Health and Welfare Benefits Plan

These benefits are provided at no additional cost, to employees in regular or limited-term positions in bargaining units represented by OCEA!

These benefits were negotiated by OCEA for all employees in regular or limited-term positions in OCEA-represented bargaining units, regardless of whether or not you are an OCEA member.

If you are a new employee, you must complete and return the Health & Welfare benefits enrollment form "A" within 60 days of your hire date. (If you do not do this, you will automatically be assigned to Option 3.) You may change your elections during "open enrollment" periods. Also, certain events (such as divorce, marriage, birth of a child, or change of employment status) may allow you to make changes, although conditions apply. For further information on these matters, contact OCEA at (714) 835-3355.

- 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 - Supervisory Management

If you are a part-time employee, your "choice" is easy. You will automatically be assigned Option 3.

If you are a full-time employee, you have a real choice. The option that is right for you will depend on your individual circumstances. For general information about the choice you should make, see Simplified Guidelines, below.

If you have no dependents (or if you have dependents and do not wish to include them for benefits coverage), and if you are a full-time employee, you should choose Option 1.

Most full-time employees with families will choose Option 2. Your family will be covered with you on the DeltaCare CAM43 (DHMO) dental plan. Your dependents do not receive vision coverage.

Do not choose Option 3. Since Option 3 is a "default" package (with benefits of less value overall), you should take the initiative to choose either Option 1 or Option 2.

Again, all part-time employees will be assigned to Option 3. All new full-time employees not returning their enrollment forms within the 60-day period will also be assigned to Option 3. This should generally be avoided. See the above guidelines.

Click the image below to view the Plan Highlights

Plan benefits are limited by plan provisions. To obtain a more detailed plan description with information on limitations and exclusions, please contact OCEA at (714) 835-3355.

About Delta Dental PPO Plan A

Delta Dental PPO Plan A allows members the flexibility to choose their own dentists, and to self refer for specialty care services. To receive the highest level of benefits with the lowest out-of-pocket expense, you should consider visiting a Delta PPO dentist. PPO dentists agree to provide treatment to PPO patients at discounted fees prenegotiated by Delta. In addition, the percentages paid by Delta will be significantly higher when you visit a Delta PPO dentist.

Dentists who are not part of Delta Dental have not agreed to discounted fees. These dentists will be paid the usual, customary, and reasonable fees for services. Since these fees can be higher than Delta’s discounted fees, you will spend more money with a dentist who is not participating with Delta Dental. You may also be required to file your own claims with Delta.

Finding a Delta PPO Dentist

Simply go to OCEA's website at www.oceamember.org and click on the Delta icon to link directly with the Delta website. You can also access Delta directly by going to www.deltadentalins.com. Be sure to click on the link that specifies Delta Preferred Providers Option. Additionally, you can call your dental office to ask if your dentist is a member of the Delta PPO or Delta Dental in network dentist. (Note: In California, Delta endodontists, periodontists, and oral surgeons are considered Delta PPO dentists even if they have not signed a PPO agreement.)

Predetermination of Benefits

If you are thinking about having extensive or expensive dental work you may consider obtaining a predetermination review before the service begins. Predeterminations are free and usually take about 3 weeks to process. You may obtain a predetermination/claim form from your dentist, or your dentist can submit on your behalf to:

Delta Dental, P.O. Box 997330, Sacramento, CA 95899-7330
(800) 765-6003 • www.deltadentalins.com

Customer Service

Delta Dental provides its members with toll-free customer service at (800) 765-6003. Customer service can provide assistance on benefit questions, eligibility, changing dentists, or explaining claim procedures. You may also e-mail Delta Dental at cms@delta.org.

About DeltaCare CAM43 (DHMO)

The DeltaCare DHMO offers you a comprehensive program of dental care with no annual benefit limit. Most preventive services like cleanings and examinations are covered in full. Other procedures will require copayments at the time the dentist performs the service.

This is a "managed" dental care program in which you must select a dentist from an extensive network to be your personal provider. This dentist will perform, arrange, or refer all of your dental care needs. You must receive services from your DeltaCare dentist for contract benefits to apply. There is no coverage for care not received from your DeltaCare dentist.

Who is Eligible?

Employees and eligible dependents.

Dependents are generally your legal spouse, registered domestic partner and children.

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.

Finding a DeltaCare Dentist

The DeltaCare Dental Network is a large, carefully selected list of dentists who meet the DeltaCare credentialing requirements and have agreed to a contractual relationship with DeltaCare.

Once you are enrolled in DeltaCare, you may choose or change dentists. Just visit the Delta Dental/DeltaCare website at www.deltadentalins.com, or call the DeltaCare customer service line at (800) 422-4234. Changes are usually effective the first of the month following your request. DeltaCare will advise you of the new effective date.

Customer Service

DeltaCare provides its members with toll-free customer service at (800) 422-4234. Customer service can provide assistance on benefit questions, eligibility, changing dentists, or explaining claim procedures. You may also visit the DeltaCare website at www.deltadentalins.com to view provider lists, obtain benefit information and view your current assigned provider.

About Vision Service Plan (VSP)

Vision Service Plan (VSP) has the nation’s largest eye care doctor network, with thousands of participating doctors. If you choose to receive services from a VSP provider, benefit coverage is more comprehensive, and your out-of-pocket expenses may be less.

If you choose to receive services from an out-of-network provider, VSP will reimburse you up to the amount allowed under the plan’s out-of-network provider reimbursement rate. Services obtained through out-of-network providers are subject to the same copayments and limitations as services obtained through VSP doctors.

Be aware that your out-of-network provider reimbursement rate does not guarantee full payment, and VSP cannot guarantee patient satisfaction when services are received from an out-of-network provider.

Finding a VSP Provider

It’s easy to find a VSP provider. You may log on to the VSP website at www.vsp.com and use the directory to look for a provider in the Chioce Network. Or you can call the VSP Member Services phone number at (800) 877-7195.

Filing a Claim

If you chooise to use an out-of-network provider, claims must be filed with VSP within six months from the date of service. Please keep a copy for your records, and send the originals to:

VSP
P.O. Box 997105
Sacramento, CA 95899-7105

Click graphic to enlarge.

About Your Basic Disability Plan

OCEA provides a Basic Disability Plan at no additional cost to all employees in regular or limited-term positions in OCEA-represented bargaining units in the County of Orange, the Fire Authority, the Superior Court, and the Law Library, regardless of whether or not you are an OCEA member. This plan is designed to help replace your income when you incur a disability. The Basic Disability Plan pays up to $1,080 per month from the 21st calendar day through the 90th calendar day of your disability and up to $900 per month from the 91st calendar day, for a maximum of 24 months. The Basic Disability Plan benefit amounts coordinate with all other sources of income received for the period of your disability (including, but not limited to, sick leave and annual leave).

Pre-Existing Condition

You may not be able to collect benefits beyond 90 days if your injury or illness is because of a pre-existing condition. A pre-existing condition is one in which a reasonably prudent person would have consulted a physician, received medical treatment, services or advice, undergone diagnostic procedures, including self-administered procedures, or taken medications in the 90 day period prior to your effective date. Please note that the pre-existing condition limitation only applies to disabilities which continue beyond 90 days.

For the Basic Disability Plan, disabilities which are not as of a result of a pre-existing condition are covered per the terms of the contract. Coverage for a pre-existing condition is not provided beyond 90 days if the disability begins during the first 12 months of your coverage.  If the disability begins after you have been covered on the plan for more than 12 months, there is no pre-existing limitation.

Definition of Disability

You will be considered disabled if, as a result of an illness, non-work related injury, or pregnancy, you are unable to perform with reasonable continuity the material duties of your own occupation.

Waiting Period

No benefits are payable during the waiting period.

Benefit Period or Duration

Benefits may be payable up to 24 months. In some cases, the maximum length of time benefits may be payable will depend on your age when you become disabled.

How to File a Claim

Contact OCEA at (714) 835-3355 for claims forms.

Life Benefit

This plan is available to full-time and part-time employees. The plan pays a benefit of $25,000 to the beneficiary upon the death of the employee.

"Living Benefit" Option

The living benefit allows you the opportunity while living and under age 60 to receive 75% of your life insurance coverage should you be diagnosed with a terminal illness with a life expectancy of twelve months or less. The minimum amount that can be requested in $5,000 or 10% of your insurance, whichever is greater.

Upon you death, your beneficiary will receive any remaining benefit.

Matching Accidental Death & Dismemberment Benefit

If the death of the employee is the result of an accident, this plan pays an additional $25,000 benefit to the beneficiary.

Conversion Policy

You may convert your basic life insurance to an individual whole life policy without evidence of insurability if:

1) Your insurance ends or is reduced due to a qualifying event, and
2) You apply in writing and pay the first premium within 30 days after your employment terminates.

The maximum you are eligible to convert is the amount of your life insurance before coverage ended.

Portability

If your life insurance ends because your employment terminates, you may be eligible to continue group life insurance without evidence of insurability. To be eligible, you must satisfy the following requirements:

1) On the date your employment terminates, you must be able to perform the material duties of your occupation.
2) On the date your employment terminates, you are under the age of 65.
3) On the date your employment terminates, you must have been covered under this plan for at least 12 months.
4) You must apply in writing within 30 days after your employment terminates.

The maximum amount you are eligible to buy is the amount of life insurance before coverage ended.

How to File a Claim

Contact OCEA at (714) 835-3355 for claim forms.