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Item C01 C.1 t, BOARD OF COUNTY COMMISSIONERS County of Monroe Mayor Sylvia Murphy,District 5 The Florida Keys � � �l'U � Mayor Pro Tern Danny Kolhage,District 1 �pw° Michelle Coldiron,District 2 Heather Carruthers,District 3 David Rice,District 4 County Commission Meeting August 21, 2019 Agenda Item Number: C.1 Agenda Item Summary #5624 BULK ITEM: Yes DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Natalie Maddox (305) 292-4450 N/A AGENDA ITEM WORDING: Approval of one-year policy renewal with Delta Dental Insurance (1/1/20-12/31/20), and a plan design change offering two plans with a Premier Network . ITEM BACKGROUND: Approval of a one-year renewal of the County's agreement with Delta Dental Insurance with plan design change to a Premier Network with two coverage options. The County currently offers two dental plans, a low and high coverage option. This change will delete the current low option plan due to limited provider network and balance-billing to members. The current high plan remains and will be called the Gold plan. A new plan will be added called the Silver plan. The Silver plan includes the same premier network of providers and does not balance- bill members, but offers a lower benefit level which is designed to serve the dental utilization needs for most members. Both Gold and Silver Plans offer preventive care coverage (cleaning and x-ray) at 100%. GOLD PLAN (Attachment: Program A —Plan 1 - Gold) This is the current HIGH Plan which for the 2020 plan-year reflects a 15%rate increase over 2019. Gold Plan Rates per payday: Employee Only rate $25.62 (increase $ 3.19; Employee & Spouse rate $48.48 (increase $ 6.03); Employee & Children rate $ 52.32 (increase $ 6.50); Family rate $ 75.78 (increase $ 9.43). SILVER PLAN (Attachment: Program E — Plan 1 — Silver) For the 2020 plan-year, this plan replaces the previous LOW Plan. Services covered remain the same but plan incurs a 10% increase in coinsurance, increases max coverage amounts from $2,000 to $3,000 per person, per year, and increases from $1,500 to $3000 the per-dependent child orthodontics lifetime benefit. Silver Plan Rates per payday: Employee Only rate $ 19.40 (increase of $7.46 from the Low Plan and decrease of$3.03 from the High Plan; Employee & Spouse rate $37.56 (increase of$14.97 from Packet Pg. 25 C.1 the Low Plan and decrease of $4.89 from the High Plan); Employee & Children rate $40.23 (increase of $15.86 from the Low Plan and decrease of $12.09 from the High Plan); Family rate $30.23 (increase of$24.92 from the Low Plan and decrease of$6.12 from the High plan). The current Delta Dental High Plan, which uses the Premier Network has approximately 668 enrollees and the current Low Plan has approximately 438 enrollees. A continued annual shift toward the high plan among plan participants has occurred during open enrollment due to erosion of the provider network in the low plan and employees in the low plan being balance-billed for services that are insufficiently covered by the low plan. Currently in Monroe County, there are 25 (twenty- five) providers in the Delta Dental High Plan premier network, and only 2 (two) providers in the Delta Dental Low Plan Network. There are approximately 29 total dental providers throughout the Florida Keys. With claims experience in the High Plan continuing to increase, Delta Dental proposed an increase in the High Plan premium of 15%; From April 2017 to April 2019, claims have at times exceeded premiums collected. Over the 2-year period, claims have run approximately 91% of premiums collected ($1,527,563.00 vs. $1,673,538.00). The $3,000 benefit level associated with the new Silver Plan, premier network is sufficient for the majority of members. Over the 2-year period, the plan had only 4 claims over $ 5,000, and only 23 claims over $3,000. On average there are 1,350 covered individuals on the County's Dental insurance. Staff considered conducting an RFP for dental insurance given the series of high-plan rate increases. However, Gallagher Benefit Services, Inc. (the County's Benefits Consultant) advised that due to our claims history, the total number of providers in Monroe County, the County would have a very low probability of improving pricing or provider network with another vendor. Gallagher recommends the County adopt this premier network, two-plan design through Delta Dental. PREVIOUS RELEVANT BOCC ACTION: 2011 Dental RFP resulted in two-year agreement with United Concordia approved by the BOCC, October 2011. In 2014, the Employee Benefits Department began to receive numerous complaints from employees about their dentists leaving the United Concordia network due to lowered reimbursements. In addition, dentists complained of United Concordia denying claims and requesting additional documentation. Due to these service and network concerns, a Dental RFP was done early 2014 resulting in Delta Dental ranked as the 41 vendor. A special Open Enrollment,just for dental in July 2014, in order for employees/retirees to drop their dental coverage or enroll with Delta Dental. Delta Dental agreed to credit any deductibles already satisfied for 2014. In May 2015, BOCC approved staff to negotiate an insurance policy with Delta Dental for a two (2) year term (9/1/15-12/31/17). October 2017, BOCC approved a one-year renewal with Delta Dental with a 20% premium increase in the High Plan due to high dental utilization and claims experience. For plan year 2018 Delta Dental again increased rates by 15% for the High Plan due to utilization and claims experience. Delta Dental has maintained the Low Plan premium rates unchanged for the Packet Pg. 26 C.1 past six years. CONTRACT/AGREEMENT CHANGES: 2 Premier Network Options STAFF RECOMMENDATION: Approval. DOCUMENTATION: 2 Yr Prem vs Claim Enrollment and Claim Illustration RateSheet Program A Plan 1_GOLD RateSheet Program E Plan 1_SILVER Delta Dental Offer Eff 1 12020 Delta Dental Comparison Rev 7 23 19 FINANCIAL IMPACT: Effective Date: 1/1/2020 Expiration Date: 12/31/2020 Total Dollar Value of Contract: Total Cost to County: None Current Year Portion: Budgeted: Source of Funds: 100% of cost funded by plan participant premiums CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: N/A If yes, amount: Grant: N/A County Match: N/A Insurance Required: Additional Details: REVIEWED BY: Natalie Maddox Completed 07/29/2019 3:50 PM Bryan Cook Completed 07/29/2019 3:51 PM Assistant County Administrator Christine Hurley Completed 07/29/2019 4:47 PM Cynthia Hall Completed 07/29/2019 5:27 PM Budget and Finance Completed 07/31/2019 9:49 AM Packet Pg. 27 C.1 Maria Slavik Completed 08/02/2019 11:24 AM Kathy Peters Completed 08/02/2019 12:42 PM Board of County Commissioners Pending 08/21/2019 9:00 AM Packet Pg. 28 C.1.c Plans and Rates E Monroe County Board of County Commissioners 0 0 Delta Dental PPO Program A - Plan 1 Delta Dental PPO Delta Dental Premier Non-Delta Dental Dentist Dentist Dentist CL Maximum Contract PPO Contracted Fees Premier Contracted 80t" Percentile Allowance Fees Benefits Diagnostic& Preventive 100% 100% 100% Sealants 90% 90% 90% Space Maintainers 100% 100% 100% Basic Restorative 90% 90% 90% Oral Surgery 90% 90% 90% Simple Extractions 90% 90% 90% 3 Endodontics 90% 90% 90% Surgical Periodontics 90% 90% 90% Non-Surgical Periodontics 90% 90% 90% Major Restorative 60% 60% 60% Prosthodontics-Fixed & o 60% 60% 60 removable M Denture Repair and Relining 90% 90% 90% Implants Not Covered Not Covered Not Covered CL CL Orthodontics—Child 50% 50% 50% Orthodontics—Adult Not Covered Not Covered Not Covered TMJ Not Covered Not Covered Not Covered I Deductible(Annual deductible does not apply to Diagnostic, Preventive and Orthodontic Services) Per Patient/Calendar year $50 $50 $50 Per Family/Calendar year $150 $150 $150 Lifetime Ortho deductible/ $0 $0 $0 M Patient 0 Maximums Per Patient/Calendar year $5000 $5000 $5000 Lifetime Ortho maximum/ Patient $3000 $3000 $3000 Packet Pg. 29 C.1.c Waiting Periods(Calculated from each primary enrollee's effective date in a dental program as reported by the employer) 2 CL Oral Surgery, Endo, Perio NA NA NA Orthodontics NA NA NA CL Major Restorative, Prosthodontics NA NA NA o 0 3 0 Contract Type Non-Retention (Non-Participating) CL Contract Term 01/01/2020 to 12/31/2020 Guaranteed From 01/01/2020 Rate Effective Dates To 12/31/2020 a Enrollee only $55.50 Enrollee+Spouse $105.03 Enrollee+Children $113.37 Family(EE, Spouse, &Child(ren)) $164.19 0 The above rates include 0.00% broker commission. Created Date: 07/01/2019.The above rates are not valid unless accompanied by the provisions in the CL attached pages. CL CL 0 I- CL Packet Pg. 30 C.1.c Assumptions and Guidelines 2 CL Monroe County Board of County Commissioners Program A - Plan 1 CL The rates quoted in this proposal are based on the information provided to Delta Dental at the time the proposal was released.This proposal is not a contract. If the group wishes to sign a contract with Delta Dental, it will be required to complete and sign a Group Application. Delta Dental's acceptance of a completed Group Application will be based on verification of group enrollment specifications. CL If during the Contract Term any new or increased tax, assessment or fee is imposed on the amounts payable to or by Delta Dental under this Contract or any immediately preceding contract between Delta Dental and Contractholder,the Premium amount will be increased by the amount of any such new or increased tax, assessment or fee by written notice to Contractholder, and the Contract shall thereby be modified on the date set forth in the notice. Maximum Contract Allowance Contracted dentists are paid directly by Delta Dental and by agreement cannot bill the enrollee more than their contracted fee. Non-contracted dentists may not always accept Delta Dental's program _ allowance as payment in full.The enrollee is responsible for paying up to the non-contracted dentist's submitted charge. Benefit payments for services rendered by non-contracted dentists are sent directly to the enrollee unless the payments are assigned to the dentist. It is the enrollee's responsibility to pay the non- contracted dentist if payment is not assigned to the dentist. Program Allowance is an amount determined by a set percentile level of all charges for such services by Providers with similar professional standing in the same geographical area. - 0 Fully Insured Non-Retention Contract CL CL Any profit or loss remaining at the end of the contract period will be absorbed by Delta Dental.The client assumes no liability in a loss situation. .� Rate Guarantee Rates are valid if purchased by the proposed effective date of 1/1/20. Delta Dental recommends 90 days advance notice for implementation. CL Contribution and Participation Rates assume an employer contribution for the employee cost and the dependent cost of coverage will be maintained for the eligible employees. Rates assume that there will be a minimum enrollment o of 1,210 primary enrollees. CL Packet Pg. 31 C.1.c Eligibility I- 2D Eligible employees may enroll on the first day of the month following completion of the employer's required eligibility period. Eligible employees who decline dental coverage may elect to enroll at the q 8 Yp 88 YCL next open enrollment.The same requirements also apply for dependent coverage. Primary enrollees electing dependent coverage must enroll all eligible dependents in the dental program. Eligibility for CL employees and dependents is subject to all state laws or regulatory requirements. Enrollees eligible Q for optional continuation of group benefits under the Consolidated Omnibus Reconciliation Act of 1986(COBRA) may continue coverage as allowed by law. 0 Limitations and Exclusions The proposed plan will be administered under Delta Dental's benefits, limitations and exclusions. CL Deductibles and Maximums Deductible and maximum amounts for in network and out of network are inclusive of each other and not in addition to. Single Dental Carrier It is assumed that Delta Dental is to be the only dental carrier and that all primary enrollees (and their dependent enrollees)will be covered under our plan(s). Additional Benefits for Pregnancy Pregnant enrollees are eligible for a benefit enhancement consisting of one additional oral evaluation and either one additional prophylaxis or one periodontal scaling/root planing procedure. Missing Teeth Restorative treatment and replacement of teeth extracted prior to the effective date are covered benefits. 0 Takeover Takeover of deductibles and maximums is included. > 0 CL Disclaimer CL The proposed plan designs are based on the current limitations and exclusions, processing policies, .� and contract specifications. Additional Information a i Ir- Rates assume this plan will be offered with the current low plan as part of a dual option fee-for- service program. L 0 I- CL Packet Pg. 32 C.1.d Plans and Rates E Monroe County Board of County Commissioners Delta Dental PPO Program E - Plan 1 Delta Dental PPO Delta Dental Premier Non-Delta Dental Dentist Dentist Dentist 0 0 Maximum Contract Allowance PPO Contracted Fees Premier Contracted 80th Percentile CL Fees Benefits Diagnostic& 100/o 100/0 100% Preventive Sealants 90% 80% 80% Space Maintainers 100% 100% 100% Basic Restorative 90% 80% 80% Oral Surgery 90% 80% 80% Simple Extractions 90% 80% 80% Endodontics 90% 80% 80% 3 Surgical Periodontics 90% 80% 80% Non-Surgical 90/o 0 0 Periodontics 80/ 80/ Major Restorative 60% 50% 50% Prosthodontics-Fixed & o 60% 50% 50% removable Denture Repair and o 0 0 90/ 80/ 80/ Relining CL CL Implants Not Covered Not Covered Not Covered Orthodontics—Child 50% 50% 50% Orthodontics—Adult Not Covered Not Covered Not Covered W TMJ Not Covered Not Covered Not Covered I Deductible(Annual deductible does not apply to Diagnostic, Preventive and Orthodontic Services) Per Patient/Calendar $50 $50 $50 year Per Family/Calendar year $150 $150 $150 0 IL Lifetime Ortho deductible/ Patient $0 $0 $0 0 Maximums Per Patient/Calendar $3000 $3000 $3000 year 0 Lifetime Ortho maximum/ Patient $3000 $3000 $3000 Packet Pg. 33 C.1.d Waiting Periods(Calculated from each primary enrollee's effective date in a dental program as reported by the employer) 0 2 CL Oral Surgery, Endo, NA NA NA g Perio CL Orthodontics NA NA NA 0 Major Restorative, NA NA NA Prosthodontics 0 CL Contract Type Non-Retention (Non-Participating) Contract Term 01/01/2020 to 12/31/2020 Guaranteed From 01/01/2020 Rate Effective Dates To 12/31/2020 3 Enrollee only $42.04 Enrollee+Spouse $81.38 Enrollee+Children $87.17 Family(EE, Spouse, & Child(ren)) $130.50 0 The above rates include 0.00% broker commission. CL CL Created Date: 07/01/2019.The above rates are not valid unless accompanied by the provisions in the attached pages. > CL 0 0 I- CL 0 0 0 0 0 0 Packet Pg. 34 C.1.d Assumptions and Guidelines E 2 CL Monroe County Board of County Commissioners Program E - Plan 1 CL The rates quoted in this proposal are based on the information provided to Delta Dental at the time 3 the proposal was released.This proposal is not a contract. If the group wishes to sign a contract with Delta Dental, it will be required to complete and sign a Group Application. Delta Dental's acceptance o of a completed Group Application will be based on verification of group enrollment specifications. CL If during the Contract Term any new or increased tax, assessment or fee is imposed on the amounts payable to or by Delta Dental under this Contract or any immediately preceding contract between Delta Dental and Contractholder,the Premium amount will be increased by the amount of any such new or increased tax, assessment or fee by written notice to Contractholder, and the Contract shall thereby be modified on the date set forth in the notice. Maximum Contract Allowance Contracted dentists are paid directly by Delta Dental and by agreement cannot bill the enrollee more than their contracted fee. Non-contracted dentists may not always accept Delta Dental's program allowance as payment in full.The enrollee is responsible for paying up to the non-contracted dentist's submitted charge. Benefit payments for services rendered by non-contracted dentists are sent directly to the enrollee unless the payments are assigned to the dentist. It is the enrollee's responsibility to pay the non- contracted dentist if payment is not assigned to the dentist. Fully Insured Non-Retention Contract 4- Any profit or loss remaining at the end of the contract period will be absorbed by Delta Dental.The o client assumes no liability in a loss situation. > 0 CL Rate Guarantee CL Rates are valid if purchased by the proposed effective date of 1/1/20. Delta Dental recommends 90 days advance notice for implementation. Contribution and Participation Rates assume an employer contribution for the employee cost and the dependent cost of coverage will be maintained for the eligible employees. Rates assume that there will be a minimum enrollment of 1,210 primary enrollees. CL 0 I- CL Packet Pg. 35 C.1.d Eligibility Eligible employees may enroll on the first day of the month following completion of the employer's E required eligibility period. Eligible employees who decline dental coverage may elect to enroll at the CL next open enrollment.The same requirements also apply for dependent coverage. Primary enrollees electing dependent coverage must enroll all eligible dependents in the dental program. Eligibility for CL employees and dependents is subject to all state laws or regulatory requirements. Enrollees eligible o 0 for optional continuation of group benefits under the Consolidated Omnibus Reconciliation Act of 1986(COBRA) may continue coverage as allowed by law. M 0 Limitations and Exclusions CL The proposed plan will be administered under Delta Dental's benefits, limitations and exclusions. Deductibles and Maximums Deductible and maximum amounts for in network and out of network are inclusive of each other and not in addition to. Single Dental Carrier It is assumed that Delta Dental is to be the only dental carrier and that all primary enrollees (and their dependent enrollees)will be covered under our plan(s). Additional Benefits for Pregnancy Pregnant enrollees are eligible for a benefit enhancement consisting of one additional oral evaluation and either one additional prophylaxis or one periodontal scaling/root planing procedure. Missing Teeth Restorative treatment and replacement of teeth extracted prior to the effective date are covered benefits. 0 4- Takeover o Takeover of deductibles and maximums is included. CL Disclaimer CL The proposed plan designs are based on the current limitations and exclusions, processing policies, and contract specifications. Additional Information cni This Plan will replace the Low Plan option only. Rates assume this plan will be offered with the current high plan as part of a dual option fee-for-service program. L 0 I- CL Packet Pg. 36 C.1.e i 0:0 July 22, 2019 3 Monroe County Board of County Commissioners 1100 Simonton Street 2 a. Key West, FL 33040 RE: Contract Renewal for Monroe County Board of County Commissioners Delta Dental PPOsm Group# 17858 We appreciate your business and thank you for choosing Delta Dental Insurance Company. Your employees are among the millions nationwide who trust their smiles to Delta Dental. We are pleased to present you with your dental plan contract renewal information. We are committed to providing you with quality plan designs combined with excellent customer service. When reviewing your dental plan, we considered cost factors related to your group's dental service utilization and claims experience. Our analysis indicates that an increase in your current rate is necessary. We have made every attempt to keep this increase as low as possible. a We have calculated your rates based on the employer/employee contribution levels in your contract remaining the same. If the contribution levels and/or enrollment guidelines have changed or will change, please notify us immediately, as such a change may affect your renewal rate. The following is the renewal information for your Delta Dental PPOsm dental plan: 0 , Effective Date January 1, 2020 m Contract Term January 1, 2020 December 31, 2020 w;�rvmm.ry ��r?mV, N.� uuW „° , nw.uury n Vouu opwR emYm'.�,reuw":.�:,�: mumm vuorc�' mw^m�;'nf ao ann9 "yw,''" 'ul uv u,warwdeve''"' a Um NUremm vmvw pq },fn u Enrollee Only 2 �, nawry m. N a a ,n .M m aNmuw ,ti ooaa .mum$42.04 C14 Enrollee +Spouse $81.38 Enrollee + �, , Children , $8717 � ��d�o ��o��,�o .N� -' w .. ,. �� "��, „ . , Family $130.50 w Delta Dental Insurance Company Delta Dental of California Delta Dental Mid-Atlantic Region Tel 521-2651 Telephone: 888-335®8227 Delta Dental of Delaware,Inc. Delta Dental of the District ofColumbia Delta Dental of New York,Inc, Delta Dental of Pe N 'a 1 DentalDelta of west Virginia Telephone: 932-0783 Packet Pg. 37 C.1.e 0 3 Effective Date January 1,2 020 — �n„ ��— r�� mn.........�� w...,, �i '�w.�—��,m—, � —.�_.rvw��„ �� b � �.,. . ��m, �.�.�. Contract Term Janua 1 2420 December 31, 2024 I2L . Division #10001, 10002, 19001 Renewal Rates i dW m m i'.mmmm�IIN1P0,mwuk.'iivIIpMMf WI'd YttH UNdGWeMvpm,,u,IWW'F4'�YIWWd�le:�u000lJnt�N4 mN v�unmMf�n:'kwnai�m.luduremx fu'�mm o'imvmmry „,mmnmrvdm,monv q„ mxeorvdYxWAWuwurpmmw?x'1 a,�mm�undovvmim',rnN�m'�w uu nimu ti!W^,w�m WOrx'6'db f4yo'tlu Ap OdU4amtl WW,WmamRd(;W 0. ��W,w�wAo m'ima'�v umm�vem�v.^ W.v 0 tp rub Mf Enrollee Only $55.50 Enrollee+Spouse $105.43 'Enrollee+ Children $113 37 Family $164.19 Please keep this renewal letter with your contract documents. It serves as an amendment to your Delta Dental Contracts for the rates and contract term. To renew your dental plan contract,please follow these steps: I) Review this letter for changes to your dental plan for January 1, 2020 2) Begin paying the rates outlined in this letter with your new contract term. a If you have any questions about your renewal, your Account Manager will be happy to help. We appreciate your continued confidence in Delta Dental. We are proud of our association with you and look forward to a long and mutually successful relationship. Sincerely, 4- 0 Delta Dental Insurance Company Ir- MohammadReza Navid Group Vice President, Sales The American Dental Association (ADA)annually updates its standard dental procedure coding system,which is a component of its Code on Dental Procedures and Nomenclature(CDT Code) reference manual. When the ADA changes the codes, carriers must adopt the changes. We process claims according to the current CDT reference manual. Changes made to comply with the CDT Code do not constitute a material change to your dental plan design. Packet Pg. 38 C.1.e Summary of Contract Amendments to 3 Monroe County Board of County Commissioners L- 2D Delta Dental PPOsM IL OTHER INFORMATION 0. 0 0 3 Delta Dental's retro-termination policy for enrollees. As a reminder, Delta Dental's policy is that enrollment may be adjusted retroactively to the immediately preceding three months plus the current month billed if no claims have been processed after the requested termination date for the enrollee. Provider reimbursement. As a reminder, Delta Dental's policy is to reimburse contracted dentists based on the network payment provisions for the geographic area in which the services are provided. a 3 0 4- 0 0 cv cv Packet Pg. 39 C.1.e 0 OHCA Notification Please be informed that consistent with the group application and group contract terms, Delta Dental considers its relationship with fully insured group health plans as subject to HIPAA's "Organized IL Health Care Arrangement" (OHCA)privacy rules as defined in 45 Code of Federal Regulations (C.F.R.) §164.501. Functionally, the exchange of enrollment information between Delta Dental and 0 your group remains the same. 3 While a Business Associate Agreement is not required between Delta Dental and your fully insured group health plan within an OHCA, any Protected Health Information(PHI) exchanged or shared between the entities remains subject to HIPAA's minimum necessary rule and other privacy rules in addition to any applicable state laws and regulations governing the disclosure of individually identifiable health information. Additionally,confidentiality requirements remain applicable to the exchange of information within an OHCA. a 3 0 4- 0 0 cv cv Packet Pg.40