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Delta Dental AgreementCITY OF DUBUQUE, IOWA MEMORANDUM March 1, 2001 TO: FROM: SUBJECT: The Honorable Mayor and City Council Members Michael C. Van Milligen, City Manager Administrative Services and Financial Agreement Between the City of Dubuque and Delta Dental Plan of Iowa Personnel Manager Randy Peck is recommending approval of the Administrative Services and Financial Agreement Between the City of Dubuque and Delta Dental Plan of Iowa for services related to the administration of the City's dental plan. I concur with the recommendation and respectfully request Mayor and City Council approval. Mi an Milligen -- MCVMJjh Attachment cc: Barry Lindahl, Corporation Counsel Randy Peck, Personnel Manager CITY OF DUBUQUE, IOWA MEMORANDUM February 22, 2001 TO: FROM: Michael C. Van Milligen, City Manager Randy Peck ~ Personnel Manager SUBJECT: Administrative Services and Financial Agreement Between the City of Dubuque and Delta Dental Plan of Iowa On February 5, 2001, I received the attached Administrative Services and Financial Agreement between the City of Dubuque and Delta Dental Plan of Iowa for services related to the administration of the City's dental plan. The effective date of this agreement is July 1, 2000. The administrative fee for processing dental claims was reduced from $2.56 per contract per month to $2.53 per contract per month. The reduction in the fee is the result of our decision to require a weekly claims settlement. The administrative fee went into effect on July 1, 2000 and will remain in effect through June 30, 2001, and was approved by the Health Care Committee on May 18, 2000, The reason for the extensive delay in receiving the final version of the Administrative Services Agreement is due to the fact that we had to work out some language issues with Delta Dental. This agreement has been reviewed by Barry Lindahl and the Segal Company, our benefit and actuarial consultant, and they found the terms to be acceptable. The Health Care Committee has also approved the agreement. J recommend that the agreement be approved. If you have any questions, please feel free to call. PLEASE SIGN THIS COPY AND RETURN IN THE ENCLOSED ENVELOPE ADMINISTRATIVE SERVICES and FINANCIAL AGREEMENT THIS AGREEMENT is by and between Delta Dental Plan of Iowa (Delta), and City of Dubuque (Employer). Group name WHEREAS, the following circumstances exist: Delta is a nonprofit corporation author/zed by the Commissioner of Insurance for the state of Iowa to transact bm/ness as a dental service plan. Employer desires to create or has established a dental benefits plan for its eligible Employees. Employer desires to enter into a financial arrangement with Delta under which Employer is solely responsible for the Claims Paid for covered dental services provided to its Members subject to the limitation on Employer's financial liability set forth in the stop loss coverage provisions of this Agreement. Employer desires that Delta pay claims for dental services furnished to Members and provide other administrative services. NOW, THEREFORE, in consideration of the mutual promises and covenants hereinafter set forth, it is hereby agreed as follows: 1. Definitions. "Administrative Fee" means either an amount per contract or a percentage of Chinas Paid, whichever is applicable, that Delta charges the Employer and which includes allocations for Delta's cost of adm/nister/ng Employer's plan and general operating costs. The Administrative Fee during the Cuntract Period is stated in the Schedule of Fees attached to this Agreement. "Administrative Services" means those services to be performed by Delta for Employer in connection with this Agreement,/ncluding, but not 1/mited to the following: claims process/ng, customer services, accounting services, actuarial services, enrollment services, data process/rig services, and such other related services as the parties may agree are appropriate and necessary to accomplish the objectives of this Agreement. Administrative Services expressly excludes any services for the administration of continued dental coverage pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or any state or federal law relating to continuation coverage &the Employer's plan. "Agreement" means this Adm/nistrative Services and Financial Agreement, Group Application, Schedule o£Fees attached to it initially and as such may be revised or amended, the Benefits Certificate(s), and the Subscribers' names and/or applications for coverage. Benefits Certificate means the written document(s) which describe and de£me a welfare benefit plan for dental services which the Employer established for its Members. "Claims" means claims for dental services that ere furnished to Members with a date of service as de£med in the Schedule of Fees as Claims Eligible for Payment. "Claims Paid" means the mount calculated by deducting from the Covered Charges any amounts attributable to Provider Savings, deductibles, copayme~nt, coinsurance, or Contract L/mitations as defined in the Benefits Certificate(s). The amount of Claims Paid during the Contract Period is determined by the date of Delta's check or remittance. "Contract Limitations" means the amounts which ere the liability of the Subscriber under this Agreement. These include the services which are not covered, charges for dental services which are not dentally necessary, penalties for failure to follow notification requirements, and charges for services that have reached a contract max/mm "Contract Period" means the period of time set forth in the Schedule of Fees or the most recent revision to the Schedule of Fees. "Covered Charges" means the amount a provider bills a Member, or DeRa, less services not covered. Services which ere covered are those dentally necessary and dentally appropriate procedures as outlined in the Benefits Section of the Benefits Certificate(s). "Delta Allowance" means the amount which equals the lesser of the Covered Charge for a service, supply, or any dental procedure covered under the dental plan or an amount which Delta establishes, annually, as its maximum allowable fee for the same service or supply. For all dental procedures covered under the plan, the max/mum allowable fee is established by Delta Dental Plan of Iowa for a covered dental procedure that is dentally necessary and dentally appropriate. It is developed from various sources, such as contracts with dentists, input from our dentist consultants, the simplicity or complexity of the procedure, and the billed charge for the same procedures by dentists in Iowa. For services billed by providers outside of Iowa, the max/mum allowable fee is based on information from that state's Delta Plan. "Employee" means an active Employee of Employer for purposes of Social Security laws or who otherwise is included as an Employee as required by law (or a member of the Boerd of Directors of an Employer). "Incurred Date" means the date dental services are provided. With regerd to inpatient hospital or facility services, the date of admission is the Incurred Date. "Member" means any person entitled to receive dental benefits as defmed in the Benefits Certificate(s). "Provider Savings" means the amount saved due to Deka's contracts with providers. It is calculated as the difference between the Covered Charge and the Delta Allowance. 2 "Subscriber" means any individual identified by Employer as a person eligible for dental coverage subject to the terms, conditions and limitations described in the Benefits Certificate(s) and who is named on an identification card issued by Delta. Responsibilities of Employer. Furnishing Information. Employer agrees to furnish Delta with timely reports and information in a form and manner reqinred by Delta so that Delta properly may discharge its responsibilities under this Agreement, including but not limited to, information pertsining to Members for the purpose of determining eligib~ty for coverage under the Benefits Certificate(s), and information necessary for the proper administration of coordination of benefits and other limitations and exclusions contained in the Benefits Certificate(s). Persons Eligible for Coverage. Prior to the Effective Date of this Agreement, Employer shall deliver to Delta a list of the names and/or completed applications for each person that Employer shall designate as being eligible for benefits set forth in the Benefits Certificate(s). On or before the fast of each month thereafter Employer shall notify Delta in writing of those persons who are no longer eligible as of that month, and thereafter Delta shall not pay Claims for serv/ces furnished such persons on or after the date of termination. At any time during the Con~ract Period, Employer may certify to Deha the names of additional eligible persons. Delta shall, from and after the commencement date of coverage Delta establishes for such person, pay Claims with Incurred Dates on or after the effective date of coverage in accordance with the terms and conditions set foxth in this Agreement. Failure to Provide Information. Employer's failure to provide timely and accurate information may cause Delta to make incorrect payments. In that event, Employer may be liable for all or part of any incorrect payments made. Payment of Claims and Administrative Fee. Employer authorizes Delta and Delta agrees to process Claims on a regular basis, subject to the limitations, conditions, and exclusions stated in the Benefits Certificate(s). Employer will pay or reimburse Delta for thc Claims Paid and Administrative Fee as set forth in this paragraph. Weekly Actual Claims Paymena Delta will bill Employer weekly. Once each week, Delia will nottfy Employer of the total billing for the week by fax (normally on Tuesday). Delta will generate an ,4 CH transaction and draft the amount of the billing from the bank account designated by Employer (normall3~ on Friday). The weekly billing will include the total of claims for the week and the last week of the ~nonth will also include the Administrative Fee for the current month. Late Payments. All payments must be paid on time in accordance with paragraph 3. ffthe Employer fails to make timely payments in full, Delta may, at its option, immediately stop the payment of all claims for the Employer's Members, regardless of the Incurred Date and may terminate this Agreement retroactively to the las[ day of the month for which full payment was made without any further notice. Payments not made when due also will be subject to an interest charge at the then prevailing prime rate plus two percent (2%) per annum. The acceptance by Delta of any late payments or partial payments shall not constitute a waiver of this provision. Examination of Books and Records. Delta may examine the financial records of Employer reasonably related to the administration of this Agreement, upon reasonable notice, as often as DeRa deems appropriate, to determine whether Employer has sufficient mounts on deposit to ensure payment of Claims and Administrative Fee. Employer or its authorized representative may examine or audit Delia's records reasonably related to Delta's discharge of Employer's liability to pay Claims. Such examination shall be conducted during regular business hours, upon reasonable advance written notice. Records subject to examination shall include case listings, third-party explanations of dental benefits, eligibility records, claims history, and coordination ofbanefits procedures. The examination period may cover the cnvzent Contract Period and the two years previous only. Upon completion of the examination, Employer shall share its examination findings with Delta and conduct an exit conference with Delta. It is agreed that disclosure of any information under this paragraph to Employer or Delta has been made in reliance upon the other party's representation that such information shall be used by it for the sole and exclusive purpose of examining or auditing information related to the aclrnlnislxation of the dental plan. Such information shall not be disclosed or otherwise made available to any person or organization not directly involved in the examination or audit and Delta and Employer shall implement whatever reasonable safeguards are necessary to ensure that such information remains confidential, subject to the Iowa Public Records Act, Iowa Code chapter 22. Change of Agreement. Delta will prdvide Employer ninety (90) days prior writtan notice of any amendment or term/nation under this paragraph. Changes to this Administrative Services and Financial Agreement or Benefits Certificate(s) will be effective only when the written amendment has been signed by authorized representatives of Delta and the Employer. Liabilities of the Parties. Employer has the liability for all Claims payments for its Members. Delta has no liability for Claims if Employer fails to pay or reimburse Delta in accordance with this Agreement. Employer agrees to hold harmless and indemnify Delta or any of its directors, officers, or employees for any and all loss, liability, damage, expense, or other cost or obligation, including reasonable attorneys' fees, resulting from and arising out of claims, demands, or tawsnlts brought against Delta by Members, or other persons by reason of the performance or nonperformance of Employer's responsibilities under this Agreement, or in connection with benefits or coverage information disclosed at Employer's request or disclosed during an examination or audit of books and records, provided the directors, officers, or employees of Delta shall have performed their duties with ordinary care and such directors, offi~rs~ or employees of Deha shall not be liable for any mistake ofjudgemeut or other action taken in good faith. Delta has made a good faith determination of what the premium tax l/ability shall be under this Agreement based upon Iowa Code Chapter 432. If the governmental authority responsible for collecting such taxes determines that additional taxes should have been assessed for the charges collected by Delta under this Agreeraent, the Employer agrees to indemnify Delta for such liability. Delta agrees to hold hamaless and indemnify Employer or any of its directors, officers, or employees for any and all loss, liability, damage, expense, or other cost or obligation, including reasonable attorneys' fees, resulting fi'om and arising out of claims, demands, or lawsuits brought against Employer by masons of Delta's failure to perform its responsibilities under this Agreement (or policy). Use of Trademarks. Delta and Employer reserve the rig~tt to control the use of their respective corporate names and any other respective symbols, assumed names, trademarks, and service marks, presently existing or subsequently established. Delta and Employer agree not to use the corporate name, symbol, assumed names, trademarks, or service marks of the other in advertising, promotional material, or otherwise without the prior written consent of the other. Any previously approved usage will cease immediately upon the termination of this Agreement and any materials using such names or marks are the property of the appropriate namesake and will be returned to the appropriate property owner upon request or at the termination of this Agreement. Term and Termination. Term and Notice of Termination. This Agreement shall become effective on the date defined on the Schedule of Fees and shall continue in force for the time period defined in the Schedule of Fees. However, either party may terminate this Agreement at any time by giving written notice of termination delivered to the other party at least sixty (60) days in advance of the effective date of termination. Renewal Terms. ~ltte parties may agree to renew the Agreement for successive Contract Periods as defined in the Schedule of Fees. Delta may change Administrative Fee, stop loss premiums and other financial factors upon renewal. Immediate Termination. Delta may terminate this Agreement at any time without notice if Employer fails to make timely and complete payments in accordance with this Agreement, or Delta determines that the Employer has inadequate funds to make payments required by this Agreement. Delta may terminate the Agreement retroactively to the last day of the month for which Employer made full payment. Eraployer is solely responsible for notifying its Subscribers of the termination of th/s Agreement for nonpayment or for any other reason. 10. 11. 12. 13. 14. 15. Effects of Termination. IfDeIta terminates tiffs Agreement for nonpayment by the Employer, Delta will not pay any Claims beyond the effective date of the termination regardless of when the services were received. Any liability of either party to the other for amounts owed or owing, or for indemnification for premium taxes under this Agreement shall not be extfmgnished by the termination of this Agreement. Termination and Claims Payments. If, following termmatiun of this Agreement for reasons other than Employer's nonpayment, Cla/ms for the most recent Con0:act Period are submitted to Delta for payment in the period specified in the Benefits Certificate(s) for timely f'thng of claims, Delta will pay claims in accordance with this Agreement and bill Employer in accordance with the procedures set forth in paragraph 4 above. Force Majeure. The parties to this Agreement shall be excused fi.om performance under this Agreement for any period during which they are prevented from performing any responsibilities under this Agreement, in whole or in part, as a result of an Act of God, war, civil disturbance, court order, labor dispute, or other cause beyond its reasonable control and such nonperformance shall not be grounds for termination or default. Complete Agreement. The parties agree that this Agreement, including all Benefit Certificate(s), Schedule of Fees, Amendments, Group Application for Coverage, and the Subscribers' names and/or applications for coverage constitutes the "Complete Agreement" between the parties and supersedes all related discussions and communications between the parties. All statements made by the employer to the Employee or statements made by the Employee or his/her family members to their dentist concerning what is covered in the Complete Agreement is deemed to be a representation and not a Warranty. No statement by the Employer, Employee, or members of the Employee's family concerning matters allegedly covered in the Complete Agreement shall be relied upon by the Employee's dental provider without verifying that the coverage is set forth hi the Complete Agreement. Governing Law. To the extent not superseded by the laws of the United States, this Agreement shall be construed in accordance with the laws of the State of Iowa. Any action in regaxd to this Agreement or arising out of the terms of this Agreement shall be instituted and litigated in the state or federal courts located in the State of Iowa and no other. Notices and Communication. Delta shall be entitled to rely upon any commumcation or notice from the Employer to Delta in connection with this Agreement to be genuine, truthful, and accurate, and to have been authorized, signed, or issued by an officer or agent of Employer empowered to make such repmsentafiun on behalf of the Employer. Delta shall secure and maintain during the term of this Agreement insurance coverage as set forth on the attached schedule and shall cause the City of Dubuque, Iowa, to be listed as an additional insured on said Delta insurance coverage. The mailing of written notices or other communications by regular U.S. Mail, postage prepaid, shall be deemed sufficient service for the purpose of this Agreement if addressed to the last address furnished in writing. Notice to Delta Dental Plan of Iowa may be addressed: Delta Dental Plan of Iowa 2401 SE Tones Dr., Suite 13 Ankeny, IA 50021 And until another address is furnished in writing, notice to Employer may be addressed: City of Dubuque City Hall- 50 West Thirteenth S~:eet Dubuque, Iowa 5200 t -4864 IN WITNESS WHEREOF, the parties have executed this Agreement, in duplicate counterparts, each counterpart being deemed as original, on the date stated below. Employer By Title City Manager Date Delta Den~f Iowa Title President and CEO Date i/ Date SCHEDULE OF FEES Employer/Plan Sponsor Full Legal Name and Address City of Dubuque City Hail - 50 West Thirteenth Street Dubuque, IA 52001-4864 Contract Period Originai Effective Date of Funding Arrangement Schedule Date 7/1/00 Contract Period to Which this Schedule is Applicable Begins 7/1/00 and Ends 7/1/89 6/30/01 Claims Eligible for Payment 1. [] Incurred means Claims with dates of service within the Contract Period 2. [] "Paid" means all Claims regardless of Incurred Date Fixed Fees Aggregate Total Administrative Stop Loss Fixed Fee Premium Fees Single $2.53 $0.00 $2.53 Family $2.53 $0.00 $2.53 Aggregate Stop Loss Coverage Aggregate Attachment Point is N/A of projected Claims Paid. Aggregate Attachment Point Single N/A Family N/A Losses Eligible for Reimbursement t. [~ "12/12" means the Losses were Incurred and Paid within the Contract Period 2. [~ "Paid" means the Losses were Paid within the Contract Period. Losses must have been incurred on or after the effective date of the Agreement. 3. ~ "12/18" means the Losses were Incurred and Paid within that same Contract Period or within the six months following the end of the Contract Period. 4. ~ Not Applicable Weekly Transfer Amount Weekly Actuai Holmes Murphy & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR [ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 9207 COMPANIES AFFORDING COVERAGE Des Moines, IA 50306-9207 COMP^~¥ A Chubb Group COMPANY Delta Dental Plan of Iowa 8 AIG/lllinois National 2401 SE Tones Drive, #1 3 COM.A~Y Ankeny IA 50021 C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ~SSUED TO THE iNSURED NAMED ABOVE FOR THE ROUCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDFrlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE iSSUED OR MAY PERTAIN, THE ~NSURANCE AFFORDED aY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION; 35357170 1/01/01 1/01/02 GENERAL,AGGREGATE I $ 2000000 35357170 OTHER THAN UMBRELLA FORM 7976O138 A WORKERS COMPENSATION AND EMPLOYERS' LIAB[UTy 6 OTHER Professional L~abi[ity 71646107 002789281 1/01/01 1/O1/01 1/01/01 ~ PERSONAL & ADV INJURY J $ 1000000 rFIRE DAMAGE {Any one fire) 1/01/02 BODILY INJURY BODILY INJURY I101102 1101102 1101102 OTHER THAN AUTO ONLY: EACH ACCIDENT lO00000 1000000 10000 lO00000 TORY LIMITS i ER I Limit: $3,000,000 100000 500000 lO0000 Additional Insured (GL): Ciw of Dubuque, Iowa City of Dubuque Attn: Randy Peck 50 West 13th Street Dubuque, IA 52001 ~o INSURANCE SCHEDULE INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES Any policy of insurance or certificate of insurance required hereunder shall be with a carrier authorized to do business in Iowa and a carrier that has received a rating of A or better in the current Best's Rating Guide. Any policy of insurance required hereunder shall provide for a thirty (30) day notice to the City of any material change or cancellation of the policy prior to its expiration date. shall have its insurance agent or company certify in writing that any policy of insurance required herein with an aggregate limit of liability has not been reduced by paid or reserved claims at the time of issuance of policy or certificate. shall furnish copies of the following policies to the City, with limits not less than the following, or greater if required by law. COMMERCIAL GENERAL LIABIUT~: General Aggregate limit Products-Completed Operation Aggregate Limit Personal and Advertising Injury limit Each Occurrence limit · Fire Damage Limit (any one occurrence) Medical Payments $2,000,000 $1,000,000 $1,000,000 $1,000,000 $ 50,000 $ 5,000 OR Combined Single Umit Medical Payments $2,000,000 5,000 Umbrella or Excess Liability* Coverage is to include: occurrence form, premises/operations/products/completed operations coverage, independent contractors' coverage, contractual liability, broad form property damage, personal injury, City of Dubuque named as an additional insured with thirty (30) days written notice of change or cancellation. PROFESSIONAL LIABILITY STATENIENT: shall furnish a certificate of insurance showing professional liability limits with limits of not less than $1,000,000 during the term of the project. *To be determined on a case-by-case basis.