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Item C44 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUM1VARY Meeting Date: October 1 2 4 Division: Employee Services Bulk Item: Yes XNo _ Department: Employee Benefits Staff Contact Person/Phone#:M F- . — 3zalez X4448 AGENDA ITEM WORDING: Approval to renew with United Concordia Insurance Company for a fully-insured voluntary dental benefit dual option(Low and High Option) with current plan for a term of up to one(1)year to become effective January 1,2015,with staff signing the necessary forms. ITEM BACKGROUND: The fully insured insurance policy is being recommended for a one year renewal with no increase in the current plan (Low Option plan) premium. In addition to the current plan, and in an effort to assist plan participants who have unsatisfactory access to in-network PPO providers and wish to have an increase in their Annual Maximum Coverage, a High Option Passive PPO benefit is being provided as an alternative. (See attached proposed plan summary). A Request for Proposals was approved by the BOCC and issued earlier this year with a bid opening date of July 10, 2014. Eleven proposals were received Administration has since decided to re-issue the Request for Proposals with there being less penalty for using out of network providers(which was included in the most recent RFP) in addition to adding a higher annual benefit maximum ($2,000 to $5,000). The policy is being renewed for up to one year to allow time to draft the RFP; bring the draft to the BOCC for approval; advertise for 45 days in accordance with purchasing policy,review/rank proposals and analyze the proposers' networks;bring back to the BOCC for approval; allow for time to transition to the new vendor(60-90 days is optimal); and hold a mid-year,special enrollment. We estimate this to take approximately six (6) months and expect to implement the new provider on or around June 1, 2015. This will also mean that the employee will be subject to a mid-year deductible ($50 individual/$150 family) with the new vendor due to the deductible not being transferrable from provider to provider. The policy with UCCI has a notice requirement of sixty (60) days and steps will be taken to ensure a smooth transition from the current provider to the new provider. PREVIOUS RELEVANT BOCC ACTION: At the October 16, 2013 meeting,the BOCC approved to renew for one (1) year with,United Concordia; At the May 21, 2014 meeting, the BOCC approved the draft Request for Proposal. CONTRACT/AGREEMENT'CHANGES: Renewal for one year with an addition to including a high option passive FPO benefit. STAFF RECOMMENDATIONS: Approval. Approximate for One year TOTAL COST 600 000 INDIRECT COST:. BUDGETED:Yes __No DIFFERENTIAL OF LOCAL PREFERENCE: COST TO COUNTY: N/A SOURCE OF FUNDS:Em to ee/Retirm Premiums REVENUE PRODUCING: Yes,_ No X AMOUNT PER MONTH Year APPROVED BY: County Atty OMH/Purc'Lgg_Z Risk MaWemeqlf DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 7/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract# FContrmucth:United Concordia Dental Effective Date:Januaryl,2015 Expiration Date:December 31,2015 Contract Purpose/Description:Avrnoval for renewal with staff completing the necessary forms, with United Concordia Dental for fully insured volunt_.ryr dental benefits for up to one yew Contract Manager:Maria Fernandez- 4448 Em Woyce Services Gonzalez (Name) (Ext.) (Department) for BOCC meetin on October 17.2014 A ends Deadline: S tember 30 2014 CONTRACT COSTS Total Dollar Value of Contract: $600.000 approx Current Year Portion: $475.91349prrox Budgeted?YesZ No❑ Account Codes: 502-229212- Grant: $ County Match: ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: of included is dollar value above a maintenance,utilities,'anitorial,salaries,etc,) CONTRACT REVIEW Changes Date Out Date In Needed Reviewer,. Division Director /� Yes❑No " �✓ �" "� 0 /�1-1( Risk Management` Yes(j No& "� c� l o -f' I I , O.M.B./Purchasing l0�'7'l� Yes❑Nog, County Attorney 10.-4. Ul4 Yes[]NoQ to zoy Comments: OMB Form Revised 9/11/95 MCP#2 n 1� o Dental Proposal for: Monroe County BOCC Effective Date: 01/01/2015 Presented By: United Concordia i 0 J Want t© have heal thier employees and save thousands in annual medical costs? Committed to oral"health At United Concordia,we know how important oral health Isto overall specialized he�1tL asvue've in dental Insurance for over 40 years, Our landmark UCWellness Oral Health Study is a three- year look atthe link between serious health conditions '° " and gum(periodontal)disease.Research revealed that patients who were pregnant or had certain chronic conditions saved thousands of dollars a year in medical costs when treated for gum disease, That means getting the right dental plan for your employees ��'=/ rl� �b � ��lll/i Tirol lla,W�,u could make a big difference to your bottom line, � l�/ �� (J� � Thoughtfully designed dental plans Our dental plans are designed to ensure flexibility meets affordability,while retaining the quality of coverage and �saWnptaRar service that customers have come to expect from use And auroptional wellness features focus on getting MEDiCAL COST SAVINGS W fTq members engaged In their oral health—enticing them to GUM DISEASE TREATMENT get the preventive care they need to avoid complex dental problems and Improve their health overall. Convenlentaccess to Information (Quality dentist access where you need It ( We strive to make sure information is available where and AAM extensive,ongoing recruitment efforts,we have when our customers need it:. bullt some of the largest dentist networks in the country, 1 • Employees can access detalls on their benefits, ensuring our members can easily-find a nearby network find a network dentist,review claims and more, dentist,no matter where they live.We hold our dentists IntheirMpDentalBeneft account,accessible on to,the highest standards,rigorously screening their ou r website or our United C oncord is rn ob ile ap p, credentials and claims to verify quality rare is provided to i • Employers can easily add,change or delete all of our members. an roliment—or view or pay bills—all in the I accountmenegement porW on ourwebsite. d��StMoOditniv��,ntal E Making your employees healthier Ourapproach is simple—it's all about the member.Theone i who actually sits In the dental chair,Thaftwhy we've developed plans that cover what members really need,and �t a why we're committed to getting them engaged In their oral 'r ° � °� ' AC�ITEfl► ( health.And because maintaining oral health can keep your employees healthier in many otherways,choosing United Concordia is a greatwayto benefit your organizations I bottom line. w+o•ao,r•oa,3 UnitedConcordia.com t�i I 1, Proposed 19 a d Plan Summary for Monroe County BQCC� Effective '01101/2015 Concordla Flex lea passive ppo program that allows members to receive care from any Iit�nsed dentist;however, membe members receive the greatest value and convenience when they receive care from a partidp nee dentist This means that members who receive care from a participating dentist are responsible only for those deductibles and coinsurance amounts that are part of the program design. Class 1 100% 1009+6�1 'Wt` 90% it 60% Class IV 50% 50% Annual Program Deductible $50/$150 excludes Class I $50/$150(exdudes Class 1) Lifetime Orthodontic Maximum $1500 $1500 061A t 2IW Employee Only $38.68 Employee and Spouse $7&01 Employee+Child $78.79 Employee+Children $7a.79 Employee+Famlly $114.12 Bid Quarffrcadons: • Rates and beneftis for effective dates thereafter must be approved by Underwriting. • Rates assume 1310 e)iglele employses,with 1310 panidpatIn s.upon sale,quoted rates and ben*%maybe acquated or coverage denied, based on achieved participation levels. Required participation must be met and maintained throughout the policy period. Commissions Included: 0% • Rates are based upon Standard Industry Clas$Iftetion Coder g19g United Concordle's standard exclusions and limitation apply. • Class IV SONIces are excluded faun Annual Program Deductible and Annual Program Maximum • High Option. • Duel Option with current pion. • • DIFFERENCE BETWEEN CURRENT PLAN(LOAN OPTION)AND ALTERNATIVE PLAN(HIGH OPTION) 1 Reimbursement is based on our schedule of maximum allowable charges(MACs).Network dentists sores to accept our allowances as payment in full for covered services,less apPlksble deductibles and coinsurance peroantages. 2. United Concordia creates out-al-network charges utilizing FAIR Health data supplemented with our charge data as appropriate.We then calculate the outwf-norm charge at Cue Both POmentle of such data.Non-natwodc dentists may bill the mernlxar for airy diHerencs beMesn our all on and their fee. fpry Proposed Dental Benefts for Monroe,County BOGC Effective Date:01/01/2015 t�xams 2 e 12 mRn<ti5 X Rays(Bitethings Only) 1 set every 12 months *rage 19 and 1 set every Te months age 19 X-Rays(All Others) 1 every 5 years for run Mouth andTanommic R Ci nitg uorlde Treatment 21 loa12 th month every 3 1 eve 12 months under a 14 Se81d � Pali�tive TreatmentF�n c - everyYears to age 14 on perm ant first end second coolers )� 2 per 2 mom n cwmbinatlon with pu 1 debrtdernent 1 every 5 years and Basic Restorative Not within 24 months of previous placement Incl Any udes cov erne for Sint a Extractions . . uency(no rrnitatYams) Rep re of Crowns,Inlays,Onlays,Dentures and 1 per 36 months Endodontics • Pulpai erapy:primary teeth " ve no p1111 rM nt tooth to repiaaa s' Ical Periodontics • Scaling and a Non-Su ._ 1 per lifetime rg nd mot planing 1 per 36 months(per area of mouth) - Periodontal maintenance:2 every 12 months(in addition to routine Cum l Oral surgery INI rtodontsl mcedures: per 35 months(per area mouth) Su Surgical Pertodantica urg Pe p May very by procedure General Anesthesia fi nutQe per session inl Orr a d Ctawns Nat within 5 ang of nevluus IeRemsntr �� °��'�� 4�� Prosthetics(Bridges,Dentures Nat wttirin 5 years of previous placement Di tment pertd � ge � , agnostic,Active,Retention Trea � � fil r de eMe toe 19 ,��f��l�` �� pendent chi dren covered to.al 2t3. UMMI ' �' d� � Due to state and i mandates to other+states,dependent ftymaY dJlfer liom that to Tfrls summary is a repress M&O 11BUng of covered san*w ud r &fins nuou.mo:tjsear yti � F Proposed Plan. SuMmary for Monroe County BOCC` Effective 01101/2015 Concordia Prefet'red Is an active PPO program that combines the cost savings available in a managed dental care program with greater access available In traditional Indemnity programs.It also allows members to receive care from any licensed dentist and Increases the plan coverage when members receive care from participating dentists. it ,�u I " . Class I � 100% 100% Class II 90% 801 Class III 80% 50% Class IV 50% 50% Annual Program Maximum $2000 $2000 Annual Program Deductible $501$15 excluder Class 1 $501$150 Lifetime Orthodontic Maximum $1500 $1500 Employee Only S28.33 Employee and Spouse $53.62 Employee+Child $67.80 Employee+Children $87.86 Employee+Family $83.81 Bid auafiacsaona: • Rates and benefits for effeacthie dater thereafter must be approved by Underwrlt1q. • Rates assume 1310 eligible employees,with 1310 participating.Upon gala quota rates and beneftb may be adjusted or coverage denied, based an achieved parwpatilon levels. Required participation must be met and malntainsd throughout the policy period.• Commissions Included: 0% • Rates are based upon Standard Industry Classlflcallon Code» 9199 • United Concordia's standard exclusions and Umkadans apply. • Class IV Services are excluded from Annual Program Deductible and Annual Program Maximum 9 Current plan as low optlom • No bensRt dmngse. CPC S1ZNt. t. Reimbursement is based on our schedule of maximum allowable charges(MACS).Network dentists agree to accept our allowances as payment in full for covered Sendces,lead applicable deductibles and coinsurance perceritagae. 2'. b Reimbursement new all w based d our schedule of maximum allowable charged(MACs).Non-network dentists may bpi the member for any difference between our allowance and themes. i 1 P,ropIosed Effective active 7�'�alrs� r�upar � : __ � anraryr 1 nha�agie f�mad"� t ewre�,r�g rnElna 1 X-Rai(AN Others) 1 m mry 5 ancrarnfa:X-Rays Gliia "Hu,arprd Gre81I1eNMQ 2 eaY nr1e� �' N mayue winder �4 � n �p�paldd'snuatd enni!'tr�lar� Palu�'Tn �t� ! � � � � der� naa� S ce Maledatae IS Sim a narsrrtha rzU III:Redo owrient Rai rcavraen M � eya� AI awl put. �Icld'onft Sao�harar:pr#raNaly w bawd no 1Vanu load lerlydnn l per35 tncndha(per w area ofmw )Pedodo . nW maintenance:Z wry 12 rnm*a(in al ga to mu lne RunOcad Periaxdcnft sires ofrii ,rga) 'tax Oral�u Proathetics rfd es.Denture: within 5 years ra! aceMwt in 5 years�" �pe� da RateMlon Treatment for depafndents! ` � � Dia s A �a 'Mil!'q�iY .� M;�i� l ! r 6 Dependent children covered to age 28. Due to state and tedera!mandates a a atherstei nu�ent �` lulltyMA This summery is a rapreaenIBNm#Ong o/covomd servfts end gmligtkns Quote as,ism ADDITIONA INFO c RMarIO N • United Concordia's dental plan is the only plan offered for acceptance or consideration.The quoted information is Invalid if any other dental carrier is offered for coverage. • In addition to the quoted overall participation requirement,a minimum of 2 enrolled contracts Is required for every DHMO program offered and a minimum of 10 enrolled contracts is required for every FFS program offered. •All Proposed rates,guarantees and caps assume no change to the proposed benefit design. United Concordia reserves the right to re-evaluate proposed rates and benefit If any state or federally mandated benefits or fees are Imposed. • United Concordia Dental is not able to accept business submitted by or pay commissions to producers who are not appointed.Any binder check or other premium payment collected from a group by non-appointed producers,and Is then submitted for acceptance to United Concordia Dental directly or through United Concordia Dental sales personnel,will be rejected and returned to the non-appointed produce3r,Your quotation of rates to groups or submission of business to United Concordia Dental will constitute acceptance of and agreement to comply with these . rules regarding appointment and commission payments. United Concordia Dental may Pay the selling broker or benefit consultant("producer")compensation for the promotion and sale of the products and services offered in this proposal. In addition to our standard compensation arrangements,we may make additional cash payments or reimbursements to selling producers in recognition of their marketing and distribution activities, persistency levels and volumes of business. Ws encourage producers and their clients to discuss what commissions or other compensation may be paid in connection with the purchase of products and services from United Concordia Companies, Inc.If you have questions regarding compensation programs related to your insurance plan,you may view the information on producer compensation that Is available on our website at www.unitedconcordia.com. • From time to time United Concordia Dental offers premium rate discounts to groups that purchase additional lines of insurance coverage from other insurance companies that are affiliated with United Concordia Dental.You may be eligible for one or more of these multiple policy discounts.Information regarding your eligibility for these discount programs is available from United Concordia Dental sales representatives.The multiple policy discount programs offered by United Concordia Dental may change or terminate at any time without prior notice. QUOW 101 U5507