. Complete Section B: Enter dependent information; if there are no dependents, skip Section B and go to Section C
  3. Complete Section C: Check the appropriate box to elect to enroll, retiree must sign and date the bottom of Section C
  4. Complete Section D: This section to be completed by Employing Agency only
  • D-1: Enter deduction code 475
  • D-2: Enter party code (1-member only, 2-member plus one dependent, or 3-member plus two or more dependents)
  • D-3: Enter premium amount
  • D-4: Enter effective date of enrollment
  • D-5: Enter BU/CBID at retirement
  • D-6: Enter permitting event date
  • D-7: Permitting Event Code is standard and already input (50
  • D-8: Enter agency name, unit code, and agency code
  • D-9: Enter any remarks, the separation date and the retirement date
  • D-10: Enter agency area code and telephone number
  • D-11: Enter date of agency signature
  • D-12: Sign name of authorized agency representative
  • D-13: One copy should be retained in the agency's files, one copy should go to the retiree, and the original should be sent to VSP.

Mark the form for the plan selection (Basic or Premier Vision plan). Please mail the completed CalHR 695 form to VSP at:

VSP–Attn: Client Services, MS 229
PO Box 997100
Sacramento, CA 95899-7100
Email to: stateofca@vsp.com​

Or fax to:
(916) 389-8304

DO NOT SEND CalHR 695 FORMS TO CalPERS or SCO!

1214. Vision Plan Premiums, Deduction Codes and Plan Addresses

Deduction Codes:

Basic Vision Plan

475-001 (Non-CoBen)

475-002 (CoBen)

Premier Vision Plan

361-475

Basic and Premier Vision Plan Premiums

2022 Dental and Vision Plan Deduction Codes and P​remiums PD​F ​

The COBRA Premium - Basic Vision Plan

2022 Cobra Group Continuation Co​verage ​​PDF​

Retiree Vision Premiums

Retiree Vision Premiums​

Vision Plan​​

Vision Service Plan (VSP)

3333 Quality Drive

Rancho Cordova, CA 95670

(800) 877-7195

Vision Plan Web sites

VSP for active employees: stateofcaemployee.vspforme.com

VSP for retirees: stateofcaretiree.vspforme.com

CalHR's Vision ​Program

Direct Payments, COBRA enrollments, and Retiree Premier Vision Plan Enrollments - send forms and payments to:

Vision Service Plan (VSP)

Attn: Client Services, MS 229

P.O. Box 997100

Sacramento, CA 95899-7100

Email:  stateofca@vsp.com

FAX: (916) 463-9031

Appeals

Please ONLY send vision enrollment appeals to:

CalHR

Benefits Division

1515 "S" Street, N-500

Sacramento, CA 95811-7258

Attention: Vision Program

or
Email to vision@calhr.ca.gov
​


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  Updated: 3/17/2020
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