Current through Register Vol. 46, No. 12, March 20, 2024
(a) Employees.
(1) An employee shall be eligible for
coverage under the plan for himself and for his dependents, if any, subject to
the provisions of this Part and of the appropriate contracts applicable to
employees and their dependents.
(2)
No employee may be covered under this plan until he has completed six months of
service following date of last entry into the service of the State or a
participating employer. Each appointment, or election, or reinstatement
following a break in service, shall be considered a new entry into
service.
(3) Coverage for any
employee and his dependents shall cease without notice upon termination of his
status as an employee as defined in section
74.1 of this Part.
The status of any person as an employee shall be deemed to terminate upon his
severance from the payroll for any reason, including retirement, except that
for the purpose of continuing his coverage under the plan, the status of such
person as an employee shall be deemed to continue during any period of
authorized leave without pay or during any other period of separation from the
payroll for which the employer continues contributions on behalf of the
employee and his dependents. For the purpose of this plan, employees in vested
status, on preferred lists or on seasonal layoff are not considered to be on
leave without pay.
(4)
Notwithstanding the foregoing, coverage under the plan for any person whose
status as an employee terminates shall continue through the last day of the
calendar month in which his employment ceases. Coverage of his enrolled
dependents shall continue for the same period.
(5) Notwithstanding any other provisions of
this Part, if the regular work schedule of an employee has been not less than
half-time per week for at least one year and then is reduced to less than
half-time per week under circumstances not expressly excepted under section
74.1(c)
of this Part, the president may, in his or her discretion and upon the request
of the employer, deem such person's status as an employee to continue for a
period not exceeding one year for the purpose of continued coverage under the
plan. Thereafter, if the regular work schedule of such employee continues to be
less than half-time per week, the president may, from time to time, review the
case and, in his or her discretion, grant extensions not exceeding one year
each during which such person's status as an employee may be deemed to
continue.
(6) In the event both
husband and wife elect coverage under the plan as employees as defined in
section
74.1 of this Part,
there shall be coordination of benefits.
(7) Notwithstanding any other provisions of
this Part in the event of the death of an employee, the coverage hereunder of
his dependents shall continue through the last day of the calendar month in
which death occurs.
(b)
Cessation of eligibility upon termination of the plan. Upon the termination of
the plan by the State, the coverage and eligibility for coverage of its
employees shall cease as of the end of the last period for which the required
contributions have been paid to the insurance carrier.
(c) Disqualification. The president may
disqualify from participation in the dental insurance plan and from receiving
benefits thereunder any employee who has secured or attempted to secure
participation in the dental insurance plan or benefits under the plan for
himself or another by fraud, deception or a false statement of a material fact,
or who has accepted benefits for himself or another knowing he was not entitled
thereto. No person shall be disqualified or denied benefits pursuant to this
subdivision unless he is first given a written statement of the reasons
therefor and afforded an opportunity to make an explanation and submit facts in
opposition to such action. Such employees may be restored to eligibility for
coverage under the plan only on approval of the president and subject to such
conditions as may be imposed by the president, including repayment of sums
expended for benefits obtained by fraud, deception or false statement of a
material fact, or accepted by the employee with knowledge that he was not
entitled thereto.
