R11-083I RESOLUTION NO. 1111- Oe :3
2
3
4 A RESOLUTION OF THE CITY COMMISSION OF BOYNTON
5 BEACH, FLORIDA, AWARDING THE RFP #060 - 1610- I1 /JMA
6 "FULLY INSURED DENTAL PLAN" TO METROPOLITAN
7 LIFE INSURANCE COMPANY OF PLANTATION, FLORIDA
8 FOR THE PERIOD OCTOBER 1, 2011 THROUGH
9 SEPTEMBER 30, 2012; AUTHORIZING THE INTERIM CITY
10 MANAGER TO EXECUTE THE PROVIDER AGREEMENT
11 BETWEEN THE CITY OF BOYNTON BEACH AND
12 METROPOLITAN LIFE INSURANCE COMPANY FOR
13 DENTAL COVERAGE; AND PROVIDING AN EFFECTIVE
14 DATE.
15
16
17 WHEREAS, on June 22, 2011, Procurement Services received and opened six (6)
18 proposals which were reviewed by staff and the City's Consultant, Willis of Florida; and
19 WHEREAS, the City Commission of the City of Boynton Beach, upon
20 recommendation of staff, deems it to be in the best interests of the residents and citizens of the
21
22
23
24
25
26
City of Boynton Beach to award the RFP #060 - 1610 -11 /JMA "Fully Insured Dental Plan" to
Metropolitan Life Insurance Company of Plantation, Florida for the period October 1, 2011
through September 30, 2012 with the option to renew for two (2) additional one -year periods
and authorize the Interim City Manager to execute the Provider Agreement between the City
of Boynton Beach and Metropolitan Life Insurance Company for dental coverage.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
27 THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
28 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed
29 as being true and correct and are hereby made a specific part of this Resolution upon adoption
30 hereof.
S: \CA \RESO\Agreements \Dental Health Benefits 201 1- 12.doc
1 Section 2. The City Commission of the City of Boynton Beach, Florida does
2 hereby award the RFP #060 - 1610 -11 /JMA "Fully Insured Dental Plan" to Metropolitan Life
3 Insurance Company of Plantation, Florida for the period October 1, 2011 through September
4 1 30, 2012 with the option to renew for two (2) additional one -year periods, a copy of which is
5 attached hereto as Exhibit "A ".
6 Section 3. The Interim City Manager is authorized to execute the Provider
7 Agreement with Metropolitan Life Insurance Company for dental coverage.
8 Section 4. That this Resolution shall become effective immediately upon passage.
9 PASSED AND ADOPTED this of day of August, 2011.
10
12
13
14 I
15
16 j
17 i
18
19
20
21
22
23
24
25
26
27 ATTEST:
CITY / OF BOYNTON BEACH, FLORIDA
Vice M ' r — William Orlov
Commissioner — Woodrow Llay ----
Commissioner — Steven Holzma
- ----
(fommissioner — Marlene Ross
28 ..
29CC llt,t.
3 � &et M. Prainito, C
3 Clerk
32
33 (Corporate Seal)
34
S: \CA \RESO\Agreements \Dental Health Benefits 2011- 12.doc
-2-
}RBI -083
PROVIDER AGREEMENT FOR
GROUP BENEFITS: FULLY INSURED DENTAL PLAN
THIS AGREEMENT is entered into between the City of Boynton Beach, hereinafter referred to
as "the City ", and Metropolitan Life Insurance Companv (MetLife) , hereinafter referred to
as "the Provider ", in consideration of the mutual benefits, terms, and conditions hereinafter
specified.
1. PROJECT DESIGNATION. The Provider is retained by the City to provide a FULLY
INSURED DENTAL PLAN for the City of Boynton Beach.
2. SCOPE OF SERVICES. Provider agrees to perform the services, identified on Exhibit "A"
attached hereto and incorporated herein by reference, including the provision of all labor,
materials, equipment and supplies. No modifications will be made to the original scope of
work without the written approval of the City Manager or his designee.
3. TIME FOR PERFORMANCE. Work under this agreement shall commence upon the giving
of written notice by the City to the Provider to proceed. Provider shall perform all services
and provide all work product required pursuant to this agreement for the period beginning
October 1, 2011 thru September 30, 2012, unless an extension of such time is granted in
writing by the City.
4. TERM: This Agreement shall be for a period of one (1) year commencing on October 1, 2011
thru September 30, 2012. The City of Boynton Beach may renew the contract at the same
terms and conditions, for two (2) additional one -year periods subject to vendor acceptance,
satisfactory performance and determination that renewal and pricing will be in the best
interest of the City. The Provider has agreed that the renewal rates for the first renewal
period of this agreement will not increase more than 5% of the initial agreement period.
5. PAYMENT. The Provider shall be paid by the City for services rendered under this
agreement as follows:
a. The monthly premium based on number of enrollees for the City's FULLY INSURED
DENTAL PLAN , as referred to herein, for services provided under this agreement for the
entire term of the Agreement
b. The Provider's records and accounts pertaining to this agreement are to be kept available
for inspection by representatives of the City and State for a period of three (3) years after the
termination of the Agreement. Copies shall be made available upon request.
6. OWNERSHIP AND USE OF DOCUMENTS. All documents, drawings, specifications and
other materials produced by the Provider in connection with the services rendered under this
Agreement shall be the property of the City whether the project for which they are made is
executed or not. The Provider shall be permitted to retain copies, including reproducible
copies, of drawings and specifications for information, reference and use in connection with
Provider's endeavors.
CA -1
7. COMPLIANCE WITH LAWS. Provider shall, in performing the services contemplated by
this Agreement, faithfully observe and comply with all federal, state and local laws,
ordinances and regulations that are applicable to the services to be rendered under this
agreement.
8. INDEMNIFICATION. Provider shall indemnify, defend and hold harmless the City, its
offices, agents and employees, from and against any and all claims, losses or liability, or any
portion thereof, including attorneys fees and costs, arising from injury or death to persons,
including injuries, sickness, disease or death to Provider's own employees, or damage to
property occasioned by a negligent act, omission or failure of the Provider.
9. INSURANCE. The Provider shall secure and maintain in force throughout the duration of
this contract comprehensive general liability insurance with a minimum coverage of
$1,000,000 per occurrence and $1,000,000 aggregate for personal injury; and $1,000,000 per
occurrence /aggregate for property damage, and professional liability insurance in the amount
of $1,000,000 per occurrence to 2 million aggregate with defense costs in addition to limits.
Said general liability policy shall name the City of Boynton Beach as an additional named
insured and shall include a provision prohibiting cancellation of said policy except upon
thirty (30) days prior written notice to the City. Certificates of coverage as required by this
section shall be delivered to the City within fifteen (15) days of execution of this agreement.
10. INDEPENDENT CONTRACTOR. The Provider and the City agree that the Provider is an
independent contractor with respect to the services provided pursuant to this agreement.
Nothing in this agreement shall be considered to create the relationship of employer and
employee between the parties hereto. Neither Provider nor any employee of Provider shall be
entitled to any benefits accorded City employees by virtue of the services provided under this
agreement. The City shall not be responsible for withholding or otherwise deducting federal
income tax or social security or for contributing to the state industrial insurance program,
otherwise assuming the duties of an employer with respect to Provider, or any employee of
Provider.
11. COVENANT AGAINST CONTINGENT FEES. The Provider warrants that he has not
employed or retained any company or person, other than a bona -fide employee working
solely for the Provider, to solicit or secure this contract, and that he has not paid or agreed to
pay any company or person, other than a bona -fide employee working solely for the Provider,
any fee, commission, percentage, brokerage fee, gifts, or any other consideration contingent
upon or resulting from the award or making of this contract.
For breach or violation of this warranty, the City shall have the right to annul this contract
without liability or, in its discretion to deduct from the contract price or consideration, or
otherwise recover, the full amount of such fee, commission, percentage, brokerage fee, gift,
or contingent fee.
CA -1
12. DISCRIMINATION PROHIBITED. The Provider, with regard to the work performed by
it under this agreement, will not discriminate on the grounds of race, color, national origin,
religion, creed, age, sex or the presence of any physical or sensory handicap in the selection
and retention of employees or procurement of materials or supplies.
13. ASSIGNMENT. The Provider shall not sublet or assign any of the services covered by
this Agreement without the express written consent of the City.
14. NON - WAIVER. Waiver by the City of any provision of this Agreement or any time
limitation provided for in this Agreement shall not constitute a waiver of any other provision.
15. TERMINATION.
a. The City reserves the right to terminate this Agreement at any time by giving thirty
(30) days written notice to the Provider.
16. DISPUTES. Any disputes that arise between the parties with respect to the performance
of this Agreement, which cannot be resolved through negotiations, shall be submitted to a
court of competent jurisdiction in Palm Beach County, Florida. This Agreement shall be
construed under Florida Law.
17. NOTICES. Notices to the City of Boynton Beach shall be sent to the following address:
City of Boynton Beach
100 E. Boynton Beach Boulevard
P.O. Box 310
Boynton Beach, FL 33425 -0310
Notices to Provider shall be sent to the following address:
Metropolitan Life Insurance Company
ATTN: Michael Puglisi
1200 South Pine Island
Suite 770
Plantation, FL 33324
CA -1
18. INTEGRATED AGREEMENT. This agreement, together with attachments or addenda,
represents the entire and integrated agreement between the City and the Provider and
supersedes all prior negotiations, representations, or agreements written or oral. This
agreement may be amended only by written instrument signed by both City and Provider.
DATED this day of
CITY OF BOYNTON BEACH
City Manager Provider
Attest/Authenticated:
Title
, 20
(Corporate Seal)
City Clerk
Approved as to Form:
Office of the City Attorney
Attest /Authenticated:
Secretary
CA -1
EXHIBIT "A"
Scone of Services
CA -2
MetL'I*fe
City of Boynton Beach
Employer Sponsored Dental
Proposal produced on June 17, 2011
Quote valid through the effective date of the coverage quoted
6/21/2011 4:51 PM Page 1 of 9 P0066554.339177.
City of Boynton Beach
Rate Summary
:',:. u �w' llt: 4�, e�l�w. AirviSJJ: u', ���nAl�tiu" �A" NW�YAu' HY4ni/ L�' W. XYlhirkY' �' AidYl&Y4YeL'�f8rk(�Li'iY�Yx"�d# ��j�aW���iiY1d1�" d6 'kLMb�l,�"BAi4:t''�'i�' •:
��� + i7WAH1:P`!I {q:gglnxl'w'F GL'n i'C�6�i.'M1 :' 4u
�... ,.. ................ 918
(Per Employee Per Month)
All Active Full Time Employees
• Employee Only 570 $28.59
• Employee + Family 348 $79.99
Rates are guaranteed from October 1, 2011 — September 30, 2012
2` year Rate Cap: The first year's renewal rates will not be increased by more than 5.0% above the current
rates.
6/21/20114:51 PM Page 2 of 9 P0066554.339177.
Summary of Benefits
Dental Insurance — New Dental Option
Class Description
All Active Full Time Employees
In- Network
Out -of- Network
Reimbursement
PDP
m R &C
90 Percentile
Type A— Preventive
100%
90%
Type B — Basic
90%
70%
Type C — MaJor
60%
50%
Calendar Year
Deductible applies
B & C
A, B & C
to:
• Individual
$25
$25
No Limit
No Limit
• Fatuity
Calendar Year
Maximum
$2,000
$1,250
(applies to A,0,C
services)
Orthodontia
50%
50%
Orthodontia Lifetime
$1,500
$1,500
Maximum
6/21/2011 4:51 PM Page 3 of 9 P0066554.339177.
Frequency & Allocations 1 Exclusions
Class Description: All Active Full Time Employees
Emergency Palliative Treatment
TYPE A
•
Benefits are payable immediately from the start date of an Individual's benefits
• Examinations ■
2 times in 12 months
■ Examinations — Problem Focused ■
Combined with Examinations Limit
I • Prophylaxis: Cleaning_ s •
2 times in 12 months
• Sealants •
1 per molar in lifetime for a child under
Benefits are payable Immediately from the start date of an Individual's benefits
age 19
• Fluoride •
1 time in 12 months for a child under
•
age 19
I Full Mouth X -Rays ■
Once in 36 months
■ Bitewing X -Rays •
For a child under 14: 2 times in 12
•
months
■
Adult: 2 times in 12 months
I •
Emergency Palliative Treatment
•
Periapical X -Rays
■
Other X -Rays
TYFE B
Benefits are payable Immediately from the start date of an Individual's benefits
•
Space Maintainers
• 1 per lifetime for a child under age 19
•
Amalgam Fillings
• 1 replacement per surface in 24
Months
•
Root Canal
■ 1 in 24 months
■
Periodontal Maintenance
• 2 perio. Treatments in 1 calendar yr,
includes 2 cleanings (total comb: 2)
•
Periodontal Suraery
• 1 per quadrant in any 36 month period
■
Scaling & Root Planing
■ 1 per quadrant in any 36 month period
■
Prefabricated Stainless Steel & Resin
• 1 per tooth in 5 calendar years
Crowns
I ■
Recementations
• 1 in 12 months
•
Labs & Other Tests
■
Resin Composite Fillings
• Anterior Teeth Only
•
Pulpotomy
Pulp Cappin,q
Pulp Therapy
•
Apexification & Recalcification
■
Periodontal Surgery — Soft &
Connective Tissue Grafts
■
Periodontics — Non - Surgical
•
Oral Surgery: Simple Extractions
•
Oral Surgery: Surgical Extractions
•
Other Oral Surgery
■
General Services
■
Harmful Habit Appliances
TYPE C
Benefits are payable after a 12 month waiting peril
benefits
• Cone Seam Imaging •
• Consultations •
• Crown Buildups / Post Core ■
• Repairs •
)d from the start date of an individual's
1 in 60 months
1 in 12 months
1 per tooth in 5 calendar years
1 In 12 months
6121/2011 4:51 PM Page 4 of 9 P0066554.339177.
• Dentures
• Immediate Temporary Dentures —
Complete / Partial
• Dentures — Rebases / Relines
• Denture Adjustments
• Fixed Bridges
• Inlays / Onlays /Crowns
• Implant Services
• Implant Repairs
• Implant Supported Prosthetic
• Tissue Conditioning
• Occlusal Adjustments
• General Anesthesia
■ 1 in 5 calendar years
• 1 replacement in 12 months
• 1 in 36 months
• 1 in 12 months
• 1 in 5 calendar years
• 1 replacement per tooth in 5 calendar
years
• 1 per tooth position in 10 calendar
years
• 1 per tooth in 10 calendar years
• 1 per toothin 10 calendar years
■ 1 in 36 months
• 1 in 12 months
Orthodontics
Benefits are payable after a 12 month waiting period from the start date of an
individual's benefits
• Orthodontic Diagnostics
• Orthodontic Treatment
Exclusions
All Active Full Time Employees
Services which are not dentally necessary, those which do not meet generally accepted
standards of care for treating the particular dental condition, or which we deem experimental
in nature.
■ Services for which a covered person would not be required to pay in the absence of dental
insurance.
■ Services or supplies received by a covered person before the insurance starts for that
person.
• Services which are neither performed nor prescribed by a dentist except for those services of
a licensed dental hygienist which are supervised and billed by a dentist and which are for
scaling or polishing of teeth or fluoride treatment.
■ Services which are primarily cosmetic unless such service is: required for reconstructive
surgery which is incidental to or follows surgery which results from a trauma, an infection or
other disease of the involved part; or required for reconstructive surgery because if a
congenital disease or anomaly of a Child which has resulted in a functional defect; or (For
residents of Texas) required for the treatment or correction of a congenital defect of a
newborn child).
• Services or appliances which restore or alter occlusion or vertical dimension.
■ Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by
disease.
• Restorations or appliances used for the purpose of periodontal splinting.
• Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
• Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental
floss.
• Initial installation of a Denture to replace one or more teeth which were missing before such
person was insured for Dental Insurance, except for congenitally missing natural teeth.
• Decoration or inscription of any tooth, device, appliance, crown or other dental work.
• Missed appointments.
• Services covered under any workers' compensation or occupational disease law.
• Services paid under any employer liability law.
• Services for which the employer of the person receiving such services is not required to pay.
• Services received at a facility maintained by the Policyholder, labor union, mutual benefit
association, or VA hospital.
• Services covered under other coverage provided by the Policyholder.
6/21/20114:51 PM Page 5 of 9 P0066554.339177.
• Temporary or provisional restorations.
• Temporary or provisional appliances.
• Prescription drugs.
• Services for which the submitted documentation indicates a poor prognosis.
• Services, to the extent such services, or benefits for such services, are available under a
government plan. This exclusion will apply whether or not the person receiving the services
is enrolled for the government plan. We will not exclude payment of benefits for such
services if the government plan requires that Dental Insurance under the group policy be paid
first.
• The following when charged by the dentist on a separate basis - Claim form completion;
infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non -
intravenous conscious sedation or analgesia such as nitrous oxide.
• Dental services arising out of accidental injury to the teeth and supporting structures, except
for injuries to the teeth due to chewing and biting of food.
• Caries susceptibility tests.
• Precision attachments associated with fixed and removable prostheses.
• Adjustment of a denture made within 6 months after installation by the same dentist who
installed it.
• Duplicate prosthetic devices or appliances.
• Replacement of a lost or stolen appliance, cast restoration or denture.
• Intra and extraoral photographic images.
• Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal
guards and night guards.
• Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of
Minnesota.
6/21/2011 4:51 PM Page 6 of 9 P0066554.339177.
Highlight
Broker Commissions included in the rate: None
Expected Participation: 100%
Employee Contributions: 1%
Financial Arrangement: Non - retrospectively Experience Rated
Situs is FLORIDA
Dependent Child Definition: A Child is covered up to age 26, A student is covered up to age 26.
Ortho coverage applies to: Adult (employee / spouse) & Child. Children are covered to the dependent age
limit.
This quote assumes the plan is not a Section 125 plan.
Late Entrant
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:
Type A Services ................... .............................No waiting period
Type B Services (Fillings) ... ..............................6 month waiting period
Type B Services — All Other Services ...............12 month waiting period
Type C Services ................... .............................24 month waiting period
Orthodontic Services (if applicable) ..................24 month waiting period
6121/2011 4:51 PM Page 7 of 9 P0066554.339177.
Underwriting Assumptions
If insurance coverage is provided, it will be governed by the terms and conditions of the insurance policy and
applicable law. If administrative services are provided, they are governed by the terms and condition of the
administrative services aqreement and by applicable law.
If MetLife is requested to duplicate contractual provisions from the prior carrier, such provisions must be
compatible with all MetLife's standards.
MetLife reserves the right to change its quoted rates and or fees at any time before the effective date. After
the effective date, rate and or fees are subject to the terms and conditions of the policy and or administrative
services agreement.
Only those eligible persons residing in the United States may be covered. Any others must be approved by
MetLife.
SIC Code: 9111
6121/2011 4:51 PM Page 8 of 9 P0066554.339177.
INTERMEDIARY COMPENSATION NOTICE
MetLife enters into arrangements concerning the sale, servicing and /or renewal of MetLife group insurance and
certain other group - related products ( "Products ") with brokers, agents, consultants, third -party administrators,
general agents, associations, and other parties that may participate in the sale, servicing and /or renewal of such
Products (each an "Intermediary"). MetLife may pay your Intermediary compensation, which may include base
compensation, supplemental compensation and /or a service fee. MetLife may pay compensation for the sale,
servicing and /or renewal of Products, or remit compensation to an Intermediary on your behalf. Your Intermediary
may also be owned by, controlled by or affiliated with another person or party, which may also be an Intermediary
and who may also perform marketing and /or administration services in connection with your Products and be paid
compensation by MetLife.
Base compensation, which may vary from case to case and may change if you renew your Products with MetLife,
may be payable to your Intermediary as a percentage of premium or a fixed dollar amount. In addition,
supplemental compensation may be payable to your Intermediary. Under MetLife's current supplemental
compensation plan, the amount payable as supplemental compensation may range from 0% to 2.25% of premium.
The supplemental compensation percentage may be based on: (1) the number of Products sold or inforce through
your intermediary during a prior one -year period; (2) the amount of premium or fees with respect to Products sold or
inforce through your Intermediary during a prior one -year period; and /or (3) a fixed percentage of the premium for
Products as set by MetLife. The supplemental compensation percentage will be set by MetLife prior to the
beginning of each calendar year and it may not be changed until the following calendar year. As such, the
supplemental compensation percentage may vary from year to year, but will not exceed 2.25% under the current
supplemental compensation plan.
The cost of supplemental compensation is not directly charged to the price of our Products except as an allocation
of overhead expense, which is applied to all eligible group insurance products, whether or not supplemental
compensation is paid in relation to a particular sale or renewal. As a result, your rates will not differ by whether or
not your Intermediary receives supplemental compensation. If your Intermediary collects the premium from you in
relation to your Products, your Intermediary may earn a return on such amounts. Additionally, MetLife may have a
variety of other relationships with your Intermediary or its affiliates that involve the payment of compensation and
benefits that may or may not be related to your relationship with MetLife (e.g., consulting or reinsurance
arrangements).
More information about the eligibility criteria, limitations, payment calculations and other terms and conditions under
MetLife's base compensation and supplemental compensation plans can be found on MetLife's Web site at
www. whymetlife .com/brokercompensation, Questions regarding Intermediary compensation can be directed to
ask4met @metlifeservice.com, or if you would like to speak to someone about Intermediary compensation, please
call (800) ASK 4MET. In addition to the compensation paid to an Intermediary, MetLife may also pay compensation
to your MetLife sales representative. Compensation paid to your MetLife sales representative is for participating in
the sale, servicing, and /or renewal of Products, and the compensation paid may vary based on a number of factors
including the type of Product(s) and volume of business sold. If you are the person or entity to be charged under an
insurance policy or annuity contract, you may request additional information about the compensation your MetLife
sales representative expects to receive as a result of the sale or concerning compensation for any alternative
quotes presented, by contacting your MetLife sales representative or calling 1 -866 796 -1800.
L1010135700[exp0911][All States]
L031 1 1 64620 [exp03121[All Territories]
R/?1l9n11 4 PM Porrta A of A Pnnfiti.."4 R 'AA177
J,
The City of Boynton Beach
City Clerk's Office
100 E BOYNTON BEACH BLVD
BOYNTON BEACH FL 33435
(561) 742-6060
FAX: (561) 742-6090
e-mail: prajnitoj@bbfl.U1s
www.boynton-beach.org
TO: Tim Howard
Deputy Director of Finance
FROM: Judith A. Pyle
Deputy City Clerk
DATE: August 3, 2011
�,UBJECT: Rll-083 Provider Agreement for Group Benefits: Fully Insured
Dental Plan
Attached for your handling is the original agreement mentioned above and a copy of
the Resolution. Once the document has been executed., please return the original to
the City Clerk's Office for further processing.
Please contact me if there are any questions. Thank you.
I
Attkhments (2)
(I Agreement & Resolution)
C: Central File
S coMN4ISSION\Departmental']'i-ansmittals\201 I \Tim Howard R1 1-083,doc
America's Gatewly try the GuU,'m-eom
The City of Boynton Beach
City Clerk's Office
100 E BOYNTON BEACH BLVD
BOYNTON BEACH FL 33435
(561) 742-6060
FAX: (561) 742-6090
e-mail: prain!toj@bbfl.us
www.boynton-beach.org
TO: Tim Howard
Deputy Director of Finance
FROM: Janet M. Prainito, MMC
City Clerk
DATE: September 28, 2011
SUBJECT: RII-083 Provider Agreement for Group Benefits: Fully Insured
Dental Plan
Attached for your information and file is an executed copy of the agreement mentioned
above. Since the document has been fully executed, I have retained the original for
Central File.
Please contact me if there are any questions. Thank you.
Attachment
C: Central File
SACC\WP\AFTER COMMiSSIOMDepartmental Transmittals1201 I\Tirn Howard R11 -083 ENecuted,doc
Amer - ica's Gateway to the Gulfstream