Agreement, City & Delta Dental
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CITY OF DUBUQUE, IOWA
MEMORANDUM
March 29, 2000
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT:
Administrative Services and Financial Agreement between City
of Dubuque and Delta Dental of Iowa
Personnel Manager Randy Peck is recommending approval of an Administrative
Services and Financial Agreement between the City of Dubuque and Delta Dental of
Iowa.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
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M~hael C. Van Milligen
MCVM/dd
Attachment
cc:
Barry Lindahl, Corporation Counsel
Tim Moerman, Assistant City Manager
Randy Peck, Personnel Manager
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CITY OF DUBUQUE, IOWA
MEMORANDUM
March 21, 2000
TO:
Michael C. Van Milligen
City Manager
Randy Peck \'7 ')
Personnel Manager ~ J
FROM:
SUBJECT:
Administrative Services and Financial Agreement between
the City of Dubuque and Delta Dental Plan of Iowa
On March 8, 2000, 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, 1999.
The administrative fee for processing dental claims increased from $2.45 per
contract per month to $2.56 per contract per month. This rate went into effect on
July 1, 1999, and will remain in effect through June 30, 2000. The rate was
approved by the Health Care Committee on April 30, 1999.
This agreement has been reviewed by corporation counsel, 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.
On behalf of the Health Care Committee, I request that the City Council
approve a motion authorizing you to sign the agreement.
If you have any questions, please feel free to call.
cc:
Health Care Committee
ADMINISTRATIVE SERVICES and FINANCIAL AGREEMENT
THIS AGREEMENT is by and between Delta Dental Plan oflowa (Delta), and
City of Dubuque (Employer).
Group name
A.
WHEREAS, the following circumstances exist:
Delta is a nonprofit corporation authorized by the Comntissioner of Insurance for the slate of
Iowa to transacl business as a dental service plan.
B.
Employer desires to create or has established a dental benefits plan for its eligible
Employees,
Employer desires to enter into a fmancial arrangemenl with Delta under which Employer is
solely responsible for the Claims Paid for covered dental services provided to its Members
subject to the lirnilalion on Employer's fmancialliabiJity sel forth in the stop loss coverage
provisions of this Agreement.
c.
D,
Employer desires that Delta pay claims for dental services furnished to Members and provide
other adntinistrative services.
NOW, THEREFORE, in consideralion of the mutual promises and covenants hereinafter
set forth, it is hereby agreed as follows:
I.
Definitions.
a.
"Administrative Fee" means either an amount per contract or a percentage
of Claims Paid, whichever is applicable, that Delta charges the Employer
and which includes allocations for Delta's cost of administering
Employer's plan and general operating costs. The Administrative Fee
during the Contracl Period is stated in the Schedule of Fees attached to this
Agreement.
b,
"Administrative Services" means those services 10 be performed by Della
for Employer in connection with this Agreement, including, but not limited
to the following: claims processing, customer services, accounting
services, actuarial services, enrollment services, data processing services,
and such other related services as the parties may agree are appropriate and
necessary 10 accomplish the objectives of this Agreement. Adntinistralive
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 of the Employer's plan.
c,
"Agreement" means this Adntinistrative Services and Financial
Agreement, Group Application, Schedule of 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,
d,
"Benefits Certifieate" means the written document(s) which describe and
defme a welfare benefit plan for dental services which the Employer
established for its Members.
e.
"Claims" means claims for dental services that are furnished to Members
with a date of service as defined in the Schedule of Fees as Claims Eligible
for Payment.
f.
"Claims Paid" means the amount calculated by deducting from the
Covered Charges any amounts attributable to Provider Savings,
deductibles, copayment, coinsurance, or Contract Limitations as deemed in
the Benefits Certificate(s), The amount of Claims Paid during the Contract
Period is determined by the date of Delta's check orremitlance.
g.
"Contract Limitations" means the amounts which are the liability of the
Subscriber under this Agreement, These include the services which are not
covered, charges for dental services which are nol dentally necessary,
penalties for failure to follow notification requirements, and charges for
services that have reached a contract maximum,
h.
"Contract Period" means the period of time set forth in the Schedule of
Fees or the most recent revision to the Schedule of Fees,
i,
"Covered Charges" means the amount a provider bills a Member. or
Delta, less services not covered. Services which are covered are those
dentally necessary and dentally appropriate procedures as outlined in the
Benefits Section of the Benefits Certificate(s).
j.
"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 maximum 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 maximum allowable
fee is based on information from that state's Delta Plan,
k.
"Employee" means an active Employee of Employer forpnrposes of
Social Security laws or who otherwise is included as an Employee as
required by law (or a member of the Board of Directors of an Employer).
I.
"Incurred Date" means the date dental services are provided, With
regard to inpalient hospital or facility services, the dale of admission is the
Incurred Dale,
m,
"Member" means any person entitled to receive dental benefits as deemed
in the Benefits Certificate(s).
n.
"Provider Savings" means the amount saved due to our contracts with
providers. It is calculated as the difference between the Covered Charge
and the Delta Allowance.
2
o.
"Subscriber" means any individual identified by Employer as a person
eligible for dental coverage subjecl to the terms, conditions and limitations
described in the Benefits Certificate(s) and who is named on an
identification card issued by Delta,
2.
Responsihilities of Employer.
a,
Furnishing Information. Employer agrees to furnish Delta with timely
reports and information in a form and manner required by Delta so that
Delta properly may discharge its responsibilities under this Agreement,
including bur not limited to, information pertaining to Members for the
pnrpose of detennining eligibility 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 Benefils Certificate(s).
b.
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 flfSI 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 services furnished such persons
on or after the date of termination.
At any lime during the Contract Period, Employer may certify to Delta the
names of additional eligible persons. Delta shall, from and after the
commencement date of coverage Delta eslablishes for such person, pay
Claims with Incurred Dates on or after the effective date of coverage in
accordance with the terms and conditions set forth in this Agreement.
c.
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.
3.
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 the Claims Paid and Adntinistrative Fee as set forth in this
paragraph.
a.
Monthly Payment Delta will bill Employer by the twentieth (2rJh)
calendar day of each month. The bill will show the amount of Claims and
Administrative Feefor the preceding month. Employer shall promptly pay
Delta at Delta's office the total shown within ten (10) days from receipt of
the bill, and in any event, no later than the last calendar day of the month.
/fthe due date falls on a weekend or holiday. payment is due the preceding
business day,
4,
Late Payments. All payments must be paid on time in accordance with paragraph
3, If the 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 last day
of the month for which full payment was made without any further notice.
Payments not made when due also will be subjecllo an interest charge at the then
prevailing prime rate plus two percent (2%) per annum, The acceptance by Delta of
any late paymenls or partial payments shall not constitute a waiver of this provision.
5,
Examination of Books and Records.
a,
Delta may examine the fmancial records of Employer reasonably related to
the adntinistration of this Agreement, upon reasonable nolice, as often as
Delta deems appropriate, to determine whether Employer has sufficient
amounts on deposit to ensure payment of Claims and Administrative Fee.
b.
Employer or its authorized representative may exantine or audit Delta's
records reasonably related to Delta's discharge of Employer's liability to
pay Claims, Such exantination shall be conducted during regular business
hours, upon reasonable advance written notice. Records subject to
exantination shall include case listings, third-party explanations of dental
benefils, eligibility records, claims history, and coordination of benefits
procedures, The examination period may cover the current Contract Period
and the two years previous only. Upon completion of the exantination,
Employer shall share its exantination fmdings with Delta and conduct an
exit conference with Delta.
c,
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
administration of the dental plan. Such information shall not be disclosed
or otherwise made available to any person or organization not directly
involved in the exantination or audit and Delta and Employer shall
implement whatever reasonable safeguards are necessary to ensure that
such informalion remains confidential, subject to the Iowa Public Records
Act, Iowa Code chapter 22.
6,
Change of Agreement.
a.
Delta will provide Employer ninety (90) days prior written notice of any
amendment or termination under this paragraph.
b.
Changes to this Adntinistrative 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.
7,
Liabilities of the Parties.
a,
Employer has the liability for all Claims payments for its Members, Delta
has no liability for Claims if Employer fails to payor 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 lawsuits brought
against Delta by Members, or other persons by reason of the performance
or nonperformance of Employer's responsibilities under this Agreement, or
4
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, officers,
or employees of Delta shall not be liable for any mistake of judgement or
other action taken in good faith.
Delta has made a good faith determination of what the premium tax
liability shall be under this Agreement based upon Iowa Code Chapter 432,
If the governmental authority responsible for collecting such taxes
determines thaI additional taxes should have been assessed for the charges
collected by Delta under this Agreement, the Employer agrees to
indemnify Delta for such liability,
b.
Delta agrees to hold harmless 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 from and arising out of claims, demands, or lawsuils brought
against Employer by reasons of Delta's failure to perform its
responsibilities under this Agreement (or policy),
8,
Use of Trademarks. Delta and Employer reserve the righl 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 inunediately 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
lermination of this Agreement.
9.
Term and Termination.
a,
Term and Notice of Termination. This Agreement shall become
effective on the date deemed on the Schedule of Fees and shall continue in
force for the time period deemed 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 alleast sixty (60) days in advance
of the effective date of termination,
b,
Renewal Terms. The 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 fmancial faclors
upon renewal.
c.
Immediate Termination. Delta may terminate this Agreemenl at any
time without notice if Employer fails to make timely and complete
payments in accordance with this Agreement, or Delta determines thaI the
Employer has inadequate funds 10 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. Employer is
solely responsible for notifYing its Subscribers of the termination of this
Agreement for nonpayment or for any other reason,
d,
Effects of Termination. If Delta terminates this 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 nol be extinguished
by the termination of this Agreement.
10,
Termination and Claims Payments. If, following termination of this Agreement
for reasons other than Employer's nonpayment, Claims for the most recent Contract
Period are submitted to Delta for payment in the period specified in the Benefits
Certificate(s) for timely filing 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,
II.
Force Majeure. The parties to this Agreement shall be excused from performance
under this Agreemenl 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.
12,
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 whal is covered in the Complete Agreement is deemed to be
a representation and nol a Warranty. No statemenl 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 in the Complete Agreement.
13.
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 Stale oflowa.
Any action in regard to this Agreement or arising out of the lerms of this Agreement
shall be instituted and litigated in the state or federal courts located in the Stale of
Iowa and no other.
14.
Notices and Communication. Delta shall be entitled to rely upon any
communication 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 10 make such
representation on behalf of the Employer.
15.
Delta shall secure and maintain during the term of this Agreement insurance
coverage as sel 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 pnrpose of this
Agreement if addressed to the last address furnished in writing.
6
Notice to Delta Dental Plan oflowa 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 - 13th & Central
Dubuque, Iowa 52001
IN WITNESS WHEREOF, the parties have executed this Agreement, in duplicate
counlerparts, each counterpart being deemed as original, on the date stated below,
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A CORDm
'ODUCER
515,223'6BOO
DATE IMMIDD/VVI
12/29/99
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANIES AFFORDING COVERAGE
Holmes Murphy & Associates
P,o, Box 9207
Des Moines, IA 50306-9207
COMPANY
A
Chubb Group
Delta Dental Plan of Iowa
2401 SE Tones Drive, #13
Ankeny IA 50021
i COMPANY
, B
AIG/illinois Nationa'
,"UREO
I COMPANY
I C
i COM~ANV
THIS IS TO THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION DF ANY CONTRACT OR OTHER DDCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
:0
.TR
TYPE OF 'NSURANCE
POUCV NUMBER
POUCV EmCTIVE POUCV EXPIRATION I
DATE IMMIOO/vVI DATE IMMIOO/vVI
UMITS
A GENERAL UABIUTY
X COMMERCIAL GENERAL LlABILITV
CLAIMS MAOE 0 OCCUR
OWNER'S' CONTRACTOR'S PROT
35357170
1/01/00
1/01/01
GENERAL AGGREGATE .
PRODUCTS, COMPIOP AGG I .
PERSONAL' ADV INJURV
2DDOOOO
2DDOOOO
EACH OCCURRENCE I .
FIRE DAMAGEJAnyo"" 1,.., I.
MEa EXP lAnyon, ","onl
1000000
1000000
100000
5000
~UTOMOBILE LIABILITY
ANV AUTO
All OWNED AUTOS
SCHEDULEO AUTOS
HIRED AUTOS
NON,OWNED AUTOS
t=]RAGE UABILITY
R ANV AUTO
RCESS UABILITY
UMBRELlA FORM
laTHER THAN UMBRELLA FORM
I WORKERS COMPENSATION AND I
EMPLO""RS' LIABILITY
THE PROPRIETOR! I
PARTNERS/EXECUTIVE R NeL
OFFICERSARE. EXCL
B I OTHER 17029719
Professioanlliab
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
Additional Insured IGLI: City Df Dubuque, Iowa
COMBINED SINGLE LIMIT
I.
BODILY INJURV
IP"..'~I
BODILV INJURV
IP"K"",n"
PRDPERTV DAMAGE
AUTDDNLV,EAACCIDENT I.
OTHER THAN AUTD DNLV.
EACH ACCIDENT .
AGGREGATE'
EACH DCCURRENCE
AGGREGATE
WC STATU,
T I
.
I.
OTH'
1/01/00
1/01/01
EL EACH ACCIDENT .
ELDISEASE,POLlCVLlMIT I.
EL DISEASE, EA EMPLDVEE I.
I $3.000,000 limit Df liBb
$250,000 Retention
City of Dubuque
Attn: Randy Peck
50 West 13th Street
Dubuque, IA 52001
SHOULD ANV OF THE ABOVE DESCRIBED POUCIES BE CANCELlEO BEFORE THE
EXPlRATlDN DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVDR TO MAIL
-2Q.. DAVS WRITTEN NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT.
BUT FAILURE TD MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY
OF
AUTH
ITS AGENTS OR REPRESENTATIVES.
w
INSURANCE SCHEDULE
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES
1,
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.
2.
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.
3.
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,
4.
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 LIABILITY:
General Aggregate Limit
Products-Completed Operation Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
. Fire Damage Limit (anyone occurrence)
Medical Payments
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$ 50,000
$ 5,000
OR
Combined Single Limit
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 STATEMENT:
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.