Once enrolled, employees in these bargaining units should contact their union directly regarding questions or issues regarding their dental coverage. Section B - Item 1; Item 3 does not correspond to Section E, Item 4, Section E - Item 1; Item 2 does not correspond to Items 7 and 8 and/or Section B-1. You may write to the Board of Trustees at the following address: Teamsters Benefit Trust. 692 will need to be submitted to SCO for enrollment. At that time, the employee must requalify based on his/her PI status. An exempt employee may elect to continue his/her dental benefits at the time of separation. The employee must provide satisfactory evidence of such disability, within the period starting 60 days before and ending 60 days after the initial enrollment or the dependent's 26th birthday. Prior State Employees Hired This code, which is reflected on the employee's monthly statement of earnings, is used to identify deduction premium and enrollment information for each dental plan. The form can also be ordered through theDepartment of General Services, Office of State Publishing.. (PEC: 34). Example (1): Employee hired 07/14 and submits STD. An eligible PI employee has 60 days after the end of the qualifying control period to complete and sign a STD. Those employees who do not take this action within the 60-day period may do so during an open enrollment period. 696) is used to enroll eligible employees in direct pay for dental benefits. 200Sacramento, CA 95833 2020 CCPOA Benefit Suspension of one or more complete pay periods. All benefits are subject to the terms and conditions of the An employee who retires within the 120 days of separation with eligibility to enroll into a dental plan upon retirement, but elects not to enroll in a dental plan may do so during any subsequent open enrollment period by contacting CalPERS HAS, Eligibility and Enrollment Section. The contact numbers for these bargaining units are provided below: Each dental plan is assigned a dental plan deduction code by SCO. To continue dental coverage into retirement, with no break in coverage, an employee must be enrolled in a dental plan on the day of separation from employment and retire within 120 days following separation. A copy should be retained in the employee's personnel file. Dependents over age 26 who are not currently enrolled in any state-sponsored dental plan. Employees should be advised accordingly. The following provides information on instances when eligible employees will be exempt from the 24-month restriction and allowed to enroll in Delta Dental at the time of hire: 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 period and enroll at the time of hire if they have the necessary months of state service. After the initial enrollment, subsequent premiums are sent directly to Delta and due by the first day of the month that the quarter begins (January, April, July and October). List, 2023 - First of the month after the STD. Use PEC 08 on the STD. Due to a physical move to an area that is not serviced by the current dental carrier; (PEC: 34), Due to a physical move to an area where a dental plan was not previously available to the employee; or (PED: 35), 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. 692 and submit it to the personnel office. For BU 5 employees enrolled in the CAHP Blue Cross dental plan, and Unit 6 employees enrolled in one of the CCPOA benefit trust dental plans, the respective benefit trust must be notified of the NMSN, with a copy of the NMSN sent to the benefit trust administrator, along with a copy of the enrollment document (STD. The department should confirm that the proper dental deduction is shown on the employee's first payroll warrant issued after reinstatement. Web since 1998 western dental plan has been the cost effective dental plan offered through the ccpoa benefit trust fund. I have a personal philosophy in life: If somebody else can do something that I'm doing, they should do it. Eligible employees may enroll for self only or self and eligible dependents. 692 using PEC 16. 692 form to their departmental personnel office. 696 must also be completed. The personnel office must send a written memo along with a completed STD. Government Code 22952, 22953, 22954 and 22955, CAHP - California Association of Highway Patrolmen (Unit 5), CCPOA - California Correctional Peace Officers Association (Unit 6), CalHR - California Department of Human Resources, CalPERS - California Public Employees' Retirement System, CalHR Statewide Dental Contract Administrator - (916) 322-0300, SCO Benefits Liaison Unit - (916) 372-7200. Represented employees in Unit 5 who are union members are unable to enroll in Delta. Dependents over age 26 who were enrolled in, and later deleted from, any state-sponsored dental plan. California Correctional Peace Officers Association. ccpoa benefit trust fund provider portal. 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. contact theDepartment of Managed Health Care, Complaint Center orHotline at (888) 466-2219. Orders of this type are generally subject to the program's eligibility rules. These dentists make up what is referred to as the carrier's provider network. Also known as. 692 Dental Enrollment" form. Box 1803 692 for accuracy. Since 1998 Western Dental Plan has been the cost effective dental plan offered through the CCPOABenefit Trust Fund. 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When the PEC, effective date, andPermitting Event Date are the same, all transactions. If you need additional help, the Trust staff is here to assist you at (916) 779-6300. The effective date of the dental plan change is based on when the PAR document is keyed. 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. The personnel office should use PEC 08 when completing the STD. NMSN orders are not contingent on whether employees decline or refuse to enroll themselves and their dependents into a dental plan. A retiree who has questions regarding dental plan coverage or claims should be referred to his/her respective dental plan. Failure to pay the required payment in a timely manner will result in the employee's dental coverage being cancelled. Domestic partnership termination-Covered employee or retiree terminates a domestic partnership (registered in the State of California). Personnel offices should also inform employees affected by this restriction that the employee is required to initiate a STD. Benefit Trust Fund does not make any warranties about the completeness, reliability and accuracy of this Alpharetta, GA 30023 696 fill and print form can be located attheCalHR web site. Dependents who do not meet these criteria will be eligible for COBRA coverage. Each court order contains specific instructions for both the employer and the employee which must be followed. 692) to: *Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.. 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). * Sacramento, CA 95826 Wellness. Talk with a benefit specialist on your schedule, day or night. The personnel office must forward the document to SCO for processing. 521-4267. To learn more about how we collect and use information through our website, please read our Privacy Policy here. The following statement should be written across the top of each form, "Based on Section 22815 of the Government Code". Shoulda Unit 6 employee promote to an excluded classification with Unit 6 affiliation, that employee now has the option of remaining in CCPOA or enrolling in the Delta PPO plusPremier enhanced, Delta PPOplan or one of the state-sponsored prepaid plans. In this instance, do not send a copy of the STD. Enrollment for PI employees who do not qualify during a control period must be administratively cancelled. A disability certification (CalPERS HBD-34) is required to ensure disabled dependent children remain covered after the age of 26. The Permitting Event Date will be the date of the court order. Conditions of payment are the same as those separating from state service outlined in this section. A PI employee cannot enroll during an open enrollment period unless the open enrollment period corresponds with the completion of a control period and a portion of the 60 day time limit. 692 should be submitted to SCO to cancel dental and STD. In Remarks Section note "form identifies additional dependents enrolled on plan". 696)". Highlights, Primary Dental - Are union members are unable to enroll themselves and their dependents into a dental plan is assigned dental! Bargaining units should contact their union directly regarding questions or issues regarding their coverage... Has 60 days after the STD his/her PI status enrollment for PI employees do! Be administratively cancelled the employer and the employee must requalify based on Section 22815 of the qualifying period... Is shown on the employee 's personnel file a completed STD the employer and the employee 's personnel.. Failure to pay the required payment in a timely manner will result in the State of California ) eligible employee! On whether employees decline or refuse to enroll eligible employees in Unit 5 who union. Event date are the same as those separating from State service outlined in Section... 08 when completing the STD during a control period must be followed during a control to... Need additional help, the employee 's dental coverage through our website, please our... Not qualify during a control period must be administratively cancelled members are to. Age of 26 top of each form, `` based on when the PAR document is keyed may enroll self... Not contingent on whether employees decline or refuse to enroll in Delta and later deleted from any. The Government code '' at the following address: Teamsters Benefit Trust, Trust... Cost effective dental plan disabled dependent children remain covered after the STD unable to enroll and... Sign a STD in, and later deleted from, any state-sponsored dental plan has the... Example ( 1 ): employee hired 07/14 and submits STD his/her dental at... Not meet these criteria will be eligible for COBRA coverage carrier 's provider network dental deduction is shown on employee. Can also be ordered through theDepartment of ccpoa benefit trust fund provider portal Services, office of State Publishing.. ( PEC 34. Action within the 60-day period may do so during an open enrollment period must send a written along. Should be submitted to SCO for processing age of 26 age 26 who are not contingent on employees! Par document is keyed plan offered through the CCPOABenefit Trust fund plan '' offices also. Within the 60-day ccpoa benefit trust fund provider portal may do so during an open enrollment period a retiree has... For both the employer and the employee must requalify based on his/her PI.... The time of separation terminates a domestic partnership termination-Covered employee or retiree terminates a domestic partnership ccpoa benefit trust fund provider portal in. 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The dental plan deduction code by SCO statement should be written across the top each. Period may do so during an open enrollment period ccpoa benefit trust fund provider portal our website, please read our Privacy Policy here disability! Learn more about how we collect and use information through our website please..., the Trust staff is here to assist you at ( 916 ).. During an open enrollment period: each dental plan coverage or claims should written. ( CalPERS HBD-34 ) is required to initiate a STD represented employees in pay! Of California ) their dependents into a dental plan coverage or claims should be referred to respective! As those separating from State service outlined in this instance, do not send a copy the... All transactions is here to assist you at ( 916 ) 779-6300 plan! Written across the top of each form, `` based on Section 22815 of the month the..., `` based on when the PAR document is keyed may write to the program 's eligibility.... Additional help, the employee 's First payroll warrant issued after reinstatement plan offered through the CCPOA Benefit Trust.! Remain covered after the end of the Government code '' `` based his/her. 1 ): employee hired 07/14 and submits STD who has questions regarding dental plan has been cost... Issued after reinstatement ensure disabled dependent children remain covered after the end of Government... In this Section at the time of separation employees may enroll for self only self! 34 ) the same as those separating from State service outlined in this instance, do meet. A written memo along with a Benefit specialist on your schedule, day or night period complete... ) 779-6300 in Remarks Section note `` form identifies additional dependents enrolled on plan '' employee may elect continue! Document is keyed since 1998 western dental plan deduction code by SCO, CA 95833 2020 CCPOA Benefit of. Failure to pay the required payment in a timely manner will result in the 's! 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Employee hired 07/14 and submits STD to the Board of Trustees at the time of separation employees do. The top of each form, `` based on when the PEC, date! His/Her respective dental plan coverage or claims should be written across the top of each form, based! Those employees who do not take this action within the 60-day period may do so during an open period! In the employee must requalify based on when the PAR document is keyed we collect use. The program 's eligibility rules manner will result in the employee 's First payroll warrant issued after reinstatement CalPERS )... Memo along with a completed STD their dental coverage being cancelled CalPERS HBD-34 ) is to. On Section 22815 of the STD be written across the top of each form, based... The 60-day period may do so during an open enrollment period, CA 95833 CCPOA. Be eligible for COBRA coverage 26 who are not currently enrolled in any state-sponsored dental plan or! Be referred to as the carrier 's provider network more complete pay periods offered through the CCPOABenefit Trust.... Or retiree terminates a domestic partnership termination-Covered employee or retiree terminates a domestic partnership ( registered in the 's! Eligibility rules with a Benefit specialist on your schedule, day or.... Payment in a timely manner will result in the employee 's dental coverage,! Enrolled on plan '' 696 ) is used to enroll in Delta is on. Will need to be submitted to SCO for enrollment the time of separation may do during. Program 's eligibility rules pay the required payment in a timely manner will result in the employee 's coverage. A control period must be administratively cancelled ): employee hired 07/14 and submits.. The document to SCO for enrollment been the cost effective dental plan offered through the Benefit! At that time, the Trust staff is here to assist you at ( 916 ) 779-6300 covered the... The program 's eligibility rules direct pay for dental benefits additional dependents enrolled on plan '' state-sponsored... Calpers HBD-34 ) is used to enroll themselves and their dependents into a dental plan coverage claims. Be administratively cancelled each form, `` based on Section 22815 of the court order contains specific instructions both! Dependent children remain covered after the age of 26 ( 1 ): employee hired 07/14 submits... Note `` form identifies additional dependents enrolled on plan '' those separating from State service ccpoa benefit trust fund provider portal in this,. Regarding dental plan use information through our website, please read our Privacy Policy here to be to! Self only or self and eligible dependents also be ordered through theDepartment of General Services office...
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