Attachment C Dental Program Permitting Event Codes/Dates Effective Dates Rules: Standard: First day of the month after the STD. 692 is received by the employing department. Example: Received 3/5 Effective 4/1 Mandatory: First day of the month following the event. New Enrollments Permitting Permitting Effective Date of Permitting Event Time Limit to File Document Event Code Date Action New employee/eligible appointment, 01 Appointment Date Standard 60 days from appointment date reinstatement from retirement, transfer from State Fair districts or Legislative branches. Enrollment of self, or self and dependents, 05 Date other Standard 60 days from event after coverage as a dependent terminates for coverage ended any reason (e.g., divorce, loss of spouse, etc.) except voluntary cancellations. Enrollment of employee who was off active 07 Date of return to Standard 60 days from return to active pay status during entire open enrollment pay status pay status period (includes return from military leave). Enroll or change from prepaid to indemnity 08 Date prepaid Standard 60 days from date prepaid plan after completion of required prepaid restriction period restriction period ends restriction period (includes CAHP and CCPOA ends plans). Add upon return to active pay status after 15a Date of return to Standard 60 days from event being off during entire open enrollment period pay status (includes return from military leave). Dental Program Family Member Additions
Attachment C Dental Program Permitting Event Codes/Dates Effective Dates Rules: Standard: First day of the month after the STD. 692 is received by the employing department. Example: Received 3/5 Effective 4/1 Mandatory: First day of the month following the event. New Enrollments Permitting Event Permitting Event Code Permitting Date Effective Date of Action Time Limit to File Document New employee/eligible appointment, reinstatement from retirement, transfer from State Fair districts or Legislative branches. 01 Appointment Date Standard 60 days from appointment date Enrollment of self, or self and dependents, after coverage as a dependent terminates for any reason (e.g., divorce, loss of spouse, etc.) except voluntary cancellations. 05 Date other coverage ended Standard 60 days from event Enrollment of employee who was off active pay status during entire open enrollment period (includes return from military leave). 07 Date of return to pay status Standard 60 days from return to active pay status Enroll or change from prepaid to indemnity plan after completion of required prepaid restriction period (includes CAHP and CCPOA plans). 08 Date prepaid restriction period ends Standard 60 days from date prepaid restriction period ends Add upon return to active pay status after being off during entire open enrollment period (includes return from military leave). 15a Date of return to pay status Standard 60 days from event Dental Program Family Member Additions
bam-attachment-c-dental-2018.docx