Voluntary Dental PlanMasterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Voluntary Dental Plan
DATE: October 23, 2013
Dubuque
band
AI- America City
1
2007 • 2012 • 2013
Personnel Manager Randy Peck recommends City Council approval of the new
premiums for the Delta Dental Plan effective January 1, 2014 through December 31,
2014 and authorizing the City Manager to sign the Financial Exhibit. The new
premiums will be $35.83 per month for a single plan and $107.63 per month for a family
plan.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
Masterpiece on the Mississippi
TO:
FROM:
SUBJECT:
DATE:
Michael C. Van Milligen, City Manager,
Randy Peck, Personnel Manager
Voluntary Dental Plan
October 22, 2013
Dubuque
1WkAmedcacUy
11111!
2007 • 2012 .7013
The Health Care Committee has been reviewing several benefit options with the hopes
of increasing enrollment in the Dental Plan. At their meeting on October 17, 2013, the
Health Care Committee modified the Delta Dental Plan by increasing the benefit period
maximum from $750 to $1,000 and the lifetime orthodontic maximum from $750 to
$1,000.
Included in the modified plan is an option for the employee to select a preferred
provider. The employee can choose to continue to use their current dentist, or use a
preferred provider dentist in order to reduce their out of pocket expense. If an employee
uses a dentist in the preferred provider network, their individual deductible would be
reduced from $25.00 to $15.00, the family deductible would be reduced from $75.00 to
$45.00, and the co- insurance amount for preventative care would be reduced from 20%
to 10 %. The premiums effective January 1, 2014 through December 31, 2014, under
this plan are as follows:
Single Plan: $35.83 per month
Family Plan: $107.63 per month
The requested action is for the City Council to approve the new rates and authorize you
to sign the attached financial exhibit.
RP:Imh
d DELTA DENTAL'
Delta Dental of Iowa
Summary of Covered Services and Benefits: Alternate 4
City of Dubuque Group # 725
Deductibles, Maximums & Eligibility Delta Dental PPO" Delta Dental Premier• / Non Par
- Individual Deductible $15 $25
- Family Deductible $45 $75
- Deductible applies to Check -Ups and Teeth Cleaning? Yes Yes
- Benefit Period Maximum $1,000 $1,000
- Eligible children to age 26 26
- Full -time (unmarried) students eligible to age 99 99
- Does Individual Deductible apply to Orthodontics? Yes Yes
- Orthodontic lifetime maximum $1,000 $1,000
- Orthodontics: Eligible children to age 19 19
- Orthodontics: Full -time students eligible to age 19 19
- Adult Orthodontics No No
Benefits
Check -Ups and Teeth Cleaning 90% 80%
(Diagnostic and Preventive Services)
- Dental Cleaning
- Oral Evaluations
• Fluoride Applications
-X-Rays
Cavity Repair and Tooth Extractions 80% 80%
(Routine and Restorative Servkes)
• Emergency Treatment
- General Anesthesia /Sedation
- Restoration of Decayed or Fractured Teeth
- Umited Occlusal Adjustments
- Routine Oral Surgery
- Posterior Composites w/ Alternate Processing
Root Canals (Endodontic Services) 50% 50%
- Apicoectomy
- Direct Pulp Cap
• Pulpotomy
- Retrograde Fillings
- Root Canal Therapy
Gum and Bone Diseases (Periodontal Services) 50% 50%
- Conservative Procedures (Non - surgical)
- Complex Procedures (Surgical)
- Periodontal Maintenance Therapy
High Cost Restorations (Cast Restorations) 50% 50%
- Cast Restorations
- Crowns
- Inlays
- Onlays
- Post and Cores
- Recementing Crowns /Inlays /Onlays
Dentures and Bridges (Prosthetic Servkes) So% 50%
- Bridges
• Dentures
- Repairs and Adjustments
- Recementing of Bridges
- Implants Not Covered
Straighter Teeth (Orthodontics) 50% 50%
This is a general description of coverage. It is not a statement of your contract. Actual coverage Is subject to terms and conditions specified in the benefits document itself
and enrollment regulations in force when the benefits become effective. Certain exclusions and limitations apply. Please refer to your dental benefits document for details.
2014
Delta Dental of Iowa
9000 Northpark Dr, Johnston IA 50131 www.deltadentalia.com
d DELTA DENTAL'
Financial Exhibit : Alternate 4
City of Dubuque
Group # 725
Changes on the Summary of Covered Services and Benefits exhibit are shown in red; all other benefits remain the same.
Employer Contribution
Single
Family
Plan Costs
Complete this Section*
ER Contribution*
0
0
Number of benefit Eligible Employees* 561
Rates guaranteed from 01/01/2014 through 12/31/2014
Single Family
Contracts 84 78
Insured rates (monthly premium) ** $35.83 $107.63
* *Insured rates do not include broker commissions
Please sign below and return to Delta Dental of Iowa at fax # 888 - 264 -1433
*Please update employer contribution and number of benefit eligible employees above and sign below.
Annual Expense
$136,861
Signature Date
Michael C. Van Milligen, City Manager
Delta Dental of Iowa
9000 Northpark Dr, Johnston IA 50131 www.deltadentalia.com
City of Dubuque Insurance Requirements for Professional Services
1.
Insurance Schedule C
shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work
is longer than 60 days. Providers presenting annual certificates shall present a Certificate at the end of
each project with the final billing. Each Certificate shall be prepared on the most current ACORD form
approved by the Iowa Department of Insurance or an equivalent. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project # or Lease of premises
at or construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa and
all carriers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque.
4. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of
Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of
this agreement.
5. Subcontractors and sub subcontractor performing work or service shall provide a Certificate of Insurance
in accord with Exhibit I.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific ISO form is listed, an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
g. Provider shall be required to carry the minimum coverage /limits, or greater if required by law or other
legal agreement, in Exhibit I.
9. Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C, Professional Services April, 2013_2.Doc
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit 1
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products - Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written on an occurrence, not claims made, form. All deviations from the
standard ISO commercial general liability form CG 0001, or Business owners form BP 0002,
shall be clearly identified.
b) Include ISO endorsement form CG 25 04 "Designated Location(s) General Aggregate Limit"
or CG 25 03 "Designated Construction Project (s) General Aggregate Limit" as appropriate.
c) Include endorsement indicating that coverage is primary and non - contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials, all its employees
and volunteers, all its boards, commissions and /or authorities and their board members,
employees and volunteers. Use ISO form CG 2026.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A
Coverage B
Statutory—State of Iowa
Employers Liability
Each Accident $100,000
Each Employee- Disease $100,000
Policy Limit- Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000...
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
Page 2 of 3 Schedule C, Professional Services April, 2013_2.Doc
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does
not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only
those claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time. Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any
defense of governmental immunity, and may do so at any time and shall do so upon the timely
written request of the insurance carrier.
4. Non - Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa
under this policy for reasons of governmental immunity unless and until a court of competent
jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of
Dubuque, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECIMEN
Page 3 of 3 Schedule C, Professional Services April, 2013_2..Doc