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Health & Dental Plan Eligibility

Published on: 12/19/2012 5:18 PM
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You may enroll in one of the three health plans if you are in a full-time or part-time coded position.  Seasonal or temporary (extra help) employees and contractors are not eligible for health and dental plan enrollment and are limited to health plan enrollment based on bargaining unit.​
You may enroll the following eligible members on your health plan:
  1. Your spouse;
  2. Your children, step children, or adopted children who are under age 26;
  3. Any other children under the age of 26 for whom you have legal guardianship (if legal guardianship was established prior to age 18);
  4. Your children, step children, adopted children or any child you have legal guardianship for       who       is under the age of 26 and are incapable of self-support because of a physical or mental disability which existed continuously prior to the age of 26 and continue to be certified as disabled on a bi-annual basis.
  5. Your registered domestic partner;
  6. Your registered domestic partner’s children if the children meet the same criteria of a child as described above.

All regular hourly and salaried employees in coded positions, working one-half time or more in a week are eligible for these plans.  Seasonal or temporary (extra help) employees and contractors are not eligible for health, dental, and vision plan enrollment. Eligible dependents must meet the criteria for enrollment as required by the dental and vision plans.  Children between the age of 19 and 23 (or 24 for Liberty Dental) must be full-time students.
You may enroll the following eligible members on your dental and/or vision plan:
  1. Your spouse;
  2. Your unmarried children, step children, adopted children who are under age 19;
  3. Any other unmarried children under the age of 19 entirely supported by you and for whom you have legal guardianship;
  4. Your unmarried children, step children, adopted children or any child you have legal guardianship for who is over the age of 19 and are incapable of self-support because of a physical or mental disability which existed continuously prior to the age of 19 and continue to be certified as disabled on a bi-annual basis;
  5. Your registered domestic partner;
  6. Your registered domestic partner’s children if the children meet the same criteria of a dependent child as described above
Any dependent who reaches the age of 19 will require verification of eligibility.  It is the responsibility of the employee to provide proof of eligibility when a dependent turns 19 by filing proof of eligibility with your Departmental Employee Service Center initially and each year thereafter on the birth date.  If you fail to provide the proof of eligibility, the County will remove the dependent from your coverage.  Additionally, if your dependent no longer meets the criteria for eligibility as an over-age dependent, it is your responsibility to notify the Departmental Employee Service Center in order to complete the necessary paperwork to remove the ineligible dependent from your dental and vision coverage.

The dental and vision plans require that your over-age dependent is a full-time student. 

Dependents who turn 23 or 24 will be automatically removed from coverage without notice at the end of their birth month. 
You have 30 days from your date of hire to enroll yourself and your eligible members in the basic benefit package.  Part-time employees may enroll in a health plan only, waive the dental and vision plan or enroll in the complete package.

You also have 30 days from the date of a qualifying event to enroll yourself and/or your eligible family members on your health, dental and vision plan.  A qualifying event is described as marriage, birth, adoption, foster placement, establishment of a same-sex domestic partnership or when you have lost other health, dental and vision coverage you may have either through another employer or through a family member’s employer.
If you wait longer than 30 days from your date of hire to enroll or you waive enrollment in your benefits, you must wait to enroll until the annual open enrollment period held each year usually during the month of September. 

There are exceptions to this rule:  Part-time employees who previously waived coverage and then have a change in their coded standard hours may enroll in their benefit package (depending on bargaining unit).   Another exception would be if you meet the criteria under California State Assembly Bill 1672.  This provision allows for an employee to enroll him/herself or dependents in the basic benefit package due to a loss of other coverage.  Contact your Departmental Employee Service Center within 30 days should you find yourself in this situation.
If you and your spouse or partner are both County employees, only one employee is allowed to carry health plan coverage.  One employee may choose to enroll in family coverage and the other employee must waive their health plan coverage and be enrolled as a dependent.  This limitation applies to health plan coverage only.  You and all eligible dependents may enroll in or remain enrolled in dental and vision coverage.  This enrollment limitation does not apply to Court employees.  If you are a Court employee, contact your Departmental Employee Service Center to determine your options for enrollment.
The County has a four-tiered rate system for Kaiser and Valley Health coverage and a two-tiered rate system for Health Net.  For full-time coded employees, the County pays the full cost of the single rate for all health plans and the full cost of the family rates for Kaiser and Valley Health regardless of the family structure.  There is a biweekly deduction for the Health Net family rate.  Premium contributions are made on a pre-tax basis.  For employees who are married or partners and both working for the County, 100% of the family rate is paid regardless of the health plan.  Rates are subject to change each fiscal year.
The County has one rate for the Dental and Vision plans regardless of the family structure.  The County pays the full cost of the dental and vision plans for full-time coded employees, whether the coverage is for single or family.
Part-time employees share the cost of health, dental, vision and basic life plans.  These rates are prorated and the shared cost is based on the number of regular hours an employee works each payperiod, but not less than the standard coded hours.  Premium contributions are made on a pre-tax basis.  For more information on prorated costs, contact your Departmental Employee Service Center.
Employees are responsible for making sure that the appropriate deduction is being taken from paychecks.  It is important that employees keep track of their paychecks and do not wait more than three payperiods for a new deduction or a change in a current deduction to appear.  If you experience a problem with your payroll deductions, contact your Departmental Employee Service Center.
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