1403 - Dental (Historical View)

** Effective: 11/21/2016 9:21:07 AM - 11/21/2016 9:23:31 AM **

Status: Active

Change Notes

made slight changes to statement.

Category

Benefits and Insurance

Audience List

Synopsis

This policy:

Introduction

The California Department of Human Resources (CalHR) administers the state's dental insurance program and sets policy and procedures on enrollment and eligibility.

Statement

Employee Eligibility

Employees are eligible for dental benefits if they:

Presently, there is an exception for the Seasonal Lifeguards in Bargaining Unit (BU) 7 and Seasonal Firefighters in BU 8, who are eligible for state-sponsored dental benefits.  Refer to the bargaining unit contracts at the CalHR website for current eligibility information.

A Permanent Intermittent (PI) employee may be eligible to enroll in dental benefits if he/she has earned a minimum of 480 paid hours at the end of a control period, or at least 960 paid hours in two consecutive control periods.  The control periods are January 1 to June 30, and July 1 to December 31.

Eligible employees may enroll in a dental plan within the first 60 days of employment or eligibility, or during the annual open enrollment period.  Open Enrollment for dental benefits is traditionally held each fall and allows eligible employees to:

Employer contribution rates are found in the bargaining unit contracts and in the Benefits Calculator at the CalHR website.  This calculator allows employees to compare dental premiums and see the employer contribution rates based on their bargaining unit.  Employees can also see the amount that will be deducted from or added to their pay warrant based on the dental plan they choose.

24-Month Prepaid Dental Plan Restriction

All newly hired eligible employees enrolling into dental benefits must enroll in a prepaid dental plan until they complete 24 months of state service.  After their enrollment restriction period, they are allowed to enroll into a Delta Dental plan.

Exception to this are:

12 Month CCPOA Western Dental Plan Restriction

All newly hired eligible employees in BU 6 enrolling into dental benefits must enroll into the CCPOA Western Dental plan for 12 months to be eligible for enrollment in the CCPOA Primary Dental plan.

Exception to this are:

Retiree Dental Enrollment

Departments are responsible for enrolling employees retiring from state services and eligible for benefits into retirement.  Departments can enroll the retiree prior to the separation date through the myCalPERS system, or by sending the enrollment document to CalPERS.  CalPERS administers retiree dental enrollment on behalf CalHR.

Dependent Eligibility

Departments are responsible for ensuring only eligible employees and their dependents are enrolled in state-sponsored dental benefits.  The Dependent Eligibility Verification Checklist (CalHR Form 781) is on the CalHR website, and assists the departmental human resources (HR) office to ensure that only eligible dependents are enrolled in benefits.  Employees and HR staff must complete and retain the Checklist for every enrollment transaction that involves adding dependents to health, dental, or vision benefits; and for the annual recertification of parent-child relationship (PCR) dependents.  Employees must initial and sign the Checklist where indicated, and provide the required documents to substantiate dependent eligibility.  The HR staff and employee must complete all relevant sections of the Checklist before enrolling dependents.

The Checklist includes three sections:

HR staff must provide a copy of the completed and signed Checklist to the employee.  The Checklist must also be retained in the employee’s Official Personnel File (OPF) along with current enrollment forms and the supporting documentation used to substantiate dependent eligibility.  These documents should not be purged from the employee’s OPF.

When an employee is appointed by another state department, proper retention of these documents enables the HR office in the receiving department to see that all required documentation was submitted and reviewed prior to enrollment.

The following information provides guidance for determining and documenting dependent eligibility for the different dependent types:

Spouse/Registered Domestic Partner

Only the employee’s legally-joined spouse or registered domestic partner may be enrolled in dental benefits.  Under no circumstances shall:

The employee must provide a marriage certificate, Declaration of Domestic Partnership, Certificate of Registry of Marriage, or affidavit of marriage/domestic partnership demonstrating a legally-recognized marriage or domestic partnership.  If the date of marriage/registration is not within the preceding 60 days, the employee must also provide a copy of the front page of their most recent federal or state tax return or any of the following documents dated within the last 60 days:  statement of account, household bill, or other document showing financial interdependency (it is acceptable to black out financial information).  The document must include the names of the employee and dependent, address and date, and must confirm the dependent as the employee’s spouse/domestic partner.

For newly married employees who submit a Certificate of Registry of Marriage, he/she is required to provide a copy of his/her marriage certificate within one year.  It is the responsibility of the department to create a follow-up process to ensure that the marriage certificate is obtained from the employee within this time period.

Ex-Spouses/Ex-Domestic Partners

Ex-spouses and ex-domestic partners are not eligible to be enrolled and are not permitted to remain as dependents for dental benefits under any circumstances.

It is essential that HR staff, supervisors, and managers communicate to employees that it is the obligation of the employee to inform their HR office in writing within 60 days of the dissolution of a marriage or domestic partnership and to submit an enrollment cancellation of the former spouse/domestic partner.

If an employee is court-ordered to provide coverage for an ex-spouse or ex-domestic partner, it is the obligation of the employee, not the state, to provide that coverage.

Children

Only the natural, adopted (including children placed for adoption), or step children of the employee may be enrolled as “children”.  The employee must provide a birth certificate, official hospital birth record, adoption certificate, or court document demonstrating that the employee is the legal parent of the child.  Birth certificates must be reviewed to verify that the employee is listed as one of the birth parents on the birth certificate.  If the name of the birth parent has changed since the birth certificate was issued, additional supporting documentation must be submitted to validate this name change.

For employees who submit a hospital birth record, he/she is required to provide a copy of the official birth certificate within one year.  It is the responsibility of the department to create a follow-up process to ensure that the official birth certificate is obtained from the employee within this time period.

Under no circumstances shall employees enroll children who are not their natural, adopted, or stepchildren.  Children of the registered domestic partner are to be enrolled using the reason code for “domestic partner children.”  The employee must provide a birth certificate, official hospital birth record, adoption certificate, or court document demonstrating that the registered domestic partner is the legal parent of the child.

Other children for whom the employee has assumed a parent-child relationship must meet the eligibility criteria for enrollment as a PCR dependent (see Parent-Child Relationship Dependents section) and the employee must provide appropriate documentation to substantiate eligibility.

Parent-Child Relationship Dependents (PCRs)

Initial Enrollment:

In a Parent-Child Relationship (PCR), the employee has intentionally assumed parental status or parental duties for a child who is not the natural born, adopted, or step child of the employee.  An eligible PCR child must be under age 26.

For all initial PCR enrollments, the employee must complete and submit the Dental Plan Enrollment Authorization (STD. 692), Affidavit of Parent-Child Relationship (CalHR Form 025),  Dependent Eligibility Verification Checklist (CalHR Form 781), and the required verification documents.

The departmental HR representative must determine if a parent-child relationship exists as evidenced by the assumption of parental status or duties and upon review of documents provided by the employee to substantiate their relationship with the dependent.

Annual Recertification:

Employees must recertify each PCR dependent annually by submitting a new signed and dated Dental Plan Enrollment Authorization (STD. 692), Affidavit of Parent-Child Relationship (CalHR Form 025), Dependent Eligibility Verification Checklist (CalHR Form 781), and the required verification documents to substantiate a continuance of the parent-child relationship.

Disabled Adult Dependents

Initial Enrollment:

A child age 26 and over who is incapable of self-support because of a mental or physical condition may be eligible for enrollment.  The disability must have existed prior to reaching age 26 and continuously since age 26, as certified by a licensed physician.     The California Public Employees' Retirement System (CalPERS) determines the eligibility of a disabled adult child upon receipt of the required Member Questionnaire for the CalPERS Disabled Dependent Health Benefit (CalPERS Form HBD-98) and the Medical Report for the CalPERS Disabled Dependent Benefit (CalPERS Form HBD-34) and will inform the departmental HR office of its determination.  The initial certification of the Disabled Dependent must occur either (1) within 60 days before and ending 60 days after the child’s 26th birthday; the employee and child must currently be enrolled for dental benefits, or (2) within 60 days of a newly eligible employee’s initial enrollment in dental benefits.

Recertification:

Recertification should be evaluated on a case-by-case basis.  The information provided by the physician in the Medical Report for the CalPERS Disabled Dependent Benefit and the status of the disability (e.g., permanent, extended) will determine if, and when, recertification is necessary.  For example, if the dependent’s current disability renders him or her incapable of self-support, but the disability should resolve or improve sufficiently for the dependent to be capable of self-support at some point in time, recertification should then be completed at that time.  It is the responsibility of the department to create a follow-up process to ensure that recertification is obtained from the employee and the dependent’s physician in a timely manner.

Accountability:

Departments are responsible for monitoring the eligibility of employees and their dependents, and for holding employees accountable for failure to notify their HR office in writing within 60 days of a change to dependent eligibility.

Employees may be held accountable if any documentation is determined to be inaccurate or fraudulent, or for failure to notify their HR office of changes to dependent eligibility.  This may include reimbursing their employer and the dental benefit plan for expenditures incurred for dental claims, processing fees, administrative expenses, and attorney fees on behalf of any ineligible family member, and disciplinary action.

CalHR may monitor eligibility and enrollment processes and may hold departmental management and/or employees accountable for compliance.

Dependent Vesting

Employee and dependent eligibility for dental benefits is the same as that for health benefits, and falls under the vesting criteria described in the bargaining unit contracts.  For current vesting information, refer to the applicable bargaining unit contract and the “Dependent Health Care Vesting - Frequently Asked Questions” on the CalHR website.

If a Permanent Intermittent (PI) employee is in a bargaining unit with dependent vesting, the vesting period begins following the completion of a qualifying control period, when the PI becomes eligible for benefits.

If an employee is appointed from a position that is subject to dependent vesting to a position that is not, the employee begins receiving 100 percent of the employer contribution upon appointment.

If an employee is appointed from a position that is not subject to dependent vesting to a position that is, the employee remains at the 100 percent employer contribution level.

Departments should continue their current process of tracking and reporting employee vesting status.  Any changes in vesting status must be reported to the State Controller’s Office (SCO).  This is especially important with respect to PIs, as SCO cannot determine when PI employees have completed the required months of service to change their vesting status.

Dental Plans

The bargaining unit designation of the employee determines the plans available to the employee.  The state pays all or part of the employee’s premium, depending on the plan selected and the number of dependents enrolled.

Currently, the state has contracts with five dental plans; Delta Dental for an indemnity type plan referred to as Delta Dental PPO plus Premier, and the Delta Preferred Provider Option (PPO) (Delta), and four prepaid plans; DeltaCare USA, SafeGuard, Premier Access, and Western Dental.  These five dental plans provide dental insurance for all eligible active employees and their eligible dependents, with the exception of employees in BU 6 who have their dental insurance provided through their respective union-sponsored trust.  In addition, BU 5 employees who are members of the California Association of Highway Patrolmen (CAHP) have their own indemnity dental plan, but may enroll in any of the four state-sponsored prepaid dental plans.  Employees in BU 5 and 6 enroll in their respective union-sponsored plan through their personnel office using the Dental Plan Enrollment Authorization (STD. 692) form, following the normal enrollment procedures.  Once enrolled, employees in these bargaining units should contact their union directly regarding questions or issues regarding their dental coverage.

For current details of the dental plans, refer to the Dental Program section of the BAM web page.

Application

Not Applicable.

Authorities

Resources

FAQs

Forms

PML

Web Pages

Authorized By

Contact Person

Bryan Bruno
Program Manager, , Benefits Division
Phone: 916-445-9841
Fax: 855-290-0158
Email: bryan.bruno@calhr.ca.gov

Superseded Policies

Not Applicable.