Dental %26 Vision Insurance - cagov/ODI-Onboarding-and-State-of-CA-Benefits GitHub Wiki
Table of Contents
Dental and Vision Insurance become effective the 1st day of the following month. (Example: If you are hired on October 1st, then your insurance becomes effective November 1st)
2024 Dental & Vision Plan Deductions and Premiums
2024 Dental Handbook
Dental Coverage Overview
The State offers three types of dental plans: Prepaid, Indemnity and PPO.
The state pays 100% of the monthly premium for the prepaid plans, so there is no monthly premium cost share deducted from your pay. There are no claim forms, deductibles, or maximum allowable benefits.
Prepaid plans provide dental services through pre-selected participating dentists throughout California. When you enroll in one of these plans, you select a dentist from the list of dentists who participate in the plan you have chosen. You may change dentists to another dentist who participates in your plan upon your request, or if your dentist leaves the plan. You may change dental plans if you move and your plan has no participating dentists within 50 miles of your new residence.
A prepaid dental plan pays its participating dentists a contracted monthly fee for each person enrolled in the plan served by that dentist. In return, the dentist provides all basic, preventive, and diagnostic services (e.g., cleanings, checkups, x-rays, fillings, oral surgery, and treatment of tooth pulp and gums).
While most dental services are performed at little or no charge to you, there may be a specific fixed charge for certain types of complex procedures such as root canals. There is a limit on the amount a prepaid provider can charge you for orthodontic services.
- DeltaCare USA; (800)422-4234
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MetLife; (800)880-1800
- Benefits provided by SafeGuard Health Plans, Inc., a MetLife company
- Premier Access; (888)534-3466
- Western Dental (866)859-7525
Indemnity plans allow you to choose to receive services from any licensed dentist, although you may have higher out-of-pocket costs if you receive services from a “non-Delta” dentist. Through Delta Dental’s participating dentists, you have full access to specialty care and guaranteed benefits through Delta Dental’s large network of dentists throughout the United States and abroad.
Delta Dental pays the dentist directly, based on the fee agreement between Delta Dental and the dentist. If the dentist’s charges exceed the fee paid by Delta Dental, you are responsible for paying the remainder of the bill and any applicable annual deductible.
The amount of your monthly premium copayment is deducted from your monthly paycheck according to the number of enrolled dependents.
| Plan | Who is Qualified | Employee Contribution |
|---|---|---|
| Delta Dental PPO premier - Basic | For represented rank-and-file (in a Bargaining Unit) employees and their dependents |
|
| Delta Dental PPO premier - Enhanced | For managerial, supervisory, confidential, exempt, & excluded employee and their dependents |
|
- Delta Dental PPO plue premier; (800)225-3368
Delta Dental PPO offers higher benefit levels when you receive services from a participating PPO dentist. However, you may choose a non-PPO dentist and still be covered. When you receive services from a participating PPO dentist, your costs are based on a discounted fee agreement between Delta Dental and the PPO dentist.
Delta Dental PPO pays the dentist directly, based on the fee agreement between Delta Dental and the dentist. If the dentist’s charges exceed the fee paid by Delta Dental, you are responsible for paying the remainder of the bill and any applicable annual deductible.
If you receive services from a dentist who is not a PPO contracted provider or a non-Delta dentist, you are responsible for paying the full bill directly to the dentist at the time of service and up to the billed amount. Your reimbursement from Delta Dental may be substantially lower.
The amount of your monthly premium copayment is deducted from your monthly paycheck according to the number of enrolled dependents.
| Employee Contribution |
|---|
| Party Code 1 (Self): $11.61 |
| Party Code 2 (Self +1): $22.58 |
| Party Code 3 (Family): $33.97 |
Enrollment into the state's Basic Vision Plan is automatic. The state is responsible for paying the monthly premium ($8.27) to VSP for the Basic Plan. Employees and their eligible dependents are required to pay a $10 deductible for an eye examination and a $25 deductible for materials (frame and/or lenses) if needed.
Set up and view your basic vision insurance by visiting the VSP website
Vision Overview
Vision Benefit Summary
| Premier Vision Plan | When to Enroll | Employer /Employee Contribution |
|---|---|---|
| All active state employees are eligible to enroll in the Premier Vision Plan for a small monthly employee cost share. The Premier Vision Plan enables employees to get a higher allowance for frames and contacts, fully covered progressive lenses, and more discounts. State of CA Vision Plan Coverage | within 60 days of new hire start date/newly eligible status or during Open Enrollment Vision Insurance Enrollment If you elect the Premier Plan, any dependents you wish to cover must also be enrolled by you into the Premier Plan coverage. You cannot choose to enroll in both the Basic and Premier Vision Plan coverage at the same time, or split your enrollment leaving any dependents on the Basic Vision Plan. |
Employer Contribution: $8.27 Employee Contribution:
|