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INSURANCE\Dental Insurance—Delta Dental 2016-6-6-16
RESOLUTION AUTHORIZING 2016-2017 PREMIUM AGREEMENT
TO DENTAL SERVICE CONTRACT BETWEEN
TOWN OF QUEENSBURY AND DELTA DENTAL
RESOLUTION NO. ,2016
INTRODUCED BY:
WHO MOVED FOR ITS ADOPTION
SECONDED BY:
WHEREAS, the Town of Queensbury wishes to enter into an Agreement for dental
insurance for July,2016—June, 2017 with Delta Dental,and
WHEREAS, a proposed Premium Agreement to Dental Service Contract is presented at
this meeting,
NOW,THEREFORE,BE IT
RESOLVED, that the Queensbury Town Board hereby approves and authorizes the
Premium Agreement to Dental Service Contract for dental insurance for July, 2016 — June, 2017
with Delta Dental substantially in the form presented at this meeting and authorizes and directs the
Town Supervisor to execute such Agreement, as well as any other needed documentation, and
BE IT FURTHER,
RESOLVED, that Town employees' cost-sharing formula(s) for dental shall remain
unchanged for 2016, and
BE IT FURTHER,
RESOLVED, that the Town Board further authorizes and directs the Town Supervisor
and/or Town Budget Officer to take such other and further action as may be necessary to effectuate
the terms of this Resolution.
Duly adopted this 6th day of June,2016,by the following vote:
AYES .
NOES :
ABSENT:
1
DELTA DENTAL OF NEW YORK, INC.
PREMIUM AGREEMENT
to
DENTAL SERVICE CONTRACT
Group No. Group Name Effective Date
06338 TOWN OF QUEENSBURY July 1,2016
1. TERMINATION DATE OF THIS CONTRACT PERIOD: June 30,2017
2. PREMIUM PAYMENT:
The Company shall pay monthly in advance during the term of this Contract to Delta
Dental as a Premium, the sum of$Based on Census in accordance with the rating
method set forth in this Premium Agreement, Section 3, on the first day of each
calendar month, from which Premiums shall be paid the share of the cost of Services
provided to Enrollees for which Delta Dental is obligated under the Contract. The
Premium is subject to change, depending on the number of Enrollees reported to
Delta Dental, as provided in Article II of the Contract and the number of Primary
Enrollees,as provided in Article X,Paragraph B.
The Premium is calculated from the monthly Rate Level(s) set forth below in
accordance with the rating method described in the Premium Agreement, Section 3.
A. RATE LEVEL(S)
1. A Rate Level for a Primary Enrollee with no Dependents
(1 Party) $ ; a Rate Level for a Primary Enrollee with
spouse (2 Party) $ ; a Rate Level for a Primary Enrollee
with one (1) Dependent Child (Alternate 2-Party) $ ; a
Rate Level for a Primary Enrollee with Spouse and all
Dependent Children (3-Party) $ ; and a Rate Level for a
Primary Enrollee with more than one (1) Dependent Child
(Alternate 3-Party)$ (5-STEP).
2. A Rate Level for a Primary Enrollee with no Dependents
(1-Party) $ ; a Rate Level for a Primary Enrollee with
Spouse (2-Party) $ ; a Rate Level for a Primary Enrollee
with a Dependent Child or Children (Alternate 2-Party)
$ ; and a Rate Level for a Primary Enrollee with all
Dependents (Family) $ ; (4-STEP).
PA-PRM-NY 1
I
3. A Rate Level for a Primary Enrollee with no Dependents
(1-Party) $ ; a Rate Level for a Primary Enrollee with
one (1) Dependent (2-Party) $ ; and a Rate Level for a
Primary Enrollee with more than one (I) Dependent (3-Party)
$ ; (3-STEP).
x 4. A Rate Level for a Primary Enrollee with no Dependents
(Single) $32.01; a Rate Level for a Primary Enrollee with all
Dependents (Family) $77.19; (2-STEP).
5. A Rate Level that covers Primary Enrollees and all
Dependents $ ; (SUPER COMPOSITE).
6. A Rate Level that covers only Primary Enrollees $ ;
(EMPLOYEE ONLY).
3. PROSPECTIVE RATING METHOD:
The Company's liability shall be limited to the deposit premium, as set forth in this
Premium Agreement, Section 2. All surpluses become the property of Delta Dental
and all deficit amounts will be paid for out of Delta Dental reserves.
IN WITNESS WHEREOF, the parties hereto have caused the Dental Service Contract to be
renewed with the substitution of this Premium Agreement to the original Contract; in all
other respects the original Contract shall remain in full force and effect.
TOWN OF OUEENSBURY
By:
Title:
DELTA DENTAL OF NEW YORK, INC.
By:
Title: President& CEO
PA-PRM-NY 2
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greatimoistattitai
April 19,2016 REVISED
Town of Queensbury
742 Bay Road •
Queensbury,_NY__128045902
RE: Contract Renewal for Town of Queensbury
Group Number 06338
We appreciate your business and thank you for choosing Delta Dental of New York. 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 a decrease in your current rate is
necessary.
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 dental plan:
'Effective Date '•--- July1, 2016
Contract Terni July 2016-June 2017
decrease -10.00%
Current Rates I Renewal Rates
{ •
Enrollee Only t $35.57 $32 01
!Enrollee+1 or More Dependents ' $85.77 $7719
Delta Dental Insurance Company Della Dental of California Delta Dental Mid-Atlantic Region
Telephone: 800-521-2651 Telephone: 888-335-8227 Della Dental of Delaware.Inc.
Delta Dental of the District of Columbia
Delta Dental of New York,Inc.
Delta Dental of Pennsylvania(Maryland)
Delta Dental of West Virginia
Telephone: 800-932-0783