HomeMy WebLinkAboutDELTA DENTAL OF CALIFORNIA (EMPLOYEE INS. RENEWALS, DENTAL, VISION, EMPLOYEE ASSISTANCE, ETC.)A-2016-229-01
INSURANCE NOT REQUIRED
WORK MAY PROCEED
CLERK OF COUNCIL AMENDMENT NO. ii TO AGREEMENT
DATE` �� ,- G RENEWAL
GROUP #00599
AGREEMENT dated January 1, 2005, as amended, between CITY OF SANTA ANA and DELTA DENTAL OF
CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2017, as follows:
Paragraph 1.4 is amended to read:
1.4 "Contract Term" means the period beginning on January 1, 2017, and ending on December 31, 2017
and each subsequent yearly period during which this Contract remains in effect.
Paragraph 3.1 is amended to read:
3.1 Within ten days after receipt of Delta Dental's invoice, Contractholder agrees to pay the following
monthly, billed Premiums to Delta Dental, at the address shown on the first page of this Contract, for
all of Contractholder's Primary Enrollees and their Dependents who are "Enrollees" as set forth in Article2
of this Contract:
$52.56 for each Primary Enrollee without enrolled Dependents; and
$129.44 for each Primary Enrollee with one or more enrolled Dependents.
Delta Dental shall use the plus stabilization existing as of December 31, 2016 to subsidize the total
monthly Premium in the following amounts:
$2.93 for each Primary Enrollee without enrolled Dependents; and
$7.22 for each Primary Enrollee with one or more enrolled Dependents.
The Contractholder is required to pay only the billed, monthly Premiums shown above. The total monthly
Premium, including billed and subsidized monthly Premiums, is:
$55.49 for each Primary Enrollee without enrolled Dependents; and
$136.66 for each Primary Enrollee with one or more 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 prior to the most current month for which the
Contractholder provides eligibility data.
Contractholder agrees to bearthe cost 70% of such Premiums without withholding or otherwise charging
Primary Enrollees for their coverage. Primary Enrollees agree to bear the remaining 30% of the cost of
coverage for themselves and the entire cost of coverage for their enrolled Dependents.
CITY OF SANTA ANA
DELTA DENTAL GROUP #00599
Date Amendment Signed:
Printed Name
Title
ATTEST:
/ " lC / ( DATE: August 10, 2016
MARIA D. HUIZA V DELTA DENTAL OF CALIFORNIA
CLERIC OF THE COUNCIL
Belinda Martinez
EVP/Chief Sales and Marketing Officer
Kevin ]ackson
SVP Underwriting/Actuarial