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HomeMy WebLinkAboutExhibit6Home office: Foil Lauderdale, Florida Address: 8751 West 8roward Blvd., Suite 300 Fort Lauderdale, Florida 33324 Pn F OCT 2 2 2004 1 RISK M;NAGEMENT. PARAGON GROUP DENTAL BENEFIT CONTRACT PARAGON DENTAL SERVICES, INC, a network administrator (herein known as "the Company" or "PARAGON") certifies that it covers certain employees for the benefits provided by the following contract(s): GROUP/CONTRACT HOLDER: City of Miami Group Contract(s)- COM 1000 Contract Number- 1000002250 Contract Effective Date: January 1, 2005 Contract Anniversary/Term of Contract: January 1st/ 36 months Premium Due Dates: First of each month beginning January 1, 2005 Notice: Any dental benefits in this certificate will apply to an employee only if: (a) he/she has elected that benefit; and (b) he/she has a confirmation letter and/or a Paragon identification card, which shows his/her election of that benefit. This contract is issued in consideration of the Application of the contract holder, a copy of which is attached hereto, and payment of the required premiums when such premiums are due. The first premium is due on the Contract Effective Date. Subsequent premiums will be due on the dates stated above at the office of the Company. All periods of time under this contract will begin and end at 12:01 AM local time at the Contract Holder's address. Leonard A. Weiss, DMD Kim Nolan, SPHR President Secretary GRPDNTCONNON 1/05FL 1 Int. PART A — GENERAL PROVISIONS THE CONTRACT The entire contract consists of: Part A - General Contract Provisions Part B - Member Certificate/Benefit Provisions Handbook Part C- Schedule of Benefits Part D- All Applications including, but not limited to, the attached copy of the Contract Hoider's Application Part E- Any endorsements, amendments and/or riders to the above All statements made by Contract Holder are deemed to be representations and not warranties. Only a duly authorized officer of the Company may change or waive any provision of this Contract. Any change or waiver must be done in writing. The Company will not be bound by any promise or representation made by any other person. No agent, broker or Company representative other than a Company officer, has any authority to change this Contract, extend the time for payment, or waive any provision of this Contract. INITIAL TERM This Group contract shall be in effect commencing at 12:01 a.m. on the Effective Date set forth in the Group Dental Contract cover page and shall extend for an initial term of three (3) years, thereafter (Initial Term). RENEWAL TERM(S) This Group Contract is renewable at the option of the Group and the Company at the end of the initial term for two additional terms of two (2) years each (renewal term), and each subsequent renewal term may be renewed at the Group's/Company's discretion subject to PARAGON'S right to modify, change, or amend the coverage and/or the premium rates applicable for the renewal term or on an annual basis. Any such changes/amendments (annual or biannual) shall be subject to the Group's acceptance and shall be made part of the Group Contract. PARAGON will offer renewal terms a minimum of 90 days in advance of the Group's anniversary date for signature by an authorized officer of the Company. The Group must notice Paragon at least 60 days prior to the Group's anniversary date as to its intent not to renew. The Renewal Agreement shall be deemed accepted and approved with the Group's signature or without the Group's signature if the first premium due for the new Contract year is paid to PARAGON on or before the tenth day of the first month of the new Contract year. Such payment of premium without the signature of an officer of the Group will obligate the group to all terms of this Policy/Group Contract for the renewal year inclusive of the Contract's termination clauses. Should the Group elect not to renew and fail to notify Paragon within 60 days prior to the Group's anniversary date, the Group would be liable for premium of two months of benefit (60 days) less the pro rata share commensurate with the date of notice (if any) plus any existing unpaid premium of the present Contract year (ex. 30 days notice of intent not renew would obligate the Group to one month's additional premium plus any existing unpaid premium of the present Contract year). PREMIUM The premium is the amount the Company charges for dental benefits under this Contract. The rates for the particular dental benefits are as follows: Dental Benefit: COM 1000 Group Size: 50 to 10,000 Employee $12.18 Family $30.52 Premium is payable on the date shown on the cover page of this Contract. Each monthly payment will pay for the dental benefit then in force under this contract for a period of one month. If the Company receives any premium that was not due, the Company will refund it to the Contract Holder. The Contract Holder must send the Company proof within 3 months of the payment in question that the payment was not due. Premiums not due include, but are not limited to, premiums paid for a period of time a member's coverage was not in force. Required Notice of Enrollment Changes PARAGON, on a monthly basis will forward to the Group an invoice for premium towards the following month's dental plan coverage, complete with a current list of Group enrollees as reflected in PARAGON'S records. The Group shall be obligated to make every effort to immediately report any changes in enrollment to PARAGON at the time of remittance of the invoiced premium. Should the group become aware of changes in enrollment beyond remittance of premium, the Group shall have ninety (90) days from the effective date of the change to report to PARAGON such a change. Providing there has not been any benefit paid on behalf of the member(s) requesting GRPDNTCONNON 1/05FL 2 Int. a change in enrollment status, adjustment in the premium amount as a result of such a change shall be reflected in PARAGON'S next monthly invoice statement to the Group. Group agrees that it may receive a credit for premiums paid, or relief from liability for unpaid but accrued premiums, for an ineligible member if Group notifies PARAGON within ninety (90) days of the date eligibility ceased. Group further agrees that such credit shall be limited to no more than ninety (90) days prior to PARAGON'S receipt of such notice. GRACE PERIOD A grace period of 31 days following the first unpaid month of benefits provided will be allowed for the payment of any premium, except the first premium. This Policy stays in force during a grace period. Full payment must be received by the 3151 day of the grace period. TERMINATION OF CONTRACT Either party may terminate this contract, with or without cause, by noticing the other party 60 days prior to the requested termination date. All notices of termination are to be considered 60-day termination notices regardless of other referenced notice periods or a lack of a notice period. Should either party terminate for cause, such notice should include a description of the facts underlying the claim that supports that the other party is in breach of this Contract. Remedy of such a breach, in a manner satisfactory to the party giving notice within twenty (20) days of the receipt of such notice, shall revive this Contract in effect for the remainder of the term. TERMINATION OF CONTRACT/NON PAYMENT OF PREMIUM This Policy terminates according to the following table: Then this Policy terminates: The Company receives, provided all premiums are paid, 60 days written notice from the Contract holder to terminate this Contract At the end of the notice period after the Company receives written notice. The Group has no further obligation. The Company receives, during a grace period, 60 days written notice from the Contract holder to terminate this Contract At the end of the grace period. The Group is obligated to premium for the grace period and one month's additional premium. Premium is not paid by the end of the grace period and no notice has been given. At the end of such grace period. The Group is obligated to premium for the grace period plus two months additional premium. The number of insured's falls below 50. At the end of a 60-day period following notification of termination by the Company and the group has not cured the default. Under State law, the Company ceases, bankrupts, becomes insolvent, is adjudicated, or a receiver is appointed, thus unable to continue to provide benefits If any of these events occur, no interest in this Contract shall be deemed an asset of creditors. No interest in this agreement shall be deemed an asset or liability of the Group. At the end of a 90-day advance written notice period given by the Company. REINSTATEMENT OF CONTRACT If this Policy terminates because the Policyholder has not paid the required premium by the end of its grace period, the Policyholder may appty for reinstatement of this Policy at the sole discretion of PARAGON. The Policyholder must request reinstatement from the Company in writing on Policyholder letterhead. The Policyholder must submit this request with all past due premiums, the grace period's premium, the current month's premium, and a reinstatement fee of $100.00, to PARAGON within 30 days of the request. If PARAGON, at its sole discretion, accepts any partial payment of past due premium, shall apply it to the account for the most overdue premium on the account. If the Company chooses to reinstate this Policy, the coverage provided hereunder will resume as of the date this Contract terminated. If the Company chooses not to reinstate this Contract, the Company will notify the Contract Holder of such decision in writing. The Company will refund any unearned premium submitted with the request for reinstatement. GRPDNTCONNON 1/05FL 3 Int. EMPLOYEE ENROLLMENT AND SUPPORT In addition to all areas outlined in the member certificate of coverage, Paragon will affect enrollment through the processing of all enrollment forms submitted by the Group, enrolled "on-line" or via the "Paragon CaII Center". Paragon is only responsible for providing benefits to employees who have been appropriately enrolled, and which the required premium payment has been received. It is understood that Paragon will need to rely on the Group to provide all enrollment forms submitted by their members and to further assure the completeness of appropriate and necessary information to effectuate the administration of member services. It is further understood that the Group will be responsible for the internal administration of it's benefit program, which they will communicate to it's employees via Group publications, marketing collateral, promotion at time of enrollment, website and ongoing support to Group employees/members throughout the initial enrollment and remainder of the Contract period. Paragon agrees to maintain adequate information so that the Group or any of its employees/members may contact Paragon to ascertain; 1. whether a particular employee/member is enrolled in the appropriate benefit plan; 2. whether a particular employee/member is current with regard to premium; and 3. Paragon agrees to be responsible for items pertaining to the service of the dental benefit plan including; Member Services, Provider Relations, Accounting and Administration, specifically by: • Maintaining appropriate staffing to ensure prompt and efficient responses to member inquiries during business hours. • Producing and distributing member ID cards and schedules of benefits at enrollment and upon request. • Maintaining Provider standards to ensure benefit delivery throughout the Paragon Network and support any member grievances that may occur. • Completing monthly billing and reconciliation in accordance with the Group's data communication. Providing reporting on a regular basis and as requested by the Group Quarterly service meetings with key persons of the Group to review service levels, Provider Relations and Administration. CONFIDENTIALTY OF INFORMATION Paragon and the Group agree to the following: All confidential and proprietary information of either party to this Contract, including but not limited to information regarding this contract, computer software, business procedures and manuals, data, review criteria, and Contract rates shall not be disclosed without the expressed written approval of the other party. Such information outlined shall only be disclosed to those persons and/or entities that are instrumental in implementing the terms of this Contract. For the purposes of this Contract, confidential information shall not include: • Information generally available or known to the Public or obtained from third parties; • Information independently developed by the other party subsequent to the completion of this Contract; and • Information provided to the other party with the intention that it be published, disseminated, released or distributed by such other party. The Parties to this Contract agree that no remedy of law may be adequate to compensate either party for breach of the provisions of the prior paragraph. Therefore both parties agree that either party shall be entitled to temporary and permanent injunctive relief against each other, in addition to all other remedies, which either party shall be otherwise entitled to, and this paragraph shall in no way limit, such other remedies of the parties. Such temporary or permanent injunctive relief may be granted along with any other remedies provided by Florida Law. Paragon and the Group agree to abide by all applicable laws of the State of Florida, governing the confidentiality of medical information as required by HIPAA. INCONTESTABILITY This Contract may not be contested after it has been in force for 2 years after the Contract effective date. This Contract may be contested at any time for nonpayment of premium or fraudulent misrepresentation. GRPONTCONNON 1/05FL 4 Int. MISSTATEMENT OF FACTS If any relevant facts about a covered member were not accurate, the Company, at its discretion, may adjust premiums due under this Contract. The facts will decide whether and in what amount insurance is valid under this Contract. INFORMATION The Contract Holder shall maintain its own records of transactions relating to this Policy, including but not limited to: 1. the names of all covered members; 2. the date upon which each member became covered under this Contract; and 3. the effective date of any change in a covered member's benefit under this Contract. The Contract Holder shall furnish the Company with a copy of such records upon request. The Contract Holder shall immediately report any change to such records to the Company. The Company has the right to inspect any records of the Contract Holder that the Company deems relevant to the administration of its benefits. Employees and/or their dependents shall be enrolled on forms approved by the Company. Errors of the Contract Holder in furnishing information will not invalidate benefits that should have become effective. Contract Holder reporting errors will not continue, extend, or otherwise create benefits which should have terminated or for which an employee/dependent was not eligible under this Contract. Premiums shall be paid, credited or offset as appropriate when such errors are detected. GOVERNING LAW The laws of the State of Florida and Miami -Dade County shall govern this Contract. Any provision of this contract, which conflicts with the laws of the State of Florida, is amended to conform to the minimum requirements of such laws. SEVERABILITY If any of the provisions of this Contract are declared to be invalid, such provisions shall be severed from this Contract and the other provisions hereof shall remain in full force and effect. LITIGATION In the event that litigation arises as a result of this Contract between the parties, each party shall bear its own costs and attorney's fees, pre -suit, suit, and on appeal. NOTICE Any notice given by PARAGON under this Contract shall be sufficient and effective for all purposes if and when mailed: (a) to the Group at its last known address, or (b) to a Member, at either his or her address as appearing in the records of PARAGON or in care of the Group at its last known address. The Group shall act as agent for all Members to receive alt notices to them hereunder and shall promptly notify Members. Each Member shall also serve as an agent of each of his or her dependents to forward all notices to them. It shall be the responsibility of the Group to promptly notify all members of the termination of this contract. In case of changes in the contract, specifically the certificate. Any notice to the Group by PARAGON will constitute notice to all members and PARAGON need give no further notice to any member in order to effectuate such a change. Should it be deemed appropriate, PARAGON reserves the right to notify/contact any and all members regarding its dental benefits and changes to them without liability to the Group. Any notice required to be given, whether pursuant to the terms and provisions hereof or otherwise, shall be in writing and shall be either personally delivered or sent by certified or registered mail, return receipt requested, addressed to the party to receive the notice at the pertinent address set forth below. If sent by registered or certified mail/return receipt requested, such notice shall have been deemed to have been delivered to the party to whom it was addressed on the third (3id) business day after the day on which it was mailed to such party or as designated on any receipt card by a postal clerk. Paragon Kim Nolan, SPHR Executive Vice President Paragon Dental Services, Inc. 8751 West Broward Blvd Suite 300 Fort Lauderdale, Florida 33324 GRPONTCONNON 1/05FL The City of Miami Ramona Fiumara, CEBS Assistant Director, Risk Management City of Miami 444 SW 2nd Ave Miami, Florida 33130 5 Int. IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written_ Provider" ATTEST. .,/ Secretary e seal) "City" ATTEST: APPROVED AS TO FORM AND CORRECTNESS: 6r a L; Fernandez C. Ate koy CITY • MIAMI a msni , ipal By: J Mole, City Manager APPROVED AS TO INSURANCE REQUIREMENTS: t ie Dania Carrillo, Risk Management Administrator GRPDNTCONNON 1/05FL 6 Int.