Insurance

The Federal COBRA law (Consolidated Omnibus Budget Reconciliation Act) requires employers to offer continuation of health-related benefits to covered employees, spouses, domestic partners, and eligible dependent children who lose coverage due to certain qualifying events.  Benefits can be continued for 18 or 36 months depending on the qualifying event.  Premiums are calculated at 102% of the total premium rate, payable by the enrollee directly to the carrier on a monthly basis.  Departments must ensure that covered employees and their dependents are provided with COBRA information and required COBRA notices, and assist employees and dependents with submission of necessary enrollment forms on time.

Employees should contact their personnel office for information regarding the availability of COBRA continuation coverage for health, dental, vision, and the FlexElect Medical Reimbursement Account. 

Under Consolidated Benefits (CoBen), the State provides a monthly benefit allowance to supervisors, managers, confidentials, and excluded employees to pay for their health, dental, and vision benefits.  After the benefits have been paid, employees receive any excess allowance as taxable income.  If employees choose benefits that cost more than the allowance, the additional amount is deducted from their pay check on a pre-tax basis.

Employees who have coverage from another source, e.g., a parent, spouse, domestic partner, or former employer, may opt to receive cash in lieu of medical or medical and dental coverage.  These payments are considered taxable income and are as follows:

$155 - cash in lieu of State-sponsored health and dental insurance.

$130 - cash in lieu of State-sponsored health insurance.

The CoBen Cash Option is available to excluded employees and rank-and-file employees in bargaining units 2, 7, 8, 16, 17, 18, and 19.   

There are four fully monthly premium paid, State-sponsored prepaid dental plans available for employees and their dependents:  SafeGuard (Enhanced), Delta Care USA, Premier Access, and Western Dental.  There are also two State-sponsored Delta Dental plans:  Preferred Providers Option (PPO) and Delta PPO plus Premier (Enhanced), which is an indemnity plan.  Both Delta plans require the employee to pay part of the monthly premium.  The following chart shows the employee’s costs for certain types of procedures.  Please consult each carrier's individual brochure for detailed information and plan limitations.

(a)  The PPO includes a third cleaning for high-risk patients (please consult evidence of coverage for more information on this benefit).

(b)  Under specified conditions, SafeGuard Enhanced Plan provides three cleanings per 12-month service period instead of the normal two cleanings.

(c)  Delta pays 50% up to a lifetime maximum of $1,000 for employee and each dependent for orthodontia.  The employee is responsible for any amount over the $1,000 maximum.

(d)  Delta pays 50% up to a lifetime maximum of $1,000 for employee and $1,500 for dependent children for orthodontia.  The employee is responsible for any amount over the $1,000 or $1,500 lifetime maximum.

(e)  The employee is responsible for maximum copay of $1,000 plus up to $250 for start-up costs.

(f)  Diagnostic and preventive benefits are exempt from the deductible.

(g)  Delta pays 50% up to a lifetime maximum of $2,500.

An employee, who registers a domestic partnership, may enroll their partner as an eligible family member in State-sponsored health, dental, and vision benefits and receive the increased employer contribution for that coverage.  To be eligible to enroll a domestic partner, the State employee and his or her same-sex partner must file a Declaration of Domestic Partnership in accordance with guidelines established by the Secretary of State's office.  If you are in a committed opposite-sex relationship where one partner is 62 years or older, you have the opportunity to register as domestic partners.

Employees are eligible to add a domestic partner's children to benefit plans if they meet the definition of economic dependents.  Because the Internal Revenue Service does not recognize domestic partner coverage, the premium difference between one-and two-party coverage will be treated as taxable income to employees who add a domestic partner and/or dependents to their health and dental benefits.

Employees should contact their personnel office for additional details regarding this benefit.

Reference:  CalHR Rule 599.950 - 599.955

FlexElect offers two employee benefits:  Reimbursement accounts for out-of-pocket medical and dependent care expenses; and cash option in lieu of your state-sponsored health and/or dental benefits.  With a Medical and/or Dependent Care Reimbursement Account, employees designate monthly pay check deductions to pay medical or dependent care expenses with pre-tax income.  Employees must reenroll each year if they want to participate in a reimbursement account the next year.

Effective January 1, 2014 FlexElect enrollees will pay a monthly administrative fee of $1.00.  Cash Option for managers, supervisors, confidential, and excluded employees is available through Consolidated Benefits.

Reference:   Govt. Code Section 19889.7 – 19849.10

The Group Legal Services Insurance Plan is a voluntary, employee-paid plan in which the monthly premium is automatically deducted from an enrolled employee's paycheck. The Plan provides 100% coverage when a Plan attorney is used. The Plan pays up to a specified maximum amount when a non-plan attorney is used for covered legal services. The covered services include such legal needs as preparing a will, buying/selling or refinancing your primary residence, adopting a child, filing personal bankruptcy, serious traffic matters (except DUI,DWI), consumer protection, defense of juvenile court charges for an insured child, representing a child in court, defense of civil actions and misdemeanors, and various domestic matters (e.g., annulments, legal separations, divorces, and defense of actions to modify or enforce valid decrees or separation agreements).

Reference:   CalHR Rule 599.920

CalPERS administers health insurance coverage for State employees.  Employees may choose from a broad range of health insurance plans including Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Association plans (requires union membership). The employer contributes towards the health premiums for permanent employees working half time or more and eligible permanent-intermittent employees.   If the monthly cost of the employee’s health premium exceeds the employer contribution, the employee pays the rest with pre-tax dollars. For additional information on health plans and premiums, visit the CalPERS website. For questions about your eligibility, contact your personnel office.

The Consolidated Benefits handbook includes rate and allowance information for excluded employees.  

A $50,000 basic group term life insurance policy for managers and a $25,000 basic group term life insurance policy for supervisory, confidential, and other specified excluded employees are fully paid by the State. Enrollment in the basic group term life insurance is automatic. The policy also includes accidental death and dismemberment coverage. Additional insurance in $10,000 increments (up to a prescribed maximum), as well as dependent coverage for their spouse/registered domestic partner and/or eligible children is available for purchase. Upon retirement, insurance coverage may be continued at the employee's expense.

For additional information about this benefit, employees can contact their personnel office.  

This voluntary employee-paid benefit is offered to managers, supervisors, confidential and excluded employees who meet the eligible criteria. This is income protection if an employee become ill or injured and is unable to work. Employees must complete the first six months elimination period of disability and must have been actively at work the day prior to their disability. If an employee's claim is approved, and if they are continuously disabled, benefits become payable after a six-month waiting period. Payments may also be reduced by other deductible income. The minimum monthly payment is the greater of $100 or 10% of your Long Term Disability (LTD) benefit. The maximum monthly LTD benefit is $10,000.

The employing department provides information and an application to all newly eligible permanent employees who work half time or more. The employee will also receive an enrollment packet from the carrier at their home address that is on file with the State Controller's Office. Employees have 60 days to enroll in the plan from the date their appointment is processed by their personnel transaction staff. Employees, who do not enroll during the initial 60-day enrollment period and wish to enroll, must wait until the next annual open enrollment period.

For additional information about this benefit, please call The Standard Insurance Company at (888) 641-7193.

Employee Designation:  Manager, Supervisor, Confidential, and Excluded

Any out-of-pocket health and/or dental premium incurred by an eligible employee is deducted from the employee’s paycheck on a pre-tax basis. 

Reference:  Govt. Codes 19849.2, 19849.3 and 19849.11

An employer-paid $150,000 Travel Insurance policy is provided to insure employees for job-related accidental death/dismemberment when using commercial carriers licensed by the Public Utilities Commission.

Vision Care Insurance

Reference:   CalHR Rule 599.927

There are two vision plans for employees to choose from. The VSP Basic Plan is provided by the State at no cost to eligible employees and their dependents. An employee may choose to upgrade to the Premier Plan for a small monthly cost in order to have higher allowances for frames and contacts, fully covered progressive lenses and more discounts.

Basic Vision Plan

Benefits for eligible employees and their dependents include an eye exam, frames, and/or lenses once each calendar year.  Medically necessary contact lenses are also fully covered.  An allowance of $75 for frames and $110 is available for elective contact lenses.  A $10 deductible for an eye exam and a $25 deductible for materials (frames and/or lenses) are required at the time of the appointment.

Eligible employees are automatically enrolled in the State’s Basic Vision Plan. The effective date is based on when the employee’s personnel office processes the Personnel Action Request (PAR) document.

Premier Vision Plan
Employees may upgrade to the Premier Vision Plan. The State contributes a portion of the Premier Plan cost. The State contributes $8.64, the equivalent of the Basic Plan cost and the employee pays a small monthly cost. This benefit for eligible employees and their dependents includes an eye exam, frames, and/or lenses once each calendar year. An allowance of $200 ($110 allowance at Costco) is available for frames and/or lenses including bifocal, progressive and transition lenses which are fully covered. A $10 deductible for an eye exam and a $25 deductible for materials (frames and/or lenses) are required at the time of the appointment.

Permanent-Intermittent Eligibility
Permanent-Intermittent (PI) employees must work at least 480 hours in a control period (January 1 – June 30 or July 1-Decemeber 31) to qualify for both the Basic or Premier Vision plans. The PI has 60 days from the end of the control period to enroll in either vision plan.