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Home My WebLink AboutCC AG PKT 2008-01-14 #M . AGENDA REPORT DAlE: January 14, 2008 TO: Honorable Mayor and City Council FROM: David Carmany, City Manager BY: Andrew J. Tse, Personnel Manager SUBJECT: A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEAL BEACH APPROVING THE RENEWAL OF THE DELTA DENTAL PREFERRED PROVIDER ORGANIZATION (PPO) AND DENTAL HEALTH MAINTENANCE ORGANIZATION (DBMO) POLICIES REFLECTING JANUARY 1, 2008 CONTRACT TERMS AND PREMIUM RATES SUMMARY OF REQUEST: . Staff requests that Council adopt the proposed resolution by approving the renewal of the Delta Dental Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO) policies reflecting January 1, 2008 contract terms and premium rates. BACKGROUND: The City of Seal Beach contracts with Delta Dental for its ancillary dental benefits. Dental benefits are provided as a result of the collective bargaining process with the City's various employee associations. Dental insurance complements health care coverage to assist the City's workforce in staying well and healthy. At the beginning of the calendar year, a renewal document is executed if any amendments were made to the policy or premium rates. The City's plan experienced a decrease in premiums for single and family coverage participants. The policy documents need to be amended to reflect the decrease for calendar year 2008. FINANCIAL IMPACT: The total cost of the Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO) plans per calendar year is $ 74,200. The decrease in premium is projected at a cost savings 0[$705.00 for calendar year 2008. . RECOMMENDATION: That the City Council approve Resolution 56_. Agenda Item JI'1 . January 14,2007 Agenda Report - Resolution 56_ Page 2 APPROVED: ~,.. David Carmany, ci Manager Attachment: Resolution 56 . . RESOLUTION NUMBER . A RESOLUTION OF THE CITY COUNCR. OF THE CITY OF SEAL BEACH APPROVING THE RENEWAL OF THE DELTA DENTAL PREFERRED PROVIDER ORGANIZATION (PPO) AND DENTAL HEALTH MAINTENANCE ORGANIZATION (DBMO) POLICIES REFLECTING JANUARY 1,2008 CONTRACl' TERMS AND PREMIUM RATES WHEREAS, the Clty CODtraclS w.th Delta Dental for dental benefits for Its workforce; and WHEREAS, dental benefits are proVIded as a result of the collective bargaInmg process w.th the Clty's various employee associations; and WHEREAS, dentalmsurance complements health care coverage to assist the Clty's workforce in sta)'lng well and healthy; and WHEREAS, the Clty's policy eJ<penenced a premium decrease fur calendar year 2008; and WHEREAS, the policy document needs amendmeat to reflect the reduced premium rate.s NOW, TI:lEREFORE, the Clty Council of the Clty of Seal Beach hereby resolves: The renewal of the Delta Dental Prefened MlWltenance OrgamzatiOD (PPO) and Dental Health MaIntenance Orgamzotlon (DHMO) poliCIes reflecbng January 1,2008 contract terms and prenuum rates are approved. . Secllon 2 Except as provuled for In SectlOD 1, there are no other correcl1ons, changes or amendments. Section 2. The C.ty Manager IS authonzed to s.gn the renewal and amendment to the Delta Dental contracL PASSED, APPROVED and ADOPTED by the CIty Counc.l of the Clty of Seal Beach at a regular meeting held on the 14th day of Januarv .2008 by the folloWlDg vote: AYES: CounCllmember NOES: CounClImember ABSENT: Counc.Imember ABSTAIN: Counc.Imember Mayor AlTEST: Clty Clerk . Resolution Number . STATE OF CALIFORNIA } COUNTY OF ORANGE } SS CITY OF SEAL BEACH } I, Linda Devme, City Clerk of the City of Seal Beach, Cahfomia, do hereby certlly tbat the foregomg resolul1OD is the onginal copy of ResolUl1OD Number _ OD file in the office of the City Clerk, passed, spproved, and sdopted by the City COIDlCU of the City of Seal Beach at a regular meelmg thereof held OD the 14th day of Jaausrv .2008. City Clerk . . . . . AMENDMENT NO.3 TO AGREEMENT GROUP #7809 AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CAUFORNIA "Delta Dental," IS hereby further amended, effective January 1, 2008 as follows: Throughout the Contract, the term "Delta Preferred Optionw IS amended to read "Delta Dental PPOw and the term "DPO. IS amended to read "PPO.. Paragraph 3.1 IS amended to read: 3.1 Within 10 days after receIpt of Delta Dental's Invoice, the Contractholder agrees to pay the follOWing monthly Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of the Contractholder's Pnmary Enrollees and their Dependents who are Enrollees as set forth In Article 2 of this Contract: ~3. 99 for each Primary Enrollee Without Dependents; $82.39 for each Primary Enrollee with one enrolled Dependent; and $122.41 for each Pnmary Enrollee with two or more enrolled Dependents. The Contractholder agrees to bear the cost of such Premiums Without withholding or otherwise charging Pnmary Enrollees for their coverage. Pnmary Enrollees agree to bear the entire cost of coverage of their enrolled Dependents. Contractholder agrees to pay the inVOiced amount. Eligibility adJustments reported to Delta Dental after the date the InVOice is prepared will be reflected on the subsequent month's Invoice. Such adJustments are limited to the three-month period pnor to the most current month for which the Contractholder proVides eligibility data. Paragraph 4.2 Is amended to Include the following note: Note on additional Benefits during pregnancy - When an Enrollee Is pregnant, Delta Dental will pay for additional services to help Improve the oral health of the Enrollee during the pregnancy. The additional services each calendar year while the Enrollee Is covered under thiS Contract Include: one additional oral exam and either ~ one additional routine cleaning or one additional periodontal scaling and root planing per quadrant. Written confirmation of the pregnancy must be proVided by the Enrollee or her dentist when the claim is submitted. Paragraph 4.5 IS amended to read: 4.5 PROSTHODONTlC BENEffiS. Delta Dental agrees to pay 50% of the Dentist's Usual, Customary and Reasonable fees or the Fee Actually Charged, whichever IS less, or 50% of the Delta Dental PPO Dentist's Fee for the construction or repair of fixed bridges, partial or complete dentures to replace miSSing, natural teeth; for Implant surgical placement and removal; and for Implant supported prosthetics, Including Implant repair and re-cementatlon. ( 11-05-07) . Sub-paragraphs (a), (e) and (i) of Paragraph 4.7 are amended to read: (a) Only the first two oral examinations, Including Initial, penodlc, and emergency examinations, office VISits for observations and specialist consultations, or combination thereof, proVided to an Enrollee In a calendar year while he or she IS an Enrollee under any Delta Dental plan are Benefits under thiS plan. See note on additional Benefits during pregnancy. (e) A prophylaXIS (cleaning) or Single Procedure that Indudes a prophylaxis IS a Benefit twice each calendar year under any Delta Dental plan. See note on additional Benefits dunng pregnancy. Routine prophylaxes are covered as a Diagnostic and Preventive Benefit and periodontal prophylaxes are covered as a BaSIC Benefit. Periodontal scaling and root planing IS a Benefit once for each quadrant each 24-month period. See note on additional Benefits dunng pregnancy. Auonde treatment IS a Benefit twice each calendar year under any Delta Dental plan. (i) Prosthodontlc appliances and Implants that were prOVided under any Delta Dental plan will be replaced only after five years have passed, except when Delta Dental determines that there IS such extensive loss of remaining teeth or change in supporting tissues that the existing fixed bridge, partial denture or complete denture cannot be made satisfactory. Replacement of a prosthodontlc appliance or implant supported prosthesIs not prOVided under a Delta Dental plan will be covered If It Is unsatisfactory and cannot be made satisfactory. Implant removal Is limited to one for each tooth dUring the Enrollee's lifetime whether proVided under a Delta Dental or any other dental care plan. . Paragraph 4.7 (k) IS hereby deleted. Paragraph 4.8 (k) IS hereby deleted. Sub-paragraph 6 of Paragraph 7.11 Is amended to read: -.- IMR Is generally not applicable to a dental plan, unless that plan covers services related to the practice of mediCine or. offered pursuant to a contract With a health plan providing medical, surgical or hospital services. . ( 11-05-07) . . . (11-05-07) CITY OF SEAL BEACH GROUP NUMBER #7809 Date Amendment Signed: By: Signature DM&AI. CAtJyw~ Printed Name (zi"~6Tr-.,{ Title DATE: November 5, Z007 DELTA DENTAL OF CAUFORNIA: ~t;/-/~ . Belinda Martinez Senior Vice President Sales/Marketing r .. c L-~ . - Kenneth E. Bernardi Vice President Underwriting lIr. Actuarial . - - . . . , , o DELTA DENTAL December 27, 2007 city of Seal Beach City Hall 211 - 8th Street Seal Beach, CA 90740 RE: CITY OF SEAL BEACH DeltaCaree USA DHMO/PREPAID GROUP #(See AppendIx A) We are pleased to present your upcoming DeltaCarellD USA DHMO/prepaid contract renewal, and welcome this opportunity to thank you for allowing us to provide your members with their dental benefits. Delta Dental of Califomia ("Delta Dental") IS committed to proVIding you WIth the most innovative plan designs combined with world-class customer service. Your benefits have been updated with the CDT-2007 American Dental Association (ADA) Current Dental Temunology and procedure codes. The code updates do not affect the delivery of benefits under your program Under your DeltaCarellD USA DHMO/prepaid plan, the renewal date of your one-year contract is January 1,2008, with a decrease in premium. Current Rates Renewal Rates Family of One Family of Two Family of Three or More $18.12 $29 90 $44.23 $15.44 $27.71 $41.00 Your current contract will automatically renew at the rates listed above, unless written notification is received via emait to UW-Cerritosliildelta.ora or by Certified Mail'" to the attention of your account manager on or before December 1, 2007. This renewal letter should be kept with your contract documents, as it serves as an amendment to your Group Dental Service Contract. If you have any questions regarding this renewal, please feel free to contact your account manager at Delta Dental of Califomia 12898 Towne Center Drive Cerritos, CA 90703 (562) 403-4040 Del8Cate USA IBIlf'IdenwIfi8n III tIreae.... byftreae enfI6ea AL- AJpha DenIfII DlAilIbMre, lire. AZ -A/phI DenMlof AnzDne, Ire, CA - Della DenIsJ oI~ co, OR,Rl....WA-__eo,R......m, WVond_.DC -DellJJDenIaII_~y, AID, TX-Np/08DM101_Im:.NV-Np/08 DenW dNew8dl, Inc. lIT - AtN Dental ofUlah. Inc. NftI-A4:N DenmltJlNew Afelaco. Jnc. NY- DeItilI DetD/ oINew YDlt PA -Deb DenWDf~,. DellI DenI8/ IIIIUI8IIC8 Ccmpeny IIf:Ia u'" 0eII'8CanI USA adm..-4..... ....",...1f8t88. rm:eptCA 7lIeIe c:ampMI8I_ Jrrenc:MIy ~ forlherOMJ ptDdut;Ia 128BB TOWl"Ilt Cen&er Dnve. CemIoI, CA 9D703-8579 (512) 824-8311 Fa (582) 924-8039 """""'"' ...... DopI (BIll).......... _' _m'.l'Il1mr1l . . . Thank you for choosing Delta Dental and for this opportunity to continue meeting your dental benefit needs. We truly appreciate your business Sincerely, Delta Dental of California 9-..~-J. .d~ Belinda Martl..; Senior Vice President, Sales/Marketing jA~~t. ~Bemardl Vice President, Underwriting & Actuarial 4~ ~~~ Araenia Martinez Account Manager cc: ABD Insurance Services 21250 Hawthorne Blvd., SUite 600 Torrance. CA 90503 . . . APPENDIX A GroUD # 02012-0047 02012-0055 02012-0070 GroUD Name ABD - CITY OF SEAL BEACH-ACTIVE ABD - CITY OF SEAL BEACH-COBRA ABD - CITY OF SEAL BEACH-RETIREES