Understanding Your 2022 California State Vision Benefits with VSP

Navigating your employee benefits can be complex, especially when it comes to vision care. As a California state employee or retiree, you have access to comprehensive vision coverage through Vision Service Plan (VSP). This guide breaks down the essential information from the 2022 vision program updates, ensuring you understand your benefits and how to utilize them effectively. While this article focuses on the 2022 program, VSP has a long history of caring for its members, and this commitment to care continues to be a cornerstone of their service.

Your Vision Plan Options: Basic and Premier

The State of California provides two vision plan options for eligible employees and retirees: the Basic Vision Plan and the Premier Vision Plan.

Basic Vision Plan: Automatic Coverage

The Basic Vision Plan is an automatic benefit for eligible state employees and their dependents. It operates through the VSP Advantage network, providing essential vision care services. You are automatically enrolled in this plan as a state employee, ensuring you have immediate access to vision benefits.

Premier Vision Plan: Enhanced Benefits

For those seeking more comprehensive coverage, the Premier Vision Plan offers enhanced benefits and a wider selection of eyewear options. While the retiree vision benefits mirror those of active employees, retirees are responsible for covering the full premium of the Premier plan.

Plan Premiums and Deduction Codes

For detailed information on plan premiums and the corresponding deduction codes, refer to the Vision Plan Deduction Codes and Premiums PDF. This document provides a complete breakdown of costs associated with both the Basic and Premier plans.

Eligibility: Who is Covered?

Understanding eligibility is crucial to accessing your vision benefits. The California Department of Human Resources (CalHR) manages the State Vision Care Program, outlining specific criteria for both employees and retirees.

Employee Eligibility

You are eligible for vision benefits as a state employee if you fall into one of the following categories:

1. Permanent employees appointed half-time or more.
2. Limited-term (LT) or temporary authorization (TAU) employees appointed for six months or more with a half-time or more time base.
3. Permanent intermittent employees working a minimum of 480 hours within a six-month control period (January 1 – June 30 and July 1 – December 31).
4. Former retired state employees currently enrolled in state COBRA vision benefits or the Retiree Vision Program who reinstate as permanent intermittent employees.
5. Employees appointed under Government Code Section 21228.
6. Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU.
7. Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.

Important Note for Bargaining Unit 6 (CCPOA) Employees: Employees in Bargaining Unit 6 have vision coverage through their union benefit trust and are not eligible for the state’s active employee vision program. However, they become eligible for the state Retiree Vision Program upon retirement.

Retiree Eligibility

Retiring state employees may enroll in the Retiree Vision Program if they meet the requirements of Government Code Section 22959.4 at the time of retirement. Eligible retiring employees include:

1. Civil service employees of the state.
2. Elected members of the Legislature.
3. Legislative employees.
4. Constitutional officers.
5. Employees, judges, or justices of the judicial branch of state government.

To continue vision coverage into retirement seamlessly, employees must be enrolled in a vision plan on their last day of employment and retire within 120 days of separation. Even if not enrolled at the time of separation, retirees who meet eligibility criteria and retire within 120 days can enroll during any subsequent open enrollment period.

Survivor Eligibility

Eligible survivors, as determined by CalPERS, may also enroll in the Retiree Vision Program. Personnel offices should contact CalHR at [email protected] to enroll survivors, indicating “Survivor Benefit” on the CalHR 695 form and including deceased employee details.

Dependent Eligibility

Eligible dependents for both employee and retiree plans include:

1. Spouse or Domestic Partner.
2. Dependent children under the age of 26, including natural, adopted, stepchildren, or children in a parent-child relationship who are economically dependent on the employee.

Coverage for dependents typically ends upon events like employee separation, death, divorce, termination of domestic partnership, or when a child turns 26 (unless disabled).

Disabled Dependent Children

Disabled dependent children under 26 enrolled as eligible family members may continue coverage after age 26 if they are incapable of self-support due to physical or mental disability and dependent on the employee or retiree for support and care. Proof of disability must be provided to the vision carrier, and annual certification may be required.

Enrollment and Changes

Basic Vision Plan Enrollment

Enrollment in the Basic Vision Plan is automatic for eligible employees and dependents. Coverage effective dates depend on when the Personnel Action Request (PAR) document is entered into the State Controller’s Office (SCO) payroll system.

• PAR keyed before the 10th of the month: Coverage starts the first day of the following month.
• PAR keyed after the 10th of the month: Coverage starts the first day of the second month following.

In certain situations, the Vision Plan Enrollment Authorization Form (STD. 700) is required for Basic Plan enrollment or changes. These situations include:

• Initial enrollment for eligible employees who were not automatically enrolled.
• Enrollment for permanent-intermittent employees meeting hour requirements.
• Re-enrollment for former retirees on COBRA who become permanent intermittent employees.
• Cancellation of coverage.
• COBRA continuation.
• Enrollment for permanent intermittent BU 6 employees after academy graduation.

Premier Vision Plan Enrollment

Active state employees (excluding rank and file BU 6) can enroll in the Premier Vision Plan by completing the Premier Vision Enrollment Authorization (CalHR 774) form. This form is not for open enrollment use. Employees must maintain Premier Plan enrollment for a minimum of 12 months, with disenrollment possible only during open enrollment periods.

Retiree Vision Program Enrollment

Retirees enroll in the Retiree Vision Program using the CalHR 695 form. This form must be submitted within 60 days of retirement to establish vision deductions through CalPERS. The CalHR 695 is also not for open enrollment use.

Making Changes to Your Enrollment

Changes to vision enrollment are governed by specific rules and timelines. Report any changes, such as adding dependents due to marriage or birth, or deleting dependents due to divorce or ineligibility, to your personnel office as soon as possible.

Mandatory Deletions

Dependents must be deleted from coverage in situations like divorce, termination of domestic partnership, death of a dependent, or when a child ages out.

Voluntary Changes

Employees can make voluntary changes such as adding new dependents or deleting dependents who gain other group coverage.

Administrative Deletions

Administrative deletions are processed by the department, such as removing dependents who are no longer eligible due to age or dual coverage.

Open Enrollment

• Basic Vision Plan: No open enrollment period as enrollment is automatic.
• Premier Vision Plan: Open enrollment allows changes to Premier Plan enrollment, with changes effective January 1 of the following year.
• Retiree Vision Plan: Retirees receive annual open enrollment information from VSP to make changes.

Plan Usage and Benefits

How to Use Your Vision Plan

Utilizing your VSP benefits is straightforward:

1. Choose a Provider: Select a VSP network provider for maximum benefits. Find a provider by calling VSP at (800) 877-7195 or visiting the VSP website for active members or VSP website for retired members.
2. Schedule an Appointment: Call the VSP doctor and mention you are a VSP member. Provide your name and social security number. Active employees use group number 30052011 (Basic) or 30034581 (Premier). Retirees use group number 30052010 (Basic) or 30058000 (Premier).
3. VSP Handles the Rest: The provider will verify your eligibility and coverage with VSP. You’ll only need to pay any applicable co-payments at the time of service.

Out-of-Network Care

You can also receive services from out-of-network providers. In this case, you will need to pay for services upfront and submit an itemized receipt to VSP for reimbursement, up to the plan’s non-member doctor schedule.

Exclusions and Limitations

Both the Basic and Premier plans are designed for visual needs, not cosmetic eyewear. Certain services and eyewear have limitations or exclusions, including:

• Orthoptics and vision training.
• Plano lenses.
• Two pairs of glasses instead of bifocals.
• Replacement of lost or broken eyewear before service eligibility.
• Medical or surgical eye treatments.
• Services covered by Worker’s Compensation or other group vision programs.

Coordination of Benefits and Dual Coverage

If you have dual vision coverage (e.g., through your spouse’s plan), you may be eligible for Coordination of Benefits (COB). This can help reduce out-of-pocket expenses by combining benefits from multiple plans. Specific rules apply for dual coverage within the state vision program and with non-VSP plans.

Direct Payment and COBRA

Direct Payment

Employees on non-pay status can continue vision coverage by making direct payments to VSP using the Vision Plan Direct Payment Authorization (STD. 703) form.

COBRA

Retiring employees are offered COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation, allowing them to maintain vision benefits for 18 to 36 months after losing coverage due to qualifying events.

Key Forms and Contact Information

• STD. 700: Vision Plan Enrollment Authorization (Basic Plan) – Attachment A – Vision Plan Enrollment Authorization (STD. 700)
• CalHR 774: Premier Vision Enrollment Authorization – Attachment B – Premier Vision Enrollment Authorization (CalHR 774)
• CalHR 695: Retiree Vision Plan Enrollment Authorization – Attachment E – Retiree Vision Plan Enrollment Authorization (CalHR 695)
• STD. 703: Vision Plan Direct Payment Authorization – Attachment D – Vision Plan Direct Payment Authorization (STD. 703)

Vision Plan Contact Information:

Vision Service Plan (VSP)
3333 Quality Drive
Rancho Cordova, CA 95670
(800) 877-7195

Website:

• Active Employees: stateofcaemployee.vspforme.com
• Retirees: stateofcaretiree.vspforme.com

Direct Payments, COBRA Enrollments, and Retiree Premier Vision Plan Enrollments (Forms and Payments):

Vision Service Plan (VSP)
Attn: Client Services, MS 229
P.O. Box 997100
Sacramento, CA 95899-7100
Email: [email protected]

By understanding your California State Vision Program benefits through VSP, you can take full advantage of the resources available to maintain your eye health and vision. Remember to consult the official plan documents and contact your personnel office or VSP directly for any specific questions or clarification.