Employee is currently enrolled in FlexElect for the Medical Reimbursement Account (MRA) and maintains his medical and dental plans under FlexElect. Employee will retire from State service on July
Desired flexelect elections
Employee wants to continue his MRA for $ per month and keep his medical and dental plans.
"Internal Revenue Service" does not require "COBRA" enrollment to continue payments into an employee's Dependent Care Reimbursement Account (only a Medical Reimbursement Account).
Employee must complete a new STD. R to enroll into the FlexElect "COBRA" Program. No action is required to continue his medical insurance into retirement. Employee must phone number library complete a STD. to continue his dental insurance into retirement.
Employees who separate from State service or become ineligible for FlexElect due to a time-base reduction can also enroll into the FlexElect "COBRA" Program, to continue their MRA.
Employee's Personnel Office must write "COBRA CONTINUATION" at the top of the STD. R and complete the "Agency Use Only" section of the STD. R; ensure form is completed accurately and submit to CalHR/BENEFITS DIVISION - FLEXELECT. Employee's Personnel Office must also ensure accuracy of the STD. and submit to CalPERS for processing.
Employee will receive a COBRA Enrollment Confirmation Letter from CalHR.
Examples: - Cancellation Due to Change in Status Event
Employee is currently enrolled in the FlexElect Cash Option in lieu of medical insurance and is enrolled in the Dependent Care Reimbursement Account (DCRA). Employee maintains a State-sponsored dental plan and is enrolled under his spouse's medical plan. Employee is covering spouse/domestic partner under his dental plan. Employee and spouse have divorced or domestic partnership termination effective October (of the same year).
Desired flexelect elections
Employee wants to cancel all of his FlexElect elections and enroll in his own medical insurance plan. Employee wants to delete spouse/domestic partner from dental plan, which is mandatory in the case of divorce or termination of domestic partnership.
Employees must take action to cancel their FlexElect within days after the date of divorce or termination of domestic partnership. This employee could have continued FlexElect and kept his DCRA, but in this case chose to cancel all FlexElect elections.
Employee must complete a STD. C and STD. R to cancel FlexElect. Employee must also complete an HBD- to enroll into a medical plan and a STD. to delete spouse/domestic partner from his dental plan. (Remember to offer spouse/domestic partner "COBRA" for dental) Employee's Personnel Office must complete the "Agency Use Only" section of the STD. C, STD. R, HBD- and STD. and ensure accuracy, then submit the package to SCO.
Employee's Personnel Office must write "COBRA CONTINUATION" at the top of the STD. R and complete the "Agency Use Only" section of the STD. R; ensure form is completed accurately and submit to CalHR/BENEFITS DIVISION - FLEXELECT. Employee's Personnel Office must also ensure accuracy of the STD. and submit to CalPERS for processing.
Employee will receive a COBRA Enrollment Confirmation Letter from CalHR.
Examples: - Cancellation Due to Change in Status Event
Employee is currently enrolled in the FlexElect Cash Option in lieu of medical insurance and is enrolled in the Dependent Care Reimbursement Account (DCRA). Employee maintains a State-sponsored dental plan and is enrolled under his spouse's medical plan. Employee is covering spouse/domestic partner under his dental plan. Employee and spouse have divorced or domestic partnership termination effective October (of the same year).
Desired flexelect elections
Employee wants to cancel all of his FlexElect elections and enroll in his own medical insurance plan. Employee wants to delete spouse/domestic partner from dental plan, which is mandatory in the case of divorce or termination of domestic partnership.
Employees must take action to cancel their FlexElect within days after the date of divorce or termination of domestic partnership. This employee could have continued FlexElect and kept his DCRA, but in this case chose to cancel all FlexElect elections.
Employee must complete a STD. C and STD. R to cancel FlexElect. Employee must also complete an HBD- to enroll into a medical plan and a STD. to delete spouse/domestic partner from his dental plan. (Remember to offer spouse/domestic partner "COBRA" for dental) Employee's Personnel Office must complete the "Agency Use Only" section of the STD. C, STD. R, HBD- and STD. and ensure accuracy, then submit the package to SCO.
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