Delta Dental Plan Renewal 2017 Copyright 2014
City of Dubuque Consent Items # 21.
ITEM TITLE: Delta Dental Plan Renewal
SUMMARY: City Manager recommending approval of the Delta Dental
renewal rates for the plan year beginning January 1 , 2017
through December 31, 2017.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
Delta Dental Renewal Rates-MVM Memo City Manager Memo
Delta Dental Renewal - Staff Memo Staff Memo
Insurance Schedule C Supporting Documentation
Delta Dental Financial E)hibit Supporting Documentation
THE CITY OF Dubuque
DUB E i"
Masterpiece on the Mississippi 2007.2012.2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Renewal Rate for the Voluntary Dental Plan
DATE: October 24, 2016
Personnel Manager Randy Peck recommends City Council approval of the Delta Dental
renewal rates for the plan year beginning January 1, 2017 through December 31, 2017.
The premiums will remain unchanged, with the single premium remaining at $35.83 per
month and the family premium remaining at $107.63 per month.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
v
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
THE CITY OF Dubuque
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Masterpiece on the Mississippi 2007.2012.2013
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Renewal Rate for the Voluntary Dental Plan
DATE: October 20, 2016
Delta Dental has submitted the renewal rates for the plan year beginning January 1,
2017 through December 31, 2017. Delta Dental is proposing that the rates remain the
same. Effective January 1, 2017 the single premium will remain at $35.83 per month
and the family premium will remain at $107.63 per month. The requested action is for
the City Council to approve the renewal rates and authorize you to sign the attached
Financial Exhibit.
RP:lmh
I
4[31DELTA DENTAL
•
City of Dubuque
Group # 1286
Contract'Period 111117 through 12/31/17
Financial Exhibit
Experience Period CIaims Paid 8/1115 through 7/31/16
Claims Paid 8/1/15 through 7/31/16
Estimate of Incurred But Not Reported Claims
Fully Incurred Claims
Trend in Claims
Projected Claims Based on Current Experience
Claims and Enrollment Fluctuation Adjustment
Projected Annual Claims Based on Current Enrollment
Fixed Fees
Administrative Fees
Operating Costs
Broker Fee
Subtotal Fixed Fees
Projected Annual Expense
I acknowledge acceptance of this renewal at the rates shown above.
$114,885
$3,553
$118,438
$6,763
8125,201
$13,757
$138,958
$28,461
$0
$28,461
$167,419
Delta Dental PP0sm
Enrollment as of 7/31116
Single
Family
Total
95
93
193
Current Rates
Effective 111/16 through 12/31/16
Single $35.83
Family $107.63
Renewal Rates
Effective 1/1/17 through 12/31/I7
Single $35.83
Family $107.63
Renewal Percentage Change
0.00%
df a member elects this voluntary benefit plan coverage, they will be required to continue coverage for 12 months before they may discontinue coverage.
Percent of Premium Contributed by Employer_ Single 0 % Family 0 °l
Total Employees F Iled: 190
Signature of Group Administrator
Please sign and return to fax # 888-337-5157
Michael C. Van Milligan, City Manager
Total Employees Eligible: 570
cityperscscityofdubuque.org
E -Mail Address
DELTA DENTAL OF IOWA
Date // 4
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C
1. Delta Dental of Iowa 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 Project Location 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. Consultants shall require all subconsultants and sub-subconsultants to obtain and maintain during the
performance of work insurance for the coverages described in this Insurance Schedule and shall obtain
certificates of insurances from all such subconsultants and sub-subconsultants.Consultants agree that it
shall be liable for the failure of a subconsultants and sub-subconsultants to obtain and maintain such
coverages.The City may request a copy of such certificates from the Consultants.
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.
8. Provider shall be required to carry the minimum coverage/limits,or greater if required by law or other
legal agreement, in Exhibit I. If provider's limits of liability are higher than the required minimum limits
then the provider's limits shall be this agreement's required limits.
9. Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C Professional Services May 2016
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit I
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. The general liability
coverage shall be written in accord with ISO form CG0001 or business owners form BP0002.
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.
I
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 Statutory—State of Iowa
Coverage B 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
a) Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
Yes X No
Page 2 of 3 Schedule C Professional Services May 2016
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 defenses) 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
4
Page 3 of 3 Schedule C Professional Services May 2016