Presentation on theme: "Dental Programs. Dental Plans and the Dental Form Your Responsibilities 24- Month Restriction Imputed Tax Situations Mandatory/Standard Rules Items the."— Presentation transcript:
Dental Plans and the Dental Form Your Responsibilities 24- Month Restriction Imputed Tax Situations Mandatory/Standard Rules Items the SCO Looks For
If you would like to be added to our list that allows you to call the carrier and update your employees dental eligibility or personal information, have your manager send an to:
Click on: State HR Professionals Click on:Benefits Administration Click on: Dental Program
Click on: State HR Professionals Click on: Personnel Policies Click on: Policy Memos – Voila!
Delta Dental Indemnity type plan referred to as Delta Dental PPO plus Premier, and the DeltaPreferred Provider Option (PPO) Four prepaid plans: DeltaCare USA, SafeGuard Premier Access and Western Dental.
These plans provide dental benefits for: All eligible active and retired employees and their eligible dependents; With the exception of employees in Bargaining Units 5 and 6 which have their own Union sponsored plans.
Requires that the enrollee choose a dentist from a specific list of dentists. These dentists make up what is referred to as the dental carrier’s provider network. The monthly premium is fully paid by the State and no premium deduction is taken from employees payroll.
To assist your employees that are enrolling in a prepaid plan, be sure they fill in section B, box # 2 of the dental enrollment form STD Do not insert the name of the dental office selected, the carriers want the numbers only.
Offers two plans the Standard and Enhanced plans. Enhanced is only offered to Supervisors, Managers, Confidential, Excluded and Exempt employees. The next slide is Section B of the STD This portion is for the prepaid plans only.
Each department is responsible for notifying: Employees of benefit eligibility guidelines and timeframes for enrollment. Applicable provisions of Consolidated Omnibus Budget Reconciliation Act (COBRA). Completing enrollment documents and submitting to SCO in a timely manner.
The next slide is an excellent tool for employees to do a cost comparison of State Sponsored dental plans. Go to: Click on: Dental Benefits under Popular Links Scroll down to - Comparison of Benefits and Covered Services
All eligible newly hired represented employees in BU’s 1-21 (except Units 2, 7, 8, 16, 17, 18, 19, and excluded employees) are required to select from one of the prepaid plans. All impacted employees must complete 24 months of employment with no permanent break in service.
It’s your responsibility to notify impacted newly hired employees of this restriction and to give these employees an end date to this restriction. At that point, it’s their responsibility to initiate a new STD. 692 to change their dental plan.
At the end of the 24-month restriction, employees will have 60 days to change their enrollment, unless they enrolled in the FlexElect cash option for dental. Once an employee reinstates after a permanent separation and previously had 24-months of State service may enroll in Delta Dental PPO plus Premier or Delta PPO Plan at the time of hire. Make a note of it in the remarks box.
Bargaining Unit 5 - must elect their dental coverage from one of the State Sponsored plans. After completing a 24-month restriction period they may enroll or change to the CAHP union-sponsored indemnity plan, Blue Cross as long as they are members of CAHP.
Unit 6 employees have their dental Insurance provided through their respective union-sponsored trust. New enrollees in BU6 must complete 12 months in Western Dental before being allowed to enroll in their indemnity plan (fee for service). Remember: we do not update BU 6.
All eligible newly hired represented employees in BU’s 2, 7, 8, 16, 17, 18, 19, and excluded (non- represented/CoBEN) may elect Delta Dental PPO plus Premier or PPO Plan. They are not restricted to State- sponsored prepaid plans.
Employees who are hired to State service with a LT or TAU appointment may use time served in those classes – no permanent break in service to count towards meeting the 24-month restriction. Including employees hired to State Service with their own current State sponsored Delta Dental.
CalPERS retiree – reinstating from retirement status and eligible as an active employee for dental coverage. New hire or transfer (no break in service) from another agency or CSU. Time not counted: Student assistants, temporary or seasonal employees (with the exception of Seasonal Firefighters and Lifeguards).
Eligible dependents are defined as: Spouse, domestic partner (certified by the Secretary of State) An eligible child/stepchild/economically dependent child. Common law marriage not allowed.
No pets allowed – no matter how much you love them and feel they are like your kids.
Same-sex marriages that occurred in California between 6/16/2008 – 11/4/2008 are valid in California. Same-sex marriages that occurred in states whose marriage was valid in the jurisdiction in which it was contracted are also valid in California.
If your employee is claiming their Domestic Partner as an economic dependent for Federal Income Tax purposes as authorized by the Internal Revenue Service, they will need to fill out the form CalHR 680. Use Party Code 2 or Party Code 3 when filling out the STD 692. Indicate in box 18 (remarks section) CalHR 680 on file.
If they are claiming them as a dependent for dental benefits this form does not need to be filled out and the Party Code would say “A” (party code 2) or “B” for a (party code 3). SCO will apply the imputed tax.
Section 508 A disability certification is required to ensure disabled dependent children remain covered after the age of 26. (CalPERS HBD 34)
Important!! 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 the age of 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.
continued: Dependents over age 26 who are not currently enrolled in any State-sponsored dental plan.
When dependent children of State employees who are under the age of 26 become State employees, they can remain on their parents plan until the age of 26. If the dependent children do not qualify for State dental benefits as State employees they may remain on their parent's State-sponsored plan, provided they are under age 26.
Dual coverage not allowed. Split coverage not allowed. All dependent children must be enrolled by one State employee if both parents are state employees. Departments must correct these enrollments retroactive to the date they began and notify the employee and submit to SCO for corrective action.
Court orders are generally subject to program’s eligibility rules. In adding a child/children complete the STD. 692, using Permitting Event Code 16. If a court order is issued and your employee has voluntarily deleted a spouse…
…you must reenroll the spouse until the divorce is final, at that point it’s mandatory that the ex-spouse be deleted from coverage and now eligible for COBRA. (PEC 17a or 21a) When completing the STD. 692 resulting from the court order indicate in the Remarks Section “Court Ordered”.
Dependents that must be deleted: Divorced. (However, COBRA must be offered.) Termination of a Domestic Partnership. (Employee must provide copy of notice of termination and COBRA must be offered to terminated domestic partner.)
Death of a dependent (maybe done administratively upon seeing death certificate – note it in the remarks box). Dependent child reaches age of 26. Dependent goes into military.
Dependent no longer economically dependent or change of custody. Dependent enrolled but never eligible. Dependent dual or split covered.
Adding new spouse, certified domestic partner and/or stepchild to a one, two, or more party enrollment. (PEC 17a or 21a) Adding newborn, adopted child, or child at each birthday until the age of 6. (PEC 19 or 22a) Adding spouse, certified domestic partner and/or dependents that lost coverage. (PEC 17b - Must provide proof of loss of coverage.)
Adding a dependent due to a change in custody and/or acquiring an economically dependent child. (PEC 16) Deleting a spouse or domestic partner who ceases to live in household (not COBRA eligible). (PEC 24b – not applicable in the event of a pending divorce, separation or annulment)
Continued : Deleting a dependent who obtains other group coverage (non-State sponsored). (PEC 23b)
Dependent who reaches age 26 and not disabled. (PEC 26d) Employees and/or dependents enrolled but not eligible. Must be deleted retroactive to the effective date. (PEC 42) Employees enrolled, but not eligible due to bargaining unit change and the employee refuses to sign. Delete retroactive to the effective date. (PEC 42)
Death of a Spouse, Domestic Partner or Child Must see the death certificate and make a note in the remarks section of the 692.
Employees enrolled in Delta Dental PPO plus Premier or SafeGuard Standard plan will have their dental benefit coverage level changed to enhanced level depending upon when the PAR is keyed. This is rarely done by an appeal. Because this is automatically done by SCO key the PAR quickly!
Employees moving from an excluded to a represented classification will automatically be moved into the Basic/Std. level of coverage. More information on this process is available in the BAM.
Mandatory Effective Date Rule: First of the month following the permitting event that allows the action to occur. Example: Event occurs any time during the month, the event will be the first day of the month immediately following the event. Divorce final 10/31. Effective 11/1.
Standard Effective Date Rule: First of the month after STD. 692 is completed and received by the employing department. Example - EE hired 1/14 and submits the 692 on 2/11 the effective date is 3/1.
Reinstatement after a Leave of Absence: Coverage in the same dental plan is automatically restored. Effective the first of the month after the first pay warrant is issued by SCO.
Reinstatement after Appeal: SCO requires that a STD. 674 Payroll Adjustment Notice, be submitted to reinstate an employee’s benefit deductions. The effective date can be current or retroactive.
Retired Annuitants – who temporarily return to State employment are not eligible to enroll in a dental plan as an active employee. Retired Annuitants – who cancel their retirement and permanently returns to State employment is eligible to enroll in a dental plan as an active employee.
Employees on non-pay status may continue dental coverage, by paying the total premium directly to the carrier. Employees must complete the STD 696 and forward to the carrier with a check for three months premium amount. The carrier will not send a bill. It does not come to CalHR.
Departments are required to continue to pay the employer 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.
To implement this benefit, you will use the process used for an employee on an unpaid leave of absence (STD. 696). If CalPERS determines the spouse and/or other eligible family member(s) is not eligible for a continuing allowance, they should be notified of COBRA eligibility.
What we look for: Dental documents signed and dated SSN is clearly visible Dental plan and organization code are correct Dependents date of birth and relationship is clearly stated
Party code is correct Permitting event code, permitting date and effective date are correct. Clearly identify the problem. Did the employee understand time frames?
Depending on action taken does the employee understand there may be AR’s? Who made the error? Effective dates. Sometimes we would like to see an appeal letter from the employee (if needed).
Corrections to a dependent name or date of birth should be noted in red on a photocopy of the most recent enrollment form and forwarded directly to the appropriate dental carrier. Do not send a copy to SCO or CalHR. An employee should report address changes directly to their carrier
When the permitting event code, effective date, and permitting event date are the same, all transactions can be reported on one form. When any of these items are different it is necessary to complete a separate STD. 692 to report each change. When submitting more than one STD. 692, each form should be numbered (in remarks section) based on the sequence of each event (i.e., 1 of 3, 2 of 3 and 3 of 3).
If you need to delete children that are over the age of 26, they must be done on separate documents unless they are twins. Periodically we get calls or s asking who is on the employees dental plan. We don’t have that information.
We never – ever do rescinds no matter what! Always submit a corrected STD 692 with “CORRECTED” written across the top. Always submit information with the dental form letting us know what you are requesting.
Section B box 1 must match section E box 2. Prepaid plans only Section B, box 2 should be filled out. Section B, box 3 must match Section E - box 3 and add family relationships.
Do not forget to put in PED, PEC, Effective date of action. And if need be any information needed to process the form, add in the remarks section. Section E box 3 must be accurate.
The form does not need CalHR approval if a document is completed by the employee within the proper time frame and; The effective date is what it should be based on when HR received the form; And if it’s a standard document or based on the permitting event date if a mandatory document.
The only time SCO rejects a form based on when it is received is when a standard document is received in HR prior to the event date. Sending the same form to both departments is causing extra work for everyone involved (CalHR, SCO) for something that isn’t necessary.
Before submitting any document to SCO, compare the new document to the most recent document in the OPF file (or at least the last master warrant in SCO system) to make sure they coincide with each other. This will avoid a lot of dings from SCO because the new information doesn’t agree with what is currently in our system (members missing, wrong plan, flex cash on file, etc).
If flex/coben cash for dental on file, submit all forms (692, 701/702) stapled together as a package. They can’t work one form without the other and if they aren’t attached together, each will be dinged for the other and usually not at the same time.
Section B “Action Codes” (i.e. there are no “R’s”, “C’s” or “add”), just A’s and D’s.
To order a small supply of EOC booklets and/or current provider lists for the prepaid plans, contact the dental carriers at the following numbers: SafeGuard: DeltaCare USA: Premier Access: Western Dental: Delta Dental:
Thank you for attending the dental portion of BAM training.