HomeMy WebLinkAboutDELTA DENTAL- EMPLOYEE GROUP INSURANCE RENEWALS-2005A- 2015 -205
AMENDMENT NO. 10 TO AGREEMENT
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, 2016, as
follows:
Paragraph 1.4 is amended to read:
1.4 "Contract Term" means the period beginning on January 1, 2016, and ending on December 31,
2016 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 Contra ctholder's Primary Enrollees and their Dependents who are
"Enrollees" as set forth in Article2 of this Contract:
$51.58 for each Primary Enrollee without enrolled Dependents; and
$127.04 for each Primary Enrollee with one or more enrolled Dependents.
Delta Dental shall use the plus stabilization existing as of December 31, 2015 to subsidize the
total monthly Premium in the following amounts:
$3.91 for each Primary Enrollee without enrolled Dependents; and
$9.62 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 bear the cost 75% of such Premiums without withholding or otherwise
charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the remaining
25% of the cost of coverage for themselves and the entire cost of coverage for their enrolled
Dependents.
Paragraph 9.2 is amended to read:
9.2 If Delta Dental terminates this Contract under paragraph 9.1 (a), all Benefits end and Delta
Dental is released from all further obligations of this Contract, effective the last day of the
month in which written notice of termination is given. The Contractholder will remain liable to
Delta Dental for the greater of: (1) the unpaid Premiums applicable for the period this
Contract was in effect before termination; or (2) the full amount of all Dentist's statements
paid or otherwise discharged by Delta Dental during the full term of this Contract, plus
15.60% of such amount (to compensate Delta Dental for its administration of the dental
plan), less amounts actually paid by the Contractholder to Delta Dental during the term of
such Contract.
CITY OF SANTA ANA
DELTA DENTAL GROUP #00599
Date Amendment Signed
�etJCIL 20S
Printed Name
Title
DATE: January 16, 2015
DELTAn DENTAL OF CALIFORNIA
Belinda Martinez
Senior Vice President
Sales /Marketing
Kevin Jackson
Group Vice President
Underwriting & Actuarial
ATTEST'
L/P R /G/ -
CLERK OF THE COUNCIL.
APPROVED AS TO FORM
IGi:�J-t[a..
Laura A. Rossini
Senior Assistant City Attorney