08/21/2024 Renewal ZZ=
June 3, 2024
Monroe County Board of County Commissioners
1 100 Simonton Street
Key West, FL 33040
RE: Contract Renewal for Monroe County Board of County Commissioners
Delta Dental PPOTM Group# 17858
We appreciate your business and thank you for choosing Delta Dental Insurance Company. Your
enrollees 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. We have made every attempt to provide the most competitive renewal
possible.
We have calculated your rates based on the employer/enrollee 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 PPOTM dental plan:
Effective Date January 01, 2025
Contract Term January 01, 2025-December 31, 2026
Division #00001, 00002, 09001 Current Rates Renewal Rates
11112025- 1213112026
% change 0.00%
Enrollee Only $42.04 $42.04
Enrollee +Spouse $81.38 $81.38
Enrollee + Child(ren) $87.17 $87.17
Family $130.50 $130.50
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Proprietary and Confidential 3
Effective Date January 01, 2025
Contract Term January 01, 2025-December 31, 2026
Division #10001, 10002, 19001 Current Rates Renewal Rates
11112025- 1213112026
% change 0.00%
Enrollee Only $55.50 $55.50
Enrollee +Spouse $105.03 $105.03
Enrollee + Child(ren) $113.37 $113.37
Family $164.19 $164.19
As part of our continued commitment to you and your dental program, Delta Dental maintains a high
level of service. Delta Dental continues to assure you of our dedication through ongoing review of our
performance standards. Please refer to the attached guarantee exhibit for further details.
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:
1. Review this letter for changes to your dental plan for January 1, 2025
2. Begin paying the rates outlined in this letter with your new contract term.
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,
Delta Dental Insurance Company
Mohammad Reza Navid
Executive Vice President, Chief Relationship and Business Development Officer
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.
Proprietary and Confidential
Summary of Contract Amendments to
Monroe County Board of County Commissioners
Delta Dental PPOTM
OTHER INFORMATION
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.
Proprietary and Confidential
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 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 your group
remains the same.
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.
Proprietary and Confidential
Delta Dental Performance Guarantees
Client: Monroe County Board of County Commissioners / 17858
Effective: 1/1/2025 - 12/31/2026
Delta Dental agrees to provide the following levels of service in the performance of its obligations under
this contract. Should any of the following service levels not be met, any payment due will be issued in the
form of a check, based on the total administration at the end of each contract period. Measurement,
reporting, and payment of each guarantee will be on a global basis and reported annually unless stated
otherwise.
The assigned account manager will partner with the client to meet the dental
benefit objectives and work on the client's behalf to optimize service levels.
Standards of service include:
a) Account manager will provide comprehensive assistance for the client in 1%
support of top-tier customer service.
b) Account manager will provide timely response and follow-up on phone calls 1%
and e-mails from the client.
c) Account manager will meet with the client's benefit staff as needed to meet
the client's objectives and oversee the annual open enrollment process, 1%
including participation in employee information meetings, if applicable.
d) Account manager will provide ongoing assistance with any issues escalated by 1%
designated benefits contacts.
The client will monitor and evaluate Delta Dental's Account Management
performance and provide feedback via a Delta Dental Client Satisfaction Survey.
Pertinent questions for this guarantee are in the Account Management section of
the survey.Client satisfaction for each of the criteria above will be deemed as being
met given a rating of Good,Very Good or Excellent.
19-04-24 198-16 V1
95%of electronic eligibility will be loaded within two (2) business days from receipt
of data.
Guarantee is contingent upon receipt of data in a mutually agreed upon format. 0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
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90%of claims received will be processed within 15 calendar days.
Claims turnaround is measured from the date of the initial receipt of the claim with
complete information to the date the claim is originally processed. 0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
99%of claims received will be processed within 30 calendar days.
Claims turnaround is measured from the date of the initial receipt of the claim with
complete information to the date the claim is originally processed. 0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
19-04-24 198-16 V1
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99%financial (dollar) accuracy.
Financial (dollar) accuracy is calculated from a random sample and defined as the
total dollar amount paid correctly in the sample divided by the total dollar amount
that paid in the sample. 1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
98% payment accuracy.
Payment accuracy is calculated from a random sample and defined as the number
of claims in the sample without payment errors divided by the total number of
claims in the sample. 1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
97% processing accuracy.
Processing accuracy is calculated from a random sample and defined as the number
of claims in the sample without payment or nonpayment errors divided by the total
number of claims in the sample. 1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
85%of all customer calls to the Contact Center will be answered within 30 seconds.
Measurement will be completed annually on a global basis and reported annually. 1%
Payments will be made on an annual basis.
95% of Customer Service phone inquiries will be resolved within one (1) business
day.
1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
19-04-24 198-16 V1
Correspondence will be responded to within an average of five(5) business days of
receipt.
Correspondence is defined as emails, web submissions, written letters, etc. Phone
calls are not included in the definition of correspondence. 1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
Call abandonment rate will be 3%or less.
Measurement will be completed annually on a global basis and reported annually. 1%
Payments will be made on an annual basis.
All new contract dentists will be credentialed upon application and will be re-
credentialed, at a minimum, once every three (3)years.
0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
85%of participants that respond to the Enrollee Satisfaction Survey will rate Delta
Dental overall as Good, Very Good or Excellent. Overall enrollee satisfaction is
measured by a survey distributed to a random sampling of enrollees.
0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
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Deltadentalins.com website (Enrollee portal) will be available on a 24/7 basis with
a 99.5%uptime with exceptions for planned outages and acts of nature.
0.5%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
19-04-24 198-16 V1
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Client-specific standard financial reporting package will be provided within 30 days
from the close of the established reporting period.
1%
Measurement will be completed annually on a global basis and reported annually.
Payments will be made on an annual basis.
TOTAL ADMINISTRATION AT RISK 15%
Unless specified above, the length of the Performance Guarantee period will follow the term of the sold
contract period.
Unless specified above, "Business Days" is defined as "Delta Dental Business Days".
* Performance Guarantees apply to Fee-for-Service Plans only; excludes assessments, taxes and commissions, if
applicable. Delta Dental will not incur penalties for its failure to meet the terms of these guarantees if this failure is
caused by fires, acts of public enemies, acts of God, epidemics, pandemics, civil disturbances, labor disputes or by
any similar act or event beyond the reasonable control of the client or Delta Dental.
19-04-24 198-16 V1