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California Employee Dental Life Group Election Form

California Employee Dental Life Group Election Form 2026

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The document is an application form for California Small Group Business Employee Dental and Life insurance coverage through Aetna. It includes sections for subscriber information, coverage selection for dental and life plans, proof of prior coverage requirements, and a notice regarding language assistance. Additionally, it specifies that the term 'spouse' includes domestic partners in compliance with California law.

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Click ‘Get Form’ to open the California Employee Dental Life Group Election Form in the editor.
Begin by filling out the Subscriber Information section. Enter your Social Security Number, Member ID Number, or your last name, first name, and middle initial.
In the Coverage Selection section, choose your desired Dental Plan from the provided options. Make sure to select either DMO or PPO plans as applicable.
Next, elect your Life Coverage by selecting from the available options. Ensure you provide a Beneficiary Designation with their full name, Social Security Number, and relationship to you.
List all individuals to be covered under dental or life insurance in the Individuals Covered section. Include their sex, birth date, and coverage election for both dental and life.
Complete the Other Insurance section by indicating if anyone has prior coverage and providing necessary details if applicable.
Finally, review all information for accuracy before signing and dating the form at the bottom.

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At what point do California employees get health benefits?

Benefit Eligibility Employees are eligible for health benefits if they have an appointment of more than six months (at least six months plus one day) and a time base of half-time or more.

What is an intermittent employee?

Intermittent employees - those employees who are employed on an irregular or occasional basis, with hours or days of work not on a prearranged schedule, and with compensation only for the time actually employed or for services actually rendered.

What does permanent intermittent employee mean?

18.1 Permanent Intermittent Appointments. A. An intermittent position or appointment is a position or appointment in which the employee is to work periodically or for a fluctuating portion of the fulltime work schedule. An intermittent employee may work up to 1,500 hours in any calendar year based upon SPB rule.

Do permanent intermittent employees get benefits?

Permanent-intermittent state employees are eligible for health benefits after working 480 hours during one of two control periods: January 1 through June 30 (effective enrollment date of August 1) Eligibility Enrollment - CalPERS ca.gov page health-benefits eli ca.gov page health-benefits eli

How many hours do you need to qualify for benefits in California?

Larger employers, with 50 employees or more full-time employees are required to offer healthcare benefits to those workers working at least 30 hours a week, or at least 130 hours a month, or pay a tax penalty. For smaller employers, with 50 employees or less, offering health benefits is left up to the employer. What is a Full-Time Employee in California? workplacerightslaw.com library faq what-is- workplacerightslaw.com library faq what-is-

Do intermittent federal employees get benefits?

Coverage for Certain Employees on Temporary Appointments and Certain Employees on Seasonal and Intermittent Schedules. and you are expected to work 130 hours per month or more for at least 90 days you are eligible to enroll with a full government contribution, provided you are not covered under the Part-time Career Act

Do CA State employees get life insurance?

An employer-paid Basic Group Term Life Insurance Plan is provided to active State employees who are designated managers, supervisors, confidential, and other specified excluded employees. Basic Group Term Life Insurance for Excluded Employees | Cal HR benefitsprograms.info state-employee ba benefitsprograms.info state-employee ba

Do CA State employees get free health insurance?

Health Benefits The State pays a portion of your premium, referred to as the employer contribution. The amount you receive is negotiated through the collective bargaining process for (union) represented employees, and determined by the California Department of Human Resources (CalHR) for excluded employees. Essential Benefits and Services - CalHR - CA.gov ca.gov employees Pages new-em ca.gov employees Pages new-em

California Employee Dental Life Group Election Form 2026

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Can I complete and sign my California Employee Dental Life Group Election Form online?

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At what point do California employees get health benefits?

What is an intermittent employee?

What does permanent intermittent employee mean?

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People also ask

Do permanent intermittent employees get benefits?

How many hours do you need to qualify for benefits in California?

Do intermittent federal employees get benefits?

Do CA State employees get life insurance?

Do CA State employees get free health insurance?

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California Employee Dental Life Group Election Form 2026

Here's how it works

How to use or fill out California Employee Dental Life Group Election Form with our platform

Complete this form in 5 minutes or less

Got questions?

Can I complete and sign my California Employee Dental Life Group Election Form online?

What internet browser do I need to edit California Employee Dental Life Group Election Form online?

At what point do California employees get health benefits?

What is an intermittent employee?

What does permanent intermittent employee mean?

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People also ask

Do permanent intermittent employees get benefits?

How many hours do you need to qualify for benefits in California?

Do intermittent federal employees get benefits?

Do CA State employees get life insurance?

Do CA State employees get free health insurance?

Related links

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