Dental & Vision Insurance - cagov/ODI-Onboarding-and-State-of-CA-Benefits Wiki

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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)

Dental Insurance

FY21 Dental Handbook Dental Coverage Overview

Pre-Paid Dental Plans

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.

Pre-Paid Dental Plans

Indemnity Dental Plans

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.

Plan Who is Qualified Employee Contribution
Delta Dental PPO premier - Basic For represented rank-and-file (in a Bargaining Unit) employees and their dependents Party Code 1 (Self): $12.71Party Code 2 (Self +1): $22.19Party Code 3 (Family): $32.07
Delta Dental PPO premier - Enhanced For managerial, supervisory, confidential, exempt, & excluded employee and their dependents Party Code 1 (Self): $52.87Party Code 2 (Self +1): $104.06Party Code 3 (Family): $146.18

Preferred Provider Option Dental Plan

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.

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.

Employee Contribution
Party Code 1 (Self): $11.61
Party Code 2 (Self +1): $22.58
Party Code 3 (Family): $33.97

Vision Insurance

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 Premiums

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 EnrollmentIf 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 2021 Employee Contribution:Party Code 1 (Self): $16.73Party Code 2 (Self +1): $25.19Party Code 3 (Family): $35.51