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Home My WebLink AboutC16131 Delta Dental Renewal ContractCITY OF PALM DESERT HUMAN RESOURCES DEPARTMENT STAFF REPORT REQUEST: Request for approval of amendment to Contract No. C16130 with Delta Dental through June 30, 2007. SUBMITTED BY: Lori Carney, Human Resources Manager CASE NOS. N/A DATE: October 13, 2005 CONTENTS: Staff Report Contract 16131 Renewal Amendment Recommendation: By Minute Motion authorize Mayor to approve renewal of Contract No. C16131 with Delta Dental through June 30, 2007. Executive Summary: A yes vote will approve the renewal amendment to the Delta Dental contract for employee dental benefits through June 30, 2007. Discussion: The City receives broker services from ABD for dental, vision, life and LTD insurance. ABD negotiates rates and contracts on our behalf as part of a municipal pool. The City approved Contract No. C16130 with Delta Dental to provide employee dental benefits July 1, 1999, and has continued the contract since that time. Continuing the contract through June 30, 2007, will ensure continuity in benefits administration. Submitted Heady Lori Carney, /Assistant heila Gilligan, Human Resour Manager City Manager ommunity Services A roval: / YYGi ./ Carlos a a, Pau City Manager Findnce�son, Director G WRWR Group DocumentslStaff Reports0elts Dental Renewal 20052006 doc '+�'��I '�' 21250 Hawthorne Blvd. Suite 600. Torrance. CA 90503 a ��1 rV! ph 310 543 9995 fax 310 543 9905 M „ ' � ` www CyberSure corn September 6, 2005 Lori Carney Human Resources Management Analyst Human Resources City of Palm Desert 73-510 Fred Waring Drive Palm Desert, CA 92260 RE: DELTA DENTAL POLICY #65 REVISED AMENDMENT #4 Dear Lori, Delta Dental has decided to reissue the amendment that was recently sent to you for signature. Attached is a revised copy of Delta Dental Amendment # 4. This is the same as the previously sent Amendment #4, with coverage for Domestic Partners added. Will you please replace that prior amendment with this one, then sign it and return it to us? The other amendment, sent to you on July 21, 2005 can be discarded. We apologize for this bit of confusion! Thank you. Please let us know if you have any questions. Sincerely, Kathryn Ehni Account Coordinator enclosures W B'N (A License NOOD58513 WA License NOABDINF•973MW NV License N011049 AMENDMENT NO. 4 TO AGREEMENT RENEWAL GROUP #65 AGREEMENT dated July 1, 1999, as amended, between CITY OF PALM DESERT and DELTA DENTAL OF CALIFORNIA "Delta", is hereby further amended, effective July 1, 2005, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on July 1, 2005, and ending on June 30, 2007 and each subsequent yearly period during which this Contract remains in effect. Paragraph 2.3 is amended to read: 2.3 Dependents are the employee's legal spouse or registered domestic partner and unmarried dependent children from birth to age 19, or to age 23, if enrolled as full- time students in an accredited school, college or university. Children include stepchildren, adopted children, children placed for adoption and foster children, provided they depend upon the Primary Enrollee for support and maintenance. The Dependents of Primary Enrollees are eligible to enroll on the same date that the employee, of whom they are a Dependent, becomes a Primary Enrollee. Later -acquired Dependents become eligible as soon as they acquire dependent status. Registered domestic partners are defined as same sex partners, who are both at least 18 years of age or older, and opposite sex partners when one or both partners are over the age of 62 and entitled to Social Security benefits. Registered domestic partners are required to register with the Secretary of State of the State of California a Declaration of Domestic Partnership. A registered domestic partner is subject to the same terms and conditions as any other Dependent enrolled under this Contract. Registered domestic partners are eligible for continuation of coverage under COBRA. Paragraph 3.1 is amended to read: 3.1 Within 10 days after receipt of Delta's invoice, The Contractholder agrees to pay the following monthly Premiums to Delta, at the address shown on the first page of this Contract, for all of the Contractholder's Primary Enrollees and their Dependents who are Enrollees as set forth in Article 2 of this Contract: $38.15 for each Primary Enrollee without Dependents; $71.94 for each Primary Enrollee with one enrolled Dependent; and $121.46 for each Primary Enrollee with two or more enrolled Dependents. The Contractholder agrees to bear the cost of such Premiums without withholding or otherwise charging Primary Enrollees for their coverage. Primary 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 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. If an Enrollee's claim has been denied or modified, the Enrollee may file a request for review (a grievance) with Delta within 180 days after receipt of the denial or modification. If in writing, the correspondence must include the group name and number, the Primary Enrollee's name and social security number, the inquirer's telephone number and any additional information that would support the claim for benefits. The correspondence should also include a copy of the treatment form, Notice of Payment and any other relevant information. Upon request and free of charge, Delta will provide the Enrollee with copies of any pertinent documents that are relevant to the claim, a copy of any internal rule, guideline, protocol, and/or explanation of the scientific or clinical judgment if relied upon in denying or modifying the claim. Delta's review will take into account all information, regardless of whether such information was submitted or considered initially. Certain cases may be referred to one of Delta's regional consultants, to a review committee of the dental society or to the state dental association for evaluation. Delta's review shall be conducted by a person who is neither the individual who made the original claim denial, nor the subordinate of such individual, and Delta will not give deference to the initial decision. If the review of a claim denial is based in whole or in part on a lack of medical necessity, experimental treatment, or a clinical judgment in applying the terms of the contract terms, Delta shall consult with a dentist who has appropriate training and experience. The identity of such dental consultant is available upon request. Delta will provide the Enrollee a written acknowledgement within five calendar days of receipt of the request for review. Delta will make a written decision within 30 calendar days of receipt, or inform the Enrollee of the pending status if more information or time is needed to resolve the matter. Delta will respond, within three calendar days of receipt, to complaints involving severe pain and imminent and serious threat to a patient's health. An Enrollee may file a complaint with the Department of Managed Health Care after he or she has completed Delta's grievance procedure or after he or she has been involved in Delta's grievance procedure for 30 calendar days. An Enrollee may file a complaint with the Department immediately in an emergency situation, which is one involving severe pain and/or imminent and serious threat to the Enrollee's health. The California Department of Managed Health Care is responsible for regulating health care service plans. If an enrollee has a grievance against Delta, the health plan, the enrollee should first telephone Delta at 1-800-765-6003 and use Delta's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to an enrollee. If help is needed with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by this health plan, or a grievance that has remained unresolved for more than 30 calendar days, the enrollee may call the department for assistance. An enrollee may also be eligible for an Independent Medical Review (IMR). If eligible for an IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. CITY OF PALM DESERT Date Amendment Signed: By: Signature Printed Name Title DATE: ]uly 28, 2005 DELTA DENTAL OF CALIFORNIA: Belinda Martinez Senior Vice President Sales/Marketing Vice President Underwriting, & Actuarial