Resolution No. 10094RESOLUTION NO. 10,094
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF VERNON RENEWING THE METROPOLITAN LIFE
INSURANCE COMPANY GROUP POLICY FOR DENTAL CARE
BENEFITS FOR ACTIVE.EMPLOYEES, IDENTIFIED
CONSULTANTS, CITY COUNCIL MEMBERS AND RETIREES
WHEREAS, on November 3, 2008, the City Council of the
City of Vernon adopted Resolution No. 9758 approving dental care
benefits with Metropolitan Life Insurance Company ("MetLife") for
the period of January 1, 2008 through December 31, 2009; and
WHEREAS, MetLife has provided the City with a renewal
for Group Policy No. KM 05723438 for dental benefits for active
employees, identified consultants, City Council members, and
retirees for the period of January 1, 2010 through December 31,
2010, with an annual rate of approximately $406,954.00; and
WHEREAS, by memo dated November 3, 2009, the Risk
Manager recommended that the City renew dental benefits for active
employees, identified consultants, City Council members and
retirees for the calendar year 2010 based on an approximate annual
premium of $406,954.00; and
WHEREAS, MetLife has requested that the City declare its
intention to renew the dental benefits; and
WHEREAS, the City Council intends to renew the dental
benefits for 2010 based upon the recommendations of the Risk
Manager.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of -Vernon'
hereby finds and determines that the recitals contained
hereinabove are true and correct.
SECTION 2-: The City Council of the City of Vernon
hereby approves the renewal of dental benefits for active
employees, identified consultants, City Council members, and
retirees that are summarized in the MetLife Dental Cost and
Benefit Summary, a copy of which is attached hereto as Exhibit A
and incorporated by reference.
SECTION 3: The City Council of the City of Vernon
hereby authorizes the City Administrator, or his designee, to take
whatever action is deemed necessary or desirable for the purpose
of implementing and carrying out the purposes of this Resolution
and the transactions herein approved or authorized.
SECTION 4: The City Clerk of the City of Vernon shall
certify to the passage, approval and adoption of this resolution,
and the City Clerk of the City of Vernon shall cause this
resolution and the City Clerk's certification to be entered in the
File of Resolutions of the Council of this City.
APPROVED AND ADOPTED this 9th day of November, 2009.
ATT ST:
MANUELA GIRON, tity Clerk
z
Hilari.o Gonzales
Name:
Title: Mayor �4��z�r pry Te
2
STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, MANUELA GIRON,-City Clerk of the City of Vernon, do hereby
certify that the foregoing Resolution, being Resolution No.
10,094, was duly passed, approved and adopted by the City Council
of the City of Vernon at a regular meeting of the City Council
duly held on Monday, November 9, 2009, and thereafter was duly
signed by the Mayor or Mayor Pro-Tem of the City of Vernon.
Executed this day of November, 2009, at Vernon,
California.
(SEAL)
MANUELA GIRON, City Clerk
3
EXHIBIT A
Network Comprehensive Dental
Plan Design for: City of Vernon
Effective Date: January 1, 2010
Choice, Service, Savings.
To help you enroll, the following pages outline your company's dental plan and address any questions you may have.
Coverage Type:
In -Network'
Out -of -Network'
Type A — Preventive
100% of PDP Fee 2
100% of R&C Fee
Type B - Basic Restorative
80% of PDP Fee
80% of R&C Fee
Type C - Major Restorative
66% of PDP Fee
60% of R&C Fee
Type D - Orthodontia
50% of PDP Fee
50% of R&C Fee
Deductible
Individual
$50
$50
Family
$150
$150
Annual Maximum Benefit:
Per Person
$1,500
$1,500
Orthodontia Lifetime Max - Child Only $750 per Person
"In -Network Benefits" means benefits under this plan for covered dental services that are provided by a Participating PDP Provider. "Out -of -Network
Benefits" means benefits under this plan for covered dental services that are not provided by a Participating PDP Provider.
Z PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full.
3 Applies to Type B and C services only.
4 Out -of -network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary
charge is based on the lowest of:
• the dentist's actual charge (the 'Actual Charge'),
• the dentist's usual charge for the same or similar services (the'Usual Charge') or
• the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the'Customary
Charge'). Services must be necessary in terms of generally accepted dental standards.
An Example of Savings When You Visit a Participating PDP Dentist
Take a look at an example* that shows how receiving services from a participating PDP dentist can save you money:
Your Dentist says you need a Crown, a Type C Service
PDP Fee: $300.00 R&C Fee: $500.00
Dentist's Usual Fee: $700.00
* Please note: this example assumes that our annual deductible has been met.
(IN -NETWORK)
When you receive care from a
Participating PDP dentist...
The PDP Fee is: $300.00
Your Plan Pays:
(60% x $300 PDP Fee) - 180.00
Your Out -of -Pocket Cost: $120.00
(OUT -OF -NETWORK)
When you receive care from a
Non -Participating PDP dentist...
Dentist's Usual Fee is: $700.00
Your Plan Pays:
(60% x $500 R&C Fee) - 300.00
Your Out -of -Pocket Cost: $400.00
Pagel of 3
Metropolitan Life Insurance Company, New York, NY 10166 L0503FTPN(exp0607)MLIC-LD
List of Covered Services & Limitations*
Ty6e A — Preveptive How Many/How Often:
Prophylaxis (cleanings) • Cleaning of teeth (oral prophylaxis) but not more than once every 6 months.
Oral Examination_ s • Oral exams but not more than once every 6 months.
Topical Fluoride Applications • Topical fluoride treatment for a Dependent child under 14 years of age but not more than every 12 months.
X-rays • Full mouth X-rays: once per 60 months.
Bitewing X-rays • Not more than once every 6 months for Dependent children under 19 years of age; every 6 months for all other Covered Persons.
Sealants • Sealants which are applied to non -restored, non -decayed, first and second permanent molars only, for dependents
up to the age of 14, but not more than once per tooth per lifetime,
Space Maintainers I • Space Maintainers for dependent children to 14 years of age.
Type B — Basic Restorative How Manv/How Often:
Fillings
• Amalgam and Resin -based Fillings.
Extractions
Oral Surgery
Endodontics
• Pulp Capping, pulpal therapy, & therapeutic pulpotomy.
• Root canal treatment not more than once every 24 months for the same tooth.
Periodontics
Periodontal scaling and root planing once per quadrant or area, every 24 months.
• Periodontal surgery once per quadrant or area, every 36 months,
Periodontal Maintenance
• Periodontal maintenance where periodontal treatment has been previously performed, but the total of covered
periodontal maintenance treatments.and the number of covered oral prophylaxes will not exceed two treatments in a
calendar year.
Anesthesia
• When dentally necessary in connection with oral surgery, extractions or other covered dental services.
Consultations
• Consultations, but not more than 2 in any 12 month period.
Emergency palliative treatment
Injections of Antibiotic Drugs
Repairs of dentures, crowns, inlays and
onlays
Prefabricated Stainless Steel Crown
• Prefabricated stainless steel crowns but not more than once in any 10 year period.
Relining and Rebasing
• Relining and Rebasing of existing movable dentures but not more than once every 36 months.
T e C - Major Restorative How Many/How Often:.
Implantology
Bridges and Dentures
• Replacing an existing removable denture or fixed bridgework if: it is needed because of the loss of one or more natural
teeth after the existing denture or bridgework was installed and the denture or bridgework cannot be made serviceable; or
it is needed because the existing denture or bridgework can no longer be used and was installed more than 60 months
prior to its replacement.
CrownsllnlayslOnlays
• Replacement of crowns, inlays or onlays but not more than once for the same tooth in a 60 month period.
Type D - Orthodontia
• All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.
• Payments are on a repetitive basis.
• Benefit for initial placement of the appliance will be made representing 20% of the total benefit.
• Orthodontic benefits end at cancellation of coverage.
Like most life insurance policies, MetLife group insurance policies contain certain exclusions, waiting periods, reductions and terms for keeping them in force. For
costs and complete details of coverage, call or write your MetLife representative, In addition, a full description of your dental benefits will be provided in the
certificate of insurance.
Page 2 of 3
Metropolitan Life Insurance Company, New York, NY 10166 L0503FTPN(exp0607)MLIC-LD
How does the MetLife PDP work?
With a dental benefit plan featuring the MetLife PDP, you receive benefits
whether or not you and/or each eligible dependent visit a participating
dentist. But, when you visit a participating dentist, you have the
opportunity to maximize your benefit plan with access to lower, out-of-
pocket expenses. The MetLife PDP is a Preferred Provider Organization,
wherein you choose a provider at the time of treatment. You do not have
to pre -select a primary dentist nor do you need an ID card or referrals for
specialty care.
What is a participating PDP dentist?
A general dentist or specialist who meets MetLife's strict credentialing
standards and accepts negotiated fees as payment -in -full for services
rendered. There are more than 94,000 participating dentist locations
nationwide, including more than 21,000 specialist locations. This makes it
easier to find a participating PDP dentist near your home or workplace,
while you're away on vacation, or while your covered dependents are
away at college.
How do I find a Participating PDP dentist?
You can call the PDP automated Computer Voice Response line to obtain
an up-to-date directory of participating dentists in your area. The system
prompts you to enter your Social Security Number and a home or work
ZIP code. A list of up to 205 participating dentists in the requested ZIP
code is then mailed to your home the next business day. To receive your
personalized directory, call1-800-474-PDP1 (7371) Mon. -Fri. 6:O0am to
11:00 pm ET or Saturday 7 am to 4:00 pm ET. You can also conduct
online provider searches (with direction and mapping capabilities) via
MetLife's Dental Internet site at www.metlife.com/dental.
Please Note: Be sure to verify provider participation when you make your
appointment.
What is a negotiated fee?
A negotiated fee refers to the PDP fee schedule which participating
dentists agree to accept as payment in full. The fee is typically 10% to
35% below average fees of dentists in your area. Your plan may
reimburse you for all or part of the PDP fee. When you use a participating
PDP dentist, you are responsible only for the difference between MetLife's
benefit payment amount and the PDP fee.
Do I need an ID card?
No, you do not need to present an ID card to confirm that you're eligible.
You should notify your dentist that you participate in Mett-ife's PDP. Your
dentist can easily verify information about your coverage through a toll -
free automated Computer Voice Response system
Do my dependents have to visit the same dentist
that I select?
No, you and your dependents each have the freedom to choose any
dentist.
Page 3 of 3
Metropolitan Life Insurance Company, New York, NY 10166
AsW Questions
My dentist does not participate in the PDP. Is there
anything I can do to encourage my dentist to
participate?
The MetLffe PDP Network is continually expanding, and new providers
may be added if they meet MetUfe's credentialing standards. You may
ask your dentist to complete a MetLife PDP nomination card or visit the
dentist directory online at www.metlife.com/dental, and MetLife will send
him or her information on how to apply for participation. The timing
depends on how quickly MetLife receives the necessary information.
Please note that there may be instances where a dentist chooses not to
participate and others where MetLife does not accept the application
under their stringent credentialing requirements.
Can I find out how much services will cost and
obtain an estimate of what will be covered prior to
treatment?
Yes, MetLife recommends that you have your dentist submit a request for
a pre-treatment estimate for services in excess of $300.00. This often
applies to services such as: crowns, bridges, inlays, and periodontics,
When your dentist 'suggests treatment, have him or her send an undated
claim form, along with the proposed treatment plan, to MetLfe. A pre-
treatment estimate will be sent to you and the dentist detailing an estimate
of what services your plan will cover and at what payment level.
How do I file a claim?
Claim forms are available from your human resources department or can
be downloaded and printed out from MetLife's dental website at
www.metlife.com/dental. Remember to bring one with you to your
appointment. Complete the employee portion, and your dentist will assist
you with the rest. You can use the same claim form whether or not your
dentist is a participating PDP dentist. MetLife will mail you a concise
explanation of benefits (EOB) statement after each claim submission. If
you have a claim inquiry or benefit questions, please call Metl-ife's Dental
Customer Service Department at 1-800- ASK - 4 - MET after your plan's
effective date.
Dental Claims Address: MetLife Dental Claims, P.O. BOX 981282,
El Paso, TX 79998-1282
If I do not enroll during my initial enrollment period
can I still purchase Dental Insurance at a later
date?
Yes, employees who do not elect coverage during their 31-day application
period may still elect coverage later. Dental coverage would be subject to
the following waiting periods.
• 6 months on Basic Restorative (Fillings)
• 12 months on all other Basic Services
• 24 months on Major Services
• 24 months on Orthodontia Services (if applicable)
L05 03 FTPN(exp0607)MLIC-LD
ovilla@metlife.com
10/13/2009 12:28 PM To Allyn_Heck@AJG.com
cc mmuler@metlife.com
Re City of Vernon
Hello Allyn,
Per our conversation this morning I have attached the updated benefit summary and the renewal rates.
Single: $39.70
Two Party: $77.31
Family: $133.03
Thanks,
Olga Villa
Sales Support Consultant
CA Insurance Lic #OF5445
550 North Brand Blvd., Suite 900, 9th Floor,
Glendale, CA 91203.
Tel: (818) 627-4369
Fax: (866) 670-0309
CITY CLERK'S OFFICE
INTEROFFICE MEMORANDUM
DATE: November 10, 2009
TO: Willard Yamaguchi, Chief Deputy.City Attorney/Risk Manager
FRO Nelly Giron, City Clerk
RE: Resolution No. 10,094 - A Resolution of the City Council of
the City of Vernon Renewing the Metropolitan Life Insurance
Company Group Policy for Dental Care Benefits for Active
Employees, Identified Consultants, City Council Members and
Retirees
Transmitted herewith is a copy of Resolution No. 10,094 referenced
above, which was approved by City Council on November 9, 2009.
Thank you.
NG : dj
c: Resolution No. 9804, 10,094
Agreement No. 09-002
l
RECEIVED
N 0 V 0 3 2009
GI IY VLtr�K'� a��IGE
Staff Report
Risk Management
APPROVED NOVO 9 V9 CITE e��i4U i.
DA: November 3, 2009 r--6�
TO: Honorable Mayor and City Council r
FR: Willard G. Yamaguchi, Risk Manager I �[
RE: MetLife Dental Insurance Renewal 2010
Active Employees, City Council Members, Identified Consultants, and Retirees
Agenda Item for November 9, 2009
Our insurance broker for dental benefits, Arthur J. Gallagher, solicited bids from MetLife, Aetna,
Cigna, Delta Dental, United Health Care, Guardian, and The Standard for active employees, city
council members, identified consultants, and retirees.
MetLife Dental 2010
MetLife submitted a bid of $406,954. This was the lowest amount bid by any of the companies.
This is an increase of $57,324 or 16.4%. Delta and The Standard were 44% — 50% higher.
Fiscal Impact
This cost for city council member dental insurance is included in the $5,500,000 that has been
budgeted for all medical insurance expenditures.
Recommendation
Risk Management recommends the renewal of the MetLife dental insurance with no change in
benefits at an approximate cost of $406,954.
cc: Donal O'Callaghan
RECEIVED
NOV 0 3 2009
Inter Office Memorandum
Risk Management
DA: November 3, 2009
�11
TO: Donal O'Callaghan, City Administrator
N(JV 0 3 2009
CITY CLERK'S OFFICE
FR: Willard G. Yamaguchi, Risk Manager
F,
RE: MetLife Dental Insurance Renewal 2010 Q 5�
Active Employees, City Council Members, Identified Consultants, and Retirees
Agenda Item for November 9, 2009
Our insurance broker for dental benefits, Arthur J. Gallagher, solicited bids from MetLife, Aetna,
Cigna, Delta Dental, United Health Care, Guardian, and The Standard for active employees, city
council members, identified consultants, and retirees.
MetLife Dental 2010
MetLife submitted a bid of $406,954. This was the lowest amount bid by any of the companies.
This is an increase of $57,324 or 16.4%. Delta and The Standard were 44% — 50% higher.
Fiscal Impact
This cost for city council member dental insurance is included in the $5,500,000 that has been
budgeted for all medical insurance expenditures.
Recommendation
Risk Management recommends the renewal of the MetLife dental insurance with no change in
benefits at an approximate cost of $406,954.
NOV 0 3 2009
BY' ir.�
Page 1 of 2
Juarez, Debbie
From: Rueda, Karina
Sent: Wednesday, November 18 2009 4:18 PM
Subject:-F-W_ :-City-of-Vernon - 1/_1/1.0-Metlife_Dental_Confir_mation
Debbie,
Here is the confirmation to the MetLife Dental for both active employees and retirees.
Karina
From: mmuler@metlife.com [mailto:mmuler@metlife.coml
Sent: Monday, October 19, 2009 4:11 PM
To: Brenda_Lee@ajg.com
Cc: Allyn_Heck@AJG.com; ivana_wong@ajg.com; Rueda, Karina; Yamaguchi, Willard
Subject: Re: City of Vernon - 1/1/10 Metlife Dental Confirmation
Hi Brenda,
Thank you for renewing the City of Vernon with MetLife. We appreciate your business. We look forward to
working with you and the City of Vernon in 2010.
Please let me know if I can be of any assistance.
Thanks,
Matt Muler
Sales Representative
550 N. Brand Blvd., Suite 900
Glendale, CA 91203
Phone: 818-627-4368
Fax:866-670-0309
- For all service, billing, and eligibility requests, please email westservice(c metlifeservice.com and CC me. Please include the group name and group
number in the subject line.
-To reach customer service for claims, benefit questions, or commissions, please call 800,275.4638
Registered Representative
Metropolitan Life Insurance Company (MLIC), New York, NY 10166. Securities offered by MetLife Securities, Inc. (MSI)
(FINRA/SIPC). MLIC and MSI are affiliates.
Brenda_Lee@ajg.com To
mmuler@metlife.com
cc Allyn_Heck@AJG.com, ivana_wong@ajg.com, wyamaguchi@ci.vernon:ca.us,
10/19/2009 02:10 PM
krueda@ci.vernon.ca.us
Subject City of Vernon - 1/1/10 Metlife Dental Confirmation
11/18/2009
Page 2 of 2
Matt:
On behalf of City of Vernon, this confirms acceptance of the dental renewal, effective 1/1/10. The City of Vernon
witrzmtinae dotal-Wth Met ' for active e Ioyeesand-retirees-witfTncF-clrange in -benefits. The renewal -rates
effective 1/1/10 throuah 12/31/10 are as follows:
Employee: $39.70
EE + 1 Dep: $77.31
EE + Family: $133.03
Thank you for your assistance with this renewal. Let us know if you have questions.
Brenda K Lee
Area Assistant Vice President
Phone: 818.539.1321 1 Mobile: 818.298.5922
Fax: 818.539.1621 1 Main: 818.539.2300 x1321
Gallagher Benefit Services, Inc. I T h i n k i n g A h e a d
505 N. Brand Blvd. 6th Floor I Glendale, CA 91203
Corp. Lic. #OD36879
Brenda_Lee@ajg.com I Learn More About Gallagher Benefit Services
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11/18/2009