HomeMy WebLinkAboutRESPONSE - RFP - 7649 DENTAL ADMINISTRATOR (12)Delta Dental PPO
Delta Dental
Premier®
Non-Participating Delta Dental PPO
Delta Dental
Premier®
Non-
Participating
Diagnostic & Preventive
100% 80% 80% 100% 80% 80%
50% 50% 50% 50% 50% 50%
Employee 496 $28.15 $29.08
Employee and Spouse 344 $58.94 $60.88
Employee and Child(ren) 184 $67.60 $69.83
Employee Spouse and Child(ren) 486 $111.73 $115.42
Total 1,510 $100,976.94 $104,309.24
Total Admin Fee PEPM $4.05
Add Adult Ortho coverage and 3rd Cleaning
Delta Dental PPOSM Plus Premier
same as current
Proposed Effective Date:
Waiting Periods None None
None
Major Services
Endodontics (root canal therapy), Periodontics (gum treatment)
Minor Restorative (fillings), Oral Surgery (extractions), General Anesthesia
(with oral surgery only), Posterior Composites
Premium Rates
4-Tier
Producer Agreement:
1,300 employees
Delta Dental PPO-Premier available nationwide
Enrollment
Assumptions
Underwriting Requirements
Minimum Enrollment:
Delta Dental PPOSM Plus Premier
Waiting Periods None
Quote:
Oral Evaluation and cleanings, Fluoride, Sealants, Space Maintainers, Bitewing
x-rays, Full Mouth/Panoramic x-rays
Deductible applies to:
Deductible/Family:
Crowns, Dentures, Partials, Bridges, Bridge/Denture Repair, Denture
Rebase/Reline, Implants
Calendar Year Maximum:
50%
Network:
COVERED SERVICES
Basic Services
Basic and Major
None
Orthodontics
Waiting Periods
80% / 60% 80% / 60%
Yes annual
Not a provision of the plan. A member must enroll timely or wait until the next annual open enrollment.
Open Enrollment:
Determined by employer
Late Entrant:
Eligibility:
Employer Contribution:
$6,115.50 $6,115.50
Net of commission
Rate Guarantee: 3-Year with a 3% cap for the 4th and 5th years
January 1, 2015
State/Access Rules:
$110,424.74
$115.78
Lifetime Benefit Maximum $1,500
Age Limit
Coinsurance 50%
$1,500
To age 26 only Adult and Child
Funding Rates
Projected
Claim Rates
$33.13
$64.93
$73.88
$119.47
80% / 60%
None
80% 80% 80% / 60%
$1,500 $1,500
$50 / $100
Basic and Major
$50 / $100
Funding Rates
Projected Claim
Rates
$32.20
$62.99
$71.65
$107,092.44
Delta Dental of Colorado
Contributory Plan Options and Rate Summary for: City of Fort Collins
Plan: Single Choice Plan 1 Single Choice Plan 2