General Information

You must fill in and return the Health & Welfare Benefits Enrollment – Form A within 60 days of your hire date or during open enrollment. If you fail to return your Health & Welfare Benefits Enrollment – Form A, you will be assigned to Option 3. (See the Health & Welfare Benefits Plan section of this guide for more information about your options.)

Note: The information in this General Information section regarding (a) “How to Enroll,” (b) “Changing Your Enrollment Options,” (c) “Effective Date of Coverage,” and (d) “When Coverage Ends for Benefits” applies to the Health & Welfare plans. The information relating to the supplemental plans may differ. For more detailed information, see the sections of this guide relating to the various specific supplemental benefits.

Enrollment changes are allowed:

•    During open enrollment.
•    When you transfer into an OCEA-represented bargaining unit from any non-OCEA-represented bargaining unit.
•    When you change from part-time to full-time employment status, or from extra-help to regular employment status.
•    Upon a family status change (marriage, divorce, birth, adoption, death, or retirement of spouse).

You have 60 days within which to submit your enrollment form with changes if you transfer into an OCEA-represented unit or change from part-time to full-time employment status.

You have 30 days within which to submit your enrollment form with changes, plus supporting documentation (marriage certificate, birth certificate, etc.), if you have a family status change.

Send all materials to:    

OCEA
830 North Ross Street
Santa Ana, CA 92701

If you are employed in an OCEA-represented bargaining unit (See Terms You Need to Know for a complete list of OCEA-represented bargaining units.) . . .

. . . and you are a member of OCEA: You are eligible for Health & Welfare benefits AND all supplemental benefits.

. . . and you are NOT a member of OCEA: You are eligible for Health & Welfare benefits, but you are not eligible for any supplemental benefits.

If you are employed in a bargaining unit not represented by OCEA, a retiree, a city or district employee, an extra-help employee ora member of REAOC . . .

. . . and you are a member of OCEA: You may be eligible for certain supplemental benefits.

. . . and you are NOT a member of OCEA or REAOC: You are not eligible for Health & Welfare or supplemental benefits.

In most cases, benefits for new employees become effective on the first of the month following 60 calendar days of continuous active employment.

Coverage can end due to any of the following events:
•    termination of employment,
•    change in bargaining unit, or
•    the plan ends.

Please contact OCEA for details regarding your benefits

Beneficiary - Person designated by a participant to receive benefits provided by the plan if the participant dies.

Twice-Monthly - As used throughout this guide, this term means “two times per month” (that is, twice per month, or 24 times per year).

Biweekly - As used throughout this guide, this term means “one time per two-week period” (that is, once every two weeks, or 26 times per year).

Cities and Districts - Municipalities, districts, agencies, and political subdivisions within the County of Orange.

Copayment - The dollar amount you must pay each time a specified service is provided.

Deductible - The annual dollar amount that you must pay for services before benefits become payable by the insurance carrier.

Eligible Dependent - • Your legal spouse • registered domestic partner • Your children can be covered under your dental and vision plans until they reach age 26 (Child must not be eligible for any other employer dental and/or vision plan; child does not need to be a full-time student; child can be married or unmarried; spouses and children of dependent children are not eligible for coverage; any child of the employee regardless of dependency status under IRS rules.)

Note: “Children” includes stepchildren and adopted children, provided they are chiefly dependent upon you for support and maintenance. Foster children are excluded.

Evidence of Insurability - Any written statement of proof of a person’s overall health status required by the insurance carrier prior to acceptance for insurance.

Full-Time Employee - An employee employed in one or more regular or limited-term positions whose normally-assigned work hours equal those of a full work-week (40 hours or more per week) or work-period.

OCEA-Represented Bargaining Units - Community Services, County General, Fire Authority General, Fire Authority Supervisory Management, Healthcare Professional, Law Library, Office Services, Probation Services, Probation Supervisory Management, Sheriff’s Special Officer/Deputy Coroner, Superior Court Clerk, Superior Court General, Superior Court Supervisor, and Supervisory Management.

Open Enrollment - A period of time each year when you may change your benefit elections without a family status change.

Part-Time Employee - An employee employed in one or more regular or limited-term positions whose normally-assigned work hours do not equal those of a full-time employee (less than 40 hours per week, but not less than 40 hours in a pay period).

Plan Year - January 1 through December 31.

Predetermination - A predetermination is a free service that Delta Dental provides to its subscribers. It can help you and your dentist make better choices about your dental care. A predetermination is particularly useful for more costly procedures such as crowns, wisdom teeth extractions, bridges, dentures, or periodontal surgery. When your dentist predetermines treatment with Delta Dental, you’ll receive an estimate before treatment begins of your share of the cost and how much Delta Dental will pay.

Retiree - You are a retiree eligible to purchase retiree benefits if you are a current member of the Retired Employees Association of Orange County (REAOC) and you are or will be receiving a retirement check from the Orange County Employees Retirement System (OCERS).

Usual, Customary and Reasonable Charge (UCR) - Fees that are regularly charged and are in the range of fees customarily charged for the same service or supply in the geographic area concerned.

Waiting Period - The period of time you must wait before benefits are payable.

Dental (PPO)
Delta Dental
www.deltadentalins.com
(800) 765-6003

Dental (DHMO)
DeltaCare
www.deltadentalins.com
(800) 422-4234

Vision
Vision Services Plan (VSP)
www.vsp.com
(800) 877-7195

Basic Disability
Standard Insurance Company
www.standard.com
(800) 368-1135

Supplemental Disability
Standard Insurance Company
www.standard.com
(800) 368-1135

Basic Life
Standard Insurance Company
www.standard.com
(800) 628-8600

Basic AD&D
Standard Insurance Company
www.standard.com
(800) 628-8600

Supplemental Life and AD&D
Standard Insurance Company
www.standard.com
(800) 628-8600