Std 692 2025

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The document is a Dental Plan Enrollment Authorization form from the California Department of Human Resources. It outlines the process for employees to enroll in, change, or cancel their dental plan coverage. The form requires personal information, including names, social security numbers, and family relationships, and includes sections for different types of actions (new enrollment, cancellation, changes). Additionally, it contains a privacy notice regarding the handling of personal information.

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Click ‘Get Form’ to open the STD 692 in the editor.
In Section A, enter your name and select the dental plan you wish to enroll in. If applicable, provide the provider/facility number for prepaid plans.
Move to Section B and indicate the type of action: New enrollment, cancellation, change, or COBRA. Fill in details about family members currently enrolled and those to be added or deleted.
Complete Section C if changing plans; otherwise, proceed to Section D. Here, check the appropriate box regarding your enrollment decision and authorize deductions from your salary.
Finally, sign and date the form in Section D. Ensure all information is accurate before submitting it through our platform.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (124 Votes)
2019	4.4 Satisfied (251 Votes)
2016	4.3 Satisfied (129 Votes)
2012	4.4 Satisfied (180 Votes)
2000	4 Satisfied (44 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the most common form of dental insurance?

The two most common types of dental plans are dental preferred provider organization (DPPO) plans and dental health maintenance organization (DHMO) plans. A DPPO plan allows you to visit any licensed dentist, in or out of network although you may pay more for out-of-network services.

Is it too late to get dental insurance?

Its not too late to shop for a private plan. If your employer offers a plan, you would need to sign up during open enrollment. But consider your options carefully. Dental insurance is actually not that great - the coverage is not like health insurance.

Do any dental plans cover 100%?

Most full-coverage dental plans cover 100% of preventive care. Basic care usually covers simple extractions and fillings, certain types of X-rays and other services like oral cancer testing. Major restorative care includes bridges, crowns, dentures, root canals, complex oral surgeries, and in some cases, implants.

What is the dental insurance for low income people in California?

Medi-Cal Dental is the program that provides free or low-cost dental services to eligible children and adults. The Medi‑Cal Dental Program provides free or low‑cost dental services to children and adults who receive Medi‑Cal, Californias Medicaid program.

What percentage does most dental insurance cover?

Understanding Dental Insurance Coverage 100% for preventive care including cleanings, exams, and X-rays. 80% for basic procedures, such as fillings. 50% for major procedures, such as crowns and dentures.

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