OHR Health, Dental, and Vision Benefits

OHR Health, Dental, and Vision Benefits


Welcome to the Office of Human Resources,
Health, Dental, and Vision Benefits tutorial. Throughout DCA, the Office of Human Resources,
is also referred to as OHR. Benefits are paid one month in advance and
are effective the first day of the month, following OHR’s receipt of enrollment forms. For example, benefit forms received on July
5th would be (*) effective August 1st and the pay warrant received on July 30th for
the July pay period would pay for August benefits. Employees are eligible for benefits if they
have an appointment of more than six months , which is at least six months plus one
day, and a time base of (*) half-time or more. Hourly employees should reference the Hourly
Employee Handbook and the applicable bargaining unit contract to determine when and if they
are eligible for benefits. The Hourly Employee handbook is located
on Inside DCA. Inside DCA is the Department of Consumer Affairs
intranet available to all employees and the web address is Inside.dca.ca.gov. This handbook is available under the Human
Resources tab. Newly eligible employees must submit health,
dental, and/or premier vision benefit forms to OHR within 60 days of eligibility. After the initial eligibility period, changes
can only be made to benefits when there is a qualifying event or during open enrollment. When a qualifying event occurs, such as
a divorce or adoption, employees have 60 days to submit benefit forms to OHR. Benefits are effective the first day of the
month following the receipt of the benefit forms. In some cases, the type of qualifying event
will change the effective date. Contact your assigned Personnel Specialist
in OHR to determine if a situation is a qualifying event. Health, dental, and vision open enrollment is customarily the second week in September
through the first week in October. OHR notifies employees of the open enrollment
dates each year. Changes made during open enrollment are effective
January 1st of the following year. This is your opportunity to make any changes
to benefits without a qualifying event. Employees in bargaining units 1, 4, 9, 10,
11, 12, 14, and 21 receive a state contribution. The state contribution is deducted from the
total cost of the benefits selected and the difference is the employee’s out-of-pocket
cost. Employees who receive a state contribution
will only see their out-of-pocket expense listed on their pay warrant. Let’s look at an example. For this example, this employee is in bargaining
unit 1 and has their family enrolled in medical benefits. Let’s assume the state contribution amount
for the current year with a family size of three or more is $1,500 and the amount
of the medical plan selected is $1,800 per month. The employee will only see the difference
of $300 for their medical coverage as a deduction on their pay warrant each month. Excluded employees and those in bargaining
units 2, 7, 16, and 19 receive a Consolidated Benefit allowance, known as a CoBen allowance,
instead of a state contribution amount. This allowance is applied towards the cost
of all benefits selected including, dental, medical and vision. The CoBen allowance is added to the pay warrant
and will appear as a negative number. In accounting terms, the negative symbol means
that the amount is being added to the warrant. The cost of the selected benefits are deducted
from it and any remaining CoBen allowance is additional taxable income for the employee. If the selected benefits cost more than the
CoBen allowance, which is usually the case, that is what the out-of-pocket expense is. Let’s look at an example of how you will
see it listed on a pay warrant. This is an actual example of the deduction
side of a pay warrant. In this example the CoBen Allowance is $1,658
and it has a negative sign next to it. The medical cost is (*) $1831.93, the dental
cost is $135.88 and the vision cost is $8.64. If you add the medical, dental and vision
together it totals $1976.45. If we subtract the CoBen allowance of $1658,
this employee’s actual out-of-pocket expense is $318.45. To view CoBen and state contribution rates, visit the California Department of Human Resources
website at CalHR.ca.gov. These rates usually change each year. Health benefits are administered by the California
Public Employees Retirement System, referred to as CalPERS. The cost for health benefits and plan information
can be found on the CalPERS website. When enrollment forms are received from employees,
OHR enters the employee’s health benefit selection directly into the CalPERS system. Dental benefits are administered by the California
Department of Human Resources, known as CalHR. The cost for dental benefits and plan
information can be found on the CalHR website. Newly hired employees in bargaining units 1, 4, 9, 10, 11, 12, 14, and 21 may only select
a prepaid dental plan until they have 24 months of state service. At the end of the 24-month period employees
have 60 days to elect or change to a plan with higher coverage. OHR routes the dental benefit forms to the State Controller’s Office. On average it takes the State Controller’s
Office (*) two to three months to process them. Due to the length of processing times, an
accounts receivable may be established for employees to pay back their portion of the
dental benefits. Employees will be notified if an accounts
receivable is established. If you or a dependent must see a dentist before
the dental benefits have been processed, contact your assigned Personnel Specialist in OHR. The Personnel Specialist will have you or
the dependent manually added to the applicable dental insurance. You will know if your enrollment forms have
been processed by reviewing your pay warrant. If the deduction for dental benefits is
not showing on the pay warrant, the enrollment has not been processed. At the end of each month, manually added employees
and/or dependents will fall off until the State Controller’s Office processes the
enrollment form. So, if there is an additional need to see
a dental provider prior to the enrollment being processed, contact the Personnel Specialist
to have you or your dependent added back on manually. Vision benefits are also administered by CalHR.
and plan information and rates are available on the CalHR website. Vision Service Plan, known as VSP, is
the only service provider. There are two plans available, Basic and Premier. Basic vision benefits are provided to
all employees and their dependents and an enrollment form is not required. Employees who do not receive a CoBen Allowance
do not pay for Basic Vision coverage. However, permanent-intermittent employees
are required to submit a Basic Vision Enrollment Form upon eligibility. Refer to the Hourly Employee Handbook for
more information regarding permanent-intermittent employees and when they become eligible. The Hourly Employee Handbook can be found
on Inside DCA under the Human Resources Tab. Premier vision benefits are available at an additional cost and an enrollment form
must be completed. To assist with determining out-of-pocket benefit
costs, there is a benefits calculator on the CalHR website. For questions regarding any of the benefits
in this tutorial, call 916-574-8300 and ask to be directed to your assigned Personnel
Specialist.

Author: Kevin Mason

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