1404 - Vision (Historical View)

** Effective: 11/21/2016 9:36:14 AM - 11/21/2016 9:37:15 AM **

Status: Active

Change Notes

Added tables as text.

Category

Benefits and Insurance

Audience List

Synopsis

This policy:

Introduction

The California Department of Human Resources (CalHR) administers the state’s vision insurance coverage for eligible state employees, retirees, and their eligible dependents. CalHR sets policy and procedures on eligibility and enrollment.

Statement

Employee Eligibility and Enrollment

Employees are eligible for vision benefits if they:

Presently, there is an exception for the Seasonal Lifeguards in Bargaining Unit (BU) 7 and Seasonal Firefighters in BU8, who are eligible for state-sponsored vision benefits. Refer to bargaining unit contracts at the CalHR website for current eligibility information.

A Permanent Intermittent (PI) employee may be eligible to enroll in vision 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.

Represented employees in Bargaining Unit 6 have vision coverage through their union trust fund and are not eligible to enroll in the state’s vision program, unless otherwise designated by the state as eligible.

Enrollment into the state's Basic Vision Plan for eligible employees and their eligible dependents is automatic. Eligible employees who positively elect to enroll into the Premier Vision Plan must enroll within the first 60 days of employment or eligibility, or during the annual open enrollment period. Open enrollment for vision benefits is traditionally held each fall and allows eligible employees to:

Employer contribution rates are found in the bargaining unit contracts and on the Benefits Calculator located on the CalHR website. This calculator allows employees to compare vision premiums and see employer contribution rates based on their bargaining unit. Employees can also see the pay warrant deduction amount based on their vision plan they choose.

12-Month Minimum Requirement

Once enrolled into the Premier Vision plan, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. The enrollee may dis-enroll 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).

Dependent Eligibility

Eligible dependents include the employee’s, registered domestic partner, and their children up to age 26 including natural born, adopted (including children placed for adoption, step children, or other children whom the employee assumed a parent-child relationship.

Dependent Eligibility Verification Checklist

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 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:

Authority to Require Documentation

Government Code section 20128 of the California Public Employees’ Retirement Law grants CalPERS authority to require information it deems necessary to determine the benefit entitlement of a member or beneficiary.  As such, departments are responsible for requesting additional information and supporting documentation, as necessary, to substantiate dependent eligibility for CalHR benefits.

Retention of Checklist, Forms, and Eligibility Documentation

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.

Guidance for Determining and Documenting Dependent Eligibility

Appropriate application of the eligibility rules for the state’s vision benefit program will:

The following information provides further 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 vision 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 vision benefits under any circumstance.

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.

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 Affidavit of Parent-Child Relationship (CalPERS Form HBD-40), the Dependent Eligibility Verification Checklist (CalHR Form 781), and the required verification documents.  Follow the certification process in accordance with CalPERS Circular Letter #600-008-15.

Annual Recertification:

Employees must recertify each PCR dependent annually by submitting a new signed and dated Affidavit of Parent-Child Relationship form, Dependent Eligibility Verification Checklist, and the required verification documents to substantiate a continuance of the parent-child relationship.  Follow the recertification process in accordance with CalPERS Circular Letter #600-008-15.

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.     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).  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 vision benefits, or (2) within 60 days of a newly eligible employee’s initial enrollment in the CalHR administered Vision Program.  Follow the certification process for disabled dependents in accordance with the State Health Benefits Guide.

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 eligibility for employees and their dependents, and to hold 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, the vision benefit plan, and/or the CalPERS system for expenditures incurred for 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.

Retiree Eligibility and Enrollment

Retiring employees who, at the time of retirement, meet the eligibility requirements of Government Code Section 22959.4 (as reflected below), may enroll in the Retiree Vision Program:

Retirees are subject to the same eligibility criteria and verification procedures as the active employees.

Premium Rates

State-Sponsored Vision Plans

Basic Vision

Premier Vision

Retiree Vision Voluntary Plans

Basic Vision

Premier Vision

Application

Refer to Benefits Administration Manual, Vision Section 1200 for instructions on completing enrollment and eligibility forms.

Authorities

Resources

FAQs

Forms

PML

Web Pages

Authorized By

Contact Person

Lisa Hatten
Program Manager, , Vision Insurance Plans
Phone: 916-445-9795
Fax: 916-322-3769
Email: lisa.hatten@calhr.ca.gov

Superseded Policies

Not Applicable.