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Home My WebLink AboutParagon Group Dental Benefit Contract'jrinq )„VflI fl A +�" ;�♦�W Ly dwonau ll/'CI,rt: ' Home office: Fort Lauderdale, Florida Address: 8751 West 8roward Blvd., Suite 30D Fort Lauderdale, Florida 33324 OCT 2 2 2004 I RISK MANAGEMENT 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 1r05FL Int. r 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 Holder'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 steall be obligate d to make every effort to immediately reportany changes in enrollment to .PARAGON the time ofiremittance of theirivoiced premium. Should the group become -aware ofchanges_in.enrollment.beyond .__. remittance of 'premiiim PARAGON h a -change: the Group shall have ninety (90) days from the effective date -of -the change to reportto nge: Providing there has not been any benefit paid on behalf of the member(s) requesting Int. . GRPDiJT2 CONNON 7lD5FL -- ,.. . . - — . a change in enrotIment status, adjustment in the premium amount as a result of sucha 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, orretief,irom.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 payinent of any premium, except the first premium. This Policy stays in force during a grace period. Full payment must be received by the 31 `r 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 paidby 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 reP mium. The number of insureds 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 e 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 preniium by the end of its grace period, the Policyholder may apply 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 6100.00, 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 terrnineted. 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. GRPONTCONNON 1/05FL 3 Int. EMPLOYEE ENROLLMENT AND SUPPORT !n 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 Call 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 ;;rdata 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. GRPDNTCONNON 1/OSF1 4 _int. MISSTATEME NT.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 havebecome 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. SEVERABI i_ITY 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 attomey's fees, pre -suit, suit, and on appeal. NOTICE Any notice given by PARAGON under this Contract shall be sufficient and effective forall 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 all 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, retum 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 (3rd) 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 GRPDNfCONNON 1/D5FL The -City of Miami Ramona Fiumara, CEBS Assistant.Director, Risk Management City of Miami - -.. 444 SW-2nd:Ave "Miami, Florida 33130 5 Int. 1999 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: `City" ATTEST: Paragon Dental Services, inc. A State of• larida C9rporatiori 0 By- ..,V.,::,, -6," fay/. Lit/ Leonarti A_ Weiss, MID/ /f/President � ft Jam ✓ JAL� 4i i Ha A. Thompson, City Cleric APPROVED AS TO FORM AND CORRECTNESS: doige I. Fem na dez Cit ,Attom koLAT (oB GRPDNTCONNON 1/05FL CITY:6 MIAMI a mitni ipal rporation By: \et -.;- Jos rrioia, City Manager APPROVED AS TO INSURANCE REQUIREMENTS: Dania Carrillo, Risk Management Administrator 6 Group Dental Contract Addendum SHENANDOAH LIr� INSURANCE COMPANY ww.pq�ago[tdcn�fal:sbm Paragon COM 1000 Dental Plan and Shenandoah Life Insurance Company Group Dental Insurance Policy Paragon Benefits and Shenandoah Life Insurance Company have partnered to offer a combination of Paragon's fee -for -service COM 1000 benefit plan and Shenandoah Life's group Wellness Plan dental insurance policy to provide you with a comprehensive dental program. The Paragon COM 1000 Plan is a comprehensive fee -for -service benefit plan that is sponsored by a large network of dental providers throughout the State of Florida (network access). The Paragon COM 1000 Plan ensures that the provider does not charge a plan member any additional amount for preventive services for which benefits are payable under the Shenandoah Life dental insurance policy. The COM 1000 Dental Plan also provides a comprehensive fee -for -service benefit plan that covers additional preventive, basic, major, and orthodontic services with no waiting periods. The COM 1000 Plan fee schedule offers guaranteed co - payments on over 300 ADA Codes that the provider cannot upgrade compared to an average of 140 ADA Codes listed on typical capitated plans ensuring that the provider does not overcharge the patient. The patient co -payments for basic and major services represent significant savings. Orthodontia and Specialty services are also covered. • (See the Schedule of Benefits for specific plan benefits). The combination of the COM 1000 Plan and the Wellness Plan provides your employees and their families with comprehensive dental care. The rates are guaranteed for one (1) year from the effective date of January 1, 2005. All administrative, reporting and account service functions are included. Status Paragon Administrative/Network Shenandoah Wellness Plan Total Monthly Premium Employee Family $7.48 $12.02 • $4.70 $18.50 $12.18 $30.52 . 1 Int. Be - r; .x t sv'ww parsGbndentat com Cu Members of the COM 10D0 denial plan are eligible to receive benefits immediately upon the effective dale of coverage with: • No wailing periods ' No claim forms to submit by members The member co -payments listed are guaranteed to be up to a 75% discount and are offered by a participating Paragon provider. The member receives: ' Most diagnostic & preventive care al no charge ▪ Cosmeli ; & orthodontia treatment The COM 1000 Dental Plan provider reimbursement is underwritten by Shenandoah Life Insurance Company's Wellness plan. Members can choose a participating Paragon provider at www.paraciondental .com Member Services Department 877-76D-2247 The patient/member is ultimately responsible for verifications to the accuracy and appropriateness of all fees applicable to any Paragon dental benefit provided by a Paragon network provider. Paragon urges all of its members to verify al fees tor proposed treatment via the 'Schedule of Benefits' and/or with Paragon Member Services Department prior to treatment The folowing member co -payments apply when a participating General Dentist performs services. Participating Spec ialsis available al fees discounted off their usual and customary charges. . CODE DESCRIPTION APPOINTMENTS 0120 Periodic oral evaluation 0140. Limited oral evaluation - problem focused 0150 Comprehensive oral evaluation - new or established patient 0160 Detailed and extensive oral evaluation - problem focused 0170 Re-evaluation - limited, problem focused 0160 Comprehensive periodontal evaluation - new or established patient 9110 Palliative (emergency) treatment of dental pain 9310.. Consultation (diagnostic service provided by dentist other than practitioner providing treatment) 9430 Office visit for observation/OSHA • 9440 .Office visit - after regularly scheduled hours 9490 Broken appointment fee BADIOGRAPHYIDIAGNOSTIC DENTISTRY '0210 x-Kay- immoral - blewings) , , 0220 X•Ray immoral- periapical first film MEMBER CO•PAY No Charge No Charge No Charge No Charge No Charge No Charge . No Charge No Charge No Charge 55.00 25.00 No Charge . No Charge COM 1000 Dental Plan CODE DESCRIPTION 0230 X-Ray - iniraoral - periapical each additional film 0240 X-Ray - iniraoral - occlusal film 0250 X-Ray - exiraoral - first film 0260 X•Ray • extraoral - each additional Bim 0270 X-Ray - bilewing - single film 0272 X-Ray - bilewing - two films '0274 X-Ray - bilewing - four films '0277 Vertical bilewiegs - 7 to 8 films 'Not to be taken if 0274 was done within prior six months. Copies of x-rays can be obtained for $2.00 per periapical film up to a maximum of $30.00. Panoramic x-ray can be obtained for a $15.00 fee. 0290 Post -ant or tat skull and facial film 0310 Sialography 0320 TMJ, including injeclion 0321 other TMJ films 0322 Tomographic survey 0330 Panoramic be (not to replace FMX) 034D Cephalometric film, non -orthodontic 0350 Oral/facial images (includes infra & extraora!) 0415 Bactcrialogic studies 0425 Caries susceptibility tests 0460 Pulp vitality tests • 0470 Diagnostic. casts PREVENTIVE DENTISTRY 1110 Routine prophylaxis -adult (once every 6 months) 1110 Additional rouline prophylaxis - adull 1120 Routine prophylaxis - children under the age of 16 (once every 6 monl's) 1120 Additional rouline prophylaxis - children under the age of 16) 1201 Topical application of fluoride (including prophylaxis) children under the age of 16 1203 Topical application of fluoride (excluding prophylaxis) children under the age of 16 1204 Topical application of fluoride (excluding prophylaxis) adult 1205 Topical application of fluoride (including prophylaxis) adult • 1310 Nutritional counseling for control of dental disease 1320 Tobacco counseling for the control & prevention of oral disease 1330 Oral hygiene Instructions 1351 Application of sealant per tooth • children under the age of 16 1510 Space maintainer - fixed -unilateral - children under the age of 16 1515 Space maintainer - fixed - bilateral - children under the age of 16 1520 Spacemaintainer- removable children under the age of 16 1525 Space maintainer •removable • bilateral children under the age of 16 1550 Re -cementation of space mainlainer 6210 Removable appliance therapy. 8220 Fixed appliance therapy _.• ._ . . MEMBER CO -PAY No Charge No Charge No Charge No Charge No Charge No Charge No Charge No Charge 150.00 150.00 250.00 150.00 150.00 No Charge 75.00 20.0D No Charge No Charge No Charge No Charge No Charge 50.00 No Charge 35.00 No Charge No Charge 5.00 5.00 No Charge No Charge No Charge 15.0D 85.0D ... _.., - 85.00 95.00 95.00 10.0D 103.0D 103.00 Inc_ CODE DESCRIPTION RESTORATIVE DENTISTRY 2140 Amalgam - 1 surface, primary or permanent 2150 Amalgam - 2 surfaces, primary orpermanent 2160 Amalgam • 3 surfaces, primary or permanent 2161 Amalgam • 4 surfaces, primary or permanent 2330 Resin -based composite -1 surface, anterior 2331 Resinbased composite - 2 surfaces, anterior 2332 Resin -based composite • 3 surfaces, anterior 2335 Resin -based composite • or involving incise! angle (anterior) 2390 Resin -based composite crown, anterior 2391 Resin -based composite • 1 surface, posterior 2392 Resin -based composite - 2 surfaces, posterior 2393 Resin -based composile - 3 surfaces, posterior 2394 Resin -based composite - 4 or more surfaces, posterior 2410 Gold foil -1 surface 2420 Gold foil - 2 surfaces • 2430 Gold foil - 3 surfaces • 2510 Inlay - metallic -1 surface 2520 Inlay - metallic - 2 surfaces 2530 Inlay - metallic - 3 or more surfaces 2542 Onlay • metallic - 2 surfaces 2543 Onlay • metallic - 3 surfaces 2544 Onlay - metallic .4 or more surfaces 2610 Inlay - porcelain/ceramic- 1 surface 2620 Inlay - porcelain/ceramic- 2 suriaces 2630 Inlay - porcelainkerarnic- 3 or more surfaces 2642 Conley - porcelain/ceramic - 2 surfaces 2643 Onlay • porcelain/ceramic -3 surfaces 2644 Onlay - porcelain/ceramic -4 or more surfaces 2650 Inlay - resin -based composite -1 surface 2651 Inlay - resin -based composde • 2 surfaces 2652 Inlay - resin -based composite - 3 or more surfaces 2362 Onlay - resin -based composite • 2 surfaces 2663 Onlay - resin -based composite -3 surfaces 2664 Onlay - resin -based composite -4 or more surfaces 2710 Crown - resin (indirect) 2720 Crovm - resin with high noble metal 2721 Crown - resin with predominantly base metal 2722 Crown - resin with noble metal 2740 Crown - porcelain/ceramic substrate 275D Crown - porcelain fused to high noble metal 2751 Crown - porcelain fused to predominantly base metal 2752 Crown - porcelain fused to noble metal 2780 Crown - 3/4 cast high noble metal 2781 Crown - 3/4 cast predominantly base metal 2782 Crown • 3/4 cast noble metal 2783 Crown - 3/4 porcelain/ceramic • 2790 Crown - fu!I cast high noble metal 2791 Crown - full cast predominantly base metal 2792 Crown • full cast noble metal 2799 Provisional crown 2910 Recement inlay 2920 Recemenl crown 2930 Prefabricated stainless steel crown - primary tooth 2931 Prefabricated stainless steel crown • perrnanent tooth 2932 Prefabricated resin crown 2933 Prefabricated stainless steel crown with resin window 2940 Sedative filling 2950 Gore butldup,'including any pins ' 2951 Pin retention • per tooth, in addition to restoration 2952 Cast post and core in addition to crown 2953 Each addilionei cast post • same tooth 2954 'Prefabricated pos(and core in addition to crown 2955' Post removal (not in conjunction with endodonlic therapy) 2957 Each additional prefabricated post - same tooth 2960. Labial venaer'(resin lamiriale) - chairside No Charge No Charge No Charge No Charge No Charge No Charge No Charge 75.0D 75.00 30.00 40.00 55.00 75.00 65.00 90.00 120.00 235.0D 235.00 235.00 285.00 285.00 285.00 275.00 275.00 275.00 300.00 300.00 300.00 200.00 200.00 200.00 235.00 235.00 235.00 195.00 270.00 270.00 270.00 365.0D 355.00 285.00 345.00 355.00 285.00 345.00 350.00 355.00 285.00 34 5.00 125.00 No Charge No Charge 60.00 60.00 70.00 130.00 No Charge 90.00 15.00 105.00 95.00 90.00 • 20.00 30.00 75.00 MEMBER CO -PAY ` CODE DESCRIPTION 2961 Labial veneer (resin laminate) - laboratory 2962 labial vaaeer (porcelain laminate) - laboratory 2970 Temporary crown (fractured tooth) 2980 Crown repair When teown endlor bridgework exceeds six (6) consecutive units, an additional charge of $30.00 per unit applies. 3 END0D0NTIC SERVICES 3110 Pulp cap - direct (excluding Gnat restoration) 3120 Pulp cap - indirect (exduding final restoration) 3220 Therapeutic pulpotomy(excluding final restoration) 3221 Pulpal debridement, primary and permanent teeth 3230 Pulpal therapy (resorb filling) - anterior, primary 3240 Pulpal Therapy (resorbabie filling) - posterior, primary 33t0 Endodonlic therapy - anterior (excluding final restoration) 3320 Endodonlc therapy - bicuspid (excudiag final restoration) 3330. Endodontic therapy -molar (excluding final restoration) 3331 Treatment of roof canal obstruction; non -surgical access 3332 Incomplete endodonfc therapy; inoperable or fractured tooth 3333 Infernal root repair of perforation defects 3346 Relreatmenl of previous root canal therapy - anterior 3347 • Retrealmenl of previous toot canal Therapy - bicuspid 3348 Retreatmenl of previous root canal therapy - molar 3351 ApexificatioNrecalcification - initial visit 3352 Apexificationlrecalcification - interim medication replacement 3353 Apexificalion/recalcilcalion - final visit 3410 Apcoeclomy/periradicular surgery - anterior 3421 Apicoectomy/periradicular surgery- bicuspid (first root) 3425 Apcoectomy/periradicular surgery - molar (first root) 3426 Api sclomy/periradicular surgery - each additional root 3430 Retrograde filling - per root 3450 Root amputation - per mot 3470 Intentional reimplantalion (including splinting) 3910 Surgical procedure for isolation of tooth with rubber dam 3920 Hemisection (including root removal) 3950 Canal preparation and fitting of preformed dowel or post PER10D0NTIC SERVICES 4210 Gingiveclomy/gingivoptasly -4 or more contiguous teeth per quad 4211 Gingtveclomy/gingivoplasly -110 3 teeth, per quad 4220 Gingival curettage per quadrant (excluding root planing) 4240 Gingival gap procedure, including root planing- 4 or more 4241 Gingival gap procedure, including root planing- 1 to 3 teeth, per quad 4245 Apically positioned gap 4249 Clinical crown lengthening .- hard tissue .4260 Osseous sgigery (including gap entry and closure) 4 or more com'iguous teeth per quad "- 4261 Osseous surgery (including flap entry and closure) -1 10 3 teeth per quadrant - 4263 Bone replacement grafi first site in quadrant • 4264 Bone replacement graft - each additionalskin quadrant . 4266 Guided tissue regeneration - resorbable barrier, per sire MEMBER CO -PAY 350.00 485.00 75.00 95.00 No Charge No Charge 65.00 65.00 60.00 65.00 125.00 215.00 305.00 65.00 65.00 65.00 145.00 250.00 365.00 90.00 90.00 90.00 175.00 175.00 175.00 100.00 35.00 85.00 175.00 95.00 80.00 75.00 135.00 60.00 '40.00 160.00 150.00 160.00 '135.00-... 395.00 235.00 -- 225.00 175.00 295.00 • CODE DESCRIPTION 4267 Guided tissue regeneration • nonresorbable barrier, per she 4270 Pedicle soft tissue grail procedure 4271 Free soft tissue graft procedure (include*donor site sorgesy) 4273 Subepilhelial connective tissue graft procedures 4274 Distal or proximal wedge procedure 4341 Periodontal scaling and root planing - 4 or more contiguous teeth per quadrant 4342 Periodontal scaling and root planing -1 Io 3 teeth, per quadrant 4355 Full mouth debridemenl to enable comprehensive evaluation and diagnosis 43131 Localized delivery of chemotherapeutic agents via a controlled release vehicle Into diseased crevicular tissue, per tooth 4910 Periodontal maintenance 4920 Unscheduled dressing change (by someone other than the !reeling dental office) PROSTHODONTICS-REMOVABLE 5110 Complete denture - maxillary 5120 Complete denture - mandibular 5130 Immediate denture - maxillary (Including Iwo relines) 5140 Immediate denture - mandibular (including Iwo refines) "- 5211 Maxillary partial denture - resin base (including clasps) 5212 Mandibular partial denture • resin base (including clasps) • 5213 Partial denture - maxillary cast metal - acrylic 5214 Partial denture - mandibular cast metal - acrylic 5281 Removable unilateral partial denture - one piece cast metal 5410 Adjustment - complete denture - maxillary 5411 Adwslment - complete denture -mandibular 5421 Adjustment - partial denture - maxillary 5422 Adjustment - partial denture - mandibular (Ali denture adjustment charges are for dentures which were not fabricated in the present office; al denture adjustments for new dentures or dentures made within twelve (12) months are al No Charge) 5510 Repair broken complete denture base . 5520 Replace broken tooth - complete denture (each tooth) 5610 Repair denture resin base 5620 Repair cast framework 5630 Repair or replace broken clasp 5640 Repair broken teeth - per tooth 5650 Add tooth to existing partial denture • 5660 Add clasp to existing partial denture 5710 Rebase complete maxillary denture 5711 Rebase complete mandibular denture 5720 Rebase maxillary partial denture 5721 Rebase mandibular partial denture 5730 Reline complete maxillary denture (chairside) 5731 Refine complete mandibular denture (chairside) 5740 Reline partial maxillary denture (chairside) 5?41 Refine partial mandibular denture (chairside) • 5750 Reline complete maxifarydenture (laboratory) 5751 Reline complete mandibular denture (laboratory) 5760 Reline partial maxillary denture (laboratory) 5761 Reline partial mandibular denture (laboratory) 5810 Interim complete denture • maxillary 5811 Interim complete denture . mandibular 5820 Interim partial denture - maxillary 5821 Interim partial denture - mandibular 5850 Tissue condilionino - maxillary " '5851 Tissue conditioning - mandibular 5862 Precision attachment 5899. Denture cleaning - PROSTH000NTICS • FIXED 6210 Ponlic - cast high noble metal `6211"'Ponlic='castpredominantly base metal 6212 Ponlic - cast noble metal "`E240 Pdnlic = porcelain fused to high noble metal MEMBER CO -PAY 335.00 225.00 225.00 280.00 100.00 60.00 35.0D 60.00 60.00 45.00 20.00 320.00 320.00 320.00' 320.00 290.00 290.00 360.00 360.00 330.00 15.00 • 15.00 15.00 15.00 50.00 50.00 50.0D 50.00 50.00 50.00 50.00 50.00 105.00 105.00 105.00 105.00 60.00 60.00 60.00 60.00 105.00 105.00 105.00 105.0D 155.00 155.00 125.00 125.00 25.00 25.00 150.00 No Charge roe _eel 350.00 280.00 340.00 350.00 4 CODE DESCRIPTION 6241 Ponlic • porcelain fused to predominantly base metal 6242 . Pontic - porcelain fused to noble metal 6245- Ponlic - porcelain/ceramic 6250 Ponlic - resin with high noble metal 6251 Ponlic - resin with predominantly base metal 6252 Ponlic - resin with noble metal 6545 Retainer - cast metal for resin bonded fixed prosthesis 6548 Retainer- porcelainlceramic for resin bonded fixed prosthesis 6720 Crown -resin with high noble metal 6721 Crown -resin with predominantly base metal 6722 Crown - resin with noble metal 6740 Crown - porcelain/ceramic 6750 Crown • porcelain fused to high noble metal 6751 Crown - porcelain !used to predominantly base metal 6752 Crown -porcelain fused to noble metal 6780 Crown - 3/4 casl high noble metal 6781 Crown - 3/4 cast predominantly base inetal 6782 Crown - 314 cast noble metal 6783 Crown :3/4 porcelain/ceramic 6790 Crown - full cast high noble metal 6791 Crown - full cast predominantly base metal 6792 Crown - full cast noble metal 6930 Recemenl fixed partial denture 6940 Stress breaker 6950 Precision attachment 6970 Cast post and core in addition to fixed partial denture retainer 6971 Cast post as pad of a fixed partial denture retainer 6972 Prefabricated post and core in addition to fixed partial denture retainer 6973 Core build up for retainer, including pins 6975 Coping - metal 6976 Each additional cast post - same tooth 6977 Each additional prefabricated post - same tooth ORAL SURGERY 7111 Coroner remnants - deciduous tooth 7140 Extraction ol erupted tooth or exposed root 7210 Surgical removal of erupted tooth 7220 Removal of impacted tooth - soft !issue 7230 Removal of impacted tooth - partially bony 7240 Removal of imparted tooth - completely bony ... 7241 Removal of impacted tooth - completely bony, wrin' unusual surgical complications 7250 Surgical removal of residual tooth mots 7260 ()mantra! fistula closure 7270 Tooth reimplanlaion 728D Surgicat access of an unerupted tooth 7281 Surgical exposure of impacted ar unerupted tooth to aid eruption 7285 Biopsy of oral tissue - hard (bone, tooth) 7286 Biopsy of oral tissue - soft (all others) 7310 Alveoloplasty with extractions - per quadrant 7320 Aiveoloplasly without extractions - per quadrant 7450 Removal of odonlogenic cysl or tumor up la 1.25 cm 7451 Removal of odontogente cyst or tumor greater than 1.25 cm 7510 Incision and drainage of abscess - intrabral soh tissue 7960 Frenuleclomy - separate procedure.. 7970 Excision of tryperplasbc hssue perarch MISCELLANEOUS SERVICES 9215 Local anesthesia 9220 General anesthesia • firs! 30 minutes 9221 General anesthesia - each additional 15 minutes 9230 Analgesia nitrous oxide ., MEMBER CO -PAY 280.00 340.00 365.00 350.00 350.00 350.00 i 80.00 375.00 365.00 365.00 365.0D 365.00 355.00 285.00 345.00 355.00 285.00 345.00 345.00 355.00 285.0D 345.00 No Charge 125.00 125.00 125.00 .;105.00 '30.00 25.00 95.00 75.00 75.00 45.00 No Charge 60.00 45.00 85.00_ 125.00 125.00 60.00 140.00 No Charge No Charge No Charge 95.00 75.00 65.00 85.00 No Charge No Charge No Charge No Charge 140 00y No Charge 115.00 60.00 20.00 per 1/2hr Int. • CODE DESCRIPTION 9241 Intravenous sedation/analgesia • first 30 minutes 9242 Intravenous conscious sedation/analgesia - each additional 15 minutes 9630 Oral irrigation/other drugs/medicament 9910 Application of desensitizing medicament 9940 Occlusal guard 9950 Occlusal analysis : mounted case 9951 Occlusal adjustment - limited 9952 Occlusal adjustment - complete 9972 Cosmetic bleaching - per arch 9972 Cosmetic bleaching - both arches (Excluding bleaching material for home usa) MEMBER CO -PAY. 1 L`.OD 60.00 15.00 per quadrant 20.00 155.00 75.00 40.00 120.00 150.00 275.00 Emergency treatment is available for palliative treatment for the abatement of pain up to $100.06 per occurrence outside the service area (Florida). ORTHODONI1A 8660 Pre -orthodontic treatment visit 8999 Orthodontic treatment plan & records 8020 Limited orthodontic treatment of the transitional dentition (up to 24 months) 8030 Limited orthodontic Treatment of the adolescent dentition (up to 24 months) 8040 Limited orthodontic treatment of the adult dentition (up to 24 months) 8070 Comprehensive orthodontic Treatment of the transitional denfifion(full treatment case up to 24 months • Including fixedlremovable appliances) 8080 Comprehensive orthodontic treatment of the adolescent denifion (full treatment case up to 24 months - including fixedlremovable appliances) 8090 comprehensive orthodontic treatment of the adult dentition (full treatment case up to 24 months - induding fixed/removable appliances) 8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s) (includes fee for fixed/removable retainers and monthly visits) Orthodontic treatment is prorated over 24 months and is only payable under a current status. Priorwritten authorization is necessary for a referral to an , odhodonhsi designated by Paragon. 2. 4. 1. 2. 3. 4. 5. 6. 40.00 9. 250.00 10. 11. 12. 1,850.00 13. 14. 15. 1.700.00 16. 2,300.00 17. 18. 300.00 19. 20. 21. 1,300.00 1,300.00 1,350.00. PARAGON SPECIALTY SERVICES This member Schedule of Benefits applies when listed dental services are performed by a participating general dentist, unless otherwise authorized by Paragon Benefits. Procedures not listed on the Schedule of Benefits That are performed by a participating general dentist will be charged at the participating general dentist's usual and customary lee Tess 25%. The participating general dentist you select may not perform all procedures fated. The co -payments shown apply to participating general dentists who do perform these services. Therefore, you are encouraged to secure availability of the scheduled services with your participating general dentist, Should the services el a specialist (Oral Surgeon, Endodontist, Orthodontist, Periodontist, Prosthodonlisl or Pedodontist) be necessary, you may receive This care in either of Iwo ways: (1) You may go directly to a participating - specialist with no referral and receive a 25% reduction off the provider's usual and customary fee; or (2) You may request specialty services 10 be provided al the listed co -payments on your benefits schedule by obtaining prior written authorization from Paragon. Should Paragon, under its sole discretion, elect to provide the desired benefil, a specific referral will be made to a designated specialist. EXC LUST ONSILIMITATIONS Any oral evaluation is limited to one (1) lime in any six (6) consecutive month period al no charge. All subsequent oral evaluations will be al a 25% discount ofl the doctor's usual and customary fee without a frequency limitation. 9itewing x-rays (2-4 films) are limited to one set in any twelve (12) consecutive month period. The dental prophylaxis or periodontal maintenance procedure is limited to orre in any six (6) consecutive month period. Any additional procedures wll follow 1110 and 4910 member co -payments as fisted In the schedule of benefits. Fluoride Treatment is limited to one (1) in any twelve (12) consecutive month period for children under the age of 16. • Sealants are limited to one (1) time per tooth in any three (3) consecutive year period. This is only allowed for unrestored permanent molar teeth for children under the age of 16. • Space maintainers and all adjustments are limited 10 children under the age of 16. Harmful habit appliances are limited to one (1) time per person under the age of 16. Services performed by a dentst or dental specialist, not contracted with Paragon without prior approval. Any dental services or apptiances which are determined io be not reasonable andfor necessary for maintaining or Improving the member's dental health, or experimental In nature, as determined by the participating Paragon dentist. Orthographic surgery or procedures and appliances for the treatment of . myofundional, myoskeletat ortemporomandibularjoint disorders unless otherwise specified as an orthodontic benefit on the Schedule of Benefits. General anesthesia or IV sedation unless otherwise listed as a covered benefit on the Schedule of Benefits. Any inpatient/outpatient hospital charges of any kind including dentist _y andlor physician charges, prescriptions, or medications. Treatment of malignancies, cysts, or neoplasms. Dental Implants and related services. Dental procedures Initiated prior to the member's eligibility under this benefit plan or started after the member's termination from the plan. Any denial procedure or treatment unable to be performed in the dental office , due 10 the general health or physical limitations of the member induding but not 6rntted to physical or emotional resistance, inablity to visit the dental olfice, or allergy to commonly utilized Local anesthetics. New dentures Include one (1) relinewtthin the first six (6) months. Replacement of crowns, fixed bridges or dentures is limited 10 once every five (5) years. When crown andlor bridgework exceed six (6) consewtive units, Mere will be an additional charge of $30.00 per unit. Co -payments for endodontic procedures do not include the cost of the final restoration. Any fixed, restorative or removable prosthetic service may require additional costs to patient as follows: High noble metal (precious) up to $130.00 Noble metal (semi-precious) _ up to $110.00 Predominantly base metal (non-preclous) . up to $55.00 Crown laboratory fees up to $125.00 Laooratory tees on rentures up to $200.00 Porcelain laboratory fees for 2610-2644, 2962, 2740 up to $50.00 Denture repair laboratory fees up to $40.00 • Employer Application Group Dental Coverage Provided by United HealthCare Insurance Company Fax Number, {6 _ 1 � --) 7 ;0 E-Mail Address of Contact; 'I• 1G (fit Contact Name:,/� �--- iSCt r ri ccliGt (� i tY)CVZ", C_I , /Th101nt.t'. C OS EMPLOYER INFORMATION Organization Type: 0 Corporation ❑ Partnership ❑ Sole Proprietor ❑ Political Subdivision' pA Other 'Submit legal opinion or minutes from Board Meeting along with application showing consent Full Legal Name of Employer. Include names of subsidiaries or affiliated companies Cic' Or) arn • Employer Identification Number.(Tax ID): 5t1 — G et ��2) l j I Subject to ERISA? ❑Yes gNo Has your firm ever filed for or is it in the process of filing for bankruptcy? ❑ Yes X•No A. f DENTAL PLAN PARTICIPATION AND SELECTION Did the group h ve dental coverage for the past If yes, ame of prior dental carrier [12) months' `Yes ❑ No !nC plz Requested effective date of coverage: '1 / / Ali effeaTVe dates must be first of the month. Total number of full time/eligible employees (EE): Total number of employees on payroll: Multi Site: ❑Yes Number of Locations: Locations: Number of COBRA participants in total group: Number of Retirees in Iota group: Dental Plan Selected: C (v Rates and Contributions Single Tier Two Tier Three Tier Tier Structure EE Rates Number of Enrolled Employees Employer.' Contribution % Employee Contribution % EE Family EE l�t 1W; Four Tier D-APP 9l01 EE+ One Family EE EE+ One _EE+ Child(ren) Family Amount of Binder Check:***This check check must accompany the group application. BILLING AND CONTACT INFORMATION Please provide the information below ifdifferent than above for billing purposes and plan administration. Address City: State: I Zip Code: Contact Name: Phone: Fax: E-Mail Address: I understand and agree that the first month's estimated premium and fully completed enrollment information for all eligible persons requesting insurance coverage must be submitted with this application BEFORE action is taken on this application. Coverage is not in effect unless and until ► receive notification of acceptance from the Company. If this application is declined, the Company will return the premium deposit submitted with the application. If my coverage is approved, premium is payable monthly in advance. I understand and agree that failure to pay premium when due will be considered a default in premium payment, and that the Company will terminate coverage following a grace period (time extension for payment of premium) of [31) days from the date of nonpayment of premium. If the coverage is terminated by the Company for nonpayment of premium, I will still owe, and the insurance company will collect, premium, for the grace period. I understand that coverage may also be terminated for other reasons as provided in the group policy. I represent and agree that all the answers and statements in this request are full, complete and true, to the best oflmy knowledge and belief, and understand that the said answers and statements form the basis upon which coverageWill be made effective. I understand that the material omissions or misrepresentations could result in voiding or reformation of coverage. I agree that the company shall be entitled -rely-on the nio rrent information in its possession regarding eligibility of employees and their dependents in pr ,ding coverage der thi policy. I understand and agree that I am responsible for notifying in the Company pro knotty of an ch es in this ' format, that may affect the eligibility of employees of their dependents, including the ddition of nevyly a ible ei r Ioyees r dependents. Authorized Officer's Nam Authorized 0ffrcer's Sign e: Title: rt.,1/r)6` Date: Agent Name: Date:. Agent Signature: Agent Number: D-APP 9/D1. Date: 10/27/2004 13:29 9546939718 PARAGON' DENTAL PAGE 02/02 AccRD CERTIFICATE OF LIABILITY INSURANC „,a_3 10/25/04. PIWOUCER USI Florida - Plantation 8100 SW Tenth 3Lxeet, 42DD0 Plantation FL 33324-321B Phone:954-474-9700 Pax:954-4174-2101 nruRE0 THIS CERT1FICATEIS ISSUED AS A MATTER OF INFORMATION DNLT RRO cowers $110 RIGHTS UPON THE CERTIFICATE MOWER- THIS CERTIFICATE DOES MOT AMEND. EXTEND OR ALTER THE: COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE 87519on V) rQcwaerdt'Inc BLvd1.. 300 FLa.atatioa is 33324 loanEA A Penn-1tPrica Insurance Co. ITioe: Lexington Insurance company INSURER C. Zurich IT SR E: COVERAGES • 116 FaJC45 DF PGLAAACE LISTED6EloW RA'7E eEEN ISSUED TOTHE INSURED NNA;D AeofE FOR THE POLIO" PERIOD INDICATED. NoTRA-OTAH01NC MIT IEA1tAREFENT, TE:tMA TJI COgOnl SI Of ANT CORTRAL T CA OMER COCLR.FJ.T WITH FESPE CT To WRCH Tt1S csuncAm M\Y BE Lr6T.ED OR µAT P 7TA 4. TYC P4utveE AFFORDED re TIT PBliCL4: Oksot1RED HEGEDI IS SuCIECT To ALL THE Tz'Rnt. ECLLSrOFLS Am ccooin0• s Of SLoI Pot tclEs. LOCl/Er-ATE L W ITS SKR.* IMT HAVE eEEN REAUCLD VY PAID cIJJI.G. IN;.R TYPE of NFsWRANCE MUCY WADS OATS (NUIDDN'T1 DATE IIARIDDm'I UwtS L� p GPIEPAL X LIRBY?Y co,Ena•t ccuErin xoRalrT 1076453 09/05/04 09/05/05. EA4oCnxaEKE 11,000,000 tww.4,4€0.vamvo $50.000 . teD E V VA/ an, oa--ao) r 5 , 000 1 CLAIMS FARCE 7 O7.CUR PfislNAl A ADv NARY s excluded GEIER J. ACCIRECAIE ; 2, 0 0 0, 0 0 0 PRoou^Ts•ca.w+DP ACC 1 excluded +F0. Acr�EtaTE UARI I•PRIF�S"PER Pon� j j''L� AIROMO6LGLWF:RTN ,_„ ~- yce 1 At, ow.ED AUTOS SCi£DLLEDAUTOS - Me, Amin •cM.c,APEG/•VTOs COMBINED SINGLE LIMIT !E. anod•aU 1 DORY AuuRY— r IP.1 ewoRl • FnOPER7 Y D..AuArk IAA •orid•rt1 t CARAGT; R EXCb^'rRHalf7 7 r— t cccuR El Ci'ALC• ...DE DEDUCTIBLE PETErmav 1 EACH OCCTRP.fT• 1 ACt:RE-GATE 1 t a r wwo<p EMPLOO1=' M ¢COEr+-ATWN AMTODY Wtil ITT • 7 �+ ( AUNTS 1 I EL coot►onsENT t EL. oso.sE - EA EAwLOYEE r E.L. OIDEn0t • rOLICY DAT r C OR•ER Employee Theft ccP0o59819 00 09/05/04 09/05/05 ' _. ..... :. .. cRreiL 50,000 D 0CRIPYIDN or Or@,A110 CA.0CAT1@fsvo4cLGpj[cLuz.oNG ADDED BY ENOOKZEWQ7rQ.ro s. rROYI57ON11 B) Xexington.Iris_ co Policy $1076553 L£tective 09/05/04-05 Professional Liability'$1,000,000 crcit claim, S1,000,000 aggregate. • CERTIFICATE HOLDER �.1; oDRTJNA!.INSURED: PtRIRERLLTTFiI' PEPTOTt 444 S'W 2"d Avenue • Miami, FL 33130 ga0U 0 ANT O= TIE ABOVEOESCRAED PDt1CIEi DE CAK8LLEfl BEFORETIE EIIPIW.RON -. RATE'TM•REOF, THE =urrVG M0URfp WLL ENOEAV0I1 TD 104. - 30 0AY'_ WRTT'TF?T scrum THE CITITIC1CaTE HOLom FAAHEDTD n LteT, BUT FM.UfL TO DO 70 P'e'osE NO OgL1GAnoN CM1LUAOI111Y Or. ANY iMD UPON THE T19URE R, IT= AGen OR . -. RE3RO=MATNEs. AUTHO NUAEYEMAINE ACORD 25S (7/57) C.ACORD CORPORATION T9E Client#: 51292 ACORD- CERTIFICATE OF LIABILITY INSURANCE PRODUCER Jason T. Brown Bateman,Gordon & Sands, Inc P.O.Box 1270 Pompano Beach, FL 33061 INSURED Paragon Dental Services, Inc. and Paragon Benefits Solutions, Inc. 8751 W. Broward Blvd, Suite #300 Fort Lauderdale, FL 33324 PARDE IDATE IMMIDDTYYYY) 12/01/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Zurich American Insurance INSURER B: NAIC # INSURER C: INSURER D: INSURER E: . COVERAGES 7HE PLICIES OF INSURANCE LISTED BELOW HAVE BEEN ANY REISSUED TO FOR THE INSURED NAMED ABOVE PERIOD QUIREMENT. TERM OR CONDITIDN OF ANY OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR NOTWITHSTANDING MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CDNDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LJ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDTYYI POLICY EXPIRATION DATE (MMPDDAYY) LIMITS LTR NSR 05/14/04 05/14/05 EACH OCCURRENCE $1 000,000 A Y GENERAL LIABILITY PAS40485493 DAMAGE TO RENTED PREMISES ? oscurrencel 11,DOO,ODO ' X COMMERCIAL GENERAL LIABILITY - .. ... 510,000 CLAIMS MADE I X I OCCUR MED EXP (Any one person) 8 ADV INJURY 11,000,000 X BIIPD Ded:250 PERSONAL S2,000,000 GENERAL AGGREGATE AGG S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY 1-15E 7 LOC PRODUCTS - COMP/OP AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . (Ea accident) 1 ANY AUTO ALL OWNED AUTOS,__ BODILY INJURY (Per Parson) $ — SCHEDULED AUTOS HIRED AUTOS �+�y'� BODILY INJURY (Per awdenl) NON -OWNED AUTOS +�y YY t 1�Y �/�1.110) 61d ro�r �' I�SC!/ / PROPERTY DAMAGE (Per accident) S // AUTO ONLY- EA ACCIDENT 5 GARAGE '�'"j LIABILITY ,� 11`/ EA ACC 5 I I ANY AUTO OTHER THAN AUTO ONLY: AGG 1 EACH OCCURRENCE 1 EXCESS/UMBRELLA LIABILrfT' AGGREGATE 5 7 OCCUR I I CLAIMS MADE S E DEDUCTIBLE $ RETENTION $ + WC S7ATU- OTH- I TOR\' LIMITS ER WORKERS COMPENSATION AND LIABILITY E.L. EACH ACCIDENT $ EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? I! yes. dews be under - E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION Holder liability performed • OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS captioned below is an additional insured for general coverages only as their interest may appear for the work by the insured. -CERTIFICATE HOLDER - City of Miami 444 SW 2 Avenue, Miami, FL 33130 ACORD 25 (2001108) 1 of2 #147832 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR 70 MAIL in DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE N0 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR " - REPRESENTATIVES.' AUTHORIZED REPRESENTATIVE.:;.: .IFT J� f�..�7 .Y-..�i�I•i.) 4..7.1 LH O ACORD CORPORATION 198E T'L I. 411 Lf-Lt r. LSR T12 Client#: 108004 PARAMIEN ' 1V•dR)DIYiYY� DA21 ACO.Ra. CERTIFICATE OF LIABILITY INSURANCE 71I07104 tfJL111i:Ffi J51 Insurance oI Florida .:cri n erciai Lines 3100 SW 10th Street, Suite 2000 :,Iarltatior., FL 33324,3218 i1511RF0 • Paragon Benefits Solutions Inc Paragon Dental Services Inc 8751 W Brctnrard Blvd, #300 Piantaiion, FL 33324 IRIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE ODES NOT AIM:NU, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL r) !maxi A. Lexington Insurance Company 19437 IN:7.fHLR I. Fidelity & Deposit Co INSURER C: INSURER INSURER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVNTHS'I•ANDING :OVERAGES ANY RECIUIREI, ENT, TERM CR CONDITION or ANY CONTRACT OR OTHER cocuMENr %MTH RESPECT TO I!'Ri1CH TUNS CERTIFICATE. MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 111E TERMS, E1CLUSIONS AND CCNDITIUI•1S OF SUCH POLICIES. AGGREGATE LIMITs SHOWMIAYHAVEBEEN REDUCEDBYPAID CLAIMS. =Doc}EwY1PATiDt1 POLICY EFFECTIVE (OCIYYI Lillis MIRE-. 1YPEOFIt•15URAHCE POLICYNUii4fl R D.ATEIhtMIOO1Y71 O•"-TEIKIM. hAC:H UUINKHJLE 5r)0 cover vENENnLLIALi1JY1' L1MA.1f'E I[Kb‘ILU -- PRL-.1.411:-I.,aruiznnwce' +IIOCDVer CCMMiifCIAL G:TJFJIAL L:,d ILI n' ':INtA:itAAI:E I J OCOCCURrt7Fn EXP(MY tmnrfrmn) ;n0 cover - . . i'[325UhlJ,l.d Aii'A INJURY MO cover ,_ GC!,:=11AL AOGREGgIT I lIn0 cover GLIPL T.CG=1E:1ATE' LtnIT 'I+1 ES PLR:n n _oc AUTO/40.01LE LIABILITY AMY 1'Jr0 AL_ OARED AUTOS S 11110U_tJ AUTOS HIRED AUI n:• IJONGIY<Ei) ALTO GNRAGK LIA`SILR'i -1 ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR I-- CLAMS MADE DEUUCI16LE RErEN-m:1N . S .. I'Rrl'.)LC1 S. CC:141< , Acir•' 2110 Cover no cover COMSIRcC•SINCLL OA soo cover (al ti ilen!) SOD LY Il.ntri r 5:10 ,COLIC' (F+r aeranl 00U LY NJURY IPe• acckle•IU sno cover PROPFI+TY (P:' accdei'l) ;no cover AU •0 GN-Y- FA FCCICKDTT 5n0 COVET OTHEriTHAv ALTO ON_Y Ep, AC-/.; Tao cover vac- sno cover [Atli oCcLnnogcr. s no cover AGGREGATE 100 cover .no cover sno cover WORKERS COMPENSATION AND EM PLOVcERS' L1A31 Lin' ANY I'130I'RIE1OR,f'AIT• NER/L-'XE:1!IIVE OFFICERNAElv1DER EXCLUC£LY? ErgFL &scare mrcer A DIRETI Prof Liab El Employee Them. 1076991 CCP0D5961901 09/05/04 9/5/04 09/05/05 9/5/05 IVJVic:STATLI.I UTH- 101,Y1.INlr$) ER E. E. EACH .4x1Grl'T sno cover IRO cover _. 0SEAS'_-EA EMPLOfEE Tno COVET E._. DStA5E'_ P0IJCYUMl1 i110 cover $1,000,000 $50,000 JESURIPTUDN OF OPERATIONS I LOCATIONS r VEHICLES; EXCLUSIONS ADDED OY ENDORSEMENT i SPEOAL PROVISIONS fl-IISCERTIFICATE VIODS AND SUPERCEEDS ALL PRIOR CERTIFICATES 61,000 deductible applies to loss slue to employee theft. •• 6'15,000 deductible applies to loss due to professional liability `Except 10 Days 'notice 3E cancellation for non-payment • :ERTIFICATE HOLDER' City of Miami Risk Management 444 SVV 2ndAve - nth floor Miami; FL-33130 CANCELLATION :- .._ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES LTC CANCELLED BEFORE: TIIE EcPIKA GC. DATE TN EI1EOr. THE ISSUING INSURER WILL ENDEAVOR 70 MAIL 'SN" DAYS WRITTE NOTICE70 TIIE CER71FICATE HOLDER NAMED TO TIIE LEFT. BUT FAILURE 1.6 00 SO SHALL- IMPOSE ND OBLIGATION OR LIABIL1'i OF ANY KIND UPON THE INSURER, ITS MENIS OR REPRESENTATIVES-- - . AUTHORIZED REPRESENTATIVE ACORD 25 (2601/7313) '( oil #S294276/M294263 • I ICPJ-[I-j-2Ol_1$ 13 :32FT•I FAX: F; 1.•1-I LFa)t ID: KARER r, ACORD CORPORATION 1! f F'rir�G I3t�2 F:= dc::i Client#: 106064 ACORD. CERTIFICATE OF LIABILITY INSURANCE PATE (MMIDD/YYYY) 12/01ro4 PRODUCER US! Insurance of Florida Lines THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Commercial 8100 SW 10th Street, Suite 2000 Plantation, FL 33324-3218 INSURERS AFFORDING COVERAGE NAIL # INSURER A: Transportation Casualty Insurance Co 24619 INSURED Paragon Dental Services, inc. INSURERS: 8751 W Broward Blvd, #300 INSURER C: Plantation, FL 33324 INSURERD; INSURER E: COVERAGES AS OF 12/01/04 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A-DDL. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDIYYI POLICY EXPIRATION DATE (MMIDDIYY) LIMITS LTR NSRC` EACH OCCURRENCE 5 GENERAL LIABILITY DAMAGE TO RENTED PREMISES !Fa 9scVrrence) S COMMERCIAL GENERAL LIABILITY EXP one $ CLAIMS MADE I I OCCUR MED (Any person) PERSONAL 8 AOV INJURY 5 $ GENERAL AGGREGATE COMP/OP AGG $ Gail. AGGREGATE LIMIT APPLIES PER: - PRODUCTS • POLICY JECT AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) S —• ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ . . _ SCHEDULED AUTOS HIRED AUTOS --'-- BODILY INJURY (Per accident) 5 NON-OWNED AUTOS rlstd p'� ,l ) jo ry p {� PROPERTY DAMAGE (Per accident) S -I� ��,� p 'vf�Q" AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY (((�� ACC $ — ANY AUTO OTHER THAN AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS/UMBRELLA LIABILITY AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE S RETENTION 11/30/04 11/30/05 - WC STA7U• IV- X TORY'IMITS " ER WORKERS COMPENSATION A ND WC07059143 EL. EACH ACCIDENT 5100,000 . EMPLOYERS' LIABILITY• ANYCERIMEMBER/PXCLUDE/EXECUTIVE E.L. DISEASE - EA EMPLOYEE 5500,000 OFFiCER/MEMBER EXCLUDED? 11 yes, describe under E.L. DISEASE -POLICY LIMIT 5,100,000 S SPECIAL PROVISIONS below OTHER DESCRIPTION *Except OF OPERATIONS 1 LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS 10 days notice of cancellation for non-payment. �._ . - CANCELLATION CERTIFICATEWOLDER BEFORE THE EXPIRATION - •- = ' _ _ City of Miami Attn Frank Gomez . __ _.,.. Rlsanagertt _ '- 444 S.W.2nd Ave-k MmE! ' - - -- - - 9th Floor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DATE THEREOF, THE -ISSUING -INSURER WILL ENDEAVOR TO MAIL > In' • DAYS WRITTEN _. ,. _ . NOTICE TO THE CERTIFICATEI. HOLDER NAMED TO THEE LEFT, BUT FAILURE TO DOSO OR IMPOSE NO OBLIGA_TI_ON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS 0 • - MIan I, FL 33130 •- - - r— REPRESENTATIVES. AUTHORIZED REPRESENTATIVE . .... .. .. .... ._ „.z.., ... e,4-.. ' D- a," uaRFR @ ACORD CORPORATION 1988 ACORD 25 (2001108) 1 of 2 #301389 DEPARTMENT OF RISK MANAGEMENT INSURANCE/SAFETY APPROVAL FORM Name Ramona Fiumara Department Risk Review Status General Liability: Zurich American Insurance Company Automobile Workers Comp: Transportation Casualty Insurance Co. Liquor Liability: Builder Risk: . Professional Liability: Lexington Insurance Company Garage Keepers Liability: Description Paragon Dental Services Project # Date: 12/2/2004 Financial Ratings Strength REQUIREMENTS: A XV B+ V. A++ XV Excess Liability: Crime Fidelity & Deposit Pollution: APPROVAL STATUS APPROVED APpR® Frank Gomez Insurance Coordinator Patrice Nova! Safety/ADA Coordinator Insurance/Safety Comments: A XV xx Insurance NOT Required City of Miami is Named Additional Insured The City is providing insurance [1City of Miami is Loss Payee Bayfront Park Named Additional Insured Not Approved Coverage is insufficient Not A Rated Company A Type of Coverage is Missing Other The City NOT Named Additional Insured Risk 001 12/2/2004 2:35 PM CITY OF MIAMI CITY ATTORNEY'S OFFICE MEMORANDUM TO: Ramona Fiumara Risk Management FROM: Rafael Suarez -Rivas, Assistant City Attorney DATE: December 16; 2004 RE: Paragon Group Dental Benefit Contract File:. K - 0401068 Enclosed please find the captioned agreement which has been approved by the City Attorney as to form and correctness. Once this agreement has been fully executed, please forward a copy of the fully executed agreement to our office so that we may close our file. If you have any further questions, please feel free to contact me at 416-1800. WHEN RETURNING FOR FURTHER REVIEW, PLEASE IDENTIFY AS K - 0401068 Enclosure(s) ..TITLE A RESOLUTION OF THE NAM1:CITY COMMISSION, WITH ATTACHMENT(S), AUTHORIZING THE CITY MANAGER TO ACCEPT AN ASSIGNMENT OF AN AGREEMENT, IN SUBSTANTIALLY THE ATTACHED FORM, FROM PARAGON DENTAL SERVICES, INC. (hereinafter referred to as "PARAGON"), A FLORIDA CORPORATION, TO STARMARK BENEFITS, INC. (hereinafter referred to as "STARMARK"), A FLORIDA CORPORATION, AMENDING THE ORIGINAL SERVICE AGREEMENT DATED DECEMBER 2, 2004, BUT EFFECTIVE AS OF JANUARY 1, 2005, TO REFLECT THE ASSET PURCHASE AGREEMENT BY STARMARK FROM PARAGON. ..BODY WHEREAS, pursuant to Resolution No. 04-0636, adopted September 23, 2004, the City Commission authorized the City Manager to negotiate a professional services agreement with PARAGON; and WHEREAS, pursuant to Resolution No. 04-0674, adopted October 14, 2004, the City Commission authorized the City Manager to execute a professional service agreement with PARAGON; and WHEREAS, STARMARK entered into an asset purchase agreement with PARAGON on March 31, 2005; and WHEREAS, pursuant to Section 1.12, Assignment of Contract, of Request for Proposal (RFP) No. 03-04-077, the successful proposer shall not assign during the term of the contract any portion or part of the Contract, except under and by virtue of written permission granted by the City through the proper official; and NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI., FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated as if fully set forth in this Section. Section 2. The City Manager is authorized {1} to accept an Assignment of an Agreement, in substantially the attached form, to reflect the legal entity name change for the business previously known as PARAGON, pursuant to Resolution No. 04-0636, adopted September 23, 2004 to STARMARK. Section 3. This Resolution shall become effective upon its adoption and signature of the Mayor.{2} APPROVED AS TO FORM AND CORRECTNESS: JORGE L. FERNANDEZ CITY ATTORNEY ..Footnote {1} The herein authorization is further subject to compliance with all requirements that may be imposed by the City Attorney, including but not limited to those prescribed by applicable City Charter and Code provisions. {2) If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution it shall become effective immediately upon override of the veto by the City Commission. Page 1 of 2 ..Title A RESOLUTION OF THE MIAMI CITY COMMISSION AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS, IN AFORM ACCEPTABLE TO THE CITY ATTORNEY, WITH THE FOLLOWING TOP -RANKED FIRMS TO PROVIDE EMPLOYEE BENEFIT DENTAL PLANS, PURSUANT TO RESOLUTION NO. 04-0636, ADOPTED SEPTEMBER 23, 2004: (1) PARAGON, FOR THE DENTAL MAINTENANCE ORGANIZATION; AND (2) METROPOLITAN LIFE, FOR THE PREFERRED PROVIDER ORGANIZATION, EACH FOR AN INITIAL THREE- YEAR PERIOD WITH THE OPTION TO RENEW FOR TWO ADDITIONAL TWO-YEAR PERIODS. ..Body WHEREAS, pursuant to public notice, Request For Proposals ("RFP") No. 03-04-077 was issued to provide Employee Benefit Dental Plans, on a contract basis for a three-year period, with the option to renew for two additional two-year periods, to be executed by the City Manager, for the Depai liuent of Risk Management; and .. . WHEREAS, the RFP for Employee Benefit Dental plans requested quotes on the current Dental Maintenance Organization ("DMO"), as well, as, an optional Preferred Provider Organization ("PPO") product; and. WHEREAS, RFPs were received on June 2, 2004, and the proposals were evaluated by an Evaluation. Committee appointed by the City Manager; and WHEREAS, contracts have been successfully negotiated with Paragon and Metropolitan Life; NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated as if fully set forth in this Section. Section 2. The City Manager is authorized {1} to execute Agreements, in a foini acceptable to the City. Attorney, with the following top -ranked firms, to provide Employee Benefit Dental Plans, pursuant to Resolution No. 04-0636, adopted September 23, 2004: (1) Paragon, for the DMO, and (2) Metropolitan Life, for the PPO, each for an initial three-year period with the option to renew for two additional two- year periods. -' Section 3 This Resolution shall become effective immediately upon its adoption and signature of the Mayor. {2} http : //egov. ci.miami.fl.us/legistarweb/utilityFuuictions/getMatterText. asp 7/31/2007 Page 2 of 2 ..Footnote {1 } The herein authorization is further subject to compliance with all requirements that may be imposed by the City Attorney, including but not limited to those prescribed by applicable City Charter and Code provisions. {2} If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective immediately upon override of the veto by the City Commission. http J/egov. ci.miami.fl.us/legistarweb/utilityFtmctions/getMatterText. asp 7/31/2007 TO: FROM: ooiorable May d Members f t e City Co rim ss on 'ola Administrator CITY OF MIAMI, FLORIDA INTER -OFFICE MEMORANDUM V‘c DATE : SUBJECT: REFERENCES ENCLOSURES: September 27, 2004 FILE A resolution authorizing the City Manager to Execute an agreement with each of the #1 Ranked firms for RFP #03-04-077 — Employee Benefit Dental Plans • RECOMMENDATION It -is respectfully recommended that the City Commission adopt the attached resolution authorizing the City Manager to execute an agreement, in a form acceptable to the City Attorney, for Employee Dental Plans with both Paragon Dental and Metropolitan Life. The agreements are both for 3 years with 2 options to renew for two years each, The funding will be provided from Account Code 514401,623301.6.657, BACKGROUND The City issued an RFP on May 7, 2004 for Employee Benefit Dental Plan requesting quotes on the current DMO, as well as, an optional PPO product, Responses for this RFP were due to the City Clerk by June 2, 2004. An evaluation committee made up of both Union representation and City Administration analyzed the proposals received and made a recommendation to the City Commission to allow the right to negotiate with the top ranked firms. The City Commission authorized permission to negotiate with these firms on the September 23, 2004 meeting. The attached agreements have been successfully negotiated to the City's satisfaction and are ready for implementation. Thank you. Page 1 of 1 (FILE ED 04-01085 FI.IE TAE Resolution MANE Dental Agreement TIME MilicataV SIAM Passed A RESOLUTION OF THE MIAMI CITY COMMISSION AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS, IN A FORM ACCEPTABLE TO THE CITY ATTORNEY, WITH THE FOLLOWING TOP -RANKED FIRMS TO PROVIDE EMPLOYEE BENEFIT DENTAL PLANS, PURSUANT TO RESOLUTION NO. 04-0636, ADOPTED SEPTEMBER 23, 2004: (1) PARAGON, F.OR THE DENTAL MAINTENANCE ORGANIZATION; AND (2) METROPOLITAN LIFE, FOR THE PREFERRED PROVIDER ORGANIZATION, EACH FOR AN INITIAL THREE-YEAR PERIOD WITH THE OPTION TO RENEW FOR TWO ADDITIONAL TWO-YEAR PERIODS. 10/13/04 10/14/04 10/15/D4 Office of the City Attorney Clty Commission Office of the Mayor ,rF,ti:r v I i yrt: (3) Reviewed and Approved ADOPTED Signed by the Mayor 1 Passed hitp://egov:Di.miami.fl.us/legistarweb/Legistar,asp?action=3&mtKey=3229 7/31/2007 -- CITY OF MIAMI, FLORIDA INTER -OFFICE MEMORANDUM TO: FROM: Honorable Mayor an embers of the,Ctity Commi slo� Joe Chi YLfi qla' Administrator DATE SUBJECT: REFERENOEB: ENCLOSURES: September 7, 2004 A resolution authorizing the City Manager to Negotiate with the #1 Ranked firms for RFP #03-04-077 —Employee Benefit Dental Plans FILE : RECOMMENDATION It is respectfully recommended that the City Commission authorize the City Manager to negotiate with the top ranked fines for RFP 403-04-077 for Employee Benefit Dental Plans, The City issued an RFP on May 7, 2004 for Employee Benefit Dental Plan requesting quotes on the current DMO, as well as, an optional PPO product. Responses for this RFP were due to the City Clerk by June 2, 2004. The cos; of this program is paid for 100% by the employees. A consensus was reached by the following committee members: Ms. Ramona Fiumara, Asst. Director of Risk Management ;Ms. Ana Gonzalez -Fajardo, Deputy Director of Labor Relations; Mr, Stuart Myers, Advisor to the City Manager; Ms. Denise Morales, Group insurance Supervisor; Ivlt, bdward Piciermann, President of IAFF Local 587; Mr. Charlie Cox, President of AFSCME Local 1907; & Mr. Joseph Simmons, President of AFSCME Local 871, The following are the ranked firms: For the provision of DMO Services 1, Paragon 2. Comp Benefits 3. Cigna 4, Florida Combined Life For the provision of PPO Services 1. Metropolitan Life 2. Cigna 3. • Comp Benefits 3. Paragon Permission is requested to negotiate with the number 1 firms for each service. Should contract negotiations fail with the top ranked firm, the Committee recommends the City negotiate with the second ranked firm. If negotiations fall with the second ranked firm, then permission to negotiate with the third ranked firms, For the PPO Services, there is a tic for third, so we would recommend negotiating with both to determine which would be the best contract for the City, On DMO services only, if contract negotiations fail with the third ranked firm, then permission to negotiate with the fourth ranked firm. The contracts will be negotiated until they are found to be acceptable'by the City. Once the contracts are negotiated, they will be brought back before commission for final approval.