Dental Program

Important Policy Updates

• National Emergency Relief and Guidelines for Employee Benefit Plans​
  
  

Content

• 501. General Information
• 502. Current State-Sponsored Dental Plans
• 503. State/Agency Responsibilities
• 504. Dental Plan Deduction Codes/Premiums
• 505. Employee Eligibility
• 506. State Plan Restriction for Newly Hired State Employees
• 24-Month Restriction Period
• Bargaining Unit 5
• Exceptions to the 24-Month Restriction
• Enrollment Processing Upon Completion of 24-Month Restriction Period
• 507. CCPOA Benefit Trust Fund Dental Enrollment
• 508. Dependent Eligibility
• 509. Move Out of Household
• 510. Enrollment
• PI Employees 
  
• Unit 6 Cadet Employees
• Continuation of Coverage for PI Employees
• 511. Allowable Changes to Enrollment
• Mandatory Deletions
• Voluntary Changes
• Administrative Deletions
• Voluntary Change of Dental Plan
• Changes in Collective Bargaining Designation (CBID) BU 5 and 6
• Enhanced and Basic Dental Coverage-Automatic Conversion
• 512. Effective Dates
• Mandatory Effective Date Rule
• Standard Effective Date Rule
• Retroactivity/Emergency Plan Change
  
• Revolving Fund Checks
• 513. Re-Enrollment of Employees
• Reinstatement after Leave of Absence
• Reinstatement after Appeal
• Retired Annuitants
• 514. Annual Open Enrollment Period
• Permitting Event Codes
• Employees Off Active Pay Status During Open Enrollment Period
• Correcting Open Enrollment Documents
• Cancel or Change Open Enrollment Documents
• 515. Continuation of Coverage While Off Pay Status
• Dental Plan Direct Payment Authorization (STD. 696)
• Absences/Situations Where Coverage Lapses
• Direct Payment of Premiums
• Addition or Deletion of Family Member While on Non-Pay Status
• Return to Pay Status
• Dental Benefits for Exempt Employees Separating from State Service
• Conditions of Eligibility
• Dental Plan Enrollment Form and Premium Payment
• Indemnity Type and PPO Plans-Delta Dental
  
• Prepaid Plans-Delta Care USA, Premier Access, SafeGuard and Western Dental
• Separating Legislative Members
• 516. 120-Day Death Benefit for Continuation of Benefits
• 517. Retiring Employees
• Vesting Requirements for Retiring Employees-General Information
• Department Responsibilities
• CalPERS Responsibilities
• Coverage for Retirees
• Coverage for Survivors of Deceased Retirees
• 518. Cancellation/Termination of Dental Enrollment Coverage
• Cancellation of Dental Enrollment
• Termination of Coverage
• 519. Consolidated Omnibus Budget Reconciliation Act
• Time Limits for COBRA
• COBRA Qualifying Events Continued for 18 Months
• COBRA Qualifying Events Continued for 36 Months
• 520. Document Completion
• 521. Dental Carriers/Benefit Information
• Evidence of Coverage (EOC) Booklets:
• Prepaid Plans
• ​Delta Dental
• Verification of Coverage
• Change of Dentist
• Employee Complaints
• Claim Forms
• Carrier Address/Phone Information for State-Sponsored Dental Plans
  
• Direct Pay
• COBRA Payment Address Information

Attachments

• A - To access the Automated Dental Plan Enrollment Authorization - STD. 692, please visit the Benefits Calculator
  
• B- Dental and Vision Plan Deduction Codes and Prem​iums
  
• C - Permitting Events Code Chart 
  
• D - State of California Dental Affidavit of Eligibility
• E - CalPERS Medical Report for Disabled Dependent (HBD-34) (Go to the CalPERS Forms and Publications page)​​
• F - Dental Plan Direct Payment Authorization
  
• G - Affidavit for Domestic Partners Being Claimed as Economic Dependents (CalHR 680)
• H - Instructions for Completion of Dental Plan Enrollment Authorization (STD. 692) | H - Instructions for Completion of Dental Plan Enrollment Authorization (STD. 692) - Text Only (RTF)
• I - Notice of Loss of Employer Sponsored Coverage (PDF) | J - Notice of Loss of Employer Sponsored Coverage - Text Only (RTF)
• J- Dental Enroll​ment ​​Checklist (PDF)​​
  

501.  GENERAL INFORMATION

While CalHR sets policy and procedures on enrollment and eligibility, the actual enrollment documents, are reviewed and processed for active employees by the State Controller's Office (SCO) and for annuitants/retirees by the California Public Employees' Retirement System (CalPERS). Only those documents requesting some type of appeal or exception approval are forwarded to CalHR Benefits Division for review.

To access the Automated Dental Plan Enrollment Authorization - STD 692, please visit the Benefits Calculator​.

Please ONLY send dental enrollment appeals to:
Department of Human Resources (CalHR)
Benefits Division
1515 “S” Street, N-500
Sacramento, CA 95811-7258
Attention: Dental Program
or
Fax/Email Dental Appeals to CalHR Benefits Division
Fax - (855) 290-0158  
Email - dental@calhr.ca.gov

Authority:

Abbreviations

CalHR, SCO and CalPERS Mailing Addresses and Phone Numbers

502. Current State-Sponsored Dental Plan

503. Responsibilities

State Departments

State Controller's Office (SCO)

California Public Employees' Retirement System (CalPERS)

Exclusive Representatives for Bargaining Units 5 and 6

The exclusive representatives for Units 5 and 6 contract directly with dental carriers for dental coverage for their members and have administrative responsibility for such coverage. Employees in Units 5 and 6 enroll in their respective union-sponsored plan through their personnel office using the standard dental enrollment form (STD. 692) and enrollment procedures. Once enrolled, employees in these bargaining units should contact their union directly regarding questions or issues regarding their dental coverage. The contact numbers for these bargaining units are provided below:

• California Association of Highway Patrolmen (CAHP), Unit 5: (800) 734-2247
• California Correctional Peace Officers Association (CCPOA), Unit 6: (800) 468-6486

504. Dental Plan Deduction Codes/Premiums

Employees Eligible to Enroll or Continue Enrollment in the State's Dental Program:

1. Permanent state employees with a time base of half-time or more who are designated Rank and File, Managerial, Supervisory, Confidential, Exempt, Excluded, Constitutional Officers, Employees of the Judicial Council, and all State Superior, Appellate, and Supreme Court Judges.
2. An employee appointed to a Limited-Term (LT) or Temporary Authorization (TAU) with an appointment of six months or more, with a time-base of half-time or more.
3. Permanent-Intermittent (PI) employees who are credited with a minimum of 480 hours worked each six-month qualifying control period, January 1 - June 30 and July 1 - December 31.
• Hours worked during a qualifying period in a permanent, (TAU) or (LT) appointment may be counted toward the 480 hours if the employee subsequently receives a PI appointment with no break in service.
• An employee who permanently separates and reinstates as a PI employee must work the 480 hours in a qualifying control period to be eligible for coverage, regardless of the length of the break in service.
• An enrolled employee whose time base changes to PI will have coverage continued until the end of the next control period. At that time, the employee must requalify based on his/her PI status.
• A PI employee who transitions into a LT position during a control period, with no break in service, may combine the hours worked as an LT with the PI hours to qualify for dental coverage at the end of that control period. The LT time base must be half-time or more.
• A Unit 6 cadet PI employee will be eligible for dental benefits upon graduation from the Academy of the California Department of Corrections and Rehabilitation.
4. Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU, and Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.
5. A former retired state employee reinstated to a PI position. However, retirees reinstated to a PI position must requalify during the next control periods.

506. State Dental Plan Restriction for Newly Hired State Employees​

24-Month Plan Restriction

Bargaining Unit 5

All newly hired represented employees in Unit 5 must elect their dental coverage from one of the state-sponsored prepaid dental plans. After completing a 24-month restriction period, Unit 5 employees must change to the CAHP union-sponsored indemnity plan, Blue Cross, if they are members of CAHP. Use PEC 08 on the STD. 692 to process the enrollment or change.

​Exceptions to the 24-Month Restriction Period

1. Newly Hired Employees with a LT or TAU Appointment

2. Employees Hired to State Service with Current Delta Dental Coverage

• CalPERS retiree, enrolled in Delta, who is reinstating from retirement status and eligible as an active employee for state dental coverage.
• New hire or transfer (no break in service) from another state government agency or California State University (CSU) or University of California (UC) systems (if prior coverage was under city, county, federal, private/public sector, or as a dependent on their parent/spouse state-sponsored plan, then the employee is not eligible for this exception).
• For these exceptions, departments must confirm current Delta Dental plan coverage. Indicate the specific exception in the remarks section on the STD. 692: Prior Delta dental coverage with "Another state Government Agency" or "CSU" or "UC".
• Prior state employees, who continued and maintained their state Delta dental coverage through COBRA (COBRA coverage must be current at the time of hire).

4. Represented Employees in Consolidated Benefits (CoBen)

5. Prepaid Dental Plan Provider (Dentist) Not Available Within 50 Miles

6. Prior State Employees That Worked For 24 Months

8. Employees Hired After Layoff

• If the employee was enrolled in Delta dental at the time of layoff, he/she will be allowed to reenroll in Delta dental and will not be required to complete a 24-month restriction period.
• If the employee had served a portion of the 24-month period prior to layoff, then that time may be included with time served upon rehire to meet the 24-month requirement for enrollment into Delta dental.

9. Permanent-Intermittent (PI) Employees

Enrollment Processing Upon Completion of 24-Month Restriction Period

507. CCPOA Benefit Trust Fund Dental Enrollment

CCPOA Benefit Trust Fund 12-Month Dental Plan Restriction

All newly hired Unit 6 employees are required to enroll and maintain coverage in a CCPOA prepaid dental plan. All Unit 6 employees must enroll in CCPOA Western dental plan for a period of twelve (12) consecutive months from the effective date of their enrollment. This stipulation includes state employees who have transferred into Unit 6 and previously satisfied the state's mandated 24-month dental plan restriction. At the end of the 12-month period, restricted employees will have 60 days to request a change to the Primary dental plan. Those employees who do not take this action within the 60-day period may do so during an open enrollment period. 

Exceptions: The only exceptions to the mandatory enrollment in a CCPOA Benefit Trust Fund-Sponsored dental program is the case of a Bargaining Unit 6 member who is: (1) married to another state employee; (2) and receiving dental benefits under the spouse's state dental program.

These Exceptions Permit the Employee to Enroll in the CCPOA Primary Dental Program:

• No prepaid dental facility or provider is within 50 miles of the employee's home or work.
• The employee has eligible dependents residing in another service area who are unable to obtain services from a prepaid provider.
• The employee is enrolled in the CCPOA prepaid dental program and then promoted within Corrections (promotion resulted in enrollment in a state-sponsored dental plan), and then later demotes back to Unit 6 (R06). The employee will not have to meet another 12-month restriction period.
• Two Unit 6 (R06) married employees, enrolled in the same dental plan who met the 12-month restriction and later divorce will not have to meet another 12-month restriction period.​
  

Enrollment Processing Upon Completion of 12-Month Restriction Period

508. Dependent Eligibility

Dependent Eligibility Definitions for State Employees

1. Family Member

Medically Disabled Eligible Dependent Children

• The disabled dependent may be continued under such coverage only under the following conditions:
• ​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 age 26.

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

"Family Members" who are not Eligible for Coverage include, but are not Limited to:

1. A stepchild for whom the employee or annuitant does not provide "parental supervision and substantial financial support" such as in the case of a stepchild not living in the employee's or annuitant's household.
   
2. An otherwise eligible dependent who is on active duty, U.S. military service.
3. A disabled child whose disability occurred after age 26.
4. A child over age 26 who was once certified as eligible and disabled but subsequently is unable to meet certification requirements for continued disability.
5. Parents, grandparents, common law marriages, children over age 26 unless medically disabled; and
6. Other relatives or persons not identified as a legal spouse, certified domestic partner or eligible child. 
   

Employees may choose to exclude from coverage dependents who meet any of the following conditions:

1. A dependent child covered under a non-state-sponsored dental plan.
2. A spouse not living in the employee's household, not applicable in the event of a pending divorce, separation, or annulment.
3. A certified domestic partner not living in the employee's household.
4. A child over age 18 or no longer economically dependent.

Employees on Their Parents Plan When Hired

Dual/Split Dental Coverage

1. State employees may not have dual coverage. At the time a spouse or dependent enrolls as a state employee, coverage as a dependent on a spouse's or parent's state dental plan must be terminated on the effective date of the enrollment as an employee.
2. There is no split coverage allowed. State employees may not split dependent coverage; all dependent children must be enrolled by one state employee. The department must correct these types of enrollments retroactive to the date they began and notify the employee accordingly. Use PEC 42 (enrolled, but not eligible) on the STD. 692 and submit to SCO for corrective action. Employees will be responsible for dental expenses incurred during a period of ineligibility. Departments should ensure that new employee benefit orientation packages provide information regarding dual/split dental coverage.

Court Ordered Dental Coverage - Family Code section 3760-3773 and 4726

Court Ordered Dental Coverage - NATIONAL MEDICAL SUPPORT NOTICE - Notice to Withhold for Health Care Coverage

Employees Currently Not Enrolled (Excluding Bargaining Units 5 and 6)

Employees Currently Enrolled (Excluding Units 5 and 6)

Employees in Units 5 or 6

Authority

509. Letter Notice - Move out of Household

510. Enrollment

Permanent-Intermittent (PI) Employees

PI Employees - CCPOA - Unit 6 Cadet Employees

Continuation of Coverage for PI Employees

511. Changes to Enrollment

Mandatory Deletions

1. Divorced spouse must be deleted from coverage even if the divorce settlement requires the employee to provide dental 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 military.
6. Dependent no longer economically dependent/change of custody.
7. Dependent enrolled but not eligible.
8. Dependent dual or split covered.

Voluntary Changes

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).

Administrative Deletions

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 PEC the employee is responsible for any costs for dental services that were performed on him/herself or any ineligible dependent.
3. Employees that are enrolled but not eligible and refuses to sign the STD. 692 to change dental plans due to bargaining unit change. Cancel retroactive to PED, which caused eligibility to terminate using code 42.
• The employee must be notified regarding this change and will not be allowed to enroll in a dental 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 Dental Plan

1. During an open enrollment period;
2. Due to a physical move to an area that is not serviced by the current dental carrier; (PEC: 34)
3. Due to a physical move to an area where a dental plan was not previously available to the employee; or (PED: 35)
4. Due to service plan cut in the employee's service area and/or the employee's current dental plan does not have a dental provider within a 50 mile radius of the employee's residence. (PEC: 34) Attachment C - Permitting Events Code Chart ​
   

Changes in Collective Bargaining Designation (CBID) Units 5 or 6

1. Unit 5 - California Association of Highway Patrolmen (CAHP): Unit 5 employees who are enrolled in the CAHP dental plan, Blue Cross, are automatically moved to the state-sponsored Delta plan when they move out of Unit 5. The effective date of the dental plan change is based on when the PAR document is keyed. CHP personnel office staff must complete a STD. 692 and forward a copy to Delta dental so it can update its records accordingly. Since SCO processes the plan change automatically, the STD. 692 is not sent to SCO. Those R05 employees who were enrolled in one of the state-sponsored prepaid plans will continue their enrollment but will be allowed to elect to change to Delta dental if eligible if they choose to do so. CHP personnel office staff are responsible for notifying employees of their options.
2. Unit 6 - California Correctional Peace Officer's Association (CCPOA): When employees move in or out of Unit 6, a new STD. 692 must be completed to change the employees to the appropriate dental plan based on their new CBID, failure to do so may result in a loss of coverage. STD. 692 should be completed and forwarded to SCO using PEC 40 with a standard effective date.

Enhanced and Basic Dental Coverage - Automatic Conversion

1. Employees moving from represented to excluded will be automatically moved into the enhanced level of coverage effective the first day of the month following their first full month as an excluded employee. For example, if the CBID identifier change over to an excluded designation is effective March 7, coverage would be effective May 1, (April pay period, first full month as excluded). Because this change is processed automatically by SCO, departments are encouraged to process PAR documents as quickly as possible so that employees receive their correct level of dental benefit coverage. The SCO runs a program each month normally two days prior to the master payroll cutoff. Any changes not processed for the current master payroll cutoff will be processed during the next pay period.
2. Employees moving from an excluded to a represented classification will be automatically moved into the basic level of coverage effective the first day of the month following the change to represented. For example, if the CBID change to represented is effective March 4, coverage would be effective May 2, (April pay period).

512. Effective Dates

Attachment C - Permitting Events Code Chart lists all of the various dental permitting event codes as well as the respective effective date rule that should be applied.

Mandatory Effective Date Rule

• Example: Event occurs any time during the month the effective date will be the first day of the month immediately following the event. Employee's date of divorce is 10/23. The effective date is 11/1.

Standard Effective Date Rule

• Example (1): Employee hired 07/14 and submits STD. 692 on 08/11. The effective date is 09/01.

• Example (2): Spouse moves out of household 03/25 and employee submits STD. 692 on 04/02. The effective date is 05/01.

• STD. 692 forms which are submitted to SCO and must be returned to the employing office due to incomplete or incorrect information will maintain the original effective date. Personnel office staff needs to be aware, however, that document processing problems will result in a delay in eligibility information being sent to the dental plans. Employees should be advised accordingly.

Retroactivity/Emergency Plan Change

Revolving Fund Checks

513. Re-Enrollment of Employees

Reinstatement after Leave of Absence

Reinstatement after Appeal

Retired Annuitants

514. Annual Open Enrollment Period

Permitting Event Codes

Employees Off Active Pay Status During Open Enrollment Period

Effective Dates

Correcting Open Enrollment Documents

Cancel or Change Open Enrollment Documents

515. Continuation of Coverage While Off Pay Status

The Dental Plan Direct Payment Authorization (STD. 696)

Absences/Situations Where Coverage Lapses

1. Leave of absence for one or more full pay periods 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. PI, 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 provisions are applicable after CalPERS' determination of survivor benefits).
8. Under approved State Disability Insurance benefits. 

Direct Payment of Premiums

1. Dental carriers do 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. 696 and sent to the carrier.
3. The dental 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 dental carrier by the first of each subsequent three-month period. STD. 696 forms received by the dental 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 dental 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 his/her dental carrier to request a refund of any direct premium overpayments paid.

Addition or Deletion of Family Members While on Non-Pay Status

1. An employee is responsible for contacting his/her personnel office and completing a new STD. 692 reflecting the enrollment change. The personnel office must forward the document to SCO for processing.
2. If an employee is on direct pay and the change results in a change of premium, a new STD. 696 must also be completed.
3. If an employee deletes any dependent prior to or during the leave, the dependent may not be re-enrolled until the next open enrollment period. 

Return to Pay Status

Dental Benefits for Exempt Employees Separating from state Service

Conditions of Eligibility

1. An exempt employee may choose not to continue his/her dental benefits at the time of separation. However, the separated exempt employee will be eligible to enroll in a dental plan at the time of his/her future date of retirement.
2. An exempt employee may elect to continue his/her dental benefits at the time of separation. The enrollment must be made within sixty (60) days from their date of permanent separation. The premium rate is 102 percent (%) of the current state rate. While this rate is the same as the COBRA rate, continuation of coverage in this instance is not part of COBRA. 

Dental Plan Enrollment Form and Premium Payment

Indemnity Type and PPO Plans - Delta Dental

Prepaid Plans - DeltaCare USA, Premier Access, SafeGuard and Western Dental

Separating Legislative Members

516. 120-Day Death Benefit for Continuation of Benefits

Authority:

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

517. Retiring Employees

Vesting Requirements for Retiring Employees - General Information

Responsibilities

CalPERS Responsibilities

Coverage for Retirees

1. A retiring employee, who is enrolled in DeltaCare USA, Premier Access, SafeGuard, or Western Dental and moves into an area where a prepaid plan is not available will be allowed to change dental enrollment to Delta Dental PPO plus Premier or Delta PPO at the time of his/her retirement.
2. An excluded employee who is enrolled in the Delta enhanced and receiving the enhanced level of coverage will be automatically moved to the basic level of coverage upon retirement. (After the STD. 692 is processed by CalPERS).
3. Employees enrolled in SafeGuard at the time of retirement will have the enhanced level of coverage (After the STD. 692 is processed by CalPERS).
4. An employee in Unit 5, CAHP, must make an irrevocable election to either remain in the CAHP indemnity plan for the duration of his/her retirement or select one of the state-sponsored plans. This option is also available to a retiring manager or supervisor who is designated as M05 or S05. If an employee elects one of the State-sponsored plans, he/she may only change to another state-sponsored plan during the normal dental open enrollment period for the duration of his/her retirement. personnel office staff should ensure that a retiring Unit 5 employee makes an election designating his/her choice of dental plan.
• If a Unit 5 employee elects not to have dental benefits at the time of retirement, they would still have the one-time election available to them during a future open enrollment period. The employee must remain in good standing and a due paying member.
5. An employee in Unit 6, CCPOA, must change to a state-sponsored dental plan when he/she retires. 

Coverage for Survivors of Deceased Retirees

518. Cancellation/Termination of Dental Enrollment Coverage

Cancellation of Dental Enrollment

1. Employees may voluntarily cancel their dental plan enrollment at any time by completing a STD. 692 and submitting it to their personnel office. These employees may not re-enroll in a dental plan until the next scheduled open enrollment period.
2. Enrollment for PI employees who do not qualify during a control period must be administratively cancelled. The effective date of cancellation is February 1 for the July 1 - December 31 control period, and August 1 for the January 1 - June 30 control period. These employees may continue coverage through COBRA.
3. Employees/dependents that were enrolled but never eligible must be retroactively cancelled back to the effective date of their enrollment.
4. Employees who lose eligibility due to a reduction in time base to less than half-time must be administratively cancelled, except for those employees approved for Partial Service Retirement.

Termination of Coverage

519. Consolidated Omnibus Budget Reconciliation Act (COBRA)

Time Limits for COBRA

COBRA Qualifying Events - Benefits Continued for 18 Months

• Voluntary Termination - Covered employee voluntarily terminates or separates from employment (e.g., retires or quits), and the termination/separation will cause a loss of coverage.
• Involuntary Termination - Covered employee is involuntarily terminated from employment (other than for gross misconduct), and the termination will cause a loss of coverage. If the termination is due to "gross misconduct," the state is not obligated to offer COBRA continuation coverage.
• Reduction of time base - Covered employee's work hours are reduced voluntarily or involuntarily, and the reduction of hours will cause a loss of coverage. Reduction of hours may include:
  
• Full-time to part-time
• Strikes
• Layoffs
• Leave of Absence
• Military call-up (24 months of coverage)
• ​Permanent Intermittent (who loses coverage based on a non-qualifying control period) 
  

• Death - Covered employee or retiree dies, and the surviving family member is not eligible for a monthly survivor allowance from CalPERS.
• Medicare coverage begins-Covered employee or retiree becomes entitled to Medicare benefits.
• Divorce or legal separation-Covered employee or retiree is divorced or legally separated
• Domestic partnership termination-Covered employee or retiree terminates a domestic partnership (registered in the State of California). 
• Change in dependent status-An eligible child of a covered employee or retiree turns age 26. 

520. Document Completion

General Information 

• New enrollments or re-enrollments
• Authorized changes to current coverage
• Cancellation of all coverage
• Elections not to enroll in a dental plan
• COBRA continuation (Use STD. 692 for prepaid plans)

521. Dental Carriers/Benefit Information

Evidence of Coverage (EOC) Booklets

1. Prepaid Plans

In the event an employee indicates that a dental claim for services has been denied, it is possible that there is a problem with the employee's enrollment and the employee is not reflected on the dental carrier's eligibility files. If this occurs, departments should do the following:

1. Verify that the correct dental plan name is reflected on the employee's pay warrant.
2. Ensure that the claim denial was not prior to the 5th or the 20th of the month. The carriers receive eligibility information from SCO via electronic download on these dates. The employee may want to have their dentist resubmit the claim.​
3. Confirm with the employee that the correct Social Security Number was entered on the claim form.
4. Review the file copy of the STD. 692 for accuracy.
1. If the STD. 692 is correct, contact the SCO Deductions Liaison Unit to verify when the document was processed and premiums paid.
2. If any of the following items are incorrect on the STD. 692, contact the SCO Deductions Liaison Unit:
1. ​Section A - Items 1, 2 or 4
2. Section B - Item 1; Item 3 does not correspond to Section E, Item 4
3. Section D - Form not signed/dated
4. ​​Section E - Item 1; Item 2 does not correspond to Items 7 and 8 and/or Section B-1

Change of Dentist

Employee Complaints

All the dental carriers have an internal complaint/grievance process in the event an employee is not satisfied with the services or benefits they receive. An employee with such a complaint should be advised to contact their dental carrier directly.​

In addition, all the dental carriers are required to be licensed under the Knox-Keene Health Care Act of 1975, which is now administered by the Department of Managed Health Care. An employee who has exhausted their dental carrier's grievance/complaint process and is not satisfied with how the matter has been handled or resolved can contact the ​Department of Managed Health Care, Complaint Center or Hotline at (888) 466-2219. ​

Claim Forms

Dental Carrier Address/Phone Information for State-Sponsored Dental Plans

Delta Dental of California

P.O. Box 997330
Sacramento, CA 95899-7330
(800) 225-3368​

www.deltadentalins.com/state

DeltaCare USA

Attn: Enrollment and Billing
P.O. Box 1803
Alpharetta, GA 30023
(800) 422-4234

www.deltadentalins.com/state

Premier Access

8890 Cal Center Drive
Sacramento, CA 95826
(888) 534-3466

 www.socdhmo.com/

Western Dental

530 South Main Street, 1st Floor
Orange, CA 92868
(866) 859-7525​
www.westerndental.com/state-of-ca

Dental Carrier Direct Payment Address Information for State-Sponsored Dental Plans (excluding COBRA)

Attn: Accounts Receivable
P. O. Box 884460
Los Angeles, CA 90088-4460
(800) 632-8555 press 2​

Dental Carrier COBRA Payment Address Information for State-Sponsored Dental Plans

MetLife

MetLife Attention: SOC COBRA Billing

P.O. Box 13724

Philadelphia, PA 19101-3724

(800) 880-1800

Premier Access

8890 Cal Center Drive

Sacramento, CA 95826

(888) 534-3466

Western Dental

Attn: Group Services

530 South Main Street, 1st Floor

Orange, CA 92868

(866) 859-7525

*Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.​​​​​​​