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HomeMy WebLinkAboutExhibit 1CITY OF MIAMI, FLORIDA INTER —OFFICE MEMORANDUM TO : FROM : Johnny Martinez, P.E. October 29, 2012 DATE: Chief Administrator/City Manager Calvin Ellis, Director, Risk Management Chairperson Evaluation Committee • Recommendation of Evaluation SUBJECT: Committee for RFP 336312 Employee Benefit Dental Plan REFERENCES: ENCLOSURES: FILE : As Chairperson of the Evaluation Committee ("Committee") for, the above services for the City of Miami, it is my responsibility to offer the findings and recommendation of the Committee. The City issued RFP 336312 for Employee Benefit Dental Plan on August 16, 2012, and the nine (9) proposals received on September 28, 2012, were deemed responsive. The Committee, appointed by the City Manager, met on October 26, 2012, and was comprised of the following individuals: 1. Calvin Ellis, Director, City of Miami Risk Management (Chair) 2. Michael Sparber, Risk Management Administrator, City of Coral Gables 3. Mary Leckband, Assistant Director, City of Miami Human Resources Following discussion, evaluation and deliberation of the nine proposals received, the Committee ranked the firms as follows: DHMO Plan 1. Cigna Health and Life Insurance / Cigna Dental Health of Florida (240 points; Ordinal Ranking:. 1) 2. The Guardian Life Insurance Company of America (236 points; Ordinal Ranking: 2) 3. Melife and SafeGuard Health Plans, Inc. (235 points; Ordinal Ranking: 5) PPO Plan 1. The Guardian Life Insurance Company of America (243 points; Ordinal Ranking: 1) 2. Humana, Inc. (242 points; Ordinal Ranking: 2) 3. Cigna Health and Life Insurance / Cigna Dental Health of Florida (239 points; Ordinal Ranking: 3) The Evaluation Committee recommends that the City negotiate with the top ranked firm, Cigna Health and Life Insurance / Cigna Dental Health of Florida, for the DHMO Plan; and with the top ranked firm, The Guardian Life Insurance Company of America, for the PPO Plan. Overall, both companies were ranked #1 by the Evaluation Committee when analyzed from both a numerical and an ordinal perspective. Should negotiations fail with the top ranked firms for each of the plans, the Evaluation Committee recommends to commence negotiations with the second ranked firms, The Guardian`Life Insurance Company of America, for the DHMO Plan, and with Humana, Inc., for the PPO Plan. Should negotiations fail with the second ranked firms, the Evaluation Committee recommends to commence negotiations with the third ranked firms, Metlife and SafeGuard Health Plan, Inc., for the DHMO Plan, and with Cigna Health and Life Insurance / Cigna Dental Health of Florida, for the PPO Plan. Upon successful contract negotiations, the recommendation from the City Manager to the City Commission seeking permission to authorize and execute the professional services agreement will be presented at the next available meeting. Your signature below represents your approval of the Committee's recommendation. Approved by: E. tor/City Manager Date: t ©- 25- l . RFP NO. 336312 - EMPLOYEE BENEFIT DENTAL PLAN SUMMARY EVALUATION SHEET Evaluators Numerical Ordinal Proposers Calvin Ellis: Numerical Calvin Ellis: Ordinal Mary Leckband: Numerical Mary Leckband: Ordinal Michael Sperber: Numerical Michael Sperber Ordinal Total Numerical Points Numerical Ranking „ Total =' w' Ordinal Points Ordinal Ranking ,... ., ,.:. ; .. ...... �.. . ,:;. .•.:u. .�. .._. aw 5... ah . .'S'u._.... y C?5 wT :"'.:;, bHMOmPlati �.�..�c�.aa mod....:•, r zs�,.,.,.�„,�. . ., a ,s..-�.�, �%��., -t�e �z;x �$�,,, .. .::4... .,a. .. ,y.; �P...�.. ��� , �k�zz.:: 80 ... ..: i. . , nr' T� �rt'+.. �:x�x•��e:N 4 �.� -:;t R S�',w�y ., ':� .0 ua.,J ' .: n .... � ,�.'-_:: +�&33�' �`�a-�< 69 v ,+ 3 `y L*, {. M; R.��.: s...��";u'�.s... ka�`�•x`� 7 '�yY• � I_S:.r .}.... �,... , s >.r_ ,�: -��::tv�=.2. ..r��'. 74 + s . .+ %c L ['D-�'�$r � � :�P :_a �s�?i:�..���.`fx -,�z, 9 ., '.y.. .: . a.. ,F -. ., , �, �, 3s �'3?+'-��� 223 .,"K..^^- f^t ife � �.:. s�c .uo�,Ss. 7 e;: 'J. .Xk. . �:. � ��:: � �#:�:. .,�+. 20 ,.W. � .� �', � ,. 8 Always Care/ Florida Dental Benefits Assurant Employee Benefits (Union Security Insurance Co) 79 6 76 2 78 3 233 4 11 3 Cigna Health and Life Insurance / Cigna Dental Health of Florida 83 2 76 2 81 1 240 1 6 1 Delta Dental Insurance Co. 84 1 70 5 75 6 229 5 12 4 Florida Combined Life (Florida Blue) 78 8 69 7 75 6 222 9 21 9 The Guardian Life Insurance Co. of America 83 2 75 4 78 3 236 2 k 9 2 Humana, Inc. 77 9 70 5 76 5 223 7 19 7 Metlife and SafeGuard Health Plans, Inc. 79 6 81 1 75 6 235 3 13 5 United Healthcare 80 4 68 9 80 2 228 6 w 15 6 .. � � DpPQ:Plan -- � :a ? T '., ;P `".` t :'� � C� i �E � 2 n t :.F. q... 7a< ,: ?•' A R �.... �: S` <3iw.,'.,; � d.d..? �s�.�.�'!'� ,,f !: - .%t ''�vst'tM���.fN± k y. Always Care/ Florida Dental Benefits 78 9 63 9 72 9 213 9 27 9 Assurant Employee Benefits (Union Security Insurance Co) 82 5 69 6 80 3 231 5 14 5 Cigna Health and Life Insurance I Cigna Dental Health of Florida 83 4 77 1 79 4 239 3 9 3 Delta Dental Insurance Co. 84 3 68 7 78 5 230 6 15 6 Florida Combined Life (Florida Blue) 80 7 67 8 73 8 220 8 23 8 The Guardian Life Insurance Co. of America 87 1 74 4 82 1 243 1 6 1 Humana, Inc. 86 2 75 3 - 81 2 242 2 7 2 Metlife and SafeGuard Health Plans, Inc. 80 7 73 5 75 7 228 7 19 7 United Healthcare 81 6 77 1 76 6 234 4 13 4 *Does not offer the DPPO Plan by itself PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and Cigna Health and Life Insurance / Cigna Dental Health of Florida This Professional Services Agreement ("Agreement") is entered into this day of , 2012 by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W. 2nd Avenue, 10th Floor, Miami, Florida 33130 ("City"), and Cigna Health and Life Insurance Company/ Cigna Dental Health of Florida, Inc. ("PROVIDER"), a Florida Corporation qualified to do business in Florida whose principal address is: 1571 Sawgrass Corporate Parkway, Suite 140, Sunrise, Florida 33323. RECITALS: WHEREAS, the City of Miami issued a Request for Proposal No. 336312 on August 16, 2012 (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of Employee Group Benefit Dental Plan, ("Services" as more fully set forth in the scope of work "SOW" attached hereto as Exhibit A Part 3) for the Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and madepart of hereof as Exhibit B), in response thereto, has been selected as the most qualified proposal for the provision of the Services. WHEREAS, the Evaluation Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements and recommended that the City Manager negotiate with the Provider; and • WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to perform the Services for the City; and Employee Benefit Dental Plan 1 WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and condition set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: Employee Benefit Dental Plan 2 TERMS: 1. RECITALS AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and made a part of this Agreement as attached Exhibit "A, Part 3". The Provider's Response dated, September 28, 2012, is hereby incorporated into and made a part of this Agreement as attached Exhibit "B". The Provider's Insurance Certificate is hereby incorporated into and made a part of this Agreement as Exhibit "C". The order of precedence whenever there is conflicting or inconsistent language between documents is as follows: (1) Provider's Professional Services Agreement ("PSA") with the Scope of Work; (2) Addenda/Addendum to the Request for Proposals; (3) Request for. Proposals; and (4) Provider's response to the Request for Proposals. 2. TERM: The initial term of this Agreement shall commence on the January 1, 2013 and shall continue in effect for a term of three (3) years ending on December 31, 2015. 3. OPTION TO EXTEND: The City, acting administratively through its City Manager, shall have two (2) option(s) to extend the term hereof for a period of one (1) year each, subject to availability, allocation and appropriation of funds and satisfactory performance by the Provider in the opinion of the City Manager. The City shall exercise its right to extend the term hereof by giving Provider at least thirty (30) days written notice prior to the expiration of the previous term. City Commission approval shall not be required as long as the total extended term does not exceed two (2) years. 4. SCOPE OF SERVICES: Employee Benefit Dental Plan 3 A. Provider agrees to provide the Services as specifically described, and under the special terms and conditions set forth in Exhibit "A, Part 3" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Provider represents to the City that: (i) it possesses all qualifications, licenses and expertise required for the performance of the Services, including but not limited to full qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, .fees, occupational licenses, etc., nor in the performance of any obligations to the City, (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A, Part 3"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. C. Provider shall at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, incompetent, insubordinate, or otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. Employee Benefit Dental Plan 4 5. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhibit "D" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45.) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. - 218.79, Florida Statutes, and other applicable laws. No advance payments shall be made at any time. C. Provider agrees and understands that (i) any and all subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by the City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, or which is otherwise obtained or prepared by Provider pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Provider agrees not to use any such infouiiation, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager Employee Benefit Dental Plan 5 in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable law be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. . Provideragreesto provide access to the City or to any of its duly authorized representatives, to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to comply with, this condition shall result in the immediate cancellation of this Agreement by the City. B. The City may, at reasonable times during the term hereof, inspect the Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreement conform to the terms hereof and/or the terms of the Administrative Services Agreement, if applicable. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be Employee Benefit Dental Plan 6 subject to, and made in accordance with, the provisions of Section 18-101 and 18-102 of the Code of the City of Miami, Florida as same may be amended or supplemented, from time to time. 8. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to.pay .any person any fee, commission,percentage, brokeragefee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable laws. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. B. Should Provider determine to dispute any public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. 10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City and Provider agree to comply with and observe all such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Employee Benefit Dental Plan 7 Provider further agrees to include in all of Provider's agreements with subcontractors for any Services related to this Agreement this provision requiring subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the City and its officials, employees, and its designated third -party administrator for. claims (collectively referred to as "Indemnitees") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its employees or subcontractors (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive or in strict liability) of the Indemnities, or any of them, or (ii) the failure of the Provider to comply materially with any of the requirements herein, or the failure of the Provider to conform to statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or state, in connection with the performance of this Agreement even if it is alleged that the City, its officials and/or employees were negligent. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider Employee Benefit Dental Plan 8 further agrees to indemnify, defend and hold harmless the Indemnitees form and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or requirement, related directly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all claims, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. This section shall be interpreted to comply with Sections 725.06 and/or 725.08, Florida Statutes. Provider's obligations to indemnify, defend and hold harmless the Indemnitees shall survive the termination of this Agreement. Provider understands and agrees that any and all liabilities regarding the use of any subcontractor for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. . 12. DEFAULT: If Provider fails to comply materially with any term or condition of this Agreement, or fails to perfoinii in any material way any of its obligations hereunder, and fails to cure such failure after reasonable notice from the City, then Provider shall be in default. Provider understands and agrees that termination of this Agreement under this section shall not release Provider from any obligation accruing prior to the effective date of termination. Should provider be unable or unwilling to commence to perform the Services within the time provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all Employee Benefit Dental Plan 9 costs and expenses incurred by the City in the re -procurement of the Services, including consequential and incidental damages. 13. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in connection therewith. In the .event .that theamount of compensation hereunder exceeds Twenty - Five Thousand Dollars and No/Cents ($25,000), the City Manager's decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager's written decision, approved by the City Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents ($25,000), or (ii) a period of sixty (60) days has expired, after submitting to the City Manager a detailed statement of the dispute, accompanied by all supporting documentation ninety (90) days if City Manager's decision is subject to City Commission approval); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. 14. TERMINATION;OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, at any time, by giving written notice to Provider at least sixty (60) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event Employee Benefit Dental Plan 10 shall the City be liable for any consequential or incidental damages. The Provider shall have no recourse or remedy against the City for a termination under this subsection except for payment of fees due prior to the effective date of termination. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to Provider, upon the occurrence of an event of a material default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date .of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. C. This Agreement may be terminated, in whole or in part, at any time by mutual written consent of the parties hereto. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. D. This Agreement may be terminated, in whole or in part, by either party if there has been a material default or breach on the part of the other party in any of its representations, warranties, covenants, or obligations contained in this Agreement and such default or breach is not cured within ninety (90) days following written notice from the non -breaching party. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Employee Benefit Dental Plan 11 Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. 15. INSURANCE: A. Provider shall, at. all . times . during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this Agreement are attached hereto as Exhibit "C" and incorporated herein by this reference. The City RFP number and title of the RFP must appear on each certificate of insurance. The Provider shall add the City of Miami as an additional named insured ;to its commercial general liability and auto policies and as a named certificate holder on all policies. Provider shall correct any insurance certificates as requested by the City's Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled, modified, or changed during the performance of the Services under this Agreement without thirty (30) calendar days prior written notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the performance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the policies of such insurance with the City. Employee Benefit Dental Plan 12 B. If, in the reasonable judgment of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000) of professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to such additional amount of professional liability coverage, and shall afford written notice of such change in requirements thirty (30) days prior to the date on which the requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of additional coverage within thirty (30) days following the City's written notice, this Agreement shall be considered terminated on the date the required change in policy coverage would otherwise take effect. C. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's subcontractors for Services related to this Agreement shall be borne solely by Provider throughout the term of this Agreement and that this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each subcontractor providing Services related to this Agreement shall be maintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to the City's Risk Management Administrator at a minimum of ten (10) calendar days in advance of such expiration. In the event that expired certificates are not Employee Benefit Dental Plan 13 replaced, with new or renewed certificates which cover the term of this Agreement and any extension thereof: (i) the City shall suspend this Agreement until such time as the new or renewed certificate(s) are received in acceptable form by the City's Risk Management Administrator; or (ii) the City may, at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. E. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. 16. NONDISCRIMINATION: Provider represents to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider's performance under this Agreement on account of race, color, sex, religion, age, handicap, marital status or national origin. Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. 17. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which may be withheld or conditioned, in the City's sole discretion through the City Manager. Provider may Employee Benefit Dental Plan 14 not change or replace sub -contractors performing work under the Services Agreement identified in Exhibit "B" without the prior written consent from the City Manager. 18. NOTICES: All notices or other communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested, addressed to the other party at the address indicated herein or to such other address as a party may designate bynotice given as herein provided... Noticeshall be deemed given on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: Yesinia Sanchez Cigna 1571 Sawgrass Corporate Parkway Sunrise, Florida 33323 Johnny Martinez City Manager 444 SW 2nd Avenue, 10th Floor Miami, FL 33130-1910 Employee Benefit Dental Plan 15 19. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County, Florida. Each party shall bear its own attorney's fees. Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and irrevocably .waive any objections. to .said jurisdiction. The parties irrevocably waive any rights to a jury trial. B. Title -and paragraph headings are for convenient reference and are not a part of this Agreement. C. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. D. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provision, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then the same shall be deemed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. E. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. Employee Benefit Dental Plan 16 F. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole authority to extend, to amend or to modify this Agreement on behalf of the City. 20. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their .heirs, executors, legal representatives,successors, or assigns. 21. INDEPENDENT CONTRACTORS: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, neither Provider, nor its employees, nor any subcontractor hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to employees of the City are not available to Provider, its employees, or any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. 22. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate Employee Benefit Dental Plan 17 or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written notice. 23. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event. The party seeking delay in performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay shall extend beyond the duration specified in such notice, additional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. 24. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on account of any delay(s) for any cause over which the City has no control. Employee Benefit Dental Plan 18 25. USE OF NAME: Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Commission. 26. NO CONFLICT OF INTEREST.:. ..... Pursuant to City of Miami Code Section 2- 611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that individual member of Provider, no employee, and no subcontractor under this Agreement nor any immediate family member of any of the same is also a member of any board, commission, or agency of the City. Provider hereby represents and warrants to the City that throughout the term of this Agreement, Provider, its employees and its subcontractors will abide by this prohibition of the City Code. 27. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. 28. SURVIVAL: All obligations (including but not limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or atliibutable to the period prior to expiration or earlier termination of this Agreement shall survive such expiration or earlier termination. 29. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force and effect, the wage rates and other factual unit costs supporting the compensation to Provider Employee Benefit Dental Plan 19 under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions thereto to exclude any significant sums by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or non- current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 30. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall constitute an original but all of which, when taken together, shall constitute one and the same agreement. 31. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreement of the parties relating to the subject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. Employee Benefit Dental Plan 20 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized, this the day andyear above written. "City" CITY OF MIAMI, a municipal ATTEST: corporation By: Dwight S. Danie, City Clerk Johnny Martinez, City Manager "Provider" ATTEST: Cigna Health and Life Insurance Company and Cigna Dental Health of Florida, Inc. Print Name: Title: (Corporate Seal) By: TBD (Authorized Corporate Officer) APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: REQUIREMENTS: Julie O. Bru City Attorney Calvin Ellis Risk Management Director Employee Benefit Dental Plan 21 CORPORATE RESOLUTION WHEREAS, Cigna Health and Life Insurance Company and Cigna Dental Health of Florida, Inc., a Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; This Resolution needs to authorize the signatory to sign Employee Benefit Dental Plan 22 EXHIBIT A REQUEST FOR PROPOSAL (RFP) See Attached Employee Benefit Dental Plan 23 EXHIBIT B PROVIDER'S PROPOSAL AND RESPONSE TO RFP See Attached Employee Benefit Dental Plan 24 EXHIBIT C INSURANCE REQUIREMENTS Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General Aggregate Limit $ 2,000,000 Personal and Adv. Injury $ 1,000,000 Products/Completed Operations $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured III. Worker's Compensation Limits of Liability Statutory -State of Florida Waiver of Subrogation IV. Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit V. Professional Liability/Errors and Omissions Coverage Employee Benefit Dental Plan 25 Combined Single Limit Each Claim $1,000,000 General Aggregate Limit $1,000,000 Deductible- not to exceed 10% The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required, above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Employee Benefit Dental Plan 26 �` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/06/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Phi 1 adel phi a PA Offi ce One Liberty Place 1650 Market Street Suite 1000 Philadelphia PA 19103 USA CONTACT PHONE FAX (A/C. No. Ext): (866) 283-7122 (NC. No.): (&47) 953-5390 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cigna Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER A: ACE American Insurance Company 22667 INSURERB: INSURERC: INSURER D: INSURER E: INSURER F: •570047425321 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POUCY EFF (MMIDD/YYYY) POUCY EXP (MM,DDIYYYVI LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea rrmir ence) CLAIMS -MADE n OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 7 POLICY n JE a n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) ALL OWNED — SCHEDULED BODILY INJURY (Per accident) A AUTOS HIRED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE (Per accident) A AUTOS UMBRELLA 'JAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSAT ON AND WC STATU- TORY LIMITS I OTH- ER EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER 'EXECUTIVE YIN E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED, (Mandatory in NH) N I A E.L. DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT A ManageCare Liab MSPG27030543001 Primary Managed Care E&O SIR applies per policy terns 10/01/2011 & condi-ions 10/01/2012 Limit $5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Cigna Dental Health of Florida, Inc is an additional named insured. CERTIFICATE HOLDER CANCELLATION city of Miami Attn: Maritza Suarez 3500 Pan American Drive Miami FL 33130 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE cz Mya tsli„tt0 ACORD 25 (2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : ACC7R0� CERTIFICATE OF LIABILITY INSURANCE DAT (MM/D0 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Philadelphia PA Office One Liberty Place 1650 Market Street ep0 suite Philadelphia PA 19103 USA Phila CONTACT PHON: (A/CC..NNo.Ext): (866) 283-7122 (A/C.No.)c (847) 953-5390 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cigna Health and Life Insurance Company 900 Cottage Grove Road Hartford CT 06152 USA INSURERA: ACE American Insurance Company 22667 INSURERB: INSURERC: INSURER D: ' INSURER E: INSURER F: CERTIFICATE NUMBER: 570047425233 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR TYPE OF INSURANCE ADDL INSR SUER w VD POLICY NUMBER M/POLICY EFF (MDD/YYYY1 POLICY EXP (MM/DDIYYYYI LIMITSLTR GENERAL — LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE n OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG GENt AGGREGATE LIMIT APPLIES PER: POLICY n JECT I I LOC AUTOMOBILE UABILJTY ANY AUTO ALL OWNED SCHEDULED COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE -POLICY LIMIT A ManageCare Liab MSPG27030543001 SIR applies per policy terns 10/01/2011 & conditions 10/01/2012 Limit $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Miami Attn: Maritza Suarez 3500 Pan American Drive Miami FL 33130 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c4 c��r�6L9.Q lGi�iJDG[lLli cJ 72G7. liES 206 . erft- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD EXHIBIT D COMPENSATION City of Miami Guaranteed Cost Funding Non -Participating January 01, 2013 - December 31, 2015 ..�T .yyam� tb �, f/,F. ewn $ ��,. E,� .", 1 ate__ es ;.0gate x� �r ila S m Ra e�' Dental HMO (P6X-V0) Employee Only $12.18 $13.59 $13.59 Employee + Spouse $27.28 Employee + Child(ren) _ $28.26 Employee + Family $30.52 $34.05 $39.25 Annual Cost Pe troommitoyegiraedrs" oiff et to or— . ai v a _58 /0. �¢.s Mire� # a , ew�"_rerx� — A , , � i�tr �nptoLgaa V`Rat�Ra s,r.. 'y � na i � Dental HMO (P7X-VO) Employee Only $12.18 $12.29 $12.29 Employee + Spouses $24.68 Employee + Child(ren) �"��,��;�. - ... $25.56 Employee + Family $30.52 $30.80 $35.51 Annual Cost egi Z_pereenttChange noted vsCCompet tor"j,: � `" .Far . . -- . t 4 T `' , . . o' . Cigna is proposing a cap for the 1/1/2016 DHMO renewal which will not exdeed 8.5% over the 1/1/2015 rates Cigna is proposing a cap for the 1/1/2017 DHMO renewal which will not exdeed 8.5% over the 1/1/2016 rates Employee Benefit Dental Plan 27 EXHIBIT E CORPORATE RESOLUTIONS AND EVIDENCE OF QUALIFICATION TO DOBUSINESS IN FLORIDA (To be provided upon document execution) Employee Benefit Dental Plan 28 PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and The Guardian Life Insurance Company of America This Professional Services Agreement ("Agreement") is entered into this day of , 2012 by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W. 2nd Avenue, 10th Floor, Miami, Florida 33130 ("City"), and The Guardian Life Insurance Company of America ("PROVIDER"), a Florida Corporation qualified to do business in Florida whose principal address is: 1511 N. Westshore Blvd, Suite 600, Tampa, Florida 33607. RECITALS: WHEREAS, the City of Miami issued a -Request for Proposal No. 336312 on August 16, 2012 (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of Employee Group Benefit Dental Plan, ("Services" as more fully set forth in the scope of work "SOW" attached hereto as Exhibit A, Part 3) for the Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof as Exhibit B), in response thereto, has been selected as the most qualified proposal for the provision of the Services. WHEREAS, the Evaluation Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements and recommended that the City Manager negotiate with the Provider; and • WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to perform the Services for the City; and Employee Benefit Dental Plan - PPO 1 WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and condition set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: Employee Benefit Dental Plan - PPO 2 TERMS: 1. RECITALS AND INCORPORATIONS;. DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and made a part of this Agreement as attached Exhibit "A, Part 3". The Provider's Response dated, September 28, 2012, is hereby incorporated into and made a part of this Agreement as attached Exhibit "B". The Provider's Insurance Certificate is hereby incorporated into and made a part of this Agreement as Exhibit "C". The order of precedence whenever there is conflicting or inconsistent language between documents is as follows: (1) Provider's Professional Services Agreement ("PSA") with the Scope of Work; (2) Addenda/Addendum to the Request for Proposals; (3) Request for Proposals; and (4) Provider's response to the Request for Proposals. 2. TERM: The initial term of this Agreement shall commence on the January 1, 2013 and shall continue in effect for a term of three (3) years ending on December 31, 2015. 3. OPTION TO EXTEND: The City, acting administratively through its City Manager, shall have two (2) option(s) to extend the term hereof for a period of one (1) year each, subject to availability, allocation and appropriation of funds and satisfactory performance by the Provider in the opinion of the City Manager. The City shall exercise its right to extend the term hereof by giving Provider at least thirty (30) days written notice prior to the expiration of the previous term. City Commission approval shall not be required as long as the total extended term does not exceed two (2) years. Employee Benefit Dental Plan - PPO 3 4. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special terms and conditions set forth in Exhibit "A" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Provider represents to the City that: (i) it possesses all qualifications, licenses and expertise required for the performance of the Services, including but not limited to full • qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, fees, occupational licenses, etc., nor in the performance of any obligations to the City, (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. C. Provider shall at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, incompetent, insubordinate, or otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. 5. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhibit "D" hereto, which by this reference is incorporated into and made a part of this Agreement. Employee Benefit Dental Plan - PPO 4 B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. - 218.79, Florida Statutes, and other applicable laws. No advance payments shall be made at any time. C. Provider agrees and understands that (i) any and all subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by the City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, or which is otherwise obtained or prepared by Provider pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Provider agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable law be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. Employee Benefit Dental Plan - PPO 5 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees. to provide access to the City or to any of its duly authorized representatives, to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to comply with, this condition shall result in the immediate cancellation of this Agreement by the City. B. The City may, at reasonable times during the term hereof, inspect the Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreement conform to the terms hereof and/or the terms of the Administrative Services Agreement, if applicable. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of Section 18-101 and 18-102 of the Code of the City of Miami, Florida as same may be amended or supplemented, from time to time. Employee Benefit Dental Plan - PPO 6 8. AWARD OF AGREEMENT: Provider. represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable laws. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. B. Should Provider determine to dispute any. public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. 10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City and Provider agree to comply with and observe all such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Provider further agrees to include in all of Provider's agreements with subcontractors for any Services related to this Agreement this provision requiring subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. Employee Benefit Dental Plan - PPO 7 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless. the Cityand its officials, employees, and its designated third -party administrator for claims (collectively referred to as "Indemnitees") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its employees or subcontractors (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive or in strict liability) of the Indemnities, or any of them, or (ii) the failure of the Provider to comply materially with any of the requirements herein, or the failure of the Provider to conform to statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or . state, in connection with the performance of this Agreement even if it is alleged that the City, its officials and/or employees were negligent. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider further agrees to indemnify, defend and hold harmless the Indemnitees form and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or requirement, related directly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all Employee Benefit Dental Plan - PPO 8 claims, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. This section shall be interpreted to comply with Sections 725.06 and/or 725.08, Florida Statutes. Provider's obligations to indemnify, defend and hold harmless the Indemnitees shall survive the termination of this Agreement. Provider understands and agrees that any and all liabilities regarding the use of any subcontractor for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. . 12. DEFAULT: If Provider fails to comply materially with any term or condition of this Agreement, or fails to perform in any material way any of its obligations hereunder, and fails to cure such failure after reasonable notice from the City, then Provider shall be in default. Provider understands and agrees that termination of this Agreement under this section shall not release Provider from any obligation accruing prior to the effective date of termination. Should provider be unable or unwilling to commence to perform the Services within the time provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re -procurement of the Services, including consequential and incidental damages. Employee Benefit Dental Plan - PPO 9 13. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds Twenty - Five Thousand Dollars and No/Cents ($25,000), the City Manager's decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager's written decision, approved by the City Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents ($25,000), or (ii) a period of sixty (60) days has expired, after submitting to the City Manager a detailed statement of the dispute, accompanied by all supporting documentation ninety (90) days if City Manager's decision is subject to City Commission approval); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. 14. TERMINATION;OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, at any time, by giving written notice to Provider at least sixty (60) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. The Provider shall have no Employee Benefit Dental Plan - PPO 10 recourse or remedy against the City for a termination under this subsection except for payment of fees due prior to the effective date of termination. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to Provider, upon the occurrence of an event of a material default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. C. This Agreement may be terminated, in whole or in part, at any time by mutual written consent of the parties hereto. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the , City be liable for any consequential or incidental damages. D. This Agreement may be teiiiiinated, in whole or in part, by either party if there has been a material default or breach on the part of the other party in any of its representations, warranties, covenants, or obligations contained in this Agreement and such default or breach is not cured within ninety (90) days following written notice from the non -breaching party. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments Employee Benefit Dental Plan - PPO 11 that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. 15. INSURANCE: A. Provider shall, at all times during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this Agreement are attached hereto as Exhibit "D" and incorporated herein by this reference... The City RFP number and title of the RFP must appear on each certificate of insurance. The Provider shall add the City of Miami as an additional named insured to its commercial general liability and auto policies and as a named certificate holder on all policies. Provider shall correct any insurance certificates as requested by the City' s Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled, modified, or changed during the performance of the Services under this Agreement without thirty (30) calendar days prior written notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the performance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the policies of such insurance with the City. B. If, in the reasonable judgment of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000) of Employee Benefit Dental Plan - PPO 12 professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to suchadditional amount of professional liability coverage, and shall afford written notice of such change in requirements thirty (30) days prior to the date on which the requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of additional coverage within thirty (30) days following the City's written notice, this Agreement shall be considered terminated on the date the required change in policy coverage would otherwise take effect. C. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's subcontractors for Services related to this Agreement shall be borne solely by Provider throughout the term of this Agreement and that this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each subcontractor providing Services related to this Agreement shall be maintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to the City's Risk Management Administrator at a minimum of ten (10) calendar days in advance of such expiration. In the event that expired certificates are not replaced, with new or renewed certificates which cover the term of this Agreement and any extension thereof: Employee Benefit Dental Plan - PPO 13 (i) the City shall suspend this Agreement until such time as the new or renewed certificate(s) .. are received. in . acceptable form by the City's Risk Management Administrator; or (ii) the City may, at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. E. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. 16. NONDISCRIMINATION: Provider represents to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider's performance under this Agreement on account of race, color, sex, religion, age, handicap, marital status or national origin. Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. 17. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which may be withheld or conditioned, in the City's sole discretion through the City Manager. Provider may not change or replace sub -contractors .performing work under the Services Agreement identified in Exhibit "B" without the prior written consent from the City Manager. Employee Benefit Dental Plan - PPO 14 18. NOTICES: All notices or other .communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested, addressed to the other party at the address indicated herein or to such other address as a party may designate by notice given as herein provided. Notice shall be deemed given on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: Shawn Afeld Senior Account Executive Guardian Life Insurance Company of America 1511 N. Westshore Blvd, Suite 600 Tampa, Florida 33607 Johnny Martinez City Manager City of Miami '1 /11 SW 2nd Avenue, 10th Floor Miami, FL 33130-1910 19. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County, Florida. Each party shall bear its own attomey's fees. Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and irrevocably waive any objections to said jurisdiction. The parties irrevocably waive any rights to a jury trial. B. Title and paragraph headings are for convenient reference and are not a part of this Agreement. Employee Benefit Dental Plan - PPO 15 C. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the sameorany other provision hereof, and no waiver shall be effective unless made in writing. D. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provision, paragraph, sentence, -word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then the same shall be deemed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. E. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. F. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole authority to extend, to amend or to modify this Agreement on behalf of the City. 20. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 21. INDEPENDENT CONTRACTORS: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, neither Provider, nor its employees, nor any subcontractor Employee Benefit Dental Plan - PPO 16 hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to, any rights or .benefits under .the Civil Service .or. Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to employees of the City are, not available to Provider, its employees, or any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. 22. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written notice. 23. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Maj eure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event. The party seeking delay in Employee Benefit Dental Plan - PPO 17 performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay. shall extend beyond the. duration specified in such notice, additional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. 24. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on account of any delay(s) for any cause over which the City has no control. 25. USE OF NAME: Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Commission. 26. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2- 611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that individual member of Provider, no employee, and no subcontractor under this Agreement nor any immediate family member of any of the same is also a member of any board, commission, or agency of the City. Provider hereby . represents and warrants to the City that Employee Benefit Dental Plan - PPO 18 throughout the term of this Agreement, Provider, its employees and its subcontractors will abide by this prohibition of the. City Code. 27. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. 28. SURVIVAL: All obligations (including but not limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or attributable to the period prior to expiration or earlier termination of this Agreement shall survive such expiration or earlier termination. 29. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force and effect, the wage rates and other factual unit costs supporting the compensation to Provider under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions thereto to exclude any significant sums by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or non- current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 30. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall constitute an original but all of which, when taken together, shall constitute one and the same agreement. Employee Benefit Dental Plan - PPO 19 31. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreementof. the parties relating. to .the subject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. Employee Benefit Dental Plan - PPO 20 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto dulyauthorized,this the day and year above written. "City" CITY OF MIAMI, a municipal ATTEST: corporation By: Dwight S. Danie, City Clerk Johnny Martinez, City Manager "Provider" ATTEST: Guardian Insurance Company of America By: Print Name: Title: (Corporate Seal) TBD (Authorized Corporate Officer) APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: REQUIREMENTS: Julie O. Bru City Attorney Calvin Ellis Risk Management Director Employee Benefit Dental Plan - PPO 21 CORPORATE RESOLUTION WHEREAS, Guardian Insurance Company of America, a -Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; This Resolution needs to authorize the signatory to sign Employee Benefit Dental Plan - PPO 22 EXHIBIT A REQUEST FOR PROPOSAL See Attached Employee Benefit Dental Plan - PPO 23 EXHIBIT B PROVIDER'S PROPOSAL AND RESPONSE TO RFP See Attached Employee Benefit Dental Plan - PPO 24 EXHIBIT C INSURANCE REQUIREMENTS I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General Aggregate Limit $ 2,000,000 Personal and Adv. Injury $ 1,000,000 Products/Completed Operations $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured III. Worker's Compensation Limits of Liability Statutory -State of Florida Waiver of Subrogation IV. Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit V. Professional Liability/Errors and Omissions Coverage Employee Benefit Dental Plan - PPO 25 Combined Single Limit Each Claim $1,000,000 General Aggregate Limit $1,000,000 Deductible- not to exceed 10% The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Employee Benefit Dental Plan - PPO 26 EXHIBIT D COMPENSATION RATES Y� G..^yae.'^�,-. a+f � 3 &. ii rii .i _.,,,)vi •._ J, -. �.Fn r. � iar yy ,K.>, £ca Plan1 �eltt 'Sa.k. -5 i+.,,.;R`' '] kN^ + s. "Na O�un�ry .... .' �... ..�R.IY ..�u 3r�i5, iU, ti� F k .fk t:4..i3zr �k al-.eK,�d°'�" ae �[] hi k y„Q$ +VN clan �, �3S.; �.s ... :c.M' �k .��5%.,,� t�i�v *.4 ; G t Plan it �Q'w�£t^ R.* tn' `Exec YR �, 4 SLAG Vut � .��'1$.. `R' e VG3P�an Rate Census Rate Census Employee Only $26.73 401 $34.81. 49 Employee & Spouse $55.03 62 Employee & Child(ren) $54.56 110 Full Family $97.33 409 $106.38 71 Monthly Premium $59,940.16 $9,258.67 Annual Premium $719,281.92 $111,104.04 Rate Guarantee 3 years 3 years Rates and premiums are based on the employee data submitted. Final rates and premiums are based on the plan and employee/dependent data provided on the enrollment forms. Rates Notes Rates and premiums were determined using a census of all eligible employees and dependents. We reserve the right to adjust rates if actual participation is below assumed level. We reserve the right to not honor this proposal if actual employee participation is below the greater of 25% or 5 enrolled employees. Contributory Status — Voluntary/Non-contributory GUARDIAN" Employee Benefit Dental Plan 27 EXHIBIT E CORPORATE RESOLUTIONS AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA (To be provided upon document execution) Employee Benefit Dental Plan - PPO 28 !lit f KENNETH ROBERTSON JOHNNY MARTINEZ, P.E. Chief Procurement Officer City Manager ... �i. ,fir\ PI 1{� tj ADDENDUM NO. 4 RFP No. 336312 September 20, 2012 Request for Proposals (RFP) for Employee Benefit Dental Plan TO: ALL PROSPECTIVE PROPOSERS: The following changes, additions, clarifications, and deletions amend the RFP documents of the above captioned RFP, and shall become an integral part of the Contract Documents. Words and/or figures stricken through shall be deleted. Underscored words and/or figures shall be added. The remaining provisions are now in effect and remain unchanged. Please note the contents herein and reflect same on the documents you have on hand. Addendum No. 3 was issued electronically on September 13, 2012, changing the RFP closing date and time to Tuesday, September 25, 2012 at 1:00 p.m. The RFP closing date and time has now been changed to Friday, September 28, 2012 at 1:00 p.m. Additionally, and as a result of the contents of Addendum No. 2, please find below Questions frbm prospective proposers and the City's Answers to those Questions: Q1: The PPO experience does not seem to match the revised census. Al: The medical census, titled Benefit Census, and marked as Exhibit 20, reflecting the total number of participants in the City's group medical plan was provided with Addendum No. 2 at the request of one of the prospective proposers, and should not be confused with the dental census, marked as Exhibit 1 (Revised) and Exhibit 2 (Revised). The Benefit Census indicates "Medical" under the °Plan Type" column. It should be noted that not all employees participating in the medical plan are participating in the dental plan. Q2: The revised census shows 1530 lives but it is not broken out to show who is on executive and regular. A2: Please refer to attached updated PPO Census, marked as Exhibit 2 (Revised 09 05 2012) with Executive and Non -Executive participants broken out. Be sure to use the Employee # field as the key record in determining number of plan participants and plan subscribers. Q3: According to the most recent experience, the exec. has 151 lives and the regular has 922 lives, which clearly does not match the revised census. A3: Please refer to Q2. Q4: Can you please confirm if the PPO Revised Census (Exhibit 2 Revised) is, in fact, the correct current enrollment? A4: Please refer to Q2. Q5: Please provide the PPO Revised Census (Exhibit 2 Revised) broken out by plan (voluntary and executive). A5: Please refer to Q2. Q6: Can you please explain why there is such a large discrepancy in the enrollment data provided (1073 in total - Voluntary and Executive) as of July 2012 and what is shown on PPO Revised Census2 (1532 in total)? A6: Please refer to Q2. Page 1 Addendum No. 4 September 20, 2012 RFP No. 336312 — Employee Benefit Dental Plan Q7: Within Attachment 19, it states there are 4 exhibits within the document but #4, the PDP Savings Report is not attached. Can you please provide? A7: Please refer to the attached, marked as Exhibit 19 (Exhibit 4). It should be noted that the Exhibit 2 referenced in. Exhibit 19 had been previously provided through Addendum No. 3 as Exhibit 16. Q8: Is there a possibility of receiving a deadline extension? Until we receive all the pertinent census data, we can't begin to underwrite the requested plans. A8: The RFP closing date has been changed to Friday, September 28, 2012 at 1:00 p.m. as stated on the first page of this addendum. ALL OTHER TERMS AND CONDITIONS OF THE RFP REMAIN THE SAME. KR/ ms Cc: RFP File Sincerely, Kt;nneth Robertson Director/Chief Procurement Officer Page 2 Tit- of woni KENNETH ROBERTSON JOHNNY MARTINEZ, P.E. Chief Procurement Officer City Manager ADDENDUM NO. 2 RFP No. 336312 September 7, 2012 Request for Proposals (RFP) for Employee Benefit Dental Plan TO: ALL PROSPECTIVE PROPOSERS: The following changes, additions, clarifications, and deletions amend the RFP documents of the above captioned RFP, and shall become an integral part of the Contract Documents. Words and/or figures stricken through shall be deleted. Underscored words and/or figures shall be added. The remaining provisions are now in effect and remain unchanged. Please note the contents herein and reflect same on the documents you have on hand. Addendum No. 1 was issued electronically on September 4, 2012, amending Section 2.2. Deadline for submitting requests for information/clarification to reflect a new deadline date of Thursday, September 6, 2012 at 5:00 p.m. Additionally, please find below Questions from prospective proposers and the City's Answers to those Questions received before the stipulated due date: Q1: The City stated in Attachment 15 that Exhibit 10 was the claims . experience for the Executive plan only. However, there are only 140 currently enrolled on the Executive plan and this experience report shows over 1000 enrolled. This seems to be combined experience with both the PPO and Executive plan? Is that a correct assumption? Is there any way to get the Executive experience broken out by month for the past three years? Al: Refer to the attached, marked as Exhibit 16, containing claims experience for the Voluntary PPO and the Executive plan for the period 8/2009 — 7/2012. Q2: Exhibit 6 is stated to be experience for the PPO plan only. However, it only goes through 5/1/2011. Can we please get updated experience broken out by month for the rest of 2011 and YTD 2012. A2: Refer to Q1. Q3: The City stated in Attachment 15 that both the MetLife PPO plan and the Executive plan do not have a fee schedule in network and then that the city does not pay out of network claims. However, they state that the voluntary plan is reimbursed at the 80th OON and the Executive plan is reimbursed at the 90th OON. Can they please clarify? Are these currently PPO plans or MAC plans? A3: They are PPO plans and are reimbursed out -of -network at the R&C level, not MAC. This means that the Executive plan reimburses for out -of -network services at a higher reimbursement level (90th percent of Reasonable & Customary charges than does the voluntary plan which reimburses for out -of -network services at the 80th percentile). Q4: Can you please provide additional claims data for all dental plans through July? A4: Refer to Q1. Q5: Can you confirm how long the DHMO rates have been $12.18 for single coverage and $30.52 for family coverage? A5: These rates have been in place since January 1, 2005. Q6: Can we obtain a copy of the entire DHMO booklet? A6: Refer to the attached, marked as Exhibit 17. Page 1 Addendum No. 2 September 7, 2012 RFP No. 336312 — Employee Benefit Dental Plan Q7: Can we obtain a copy of the most recent Solstice bill? A7: Refer to the attached, marked as Exhibit 18. Q8: Page 38 of the RFP requests a service fee schedule for all applicable locations, can you clarify? Are you looking for specific procedures codes and what our reimbursement levels are for those codes? A8: Yes, we are looking for specific procedure codes and their reimbursement levels. Q9: Has Met Life been the current dental carrier since 2008? Q9: Yes. Q10: Is additional claims experience available prior to 06/2011? A10: Refer to Q1. Q11:.Exhibit .10 is labeled.as "Executive Plan Claims Experience". Due to the enrollment on this report, it appears to be for the total population. Please confirm that Exhibit 10 represents claims for both Executive and Voluntary PPO plans. All: Refer to Q1. Q12: Exhibit 6 — Voluntary Plan Claims Experiences was provided from June 2010 through May 2011. Can you provide Voluntary claim and enrollment data from June 2011 through May 2012? Al2: Refer to Q1. Q13: Exhibit 13 — Dental PPO Utilization Report was provided for the period 1/1/2010 through 9/30/2011. Can you provide an updated report through June, 2012? A13: Refer to Q1. Q14: Does Exhibit 13 — Dental PPO Utilization Report represent both the Voluntary and Executive PPO plans? If not, please provide reports by plan (Le. Voluntary and Executive). A14: Refer to Q1. Q15: Can you please confirm a due date of Sept. 18th? A15.: The RFP is schedule to close on Tuesday, September 18, 2012 at 1:00 p.m. Q16: The PPO census provided does not have the zip codes listed needed to run a disruption report. Can you please provide a revised PPO census? A16: Refer to the attached, marked as Exhibit 2 (Revised). Q17: It seems that zip codes were only provided for the employeesin the DMO, we would need them for the PPO as well. A17: Refer to Q16. Q18: We note that there is a disruption report in pdf format, however, this would be needed in excel format. A18: Refer to the attached; marked as Exhibit 3(Revised) Q19: We found the rate history, however, it ends at 2010, we would need 2011 & 12, and if possible, the renewal. A19: Refer to the attached, marked as Exhibit 19, with the MetLife renewal for the Voluntary Dental PPO and the executive plan. This includes rates for 2012. The rates for 2011 are: Voluntary EE Only $30.55 EE + Spouse $62.91 EE + Child(ren) $62.36 EE + Family " $111.24 Executive Plan EE Only $39.78 EE + Family $121.58 The renewal from Solstice has not yet been received. Page 2 Addendum No. 2 September 7, 2012 RFP No. 336312 — Employee Benefit Dental Plan Q20: Do both plans have the same rates? A20: The plans do not have the same rates. Q21: I have been told that the DHMO disruption file (exhibit 3) does not have enough information for us to complete an accurate report. We will need the following information in addition: • Complete address including zip code of the facility they work at • TIN of the facility A21: Refer to the attached, marked as Exhibit 3 (Revised). Q22: Does the census show the employees who are taking the coverage? If so, will you please send a census that shows all eligible. A22: Refer to the attached census spreadsheet, marked as Exhibit 20, based on the total population of City employees and retirees that are participating in the Group Benefit Plan. Q23: Their census is 4 tier, but rates are 2 tier (Executive plan and DMO) and 4 tier (PPO). Please confirm if you would like us to match current tiers. A23: Please match the current 2 tier (HMO) and 4 tier (PPO) rate structure. In addition, please provide a separate 4 tier rate structure for the DHMO plan. Q24: Is the executive plan voluntary too? The regular PPO is, please confirm. A24: The Executive plan is paid for by the City of Miami. It is not voluntary. Q25: The enrollment shown on the rate exhibit is very different from the enrollment I'm .getting on the census. Is the census complete? Is the rate exhibit incorrect? Below is what we are finding on each of the documents. Rate exhibit Census DMO - 1800 500 PPO 881 982 _ Exec 140 121 A25: An updated census for the DHMO (Solstice) and DPPO (MetLife) are attached, marked as Exhibit 1 (Revised) and Exhibit 2 (Revised). Q26: The document labeled executive claims appears not correct. It lists subscribers in the 1000 subs range, but this plan should only have about 140 people enrolled according to their other documents. We do not seem to find • 2012 claims. Please provide monthly claims, FOR EACH PLAN, with corresponding enrollment and premium (if possible) for at least the last 12 months. A26: Refer to Q1. Q27: Can you provide us with the DPPO census including home zip codes? A27: Refer to Q16. Q28: Can you provide addresses for the Dentists that are in the Solstice Network for purposes of running a more accurate disruption report? A28: Refer to Q21. Q29: Please provide a price sheet where we need to enter the amount for Section 1.64 Prompt Payment? A29: This should be included as part of your proposal response. Q30: The RFP requests as Attachment B that we provide "Service Fee Schedules for all applicable locations". Can you please clarify what the City is looking for here? A30: We are looking for the provider contracted amounts for dental procedures in the geographic areas where the City of Miami has members. Q31: The RFP is asking for a GEO Access Report by Specialty for 2 in 15. However, I only have a census with zip codes for those employees on the DHMO. The PPO & Executive census did not provide a zip code. Do you think we can obtain that information? A31: Refer to Q16. Page 3 Addendum No. 2 RFP No. 336312 — Employee Benefit Dental Plan Q32: The unfortunate issue is that we cannot even start to underwrite this until we receive the information from you on the claims and census. We would like to request an additional week to get this underwritten. Please let me know if the City of Miami can grant an extension. A32: The RFP closing date and time cannot be changed. Q33: The dental PPO experience ends May 2011. Please provide financial experience from June 2011 through to the most current, at least through June 2012. A33: Refer to Q1. Q34: Please provide zip codes for the PPO census. A34: Refer to Q16. September 7, 2012 Q35: Can you please provide zip codes for the DPPO census? At this time we can only run the Geo access reports on the DMO census, since it is the only one with zip codes. A35: Refer to Q16. Q36:. On page 19 (1.60 G) you request 1 original and 3 copies of the RFP, but on page 36 (4.1) you request 1 original and 10 copies. Can you tell us which is correct? A36: 1 original and five (5) copies is the correct distribution. Section 4.1. Submission Requirements has been amended to reflect the correct number of copies. Q37: Would consecutive numbering within sections be acceptable, (re: pg 36, section 4.1 2 Table of Contents)? (Le. numbering would start at "Page 1" for each section). A37: Yes, consecutive number within the sections is acceptable. Q38: There are discrepancies regarding enrollment by tier when comparing the "dental costs" sheet provided in the RFP with the current group census. Will you please provide/confirm the correct enrollment by tier and by plan? A38: Refer to Q25. ALL OTHER TERMS AND CONDITIONS OF THE RFP REMAIN THE SAME. -KR/ ms Cc: RFP File Sincerely, Kenneth Robertson Director/Chief Procurement Officer Page 4 City of Miami Request for Proposals (RFP) Purchasing Department Miami Riverside Center 444 SW 2nd Avenue, 6d' Floor Miami, Florida 33130 Web Site Address: http://ci.miami.Fl.us/procurement RFP Number: 336312,4 Title: Request for Proposals for Employee Benefit Dental Plan Issue Date/Time: 16-AUG-2012 RFP Closing Date/Time: 09/28/2012 @ 13:00:00 Pre -Bid Conference: None Pre -Bid Date/Time: Pre -Bid Location: Deadline for 'Request for Clarification: Thursday, September 6, 2012 at 5:00 P.M. Buyer: Hard Copy Submittal Location: Buyer E-Mail Address: Buyer Facsimile: Suarez, Maritza City of Miami - City Clerk 3500 Pan American Drive Miami FL 33133 US msuarezci.miami.fl.us (305) 400-5025 Page 1 of 39 Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to -this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: We (I) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: SUPPLIER NAME- ADDRESS - PHONE. FAX EMAIL: BEEPER. SIGNED BY - TITLE: DATE. FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISOUALIFY THIS BID. Page 2 of 39 Certifications Legal Name of Firm: Entity Type: Partnership, Sole Proprietorship, Corporation, etc. Year Established: Office Location: City of Miami, Miami -Dade County, or Other Occupational License Number: Occupational License Issuing Agency: Occupational License Expiration Date: Page 3 of 39 Line: 1 Description: Disregard this line item. Please refer to Attachment A Category: 94620-10 Unit of Measure: Dollar Unit Price: $ Number of Units: 1 Total: $ Page 4 of 39 Request for Proposals (RFP) 336312,4 Table of Contents Terms and Conditions 6 1. General Conditions 6 1.1. GENERAL TERMS AND CONDITIONS 6 2. Special Conditions 26 2.1. PURPOSE 26 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/CLARIFICATION 26 2.3. TERM OF CONTRACT 26 2.4. CONDITIONS FOR RENEWAL 26 2.5. NON -APPROPRIATION OF FUNDS 26 2.6. MINIMUM QUALIFICATION REQUIREMENTS .27 2.7. CONTRACT EXECUTION 27 2.8. FAILURE TO PERFORM 27 2.9. INSURANCE REQUIREMENTS 28 2.10. PRE-BID/PRE-PROPOSAL CONFERENCE 29 2.11. CONTRACT ADMINISTRATOR 30 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) 30 2.13. COMPLETE PROJECT REQUIRED 30 2.14. TERMINATION 30 2.15. ADDITIONAL TERMS AND CONDITIONS 31 2.16. CHANGES/ALTERATIONS 31 2.17. COMPENSATION PROPOSAL 31 2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD 31 2.19. ADDITIONAL SERVICES 32 2.20. RECORDS 32 2.21. AMENDMENTS TO THE CONTRACT 32 2.22. TRUTH IN NEGOTIATION CERTIFICATE 33 3. Specifications 34 3.1. SPECIFICATIONS/SCOPE OF WORK 34 4. Submission Requirements 36 4.1. SUBMISSION REQUIREMENTS 36 5. Evaluation Criteria 39 5.1. EVALUATION CRITERIA 39 Page 5 of 39 Request for Proposals (RFP) 336312,4 Terms and Conditions 1. General Conditions 1.1. GENERAL TERMS AND CONDITIONS Intent: The General Terms and Conditions described herein apply to the acquisition of goods/equipment/services with an estimated aggregate cost of $25,000.00 or more. Definition: A formal solicitation is defined as issuance of an Invitation for Bids, Request for Proposals, Request for Qualifications, or Request for Letters of Interest pursuant to the City of Miami Procurement Code and/or Florida Law, as amended. Formal Solicitation and Solicitation shall be defined in the same manner herein. 1.1. ACCEPTANCE OF GOODS OR EQUIPMENT - Any good(s) or equipment delivered under this formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with the terms herein and be fully in accordance with specifications and of the highest quality. In the event the goods/equipment supplied to the City are found to be defective or does not conform to specifications, the City reserves the right to cancel the order upon written notice to the Contractor and return the product to the Contractor at the Contractor's expense. 1.2. ACCEPTANCE OF OFFER - The signed or electronic submission of your solicitation response shall be considered an offer on the part of the bidder/proposer; such offer shall be deemed accepted upon issuance by the City of a purchase order. 1.3. ACCEPTANCE/REJECTION — The City reserves the right to accept or reject any or all responses or parts of after opening/closing date and request re -issuance on the goods/services described in the formal solicitation. In the event of such rejection, the Director of Purchasing shall notify all affected bidders/proposers and make available a written explanation for the rejection. The City also reserves the right to reject the response of any bidder/proposer who has previously failed to properly perform under the terms and conditions of a contract, to deliver on time contracts of a similar nature, and who is not in a position to perform the requirements defined in this formal solicitation. The City further reserves the right to waive any irregularities or minor informalities or technicalities in any or all responses and may, at its discretion, re -issue this formal solicitation. 1.4. ADDENDA — It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are available at the City's website at: http://www.ci.miami.fl.us/procurement 1.5. ALTERNATE RESPONSES MAY BE CONSIDERED - The City may consider one (1) alternate response from the same Bidder/Proposer for the same formal solicitation; provided, that the alternate response offers a different product that meets or exceeds the formal solicitation requirements. In order for the City to consider an alternate response, the Bidder/Proposer shall complete a separate Price Sheet form and shall mark "Alternate Response". Alternate response shall be placed in the same response. This provision only applies to formal solicitations for the procurement of goods, services, items, equipment, materials, and/or supplies. 1.6. ASSIGNMENT - Contractor agrees not to subcontract, assign, transfer, convey, sublet, or otherwise dispose of the resulting Contract, or any or all of its right, title or interest herein, without City of Miami's prior written consent. 1.7. ATTORNEY'S FEES - In connection with any litigation, mediation and arbitration arising out of this Contract, each party shall bear their own attorney's fees through and including appellate litigation and any post judgment Page 6 of 39 Request for Proposals (RFP) 336312,4 proceedings. 1.8. AUDIT RIGHTS AND RECORDS RETENTION - The Successful Bidder/Proposer agrees to provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any books, documents, papers, and records of Contractor which are directly pertinent to this formal solicitation, for the purpose of audit, examination, excerpts, and transcriptions. The Successful Bidder/Proposer shall maintain and retain any and all of the books, documents, papers and records pertinent to the Contract for three (3) years after the City makes final payment and all other pending matters are closed. Contractor's failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract by the City. 1.9. AVAILABILITY OF CONTRACT STATE-WIDE - Any Governmental, not -for -profit or quasi -governmental entity in the State of Florida, may avail itself of this contract and purchase any and all goods/services, specified herein from the successful bidder(s)/proposer(s) at the contract price(s) established herein, when permissible by federal, state, and local laws, rules, and regulations. Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and resulting bid contract or agreement will establish its own contract/agreement, place its own orders, issue its own purchase orders, be invoiced there from and make its own payments, determine shipping terms and issue its own exemption certificates as required by the successful bidder(s)/proposer(s). 1.10. AWARD OF CONTRACT: A. The Formal Solicitation, Bidder's/Proposer's response, any addenda issued, and the purchase order shall constitute the entire contract, unless modified in accordance with any ensuing contract/agreement, amendment or addenda. B. The award of a contract where there are Tie Bids will be decided by the Director of Purchasing or designee in the instance that Tie Bids can't be determined by applying Florida Statute 287.087, Preference to Businesses with Drug -Free Workplace Programs. C. The award of this contract may be preconditioned on the subsequent submission of other documents as specified in the Special Conditions or Technical Specifications. Bidder/Proposer shall be in default of its contractual obligation if such documents are not submitted in a timely manner and in the form required by the City. Where Bidder/Proposer is in default of these contractual requirements, the City, through action taken by the Purchasing Department, will void its acceptance of the Bidder's/Proposer's Response and may accept the Response from the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution from Bidder/Proposer and its bid/proposal bond or guaranty, if applicable, as a result of damages or increased costs sustained as a result of the Bidder's/Proposer's default. D. The term of the contract shall be specified in one of three documents which shall be issued to the successful Bidder/Proposer. These documents may either be a purchase order, notice of award and/or contract award sheet. E. The City reserves the right to automatically extend this contract for up to one hundred twenty (120) calendar days beyond the stated contract term in order to provide City departments with continual service and supplies while a new contract is being solicited, evaluated, and/or awarded. If the right is exercised, the City shall notify the Bidder/Proposer, in writing, of its intent to extend the contract at the same price, terms and conditions for a specific number of days. Additional extensions over the first one hundred twenty (120) day extension may occur, if, the City and the Successful Bidder/Proposer are in mutual agreement of such extensions. F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude upon completion of the expressed or implied warranty periods. Page 7 of 39 Request for Proposals (RFP) 336312,4 G. The City reserves the right to award the contract on a split -order, lump sum or individual -item basis, or such combination as shall best serve the interests of the City unless otherwise specified. H. A Contract/Agreement may be awarded to the Bidder/Proposer by the City Commission based upon the minimum qualification requirements reflected herein. As a result of a RFP, RFQ, or RFLI, the City reserves the right to execute or not execute, as applicable, an Agreement with the Proposer, whichever is determined to be in the City's best interests. Such agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. 1.11. BID BOND/ BID SECURITY - A cashier's or certified check, or a Bid Bond signed by a recognized surety company that is licensed to do business in the State of Florida, payable to the City of Miami, for the amount bid is required from all bidders/proposers; if so indicated under the Special Conditions. This check or bond guarantees that a bidder/proposer will accept the order or contract/agreement, as bid/proposed, if it is awarded to bidder/proposer. Bidder/Proposer shall forfeit bid deposit to the City should City award contract/agreement to Bidder/Proposer and Bidder/Proposer fails to accept the award. The City reserves the right to reject any and all surety tendered to the City. Bid deposits are returned to unsuccessful bidders/proposers within ten (10) days after the award and successful bidder's/proposer' s acceptance of award. If sixty (60) days have passed after the date of the formal solicitation closing date, and no contract has been awarded, all bid deposits will be returned on demand. 1.12. RESPONSE FORM (HARDCOPY FORMAT) - All forms should be completed, signed and submitted accordingly. 1.13. BID SECURITY FORFEITED LIQUIDATED DAMAGES - Failure to execute an Agreement and/or file an acceptable Performance Bond, when required, as provided herein, shall be just cause for the annulment of the award and the forfeiture of the Bid Security to the City, which forfeiture shall be considered, not as a penalty, but in mitigation of damages sustained. Award may then be made to the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or all responses may be rejected. 1.14. BRAND NAMES - If and wherever in the specifications brand names, makes, models, names of any manufacturers, trade names, or bidder/proposer catalog numbers are specified, it is for the purpose of establishing the type, function, minimum standard of design, efficiency, grade or quality of goods only. When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is added. When bidding/proposing an approved equal, Bidders/Proposers will submit, with their response, complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the City to evaluate and determine the equality of the item(s) bid/proposed. The City shall be the sole judge of equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be requested if the proposed brand is other than specified by the City. Such samples are to be furnished after formal solicitation opening/closing only upon request of the City. If samples should be requested, such samples must be received by the City no later than seven (7) calendar days after a formal request is made. 1.15. CANCELLATION - The City reserves the right to cancel all formal solicitations before its opening/closing. In the event of bid/proposal cancellation, the Director of Purchasing shall notify all prospective bidders/proposers and make available a written explanation for the cancellation. 1.16. CAPITAL EXPENDITURES - Contractor understands that any capital expenditures that the firm makes, or prepares to make, in order to deliver/perform the goods/services required by the City, is a business risk which the contractor must assume. The City will not be obligated to reimburse amortized or unamortized capital expenditures, or to maintain the approved status of any contractor. If contractor has been unable to recoup its capital expenditures during the time it is rendering such goods/services, it shall not have any claim upon the City. 1.17. CITY NOT LIABLE FOR DELAYS - It is further expressly agreed that in no event shall the City be liable Page 8 of 39 Request for Proposals (RFP) 336312,4 for, or responsible to, the Bidder/Proposer/Consultant, any sub-contractor/sub-consultant, or to any other person for, or on account of, any stoppages or delay in the work herein provided for by injunction or other legal or equitable proceedings or on account of any delay for any cause over which the City has no control. 1.18. COLLUSION —Bidder/Proposer, by submitting a response, certifies that its response is made without previous understanding, agreement or connection either with any person, firm or corporation submitting a response for the same items/services or with the City of Miami's Purchasing Department or initiating department. The Bidder/Proposer certifies that its response is fair, without control, collusion, fraud or other illegal action. Bidder/Proposer certifies that it is in compliance with the Conflict of Interest and Code of Ethics Laws. The City will investigate all potential situations where collusion may have occurred and the City reserves the right to reject any and all bids/responses where collusion may have occurred. 1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Contractor understands that contracts between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, records keeping, etc. City and Contractor agree to comply with and observe all applicable laws, codes and ordinances as that may in any way affect the goods or equipment offered, including but not limited to: A. Executive Order 11246, which prohibits discrimination against any employee, applicant, or client because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following: employment practices, rate of pay or other compensation methods, and training selection. B. Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation. C. The State of Florida Statutes, Section 287.133(3)(A) on Public Entity Crimes. D. Environment Protection Agency (EPA), as applicable to this Formal Solicitation. E. Uniform Commercial Code (Florida Statutes, Chapter 672). F. Americans with Disabilities Act of 1990, as amended.. G. National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation. H. National Forest Products Association (NFPA), as applicable to this Formal Solicitation. I. City Procurement Ordinance City Code Section 18, Article III. J. Conflict of Interest, City Code Section 2-611;61. K. Cone of Silence, City Code Section 18-74. L. The Florida Statutes Sections 218.73 and 218.74 on Prompt Payment.. .. Lack of knowledge by the bidder/proposer will in no way be a cause for relief from responsibility. Non-compliance with all local, state, and federal directives, orders, and laws may be considered grounds for termination of contract(s). i Copies of the City Ordinances may be obtained from the City Clerk's Office. 1.20. CONE OF SILENCE - Pursuant to Section 18-74 of the City of Miami Code, a "Cone of Silence" is imposed upon each RFP, RFQ, RFLI, or IFB after advertisement and terminates at the time the City Manager issues a written recommendation to the Miami City Commission. The Cone of Silence shall be applicable only to Contracts for the provision of goods and services and public works or improvements for amounts greater than S200,000. The Cone of Silence prohibits any communication regarding RFPs, RFQs, RFLI or IFBs (bids) between, among others: Page 9 of 39 Request for Proposals (RFP) 336312,4 Potential vendors, service providers, bidders, lobbyists or consultants and the City's professional staff including, but not limited to, the City Manager and the City Manager's staff; the Mayor, City Commissioners, or their respective staffs and any member of the respective selection/evaluation committee. The provision does not apply to, among other communications: oral communications with the City purchasing staff, provided the communication is limited strictly to matters of process or procedure already contained in the formal solicitation document; the provisions of the Cone of Silence do not apply to oral communications at duly noticed site visits/inspections, pre -proposal or pre -bid conferences, oral presentations before selection/evaluation committees, contract negotiations during any duly noticed public meeting, or public presentations made to the Miami City Commission during a duly noticed public meeting; or communications in writing or by email at any time with any City employee, official or member of the City Commissionunless specifically prohibited by the applicable RFP, RFQ, RFLI or IFB (bid) documents (See- Section 2.2. of the Special Conditions); or communications in connection with the collection of industry comments or the performance of market research regarding a particular RFP, RFQ, RFLI OR IFB by City. Purchasing staff. Proposers or bidders must file a copy of any written communications with the Office of the City Clerk, which shall be made available to any person upon request. The City shall respond in writing and file a copy with the Office of the City Clerk, which shall be made available to any person upon request. Written communications may be in the form of e-mail, with a copy to the Office of the City Clerk. In addition to any other penalties provided by law, violation of the Cone of Silence by any proposer or bidder shall render any award voidable. A violation by a particular Bidder, Proposer, Offeror, Respondent, lobbyist or consultant shall subject same to potential penalties pursuant to the City Code. Any person having personal knowledge of a violation of these provisions shall report such violation to the State Attorney and/or may file a complaint with the Ethics Commission. Proposers or bidders should reference Section 18-74 of the City of Miami Code for further clarification. This language is only a summary of the key provisions of the Cone of Silence. Please review City of Miami Code Section 18-74 for a complete and thorough description of the Cone of Silence. You may contact the City Clerk at 305-250-5360, to obtain 'a copy of same. 1.21. CONFIDENTIALITY - As a political subdivision, the City of Miami is subject to the Florida Sunshine Act and Public Records Law. If this Contract/Agreement contains a confidentiality provision, it shall have no application when disclosure is required by Florida law or upon court order. 1.22. CONFLICT OF INTEREST — Bidders/Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm. A. Bidder/Proposer further agrees not to use or attempt to use any knowledge, property or resource which may be within his/her/its trust, or perform his/her/its duties, to secure a special privilege, benefit, or exemption for himself/herself/itself, or others. Bidder/Proposer may not disclose or use information not available to members of the general public and gained by reason of his/her/its position, except for information relating exclusively to governmental practices, for his/her/its personal gain or benefit or for the personal gain or benefit of any other person or business entity. B. Bidder/Proposer hereby acknowledges that he/she/it has not contracted or transacted any business with the City or any person or agency acting for the City, and has not appeared in representation of any third party before any Page 10 of 39 Request for Proposals (RFP) 336312,4 board, commission or agency of the City within the past two years. Bidder/Proposer further warrants that he/she/it is not related, specifically the spouse, son, daughter, parent, brother or sister, to: (i) any member of the commission; (ii) the mayor; (iii) any city employee; or (iv) any member of any board or agency of the City. C. A violation of this section may subject the Bidder/Proposer to immediate termination of any professional services agreement with the City, imposition of the maximum fine and/or any penalties allowed by law. Additionally, violations may be considered by and subject to action by the Miami -Dade County Commission on Ethics. 1.23. COPYRIGHT OR PATENT RIGHTS — Bidders/Proposers warrant that there has been no violation of copyright or patent rights in manufacturing, producing, or selling the goods shipped or ordered and/or services provided as a result of this formal solicitation, and bidders/proposers agree to hold the City harmless from any and all liability, loss, or expense occasioned by any such violation. 1.24. COST INCURRED BY BIDDER/PROPOSER - All expenses involved with the preparation and submission of Responses to the City, or any work performed in connection therewith shall be borne by the Bidder(s)/Proposer(s). 1.25. DEBARMENT AND SUSPENSIONS (Sec 18-107) (a) Authority and requirement to debar and suspend. After reasonable notice to an actual or prospective Contractual Party, and after reasonable opportunity for such party to be heard, the City Manager, after consultation with the Chief Procurement Officer and the city attorney, shall have the authority to debar a Contractual Party, for the causes listed below, from consideration for award of city Contracts. The debarment shall be for a period of not fewer than three years. The City Manager shall also have the authority to suspend a Contractual Party from consideration for award of city Contracts if there is probable cause for debarment, pending the debarment determination. The authority to debar and suspend contractors shall be exercised in accordance with regulations which shall be issued by the Chief Procurement Officer after approval by the City Manager, the city attorney, and the City Commission. (b) Causes for debarment or suspension. Causes for debarment or suspension include the following: (1) Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public or private Contract or subcontract, or incident to the performance of such Contract or subcontract. (2) Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property, or any other offense indicating a lack of business integrity or business honesty. (3) Conviction under state or federal antitrust statutes arising out of the submission of Bids or Proposals. (4) Violation of Contract provisions, which is regarded by the Chief Procurement Officer to be indicative of nonresponsibility. Such violation may include failure without good cause to perform in accordance with the terms and conditions of a Contract or to perform within the time limits provided in a Contract, provided that failure to perform caused by acts beyond the control of a party shall not be considered a basis for debarment or suspension. (5) Debarment or suspension of the Contractual Party by any federal, state or other governmental entity. (6) .False certification pursuant to paragraph (c) below. (7) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which Page 11 of 39 Request for Proposals (RFP) 336312,4 the violation remains noncompliant. (8) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which a civil penalty or fine is due and owing to the city. (9) Any other cause judged by the City Manager to be so serious and compelling as to affect the responsibility of the Contractual Party performing city Contracts. (c) Certification. All Contracts for goods and services, sales, and leases by the city shall contain a certification that neither the Contractual Party nor any of its principal owners or personnel have been convicted of any of the violations set forth above or debarred or suspended as set forth in paragraph (b)(5). (d) Debarment and suspension decisions. Subject to the provisions of paragraph (a), the City Manager shall render a written decision stating the reasons for the debarment or suspension. A copy of the decision shall be provided promptly to the Contractual Party, along with a notice of said party's right to seek judicial relief. 1.26. DEBARRED/SUSPENDED VENDORS —An entity or affiliate who has been placed on the State of Florida debarred or suspended vendor list may not submit a response on a contract to provide goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit response on leases of real property to a public entity, may not award or perform work as a contractor, supplier, subcontractor, or consultant under contract with any public entity, and may not transact business with any public entity. 1.27. DEFAULT/FAILURE TO PERFORM - The City shall be the sole judge of nonperformance, which shall include any failure on the part of the successful Bidder/Proposer to accept the award, to furnish required documents, and/or to fulfillany portion of this contract within the time stipulated. Upon default by the successful Bidder/Proposer to meet any terms of this agreement, the City will notify the Bidder/Proposer of the default and will provide the contractor three (3) days (weekends and holidays excluded) to remedy the default. Failure on the contractor's part to correct the default within the required three (3) days shall result in the Contract being terminated and upon the City notifying in writing the contractor of its intentions and the effective date of the termination. The following shall constitute default: A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the time required or failing to use the subcontractors, entities and personnel as identified and set forth, and to the degree specified in the Contract. B. Failure to begin the work under this Contract within the time specified. C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to ensure timely completion. D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as nonconforming with the terms of the Contract. E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the successful Bidder/Proposer incapable of performing the work in accordance with and as required by the Contract. F. Failure to comply with any of the terms of the Contract in any material respect. All costs and charges incurred by the City as a result of a default or a default incurred beyond the time limits stated, together with the cost of completing the work, shall be deducted from any monies due or which may become due on Page 12 of 39 Request for Proposals (RFP) 336312,4 this Contract. 1.28. DETERMINATION OF RESPONSIVENESS - Each Response will be reviewed to determine if it is responsive to the submission requirements outlined in the Formal Solicitation. A "responsive" response is one which follows the requirements of the formal solicitation, includes all documentation, is submitted in the format outlined in the formal solicitation, is of timely submission, and has appropriate signatures as required on each document. Failure to comply with these requirements may deem a Response non -responsive. 1.29. DISCOUNTS OFFERED DURING TERM OF CONTRACT - Discount Prices offered in the response shall be fixed after the award by the Commission, unless otherwise specified in the Special Terms and Conditions. Price discounts off the original prices quoted in the response will be accepted from successful Bidder(s)/Proposer(s) during the term of the contract. Such discounts shall remain in effect for a minimum of 120 days from approval by the City Commission Any discounts offered by a manufacturer to-Bidder/Proposer will be passed on to the City. 130. DISCREPANCIES, ERRORS, AND OMISSIONS - Any discrepancies, errors, or ambiguities in the Formal Solicitation or addenda (if any) should be reported in writing to the City's Purchasing Department. Should it be found necessary, a written addendum will be incorporated in the Formal Solicitation and will become part of the purchase agreement (contract documents). The City will not be responsible for any oral instructions, clarifications, or other communications. A. Order of Precedence — Any inconsistency in this formal solicitation shall be resolved by giving precedence to the following documents, the first of such list being the governing documents. 1) Addenda (as applicable) 2) Specifications 3) Special Conditions 4) General Terms and Conditions 1.31. EMERGENCY / DISASTER PERFORMANCE - In the event of a hurricane or other emergency or disaster situation, the successful vendor shall provide the City with the commodities/services defined within the scope of this formal solicitation at the price contained within vendor's response. Further, successful vendor shall deliver/perform for the city on a priority basis during such times of emergency. 1.32. ENTIRE BB) CONTRACT OR AGREEMENT - The Bid Contract or Agreement consists of this City of Miami Formal Solicitation and specifically this General Conditions Section, Contractor's Response and any written agreement entered into by the City of Miami and Contractor in cases involving RFPs, RFQs; and RFLIs, and represents the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes all other negotiations, understanding and representations, if any, made by and between the parties. To the extent that the agreement conflicts with, modifies, alters or changes any of the terms and conditions contained in the Formal Solicitation and/or Response, the Formal Solicitation and then the Response shall control. This Contract may be modified only by a written agreement signed by the City of Miami and Contractor. 1.33. ESTIMATED QUANTITIES -Estimated quantities or estimated dollars are provided for your guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the contract period. The City is not obligated to place an order for any given amount subsequent to the award of this contract. Said estimates may be used by the City for purposes of determining the low bidder or most advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities at the prices bid/proposed or at lower prices in this Formal Solicitation. 1.34. EVALUATION OF RESPONSES Page 13 of 39 Request for Proposals (RFP) 336312,4 A.Rejection of Responses The City may reject a Response for any of the following reasons: 1) Bidder/Proposer fails to acknowledge receipt of addenda; 2) Bidder/Proposer mistates or conceals any material fact in the Response ; 3) Response does not conform to the requirements of the Formal Solicitation; 4) Response requires a conditional award that conflicts with the method of award; 5) Response does not include required samples, certificates, licenses as required; and, 6) Response was not executed by the Bidder's/Proposer(s) authorized agent. The foregoing is not an all inclusive list of reasons for which a Response may be rejected. The City may reject and re -advertise for all or any part of the Formal Solicitation whenever it is deemed in the best interest of the City. B. Elimination From Consideration 1) A contract shall not be awarded to any person or firm which is in arrears to the City upon any debt or contract, or which is a defaulter as surety or otherwise upon any obligation to the City. 2) A contract may not be awarded to any person or firm which has failed to perform under the terms and conditions of any previous contract with the City or deliver on time contracts of a similar nature. 3) A contract may not be awarded to any person or firm which has been debarred by the City in accordance with the City's Debannent and Suspension Ordinance. C. Determination of Responsibility 1) Responses will only be considered from entities who are regularly engaged in the business of providing the goods/equipment/services required by the Formal Solicitation. Bidder/Proposer must be able to demonstrate a satisfactory record of performance and integrity; and, have sufficient financial, material, equipment, facility, personnel resources, and expertise to meet all contractual requirements. The terms "equipment and organization" as used herein shall be construed to mean a fully equipped and well established entity in line with the best industry practices in the industry as determined by the City. 2) The City may consider any evidence available regarding the financial, technical and other qualifications and abilities of a Bidder/Proposer, including past performance (experience) with the City or any other governmental entity in making the award. 3) The City may require the Bidder(s)/Proposer(s) to show proof that they have been designated as an authorized representative of a manufacturer or supplier which is the actual source of supply, if required by the Formal Solicitation. 1.35. EXCEPTIONS TO GENERAL AND/OR SPECIAL CONDITIONS OR SPECIFICATIONS - Exceptions to the specifications shall be listed on the Response and shall reference the section. Any exceptions to the General or Special Conditions shall be cause for the bid (IFB) to be considered non -responsive. It also may be cause for a RFP, RFQ, or RFLI to be considered non -responsive; and, if exceptions are taken to the terms and conditions of the resulting agreement it may lead to terminating negotiations. 1.36. F.O.B. DESTINATION - Unless otherwise specified in the Formal Solicitation, all prices quoted/proposed by the bidder/proposer must be F.O.B. DESTINATION, inside delivery, with all delivery costs and charges included in the bid/proposal price, unless otherwise specified in this Formal Solicitation. Failure to do so may be cause for rejection of bid/proposal. Page 14 of 39 Request for Proposals (RFP) 336312,4 1.37. FIRM PRICES - The bidder/proposer warrants that prices, terms, and conditions quoted in its response will be firm throughout the duration of the contract unless otherwise specified in the Formal Solicitation. Such prices will remain firm for the period of performance or resulting purchase orders or contracts, which are to be performed or supplied over a period of time. 1.38. FLORIDA MINIMUM WAGE - The Constitution of the State of Florida, Article X, Section 24, states that employers shall pay employee wages no less than the minimum wage for all hours worked in Florida. Accordingly, it is the contractor's and its' subcontractor(s) responsibility to understand and comply with this Florida constitutional minimum wage requirement and pay its employees the current established hourly minimum wage rate, which is subject to change or adjusted by the rate of inflation using the consumer price index for urban wage eamers and clerical workers, CPI-W, or a successor index as calculated by the United States Department of Labor. Each adjusted minimum wage rate calculated shall be determined and published by the Agency Workforce Innovation on September 30th of each year and take effect on the following January 1st. At the time of responding, it is bidder/proposer and his/her subcontractor(s), if applicable, full responsibility to determine whether any of its employees may be impacted by this Florida Law at any given point in time during the term of the contract. If impacted, bidder/proposer must furnish employee name(s), job title(s), job description(s), and current pay rate(s). Failure to submit this information at the time of submitting a response constitute successful bidder's/proposer's acknowledgement and understanding that the Florida Minimum Wage Law will not impact its prices throughout the term of contract and waiver of any contractual price increase request(s). The City reserves the right to request and successful bidder/proposer must provide for any and all information to make a wage and contractual price increase(s) determination. 139. GOVERNING LAW AND VENUE - The validity and effect of this Contract shall be governed by the laws of the State of Florida. The parties agree that any action, mediation or arbitration arising out of this Contract shall take place in Miami -Dade County, Florida. 1.40. HEADINGS AND TERMS - The headings to the various paragraphs of this Contract have been inserted for convenient reference only and shall not in any manner be construed as modifying, amending or affecting in any way the expressed terms and provisions hereof. 1.41. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) - Any person or entity that performs or assists the City of Miami with a function or activity involving the use or disclosure of "individually identifiable health information (IIHI) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of •1996 and the City of Miami Privacy Standards. HIPAA mandates for privacy, security and electronic transfer standards, which include but are not limited to: A. Use of information only for performing services required by the contract or as required by law; B. Use of appropriate safeguards to prevent non -permitted disclosures; C. Reporting to the City of Miami of any non -permitted use or disclosure; D. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to the Bidder/Proposer and reasonable assurances that III-I/PHI will be held confidential; E. Making Protected Health Information (PHI) available to the customer; F. Making PHI available to the customer for review and amendment; and incorporating any amendments requested by the customer; G. Making PHI available to the City of Miami for an accounting of disclosures; and H. Making internal practices, books and records related to PHI available to the City of Miami for compliance audits. Page 15 of 39 Request for Proposals (RFP) 336312,4 PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its privacy information practices including specifically, a description of the types of uses and disclosures that would be made with protected health information. 1.42 INDEMNIFICATION - Contractor shall indemnify , hold harmless and defend the City, its officials, officers, agents, directors, and employees, from liabilities, damages, losses, and costs, including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance of this Contract and will indemnify, hold harmless and defend the City, its officials, officers, agents, directors and employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought against City by reason of any such claim or demand, Contractor shall, upon written notice from City, resist and defend such action or proceeding by counsel satisfactory to City. The Contractor expressly understands and agrees that any insurance protection required by this Contract or otherwise provided by Contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The indemnification provided above shall obligate Contractor to defend at its own expense to and through appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at City's option, any and all claims of liability and all suits and actions of every name and description which may be brought against City whether performed by Contractor, or persons employed or utilized by Contractor. This indemnity will survive the cancellation or expiration of the Contract. This indemnity will be interpreted under the laws of the State of Florida, including without limitation and which conforms to the limitations of §725.06 and/or §725.08, Fla. Statues, as amended from time to time as applicable. Contractor shall require all Sub -Contractor agreements to include a provision that they will indemnify the City. The Contractor agrees and recognizes that the City shall not be held liable or responsible for any claims which may result from any actions or omissions of the Contractor in which the City participated either through review or concurrence of the Contractor's actions. In reviewing, approving or rejecting any submissions by the Contractor or other acts of the Contractor, the City in no way assumes or shares any responsibility or liability of the Contractor or Sub -Contractor, under this Agreement. 1.43. FORMATION AND DESCRIPTIVE LITERATURE —Bidders/Proposer must furnish all information requested in the spaces provided in the Formal Solicitation.. Further, as may be specified elsewhere, each Bidder/Proposer must submit for evaluation, cuts, sketches, descriptive literature, technical specifications, and Material Safety Data Sheets (MSDS)as required, covering the products offered. Reference to literature submitted with a previous response or on file with the Buyer will not satisfy this provision. 1.44. INSPECTIONS - The City may, at reasonable times during the term hereof, inspect Contractor's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods and/or services required to be provided by the Contractor under this Contract conform to the terms and conditions of the Formal Solicitation. Contractor shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of the City of Miami Ordinance No. 12271 (Section 18-79), as same may be amended or supplemented from time to time. 1.45. INSPECTION OF RESPONSE - Responses received by the City pursuant to a Formal Solicitation will not be made available until such time as the City provides notice of a decision or intended decision or within 30 days after bid closing, whichever is earlier. Bid/Proposal results will be tabulated and may be furnished upon request via Page 16 of 39 Request for Proposals (RFP) 336312,4 fax or e-mail to the Sr. Procurement Specialist issuing the Solicitation. Tabulations also are available on the City's Web Site following recommendation for award. 1.46. INSURANCE - Within ten (10) days after receipt of Notice of Award, the successful Contractor, shall furnish Evidence of Insurance to the Purchasing Department, if applicable. Submitted evidence of coverage shall demonstrate strict compliance to all requirements listed on the Special Conditions entitled "Insurance Requirements". The City shall be listed as an "Additional Insured." Issuance of a Purchase Order is contingent upon the receipt of proper insurance documents. If the insurance certificate is received within the specified time frame but not in the manner prescribed in this Solicitation the Contractor shall be verbally notified of such deficiency and shall have an additional five (5) calendar days to submit a corrected certificate to the City. If the Contractor fails to submit the required insurance documents in the manner prescribed in this Solicitation within fifteen (15) calendar days after receipt Notice of Award, the contractor shall be in default of the contractual terms and conditions and shall not be awarded the contract. Under such circumstances, the Bidder/Proposer may be prohibited from submitting future responses to the City. Information regarding any insurance requirements shall be directed to the Risk Administrator, Department of Risk Management, at 444 SW 2nd Avenue, 9th Floor, Miami, Florida 33130, 305-416-1604. The Bidder/Proposer shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in effect for the duration of the contractual period; including any and all option terms that may be granted to the Bidder/Proposer. 1.47. INVOICES - Invoices shall contain purchase order number and details of goods and/or services delivered (i.e. quantity, unit price, extended price, etc); and in compliance with Chapter 218 of the Florida Statutes (Prompt Payment Act). 1.48. LOCAL PREFERENCE A. City Code Section 18-85, states, "when a responsive, responsible non -local bidder submits the lowest bid price, and the bid submitted by one or more responsive, responsible local bidders who maintain a local office, as defined in Section 18-73, is within fifteen percent (15%) of the price submitted by the non -local bidder, then that non -local bidder and each of the aforementioned responsive, responsible local bidders shall have the opportunity to submit a best and final bid equal to or lower than the amount of the low bid previously submitted by the non -local bidder. Contract award shall be made to the lowest responsive, responsible bidder submitting the lowest best and final bid. In the case of a tie in the best and final bid between a local bidder and a non -local bidder, contract award shall be made to the local bidder." B. City Code Section 18-86, states, "the RFP, RFLI or RFQ, as applicable, may, in the exercise of the reasonable professional discretion of the City Manager, director of the using agency, and the Chief Procurement Officer, include a five (5%) percent evaluation criterion in favor of proposers who maintain a local office, as defined in Section 18-73. In such cases, this five (5%) percent evaluation criterion in favor of proposers who maintain a local office will be specifically defined in the RFP, RFLI or RFQ, as applicable; otherwise, it will not apply. 1.49. MANUFACTURER'S CERTIFICATION - The City reserves the right to request from bidders/proposers a separate Manufacturer's Certification of all statements made in the bid/proposal. Failure to provide such certification may result in the rejection of bid/proposal or termination of contract/agreement, for which the bidder/proposer must bear full liability. 1.50. MODIFICATIONS OR CHANGES IN PURCHASE ORDERS AND CONTRACTS - No contract or understanding to modify this Formal Solicitation and resultant purchase orders or contracts, if applicable, shall be binding upon the City unless made in writing by the Director of Purchasing of the City of Miami, Florida through Page 17 of 39 Request for Proposals (RFP) 336312,4 the issuance of a change order, addendum, amendment, or supplement to the contract, purchase order or award sheet as appropriate. 1.51. NO PARTNERSHIP OR JOINT VENTURE - Nothing contained in this Contract will be deemed or construed to create a partnership or joint venture between the City of Miami and Contractor, or to create any other similar relationship between the parties. 1.52. NONCONFORMANCE TO CONTRACT CONDITIONS - Items may be tested for compliance with specifications under the direction of the Florida Department of Agriculture and Consumer Services or by other appropriate testing Laboratories as determined by the City. The data derived from any test for compliance with specifications is public record and open to examination thereto in accordance with Chapter 119, Florida Statutes. Items delivered not conforming to specifications may be rejected and returned at Bidder's/Proposer's expense. These non -conforming items not delivered as per delivery date in the response and/or Purchase Order may result in bidder/proposer being found in default in which event any and all re -procurement costs may be charged against the defaulted contractor. Any violation of these stipulations may also result in the supplier's name being removed from the City of Miami's Supplier's list. 1.53. NONDISCRIMINATION —Bidder/Proposer agrees that it shall not discriminate as to race, sex, color, age,. religion, national origin, marital status, or disability in connection with its performance under this formal solicitation. Furthermore, Bidder/Proposer agrees that no otherwise qualified individual shall solely by reason of his/her race, sex, color, age, religion, national origin, marital status or disability be excluded from the participation in, be denied benefits of, or be subjected to, discrimination under any program or activity. In connection with the conduct of its business, including performance of services and employment of personnel, Bidder/Proposer shall not discriminate against any person on the basis of race, color, religion, disability, age, sex, marital status or national origin. All persons having appropriate qualifications shall be afforded equal opportunity for employment. 1.54. NON-EXCLUSIVE CONTRACT/ PIGGYBACK PROVISION - At such times as may serve its best interest, the City of Miami reserves the right to advertise for, receive, and award additional contracts for these herein goods and/or services, and to make use of other competitively bid (governmental) contracts, agreements, or other similar sources for the purchase of these goods and/or services as may be available. It is hereby agreed and understood that this formal solicitation does not constitute the exclusive rights of the successful bidder(s)/proposer(s) to receive all orders that may be generated by the City in conjunction with this Formal Solicitation. In addition, any and all commodities, equipment, and services required by the City in conjunction with construction projects are solicited under a distinctly different solicitation process and shall not be purchased under the terms, conditions and awards rendered under this solicitation, unless such purchases are determined to be in the best interest of the City. 1.55. OCCUPATIONAL LICENSE - Any person, firm, corporation or joint venture, with a business location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of Miami Charter. Others with a location outside the City of Miami shall meet their local Occupational License Tax requirements. A copy of the license must be submitted with the response; however, the City may at its sole option and in its best interest allow the Bidder/Proposer to supply the license to the City during the evaluation period, but prior to award. 1.56. ONE PROPOSAL - Only one (1) Response from an individual, firm, partnership, corporation or joint venture Page 18 of 39 Request for Proposals (RFP) 336312,4 will be considered in response to this Formal Solicitation. When submitting an alternate response, please refer to the herein condition for "Alternate Responses May Be Considered". 1.57. OWNERSHIP OF DOCUMENTS - It is understood by and between the parties that any documents, records, files, or any other matter whatsoever which is given by the City to the successful Bidder/Proposer pursuant to this formal solicitation shall at all times remain the property of the City and shall not be used by the Bidder/Proposer for any other purposes whatsoever without the written consent of the City. 1.58. PARTIAL INVALIDITY - If any provision of this Contract or the application thereof to any person or circumstance shall to any extent be held invalid, then the remainder of this Contract or the application of such provision to persons or circumstances other than those as to which it is held invalid shall not be affected thereby, and each provision of this Contract shall be valid and enforced to the fullest extent permitted by law. 1.59. PERFORMANCE/PAYMENT BOND —A Contractor may be required to furnish a Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred percent (100%) of the contract price. 1.60. PREPARATION OF RESPONSES (HARDCOPY FORMAT) —Bidders/Proposers are expected to examine the specifications, required delivery, drawings, and all special and general conditions. All bid/proposed amounts, if required, shall be either typewritten or entered into the space provided with ink. Failure to do so will be at the Bidder's/Proposer's risk. A. Each Bidder/Proposer shall furnish the information required in the Formal Solicitation. The Bidder/Proposer shall sign the Response and print in ink or type the name of the Bidder/Proposer, address, and telephone number on the face page and on each continuation sheet thereof on which he/she makes an entry, as required. B. If so required, the unit price for each unit offered shall be shown, and such price shall include packaging, handling and shipping, and F.O.B. Miami delivery inside City premises unless otherwise specified. Bidder/Proposer shall include in the response all taxes, insurance, social security, workmen's compensation, and any other benefits normally paid by the Bidder/Proposer to its employees. If applicable, a unit price shall be entered in the "Unit Price" column for each item. Based upon estimated quantity, an extended price shall be entered in the "Extended Price" column for each item offered. In case of a discrepancy between the unit price and extended price, the unit price will be presumed correct. C. The Bidder/Proposer must state a definite time, if required, in calendar days for delivery of goods and/or services. D. The Bidder/Proposer should retain a copy of all response documents for future reference. E. All responses, as described, must be fully completed and typed or printed in ink and -must be signed in ink with the firm's name and by an officer or employee having authority to bind the company or firm by his/her signature. Bids/Proposals having any erasures or corrections must be initialed in ink by person signing the response or the response may be rejected. F. Responses are to remain valid for at least 180 days. Upon award of a contract, the content of the Successful Bidder's/Proposer's response may be included as part of the contract, at the City's discretion. G. The City of Miami's Response Forms shall be used when Bidder/Proposer is submitting its response in hardcopy format. Use of any other forms will result in the rejection of the response. IF SUBMITTING HARDCOPY FORMAT, THE ORIGINAL AND THREE (3) COPIES OF THESE SETS OF FORMS, UNLESS OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE RETURNED TO THE CITY Page 19 of 39 Request for Proposals (RFP) 336312,4 OR YOUR RESPONSE MAY BE DEEMED NON -RESPONSIVE. 1.61. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by reason of market change or on the part of the contractor to other customers shall be passed on to the City of Miami. 1.62. PRODUCT SUBSTITUTES - In the event a particular awarded and approved manufacturer's product becomes unavailable during the term of the Contract, the Contractor awarded that item may arrange with the City's authorized representative(s) to supply a substitute product at the awarded price or lower, provided that a sample is approved in advance of delivery and that the new product meets or exceeds all quality requirements. 1.63. CONFLICT OF INTEREST, AND UNETHICAL BUSINESS PRACTICE PROHIBITIONS - Contractor represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Contract and that it has.not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Contract. 1.64. PROMPT PAYMENT —Bidders/Proposers may offer a cash discount for prompt payment; however, discounts shall not be considered in determining the lowest net cost for response evaluation purposes. Bidders/Proposers are required to provide their prompt payment terms in the space provided on the Formal Solicitation. If no prompt payment discount is being offered, the Bidder/Proposer must enter zero (0) for the percentage discount to indicate no discount. If the Bidder/Proposer fails to enter a percentage, it is understood and agreed that the terms shall be 2% 20 days, effective after receipt of invoice or final acceptance by the City, whichever is later. When the City is entitled to a cash discount, the period of computation will commence on the date of delivery, or receipt of a correctly completed invoice, whichever is later. If an adjustment in payment is necessary due to damage, the cash discount period shall commence on the date final approval for payment is authorized. If a discount is part of the contract, but the invoice does not reflect the existence of a cash discount, the City is entitled to a cash discount with the period commencing on the date it is determined by the City that a cash discount applies. Price discounts off the original prices quoted on the Price Sheet will be accepted from successful bidders/proposers during the term of the contract. 1.65. PROPERTY - Property owned by the City of Miami is the responsibility of the City of Miami. Such property furnished to a Contractor for repair, modification, study, etc., shall remain the property of the City of Miami Damages to such property occurring while in the possession of the Contractor shall be the responsibility of the Contractor. Damages occurring to such property while in route to the City of Miami shall be the responsibility of the Contractor. In the event that such property is destroyed or declared a total loss, the Contractor shall be responsible for replacement value of the property at the current market value, less depreciation of the property, if any. 1.66. PROVISIONS BINDING - Except as otherwise expressly provided in the resulting Contract, all covenants, conditions and provisions of the resulting Contract shall be binding upon and shall inure to the benefit of the parties hereto and their respective heirs, legal representatives, successors and assigns. 1.67. PUBLIC ENTITY CRIMES - A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a response on a contract to provide any goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit responses on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section Page 20 of 39 Request for Proposals (RFP) 336312,4 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. 1.68. PUBLIC RECORDS - Contractor understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City contracts, subject to the provisions of Chapter 119, Florida Statutes, and City of Miami Code, Section 18, Article III, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable law. Contractor's failure or refusal to comply with the provision of this section shall result in the immediate cancellation of this Contract by the City. 1.69. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All materials used in the manufacturing or construction of supplies, materials, or equipment covered by this solicitation shall be new. The items bid/proposed must be of the latest make or model, of the best quality, and of the highest grade of workmanship, unless as otherwise specified in this Solicitation. 1.70. QUALITY OF WORK/SERVICES - The work/services performed must be of the highest quality and workmanship. Materials furnished to complete the service shall be new and of the highest quality except as otherwise specified in this Solicitation. 1.71. REMEDIES PRIOR TO AWARD (Sec. 18-106) - If prior to Contract award it is determined that a formal solicitation or proposed award is in violation of law, then the solicitation or proposed award shall be cancelled by the City Commission, the City Manager or the Chief Procurement Officer, as may be applicable, or revised to comply with the law. 1.72. RESOLUTION OF CONTRACT DISPUTES (Sec. 18-105) (a) Authority to resolve Contract disputes. The City Manager, after obtaining the approval of the city attorney, shall have the authority to resolve controversies between the Contractual Party and the city which arise under, or by virtue of, a Contract between them; provided that, in cases involving an amount greater than $25,000, the City Commission must approve the City Manager's decision. Such authority extends, without limitation, to controversies based upon breach of Contract, mistake, misrepresentation or lack of complete performance, and shall be invoked by a Contractual Party by submission of a protest to the City Manager. (b) Contract dispute decisions. If a dispute is not resolved by mutual consent, the City Manager shall promptly render a written report stating the reasons for the action taken by the City Commission or the City Manager which shall be final and conclusive. A copy of the decision shall be immediately provided to the protesting party, along with a notice of such party's right to seek judicial relief, provided that the protesting party shall not be entitled to such judicial relief without first having followed the procedure set forth in this section. 1.73. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (Sec. 18-104) (a) Right to protest. The following procedures shall be used for resolution of protested solicitations and awards except for purchases of goods, supplies, equipment, and services, the estimated cost of which does not exceed $25,000. Protests thereon shall be governed by the Administrative Policies and Procedures of Purchasing. 1.Protest of Solicitation. i. Any prospective proposer who perceives itself aggrieved in connection with the solicitation of a Contract may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the Request for Proposals, Request for Qualifications or Request for Letters of Interest is published in a newspaper of general circulation. A notice of intent to file a protest is considered Page 21 of 39 Request for Proposals (RFP) 336312,4 filed when received by the Chief Procurement Officer; or ii. Any prospective bidder who intends to contest the Solicitation Specifications or a solicitation may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the solicitation is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. 2. Protest of Award. i. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the proposer of the notice of the City Manager's recommendation for award of Contract, which will be posted on the City of Miarni Purchasing Department website, in the Supplier Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. It shall be the responsibility of the Bidder/Proposer to check this section of the website daily after responses are submitted to receive the notice; or ii. Any actual Responsive and Responsible Bidder whose Bid is lower than that of the recommended bidder may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the bidder of the notice of the city's determination of non responsiveness or non responsibility. The receipt by bidder of such notice shall be confirmed by the city by facsimile or electronic mail or U.S. mail, return receipt requested. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. di. A written protest based on any of the foregoing must be submitted to the Chief Procurement Officer within five (5) days after the date the notice of protest was filed. A written protest is considered filed when received by the Chief Procurement Officer. The written protest may not challenge the relative weight of the evaluation criteria or the formula for assigning points in making an award determination. The written protest shall state with particularity the specific facts and law upon which the protest of the solicitation or the award is based, and shall include all pertinent documents and evidence and shall be accompanied by the required Filing Fee as provided in subsection (f). This shall form the basis for review of the written protest and no facts, grounds, documentation or evidence not contained in the protester's submission to the Chief Procurement Officer at the time of filing the protest shall be permitted in the consideration of the written protest. No time will be added to the above limits for service by mail. In computing any period of time prescribed or allowed by this section, the day of the act, event or default from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included unless it is a Saturday, Sunday or legal holiday in which event the period shall run until the end of the next day which is neither a Saturday, Sunday or legal holiday. Intermediate Saturdays, Sundays and legal holidays shall be excluded in the computation of the time for filing. (b) Authority to resolve protests. The Chief Procurement Officer shall have the authority, subject to the approval of the City Manager and the city attorney, to settle and resolve any written protest. The Chief Procurement Officer . shall obtain the requisite approvals and communicate said decision to the protesting party and shall submit said decision to the City Commission within 30 days after he/she receives the protest. In cases involving more than $25,000, the decision of the Chief Procurement Officer shall be submitted for approval or disapproval thereof to the City Commission after a favorable recommendation by the city attorney and the City Manager. Page 22 of 39 Request for Proposals (RFP) 336312,4 (c) Compliance with filing requirements. Failure of a party to timely file either the notice of intent to file a protest or the written protest, together with the required Filing Fee as provided in subsection (f), with the Chief Procurement Officer within the time provided in subsection (a), above, shall constitute a forfeiture of such party's right to file a protest pursuant to this section. The protesting party shall not be entitled to seek judicial relief without first having followed the procedure set forth in this section (d) Stay of Procurements during protests. Upon receipt of a written protest filed pursuant to the requirements of this section, the city shall not proceed further with the solicitation or with the award of the Contract until the protest is resolved by the Chief Procurement Officer or the City Commission as provided in subsection (b) above, unless the City Manager makes a written determination that the solicitation process or the Contract award must be continued without delay in order to avoid an immediate and serious danger to the public health, safety or welfare. (e) Costs. All costs accruing from a protest shall be assumed by the protestor. (f) Filing Fee. The written protest must be accompanied by a filing fee in the form of a money order or cashier's check payable to the city in an amount equal to one percent of. the amount of the Bid or proposed Contract, or $5000.00, whichever is less, which filing fee shall guarantee the payment of all costs which may be adjudged against the protestor in any administrative or court proceeding. If a protest is upheld by the Chief Procurement Officer and/or the City Commission, as applicable, the filing fee shall be refunded to the protestor less any costs assessed under subsection (e) above. If the protest is denied, the filing fee shall be forfeited to the city in lieu of payment of costs for the administrative proceedings as prescribed by subsection (e) above. 1.74. SAMPLES - Samples of items, when required, must be submitted within the time specified at no expense to the City. If not destroyed by testing, bidder(s)/proposer(s) will be notified to remove samples, at their expense, within 30 days after notification. Failure to remove the samples will result in the samples becoming the property of the City. 1.75. SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES - Contractor shall not sell, assign, transfer or subcontract at any time during the term of the Contract, or any part of its operations, or assign any portion of the performance required by this contract, except under and by virtue of written permission granted by the City through the proper officials, which may be withheld or conditioned, in the City's sole discretion. 1.76. SERVICE AND WARRANTY —When specified, the bidder/proposer shall define all warranty, service and replacements that will be provided. Bidders/Proposer must explain on the Response to what extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable, should be submitted with your response. 1.77. SILENCE OF SPECIFICATIONS - The apparent silence of these specifications and any supplemental specification as to any detail or the omission from it of detailed description concerning any point shall be regarded as meaning that only the best commercial practices are to prevail and that only materials of first quality and correct type, size and design are to be used. All workmanship and services is to be first quality. All interpretations of these specifications shall be made upon the basis of this statement. If your firm has a current contract with the State of Florida, Department of General Services, to supply the items on this solicitation, the bidder/proposer shall quote not more than the contract price; failure to comply with this request will result in disqualification of bid/proposal. 1.78. SUBMISSION AND RECEIPT OF RESPONSES - Responses shall be submitted electronically via the Oracle System or responses may be submitted in hardcopy format to the City Clerk, City Hall, 3500 Pan American Drive, Miami, Florida 33133-5504, at or before, the specified closing date and time as designated in the IFB, RFP, Page 23 of 39 Request for Proposals (RFP) 336312,4 RFQ, or RFLI. NO EXCEPTIONS. Bidders/Proposers are welcome to attend the solicitation closing; however, no award will be made at that time. A. Hardcopy responses shall be enclosed in a sealed envelope, box package. The face of the envelope, box or package must show the hour and date specified for receipt of responses, the solicitation number and title, and the name and return address of the Bidder/Proposer. Hardcopy responses not submitted on the requisite Response Forms may be rejected. Hardcopy responses received at any other location than the specified shall be deemed non -responsive. Directions to City Hall: FROM THE NORTH: I-95 SOUTH UNTIL IT TURNS INTO US1. US1 SOUTH TO 27TH AVE., TURN LEFT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. FROM THE SOUTH: US1 NORTH TO 27TH AVENUE, TURN RIGHT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. B. Facsimile responses will not be considered. C. Failure to follow these procedures is cause for rejection of bid/proposal. D. The responsibility for obtaining and submitting a response on or before the close date is solely and strictly the responsibility of Bidder/Proposer. The City of Miami is not, responsible for delays caused by the United States mail delivery or caused by any other occurrence. Responses received after the solicitation closing date and time will be returned unopened, and will not be considered for award. E. Late responses will be rejected. F. All responses are subject to the conditions specified herein. Those which do not comply with these conditions are subject to rejection. G. Modification of responses already submitted will be considered only if received at the City before the time and date set for closing of solicitation responses. All modifications must be submitted via the Oracle System or in writing. Once a solicitation closes (closed date and/or time expires), the City will not consider any subsequent submission which alters the responses. H. If hardcopy responses are submitted at the same time for different solicitations, each response must be placed in a separate envelope, box, or package and each envelope, box or package must contain the information previously stated in 1.82.A. 1.79. TAXES - The City of Miami is exempt from any taxes imposed by the State and/or Federal Government. Exemption certificates will be provided upon request. Notwithstanding, Bidders/Proposers should be aware of the fact that all materials and supplies which are purchased by the Bidder/Proposer for the completion of the contract is subject to the Florida State Sales Tax in accordance with Section 212.08, Florida Statutes, as amended and all amendments thereto and shalt be paid solely by the Bidder/Proposer. 1.80. TERMINATION —The City Manager on behalf of the City of Miami reserves the right to terminate this contract by written notice to the contractor effective the date specified in the notice should any of the following apply: A. The contractor is determined by the City to be in breach of any of the terms and conditions of the contract. Page 24 of 39 Request for Proposals (RFP) 336312,4 B. The City has determined that such termination will be in the best interest of the City to terminate the contract for its own convenience; C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is contingent upon the availability of appropriate funds. 1.81. TERMS OF PAYMENT - Payment will be made by the City after the goods and/or services awarded to a Bidder/Proposer have been received, inspected, and found to comply with award specifications, free of damage or defect, and properly invoiced. No advance payments of any kind will be made by the City of Miami. Payment shall be made after delivery, within 45 days of receipt of an invoice and authorized inspection and acceptance of the goods/services and pursuant to Section 218.74, Florida Statutes and other applicable law. 1.82. TIMELY DELIVERY - Time will be of the essence for any orders placed as a result of this solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made within the time(s) specified on their Response. Deliveries are to be made during regular City business hours unless otherwise specified in the Special Conditions. 1.83. TITLE - Title to the goods or equipment shall not pass to the City until after the City has accepted the goods/equipment or used the goods, whichever comes first. 1.84.TRADE SECRETS EXECUTION TO PUBLIC RECORDS DISCLOSURE- All Responses submitted to the City are subject to public disclosure pursuant to Chapter 119, Florida Statutes. An exception may be made for "trade secrets." If the Response contains information that constitutes a "trade secret", all material that qualifies for exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE SECRETS EXCEPTION," with your firm's name and the Solicitation number and title marked on the outside. Please be aware that the designation of an item as a trade secret by you may be challenged in court by any person. By your designation of material in your Response as a "trade secret" you agree to indemnify and hold harmless the City for any award to a plaintiff for damages, costs or attorney's' fees and for costs and attorney's fees incurred by the City by reason of any legal action challenging your claim. 1.85. UNAUTHORIZED WORK OR DELIVERY OF GOODS- Neither the qualified Bidder(s)/Proposer(s) nor any of his/her employees shall perform any work or deliver any goods unless a change order or purchase order is issued and received by the Contractor. The qualified Bidder(s)/Proposer(s) shall not be paid for any work performed or goods delivered outside the scope of the contract or any work performed by an employee not otherwise previously authorized. 1.86. USE OF NAME - The City is not engaged in research for advertising, sales promotion, or other publicity purposes. No advertising, sales promotion or other publicity materials containing information obtained from this Solicitation are to be mentioned, or imply the name of the City, without prior express written permission of the City Manager or the City Commission. 1.87. VARIATIONS OF SPECIFICATIONS - For purposes of solicitation evaluation, bidders/proposers must indicate any variances from the solicitation specifications and/or conditions, no matter how slight. If variations are not stated on their Response, it will be assumed that the product fully complies with the City's specifications. Page 25 of 39 Request for Proposals (RFP) 336312,4 2. Special Conditions 2.1. PURPOSE The purpose of this Solicitation is to establish a contract, for Employee Benefit Dental Plan, as specified herein, from a source(s) of supply that will give prompt and efficient service fully compliant with the terms, conditions and stipulations of the solicitation. 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/CLARIFICATION Any questions or clarifications concerning this solicitation shall be submitted.by email or facsimile to the Purchasing Department, Attn: Maritza Suarez, CPPB; fax: (305) 400-5025 or email: msuarez@ci.miami.fl.us. The solicitation title and number shall be referenced on all correspondence. All questions must be received no later than Thursday, September 6, 2012 at 5:00 P.M.. All responses to questions will be sent to all prospective bidders/proposers in the form on an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER SAID DEADLINE. 23. TERM OF CONTRACT The proposer(s) qualified to provide the service(s) requested herein (the "Successful Proposer(s)") shall be required to execute a contract ("Contract") with the City, which shall include, but not be limited to, the following terms: (1) The term of the Contract(s) shall be for three (3) years with an option to renew for two (2) additional one (1) year periods. (2) The City shall have the option to extend or terminate the Contract. Continuation of the contract beyond the initial period is a City prerogative; not a right of the bidder/proposer. This prerogative will be exercised only when such continuation is clearly in the best interest of the City. 2.4. CONDITIONS FOR RENEWAL Each renewal of this contract is subject to the following: (1) continued satisfactory performance compliance with the specifications, terms and conditions established herein and (2) Availability of funds. In the event the Contractor is unable to extend the contract for any subsequent period, advance written notice and explanation shall be submitted to the Chief Procurement Officer no later than ninety (90) days prior to the expiration date of the contract period in effect at such time and shall be subject to the City's acceptance. Failure to comply with these requirements may render the Contract in default of this contract. 2.5. NON -APPROPRIATION OF FUNDS In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in any fiscal period for payments due under this contract, then the City, upon written notice to Contractor or his assignee of such occurrence, shall have the unqualified right to terminate the contract without any penalty or expense to the City. No Page 26 of 39. Request for Proposals (RFP) 336312,4 guarantee, warranty or representation is made that any particular or any project(s) will be awarded to any firm(s). 2.6. MINIMUM QUALIFICATION REQUIREMENTS For a Proposer to be deemed responsive the following minimum qualification requirements cited below shall be satisfied. In determining Said responsiveness, each such minimum qualification requirement shall be addressed in detail in the Proposal submittal. Failure to meet each such following minimum qualification requirements and/or failure to provide sufficient detailed documentation concerning the same, shall result in the Proposal being deemed non -responsive: A. All Companies submitting Proposals must be licensed by the State of Florida and have a demonstrated level of good performance with public entities of equivalent size, including municipalities, for a minimum of two (2) years. B. Proposers must have an organization that has demonstrated the ability to deliver cost-effective service, and efficient loss control and claims processing. C. Provide sufficient telephone service, including toll -free and local service 8-5 EST, to handle inquiries directly from plan participants as well as authorized City representatives. D. Must disclose the following if broker fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a no -commission basis. E. Must assume current policy benefit structure and provide a "no loss/no gain" assumption of risk and credit for all annual deductibles. F. Must comply with all federal legislation including but not limited to HIPAA and COBRA. G. Proposer must agree to allow the City or its representative the right to audit all claims, financial data, and other information relevant to the City's account. H. The City requires that the pre-existing condition limitations and the actively at work provision be waived for the initial enrollment for those employees who have already satisfied the waiting period for pre-existing conditions under the current plan. I. Proposer must have bilingual capabilities in the customer service and enrollment assistance areas as well as in communications materials. English and Spanish are mandatory. Creole is desired as well. J. Proposer shall have no record of judgments or pending lawsuits against the City and/or bankruptcy, and not have any conflicts of interest that have not been waived by the City Commission. K. Neither Proposer nor any member, officer, or stockholder of Proposer shall be in arrears or in default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City. 2.7. CONTRACT EXECUTION The selected Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be awarded an opportunity to negotiate a contract ("Contract") with the City. The City reserves the right to execute or not execute, as applicable a Professional Services Agreement ("Agreement") with the selected Proposer(s) in substantially the same form as the Agreement included as part of this solicitation (refer to Attachment B). Such Agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. 2.8. FAILURE TO PERFORM Page 27 of 39 Request for Proposals (RFP) 336312,4 Should it not be possible to reach the contractor or supervisor and/or should remedial action not be taken within 48 hours of any failure to perform according to specifications, the City reserves the right to declare Contractor in default of the contract or make appropriate reductions in the contract payment. 2.9. INSURANCE REQUIREMENTS INDEMNIFICATION Bidder shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of bidder's performance under the provisions of the contract, including all acts or omissions to act on the part of bidder, including any person performing under this Contract for or on bidder's behalf; provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Contract, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. The bidder shall furnish to City of Miami, c/o Purchasing Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: - (1) Worker's Compensation A. Limits of Liability Statutory - State of Florida Waiver of Subrogation (2) Commercial General Liability: A. Limits of Liability Bodily Injury and Property Damage Liability - Each Occurrence: S 1.000.000 General Aggregate Limit: $2,000,000 Personal and Adv. Injury: $1,000,000. Products/Completed Operations: $1,000,000.00. B. Endorsements Required: City of Miami included as an Additional insured. Primary Insurance Clause Contigent & Contractual Liability Premises and Operations Liability (3) BusinessAutomobile Liability A. Limits of Liability Bodily injury and property damage liability combined single limits. Owned/Scheduled Autos, including, including hired, borrowed or non -owned autos. Any one accident - $1,000,000 B. Endorsements Required: City of Miami included as an Additional Insured (4) Employer's Liability Page 28 of 39 (5) Request for Proposals (RFP) 336312,4 A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit Professional Liability/Errors and Omissions Coverage: A. Limits of Liability Combined Single Limit Each Claim - $1,000,000 General Aggregate Limit - S1,000,000 Deductible - not to exceed 10% BINDERS ARE UNACCEPTABLE. - The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the bidder. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The Company must be rated no less than "A" as to management, and no less than "Class V" as to financial strength, by the latest edition of Best's Insurance Guide, published by.A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and/or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Certificates will indicate no modification or change in insurance shall be made without thirty (30) days written advance notice to the certificate holder. NOTE: CITY BID NUMBER AND/OR TITLE OF BID MUST APPEAR ON EACH CERTIFICATE. Compliance with the foregoing requirements shall not relieve the bidder of his liability and obligation under this section or under any other section of this Agreement. —If insurance certificates are scheduled to expire during the contractual period, the Bidder shall be responsible for submitting new or renewed insurance certificates to the City at a minimum of ten (10) calendar days in advance of such expiration. —In the event that expired certificates are not replaced with new or renewed certificates which cover the contractual period, the City shall: (4) Suspend the contract until such time as the new or renewed certificates are received by the City in the manner prescribed in the Invitation To Bid. (5) The City may, at its sole discretion, terminate this contract for cause and seek re -procurement damages from the Bidder in conjunction with the General and Special Terms and Conditions of the Bid. The Bidder shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in force for the duration of the contractual period; including any and all option terms that may be granted to the Bidder. 2.10. PRE-BID/PRE-PROPOSAL CONFERENCE None Page 29 of 39 Request for Proposals (RFP) 336312,4 2.11. CONTRACT ADMINISTRATOR Upon award, contractor shall report and work directly with Mr. Richard Kaufman, and Ms. Barbara Pick, AON Hewitt, who shall be designated as the Contract Administrator. 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) A Sub -Consultant, herein known as Sub-Contractor(s) is an individual or firm contracted by the Proposer or Proposer's firm to assist in the performance of services required under this Solicitation. A Sub -Contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City. Sub -Contractors are allowed by the City in the performance of the services delineated within this Solicitation. Proposer must clearly reflect in its Proposal the major Sub -Contractors to be utilized in the performance of required services. The City retains the right to accept or reject any Sub -Contractors proposed in the response of Successful Proposer or prior to contract execution. Any and all liabilities regarding the use of a Sub -Contractor shall be bome solely by the Successful Proposer and insurance for each Sub -Contractors must be maintained in good standing and approved by the City throughout the duration of the Contract. Neither Successful Proposer nor any of its Sub -Contractors are considered to be employees or agents of the City. Failure to list all Sub -Contractors and provide the required information may disqualify any proposed Sub -Contractors from performing work under this Solicitation. Proposers shall include in their Responses the requested Sub -Contractor information and include all relevant information required of the Proposer. In addition, within five (5) working days after the identification of the award to the Successful Proposer, the Successful Proposer shall provide a list confirming the Sub -Contractors that the Successful Proposer intends to utilize in the Contract, if applicable. The list shall include, at a minimum, the name, location of the place of business for each Sub -Contractor, the services Sub -Contractor will provide relative to any contract that may result from this Solicitation, any applicable licenses, references, ownership, and other information required of Proposer. 2.13. COMPLETE PROJECT REQUIRED These specifications describe the various items or classes of work required, enumerating or defining the extent of same necessary, but failure to list any item or classes under scope of the several sections shall not relieve the contractor from furnishing, installing or performing such work where required by any part of these specifications, or necessary to the satisfactory completion of the project. 2.14. TERMINATION A. FOR DEFAULT If Contractor defaults in its performance under this Contract and does not cure the default within 30 days after written notice of default, the City Manager may terminate this Contract, in whole or in part, upon written notice without penalty to the City of Miami. In such event the Contractor shall be liable for damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is determined for any reason that the Contractor was not in default or (2) the Contractor's failure to perform is without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a termination for the convenience of the City of Miami. Page 30 of 39 Request for Proposals (RFP) 336312,4 B. FOR CONVENIENCE The City Manager may terminate this Contract, in whole or in part, upon 30 days prior written notice when it is in the best interests of the City of Miami. If this Contract is for supplies, products, equipment, or software, and so terminated for the convenience by the City of Miami the Contractor will be compensated in accordance with an agreed upon adjustment of cost. To the extent that this Contract is for services and so terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions of the Contract for those services rendered prior to termination. 2.15. ADDITIONAL TERMS AND CONDITIONS No additional terms and conditions included as part of your solicitation response shall be evaluated or considered, and any and all such additional terms and conditions shall have no force or effect and are inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently, appearing separately in transmittal letters, specifications, literature, price lists or warranties, it is understood and agreed that the General Conditions and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that the bidder's/proposer's authorized signature affixed to the bidder's/proposer's acknowledgment form attests to this. If a Professional Services Agreement (PSA) or other Agreement is provided by the City and is expressly included as part of this solicitation, no additional terms or conditions which materially or substantially vary, modify or alter the terms or conditions of the PSA or Agreement, in the sole opinion and reasonable discretion of the City will be considered. Any and all such additional terms and conditions shall have no force or effect and are inapplicable to this PSA or Agreement. 2.16. CHANGES/ALTERATIONS Proposer may change or withdraw a Proposal at any time prior to Proposal submission deadline; however, no oral modifications will be allowed. Written modifications shall not be allowed following the proposal deadline. 2.17. COMPENSATION PROPOSAL Each Proposer shall detail any and all fees and costs to provide the required services as listed herein. Proposer shall additionally provide a detailed list of all costs to provide all services as detailed in Section III Scope of Services, as proposed. The City reserves the right to add or delete any service, at any time. Should the City determine to add an additional service for which pricing was not previously secured, the City shall seek the Successful Proposer to provide reasonable cost(s) for same. Should the City determine the pricing unreasonable, the City reserves the right to negotiate cost(s) or seek another vendor for the provision of said service(s). Failure to submit compensation proposal as required shall disqualify Proposer from consideration. 2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD The procedure for response evaluation, selection and award is as follows: (1) Solicitation issued. (2) Receipt of responses (3) Opening and listing of all responses received Page 31 of 39 Request for Proposals (RFP) 336312,4 (4) Purchasing staff will review each submission for compliance with the submission requirements of the Solicitation, including verifying that each submission includes all documents required. (5) An Evaluation Committee, appointed by the City Manager, comprised of appropriate City Staff and members of the community, as deemed necessary, with the appropriate technical expertise and/or knowledge, shall meet to evaluate each response in accordance with the requirements of this Solicitation and based upon the evaluation criteria as specified herein. (6) The Evaluation Committee reserves the right, in its sole discretion, to request Proposers to make oral presentations before the Committee as part of the evaluation process. The presentation may be scheduled at the convenience of the Evaluation Committee and shall be recorded. (7) The Evaluation Committee reserves the right to rank the Proposals and shall submit its recommendation to the . City Manager for acceptance. If the City Manageraccepts the Committee's recommendation, the City Manager's recommendation for award of contract will be posted on the City of Miami Purchasing Departrnent website, in the Supplier Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. The City Manager shall make his recommendation to the City Commission requesting the authorization to negotiate and/or execute an agreement with the recommended Proposer(s). No Proposer(s) shall have any rights against the City arising from such negotiations or termination thereof. (8) The City Manager reserves the right to reject the Committee's recommendation, and instruct the Committee to re-evaluate and make another recommendation, reject all proposals, or recommend that the City Commission reject all proposals. (9) The City Commission shall consider the City Manager's and Evaluation Committees' recommendation(s) and, if appropriate and required, approve the City Manager's recommendation(s). The City Commission may also reject any or all response. (10) If the City Commission approves the recommendations, the City will enter into negotiations with the selected Proposer(s) for a contract for the required services. Such negotiations may result in contracts, as deemed appropriate by the City Manager. (11) The City Commission shall review and approve the negotiated Contract with the selected Proposer(s). 2.19. ADDITIONAL SERVICES Services not specifically identified in this request may be added to any resultant contract upon successful negotiation and mutual consent of the contracting parties. 2.20. RECORDS During the contract period, and for a least five (5) subsequent years thereafter, Successful Proposer shall provide City access to all files and records maintained on the City's behalf. 2.21. AMENDMENTS TO THE CONTRACT The City Manager shall have the right and authority to amend this Contract on behalf of the City. Page 32 of 39 Request for Proposals (RFP) 336312,4 2.22. TRUTH IN NEGOTIATION CERTIFICATE Execution of the resulting agreement by the Successful Proposer shall act as the execution of truth -in -negotiation certificate stating that wage rates and other factual unit costs supporting the compensation of the resulting Agreement are accurate, complete, and current at the time of contracting. The original contract price and any additions thereto shall be adjusted to exclude any significant sums by which City determines the contract price was increased due to inaccurate, incomplete, or non -current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year following the end of the Agreement. Page 33 of 39 Request for Proposals (RFP) 336312,4 3. Specifications 3.1. SPECIFICATIONS/SCOPE OF WORK 3.1.1. Background Information The City of Miami is seeking to qualify dental care providers for its Employee Benefit Dental Plan. The City currently has a total of 3109 employees and retirees eligible for the dental plan. The City currently offers a fully insured dental DMO (DHMO) through Solstice Benefits. This plan has approximately 2,525 participants. The City also offers a fully -insured PDO plan through MetLife for employees. This plan has approximately 467 participants. The City also offers a fully -insured Executive PDO (DPPO) plan which has approximately 117 participants. The managed dental planandthe preferred dental plan for the general employees are voluntary and supported one hundred percent (100%) by employee contributions. The Executive PPO is funded fully by the City of Miami. Please refer to the attached exhibits for details on the City's current dental benefits plan(s). 3.1.2. Dental Plan(s) Solicited It is the City's intent to offer their employees/retirees the following options: 1. An affordable dental HMO product (DMO) (DHMO. 2. An affordable dental PPO product (PDO) (DPPO). The City is seeking Proposals on both a fully insured and self -insured basis for the dental care coverage. The City is requesting Proposals to be based upon the current dental plan designs offered, but will accept and review alternatives. All alternate plans must clearly designate deviations from the current schedule of benefits. The City will be evaluating the Proposals to access the capabilities in each of the following areas: Fully Insured Dental Plans 1. Financial stability and experience _ 2. Network Disruption Report for both DHMO and DPPO 3. Plan design and benefits 4. Overall plan costs (fees, claims and/or premiums) and discount arrangements 5. Reporting capabilities 6. Communications and enrollment capabilities 7. Claims administration capabilities 8. Ability to offer requested plan designs/alternatives 9. Account management staff. 10. Banking 3.1.3. Attachments and Exhibits To assist you in the preparation of your Proposal, the City is attaching the following documentation: List of Exhibits provided as information/documentation to prepare Proposal 1. DMO (DHMO) Census 2. PDO (DPPO) Census 3. . Listing of DMO Top Dental Providers 4. Current rates 5. Summary of benefits for current DMO benefits Page 34 of 39 Request for Proposals (RFP) 336312,4 6. 2008-2011 Voluntary Plan Claims Experience 7. PPO Plan Designs 8. Summary of Benefits for PDO 9. Listing of PPO Top Dental Providers 10. Executive Plan Claims Experience 11. Class I Executive Booklet 12. PPO Rate History 13. PPO Utilization Report 14. PPO Claims Experience 15. Anticipated Questions and Answers NOTE: Attachment A (Questionnaire) must be completed and returned with Proposal. Failure to complete and return Attachment A will deem any submitted Proposal non -responsive. Page 35 of 39 Request for Proposals (RFP) 336312,4 4. Submission Requirements 4.1. SUBMISSION REQUIREMENTS Proposers shall carefully follow the format and instruction outlined below, observing format requirements where indicated. Proposals should contain the information itemized below and in the order indicated. This information should be provided for the Proposer and any Sub -Consultants to be utilized for the work contemplated by this Solicitation. Proposals submitted which do not include the following items may be deemed non -responsive and may not be considered for contract award. Proposers shall submit responses in a hardcopy format, consisting of one (1) original and five (5) copies, and in an electronic format via a CD-ROM. On-line submittals, via the Oracle System, shall not be accepted. Failure to do so may deem the Proposal non -responsive. PROPOSAL FORMAT The response to this solicitation should be presented in the following format. Failure to do so may deem your Proposal non -responsive. 1. Cover Page The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax Numbers, if applicable Email addresses; Title of RFP; RFP Number; Federal Employer Identification Number or Social Security Number. 2. Table of Contents The table of contents should outline, in sequential order, the major sections of the Proposal as listed below, including all other relevant documents requested for submission. All pages of the Proposal, including the enclosures, should be clearly and consecutively numbered and correspond to the table of contents. 3. Executive Summary: Provide an Executive Summary describing elements contained within Proposer's Proposal, including such factors as Organization, Qualifications and Capabilities; Proposed Network and Plan(s) Designs; Customer Service, Banking, Reporting Capabilities, and Benefit Administration; and Price and Cost Effectiveness. 4. Proposer's Organization. Qualifications, Capabilities & Financial Stability a) Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. Proposer should include the name of the organization, business phone/fax/email address, contact person and federal tax ID. b) Provide a list of all principals, owners or directors. c) Provide copy of current license to provide said services in the State of Florida. d) Provide (1) the number of years in existence of Proposer, both nationally and in the Florida market; (2) the current number of employees enrolled in the Proposer's plan, both nationally and in Florida, and (3) the primary markets served. Also, discuss specifically Proposer's involvement in providing dental care benefits, particularly in the South Florida market. e) Disclose whether broker's fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same. f) Provide the current number of employees of Proposer; its depth and experience, and number and job Page 36 of 39 Request for Proposals (RFP) 336312,4 classifications of employees anticipated to be assigned to the City's account, particularly in Miami -Dade and Broward Counties, including the overall qualifications of assigned staff particularly its experience with dental benefit administration in Florida. Include discussion of employees' diversity and ability of speaking more than one language. g) Provide a List of 2 clients of equivalent size who, for whatever reason, discontinued to use Proposer's services within the past year, and indicate the reasons for the same. Include contact name and number, as well as two current clients. The City reserves the right to contact any reference as part of the evaluation process. Also include your company's total enrollment for 2010 vs. your 2011 enrollment. h) List the subcontractors or sub consultants and include a brief history of their background and experience. i) Provide detailed responses to Attachment A, as applicable. Failure to complete. in full, Attachment and return same with Proposal shall deem anv Proposal received non -responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) j) Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental care services to the City. 5. Proposed Network and Plan(s) Designs a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full. Attachment and return same with Proposal shall deem anv Proposal received non -responsive. (Note: Proposers may submit partial proposals based on the products offered through their company) b). Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. 6. Customer Service. Banking, Reporting Capabilities. & Benefit Administration a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non -responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) b). Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. 7. Price and Cost Effectiveness a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non -responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) It is the intention of the City for all contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same. b). Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. 8. Local Preference For Proposers seeking local preference consideration in the evaluation process, the following information must be provided with proposal, pursuant to Section 1.49 of the General Conditions: a) State the Primary Office Location of the Proposer b) Provide location from which the Proposer will be based to perform the work. 9. Performance Guarantees Performance Guarantees will be required regarding: a) Implementation b) Time to Process Page 37 of 39 Request for Proposals (RFP) 336312,4 c) Processing Accuracy d) Financial Accuracy e) Average speed of response f) Account management J0. List of Attachments to be completed and returned with Proposal (Submit Ouestionnaires appropriate to the products you are proposing) a) Attachment A b) Service Fee Schedules for all applicable locations c) Copies of network directories (DadeBroward/Monroe/Palm Beach/Ocala/Orlando/Raleigh, N.C.) d) Sample communications and ID card e) Geo Access reports f) Disruption reports for DHMO. DPPO or both if applicable. Disruption report must be based on current DHMO provider for proposed DHMO services. and current DPPO provider for proposed DPPO services g) Report samples Page 38 of 39 Request for Proposals (RFP) 336312,4 5. Evaluation Criteria 5.1. EVALUATION CRITERIA The City's Selection Committee will evaluate proposals and will select the proposer which meets the best interests of the City. The City shall be the sole judge of its own best interests, the proposals, and the resulting negotiated agreement. Proposals received shall be evaluated on the criteria noted below. In performing the evaluation, only information contained within the Proposal will be considered, unless otherwise stipulated and/or other clarifying information is requested by the City. Proposals from firms that do not meet the minimum qualifications set forth will not be considered further. The proposer granted the contract will be required to maintain the minimum qualification requirements during the term of the contract and any renewals. Each member of the Selection Committee shall independently review each proposal using the criteria listed below. Proposers meeting the Minimum Qualifications criteria will have their proposals evaluated and scored. The Selection Committee will rank and recommend proposer deemed to be the most highly qualified to perform the required services. The following criteria will be utilized to select the firms submitting proposals: CRITERIA PERCENTAGE Proposer's Organization, Qualifications, Capabilities 15 and Financial Stability Proposed Network and Plan(s) Designs 30 Customer Service, Banking, Reporting Capabilities, and Benefit 20 Administration Price and Cost Effectiveness 25 Local Preference, if applicable 5 Performance Guarantees 5 100 % Page 39 of 39 RFP No. 336312 — Employee Benefit Dental Plan Attachment A ATTACHMENT A Questionnaire for Employee Benefit Dental Plan(s) This Questionnaire must be fully completed, in the order stipulated, and returned with Proposal. Failure to answer all questions and provide with Proposal shall deem Proposal non -responsive. Financial Stability and Experience 1. Please provide the full business name of your company, mailing and physical address, telephone and fax number, email address, and web site address. 2. Which location would be the primary office to service the City's account and what services will be provided through this office? 3. Please list other companies with whom you have financial interest (i.e. insurance companies, PPOs, HMO, MGUs, Brokerage operations, etc.). 4. In the last five years, has your business entity ever been involved in a merger or had a change of ownership? If yes, please describe. 5. Within the last five years, has your business entity had a change of name, and/or used a d.b.a. or is it operating under an assumed name? 6. If an insurance company, what is your current rating with A.M. Best, Moodys, Fitch or Standard & Poor's? 7. Describe any previous or pending lawsuits and/or bankruptcies in the last 7 years. 8. Have any of the principals in your firm or any of your employees (former or current), ever been indicted or convicted of mishandling/misappropriating any insurance company or client funds? If yes, please provide details. 9. Describe your current procedures for handling client or insured complaints and State Insurance Department complaints. 10. Has the company (TPA) or its principals ever been adjudged bankrupt? If yes, please explain. 11. Have you ever been involved in an audit by the Depailiiient of Labor (DOL)? If yes, please provide details. 12. Do you carry a TPA errors & omissions policy? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits. of coverage for the policy? 1 RFP No. 336312 — Employee Benefit Dental Plan Attachment A • What is the deductible or self -insured retention? • Is contract a claims made policy or a claims made and reported policy form? 13. Do you carry a comprehensive general liability policy? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? • What is the deductible or self -insured retention? 14. Do you carry a fidelity bond? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? • What is the deductible or self -insured retention? • What are the total annual aggregate funds handled for all clients? 15. Have claims been made against any of the above policies in the past three (3) years? If yes, please provide details. 16. Provide a list of 5 references of clients of similar size, preferably in the public sector. Please include contact name and telephone number. Adequacy of Network and Qualifications of Providers 1. Please provide the Geo Access summaries for employees who fall both within and outside the network. The City would like to use 2 providers in 15 miles as the access standard. Provide this report for General Dentists, Endodontists, Periodontists, Oral Surgeons and Orthodontists. 2. Complete the following tables regarding your network with both the number of unique providers and individual office locations separately: Number of Unique Providers County General Ortho Endo Oral/Max Ped Periodontics Miami Dade Broward Monroe Palm Beach 2 RFP No. 336312 - Employee Benefit Dental Plan Attachment A Number of Locations County General Ortho Endo Oral/Max Ped Periodontics Miami Dade Broward Monroe Palm Beach Number of Providers Accepting New Patients County General Ortho Endo Oral/Max Ped Periodontics Miami Dade Broward Monroe Palm Beach 3. How often are provider contracts renegotiated? 4. Do your contracts include a specific clause which limits the amount of increase? Are there automatic annual increase provisions included in any of your contracts? 5. Are you able to service participants/dependents out of the Miami area through your DMO (DHMO) network? How? 6. What is your standard process and advance notification timeframe to notify the City and its members of network changes? 7. Do you have a system for maintaining credentialing information? How often is each provider re- credentialed? 8. Please list your 2010 and 2011 annual network turnover rates (percentages) for both voluntary and involuntary turnover. 9. Enter the percentage of providers that are reimbursed by the following methods in the table below: Method of Reimbursement % Reimbursed by Method Salary Discounted Fee for Service w/Withhold Fee for Service w/Bonus Fee Schedule Capitation Capitation w/Withhold Capitation w/Bonus Percentage Discount Other, please specify 3 RFP No. 336312 — Employee Benefit Dental Plan Attachment A 10. Is your plan licensed by the State of Florida? Licensed in what States outside of Florida? 11. When physicians are eliminated from the network, what is the timeframe given to allow participants to elect a new dentist? What is done for those that require a transition of care? 12. Can employees nominate their dentist to become a part of your network? 13. When is an area considered a network? What is the minimum number of dentists and specialists required necessary to constitute a network? 14. If a provider leaves the network and doesn't notify the participant, who is responsible for the claim payment? 15. How will your company interact with the medical provider on claims that are both medical and dental in nature? 16. Are your network providers prohibited from balance billing the patient for any excess of contracted amount, except for deductibles and coinsurance? 17. Are network directories provided on-line? 18. Are printed directories available? At what cost? How often are they updated? 19. What is the network access fee? Is this included in the administrative services fee or included in claims, or in other? Overall Plan Costs and Discount Arrangements 1. Is a rate/fee guarantee included? For what time period? 2. If you are proposing a self -insured plan, will you administer run -out? For how long? At what cost? 3. Are there any initial set-up fees? 4. Confirm you will provide 120 days notice for rate/fee changes. 5. Describe any programs that you have developed to address special areas of focus, in particular, detection of overcharges and overpayments. • How is criteria developed for these programs? • Are outside dentists/consultants retained to review questionable claims? 6. Please respond to the following with respect to claim overpayments: RFP No. 336312 — Employee Benefit Dental Plan Attachment A • If errors that resulted in overpayments to providers were detected in such samples, would our client be able to recover these overpayments directly from your organization? • If not, how would such overpayments be recovered? • How would you keep our client apprised of your efforts to recover overpayments? 7. Please complete the following Claims Administration and Member Services chart Claim Administration:and Member:Services Included Additional Cost Amt Toll free telephone access to claim and member services Cost Containment programs, specify Claim adjudication Production and distribution of standard drafts, EOBs Network Access Multilingual language line Coordination of benefits Member satisfaction surveys Plan Sponsor Services Included Additional ost=Ant Drafting of plan documents Printing /mailing of plan documents to employee homes Counseling with respect to federal and state regulatory requirements Initial system set up and administration of plan year revisions Consultation with respect to benefits and plan design Financial underwriting for both new business and ongoing revision Initial and ongoing eligibility and enrollment services Production and issuance of standard enrollment forms and ID cards to employee homes Billing/premium collection Provision of expected costs for budgeting purposes Provision of information for 5500 reporting Claim fiduciary responsibility Communication/Adm nistrativ e:Materials Additional ; Cost-Amt Production and distribution of standard provider directories Productions of standard claim forms Production of standard employee communication materials Shipping of communication materials to employees 5 RFP No. 336312 — Employee Benefit Dental Plan Attachment A -Baiiking ."Included Additional Cost Amt Outgoing wire requests and bank draft handling charge Bank reconciliation charges Other banking charges, specify Additional Services Included in EPP . .Additional Cost Amt COBRA administration and direct billing HIPPA certification/compliance Internet services 8. Please complete the appropriate section below: DMO Third Party Administrator Fees Total.Fees Employee Family ':Full}:Insured Premiums DMO - : - -Premiums :. .. Employee Employee + Child Employee + Spouse Family FullyInsured'Premiums. Other `. Premiums Employee Employee + Child Employee + Spouse Family 9. If you have proposed a self -insured plan, please indicate projected claims: Plan .Option DMO <Projected:ClaimsBased onPlanDesigns Other 10. Other than those listed on the administrative services chart, are there any other fees or charges that the City would incur if the City accepted your proposal? If so, please indicate here. 11. Please complete the following in -network Negotiated Fees chart for the designated counties as it applies to the DMO: ADA Code Procedure Description Negotiated Fee (What Patient Pays) Broward County Miami Dade County Palm Beach County Monroe County 0120 Adult Exam 1110 Adult cleaning 2150 Amalgam Restoration 7110 . Simple Extraction 3310 Anterior Root Canal 6 RFP No. 336312 — Employee Benefit Dental Plan Attachment A ADA Code Procedure Description Negotiated Fee (What Patient Pays) Broward County Miami Dade County Palm Beach County Monroe County 2750 Porcelain/Gold Crown 5110 Complete Upper Denture 6240 Porcelain/Gold Bridge Abutment 6750 Porcelain/Gold Bridge Pontic 12. Please attach any corresponding fee schedules that will apply. 13. Is more than one fee schedule utilized on a national basis? If so, please explain. 14. Are you willing to offer the executive plans as standalone plans? At what cost? Reporting Capabilities 1. Attach sample copies of your proposed reporting packages. Include proposed reports for financial, claims, utilization, billing, accounting, banking, etc. 2. What reporting is available on-line? 3. Is on-line reporting accessible to individuals designated by the City (and approved via HIPAA)? Communications and Enrollment Capabilities 1. Describe your internet capabilities in regards to the following areas: • Customization to City of Miami plan design information • Enrollment • Forms • Change of status • Employee personal access information (claims, EOBs, dependent information, etc.) • Banking • Employer/consultant reporting • Comparative dental cost information • Other 2. What communication materials/assistance are included in your quoted fees/premiums (include materials, staffing and on-line capabilities)? 3. Can the City's logo be included on these materials? Is there an additional charge? 4. Describe your enrollment options (paper, on-line, recorded media, etc.). 7 RFP No. 336312 — Employee Benefit Dental Plan Attachment A 5. Describe the communications that are available, and in what format for: • Enrollment • Network information • Claims information 6. Please attach samples (including ID card) Claims Administration Capabilities 1. How many months of historical claim data are stored in your claims system? 2. How far back in time can claims be processed on your system? 3. Is your system an on-line, direct access system or a plan/claims information storage and retrieval system? Provide a flowchart or brief description of its operation. 4. How long has your claims payment system been operational? 5. Can eligibility and claims transactions be accessed by the same person? 6. Describe enhancements made in the last 12 months and those planned for the next 12 months. 7. Describe the mechanics/process of screening for duplicate claims. 8. Can your system accept and track full eligibility data? 9. Can your system track each dependent by the dependent's name and social security number? 10. What is your process for establishing student eligibility? Incapacitated dependent status? 11. Under what conditions and by which individuals can your claims system be manually overridden? 12. How are manual overrides (if any) to your claims system are reviewed by claims managers? 13. What are the minimum requirements for claims history transferred to your system(s) on a new account basis? 14. What system platforms are utilized for plan administration? Please describe. 15. Will a direct claims payment system be utilized? 16. How long has the claims payment system been in place? 17. What percentage of claims are automatically adjudicated? 18. What are the claims administration standards? 19. How are non -network and out -of -area provider claims identified and paid? 8 RFP No. 336312 — Employee Benefit Dental Plan Attachment A 20. What are the Eastern Standard Time hours of operation for the claims unit? 21. How are claims staffing levels established? 22. Is there a dedicated claims unit for the City? 23. How many bilingual customer service staff members do you have, and what languages do they speak? 24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as required to date and for future scheduled compliance. 25. Do you maintain Performance Standards? If so, please describe the metrics and processes used? Is a third party independent auditing company used in the process? Ability to Administer Requested Plan Designs/Alternatives 1. Are you able to administer the dental plan designs as designated in this proposal? 2. If not, please indicate the deviations per plan. All deviations must be indicated in your response. Account Management Staff 1. Complete the following chart with information on the management and service team you propose for our clients. Role Name Title Percent of Time Commitment to City of Miami Through Implementation After Implementation Account Manager Day to Day Liaison Implementation Coordinator Customer Service Supervisor Claim Administration Supervisor Network Management Liaison Other 2. Include the resumes of the above proposed team members. 3. Is designated staff expected to maintain measurable client satisfaction standards? If so, please describe. 9 RFP No. 336312 - Employee Benefit Dental Plan Attachment A Banking 1. What are your billing and premium payment procedures? 2. What financial reporting is included? 3. What are the funding requirements (i.e., checks issued, checks cleared?) 4. Is bank reconciliation included in your fees/premiums? 5. Please give the following information for your principal banking relationship (to be used as reference): • Bank name • Address • Phone number • Contact name and title 10 RFP No. 336312 - Employee Benefit Dental Plan Attachment B PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and (TBD) Insurance Company This Professional Services Agreement ("Ag reement") is entered into this day of , 2013 by and between the City of Miam i, a municipal corporation of the State of Florida, whose address is 444 S.W . 2nd Avenue, 10th Floor, Miami, Florida 33130 ("City"), and Insurance Company, ("PROVIDER") a Florida Co rporation qualified to do business in Florida whose principal address is: . RECITALS: WHEREAS, the City of Miami issued a Request for Proposal No. 336312 .on August 16, 2012 (the "RFP" attached hereto, in corporated hereby, and made a part of as Exhibit A) for the provision of Employee Group Benefit Dental Plan, ("Services" as m ore fully set forth in the scope of work "SOW" attached hereto as Exhibit B) for the Risk Managem ent Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and m ade part of hereof as Exhibit C), in response thereto, has been selected as the m ost qualified proposal for the provision of the Services. WHEREAS, the Evaluation Comm ittee appointed by the City Manager determined that the Proposal submitted by the Provider w as responsive to th e RFP requirem ents and recommended that the City Manager negotiate with the Provider; and WHEREAS, the City wishes to enga ge the Services of Provider, and Provider wishes to perform the Services for the City; and WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and condition set forth herein. Employee Benefit Dental Plan 1 RFP No. 336312 - Employee Benefit Dental Plan Attachment B NOW, THEREFORE, in consideration of th e mutual covenants and prom ises herein contained, Provider and the City agree as follows: Employee Benefit Dental Plan 2 RFP No. 336312 - Employee Benefit Dental Plan Attachment B TERMS: 1. RECITALS AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporatedinto and made a part of this Agr Bement. The City 's RFP is he reby incorporated into an d made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereb y incorporated into and made a part of this Agreement as attached Exhibit `B". The Provider's Response dated, _, 2012, is hereby incorporated into and m ade a part of this Agreem ent as attached Exhibit "C". The Provider's In surance Certificate is h ereby incorporated into and made a part of this Agreement as Exhibit "D". The order of precedence whenever there is conflicting or inconsistent language between docum ents is as follows: (1) Provider's Professional Services Agreem ent ("PSA") with the Scope of W ork; (2) Addenda /Addendum to the Reques t for P roposals; (3) Request for Proposals; and (4) T BD Insurance Company and, response to the Request for Proposals. 2. TERM: The initial term of this Agreement shall commence on the January 1, 2013 and shall continue in effect for a term of three (3) years ending on December 31, 2015. 3. OPTION TO EXTEND: The City , acting adm inistratively through its City Manager, shall have two (2) option(s) to extend the term hereof for a period of one (1) year each, subject to availability, allocation and appropriation of funds and sati sfactory performance by the Provide r in the opinion of the City Manager. The City sh all exercise its right to extend the term hereof by giving Provider at least Employee Benefit Dental Plan 3 RFP No. 336312 - Employee Benefit Dental Plan Attachment B thirty (30) days written notice prior to the expi ration of the previous term . City Comm ission approval shall not be required as long as the total extended term does not exceed two (2) years. 4. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special terms and conditions set forth in Exhi bit "A" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Provider represents to the City that: (i) it possesses all qualifications, licenses and expertise required for the perf ormance of the Services, incl uding but not lim ited to full qualification to do business in Flor ida; (ii) it is not delinquent in the paym ent of any sum s due the City, including payment of perm its, fees, occupational licenses, etc., nor in the performance of any obligations to th e City, (iii) all personn el assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A" ; and (v) eac h person executing this Agreem ent on behalf of Pr ovider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. C. Provider shall at all tim es provide f ully qualified, com petent and physically capable employees to perform the Services under this Agreem ent. City may require Provider to remove any em ployee the City d eems careless, incompetent, insubordinate, or otherwise objectionable and whose continued se rvices under this Agreement is not in th e best interest of the City. 5. COMPENSATION: Employee Benefit Dental Plan 4 RFP No. 336312 - Employee Benefit Dental Plan Attachment B A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhi bit "E" he reto, which by this re ference is incorporated into and made a part of this Agreement. B. Payment shall be m ade in arrears base d upon work performed to the satisfaction of the City within forty-five (45) days after r eceipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. - 218.79, Florida Statutes, and other applicable laws. No advance payments shall be m ade at any time. C. Provider agrees and unders tands that (i) any and al 1 subcontractors providing Services related to this Agreem ent shall be pa id through Provider and not paid directly by the City, and (ii) any and all liabilities regarding pa yment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, or which is otherwise obtained or prepared by Provider pursuant to or under the term s of this Agreement, is and shall at all tim es remain the property of the City. Provider agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent Employee Benefit Dental Plan RFP No. 336312 - Employee Benefit Dental Plan Attachment B to the termination of this Agreement; however, in no way shall the con fidentiality as permitted by applicable law be breached. The City shall m aintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees to p rovide access to the Ci ty or to any o f its du ly authorized representatives, to any books, docum ents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, exam ination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreem ent, audit and inspect, or cause to be audited and inspected, those books, docum ents, papers, a nd records of Provider which are related to Provider's performance under this Agreem ent. Pr ovider agrees to m aintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to com ply with, th is condition shall result in the immediate cancellation of this Agreement by the City. B. The City may, at reaso nable times during the term hereof, inspectthe Provider's facilities and perform such tests, as the City deem s reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreem ent conform to the terms hereof and/or the term s of the Administrative Services Agreement, if applicable. Provider shall make available to the City all reason able facilities and assistance to f acilitate the performance of tests or inspecti ons by City rep resentatives. All tests and inspections shall b e subject to, and m ade in accordan ce with, the provisions of Section 18-101 and 18-102 of the Employee Benefit Dental Plan 6 RFP No. 336312 - Employee Benefit Dental Plan Attachment B Code of the City of Miam i, Florida as sam e may be am ended or supplemented, from time to time. 8. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not em ployed or retained any person or company employed by the C ity to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reason able times, to all documents and inf ormation pertaining to C ity Agreements, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to a 11 documents subject to disclosure under applicable laws. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. B. Should Provider determ inc to dispute any public access provision required b y Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. 10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agr eements with local governm ents are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City an d Provider agree to com ply with and observe all such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Provider further agrees to incl ude in all of Provider's agreem ents with subcontractors for any Services related to this Agreem ent this pro vision requiring subcontractors to c omply with Employee Benefit Dental Plan 7 RFP No. 336312 - Employee Benefit Dental Plan Attachment B and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harm less the City and its officials, em ployees, and its designated third -party administrator for claims (collectively referred to as "Indemnitees") and each of them from and against all to ss, costs, penalties, fines, damages, claim s, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Ag reement (whether active or pass ive) of Prov ider or its employees or subcontractors (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, om ission, default or negligence (whe ther active or passive or in strict liability) of the Indemnities, or any of them, or (ii) the f ailure of the Provider to comply materially with any of the requ irements herein, or the failure of the Provider to conform to statutes, ordinances, or other re gulations or requirements of any governmental authority, local, federal or state, in connection with the performance of this Agreement even if it is alleged that the City, its officials and/or employees were negliOent.. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them , from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Pr ovider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider further agrees to indem nify, defend and hold harmless the Indemnitees form and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, Employee Benefit Dental Plan 8 RFP No. 336312 - Employee Benefit Dental Plan Attachment B order, rule, regulation, conditi on, or requirem ent, related dire ctly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all claim s, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. This section shall be interpreted to com ply with Sections 725.06 and/or 725.08, Florida Statutes. Provider's obligations to indem nify, defend and hold harm less the Indemnitees shall survive the termination of this Agreement. Provider understands and agrees that any a nd all liab ilities regarding the use of any subcontractor for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. . 12. DEFAULT: If Provider fails to comply materially with any term or condition of this Agreement, or fails to perform in any m aterial way any of its obligations hereunder, a nd fails to cure such failure after reasonable notice f rom the City, then Provider shall be in default. Provider understands and agrees that term ination of this Agreement under this section shall not release Provider from any obligation accruing prior to th e effective date of termination. Should provider be unable or unwilling to commence to perfor m the Servic es within the tim e provided o r contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in pr eparation and negotiation of this Agreement, as well as a 11 costs and expenses incurred by the City in th e re -procurement oft he Services, including consequential and incidental damages. Employee Benefit Dental Plan 9 RFP No. 336312 - Employee Benefit Dental Plan Attachment B 13. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all d isputes between Provider and the City based upon an alleged violatio n of the term s of this Agreement by the City shall be sub mitted to the City Manager for his/her resolution, prior to Provi der being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds Twenty - Five Thousand Dollars and No/Cents ($25,000), th e City Manager's decision shall be approved or disapproved by the City Comm ission. Provider sh all not be entitled to seek judicial relief unless: (i) it has first received City Mana ger's written decision, approved by the City Commission if the am ount of compensation hereunder exceeds Twenty-F ive Thousand Dollars and No/Cents ($25,000), or (ii) a period of six ty (60) days has expired, after subm itting to the City Manager a detailed statement of the di spute, accompanied by all supporting documentation ninety (90) days if City Manager's decision is subject to City Commission approval); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. 14. TERMINATION;OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its s ole discretion, at any tim e, by giving written n otice to Provider at least sixty (60) calendar days prior to the effective date of such term ination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no ev ent shall the City be liab le to Provid er for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. The Provider shall have no Employee Benefit Dental Plan 10 RFP No. 336312 - Employee Benefit Dental Plan Attachment B recourse or remedy against the City for a termination under this subsection except for payment of fees due prior to the effective date of termination. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to Provider, upon the oc currence of an event of a m aterial default hereunder. In such event, the City shall not be obligated to pay any am ounts to Provider for Services rendered by Provider after the date of term ination, but the parties shall remain responsible for any paym ents that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional com pensation and expenses incurred, other than that provided herein, and in no event sh all the City be liable for a ny consequential or incidental damages. C. This Agreement may be terminated, in w hole or in part, at any tim e by mutual written consent of the parties hereto. In such ev ent, the City shall no t be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall rem ain responsible for any paym ents that have becom e due and owing as of the effective date of ter mination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided here in, and in no event shall the City be liable for any consequential or incidental damages. D. This Agreement may be terminated, in whole o r in part, by either party if there has been a material default or breach on the part of the other part y in any of its representations, warranties, covenants, or obligatio ns contained in this Agreem ent and such default or breach is not cured within ninety (90) days following wr itten notice from the non -breaching party. In such event, the City shall not be obligated to pay any am ounts to Provider for Services rendered by Provider after the date of term ination, but the parties shall remain responsible for any paym ents Employee Benefit Dental Plan 11 RFP No. 336312 - Employee Benefit Dental Plan Attachment B that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional com pensation and expenses incurred, other than that provided herein, and in no event sh all the City be liable for a ny consequential or incidental damages. 15. INSURANCE: A. Provider shall, at all tim es during the term hereof, maintain such insuranc e coverage(s) as m ay be required by the City. Th e insurance coverage(s) required as of th e Effective Date of this Agreem ent are attached hereto as Exhibit "D" and incorporated herein by this reference... The City RFP number and titl e of the RFP m ust appear on each certificate of insurance. The Provid er shall add the City o f Miami as an additional nam ed insured to its commercial general liability and auto policies a nd as a named certificate holder on all policie s. Provider shall correct any insurance certificates as reques ted by the City's Risk Managem ent Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providi ng that it will n of be canceled, modified, or changed during the performance of the Services under this Agreement without thirty (30) calendar days prior written notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the perform ance of Services hereunder, provided,'. however, that Provider shall at any tim e upon re quest file duplicate copies of the policies of such insurance with the City. B. If, in the reasonable judgm ent of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000).of Employee Benefit Dental Plan 12 RFP No. 336312 - Employee Benefit Dental Plan Attachment B professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to such additional am ount of professional liability coverage, arid shall afford written notice of such change in requirem ents thirty (30) days pr for to the d ate on which th e requirements shall take effect. Should the Provider fail or refuse to sa tisfy the requirement of additional coverage within thirty (30) days foll owing the City's wr itten notice, this Agreement shall be co nsidered terminated on the date the required change in policy coverage would otherwise take effect. C. Providerunderstands and agrees that any and all liabilities regarding the use of any of Provider's em ployees or any of Provider's subcontractors for Services related to th is Agreement shall be borne solely by Provider throughout the term of this Agreement and that this provision shall survive the to rmination of this Agreement. Provider further and erstands and agrees that insurance for each em ployee of Provider and each subcontractor prov iding Services related to this Agreem ent shall be m aintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreem ent remain in full force and effect for the duration of this Agreem ent, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to th e City's Ri sk Management Administrator at a m inimum of ten (10) calendar days in advance of such expiration. In the event that expired certificates are not replaced, with new or renewed certificates which cove r the term of this Agre ement and any extension thereof: Employee Benefit Dental Plan 13 RFP No. 336312 - Employee Benefit Dental Plan Attachment B (i) the City sh all suspend this Agreem ent until su ch time as the new or renewed certificate(s) are received in acceptable form by the City's Risk Managem ent Administrator; or (ii) the City may, at its so le discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. E. Compliance with the foregoing requirem ents shall no t relieve Provider of its liabilities and obligations under this Agreement. 16. NONDISCRIMINATION: Provider represents to the City that Pr ovider does not and will not engage in discriminatory practices and that the re shall be no discrimination in c onnection with Provider's performance under this Agreement on account of race, color, sex, religion, age, handicap, marital status or national origin. Provider further covena nts that no otherwise qualified individual shall, solely by reason of his/her race, co lor, sex, re ligion, age, handicap, m arital status or national origin, be excluded from particip ation in, be denied services, or be subject to discrim ination under any provision of this Agreement. Employee Benefit Dental Plan 14 RFP No. 336312 - Employee Benefit Dental Plan Attachment B 17. ASSIGNMENT: This Agreement shall not be assigned by Provide r, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which m ay be withheld or conditioned, in the City's sole discretion through the City Manager. Provider m ay not change or rep lace sub -contractors performing work under the Services Agreem ent identified in Exhibit `B" without the prior written consent from the City Manager. 18. NOTICES: All notices or other co mmunications required under this Agreem ent shall be in writin g and shall be given by hand-deliv ery or by r egistered or certified U.S. Mail, return receipt requested, addressed to the other party at the addre ss indicated herein or to such, other address as a party may designate by notice given as herein provided. Notice shall be deemed given on the day on which personally de livered; or, if by m ail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: TBD Johnny Martinez TBD City Manager TBD 444 SW 2nd Avenue, 10th Floor TBD Miami, FL 33130-1910 Employee Benefit Dental Plan 15 RFP No. 336312 - Employee Benefit Dental Plan Attachment B 17. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any pro ceedings between the parties shal 1 be in Miam i-Dade County, Florida. Each party shall bear its own attorney 's fees. Each party waives any defense, whether asserted by motion or pleading, th at the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the pers onal jurisdiction of the aforementioned courts and irrevocably waive any objections to said - jurisdiction. The parties irrevocably waive any rights to a jury trial. B. Title and p aragraph headings are fo r convenient reference and are not a part of this Agreement. C. No waiver or breach of any provis ion of this Agreement shall constitute a waiver of any subs equent breach of the sa me or a ny other provision hereof, and no waiver shall be effective unless made in writing. D. Should any provision, paragr aph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under th e laws of the State of Flor ida or the City of Miam i, such provisio n, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not m odifiable, then the same shall be deem ed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. E. Provider shall comply with all ap plicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. Employee Benefit Dental Plan 16 RFP No. 336312 - Employee Benefit Dental Plan Attachment B F. This Agreement constitutes th e sole and entir e agreement between the parties hereto. No modification or am endment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole au thority to extend, to am end or to modify this Agreement on behalf of the City. 18. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 19. INDEPENDENT CONTRACTORS: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, neither Pr ovider, nor its employees, nor any subcontractor hired by Provider to provide any Services under th is Agreement shall attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider fu rther understands that Florida Workers' Compensation benefits available to employees of the City are not available to Provider, its em ployees, or any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider re ndering Services to the City under this Agreem ent. Provider further understands and agrees that Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. 20. CONTINGENCY CLAUSE: Funding for this Agreem ent is contingent on the availability of funds and con tinued authorization for program activities and the Agreem ent is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate Employee Benefit Dental Plan 17 RFP No. 336312 - Employee Benefit Dental Plan Attachment B or appropriate funds, a nd/or change in applic able laws or regulations, upon thirty (30) days written notice. 21. FORCE MAJEURE: A "Force Majeure Event" shall m can an act of God, act of governmental body or m ilitary authority, fi re, explosion, power fa ilure, flood, storm, hurricane, sink hole, of her natural disasters, ep idemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or em bargo. In th e event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreem ent by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the num ber of days equal to the total number of days, if any, that such party is actually delayed by such Force M ajeure Event. The party seeking delay in performance shall give notice to the other pa rty specifying the antic ipated duration of the delay, and if such delay shall ex tend beyond the duration specified in such notice, ad ditional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Ev ent shall use its best efforts to rectify any condition ca using such delay and shall cooperate with the other party to overcome any delay that has resulted. 22. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for or on a ccount of, any stoppages or delay(s ) in work herein provided for, or any dam ages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on acc ount of any delay(s) for any cause over which the City has no control. Employee Benefit Dental Plan 18 RFP No. 336312 - Employee Benefit Dental Plan Attachment B 23. USE OF NAME: Provider understands and agrees th at the City is no t engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of norm al and custom ary marketing and prom otion of its work, to use the general results of this project and the nam e of the City. The Provider agrees to protect any confidential information provided by the City and will n of release information of a specific nature without prior written consent of the City Manager or the City Commission. 24. NO CONFLICT OF INTEREST: Pursuant to City of Miam i Code Section 2- 611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that individual m ember of Provider, no e mployee, and no subcontractor under this Agreem ent nor any imm ediate family member of any of the same is also a m ember of any board, commission, or agency of the City. Provider he reby represents and warrants to th e City tha t throughout the term of this Agreement, Provider, its employees and its subcontractors will abide by this prohibition of the City Code. 25. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. 26. SURVIVAL: All obligations (including but not lim ited to indem nity and obligations to defend and hold harm less) and rights of any party ar ising during or attributable to the period prior to expiration or expiration or earlier termination. 27. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, re presents and warrants to City th at on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force and effect, the wage rates and other factual un it costs supporting the co mpensation to Provider Employee Benefit Dental Plan earlier termination of this Agreement shall su rvive such 19 RFP No. 336312 - Employee Benefit Dental Plan Attachment B under this Agreem ent are and will continu e to be accurate, com plete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions theret o to exclude any s ignificant sums by which the City d etermines the contract price of compensation hereunder was in creased due to inaccurate, incomplete, or non- current wage rates and other factual unit costs. All such contract adjustm ents shall be m ade within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 28. COUNTERPARTS: This Agreement may be executed in three or m ore counterparts, each of which shall constitu to an original but all of which, when taken together, shall constitute one and the same agreement. 29. ENTIRE AGREEMENT: This instrument and its attachm ents constitute the sole and only agreement of the parties r elating to the s ubject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly se t forth in this Agreement are of no force or effect. Employee Benefit Dental Plan 20 RFP No. 336312 - Employee Benefit Dental Plan Attachment B IN WITNESS WHEREOF, the parties hereto have caused th is instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written. "City" CITY OF MIAMI, a municipal ATTEST: corporation By: Priscilla A. Thompson, City Clerk Johnny Martinez, City Manager "Provider" ATTEST: TBD Insurance Company Print Name: Title: By: TBD (Corporate Seal) (Authorized Corporate Officer) APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: REQUIR EMENTS: Julie O. Bru Calvin City Attorney Risk Employee Benefit Dental Plan Ellis Management Director 21 RFP No. 336312 - Employee Benefit Dental Plan Attachment B CORPORATE RESOLUTION WHEREAS, Humana Dental Insurance Company and CompBenefits Company, a Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; This Resolution needs to authorize the signatory to sign Employee Benefit Dental Plan 22 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT A `- ADMINISTRATIVE SERVICES AGREEMENT Employee Benefit Dental Plan 23 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT B PROVIDER PROPOSAL RESPONSE AS TO TERMS & CONDITIONS Employee Benefit Dental Plan 24 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT C PROPOSED RENEWAL TERMS AND CONDITIONS Employee Benefit Dental Plan 25 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT D INSURANCE REQUIREMENTS I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General Aggregate Limit $ 2,000,000 Personal and Adv. Injury $ 1,000,000 Products/Completed Operations $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured III. Worker's Compensation Limits of Liability Statutory -State of Florida Waiver of Subrogation IV. Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit V. Professional Liability/Errors and Omissions Coverage Employee Benefit Dental Plan 26 RFP No. 336312 - Employee Benefit Dental Plan Attachment B Combined Single Limit Each Claim $1,000,000 General Aggregate Limit $1,000,000 Deductible- not to exceed 10% The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Employee Benefit Dental Plan 27 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT E COMPENSATION Employee Benefit Dental Plan 28 RFP No. 336312 - Employee Benefit Dental Plan Attachment B EXHIBIT F CORPORATE RESOLUTIONS AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA (To be provided upon document execution) Employee Benefit Dental Plan 29 Cigna Dental Benefit Solutions for: City of Miami RFP No. 336312 September 2012 Prepared for: AON-Hewitt A Proposal for: Cigna DHMO and DPPO Provided by: Cigna Health and Life Insurance Company (CHLIC) and Cigna Dental Health of Florida, Inc. are the legal names of the companies submitting this response to the City of Miami Request for Proposal. In this proposal, CHLIC and Cigna Dental Health of Florida, Inc. may use the name "Cigna" and other service marks, or division/trade names, in reference to CHLIC and Cigna Dental Health of Florida, Inc. and/or the products and services offered by CHLIC and Cigna Dental Health of Florida, Inc. and affiliated Cigna companies. "Cigna" and the "Tree of Life" logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, and not by Cigna Corporation. Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Coverpage 1. Contact Person Yesenia Sanchez. 2. Firm Liaison Yesenia Sanchez 3. Primary Office DHMO Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, Florida, 33323 Corporate Address Cigna Health and Life Insurance Company (CHLIC), a Cigna company, is located at: 900 Cottage Grove Road Bloomfield, Connecticut, 06152 4. Local Business Office Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, Florida, 33323 5. Business Phone/Fax Numbers DHMO Phone: 954.514.6600 Corporate Address Phone Number: 860.226.6000 6. Title of RFP City of Miami No. 336312 7. RFP Number No. 336312 8. Federal Employer Identification Number Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Coverpage DHMO The federal taxpayer ID number for Cigna Dental Health, Inc. is 59-2308055. Subsidiaries providing coverage in different states have different ID numbers. For Florida, the federal tax ID number is 59-1611217. CHLIC The federal taxpayer ID number for Cigna Health and Life Insurance Company is 59- 1031071. Improved Oral Health. Lower Costs. Table of Contents Caveats City of Miami RFP No. 336312 Executive Summary • Organization • Qualifications/Capabilities • Proposed Networks & Plan Designs o City of Miami - Executive Plan Benefit Summary o City of Miami - Voluntary Plan Benefit Summary o DHMO Patient Charge Schedule - P6XVO • Customer Service • Banking • Reporting Capabilities • Benefit Administration • Price and Cost Effectiveness Certification Statement Certifications Addendums Terms and Conditions 1. General Conditions 2. Special Conditions 3. Specifications 4. Submission Requirement 5. Evaluation Criteria Attachment A - Questionnaire Attachment B - Professional Services Agreement Exhibits Copyright 2012 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Caveats Producer Compensation Programs and Reporting The producer (broker) may receive compensation or other things of value from the Cigna companies in various forms. • Cigna may pay service fees to brokers for services related to enrollment, billing premium, maintaining employee/member records, paying claims and other administrative services. Service fees are paid by the customer and are collected and paid to the producer by Cigna in conjunction with our normal monthly commission processing. • Cigna companies may have entered into, or may enter into, an agreement with the broker, under which the broker may be compensated for providing marketplace intelligence or for the performance ofadministrative services. The qualification for andramount of this compensation may be based upon overall business growth and/or retention levels. Any such compensation is funded through the Cigna companies' general overhead. Any such payments are separate from commissions. • In addition to commissions and other fees noted above, the broker may qualify for incentive compensation (monetary or non monetary). For example, the broker may receive additional payments based upon new sales, new customer base growth or retention. This incentive compensation is funded from Cigna companies' general overhead. Any such payments are separate from commissions. • Cigna companies sponsor programs to inform brokers about their products and services (including producer advisory councils). These events are funded through the Cigna companies' general overhead. • Cigna requires producers to provide us with written certification confirming their obligation to disclose (i) commissions, service or communication fees and participation in override programs to the customer prior to closing the sale; and (ii) provide details concerning these items to the customer's satisfaction. • Cigna includes general disclosures within our proposal documents about commissions, service and communication fees, the existence of our override programs, eligibility to participate in company sponsored events, and participation on advisory councils • Cigna includes disclosures on ERISA Form 5500 Schedule A and Schedule C information (and a similar disclosure statement for non-ERISA plans) provided to customers. Copyright 2012 i Cigna Improved Oral Health. Lower Costs. Caveats Disclaimer City of Miami RFP No. 336312 The information contained in the following proposal by Cigna is proprietary and highly confidential. It is being provided with the understanding that it will not be used by City of Miami, its representatives, or consultants for any purpose other than the evaluation of Cigna in connection with the services described in the following proposal. Dissemination of the information contained herein by City of Miami, its representatives, or consultants shall be limited to their respective employees who are directly involved in the evaluation process. Under no circumstances is any of the information contained herein (including excerpts, summaries, extracts and evaluations thereof) to be disseminated, disclosed, or otherwise communicated to any person or entity other than by City of Miami, its representatives, and consultants involved in the evaluation process. "Dental HMO" is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. Copyright 2012 ii Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Why City of Miami should choose Cigna. While the need for dental insurance has risen for both public and private sector clients, finding the appropriate dental plan that offers the right combination of choice, savings, quality, and service is an ongoing challenge. At Cigna, we understand our clients' long-term strategic goals, and have 40 successful years of experience administering them. It is our mission to find the appropriate balance of coverage, network availability, and cost for our clients. What you can expect from Cigna • innovative plans, funding arrangements, and features • dedicated account management team • time -saving eCommerce capabilities • nationwide discounts Choice Our goal is to provide you with a program that fits your budget and provides extensive coverage for your employees' dental needs. We believe the Cigna Dental Care (DHMO) and Cigna DPPO plans are the right options for your employees. The Cigna DHMO plan provides a broad range of covered services. Our patient charge schedule options allow you to choose from a wide range of coverage levels and premiums. Each patient charge schedule covers a wide array of dental procedures, including orthodontics. Our plans provide preventive services with no patient charge and without deductibles or annual dollar maximums to limit care. The Cigna DPPO plan, with its plan design flexibility, cost-effectiveness, and extensive dentist choice, is one of the most sought-after plan coverage's in the market today. Our DPPO plan coverage is easily adaptable to meet your specific coverage or financial needs. With the Cigna DPPO plan there is no gatekeeper element; members do not need to choose a primary dentist at enrollment and can visit specialists at any time without referrals. They can also choose to visit out -of -network dentists at a higher out-of-pocket cost. Savings We are dedicated to helping you achieve your savings goals while offering your employees quality dental coverage. Our DHMO plans are typically 30-40 percent lower in premiums, and have 40-50 percent less out-of-pocket expenses than a comparable indemnity plan. Covered services and coverage levels are also the same for every location served by Cigna Dental Care network dentists. Our patient charges are pre-set, pre -published fees and are not discounts from the dentists' usual charges. Employees nationwide will pay the same amount for services, and they will always know their costs in advance. Our Cigna DPPO plans offer deeper discounts than many other carriers. Our contracted fee schedules are based on a discount of average area charges. Our average discount nationwide is 35 percent. Some carriers discount individual dentists' charges, resulting in higher claim costs and more out-of-pocket charges to the member. Network Cigna Dental's networks are among the largest in the country with over 50,000 DHMO dentists contracted access points and over 250,000 DPPO dentists contracted access points. We conduct on -site reviews of every DHMO general dentists' office, and 20 percent of Copyright 2012 Page 3 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary DPPO offices since they also participate in the DHMO. And should the opportunity exist for us to maximize network expansion to better meet your needs; we will work closely with you to meet those objectives. Our seamless networks also mean members will receive the same coverage wherever they live, from dentists held to the same quality standards. Network dentists are pre -qualified through our NCQA- based credentialing process. They are also monitored on an ongoing basis through our stringent quality management program. Service Your local account management team will work with you to create a strategic service plan that outlines enrollment activities, network recruitment plans, and communications initiatives. This team is equipped and ready to deliver service that goes above and beyond what you would typically expect. From case installation to contract renewals, they advocate on your behalf to deliver seamless service so you can receive the most from your coverage program. And because our customer service centers are measured against the same standards, employees can be assured of the same quality service, whichever Cigna Dental plan they select. Members may call our customer service department at 1.800.Cigna24 with questions about coverage, network dental offices, procedures, or any other concerns. The Scranton, Pennsylvania customer service claim center is available 24 hours a day, seven days a week. Our voice response system is available 24-hours a day, 7 days a week, except from 1:00 a.m. through 10:00 a.m. on Sundays for maintenance. DHMO members can use the voice response system to view eligibility and coverage information or they can use our automated quick transfer option to change network dental offices. DPPO members can use the voice response system to check claim status, eligibility, and coverage information. Employees may also use the internet to learn more about their dental coverage. With www.Cigna.com, requests are processed by a team of trained internet service specialists. And by using myCigna.com, they can find their coverage information and health and wellness information personalized to their preferences and profiles. Cigna: The Right Decision We look forward to this opportunity with City of Miami. As an industry leader, our team will provide you and your employees with quality dental care, member -focused service, and accessible networks - while helping you maintain and manage costs. Cigna is the best choice when selecting a dental plan Time -saving Web capabilities Cigna's websites at www.Cisna.com and myCigna.com provide convenient access to dental plan information. • eligibility verification • personalized coverage information • claim status inquiry (DPPO) • treatment cost estimator • benefit manager toolkit • frequently asked questions • dentist search with maps and directions • on-line claim forms (DPPO) • printable ID cards • dental prevention and wellness information with WebMD articles • glossary of dental terms • DHMO network dental office transfer requests Copyright 2012 Page 4 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Organization Overview Cigna and its predecessor companies have a long history of supporting Americans' health care needs. Starting with the formation of Connecticut General Life Insurance Company (CGLIC) and Insurance Company of North America (INA), we have more than 200 years of history. In 1990, Cigna became the largest investor -owned managed care organization in the country, and still concentrates on meeting client needs for best -in -class health care and employee benefit plan coverage and services. Cigna Health and Life Insurance Company .(CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. It is an indirect, wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. Cigna's rich and exciting history reveals the foundation of experience that shapes our current plan coverage and business strategies. Today, Cigna companies comprise one of the nation's leading providers of employee benefits, health care coverage, and insurance products to businesses and individuals worldwide. No matter how much success we have enjoyed, Cigna has never wavered from its main purpose —to improve the health, well-being, and sense of security of the individuals we serve. Copyright 2012 Page 5 of 151 Cigna Improved Oral Health. Lower Costs. Executive Summary Qualifications and Capabilities City of Miami RFP No. 336312 Cigna provides extensive coverage's, features that focus on overall wellness, flexible plan designs, large networks, competitive pricing, versatile funding options, and unique service and technology options. This, along with our multi -plan coverage capabilities, consistent national offerings, and ability to handle even the most complex cases gives us a unique competitive advantage. Extensive DHMO Coverage - Every DHMO plan is not the same —our standard DHMO plans have richer coverage's than many other carriers. Undisclosed fees and covered services frequency limitations can make other plans appear less costly; however, members pay more in out-of-pocket costs. We cover missing teeth, pediatric care to age seven, second opinions, and bitewing x-rays whenever you need them, with no frequency limitations. We also offer value plans which have alternate coverage limitations, plans that have discounted specialty care, plans that separate lab fees from copays, and plans that have higher member copays when care is rendered by a network specialty dentist. This variety of DHMO plan options gives clients more choice and price flexibility when choosing dental coverage's for their employees. Flexible Plan Designs - We offer a wide range of DHMO and DPPO plans. These can be offered alone or packaged together based on your specific coverage and savings goals. We also provide a variety of DHMO charge schedules and fully customizable DPPO plans. Unique Plan Coverage Features - Because regular, routine oral carehelps employees address minor problems before they become major and more expensive to treat, employees also have the option of selecting one of the following WellnessPlus® features for our DPPO plans: 1. progressive maximum 2. progressive coinsurance coverage 3. progressive/regressive coinsurance coverage With WellnessPlus, members who receive preventive services on an annual basis will be rewarded with an increase in their annual dollar maximum or coverage level (depending on the feature chosen by the client) in the following year up to the amount specified by the client's plan design. This incentive feature is designed to encourage preventive care because regular, oral care may help employees address minor problems before they become major and more expensive to treat. In addition to WellnessPlus, we offer Cigna Waiver Saver®. Cigna Dental Waiver Saver is a plan design feature that allows Class I services to not be applied to a members plan deductible and/or maximums. This plan design feature strives to focus on encouraging employees to seek preventive care by removing any perceived/real financial barriers (such as out-of-pocket costs). Plan designs with features placing a greater focus on providing incentives to employees to seek preventive and diagnostic care may over time result in the early detection of oral health problems and reduce the need for more costly restorative services. Copyright 2012 Page 6 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Employees also see an immediate benefit since the waiving of their deductibles is realized at first use of the plan. Employees are able to see that the amount left in their annual maximum remains the same after the use of the plan for Class I services. This demonstrates that the entire annual maximum amount will be available for the cost of potential restorative procedures if ever needed, therefore reducing their potential out-of-pocket costs. Broad Network Access - Cigna's dental networks are among the largest in the country with over 50,000 DHMO dentist access points and over 250,000 DPPO dentist access points. We perform on -site reviews of DHMO general dentists' offices, and 20 percent of DPPO offices since they also participate in the DHMO. We continue to grow, so we can customize our networks to better serve your needs. We have 40 field -based professionals across the United States dedicated to network recruitment and dentist support. DHMO Savings - DHMO plans are typically 30-40 percent lower in premiums, and have 40- 50 percent less out-of-pocket expenses than a comparable indemnity plan. By adding the CignaFlex Advantage feature, you will encourage more employees to try out the cost -saving Cigna Dental Care plan. DPPO Savings - The Cigna DPPO plans offer deeper discounts than many other carriers; our contracted fee schedules are based on a discount of average area charges. Our average discount nationwide is 30.1 percent. Some carriers discount individual dentists' charges, resulting in higher claim costs and more out-of-pocket charges to the member. Versatile Funding Options - We have several funding options available. Our DPPO plan coverage's are available self -funded as well as fully insured; both non -participating and participating. Most other carriers do not offer a participating arrangement. Advanced Technology - If your goal is to find one carrier to handle your medical and dental coverage's, we can provide a fully integrated, single source solution for all of your health care needs. We offer integrated medical and dental billing and eligibility, taking the hassle out of administering multiple coverage plans. Our dental online self-service options make it simple for your employees to use our plans. Our Dental Treatment Cost Estimator is a user-friendly, comprehensive web -based tool that allows members enrolled in any Cigna dental plan to estimate and plan for their dental care costs —both on a procedure code level and a treatment level. This online tool helps members objectively understand their estimated cost and scope of services for over 400 treatments and procedures. Unique Service Capabilities - Your local account management team will work with you to create a strategic service plan that outlines enrollment activities, communications initiatives, and network recruitment plans. This team is equipped and ready to deliver service that goes above and beyond what you would typically expect. They provide consultative support so you can receive the most from yourcoverage program from case installation to contract renewals. Healthy Rewards® - This program is available to our dental members. It provides discounts on services like acupuncture, chiropractic services, massage therapy, laser vision correction, Copyright 2012 Page 7 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary vitamins, herbal supplements, and non-prescription health and beauty products. There are no added fees or limits to the number of services members can use. Copyright 2012 Page 8 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Proposed Networks & Plan Designs We are at this time proposing the Cigna Dental HMO network along with the Cigna DPPO Radius network. Cigna has attached benefit plan summaries to this section of the proposal. Copyright 2012 Page 9 of 151 Cigna City of Miami (Voluntary Plan) Cigna Dental PPO Benefit Summary Effective 01/01/2013 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Cigna. ' } M S �s 6 Y Y �j,,. db Y�Clgna Radlus ANetWoric Benefts f .. a. : , .: ii yam ..d '3 34.R f �'",x$ ,4 t Y ignalDental PPO In=Network'. x', Out-of.VNetwork.'..,,, Calendar Year Maximum (Class I, II, and 111 Expenses) $1000, Class I Applies $1000, Class I Applies Calendar Year Deductible Per Individual Per Family $100 $300 $100 $300 Class I Expenses - Preventive & Diagnostic Care Oral Exams Cleanings Routine X-Rays Fluoride Application Sealants Space Maintainers (limited to non -orthodontic treatment) Non -Routine X-Rays Emergency Care to Relieve Pain 100%, No Deductible 100%, No Deductible Class I1 Expenses - Basic Restorative Care Fillings Oral Surgery - Simple Extractions Major Periodontics Minor Periodontics Relines, Rebases, and Adjustments 80%, After Deductible 80%, After Deductible Class III Expenses - Major Restorative Care Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Root Canal Therapy / Endodontics Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns / Inlays / Onlays Dentures Bridges 50%, After Deductible 50%, After Deductible Class IV Expenses - Orthodontia Coverage for Eligible Children Only Lifetime Maximum 50%, No Ortho Deductible $1,500 50%, No Ortho Deductible $1,500 Missing Tooth Provision Teeth missing prior to coverage under the Cigna Dental plan are not covered. Late Entrant Limit 50% coverage on Class III and IV for a specified time period. Pretreatment Review Available on a voluntary basis when extensive work in excess of $200 is proposed. Out -of -Network Reimbursement 80th Percentile Student/Dependent Age 26/26 P0003 (NS002 DNSP) Network. Prepared by Underwriting. Cigna Dental PPO / Indemnity Exclusions and Limitations: Procedure Exams Prophylaxis (cleanings) Fluoride X-Rays (routine) X-Rays (non -routine) Model Minor Perio (non -surgical) Perio Surgery Crowns and Inlays Prosthesis Over Implants Bridges Dentures and Partials Relines, Rebases Adjustments Repairs — Bridges Repairs — Dentures Sealants Space Maintainers Alternate Benefit Exclusions & Limitations Two per Calendar year Two per Calendar year 1 per calendar year for people under 19 Bitewings: 2 per calendar year Full mouth: 1 'every 3 calendar years. Panorex: 1 every 3 calendar years Payable only when in conjunction with Ortho workup and extensive Perio treatment Various limitations depending on the service Various limitations depending on the service Replacement every 5 years 1 per every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non -Orthodontic treatment When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. Benefit Exclusions: * Services performed primarily for cosmetic reasons * Replacement of a lost or stolen appliance * Replacement of a bridge or denture within five years following the date of its original installation * Replacement of a bridge or denture which can be made useable according to accepted dental standards * Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion , * Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars * Bite registrations; precision or semi -precision attachments; splinting * Surgical implant of any type * Instruction for plaque control, oral hygiene and diet * Dental services that do not meet common dental standards * Services that are deemed to be medical services * Services and supplies received from a hospital * Charges which the person is not legally required to pay * Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service . * Experimental or investigational procedures and treatments • Any injury resulting from, or in the course of, any employment for wage or profit * Any sickness covered under any workers' compensation or similar law * Charges in excess of the reasonable and customary allowances * To the extent that payment is unlawful where the person resides when the expenses are incurred; * Procedures performed by a Dentist who is a member of the covered person's family (covered person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents); * For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; * To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; * To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a "no-fault" insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. * In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Cigna HealthCare. "Cigna is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwriting. Cigna Radius Network (P0003 / NS002 DNSP) 09/07/2012 11:37 AM City of Miami (Executive Plan) Cigna Dental PPO Benefit Summary Effective 01/01/2013 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Cigna. e z-, Gfgna R04.161Network ktN `�Y+r �x `� 3x ': �` f 2 `Ga ' �f':i _ ,Ctgna Dental PP,O z V.x .... 4 �v ,£ {t Y .� Y. _-..,+i t � 3� 4 Y { `.�. .., _ enefits . z� a,i '�.S .. work ? E E� .; �'"'e: d ~ k. ,,� In -Network_ ., �. � �z �E� '� � ��:4 ut-of-Netyirork , t;.,. Calendar Year Maximum (Class I, II, and III Expenses) $1500, Class I Applies $1500, Class I Applies Calendar Year Deductible Per Individual Per Family $50 $150 $50 $150 Class I Expenses - Preventive & Diagnostic Care Oral Exams Cleanings Routine X-Rays Fluoride Application Sealants Space Maintainers (limited to non -orthodontic treatment) Non -Routine X-Rays Emergency Care to Relieve Pain 100%, No Deductible 100%, No Deductible Class II Expenses - Basic Restorative Care Fillings Oral Surgery - Simple Extractions Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Major Periodontics Minor Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Repairs - Bridges, Crowns, and Inlays Repairs - Dentures 80%, After Deductible 80%, After Deductible Class 11I Expenses - Major Restorative Care crowns/ Inlays / Onlays Dentures Bridges 80%, After Deductible 80%, After Deductible Class IV Expenses - Orthodontia Coverage for Eligible Children Only Lifetime Maximum 80%, No Ortho Deductible $1,500 80%, No Ortho Deductible $1,500 Class V Expenses -TMJ For treatment of Temporomandibular Joint (TMJ) Disorders Lifetime Maximum 50% After Deductible $750 50% After Deductible $750 Missing Tooth Provision Late Entrant Limit Teeth missing prior to coverage under the Cigna Dental plan are not covered. 50% coverage on Class III and IV for a specified time period. Pretreatment Review Available on a voluntary basis when extensive work in excess of $200 is proposed. Out -of -Network Reimbursement 90th Percentile Student/Dependent Age 26/26 P0003 (NS002 DNSP) Network. Prepared by Underwriting. 09/07/2012 11:28 AM Cigna Dental PPO / Indemnity Exclusions and Limitations: Procedure Exams Prophylaxis (cleanings) Fluoride X-Rays (routine) X-Rays (non -routine) Model Minor Perio (non -surgical) Perio Surgery Crowns and Inlays Prosthesis Over Implants Bridges Dentures and Partials Relines, Rebases Adjustments Repairs — Bridges Repairs — Dentures Sealants. Space Maintainers Altemate Benefit Exclusions & Limitations Two per Calendar year Two per Calendar year 1 per calendar year for people under 19 Bitewings: 2 per calendar year Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years Payable only when in conjunction with Ortho workup and extensive Perio treatment Various limitations depending on the service Various limitations depending on the service Replacement every 5 years 1 per every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non -Orthodontic treatment When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses, Benefit Exclusions: Services performed primarily for cosmetic reasons * Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation • Replacement of a bridge or denture which can be made useable according to accepted dental standards * Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, stabilize periodontally involved teeth, or restore occlusion *Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars * Bite registrations; precision or semi -precision attachments; splinting * Surgical implant of any type * Instruction for plaque control, oral hygiene and diet * Dental services that do not meet common dental standards Services that are deemed to be medical services • * Services and supplies received from a hospital * Charges which the person is not legally required to pay * Charges made by a hospital which performs services for the U.S. Govemment if the charges are directly related to a condition connected to a military service * Experimental or investigational procedures and treatments *Any injury resulting from, or in the course of, any employment for wage or profit * Any sickness covered under any workers' compensation or similar law * Charges in excess of the reasonable and customary allowances * To the extent that payment is unlawful where the person resides when the expenses are incurred; * Procedures performed by a Dentist who is a member of the covered person's family (covered person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents); * For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; * To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; * To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a "no-fault" insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. • In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Cigna HealthCare. "Cigna is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwriting. Cigna Radius Network (P0003 / NS002 DNSP) 09/07/2012 11:28 AM P7XVO edDOfso ccbeoo C Cigna Dental Care® (*DHMO) Patient Charce Schedule This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. Important Highlights This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist, Orthodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child's 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child's 7th birthday. • Procedures NOT listed on this Patient Charge Schedule are NOT covered and are the patient's responsibility at the dentist's usual fees. • The administration of IV sedation, general anesthesia, and/or Nitrous Oxide is not covered except as specifically listed on this Patient Charge Schedule.The application of local anesthetic is covered as part of your dental treatment. • Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. • This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement. • Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. 1011 P7 Cigna Dental Care® Patient Charge Schedule (P7XVO) Important Highlights (continued) ill All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. Ei The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures. Office Visit Fee (Per patient, per office visit in addition to any other applicable patient charges) Diagnostic/Preventive — Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic Oral Evaluations (D0120), Comprehensive Oral Evaluations (D0150), Comprehensive Periodontal Evaluations (D0180), and Oral Evaluations for Patients Under 3 Years of Age (D0145). D9310 D9430 D9450 D0120 D0140 D0145 D0150 D0160 D0170 D0210 D0220 D0230 Consultation (Diagnostic Service Provided by Dentist or Physician Other than Requesting Dentist or Physician) Office Visit for Observation — No Other Services Performed Case Presentation — Detailed and Extensive Treatment Planning Periodic Oral Evaluation — Established Patient Limited Oral Evaluation — Problem Focused Oral Evaluation for a Patient Under 3 Years of Age and Counseling with Primary Caregiver Comprehensive Oral Evaluation — New or Established Patient Detailed and Extensive Oral Evaluation — Problem Focused, By Report Re-evaluation — Limited, Problem Focused (Not Postoperative Visit) X-Rays Intraoral — Complete Series (Including Bitewings) (Limit 1 Every 3 Years) X-Rays Intraoral — Periapical — First Film X-Rays Intraoral — Periapical — Each Additional Film $12.00 $6.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 -2- Cigna Dental Care® Patient Charge Schedule (P7XVO) D0240 D0250 D0260 D0270 D0272 D0273 D0274 D0277 D0330 D0350 D0415 D0425 D0431 D0460 D0470 D0472 D0473 D0474 D0486 D1110 D1120 D1203 ureDesscrip X-Rays Intraoral — Occlusal Film X-Rays Extraoral — First Film X-Rays Extraoral — Each Additional Film X-Rays (Bitewing) — Single Film X-Rays (Bitewings) — 2 Films X-Rays (Bitewings) — 3 Films X-Rays (Bitewings) — 4 Films X-Rays (Bitewings, Vertical) — 7 to 8 Films X-Rays (Panoramic Film) — (Limit 1 Every 3 Years) Oral/Facial Photographic Images Collection of Microorganisms for Culture and Sensitivity Caries Susceptibility Tests Oral Cancer Screening Using a Special Light Source Pulp Vitality Tests Diagnostic Casts Pathology Report — Gross Examination of Lesion (Only When Tooth Related) Pathology Report — Microscopic Examination of Lesion (Only When Tooth Related) Pathology Report — Microscopic Examination of Lesion and Area (Only When Tooth Related) Accession of Brush Biopsy Sample, Microscopic Examination, Preparation and Transmission of Written Report Prophylaxis (Cleaning) — Adult (Limit2 per Calendar Year) Additional Prophylaxis (Cleaning) — In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year Prophylaxis (Cleaning) — Child (Limit 2 per Calendar Year) Additional Prophylaxis (Cleaning) — In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year Topical Application of Fluoride — Child (Up to 19th Birthday) (Limited to 2 per Calendar Year). There is a Combined Limit of a Total of 2 D 1203s and/or D 1206s per Calendar Year. $0.00 $0.00 $0.00 $0.00 $0.0o $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $55.00 $0.00 $45.00 $0.00 -3- Cigna Dental Care® Patient Charge Schedule (P7XVO) D1204 Topical Fluoride Application — Adult D1206 D1310 D1320 D1330 D1351 D1352 D1510 D1515 D1520 D1525 D1550 D1555 Topical Fluoride Varnish —Therapeutic Application for Moderate to High Caries Risk Patients — Child (Up to 19th Birthday) (Limited to 2 per Calendar Year). There is a Combined Limit of a Total of 2 D 1203s and/or D 1206s per Calendar Year. Nutritional Counseling for Control of Dental Disease Tobacco Counseling for the Control and Prevention of Oral Disease Oral Hygiene Instructions Sealant— Per Tooth Preventive Resin Restoration in a Moderate to High Caries Risk Patient — Permanent Tooth Space Maintainer — Fixed — Unilateral Space Maintainer — Fixed — Bilateral Space Maintainer — Removable — Unilateral Space Maintainer — Removable — Bilateral Recementation of Space Maintainer Removal of Fixed Space Maintainer Restorative (Fillings) $0.00 $0.00 $0.00 $0.00 $0.00 $12.00 $12.00 $ 35.00 $35.00 $45.00 $45.00. $6.00 $6.00 D2140 D2150 D2160 D2161 D2330 D2331 D2332 D2335 D2390 D2391 Amalgam —1 Surface, Primary or. Permanent Amalgam — 2 Surfaces, Primary or Permanent Amalgam — 3 Surfaces, Primary or Permanent Amalgam — 4 or More Surfaces, Primary or Permanent Resin -Based Composite — 1 Surface, Anterior Resin -Based Composite — 2 Surfaces, Anterior Resin -Based Composite — 3 Surfaces, Anterior Resin -Based Composite — 4 or More Surfaces or Involving Incisal Angle, Anterior Resin -Based Composite Crown, Anterior Resin -Based Composite —1 Surface, Posterior $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.00 $70.00 -4- Cigna Dental Care® Patient Charge Schedule (P7XVO) D2392 D2393 D2394 Resin -Based Composite — 2 Surfaces, Posterior Resin -Based Composite — 3 Surfaces, Posterior Resin -Based Composite — 4 or More Surfaces, Posterior $80.00 $95.00 $105.00 Crown and Bridge — All charges for crown and bridge (fixed partial denture) are per unit (each replacement or supporting tooth equals 1 unit) — Replacement limit 1 every 5 years. The charges below include the cost of base metal. Noble metal and high noble metal (precious) or titanium metal, if used, will be charged to the Member at an additional maximum amount of $150.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Porcelain, if used on molar teeth, will be charged to the Member at an additional maximum amount of $75.00 per tooth. Porcelain/Ceramic substrate crowns on molar teeth are not covered. D2510 D2520 D2530 D2542 D2543 D2544 D2740 D2750 D2751 D2752 D2780 D2781 D2782 D2783 D2790 Complex Rehabilitation — AN ADDITIONAL $125 CHARGE PER UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit — ask your dentist for the guidelines) Inlay — Metallic —1 Surface Inlay — Metallic — 2 Surfaces Inlay — Metallic — 3 or More Surfaces Onlay — Metallic — 2 Surfaces Onlay — Metallic — 3 Surfaces Onlay — Metallic — 4 or More Surfaces Crown — Porcelain/Ceramic Substrate Crown — Porcelain Fused to High Noble Metal Crown — Porcelain Fused to Predominantly Base Metal Crown — Porcelain Fused to Noble Metal Crown — 3/4 Cast High Noble Metal Crown — 3/4 Cast Predominantly Base Metal Crown — 3/4 Cast Noble Metal Crown — 3/4 Porcelain/Ceramic Crown — Full Cast High Noble Metal $ 260.00 $ 260.00 $260.00 $260.00 $260.00 $260.00 $285.00 $270.00 $240.00 $270.00 $ 260.00 $225.00 $260.00 $240.00 $260.00 -5- Cigna Dental Care® Patient Charge Schedule (P7XVO) D2791 D2792 D2794 D2799 D2610 D2620 D2630 D2642 D2643 D2644 D2650 D2651 D2652 D2662 D2663 D2664 D2710 D2712 D2720 D2721 D2722 D2910 D2915 D2920 D2930 D2931 D2932 D2933 D2934 Crown — Full Cast Predominantly Base Metal $225.00 Crown — Full Cast Noble Metal $260.00 Crown —Titanium $260.00 Provisional Crown $100.00 Inlay — Porcelain/Ceramic, 1 Surface $240.00 Inlay — Porcelain/Ceramic, 2 Surfaces $240.00 Inlay — Porcelain/Ceramic, 3 or More Surfaces $240.00 Onlay — Porcelain/Ceramic, 2 Surfaces $240.00 Onlay — Porcelain/Ceramic, 3 Surfaces $240.00 Onlay — Porcelain/Ceramic, 4 or More Surfaces $240.00 Inlay — Resin -Based Composite, 1 Surface $225.00 Inlay — Resin -Based Composite, 2 Surfaces $225.00 Inlay — Resin -Based Composite, 3 or More Surfaces $225.00 Onlay — Resin -Based Composite, 2 Surfaces $225.00 Onlay — Resin -Based Composite, 3 Surfaces $225.00 Onlay — Resin -Based Composite, 4 or More Surfaces $225.00 Crown — Resin -Based Composite, Indirect $225.00 Crown — 3/4 Resin -Based Composite, Indirect $225.00 Crown — Resin with High Noble Metal $260.00 Crown — Resin with Predominantly Base Metal $225.00 Crown — Resin with Noble Metal $260.00 Recement Inlay — Onlay or Partial Coverage Restoration $0.00 Recement Cast or Prefabricated Post and Core $0.00 Recement Crown $0.00 Prefabricated Stainless Steel Crown — Primary Tooth $35.00 Prefabricated Stainless Steel Crown — Permanent Tooth $35.00 Prefabricated Resin Crown $45.00 Prefabricated Stainless Steel Crown with Resin Window $45.00 Prefabricated Esthetic Coated Stainless Steel Crown — $130.00 Primary Tooth -6- Cigna Dental Care® Patient Charge Schedule (P7XVO) D2940 D2950 D2951 D2952 D2953 D2954 D2957 D2960 D2970 D2971 D2980 D6210 D6211 D6212 D6214 D6240 D6241 D6242 D6245 D6250 D6251 D6252 D6253 D6545 D6600 D6601 D6602 D6603 D6604 Protective Restoration Core Buildup — Including Any Pins Pin Retention — Per Tooth — In Addition to Restoration Post and Core — In Addition to Crown, Indirectly Fabricated Each Additional Indirectly Prefabricated Post— Same Tooth Prefabricated Post and Core — In Addition to Crown Each Additional Prefabricated Post — Same Tooth Labial Veneer (Resin Laminate) — Chairside Temporary Crown (Fractured Tooth) Additional Procedures to Construct New Crown Under Existing Partial Denture Framework Crown Repair, By Report Pontic — Cast High Noble Metal Pontic — Cast Predominantly Base Metal Pontic — Cast Noble Metal Pontic — Titanium Pontic — Porcelain Fused to High Noble Metal Pontic — Porcelain Fused to Predominantly Base Metal Pontic — Porcelain Fused to Noble Metal Pontic — Porcelain/Ceramic Pontic— Resin with High Noble Metal Pontic — Resin with Predominantly Base Metal Pontic — Resin with Noble Metal Provisional Pontic Retainer — Cast Metal for Resin Bonded Fixed Prosthesis Inlay— Porcelain/Ceramic, 2 Surfaces Inlay — Porcelain/Ceramic, 3 or More Surfaces Inlay — Cast High Noble Metal, 2 Surfaces Inlay — Cast High Noble Metal, 3 or More Surfaces Inlay — Cast Predominantly Base Metal, 2 Surfaces -7- $6.00 $65:00 $10.00 $65.00 $65.00 $40.00 $40.00 $250.00 $6.00 $65.00 $18.00 $260.00 $225.00 $260.00 $260.00 $250.00 $220.00 $250.00 $220.00 $260.00 $ 225.00 $260.00 $225.00 $225.00 $240.00 $240.00 $260.00 $ 260.00 $ 225.00 Cigna Dental Care® Patient Charge Schedule (P7XVO) D6605 D6606 D6607 D6608 D6609 D6610 D6611 D6612 D6613 D6614 D6615 D6624 D6634 D6710 D6720 D6721 D6722 D6740 D6750 D6751 D6752 D6780 D6781 D6782 D6783 D6790 D6791 D6792 D6794 Inlay — Cast Predominantly Base Metal, 3 or More Surfaces Inlay — Cast Noble Metal, 2 Surfaces Inlay — Cast Noble Metal, 3 or More Surfaces Onlay — Porcelain/Ceramic, 2 Surfaces Onlay — Porcelain/Ceramic, 3 or More Surfaces Onlay — Cast High Noble Metal, 2 Surfaces Onlay — Cast High Noble Metal, 3 or More Surfaces Onlay — Cast Predominantly Base Metal, 2 Surfaces Onlay — Cast Predominantly Base Metal, 3 or More Surfaces Onlay — Cast Noble Metal, 2 Surfaces Onlay — Cast Noble Metal, 3 or More Surfaces Inlay —Titanium Onlay —Titanium Crown — Indirect Resin Based Composite Crown — Resin with High Noble Metal Crown — Resin with Predominantly Base Metal Crown — Resin with Noble Metal Crown — Porcelain/Ceramic Crown — Porcelain Fused to High Noble Metal Crown — Porcelain Fused to Predominantly Base Metal Crown — Porcelain Fused to Noble Metal Crown — 3/4 Cast High Noble Metal Crown — 3/4 Cast Predominantly Base Metal Crown — 3/4 Cast Noble Metal Crown — 3/4 Porcelain/Ceramic Crown — Full Cast High Noble Metal Crown — Full Cast Predominantly Base Metal Crown — Full Cast Noble Metal Crown —Titanium $225.00 $260.00 $260.00 $240.00 $240.00 $260.00 $260.00 $225.00 $225.00 $260.00 $260.00 $250.00 $220.00 $225.00 $260.00 $225.00 $ 260.00 $220.00 $ 250.00 $220.00 $250.00 $260.00 $225.00 $ 260.00 $ 220.00 $ 260.00 $225.00 $260.00 $260.00 -8- Cigna Dental Care® Patient Charge Schedule (P7XV0) D6930 Recement Fixed Partial Denture $0.00 D6950 Precision Attachment $195.00 Implant Supported Prosthetics— All charges for crown and bridge (fixed partial denture) are per unit (each replacement on a supporting implant(s) equals 1 unit) — Replacement limit 1 every 5 years. All charges for an implant supported denture are limited to replacement of 1 every 5 years. The charges below include the cost of base metal. Noble metal and high noble metal (precious) or titanium metal, if used, will be charged to the Member at an additional maximum amount of $150.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Porcelain, if used on molar teeth, will be charged to the Member at an additional maximum amount of $75.00 per tooth. Porcelain/Ceramic substrate crowns on molar teeth are not covered. D6053 D6054 D6058 D6059 D6060 D6061 D6062 D6063 D6064 D6065 Complex Rehabilitation on Implant Supported Prosthetic Procedures — AN ADDITIONAL $125 CHARGE PER UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit — ask your dentist for the guidelines) Implant/Abutment Supported Removable Denture for Completely Edentulous Arch Implant/Abutment Supported Removable Denture for Partially Edentulous Arch Abutment Supported Porcelain/Ceramic Crown Abutment Supported Porcelain Fused to Metal Crown (High Noble Metal) Abutment Supported Porcelain Fused to Metal Crown (Predominantly Base Metal) Abutment Supported Porcelain Fused to Metal Crown (Noble Metal) Abutment Supported Cast Metal Crown (High Noble Metal) Abutment Supported Cast Metal Crown (Predominantly Base Metal) Abutment Supported Cast Metal Crown (Noble Metal) Implant Supported Porcelain/Ceramic Crown $725.00 $740.00 $625.00 $ 760.00 $580.00 $ 760.00 $710.00 $525.00 $710.00 $625.00 Cigna Dental Care Patient Charge Schedule (P7XVO) D6066, D6067 D6068 D6069 D6070 D6071 D6072 D6073 D6074 D6075 D6076 D6077 D6078 D6079 D6092 D6093 D6094 D6194 Implant Supported Porcelain Fused to Metal Crown (Titanium, Titanium Alloy, High Noble Metal) Implant Supported Metal Crown (Titanium, Titanium Alloy, High Noble Metal) Abutment Supported Retainer for Porcelain/Ceramic Fixed Partial Denture Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture (High Noble Metal) Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture (Predominantly Base Metal) • Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture (Noble Metal) Abutment Supported Retainer for Cast Metal Fixed Partial Denture (High Noble Metal) Abutment Supported Retainer for Cast Metal Fixed Partial Denture (Predominantly Base Metal) Abutment Supported Retainer for Cast Metal Fixed Partial Denture (Noble Metal) Implant Supported Retainer for Ceramic Fixed Partial Denture Implant Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture (Titanium, Titanium Alloy, High Noble Metal) $760.00 $710.00 $560.00 $740.00 $560.00 $740.00 $710.00 $525.00 $710.00 $560.00 $740.00 Implant Supported Retainer for Cast Metal Fixed Partial $710.00 Denture (Titanium, Titanium Alloy, High Noble Metal) Implant/Abutment Supported Fixed Denture for Completely $725.00 Edentulous Arch Implant/Abutment Supported Fixed Denture for Partially $740.00 Edentulous Arch Recement Implant/Abutment Supported Crown $40.00 Recement Implant/Abutment Supported Fixed Partial Denture Abutment Supported Crown (Titanium) Abutment Supported Retainer Crown for Fixed Partial Denture (Titanium) $40.00 $710.00 $710.00 -10- Cigna Dental Care® Patient Charge Schedule (P7XVO) Endodontics (Root Canal Treatment, Excluding Final Restorations) D3110 D3120 D3220 D3221 D3222 D3230 D3240 D3310 D3320 D3330 D3331 D3332 D3333 D3346 D3347 D3348 D3351 D3352 D3353 Pulp Cap — Direct (Excluding Final Restoration) $0.00 Pulp Cap — Indirect (Excluding Final Restoration) $0.00 Pulpotomy — Removal of Pulp, Not Part of a Root Canal $12.00 Pulpal Debridement (Not to be used when root canal is done ' $55.00 on the same day) Partial Pulpotomy for Apexogenesis — Permanent Tooth with j $17.00 Incomplete Root Development Pulpal Therapy (Resorbable Filling) — Anterior, Primary Tooth $40.00 (Excluding Final Restoration) Pulpal Therapy (Resorbable Filling) — Posterior, Primary Tooth $45.00 (Excluding Final Restoration) Anterior Root Canal — Permanent Tooth (Excluding Final $100.00 Restoration) Bicuspid Root Canal — Permanent Tooth (Excluding Final $150.00 Restoration) Molar Root Canal — Permanent Tooth (Excluding Final $305.00 Restoration) Treatment of Root Canal Obstruction — Nonsurgical Access $105.00 Incomplete Endodontic Therapy — Inoperable, Unrestorable $85.00 or Fractured Tooth Internal Root Repair of Perforation Defects $105.00 Retreatment of Previous Root Canal Therapy — Anterior $165.00 Retreatment of Previous Root Canal Therapy — Bicuspid ! $215.00 Retreatment of Previous Root Canal Therapy — Molar $340.00 Apexification/Recalcification — Initial Visit (Apical Closure/ $95.00 Calcific Repair of Perforations, Root Resorption, etc.) Apexification/Recalcification — Interim Medication Replacement (Apical Closure/Calcific Repair of Perforations, Root Resorption, etc.) Apexification/Recalcification — Final Visit (Includes Completed ! $80.00 Root Canal Therapy — Apical Closure/Calcific Repair of Perforations, Root Resorption, etc.) $80.00 -11- Cigna Dental Care® Patient Charge Schedule (P7XVO) D3410 D3421 D3425 D3426 D3430 D3450 D3920 Apicoectomy/Periradicular Surgery — Anterior Apicoectomy/Periradicular Surgery — Bicuspid (First Root) Apicoectomy/Periradicular Surgery — Molar (First Root) Apicoectomy/Periradicular Surgery (Each Additional Root) Retrograde Filling per Root Root Amputation — Per Root Hemisection (Including Any Root Removal), Not Including Root Canal Therapy $115.00 $115.00 $115.00 $75.00 $75.00 $115.00 $110.00 Periodontics (Treatment of Supporting Tissues [Gum and Bone) of the Teeth) Periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the Patient Charge Schedule. The Relevant Procedure Codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months, when covered on the Patient Charge Schedule. D0180 D4210 D4211 D4240 D4241 D4245 D4249 D4260 D4261 D4263 D4264 D4265 D4266 D4267 Comprehensive Periodontal Evaluation — New or Established Patient Gingivectomy or Gingivoplasty-4 or More Teeth per Quadrant $160.00 Gingivectomy or Gingivoplasty — 1 to 3 Teeth per Quadrant $100.00 Gingival Flap (Including Root Planing) — 4 or More Teeth $185.00 per Quadrant Gingival Flap (Including Root Planing) —1 to 3 Teeth $140.00 per Quadrant Apically Positioned Flap $200.00 Clinical Crown Lengthening — Hard Tissue $155.00 Osseous Surgery — 4 or More Teeth per Quadrant $360.00 Osseous Surgery —1 to 3 Teeth per Quadrant $275.00 Bone Replacement Graft — First Site in Quadrant $250.00 Bone Replacement Graft — Each Additional Site in Quadrant $115.00 Biologic Materials to Aid in Soft and Osseous Tissue $95.00 Regeneration Guided Tissue Regeneration — Resorbable Barrier per Site $215.00 Guided Tissue Regeneration Nonresorbable Barrier per Site $255.00 (Includes Membrane Removal) -12- $0.00 Cicna Dental Care® Patient Charge Schedule (P7XVO) D4270 D4271 D4273 D4274 D4275 D4341 D4342 D4355 D4381 D4910 D9940 D9942 D9951 D9952 474ae"escn Pedicle Soft Tissue Graft Procedure $300.00 Free Soft Tissue Graft Procedure (Including Donor Site Surgery) Subepithelial Connective Tissue Graft Procedures, Per Tooth Distal or Proximal Wedge Procedure (When Not Performed in Conjunction with Surgical Procedures in the Same Anatomical Area) Soft Tissue Allograft Periodontal Scaling and Root Planing — 4 or More Teeth per Quadrant (Limit 4 Quadrants per Consecutive 12 Months) Periodontal Scaling and Root Planing — 1 to 3 Teeth — per Quadrant (Limit 4 Quadrants per Consecutive 12 Months) Full Mouth Debridement to Allow Evaluation and Diagnosis (1 per Lifetime) Localized Delivery of Antimicrobial Agents per Tooth — By Report Periodontal Maintenance (Limited tot per Calendar Year) (Only Covered after Active Therapy) Additional Periodontal Maintenance Procedures (Beyond 2 per Calendar Year) Periodontal Charting for Planning Treatment of Periodontal Disease Periodontal Hygiene Instruction Occlusal Guard — By Report (Limit 1 per 24 Months) Repair and/or Reline of Occlusal Guard Occlusal Adjustment Limited Occlusal Adjustment Complete $300.00 $75.00 $85.00 $460.00 $50.00 $40.00 $50.00 $60.00 $40.00 $70.00 $0.00 $0.00 $125.00 $40.00 $45.00 $70.00 Prosthetics (Removable Tooth Replacement — Dentures) Includes up to 4 adjustments within first 6 months after insertion — Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the Member of $200.00 per denture. D5110 Full Upper Denture D5120 Full Lower Denture $225.00 $ 225.00 -13- Cigna Dental Care® Patient Charge Schedule (P7XVO) D5130 D5140 D5211 D5212 D5213 D5214 D5225 D5226 D5281 D5410 D5411 D5421 D5422 D5850 D5851 D5862 Immediate Full Upper Denture Immediate Full Lower Denture Upper Partial Denture — Resin Base (Including Clasps, Rests and Teeth) Lower Partial Denture — Resin Base (Including Clasps, $225.00 Rests and Teeth) Upper Partial Denture — Cast Metal Famework (Including $240.00 Clasps, Rests and Teeth) Lower Partial Denture — Cast Metal Framework (Including $240.00 Clasps, Rests and Teeth) Upper Partial Denture — Flexible Base (Including Clasps, $165.00 Rests and Teeth) Lower Partial Denture — Flexible Base (Including Clasps, $165.00 Rests and Teeth) Removable Unilateral Partial Denture — One Piece Cast Metal $225.00 Including Clasps and Teeth) Adjust Complete Denture — Upper Adjust Complete Denture — Lower Adjust Partial Denture — Upper Adjust Partial Denture-- Lower Tissue Conditioning — Upper Tissue Conditioning — Lower Precision Attachment — By Report $ 245.00 $245.00 $225.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $160.00 Repairs to Prosthetics D5510 D5520 D5610 D5620 D5630 D5640 D5650 Repair Broken Complete Denture Base Replace Missing or Broken Teeth — Complete Denture (Each Tooth) Repair Resin Denture Base Repair Cast Framework Repair or Replace Broken Clasp Replace Broken Teeth — Per Tooth Add Tooth to Existing Partial Denture $40.00 $40.00 $40.00 $40.00 $45.00 $40.00 $40.00 -14- Cigna Dental Care® Patient Charge Schedule (P7XVO). lie ajge $45.00 j $200.00 $200.00 escrrption r3i5e e um Add Clasp to Existing Partial Denture Replace All Teeth and Acrylic on Cast Metal Framework — Upper . Replace All Teeth and Acrylic on Cast Metal Framework — Lower D5660 D5670 .D5671 Denture Relining (Limit 1 Every 36 Months) D5710 Rebase Complete Upper Denture $75.00 D5711 Rebase Complete Lower Denture $75.00 D5720 Rebase Upper Partial Denture $75.00 D5721 Rebase Lower Partial Denture $75.00 D5730 Reline Complete Upper Denture - Chairside $45.00 D5731 Reline Complete Lower Denture — Chairside $45.00 D5740 Reline Upper Partial Denture — Chairside $45.00 D5741 Reline Lower Partial Denture — Chairside $45.00 D5750 . Reline Complete Upper Denture — Laboratory $75.00 D5751 Reline Complete Lower Denture — Laboratory $75.00 D5760 Reline Upper Partial Denture — Laboratory $75.00 D5761 Reline Lower Partial Denture — Laboratory $75.00 Interim Dentures (Limit 1 Every 5 Years) D5810 Interim Complete Denture— Upper $280.00 D5811 Interim Complete Denture— Lower $280.00 D5820 Interim Partial Denture — Upper $95.00 D5821 Interim Partial Denture — Lower $95.00 Oral Surgery (Includes Routine Postoperative Treatment) Surgical Removal of Impacted Tooth — Not covered for ages below 15 unless pathology i i (disease) exists. D7111 Extraction of Coronal Remnants — Deciduous Tooth $6.00 D7140 Extraction, Erupted Tooth or Exposed Root — Elevation and/or Forceps Removal $6.00 -15- Cigna Dental Care® Patient Charge Schedule (P7XVO) D7210 D7220 D7230 D7240 D7241 D7250 D7251 D7260 D7261 D7270 D7280 D7283 D7285 1' D7286 D7287• D7288 D7310 D7311 D7320 D7321 D7450 D7451 Surgical Removal of Erupted Tooth — Removal of Bone and/or Section of Tooth Removal of Impacted Tooth — Soft Tissue $65.00 Removal of Impacted Tooth - Partially Bony . $85.00 Removal of Impacted Tooth — Completely Bony $110.00 Removal of Impacted Tooth — Completely Bony, Unusual $135.00 Complications (Narrative Required) Surgical Removal of Residual Tooth Roots — Cutting Procedure $50.00 Coronectomy - Intentional Partial Tooth Removal $85.00 Oroantral Fistula Closure $135.00 Primary Closure of a Sinus Perforation $135.00 Tooth Stabilization of Accidentally Evulsed or Displaced Tooth $105.00 Surgical Access of an Unerupted Tooth (Excluding Wisdom $110.00 Teeth) Placement of Device to Facilitate Eruption of Impacted Tooth $110.00 Biopsy of Oral Tissue — Hard (Bone, Tooth) (Tooth Related — Not $0.00 allowed when in conjunction with another surgical procedure) Biopsy of Oral Tissue — Soft (All Others) (Tooth Related — Not $0.00 allowed when in conjunction with another surgical procedure) Exfoliative Cytological Sample Collection $50.00 Brush Biopsy—Transepithelial Sample Collection $50.00 Alveoloplasty in Conjunction with Extractions — $65.00 4 or More Teeth or Tooth Spaces per Quadrant Alveoloplasty in Conjunction with Extractions — $65.00 1 to 3 Teeth or Tooth Spaces per Quadrant Alveoloplasty Not in Conjunction with Extractions — $85.00 4 or More Teeth or Tooth Spaces per Quadrant Alveoloplasty Not in Conjunction with Extractions — $85.00 1 to 3 Teeth or Tooth Spaces per Quadrant Removal of Benign Odontogenic Cyst or Tumor — $0.00 Up to 1.25 cm Removal of Benign Odontogenic Cyst or Tumor — $0.00 Greater than 1.25 cm -16- Cigna Dental Care® Patient Charge Schedule (P7XVO) D7471 D7472 D7473 D7485 D7510 D7511 D7520 D7521 D7910 D7960 D7963 Removal of Lateral Exostosis — Maxilla or Mandible Removal of Torus Palatinus Removal of Torus Mandibularis Surgical Reduction of Osseous Tuberosity Incision and Drainage of Abscess — Intraoral Soft Tissue Incision and Drainage of Abscess -Intraoral Soft Tissue Complicated Incision and Drainage of Abscess — Extraoral Soft Tissue Incision and Drainage of Abscess — Extraoral SoftTissue— Complicated (Includes Drainage of Multiple Fascial Spaces) Suture of Recent Small Wounds up to 5 cm Frenulectomy — Also Known as Frenectomy or Frenotomy — Separate Procedure Not Incidental to Another Frenuloplasty $100.00 575.00 $75.00 $60.00 $40.00 $40.00 $40.00 $40.00 $35.00 $ 50.00 $50.00 Orthodontics (Tooth Movement) Orthodontic Treatment (Maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.) D8050 D8060 D8070 D8080 D8090 D8210 D8220 D8660 Interceptive Orthodontic Treatment of the Primary Dentition — Banding Interceptive Orthodontic Treatment of the Transitional Dentition — Banding Comprehensive Orthodontic Treatment of the Transitional Dentition — Banding Comprehensive Orthodontic Treatment of the Adolescent Dentition — Banding Comprehensive Orthodontic Treatment of the Adult Dentition — Banding Removable Appliance Therapy Fixed Appliance Therapy Pre -Orthodontic Treatment Visit $485.00 $485.00 $485.00 $485.00 $485.00 $ 0.00 $0.00 $125.00 -17- Cigna Dental Care® Patient Charge Schedule (P7XVO) D8670 D8680 D8693 D8999 Periodic Orthodontic Treatment Visit — As Part of Contract Children — Up to 19th Birthday: 24-Month Treatment Fee Charge per Month for 24 Months Adults: 24-Month Treatment Fee Charge per Month for 24 Months Orthodontic Retention — Removal of Appliances, Construction and Placement of Retainer(s) Rebonding or Recementing; and/or Repair, As Required, of Fixed Retainers Unspecified Orthodontic Procedure — By Report (Orthodontic Treatment Plan and Records) $1,600.00 $67.00 $2,600.00 $108.00 $295.00 $0.00 $290.00 General Anesthesia/IV Sedation — General anesthesia is covered when performed by an Oral Surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. IV sedation is covered when performed by a Periodontist or Oral Surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. Plan limitation for this benefit is 1 hour per appointment.There is no coverage for general anesthesia or intravenous sedation when used for the purpose of anxiety control or patient management. D9211 D9212 D9215 D9220 D9221 D9241 D9242 D9610 D9612 D9630 D9910 Regional Block Anesthesia Trigeminal Division Block Anesthesia Local Anesthesia General Anesthesia — First 30 Minutes General Anesthesia — Each Additional 15 Minutes IV Conscious Sedation — First 30 Minutes IV Conscious Sedation — Each Additional 15 Minutes Therapeutic Parenteral Drug, Single Administration Therapeutic Parenteral Drugs, 2 or More Administrations, Different Medications Other Drugs and/or Medicaments — By Report Application of Desensitizing Medicament $0.00 $0.00 $0.00 $160.00 $75.00 $160.00 $75.00 $15.00 $25.00 $15.00 $15.00 -18- Cigna Dental Care® Patient Charge Schedule (P7XVO) Emergency Services D9110 D9120 D9440 Palliative (Emergency) Treatment of Dental Pain — Minor Procedure Fixed Partial Denture Sectioning Office Visit — After Regularly Scheduled Hours $6.00 $0.00 $40.00 Miscellaneous Services — External Bleaching (D9972) is limited to the use of take-home bleaching trays. All other bleaching methods are not covered. D9972 External Bleaching per Arch This may contain CDT codes and/or portions of, or excerpts from the Nomenclature contained within the Current Dental Terminology, a copyrighted publication provided by the American Dental Association. The American Dental Association does not endorse any codes which are not included in its current publication. $125.00 -19- After your enrollment is effective: Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll -free number listed on your ID card or plan materials. Multiple ways to locate a *DHMO Network General Dentist: • Online provider directory at www.Cigna.com • Online provider directory on myCigna.com • Call the number located on your ID card to: — Use the Dental Office Locator via Speech Recognition — Speak to a Customer Service Representative EMERGENCY: If you have a dental emergency as defined in your group's plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any licensed dentist. Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group's plan documents for a complete definition of dental emergency, your emergency benefit and a listing of Exclusions and Limitations. *The term "DHMC !" is used to refer to product designs that may differ by state of residence of enrollee, Including but not limited to, prepaid glans, managed Care plan_, and plans with open access features. "Cigna and "Cigna Dental' are registered service marks and the "Tree of Life" logo is a service mark of Cigna intellectual Property, Inc., iicenCed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Connecticut General. Life Insurance Company (''CGLIC"), Cigna Health and Life Insurance Company "CF L C"' Cigna Healthcare of Connecticut, Inc., and Cigna Dental Health, Inc f°C[1HI"i and its Care subsidiaries, and not byCigna Corporation, The Cigna DentalC.ra plan is provides by Cigna Dental Health Pan of Arizona, Inc.; Cigna Dental Health of California, Inc; Cigna Dental Health of Colorado, Inc.; Cigna Dental Health of Dear^ware Inc.; Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes; Cigna Dental Health of Kansas; Inc (Kansas and Nebraska); Cigna Dental Health of Kentucky, Inc.; Cigna Dental Health of Maryland, Inc; Cigna Dental Health of Missouri, Inc.; Cigna Dental Health of Ne'vw Jersey, Inc; Cigna Dental Health of North Carolina, Inc.; Cigna Dental Health of Ohio, Inc; Cigna Dental Heath of Pennsylvania, Inc.; Cigna Dental Health ofTexas, Inc; and Cigna Dental Health of Virginia, inc. in othe. St ies, the Cigna Dental Care plan is underwritten by CGLIC, CGLIC, or Cigna dealthCare of Connecticut, Inc., and administered by CDHI. 830591 10111 © 2011 Cigna oto (1 ¢ee P6XVO CIGNA Dental Care® (*DHMO) Patient Charge Schedule This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. gna. Important Highlights This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by CIGNA Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist, Orthodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by CIGNA Dental. Prior authorization is not required for specialty referrals for Pediatric and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.CIGNA24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child's 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child's 7th birthday. Procedures NOT listed on this Patient Charge Schedule are NOT covered and are the patient's responsibility at the dentist's usual fees. The administration of IV sedation, general anesthesia, and/or Nitrous Oxide is not covered except as specifically listed on this Patient Charge Schedule.The application of local anesthetic is covered as part of your dental treatment. CIGNA Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement. Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. 52159 830590 101l" ..,...., Cigna Dental Care® Patient Charge Schedule (P6XVO) Important Highlights (continued) • All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. • The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures. oc a ores 3es,cription Office Visit Fee (Per patient, per office visit in addition to any other applicable patient charges) • Office Visit Fee $5.00 Diagnostic/Preventive — Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic Oral Evaluations (D0120), Comprehensive Oral Evaluations (D0150), Comprehensive Periodontal Evaluations (D0180), and Oral Evaluations for Patients Under 3 Years of Age (D0145). D9310 D9430 D9450 D0120 D0140 D0145 D0150 D0160 D0170 D0210 D0220 D0230 Consultation (Diagnostic Service Provided by Dentist or $11.00 Physician Other than Requesting Dentist or Physician) Office Visit for Observation — No Other Services Performed $6.00 Case Presentation — Detailed and Extensive Treatment Planning Periodic Oral Evaluation — Established Patient Limited Oral Evaluation — Problem Focused Oral Evaluation for a Patient Under 3 Years of Age and Counseling with Primary Caregiver Comprehensive Oral Evaluation — New or Established Patient Detailed and Extensive Oral Evaluation — Problem Focused, By Report Re-evaluation — Limited, Problem Focused (Not Postoperative Visit) X-Rays Intraoral — Complete Series (Including Bitewings) (Limit 1 Every 3 Years) X-Rays Intraoral — Periapical — First Film X-Rays Intraoral — Periapical — Each Additional Film $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 -2- Cigna Dental Care® Patient Charge Schedule (P6XVO) D0240 D0250 D0260 D0270 D0272 D0273 D0274 D0277 D0330 D0350 D0415 D0425 D0431 D0460 D0470 D0472 D0473 D0474 D0486 D1110 D1120 D1203 procedure escriptron whiritat X-Rays Intraoral — Occlusal Film $0.00 X-Rays Extraoral — First Film $0.00 X-Rays Extraoral — Each Additional Film $0.00 X-Rays (Bitewing) — Single Film $0.00 X-Rays (Bitewings) — 2 Films $0.00 X-Rays (Bitewings) — 3 Films $0.00 X-Rays (Bitewings) — 4 Films $0.00 X-Rays (Bitewings, Vertical) — 7 to 8 Films $0.00 X-Rays (Panoramic Film) — (Limit 1 Every3 Years) $0.00 Oral/Facial Photographic Images $0.00 Collection of Microorganisms for Culture and Sensitivity $0.00 Caries Susceptibility Tests $0.00 Oral Cancer Screening Using a Special Light Source $50.00 Pulp Vitality Tests $0.00 Diagnostic Casts $0.00 Pathology Report — Gross Examination of Lesion $0.00 (Only When Tooth Related) Pathology Report — Microscopic Examination of Lesion $0.00 (Only When Tooth Related) Pathology Report— Microscopic Examination of Lesion and $0.00 Area (Only When Tooth Related) Accession of Brush Biopsy Sample, Microscopic Examination, $0.00 Preparation and Transmission of Written Report Prophylaxis (Cleaning) — Adult (Limit2 per Calendar Year) $0.00 Additional Prophylaxis (Cleaning) — In Addition to the $50.00 2 Prophylaxes (Cleanings) Allowed per Calendar Year Prophylaxis (Cleaning) — Child (Limit2 per Calendar Year) $0.00 Additional Prophylaxis (Cleaning) — In Addition to the $40.00 2 Prophylaxes (Cleanings) Allowed per Calendar Year Topical Application of Fluoride — Child (Up to 19th Birthday) $0.00 (Limited to 2 per Calendar Year). There is a Combined Limit of a Total of D1203s and/or D1206s per Calendar Year. -3- Cigna Dental Care® Patient Charge Schedule (P6XVO) D1206 D1310 D1320 D1330 D1351 D1352 D1510 D1515 D1520 D1525 D1550 D1555 Topical Fluoride Application — Adult Topical Fluoride Varnish —Therapeutic Application for Moderate to High Caries Risk Patients — Child (Up to 19th Birthday) (Limited to 2 per Calendar Year). There is a Combined Limit of a Total of 2 D 1203s and/or D 1206s per Calendar Year. Nutritional Counseling for Control of Dental Disease Tobacco Counseling for the Control and Prevention of Oral Disease Oral Hygiene Instructions Sealant— Per Tooth Preventive Resin Restoration in a Moderate to High Caries Risk Patient — Permanent Tooth Space Maintainer — Fixed — Unilateral Space Maintainer — Fixed — Bilateral Space Maintainer — Removable — Unilateral Space Maintainer — Removable — Bilateral Recementation of Space Maintainer Removal of Fixed Space Maintainer $0.00 $0.00 $0.00 $0.00 $0.00 $11.00 $11.00 $30.00 $30.00 $40.00 $40.00 $6.00 $6.00 Restorative (Fillings) D2140 D2150 D2160 D2161 D2330 D2331 D2332 D2335 D2390 D2391 Amalgam —1 Surface, Primary or Permanent Amalgam — 2 Surfaces, Primary or Permanent Amalgam — 3 Surfaces, Primary or Permanent Amalgam — 4 or More Surfaces, Primary or Permanent Resin -Based Composite — 1 Surface, Anterior Resin -Based Composite — 2 Surfaces, Anterior Resin -Based Composite — 3 Surfaces, Anterior Resin -Based Composite —4 or More Surfaces or Involving Incisal Angle, Anterior Resin -Based Composite Crown, Anterior Resin -Based Composite — 1 Surface, Posterior $0.00 $0.00 $0.00 $ 0.00 $0.00 $ 0.00 $0.00 $0.00 $40.00 $65.00 -4- Cigna Dental Care° Patient Charge Schedule (P6XVO) D2392 D2393 D2394 Resin -Based Composite — 2 Surfaces, Posterior $75.00 Resin -Based Composite — 3 Surfaces, Posterior $85.00 Resin -Based Composite — 4 or More Surfaces, Posterior $95.00 Crown and Bridge — All charges for crown and bridge (fixed partial denture) are per unit (each replacement or supporting tooth equals 1 unit) — Replacement limit 1 every 5 years. The charges below include the cost of base metal. Noble metal and high noble metal (precious) or titanium metal, if used, will be charged to the Member at an additional maximum amount of $150.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Porcelain, if used on molar teeth, will be charged to the Member at an additional maximum amount of $75.00 per tooth. Porcelain/Ceramic substrate crowns on molar teeth are not covered. D2510 D2520 D2530 D2542 D2543 D2544 D2740 D2750 D2751 D2752 D2780 D2781 D2782 D2783 D2790 Complex Rehabilitation — AN ADDITIONAL $125 CHARGE PER UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit — ask your dentist for the guidelines) Inlay — Metallic —1 Surface Inlay — Metallic — 2 Surfaces Inlay — Metallic — 3 or More Surfaces Onlay — Metallic — 2 Surfaces Onlay — Metallic — 3 Surfaces Onlay — Metallic — 4 or More Surfaces Crown — Porcelain/Ceramic Substrate Crown — Porcelain Fused to High Noble Metal Crown — Porcelain Fused to Predominantly Base Metal Crown — Porcelain Fused to Noble Metal Crown — 3/4 Cast High Noble Metal Crown — 3/4 Cast Predominantly Base Metal Crown — 3/4 Cast Noble Metal Crown — 3/4 Porcelain/Ceramic Crown — Full Cast High Noble Metal $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $255.00 $230.00 $215.00 $230.00 $220.00 $205.00 $220.00 $215.00 $220.00 -5- Cigna Dental Care® Patient Charge Schedule (P6XVO) D2791 D2792 D2794 D2799 D2610 D2620 D2630 D2642 D2643 D2644 D2650 D2651 D2652 D2662 D2663 D2664 D2710 D2712 D2720 D2721 D2722 D2910 D2915 D2920 D2930 D2931 D2932 D2933 D2934 Crown — Full Cast Predominantly Base Metal Crown — Full Cast Noble Metal Crown —Titanium Provisional Crown Inlay — Porcelain/Ceramic, 1 Surface Inlay — Porcelain/Ceramic, 2 Surfaces Inlay — Porcelain/Ceramic, 3 or More Surfaces Onlay— Porcelain/Ceramic, 2 Surfaces Onlay— Porcelain/Ceramic, 3 Surfaces Onlay — Porcelain/Ceramic, 4 or More Surfaces Inlay — Resin -Based Composite, 1 Surface Inlay — Resin -Based Composite, 2 Surfaces Inlay — Resin -Based Composite, 3 or More Surfaces Onlay— Resin -Based Composite, 2 Surfaces Onlay— Resin -Based Composite, 3 Surfaces Onlay — Resin -Based Composite, 4 or More Surfaces Crown — Resin -Based Composite, Indirect Crown — 3/4 Resin -Based Composite, Indirect Crown — Resin with High Noble Metal Crown — Resin with Predominantly Base Metal Crown — Resin with Noble Metal Recement Inlay — Onlay or Partial Coverage Restoration Recement Cast or Prefabricated Post and Core Recement Crown Prefabricated Stainless Steel Crown — Primary Tooth Prefabricated Stainless Steel Crown — Permanent Tooth Prefabricated Resin Crown Prefabricated Stainless Steel Crown with Resin Window Prefabricated Esthetic Coated Stainless Steel Crown — Primary Tooth -6- $205.00 $220.00 $220.00 $100.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $220.00 $205.00 $220.00 $ 0.00 $ 0.00 $0.00 $30.00 $30.00 $40.00 $40.00 $120.00 Cigna Dental Care® Patient Charge Schedule (P6XVO) D2940 D2950 D2951 D2952 D2953 D2954 D2957 D2960 D2970 D2971 D2980 D6210 D6211 D6212 D6214 D6240 D6241 D6242 D6245 D6250 D6251 D6252 D6253 D6545 D6600 D6601 D6602 D6603 D6604 Protective Restoration Core Buildup — Including Any Pins $6.00 $55.00 Pin Retention — Per Tooth — In Addition to Restoration $10.00 Post and Core — In Addition to Crown, Indirectly Fabricated $55.00 Each Additional Indirectly Prefabricated Post — Same Tooth $55.00 Prefabricated Post and Core — In Addition to Crown $35.00 Each Additional Prefabricated Post — Same Tooth $35.00 Labial Veneer (Resin Laminate) — Chairside $250.00 Temporary Crown (Fractured Tooth) $6.00 Additional Procedures to Construct New Crown Under $55.00 Existing Partial Denture Framework Crown Repair, By Report $17.00 Pontic — Cast High Noble Metal $220.00 Pontic — Cast Predominantly Base Metal $205.00 Pontic — Cast Noble Metal $220.00 Pontic —Titanium $220.00 Pontic — Porcelain Fused to High Noble Metal $210.00 Pontic — Porcelain Fused to Predominantly Base Metal $195.00 Pontic — Porcelain Fused to Noble Metal $210.00 Pontic — Porcelain/Ceramic $195.00 Pontic — Resin with High Noble Metal $220.00 Pontic — Resin with Predominantly Base Metal $205.00 Pontic — Resin with Noble Metal $220.00 Provisional Pontic $205.00 Retainer — Cast Metal for Resin Bonded Fixed Prosthesis $205.00 Inlay — Porcelain/Ceramic, 2 Surfaces $215.00 Inlay — Porcelain/Ceramic, 3 or More Surfaces $215.00 Inlay — Cast High Noble Metal, 2 Surfaces $220.00 Inlay — Cast High Noble Metal, 3 or More Surfaces $220.00 Inlay — Cast Predominantly Base Metal, 2 Surfaces $205.00 -7- Cigna Dental Care®, Patient Charge Schedule (P6XVO) D6605 D6606 D6607 D6608 D6609 D6610 D6611 D6612 D6613 D6614 D6615 D6624 D6634 D6710 D6720 D6721 D6722 D6740 D6750 D6751 D6752 D6780 D6781 D6782 D6783 D6790 D6791 D6792 D6794 Inlay — Cast Predominantly Base Metal, 3 or More Surfaces Inlay — Cast Noble Metal, 2 Surfaces Inlay — Cast Noble Metal, 3 or More Surfaces Onlay — Porcelain/Ceramic, 2 Surfaces Onlay — Porcelain/Ceramic, 3 or More Surfaces Onlay — Cast High Noble Metal, 2 Surfaces Onlay — Cast High Noble Metal, 3 or More Surfaces Onlay — Cast Predominantly Base Metal, 2 Surfaces Onlay — Cast Predominantly Base Metal, 3 or More Surfaces Onlay — Cast Noble Metal, 2 Surfaces Onlay — Cast Noble Metal, 3 or More Surfaces Inlay —Titanium Onlay —Titanium Crown — Indirect Resin Based Composite Crown — Resin with High Noble Metal Crown — Resin with Predominantly Base Metal Crown — Resin with Noble Metal Crown — Porcelain/Ceramic Crown — Porcelain Fused to High Noble Metal Crown — Porcelain Fused to Predominantly Base Metal Crown — Porcelain Fused to Noble Metal Crown — 3/4 Cast High Noble Metal Crown — 3/4 Cast Predominantly Base Metal Crown — 3/4 Cast Noble Metal Crown — 3/4 Porcelain/Ceramic Crown — Full Cast High Noble Metal Crown — Full Cast Predominantly Base Metal Crown — Full Cast Noble Metal Crown —Titanium $205.00 $220.00 $220.00 $215.00 $215.00 $220.00 $220.00 $205.00 $205.00 $220.00 $220.00 $210.00 $195.00 $205.00 $220.00 $205.00 $220.00 $195.00 $210.00 $195.00 $210.00 $220.00 $205.00 $220.00 $195.00 $220.00 $205.00 $220.00 $220.00 -8- Cigna Dental Care® Patient Charge Schedule (P6XVO) D6930 • D6950 noes are -1041 Recement Fixed Partial Denture Precision Attachment $195.00 implant Supported Prosthetics — All charges for crown and bridge (fixed partial denture) are per unit (each replacement on a supporting implant(s) equals 1 unit) — Replacement limit 1 every 5 years. All charges for an implant supported denture are limited to replacement of 1 every 5 years. The charges below include the cost of base metal. Noble metal and high noble metal (precious) or titanium metal, if used, will be charged to the Member at an additional maximum amount of $150.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Porcelain, if used on molar teeth, will be charged to the Member at an additional maximum amount of $75.00 per tooth. Porcelain/Ceramic substrate crowns on molar teeth are not covered. D6053 D6054 D6058 D6059 D6060 D6061 D6062 D6063 D6064 D6065 Complex Rehabilitation on Implant Supported Prosthetic Procedures — AN ADDITIONAL $125 CHARGE PER UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit — ask your dentist for the guidelines) Implant/Abutment Supported Removable Denture for $685.00 Completely Edentulous Arch Implant/Abutment Supported Removable Denture for $700.00 Partially Edentulous Arch Abutment Supported Porcelain/Ceramic Crown $595.00 Abutment Supported Porcelain Fused to Metal Crown (High $720.00 Noble Metal) Abutment Supported Porcelain Fused to Metal Crown $555.00 (Predominantly Base Metal) Abutment Supported Porcelain Fused to Metal Crown (Noble $720.00 Metal) Abutment Supported Cast Metal Crown (High Noble Metal) $670.00 Abutment Supported Cast Metal Crown (Predominantly Base $505.00 Metal) - Abutment Supported Cast Metal Crown (Noble Metal) $670.00 Implant Supported Porcelain/Ceramic Crown $595.00 -9- Cigna Dental Care° Patient Charge Schedule (P6XVO) D6066 D6067 D6068 D6069 D6070 D6071 D6072 D6073 D6074 D6075 D6076 D6077 D6078 D6079 D6092 D6093 D6094 D6194 _roceaurel i Implant Supported Porcelain Fused to Metal Crown (Titanium, $720.00 Titanium Alloy, High Noble Metal) Implant Supported Metal Crown (Titanium, Titanium Alloy, $670.00 High Noble Metal) Abutment Supported Retainer for Porcelain/Ceramic Fixed $535.00 Partial Denture Abutment Supported Retainer for Porcelain Fused to Metal $700.00 Fixed Partial Denture (High Noble Metal) Abutment Supported Retainer for Porcelain Fused to Metal $535.00 Fixed Partial Denture (Predominantly Base Metal) Abutment Supported Retainer for Porcelain Fused to Metal $700.00 Fixed Partial Denture (Noble Metal) Abutment Supported Retainer for Cast Metal Fixed Partial $670.00 Denture (High Noble Metal) Abutment Supported Retainer for Cast Metal Fixed Partial $505.00 Denture (Predominantly Base Metal) Abutment Supported Retainer for Cast Metal Fixed Partial $670.00 Denture (Noble Metal) Implant Supported Retainer for Ceramic Fixed Partial Denture $535.00 Implant Supported Retainer for Porcelain Fused to Metal $700.00 Fixed Partial Denture (Titanium, Titanium Alloy, High Noble Metal) Implant Supported Retainer for Cast Metal Fixed Partial $670.00 Denture (Titanium, Titanium Alloy, High Noble Metal) Implant/Abutment Supported Fixed Denture for Completely $685.00 Edentulous Arch Implant/Abutment Supported Fixed Denture for Partially ' $700.00 Edentulous Arch Recement Implant/Abutment Supported Crown Recement Implant/Abutment Supported Fixed Partial Denture Abutment Supported Crown (Titanium) Abutment Supported Retainer Crown for Fixed Partial Denture (Titanium) $40.00 $40.00 $670.00 $ 670.00 -10- Cigna Dental Care® Patient Charce Schedule (P6XVO) Endodontics (Root Canal Treatment, Excluding Final Restorations) D3110 D3120 D3220 D3221 D3222 D3230 D3240 D3310 D3320 D3330 D3331 D3332 D3333 D3346 D3347 D3348 D3351 D3352 D3353. Pulp Cap — Direct (Excluding Final Restoration) Pulp Cap — Indirect (Excluding Final Restoration) Pulpotomy — Removal of Pulp, Not Part of a Root Canal Pulpal Debridement (Not to be used when root canal is done on the same day) Partial Pulpotomy for Apexogenesis — Permanent Tooth with Incomplete Root Development Pulpal Therapy (Resorbable Filling) — Anterior, Primary Tooth (Excluding Final Restoration) Pulpal Therapy (Resorbable Filling) — Posterior, Primary Tooth (Excluding Final Restoration) Anterior Root Canal — Permanent Tooth (Excluding Final Restoration) Bicuspid Root Canal — Permanent Tooth (Excluding Final Restoration) Molar Root Canal — Permanent Tooth (Excluding Final Restoration) Treatment of Root Canal Obstruction — Nonsurgical Access Incomplete EndodonticTherapy— Inoperable, Unrestorable or Fractured Tooth Internal Root Repair of Perforation Defects Retreatment of Previous Root Canal Therapy — Anterior Retreatment of Previous Root Canal Therapy — Bicuspid Retreatment of Previous Root Canal Therapy — Molar Apexification/Recalcification — Initial Visit (Apical Closure/ Calcific Repair of Perforations, Root Resorption, etc.) Apexification/Recalcification — Interim Medication Replacement (Apical Closure/Calcific Repair of Perforations, Root Resorption, etc.) Apexification/Recalcification — Final Visit (Includes Completed Root Canal Therapy — Apical Closure/Calcific Repair of Perforations, Root Resorption, etc.) $0.00 $0.00 $11.00 $50.00 $17.00 $35.00 $40.00 $ 90.00 $135.00 $275.00 $95.00 $80.00 $ 95.00 $150.00 $195.00 $310.00 $85.00 $ 75.00 $75.00 -11- Cigna Dental Care® Patient Charge Schedule (P6XVO) D3410 D3421 D3425 D3426 D3430 D3450 D3920 Apicoectomy/Periradicular Surgery — Anterior Apicoectomy/Periradicular Surgery — Bicuspid (First Root) Apicoectomy/Periradicular Surgery — Molar (First Root) Apicoectomy/Periradicular Surgery (Each Additional Root) Retrograde Filling per Root Root Amputation — Per Root Hemisection (Including Any Root Removal), Not Including Root Canal Therapy $105.00 $105.00 $105.00 $70.00 $70.00 $105.00 $100.00 Periodontics (Treatment of Supporting Tissues (Gum and Bone] of the Teeth) Periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the Patient Charge Schedule. The Relevant Procedure Codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months, when covered on the Patient Charge Schedule. D0180 D4210 D4211 D4240 D4241 D4245 D4249 D4260 D4261 D4263 D4264 D4265 D4266 D4267 Comprehensive Periodontal Evaluation — New or Established Patient Gingivectomy or Gingivoplasty — 4 or More Teeth per Quadrant Gingivectomy or Gingivoplasty — 1 to 3 Teeth per Quadrant Gingival Flap (Including Root Planing) — 4 or More Teeth per Quadrant Gingival Flap (Including Root Planing) —1 to 3 Teeth per Quadrant Apically Positioned Flap Clinical Crown Lengthening — Hard Tissue Osseous Surgery — 4 or More Teeth per Quadrant Osseous Surgery —1 to 3 Teeth per Quadrant Bone Replacement Graft — First Site in Quadrant Bone Replacement Graft — Each Additional Site in Quadrant Biologic Materials to Aid in Soft and Osseous Tissue Regeneration Guided Tissue Regeneration — Resorbable Barrier per Site Guided Tissue Regeneration — Nonresorbable Barrier per Site (Includes Membrane Removal) $0.00 $145.00 $90.00 $165.00 $125.00 $185.00 $140.00 $325.00 $250.00 $230.00 $105.00 $ 95.00 $215.00 $255.00 -12- Cigna Dental Care® Patient Charge Schedule (P6XVO) D4270 Pedicle Soft Tissue Graft Procedure D4271 D4273 D4274 D4275 D4341 D4342 D4355 D4381 D4910 D9940 D9942 D9951 D9952 Free Soft Tissue Graft Procedure (Including Donor Site Surgery) Subepithelial Connective Tissue Graft Procedures, Per Tooth Distal or Proximal Wedge Procedure (When Not Performed in Conjunction with Surgical Procedures in the Same Anatomical Area) Soft Tissue Allograft Periodontal Scaling and Root Planing —4 or More Teeth per Quadrant (Limit 4 Quadrants per Consecutive 12 Months) Periodontal Scaling and Root Planing —1 to 3 Teeth — per Quadrant (Limit 4 Quadrants per Consecutive 12 Months) Full Mouth Debridement to Allow Evaluation and Diagnosis (1 per Lifetime) Localized Delivery of Antimicrobial Agents per Tooth — By Report Periodontal Maintenance (Limited tot per Calendar Year) (Only Covered after Active Therapy) Additional Periodontal Maintenance Procedures (Beyond 2 per Calendar Year) Periodontal Charting for Planning Treatment of Periodontal Disease Periodontal Hygiene Instruction Occlusal Guard — By Report (Limit 1 per24 Months) Repair and/or Reline of Occlusal Guard Occlusal Adjustment Limited Occlusal Adjustment Complete $ 75.00 $80.00 $420.00 $45.00 $ 35.00 $45.00 $60.00 $35.00 $65.00 $0.00 $0.00 $110.00 $40.00 $40.00 $65.00 Prosthetics (Removable Tooth Replacement — Dentures) Includes up to 4 adjustments within first 6 months after insertion — Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the Member of 5200.00 per denture. D5110 Full Upper Denture D5120 Full Lower Denture $185.00 $185.00 -13- Cigna Dental Care® Patient Charge Schedule (P6XVO) D5130 Immediate Full Upper Denture D5140 Immediate Full Lower Denture D5211 Upper Partial Denture — Resin Base (Including Clasps, Rests and Teeth) D5212 Lower Partial Denture— Resin Base (Including Clasps, Rests and Teeth) D5213 Upper Partial Denture — Cast Metal Famework (Including Clasps, Rests and Teeth) D5214 Lower Partial Denture — Cast Metal Framework (Including Clasps, Rests and Teeth) D5225 Upper Partial Denture - Flexible Base (Including Clasps, Rests and Teeth) D5226 D5281 D5410 D5411 D5421 D5422 D5850 D5851 D5862 Lower Partial Denture — Flexible Base (Including Clasps, Rests and Teeth) Removable Unilateral Partial Denture — One Piece Cast Metal Including Clasps and Teeth) Adjust Complete Denture — Upper $11.00 Adjust Complete Denture — Lower $11.00 Adjust Partial Denture — Upper $11.00 Adjust Partial Denture— Lower $11.00 Tissue Conditioning — Upper $11.00 Tissue Conditioning — Lower $11.00 Precision Attachment — By Report $160.00 $205.00 $205.00 $185.00 $185.00 $200.00 $200.00 $165.00 $165.00 $185.00 Repairs to Prosthetics D5510 i Repair Broken Complete Denture Base D5520 D5610 D5620 D5630 D5640 D5650 Replace Missing or Broken Teeth — Complete Denture (Each Tooth) Repair Resin Denture Base Repair Cast Framework Repair or Replace Broken Clasp Replace Broken Teeth — Per Tooth Add Tooth to Existing Partial Denture $35.00 $35.00 $35.00 $35.00 $40.00 $35.00 $35.00 -14- Cigna Dental Care Patient Charge Schedule (P6XVO) ,od —ton oce lure es -cry D5660 Add Clasp to Existing Partial Denture • $40.00 D5670 Replace All Teeth and Acrylic on Cast Metal Framework— $185.00 Upper • D5671 - Replace All Teeth and Acrylic on Cast Metal Framework — $185.00 Lower Denture Relining (Limit 1 Every 36 Months) D5710 Rebase Complete Upper Denture $70.00 D5711 Rebase Complete Lower Denture $70.00 D5720 Rebase Upper Partial Denture $70.00 D5721 Rebase Lower Partial Denture $70.00 D5730 Reline Complete Upper Denture — Chairside $40.00 D5731 Reline Complete Lower Denture — Chairside $40.00 D5740 Reline Upper Partial Denture — Chairside $40.00 D5741 Reline Lower Partial Denture — Chairside $40.00 D5750 Reline Complete Upper Denture — Laboratory $70.00 D5751 Reline Complete Lower Denture — Laboratory $70.00 D5760 Reline Upper Partial Denture — Laboratory $70.00 D5761 Reline Lower Partial Denture — Laboratory $70.00 Interim Dentures (Limit 1 Every 5 Years) D5810 Interim Complete Denture — Upper $255.00 D5811 Interim Complete Denture — Lower $255.00 D5820 Interim Partial Denture— Upper $85.00 D5821 Interim Partial Denture— Lower $85.00 Oral Surgery (Includes Routine Postoperative Treatment) Surgical Removal of Impacted Tooth — Not covered for ages below 15 unless pathology (disease) exists. D7111 Extraction of Coronal Remnants — Deciduous Tooth $6.00 D7140 Extraction, Erupted Tooth or Exposed Root — Elevation and/or Forceps Removal $6.00 -15- Cigna Dental Care® Patient Charge Schedule (P6XVO) D7210 D7220 D7230 D7240 D7241 D7250 D7251 D7260 D7261 D7270 D7280 D7283 D7285 D7286 D7287 D7288 D7310 D7311 D7320 D7321 D7450 D7451 Surgical Removal of Erupted Tooth — Removal of Bone and/or Section of Tooth Removal of Impacted Tooth — Soft Tissue Removal of Impacted Tooth — Partially Bony Removal of Impacted Tooth — Completely Bony Removal of Impacted Tooth — Completely Bony, Unusual Complications (Narrative Required) Surgical Removal of Residual Tooth Roots — Cutting Procedure Coronectomy - Intentional Partial Tooth Removal Oroantral Fistula Closure Primary Closure of a Sinus Perforation Tooth Stabilization of Accidentally Evulsed or Displaced Tooth Surgical Access of an Unerupted Tooth (Excluding Wisdom Teeth) Placement of Device to Facilitate Eruption of Impacted Tooth Biopsy of Oral Tissue — Hard (Bone, Tooth) (Tooth Related — Not allowed when in conjunction with another surgical procedure) Biopsy of Oral Tissue — Soft (AII Others) (Tooth Related — Not allowed when in conjunction with another surgical procedure) Exfoliative Cytological Sample Collection Brush Biopsy—Transepithelial Sample Collection Alveoloplasty in Conjunction with Extractions — 4 or More Teeth or Tooth Spaces per Quadrant Alveoloplasty in Conjunction with Extractions — 1 to 3 Teeth or Tooth Spaces per Quadrant Alveoloplasty Not in Conjunction with Extractions — 4 or More Teeth or Tooth Spaces per Quadrant Alveoloplasty Not in Conjunction with Extractions — 1 to 3 Teeth or Tooth Spaces per Quadrant Removal of Benign Odontogenic Cyst orTumor — Up to 1.25 cm Removal of Benign Odontogenic Cyst or Tumor — Greater than 1.25 cm $35.00 $55.00 $80.00 $100.00 $125.00 $45.00 $80.00 $125.00 $125.00 $ 95.00 $100.00 $100.00 $0.00 $0.00 $ 50.00 $50.00 $55.00 $55.00 $ 80.00 $80.00 $0.00 $0.00 -16- Cigna Dental Care® Patient Charge Schedule (P6XVO) D7471 D7472 D7473 D7485 D7510 D7511 D7520 D7521 D7910 D7960 D7963 Removal of Lateral Exostosis — Maxilla or Mandible $90.00 Removal of Torus Palatinus $70.00 Removal of Torus Mandibularis $70.00 Surgical Reduction of Osseous Tuberosity $60.00 Incision and Drainage of Abscess — Intraoral Soft Tissue $35.00 Incision and Drainage of Abscess — Intraoral Soft Tissue $35.00 Complicated Incision and Drainage of Abscess — Extraoral Soft Tissue $35.00 Incision and Drainage of Abscess — Extraoral Soft Tissue — $35.00 Complicated (Includes Drainage of Multiple Fascia) Spaces) Suture of Recent Small Wounds up to 5 cm $30.00 Frenulectomy — Also Known as Frenectomy or Frenotomy — $45.00 Separate Procedure Not Incidental to Another Frenuloplasty $45.00 Orthodontics (Tooth Movement) Orthodontic Treatment (Maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.) D8050 D8060 D8070 D8080 D8090 D8210 D8220 D8660 Interceptive Orthodontic Treatment of the Primary $440.00 Dentition — Banding Interceptive Orthodontic Treatment of the Transitional $440.00 Dentition — Banding Comprehensive Orthodontic Treatmentof the Transitional $440.00 Dentition — Banding Comprehensive Orthodontic Treatment of the Adolescent $440.00 Dentition — Banding Comprehensive Orthodontic Treatment of the Adult $440.00 Dentition — Banding Removable Appliance Therapy $0.00 Fixed Appliance Therapy ! $0.00 Pre -Orthodontic Treatment Visit $125.00 -17- Cigna Dental Care® Patient Charge Schedule (P6XVO) D8670 D8680 D8693 D8999 Periodic Orthodontic Treatment Visit — As Part of Contract Children — Up to 19th Birthday: 24-Month Treatment Fee Charge per Month for 24 Months Adults: 24-Month Treatment Fee $2,160.00 Charge per Month for 24 Months $90.00 Orthodontic Retention — Removal of Appliances, Construction $285.00 and Placement of Retainer(s) Rebonding or Recementing; and/or Repair, As Required, of $0.00 Fixed Retainers Unspecified Orthodontic Procedure — By Report (Orthodontic $280.00 Treatment Plan and Records) $1,460.00 $61.00 General Anesthesia/1V Sedation — General anesthesia is covered when performed by an Oral Surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. IV sedation is covered when performed by a Periodontist or Oral Surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. Plan limitation for this benefit is 1 hour per appointment. There is no coverage for general anesthesia or intravenous sedation when used for the purpose of anxiety control or patient management. D9211 D9212 .! D9215 D9220 D9221 D9241 D9242 D9610 D9612 D9630 D9910 Regional Block Anesthesia Trigeminal Division Block Anesthesia Local Anesthesia General Anesthesia — First 30 Minutes General Anesthesia — Each Additional 15 Minutes IV Conscious Sedation — First 30 Minutes IV Conscious Sedation — Each Additional 15 Minutes Therapeutic Parenteral Drug, Single Administration Therapeutic Parenteral Drugs, 2 or More Administrations, Different Medications Other Drugs and/or Medicaments — By Report Application of Desensitizing Medicament $0.00 $0.00 $0.00 $160.00 $75.00 $160.00 $75.00 $15.00 $25.00 $15.00 $15.00 -18- Cigna Dental Care® Patient Charge Schedule (P6XVO) Emergency Services D9110 D9120 D9440 Palliative (Emergency) Treatment of Dental Pain — Minor Procedure Fixed Partial Denture Sectioning Office Visit — After Regularly Scheduled Hours Miscellaneous Services — External Bleaching (D9972) is limited to the use of take-home bleaching trays. All other bleaching methods are not covered. $6.00 $35.00 D9972 I External Bleaching per Arch $125.00 s This may contain CDT codes and/or portions of, or excerpts from the Nomenclature • contained within the Current Dental Terminology, a copyrighted publication provided by the American Dental Association. The American Dental Association does not endorse any codes which are not included in its current publication. -19- After your enrollment is effective: CaII the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling CIGNA Dental at the toll -free number listed on your ID card or plan materials. Multiple ways to locate a *DHMO Network General Dentist: • Online provider directory at www.cigna.com • Online provider directory on myCIGNA.com Call the number located on your ID card to: — Use the Dental Office Locator via Speech Recognition — Speak to a Customer Service Representative EMERGENCY: If you have a dental emergency as defined in your group's plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any licensed dentist. Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group's plan documents for a complete definition of dental emergency, your emergency benefit and a listing of Exclusions and Limitations. 'The term`DHIvIO°is used to refer to product designs that may differ by state of residence cfenrc lee, including but net limited to, prepaid plans, managed care plans, and plans with open access features. "Cigna' and `Cigna Dental.' are registered service marks and the Tree of Life' iogn is a service mark of Cigna intellectual Cigna inc., licensed for use. by (.croC%'aTl^.'3 and its operating subsidiaries. Ali products and services are provided exclusively by such operating subsidiaries, including Connecticut Genera' Life Insurance Company ;CGLIC "). Cigna Heath and Life Insurance Corn any (" CHL C'), Cigna Hea thCare of Connecticut, inc„ and Cigna Denta Health, Inc (`CDHI") and its t ,The Cigna Care LDental Health Plan of ,Arizona, subsidiaries, i_s, and not �;• Cigna Corperat�.n. gn•a Dental plan sprovided y Cigna inc.; Cigna Dental Health ofCaifcrnia, Inc.; Cigna Dental Heath of Coorado, Inc.; Cigna Dental Health of Delaware, Inc.; Cigna Dental Health of Florida, Inc, a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes; Cigna Denial Health ;f Kansas, Inc.(Kansas and Nebraska); Cigna Dental Health of Kentucky, Inc.; Cigna Dental Health of Maryland, Inc.; Cigna Dental Health of Missouri, Inc.; Cigna Dental Health of i e„ -Jersey, Inc.; Cigna Dental Health of North Carolina, Inc.; Cigna Dental Health of Ohio, Inc.; Cigna Dental Health of Pennsylvania, Inc.; Cigna Dental Health of Texas, Inc; and Cigna Dental Health of Virginia, Inc in other states, the Cigna Dental Care plan is underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc., and administered by CDHI. 830590 10/11 J 2011 CIGNA n Improved Oral Health. Lower Costs. Executive Summary Customer Service City of Miami RFP No. 336312 Cigna chose to be the only national health service company to expand our customer service hours to include the weekends, holidays, and overnight hours. Ourtoll-free customer service number, 1.800.Cigna24 is staffed 24 hours a day, 7 days a week to answer questions about coverage, DHMO dental office transfers, DPPO claims, procedures, or any other concerns. Our voice response system is available 24 hours a day, 7 days a week. DHMO members can use the voice response system to view eligibility and coverage information or they can use our automated quick transfer option to change network dental offices. DPPO members can use the voice response system to check claim status, eligibility, and coverage information. The toll -free number provides assistance 24-hours a day, allowing the member to enter their zip code and hear a list of nearby dental offices via the dental office locator. This list can also be faxed immediately to assist in enrollment or dental office transfers for the DHMO. Members can also enter a dentist's phone number to see if he or she participates in the network. If there are multiple dentists with the same phone number, the system will speak back the name of each dentist, and clearly identifies DHMO capped dental offices. This information is updated nightly. Members can access over 1,000 health and dental by calling our toll -free number. Updated network information, referral status, and our website at myCigna.com. Our customer service organization focuses on providing the best service and customer satisfaction for our members. topics through our health information line eligibility verification is also available on Copyright 2012 Page 10 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Banking Fully Insured The proposed plan is fully insured; banking will be administered by Cigna. ASO Citibank or JPMorgan Chase administers our ASO banking arrangements; however, the City may select any bank to fund their program account. We issue claim checks through our claim administration process with several controls in place. As checks are issued, the daily issue data is sent to Citibank or JPMorgan Chase. Checks are paid through the central disbursing account for ASO accounts. This is an unfunded, zero - balance account, so when checks are paid, it becomes momentarily overdrawn. There is an estimated three to four day float for single payment checks and a five to seven day float for bulk payment checks. Paid checks are matched against the outstanding issue file and immediately transferred to the account from which they were drawn. This ensures that your account is not debited unless the paid and outstanding checks match in the issue file. Your account is then debited, and the central disbursing account is credited, bringing the latter to its proper zero -balance. You have a choice of daily or weekly funding for your account. The required imprest amount for an ASO account is the greater of three days average claim activity or $10,000 if funded daily, or the greater of seven days average claim activity or $10,000 if funded weekly. If you choose daily funding, Citibank or JPMorgan Chase will wire request funds from your bank daily for the aggregate amount of checks cleared the night before. If you choose weekly funding, they will wire request funds from your local bank on the first business day of each week for the aggregate amount of checks cleared the prior week. Your local bank must honor the request for funds via Fed Wire transfer the same day to immediately restore your account to the imprest balance. Funding arrangements can be made using the Automated Clearing House, which requires an additional day's imprest whether funding daily or weekly. We provide daily, weekly, or monthly registers of checks issued or cleared and a monthly ASO worksheet summarizing claim activity. Citibank or JPMorgan Chase supplies us with a detailed monthly statement and reconciliation. Paid checks are microfilmed and kept in the financial services unit as proof of payment. Copyright 2012 Page 11 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Reporting Cigna offers a wide range of dental plan coverage's and features that meet the needs of existing and prospective clients. Dental utilization information was integrated into the consultative analytics platform (CAP) in late 2011 to enable more flexible request parameters, a consistent look and feel to medical/pharmacy/other reporting and updated norm information. We generally provide a standard package of dental information reports quarterly or annually at no charge. There is a charge for standard reports produced more frequentlyand for optional reports. Reporting includes: 1. Dental Summary — Exhibits total costs (including employer paid and member cost share) and per capita costs compared to book of business norms. 2. Dental Utilization by Type of Service — Exhibits per capita cost and utilization by service category. 3. Dental Utilization by Type of Service and Network — Exhibits per capita cost and utilization by service category by network option for a single time period. 4. Dental Cleanings Utilization — Exhibits percent of unique members with one or more cleanings. 5. Dental Top Quality 10 Procedure Types — Exhibits the top 10 procedures based on the number of services in descending order. 6. Dental Network Utilization and Cost Share — Exhibits percent of claims paid by the member versus employer and amounts paid in network. 7. Dental Claim Cost and Savings Summary — Exhibits waterfall of total charges, savings and discounts for one or two time periods versus norm. 8. Dental Claim Distribution (all services, including orthodontic) — Exhibits payable claims by dollar range counted by unique member with orthodontic costs. 9. Dental Claim Distribution (excluding orthodontic) — Exhibits payable claims by dollar range counted by unique member without orthodontic costs. 10. Dental Customer Base Summary — Exhibits summary of population enrollment by plan coverage and age band. 11. Dental DHMO Summary — Exhibits summary statistics for member numbers, utilization, and savings for the DHMO plan coverage's only. 12. Dental Utilization by Type of Service (DHMO ONLY) - Exhibits service categories details for DHMO utilization only. Copyright 2012 Page 12 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Benefit Administration Your account management team skillfully coordinates resources to effectively manage your coverage plan. The team provides designated resources for customer service, accounting, claims, and underwriting and brings the expertise that translates to exceptional service delivery, focused on building processes and tools that best meet your needs. The account management team consists of: New Business Manager New business manager, Yesenia Sanchez, oversees the account management process. Yesenia is responsible for: 1. responding to bid specifications 2. working with underwriters to price proposed plans 3. understanding your needs and determining the best plan coverage and funding options available 4. working with the implementation team and account management team Client Manager The client manager (CM) ensures your account is implemented properly, and will work with you to develop an account management process for ongoing service. The CM is specifically responsible for: 1. monitoring services and ensuring that they are delivered to your satisfaction 2. conducting regular account management meetings 3. analyzing and communicating financial and utilization reports, whether web -based or hard copy Implementation Manager The implementation manager (IM) is responsible for the overall successful implementation of your plan. The IM coordinates activities between the City and Cigna departments, including sales and other service partners in underwriting, claim processing, contracts, eligibility, and billing to ensure efficient and accurate execution of the plan. Client Engagement Manager A client engagement manager (CEM) supports your team with technical expertise in covered services, processes, and health and wellness strategy. The CEM works closely with the client manager, implementation manager, client service partner, and other members of Cigna's internal team to service your account on an ongoing basis and to ensure that client and member support is provided efficiently and effectively. The CEM is the primary contact between your human resource staff and Cigna for addressing routine coverage questions, supporting member education, coordinating the open enrollment process, and facilitating scheduled service meetings. They work closely with you to develop, implement, and facilitate health and wellness and health advocacy programs and events. Copyright 2012 Page 13 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Executive Summary Client Service Partner The client service partner (CSP) is your single point of contact for escalated call, claim, billing, and eligibility questions. The CSP manages ongoing tracking and trending of your service experience to identify opportunities for service improvement. They work closely with your account management team (including your client engagement manager) to monitor service trends and identify opportunities for improvement. Eligibility Account Specialist The eligibility account specialist (EAS) updates member eligibility based on the receipt of information/enrollment data from the City. The EAS will work with the City to reconcile error reports; ensuring accurate eligibility information is maintained in our eligibility system. They are also your contact for client -specific questions or service issues about automated and manual eligibility. Other Team Members Supporting the account service team are service representatives from each of the following: claim, eligibility, billing, local health plans, contracts and compliance, banking, underwriting, and reporting. Copyright 2012 Page 14 of 151 Cigna Improved Oral Health. Lower Costs: City of Miami RFP No. 336312 Executive Summary Price and Cost Effectiveness Cigna has attached financial exhibits in this section of the proposal. Copyright 2012 Page 15 of 151 Cigna City of Miami Guaranteed Cost Funding Non -Participating January 01, 2013 - December 31, 2015 £ n 3� a it S �'" } '" 4'z4, i' i'Asai'.e t #� Tier �; ��� �� � o al Expected a •cw'%y?.':<,\ ��� wes ;?!4',a Competitor Y �Zif�`. N'r.h.^„y,�.c& � Rates Quoted Rates Dental PPO - Executive Employee Only 39 $39.78 $38.85 Employee + Family 101 $121.58 $118.73 Annual Cost 140 $165,972 $162,078 .. `.. e•rcent Change (Quot -d Vs Con petitor), ... , ; 4 - ;:.y.� t r= . ; 2 35% <.h, ' Y kl it "' S 4:. 4� }S '• yM o''°h} 2 Y F k2 ,� T* �s ¢ k ? t 3 E ected ,� i i �° t b i rSy Compettor Rates fr {? j 4 <�"^'?. noted Rates Dental PPO - Voluntary Employee Only 485 $30.55 $29.83 Employee + Spouse 158 $62.89 $61.42 Employee + Child(ren) 97 $62.35 $60.89 Employee + Family 141 $111.23 $108.62 Annual Cost 881 $557,817 $544,729 .. ercei Changel(Quoted ds Competitor), .;u .,,. r < ...' _ fp, 2•359/01.,A i . t$7O6 8O Percent Change (Quoted vs Competitor) -2.35% Cigna is proposing a cap for the 1/1/2016 DPPO renewal which will not exdeed 9.5% over the 1/1/2015 rates Cigna is proposing a cap for the 1/1/2017 DPPO renewal which will not exdeed 9.5% over the 1/1/2016 rates - Cigna City of Miami (ASO) ASO Quote January 01, 2013 - December 31, 2013 Ci Dental Dental Admin Fees Dental Network Access Fees Commission Fees TOTAL ASO FEES 1,021 1,021 1,021 $2.80 $0.80 $0.00 $2,859 $817 $0 $34,306 $9,802 $0 1,021 $3.60 $3,676 $44,107 Premium Equivalent Annual ASO Fees + Commissions + Expected Claims = Expected Premium Equivalent Dental $44,107 $0 $580,737 $ 624,844 January 01, 2014 - December 31, 2014 Dental Dental Admin Fees Dental Network Access Fees Commission Fees Total ASO Fees 1,021 1,021 1,021 1,021 $2.80 $2,859 $0.80 $817 $0.00 $0 $3.60 $3,676 $34,306 $9,802 $0 $44,107 January 01, 2015 - December 31, 2015 Dental Dental Admin Fees Dental Network Access Fees Commission Fees Total ASO Fees 1,021 $2.80 $2,859 $34,306 1,021 $0.80 $817 $9,802 1,021 $0.00 $0 $0 1,021 $3.60 $3,676 $44,107 City of Miami Guaranteed Cost Funding Non -Participating January 01, 2013 -December 31, 2015 L� y$,$ ;,�, A .' .� i Y ��� 2 tier >° S i§i e _ � Com etitor Rates; , -� 2 Tier SA � G nab r Rates . a 1� 4 Tter ,7 � x� Ci '$` i"t Rates,= ..w Dental HMO (P6X-V0) Employee Only $12.18 $13.59 $13.59 Employee + Spouse $27.28 Employee + Child(ren) $28.26 Employee + Family $30.52 $34.05 $39.25 Annual Cost ercent_Chan i . . . , . � ge,.(Quoteif;vs Com�eit�torj..<_�._. � � t � ��_ � . ' 4 .,; ..., >�.� ,1 Z09 ci r a_ av'svl?` S t bla Competor h, ! d � .,-,. Rates�:�� 2 Tier �iL'S am} Cgna 33t G• �3 Y 'Rafes �,� t OgnaL� ro'A. ��,Rates.,.2. Dental HMO (P7X-V0) $12.18 $12.29 $12.29 $24.68 $25.56 $35.51 Employee Only Employee + Spouse" Employee + Child(ren)..,: Employee + Family Annual Cost $30.52 $30.80 �, t PercentChange,.(Quotedvs'Competitor)at ,... ��.�. ��.���..-�'.�; �x . �,..i�,�` -0909/�,. Cigna is proposing a cap for the 1/1/2016 DHMO renewal which will not exdeed 8.5% over the 1/1/2015 rates Cigna is proposing a cap for the 1/1/2017 DHMO renewal which will not exdeed 8.5% over the 1/1/2016 rates 0 DPPO Performance Guarantees City of Miami Effective Start Date: January 1, 2013 IMPLEMENTATION Identification Card Delivery Implementation ID Card Timeliness. 98% of the ID cards will be mailed by the agreed upon commitmentdate in the Implementation Calendar. Results measured at Account Level. Claim Readiness Implementation Claim Readiness. Benefit Profile and eligibility information loaded on claims processing system as of the Commitment Date set forth in the approved Implementation Calendar. Results measured at Account Level. CaII Readiness Implementation Call Readiness. Service Center(s) ready to respond to customer inquiries as of the Commitment Date set forth in the approved Implementation Calendar. Results measured at Account Level. Implementation Satisfaction Implementation Satisfaction. Score of no Tess than three (3) on Statement 1 of the CIGNA HealthCare Implementation Survey. Results measured at Account Level. SERVICE Claim Time -to -Process Dental Time to Process. Measured for the Term of the Agreement, results will meet or exceed: 98% of Claims processed w/in 20 Business Days. Results measured at the Account Level. Financial Accuracy Dental Financial Accuracy. Measured for the Term of the Agreement, results will meet or exceed: 99% of total audited claim dollars are correctly paid. Results measured at Office Level. ® Cigna. Amount At Risk $1,500.00 Amount At Risk $1,500.00 Amount At Risk $1,500.00 Amount At Risk $1,500.00 Amount At Risk $1,500.00 Amount At Risk $1,500.00 Processing Accuracy Amount At Risk Dental Processing Accuracy (Overall Accuracy). Measured for the Term of the Agreement, results will meet or exceed: 95% of total audited claims $1,500.00 are correctly processed. Results measured at Office Level. Average Speed of Answer Amount At Risk Dental ASA. Measured for the Term of the Agreement, results will not exceed: 45 seconds to answer a phone. call. Results measured at Special $1,500.00 Account Queue. Account Management Account Management. Composite Score (all categories) of 3.0 or better on the Account Management Report Card based on four (4) quarterly scorecards. Results measured at Account Level. • Amount At Risk $1,500.00 Page 1 09/18/2012 DHMO Performance Guarantees City of Miami Effective Start Date: January 1, 2013 DENTAL HMO Average Speed of Answer Dental HMO ASA. Measured for the Term of the Agreement, results will not exceed: 45 seconds to answer a phone call. • Results measured at Special Account Queue. Post enrollment measure DHMO ID Cards Maintenance. Measured for the Term of the Agreement, results will meet or exceed: 98.5% mailed within 10 business days after the release of, not receipt of, clean and accurate eligibility to the ID card vendor. Results measured at Account Level. Time to Process - Specialty Referral Claims Rate Dental HMO Time to Process. Measured for the Term of the Agreement, result will meet or exceed: 98% within 15 Business Days. Results measured at Office Level. Implementation Service Readiness Dental HMO Implementation Satisfaction. Score of no less than three (3) on Statement 1 of the CIGNA HealthCare Implementation Survey. Results measured at Account Level. Implementation Service Readiness • Dental HMO Service Readiness. Results will meet or exceed: Standard offered based on PCS loaded into Webster and ready to service calls by commitment date. s Cigna. PS PY $1.32 PSPY $1.32 PSPY $1.32 PSPY $1.32 PSPY $1.32 Total Amount at Risk Per Enrolled Subscriber Total $ Maximum Amount at Risk $6.60 $3,260.00 Page 1 09/18/2012 Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of .errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation, •completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of .any of the violations, .or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). .EXCEPTIONS: None. We (I) certify that: any and all information contained in this submission is 'true; and we (1):further certify that this submission is made without prior understanding, agreement, or connection with any corporation, :firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the .submitier. Please print the following: and sign your name: SUPPLIER NAME: Cigna Health and Life Insurance Company (CHLIC),..Cigna Dental Health of Florida_ Inc ADDRESS: 1571 Sawgrass Corporate Parkway, Suite.140, Sunrise. FL 33323 PHONE: (954) 514-6600 FAX: (866) 308-5010 EMAIL: Laurie:Flebatte(a?Cigna.corn BEEPER: N/A. SIGNED BY: ./"`1 `' 1(, < _.. TITLE: Laurie A. Flebotte, Vice President DATE: 14-September-2012 FAILURE TO COMPLETE, 'SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. Copyright 2012 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Certifications Legal Name of Firm: While we have various legal names depending on regulatory filing by market, our company brand names are Cigna Dental Care® and Cigna DentalsM. The name of our company is Cigna Health and Life Insurance Company and Cigna Dental Health of Florida, Inc. Entity Type: Partnership, Sole Proprietorship, Corporation, etc. Corporation Year Established: The Insurance Company of North America (INA), founded in 1792, and Connecticut General Life Insurance Company, founded in 1865, merged in 1982 to form Cigna. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. It is an indirect, wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. Office Location: City of Miami, Miami -Dade County, or Other Dental coverage will be handled by the existing Cigna account management team located in Broward County — Sunrise, Florida. Occupational License Number: 010575-00740000 Occupational License Issuing Agency: The City of Miami Finance Department Occupational License Expiration Date: September 30, 2012 (Cigna is the process of updating filing for the next year.) Copyright 2012 Page 17 of 151 Cigna Iit of 4itut KENNETH ROBERTSON JOHNNY MARTINEZ, P.E. Chief Pmcurement Officer City Manager ADDENDUM ND. 4 RFP No. 336312 September 20, 2012 Request for Proposals (RFP) for Employee Benefit Dental Plan TO: ALL PROSPECTIVE PROPOSERS: The following changes, additions, clarifications, and deletions amend the RFP documents of the above captioned RFP, and shall become an integral part of the Contract Documents. Words and/or figures stricken through shall be deleted. Underscored words and/or figures shallbe added. The remaining provisions are now in effect and remain unchanged. Please note the contents herein and reflect same on the documents you have on hand. Addendum No. 3 was issued electronically on September 13, 2012, changing the RFP :closing date and .time to Tuesday, September25, 20.12 at 1:00 p.m. The RFP dosing date and time has now been changed to Friday, September 28..2012.at 1:00 p.m. Additionally, and as a result of the contents of Addendum No. 2, please find below ,.Questions from prospective proposers and the .City's.Answers to those Questions: Q1: The PPO experience does riot seem to match the revised census. Al: The medical .census, titled Benefit Census, and marked: as Exhibit20, reflecting the ..total number of participants in the City's group medical plan :was provided with. Addendum 'No. .2-at the request of one of the prospective proposers, and should not be confused with the dental census, marked as Exhibit 1 (Revised) and Exhibit 2 (Revised). The Benefit Census indicates "Medical" under the "Plan Type' column_ It should be noted that not all employees :participating in the medical plan: are: participating in.the :dental :plan_ _ Q2: The revised.. census shows 1530 lives but it is not broken out to show who is on executive and: regular. A2: Please refer to updated PPO Census, marked as Exhibit.2 (Revised .09'05:2012).with Executive and Non -Executive participants "broken -out Be sure to use the Employee #'.field as the key record :in determining number of plan, participants and plan subscribers. 43: According to the: most recent experience, the exec. has 151 lives and the regular has 922 lives, which clearly does not match the revised census. A3: Please refer to Q2. Q4: Can you please confirm if the PPO Revised Census((Exhibit 2 Revised) is, in fact, the correct current enrollment? A4: Please refer `to;Q2. 05: Please provide the PPO Revised Census (Exhibit 2 Revised) brokenout by plan (voluntary and: executive).. A'5: .Please refer to Q2. Q6: Can: you., please explain why there is such large discrepancy in the enrollment data provided (1073 in total - Voluntary and Executive) as of July 2012 and what is shown on PPO. Revised Census2 (1532'in:total)? AS: Please refer to Q2. Pagel Addendum No. 4 September 20, 2012 RFP No. 336312 — Employee Benefit Dental Plan Q7: Within Attachment 19, it states there are 4 exhibits within the document but #4, the PDP Savings Report is riot attached. Can you please provide? A7: Please refer to the attached, marked as Exhibit 19 (Exhibit 4). It should be noted that the Exhibit _ referenced in Exhibit 19 had .been .previously provided through Addendum No. 3. as Exhibit 16. Q8: Is there a possibility of receiving a deadline extension? Until we receive all the pertinent census data, we can't begin to underwrite the requested plans. A8: The RFP closing date has been changed to. Friday, September:28, 2012 at 1:00 p.m. as stated on the first page of this addendum. ALL OTHER TERMS AND CONDITIONS OF THE RFP REMAIN THE SAME. Sincerely, nneth Robertson Director/Chief Procurement Officer KR/ ms Cc: RFP File Acknowledgment f receipt of Addendum No. 4 Signature:' Name: Laurie A. Flebotte Date: _21-September-2012 Title: _Vice. President,. Cigna Health and Life insurance Company (CHLIC) and Cigna Dental Health of Florida, Inc Page 2 it of � , x, a ,, I Request for Proposals (RFP) Purchasing Department Miami Riverside. Center 444 SW Avenue, 61^ Floor Miami, Florida 33130 Web Site Address: http://ci.miami.fl.us/procurement RFP Number: Title: Issue Date/Time: RFP Closing Date/Time: Pre -Bid Conference: Pre -Bid Date/Time: Pre -Bid Location: Deadline for Request. for. Clarification: Buyer: Hard Copy.. Submittal Location: Buyer E-Mail Address: Buyer Facsimile: 336312,3 Request for Proposals for Employee Benefit Dental Plan 16-AUG-2012 25-SEP-2012 @ .13:00:00 None Thursday, September 6, 2012_at 5:00 P.M. Suarez, Maritza City of Miami - City Clerk 3500 Pan American. Drive Miami FL 33133 US miStiarez@Ci.niiatriLR.us (305).400-5025 Acknowiedgment f receipt of Addenda No. 3 Signature: Name: Laurie A.. Flebotte. Date: _14-September-2012 Title: _Vice President, Cigna Health and Life Insurance Co>'npany (CHLIC) and. Cigna Dental Health of Florida, Inc Page 1 of 39 KENNETH ROBERTSON Chief -Procurement Officer Tit _a -Lauri ADDENDUM NO. 2 JOHNNY MARTINEZ, P.E. City Manager RFP No. 33631.2 September 7, 2012 Request for Proposals (RFP) for Employee Benefit Dental Plan TO: ALL: PROSPECTIVE PROPOSERS: The following. changes, additions, clarifications, and deletions: amend the RFP documents of the above captioned RFP, and shall become an integral part of the Contract Documents. Words andlor figures stricken through shall be deleted. Underscored :Words and/or figures shall be ,added. The remaining provisions are now in effect and remain unchanged. Please note the contents herein and reflect same on the documents you have on hand. Addendum No. 1 was issued electronically on September 4, 2012, amending Section 2.2. Deadline for submitting requests for information/clarification to reflect a new deadline date of Thursday, September 6,, 2012 at 5:00 p.m. Additionally, .please find below .Questions from .prospective proposers and the City's Answers to those Questions received before the stipulated due date: Q1: The City stated in Attachment 15 that Exhibit 10 was the claims experience for the Executive plan. only. However, there are only 140 currently enrolled on the Executive: plan and this experience report shows over 1000 enrolled. This seems to be combined experience with both the PPO and Executive plan? Is that a correct assumption? Is there any way to getthe.Executive experience broken out by month for the past .three years? Al: Refer to the 'attached, marked as Exhibit 16, containing .claims experiencefor the Voluntary PPO and the Executive plan for the period 8/2009 — 7/2012. Q2: Exhibit .6:is stated to be experience for the PPO plan only. However, it only goes through 5/1/2011. Can we please getupdated experience broken out by month for the rest of 2011 and YID 2012. A2: Refer to 01. Q3: The Citystated in Attachment 15 that `.both the MetLife PPO .plan and the Executive plan do not have a fee schedule in network and then that the city does not -pay out of network claims. However, they state that the voluntary plan is reimbursed at the 80th OON and the Executive plan is reimbursed at the ::!90tn, OON. Can they please; clarify? Are these: currently PPO plans or MAC plans? A3: They are PPO plans and are reimbursed out -of -network at the R&C level, not MAC. This means that the Executive ,plan reimburses for out -of -network services at a higher reimbursement level (90t" percent of Reasonable & Customary: charges than does the .voluntary plan which reimburses for out -of -network services at the 80t" percentile). Q4:. Can you please provide additional claims data for all dental pions through. July? A4: Refer to Q'I. Q5: Can you confirm how long the DHMO rates have been $12.18 for single coverage and $30.52 for family coverage? A5: These rates have been: in place since January 1, 2005. Q6: Can weobtain a copy :ofthe entire DHMO booklet? A6: Refer to the attached,; marked as Exhibit 17. Page <l • Addendum No. 2 • September 7, 2012 RFP No. 336312 —.Employee Benefit Dental Plan Q7: Can we obtain a copy of the most recent Solstice bill? A7: Refer to the attached, marked as Exhibit 18. 08: Page 38 of the RFP requests a service fee schedule for all applicable locations, can you clarify? Are you looking for specific procedures codes and what our reimbursement levels are for those codes? A8: Yes, we are looking for specific procedure codes and their reimbursement levels. Q9: Has Met Life been the current dental carrier since 2008? Q9: Yes. Q10: Is additional claims experience availableprior to 06/2011? A10: Refer to Q1. Q11: Exhibit 10 is labeled as "Executive Plan .Claims Experience". Due to the enrollment on this report, it appears to be for the total population. Please confirm that Exhibit 10 represents claims for both Executive and Voluntary PPO plans. All: Refer to Q1 Q12: Exhibit — Voluntary Plan Claims Experiences was provided from June .2010 through May 2011. Can you provide Voluntary claim.and enrollment data from June 2011 through May.2012? Al2: Refer to Q1. Q1.3: Exhibit 13 —:Dental PPO Utilization Report was provided for the .period 111/2010 through 9/30/2011. Can you provide an updated: report through June, 2012? A13: Refer to Q1. Q14: Does Exhibit 13 — Dental PPO Utilization Report represent both .the Voluntary and Executive PPO plans? .If not, please provide reports by plan (i.e. Voluntary and Executive). A14: Refer to Q1. Q15: Can you .please confirm due date of Sept. 18th? A15: The RFPis: schedule to close on Tuesday, September 18, 2012 at 1:00 pm. Q1.6: The PPO census provided does not have the zip codeslistedneeded to run adisruption report.:. Can; you: please provide a. revised. PPO census? A16: Refer :to.the attached, marked as Exhibit 2 (Revised)., Q17:. It seems that zip codes were only provided for the employeesin the DMO, we would need, them .for 'the PPO as 'well, A17: Refer to Q15. Q18: We note there is :a disruption report in pdf format, however, this would be, needed in excel format. A18: Refer to the attached, marked as Exhibit 3(Revised) Q.19: We found the rate history, however, it ends at 2010, we would need 2011 '& 12, and if possible, the renewal. A19: Refer to the attached, marked as Exhibit 19, with the MetLife renewal for the Voluntary Dental PPO and the executive plan. This includes rates for 2012. The rates for 2011 .are: Voluntary EE Only $30_55 Executive Plan EE + Spouse $62:91 EE Only $39.78 EE + Children) $62.36 EE + Family $121.58 EE + Family ' $111.24 The renewal from Solstice has not yet been received. Page.2 Addendum No. 2 September 7, 2012 RFP No. 336312 —Employee Benefit Dental Plan Q20: Do both plans have the same rates? A20: The plans do not have the same rates. Q21: I have been told that the. DHMO disruption file (exhibit 3) does not have enough information for us to complete an accurate report. We will need the following information in addition: • Complete address Including zip code of the facility they work at • TIN of the facility A21: Refer to the attached, marked as Exhibit 3 (Revised). Q22: Does the census show the :employees who are taking the coverage? If so, will you please send a census that shows all eligible. A22: Refer to .the attached, census spreadsheet, marked as Exhibit 20, based on the total population of City employees and retirees that are participating in the Group Benefit Plan. Q23: Their census is 4 tier, but rates are 2 tier (Executive.. plan and DMO) and 4 tier .(PPO). Please confirm if you would like us to match current tiers. A23: Please match the current 2 tier (HMO) and 4 tier (PPO) rate structure. In addition, please provide a separate 4 tier rate structure for the DHMO plan. Q24: Is the executive plan voluntary too? The regular PPO is, please confirm. A24: The. Executive plan is paid for by the City of Miami. It is not voluntary. 075: The enrollment shown on the rate exhibit.. is very different from the enrollment Pm getting on the census. Is the census. complete? Is the rate exhibit incorrect? Below is what we are finding on each of the documents. Rate exhibit Census DMO - 1800 500 PPO 881 982 Exec 140 121 A25: An updated census for the DHMO (Solstice) and.DPPO (MetLife) are attached, marked as Exhibit 1 (Revised) and Exhibit 2 (Revised). Q26: The document labeled executive claims appears not correct. It lists subscribers in the 10.00 subs range, but this. plan should .only have : about 140 people enrolled according to their. other :documents. We do not seem to find 2012 claims. Please provide monthly claims, FOR EACH PLAN, with corresponding enrollment and premium (if possible) for at least the last 12 months. A26: Refer to Q1. Q27: Can you provide us with .the DPPO census :including home zip codes? A27: Refer to Q16. Q28: Can you provide .addresses for the .Dentists that are in the Solstice Network for purposes of running a more accurate disruption report? A28: Refer to Q21. Q29: Please provide a price sheet where we need to enter the .amount for -Section 1.64 Prompt Payment? A29: This should be included as part of your:proposal response. Q30: The RFP requests as. Attachment :B that:we: provide" Service Fee Schedules for allapplicable locations". Can you please clarify what the City is .looking for here? .. A30: We are looking for the provider contracted amounts for dental procedures in the _geographic areas where the City of Miami has members. Q31: The RFP is asking for a GEO Access: Report :by"Specialty for:2 in 15. However, .l only have a census with :zip codes for those .employees on the DHMO. The PPO & Executive census did not provide a zip code. Do you think we can :obtain that inforrnation? A31: Refer to Q16. Page .3 Addendum No. 2 September 7, 2012 RFP No. 336312 — Employee Benefit Dental Plan Q32: The unfortunate issue is that we cannot even start to underwrite this until we receive the information from you on the claims and census. We would like to request an additional week to get this underwritten. Please let me know if the City of Miami can grant an extension. A32: The RFP closing date and time cannot be changed. Q33: The dental PPO experience ends May 2011. Please provide financial experience from June 2011 through to the most current, at least through June 2012. A33: Refer to Q1. Q34: Please provide zip codes for the PPO census. A34: Refer. to Q16. Q35: Can you please provide zip codes for the'DPPO census? At this time we can only run the Geo access reports on the DMO census, since it is the only one with zip codes. A35: Refer to Q16. Q36:..On page 19.(1.60 G) you request 1 original and 3 copies of the RFP, but on page:36 (4.1) you requestl original and 10 copies. Can you tell us which is correct? A36: 1 original .and five (5) copies :is the correct distribution. Section 4.1. Submission Requirements has been amended to reflect the correctnumberof copies. Q37: Would consecutive numbering within sections be acceptable, (re: pg 36, section 4.1 2 Table of Contents)? (i.e. numbering .would start at "Page 1" for each section). A37: Yes, consecutive number within thesections is acceptable. Q38: There are discrepancies regarding enrollment by tier when comparing the "dental .costs" sheet provided in the RFP with the current group census. Will you please provide/confirm the correct enrollment by tier and by plan? A38: Referto Q25. ALL OTHER TERMS AND CONDITIONS OF THE RFP REMAIN THE SAME. 'Sincerely, inethbeson. Director/Chief Procurement Officer KR/ ms Cc: RFP File :Acknowledgment of receipt of:Addenda No..2 Signature:... Name: Laurie A. Flebotte Date: 14-September-2012 Title:. Vice' President, Cigna Health and Life:lnsurance. Company (CHLIC).and Cigna Dental Health of Florida, Inc Page 4 Buyer.E-Mail Address: Buyer Facsimile: City o . r rt is .i Request for Proposals (RFP) Purchasing Department Miami Riverside Center 444 SW 2nd Avenue, 6th Floor Miami, Honda 33130 .Web Site Address: httpJ/a.miami.N.us/procurement RFP Number: 336312,1 Title: Request for Proposals for Employee Benefit Dental Plan Issue Date/Time: 16-AUG-2012 RFP Closing Date/Time: 18-SEP-2012 @ 13:00:00 Pre -Bid Conference: None. Pre -Bid Date/Time: Pre -Bid Location: Deadline for Request for Clarification: Thursday, September 6, 2012 at 5:00 P.M. Buyer: Suarez, Maritza Hard Copy Submittal:Location: City of Miami - City Clerk 3500 Pan. American Drive. Miami ..FL'33133 U.S msuarez@ci:miami:flsus (305) 400-5025 Acknowledg it of receipt of • Addenda No. 1 Signature(�f Name: _Laurie A. Flebotte Date: _`14-September-2012 Title: _VicePresident, Cigna Health and Life Insurance Company (CHLIC).and Cigna Dental Health of Florida, IncT Page.1 of 39.. Improved Oral Health. Lower Costs: City of Miami RFP No. 336312 Terms and Conditions 1. General Conditions 1.1. GENERAL TERMS AND CONDITIONS Intent: The General Terms and Conditions described herein apply to the acquisition of goods/equipment/services with an estimated aggregate cost of $25,000.00 or more. Understood. Definition: A formal solicitation is defined as issuance of an Invitation for Bids, Request for Proposals, Request for Qualifications, or Request for Letters of Interest pursuant to the City of Miami Procurement Code and/or Florida Law, as amended. Formal Solicitation and Solicitation shall be defined in the same manner herein. Agreed. 1.1. ACCEPTANCE OF GOODS OR EQUIPMENT - Any good(s) or equipment delivered under this formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with the terms herein and be fully in accordance with specifications and of the highest quality. In the event the goods/equipment supplied to the City are found to be defective or does not conform to specifications, the City reserves the right to cancel the order upon written notice to the Contractor and return the product to the Contractor at the Contractor's expense. This is inapplicable to the services contemplated by this proposal. 1.2. ACCEPTANCE OF OFFER - The signed or electronic submission of your solicitation response shall be considered an offer on the part of the bidder/proposer; such offer shall be deemed accepted upon issuance by the City of a purchase order. Agreed. 1.3. ACCEPTANCE/REJECTION - The City reserves the right to accept or reject any or all responses or parts of after opening/closing date and request re -issuance on the goods/services described in the formal solicitation. In the event of such rejection, the Director of Purchasing shall notify all affected bidders/proposers and make available a written explanation for the rejection. The City also reserves the right to reject the response of any bidder/proposer who has previously failed to properly perform under the terms and conditions of a contract, to deliver on time contracts of a similar nature, and who is not in a position to perform the requirements defined in this formal solicitation. The City further reserves the right to waive any irregularities or minor informalities or technicalities in any or all responses and may, at its discretion, re -issue this formal solicitation. Understood. Copyright 2012 Page 18 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.4. ADDENDA — It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are available at the . City's website at:, http://www.ci.miami.fl.us/procurement Agreed. 1.5. ALTERNATE RESPONSES MAY BE CONSIDERED - The City may consider one (1) alternate response from the same Bidder/Proposer for the same formal solicitation; provided, that the alternate response offers a different product that meets or exceeds the formal solicitation requirements. In order for the City to consider an alternate response, the Bidder/Proposer shall complete a separate Price Sheet form and shall mark "Alternate Response". Alternate response shall be placed in the same response. This provision only applies to formal solicitations for the procurement of goods, services, items, equipment, materials, and/or supplies. Understood. 1.6. ASSIGNMENT - Contractor agrees not to subcontract, assign, transfer, convey, sublet, or otherwise dispose of the resulting Contract, or any or all of its right, title or interest herein, without City of Miami's prior written consent. Cigna agrees not to assign this contract without prior written consent, however while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna or by vendors with a particular expertise in order to help contain costs without prior written approval for such affiliates or vendors. Every such service will be supervised by Cigna, which will be wholly .responsible and liable for the services set forth in the contract. 1.7. ATTORNEY'S FEES - In connection with any litigation, mediation and arbitration arising out of this Contract, each party shall bear their own attorney's fees through and including appellate litigation and any post -judgment proceedings. Agree. 1.8. AUDIT RIGHTS AND RECORDS RETENTION - The Successful Bidder/Proposer agrees to provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any books, documents, papers, and records of Contractor which are directly pertinent to this formal solicitation, for the purpose of audit, examination, excerpts, and transcriptions. The Successful Bidder/Proposer shall maintain and retain any and all of the books, documents, papers and records pertinent to the Contract for three (3) years after the City makes final payment and all other pending matters are closed. Contractor's failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract by the City. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries all risk associated with such processes; therefore, external audits are not permitted. Cigna has an internal claim quality assurance program to monitor internal performance Copyright 2012 Page 19 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions standards to ensure the accuracy of claims payment. However, when required by applicable state or federal law and in keeping with the standards of the industry and Cigna's standard audit and review procedures, Cigna shall cooperate with a required audit or review of applicable documents conducted by a duly authorized representative. ASO Claim audits are permitted in accordance with the following terms: Upon 45 days advance written request, documents relating only to claims administration services shall be made available to the City for its audit or inspection. The City will designate with Cigna's consent, an independent, and a third party auditor to conduct the audit. In addition, the City and Cigna will agree upon the date for the audit during regular business hours at Cigna's office(s). The City may review payment documents relating to a random, statistically valid sample of 225 claims paid. The scope of the audit may include types of claims prone to overpayments provided the types of claims prone to underpayments are equally included and will exclude electronic analysis. Any claim adjustments will be based upon the actual claims reviewed and not on statistical projections or extrapolations. Such audits shall be conducted pursuant to the terms of Cigna's Claim Audit Agreement executed by all parties. In addition, if the City has 5,000 or more employee members, the City may conduct one such audit every plan year (but not within six months of a prior audit); otherwise, the City may conduct one such audit every two plan years (but not within 18 months of a prior audit). No audit shall review claims paid more than two years before the date of the audit. The City will remain responsible for all costs associated with an audit. 1.9. AVAILABILITY OF CONTRACT STATE-WIDE - Any Governmental, not -for - profit or quasi -governmental entity in the State of Florida, may avail itself of this contract and purchase any and all goods/services, specified herein from the successful bidder(s)/proposer(s) at the contract price(s) established herein, when permissible by federal, state, and local laws, rules, and regulations. Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and resulting bid contract or agreement will establish its own contract/agreement, place its own orders, issue its own purchase orders, be invoiced there from and make its own payments, determine shipping terms and issue its own exemption certificates as required by the successful bidder(s)/proposer(s). This proposal is prepared solely and specifically for the City of Miami. If other jurisdictions request services from Cigna, we will be happy to respond to their RFP's and discuss separate agreements with them. 1.10. AWARD OF CONTRACT: A. The Formal Solicitation, Bidder's/Proposer's response, any addenda issued, and the purchase order shall constitute the entire contract, unless modified in accordance with any ensuing contract/agreement, amendment or addenda. In order to fully describe our services, Cigna will require that we incorporate the policies and certificates and current ASO agreement as applicable to be part of this Contract. Copyright 2012 Page 20 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions B. Theaward of a contractwhere there are Tie Bids will be decided by the Director of Purchasing or designee in the instance that Tie Bids can't be determined by applying Florida Statute 287.087, Preference to Businesses with Drug -Free Workplace Programs. Understood. C. The award of this contract may be preconditioned on the subsequent submission of other documents as specified in the Special Conditions or Technical Specifications. Bidder/Proposer shall be in default of its contractual obligation if such documents are not submitted in a timely manner andin the form required by the City. Where Bidder/Proposer is in default of these contractual requirements, the City, through action taken by the Purchasing Department, will void its acceptance of the Bidder's/Proposer's Response and may accept the Response from the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution from Bidder/Proposer and its bid/proposal bond or guaranty, if applicable, as a result of damages or increased costs sustained as a result of the Bidder's/Proposer's default. Understood. D. The term of the contract shall be specified in one of three documents which shall be issued to the successful Bidder/Proposer. These documents may either be a purchase order, notice of award and/or contract award sheet. Understood. E. The City reserves the right to automatically extend this contract for up to one hundred twenty (120) calendar days beyond the stated contract term in order to provide City departments with continual service and supplies while a new contract is being solicited, evaluated, and/or awarded. If the right is exercised, the City shall notify the Bidder/Proposer, in writing, of its intent to extend the contract at the same price, terms and conditions for a specific number of days. Additional extensions over the first one hundred twenty (120) day extension may occur, if, the City and the Successful Bidder/Proposer are in mutual agreement of such extensions. Agree. F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude upon completion of the expressed or implied warranty periods. This is inapplicable to the insurance services contemplated by this proposal. G. The City reserves the right to award the contract on a split -order, lump sum or individual -item basis, or such combination as shall best serve the interests of the City unless otherwise specified. This is inapplicable to the insurance services contemplated by this proposal. Copyright 2012 Page 21 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions H. A Contract/Agreement may be awarded to the Bidder/Proposer by the City Commission based upon the minimum qualification requirements reflected herein. As a result of a RFP, RFQ, or RFLI, the City reserves the right to execute or not execute, as applicable, an Agreement with the Proposer, whichever is determined to be in the City's best interests. Such agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. In order to fully describe our services, Cigna will require that we incorporate the policies and certificates and current ASO agreement as applicable to be part of this Contract. 1.11. BID BOND/ BID SECURITY -A cashier's or certified check, or a Bid Bond signed by a recognized surety company that is licensed to do business in the State of Florida, payable to the City of Miami, for the amount bid is required from all bidders/proposers, if so indicated under the Special Conditions. This check or bond guarantees that a bidder/proposer will accept the order or contract/agreement, as bid/proposed, if it is awarded to bidder/proposer. Bidder/Proposer shall forfeit bid deposit to the City should City award contract/agreement to Bidder/Proposer and Bidder/Proposer fails to accept the award. The City reserves the right to reject any and all surety tendered to the City. Bid deposits are returned to unsuccessful bidders/proposers within ten (10) days after the award and successful bidder's/proposer's acceptance of award. If sixty (60) days have passed after the date of the formal solicitation closing date, and no contract has been awarded, all bid deposits will be returned on demand. Understood. 1.12. RESPONSE FORM (HARDCOPY FORMAT) - All forms should be completed, signed and submitted accordingly. Understood. 1.13. BID SECURITY FORFEITED LIQUIDATED DAMAGES -Failure to execute an Agreement and/or file an acceptable Performance Bond, when required, as provided herein, shall be just cause for the annulment of the award and the forfeiture of the Bid Security to the City, which forfeiture shall be considered, not as a penalty, but in mitigation of damages sustained. Award may then be made to the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or all responses may be rejected. Understood. 1.14. BRAND NAMES -If and wherever in the specifications brand names, makes, models, names of any manufacturers, trade names, or bidder/proposer catalog numbers are specified, it is for the purpose of establishing the type, function, minimum standard of design, efficiency, grade or quality of goods only. When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is added. When bidding/proposing an approved equal, Bidders/Proposers will submit, with their Copyright 2012 Page 22 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions response, complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the City to evaluate and determine the equality of the item(s) bid/proposed. The City shall be the sole judge of equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be requested if the proposed brand is other than specified by the City. Such samples are to be furnished after formal solicitation opening/closing only upon request of the City. If samples should be requested, such samples must be received by the City no later than seven (7) calendar days after a formal request is made. This is inapplicable to the insurance services contemplated by this proposal. 1.15. CANCELLATION -The City reserves the right to cancel all formal solicitations before its opening/closing. In the event of bid/proposal cancellation, the Director of Purchasing shall notify all prospective bidders/proposers and make available a written explanation for the cancellation. Understood. 1.16. CAPITAL EXPENDITURES -Contractor understands that any capital expenditures that the firm makes, or prepares to make, in order to deliver/perform the goods/services required by the City, is a business risk which the contractor must assume. The City will not be obligated to reimburse amortized or unamortized capital expenditures, or to maintain the approved status of any contractor. If contractor has been unable to recoup its capital expenditures during the time it is rendering such goods/services, it shall not have any claim upon the City. Agree. 1.17. CITY NOT LIABLE FOR DELAYS -It is further expressly agreed that in no event shall the City be liable for, or responsible to, the Bidder/Proposer/Consultant, any sub-contractor/sub-consultant, or to any other person for, or on account of, any stoppages or delay in the work herein provided for by injunction or other legal or equitable proceedings or on account of any delay for any cause over which the City has no control. Agree. 1.18. COLLUSION —Bidder/Proposer, by submitting a response, certifies that its response is made without previous understanding, agreement or connection either with any person, firm or corporation submitting a response for the same items/services or with the City of Miami's Purchasing Department or initiating department. The Bidder/Proposer certifies that its response is fair, without control, collusion, fraud or other illegal action. Bidder/Proposer certifies that it is in compliance with the Conflict of Interest and Code of Ethics Laws. The City will investigate all potential situations where collusion may have occurred and the City reserves the right to reject any and all bids/responses where collusion may have occurred. Agree. Copyright 2012 Page 23 of'151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Contractor understands that contracts between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, records keeping, etc. City and Contractor agree to comply with and observe all applicable laws, codes and ordinances as that may in any way affect the goods or equipment offered, including but not limited to: A. Executive Order 11246, which prohibits discrimination against any employee, applicant, or client because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following: employment practices, rate of pay or other compensation methods, and training selection. B. Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation. C. The State of Florida Statutes, Section 287.133(3)(A) on Public Entity Crimes. D. Environment Protection Agency (EPA), as applicable to this Formal Solicitation. E. Uniform Commercial Code (Florida Statutes, Chapter 672). F. Americans with Disabilities Act of 1990, as amended. G. National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation. H. National Forest Products Association (NFPA), as applicable to this Formal Solicitation. I. City Procurement Ordinance City Code Section 18, Article III. J. Conflict of Interest, City Code Section 2-611;61. K. Cone of Silence, City Code Section 18-74. L. The Florida Statutes Sections 218.73 and 218.74 on Prompt Payment. Lack of knowledge by the bidder/proposer will in no way be a cause for relief from responsibility. Non-compliance with all local, state, and federal directives, orders, and laws may be considered grounds for termination of contract(s). Copies of the City Ordinances may be obtained from the City Clerk's Office. Agree, as applicable. Cigna has processes in place to comply with applicable federal laws, regulatory requirements, and applicable state laws to the extent they are not preempted by applicable provisions of federal laws. Copyright 2012 Page 24 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.20. CONE OF SILENCE - Pursuant to Section 18-74 of the City of Miami Code, a "Cone of Silence" is imposed upon each RFP, RFQ, RFLI, or IFB after advertisement and terminates at the time the City Manager issues a written recommendation to the Miami City Commission. The Cone of Silence shall be applicable only to Contracts for the provision of goods and services and public works or improvements for amounts greater than $200,000. The Cone of Silence prohibits any communication regarding RFPs, RFQs, RFLI or IFBs (bids) between, among others: Potential vendors, service providers, bidders, lobbyists or consultants and the City's professional staff including, but not limited to, the City Manager and the City Manager's staff; the Mayor, City Commissioners, or their respective staffs and any member of the respective selection/evaluation committee. Agree. The provision does not apply to, among other communications: oral communications with the City purchasing staff, provided the communication is limited strictly to matters of process or procedure already contained in the formal solicitation document; the provisions of the Cone of Silence do not apply to oral communications at duly noticed site visits/inspections, pre -proposal or pre -bid conferences, oral presentations before selection/evaluation committees, contract negotiations during any duly noticed public meeting, or public presentations made to the Miami City Commission during a duly noticed public meeting; or communications in writing or by email at any time with any City employee, official or member of the City Commission unless specifically prohibited by the applicable RFP, RFQ, RFLI or IFB (bid) documents (See Section 2.2. of the Special Conditions); or communications in connection with the collection of industry comments or the performance of market research regarding a particular RFP, RFQ, RFLI OR IFB by City Purchasing staff. Proposers or bidders must file a copy of any written communications with the Office of the City Clerk, which shall be made available to any person upon request. The City shall respond in writing and file a copy with the Office of the City Clerk, which shall be made available to any person upon request. Written communications may be in the form of e-mail, with a copy to the Office of the City Clerk. In addition to any other penalties provided by law, violation of the Cone of Silence by any proposer or bidder shall render any award voidable. A violation by a particular Bidder, Proposer, Offeror, Respondent, lobbyist or consultant shall subject same to potential penalties pursuant to the City Code. Any person having personal knowledge of a violation of these provisions shall report such violation to the State Attorney and/or may file a complaint with the Ethics Commission. Proposers or bidders should reference Section 18-74 of the City of Miami Code for further clarification. This language is only a summary of the key provisions of the Cone of Silence. Please review City of Miami Code Section 18-74 for a complete and thorough description of the Cone of Silence. You may contact the City Clerk at 305-250-5360, to obtain a copy of same. Copyright 2012 Page 25 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Agree. 1.21. CONFIDENTIALITY - As a political subdivision, the City of Miami is subject to the Florida Sunshine Act and Public Records Law. If this Contract/Agreement contains a confidentiality provision, it shall have no application when disclosure is required by Florida law or upon court order. Understood. 1.22. CONFLICT OF INTEREST — Bidders/Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed officialor employee of the City of Miami is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm. Agree. A. Bidder/Proposer further agrees not to use or attempt to use any knowledge, property or resource which may be within his/her/its trust, or perform his/her/its duties, to secure a special privilege, benefit, or exemption for himself/herself/itself, or others. Bidder/Proposer may not disclose or use information not available to members of the general public and gained by reason of his/her/its position, except for information relating exclusively to governmental practices, for his/her/its personal gain or benefit or for the personal gain or benefit of any other person or business entity. Agree. B. Bidder/Proposer hereby acknowledges that he/she/it has, not contracted or transacted any business with the City or any person or agency acting for the City, and has not appeared in representation of any third party before any board, commission or agency of the City within the past two years. Bidder/Proposer further warrants that he/she/it is not related, specifically the spouse, son, daughter, parent, brother or sister, to: (i) any member of the commission; (ii) the mayor; (iii) any city employee; or (iv) any member of any board or agency of the City. Agree. C. A violation of this section may subject the Bidder/Proposer to immediate termination of any professional services agreement with the City, imposition of the maximum fine and/or any penalties allowed by law. Additionally, violations may be considered by and subject to action by the Miami -Dade County Commission on Ethics. Understood. Copyright 2012 Page 26 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.23. COPYRIGHT OR PATENT RIGHTS — Bidders/Proposers warrant that there has been no violation of copyright or patent rights in manufacturing, producing, or selling the goods shipped or ordered and/or services provided as a result of this formal solicitation, and bidders/proposers agree to hold the City harmless from any and all liability, loss, or expense occasioned by any such violation. Agree. 1.24. COST INCURRED BY BIDDER/PROPOSER - All expenses involved with the preparation and submission of Responses to the City, or any work performed in connection therewith shall be borne by the Bidder(s)/Proposer(s). Understood. 1.25. DEBARMENT AND SUSPENSIONS (Sec 18-107) (a) Authority and requirement to debar and suspend. After reasonable notice to an actual or prospective Contractual Party, and after reasonable opportunity for such party to be heard, the City Manager, after consultation with the Chief Procurement Officer and the city attorney, shall have the authority to debar a Contractual Party, for the causes listed below, from consideration for award of city Contracts. The debarment shall be for a period of not fewer than three years. The City Manager shall also have the authority to suspend a Contractual Party from consideration for award of city Contracts if there is probable cause for debarment, pending the debarment determination. The authority to debar and suspend contractors shall be exercised in accordance with regulations which shall be issued by the Chief Procurement Officer after approval by the City Manager, the city attorney, and the City Commission. Agree. (b) Causes for debarment or suspension. Causes for debarment or suspension include the following: (1) Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public or private Contract or subcontract, or incident to the performance of such Contract or subcontract. (2) Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property, or any other offense indicating a lack of business integrity or business honesty. (3) Conviction under state or federal antitrust statutes arising out of the submission of Bids or Proposals. (4) Violation of Contract provisions, which is regarded by the Chief Procurement Officer to be indicative of nonresponsibility. Such violation may include failure without good cause to perform in accordance with the terms and conditions of a Contract or to perform within the time limits provided in a Copyright 2012 Page 27 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Contract,provided that failure to perform caused by acts beyond the control of a party shall not be considered a basis for debarment or suspension. (5) Debarment or suspension of the Contractual Party by any federal, state or other governmental entity. (6) False certification pursuant to paragraph (c) below. (7) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which the violation remains noncompliant. (8) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which a civil penalty or fine is due and owing to the city. (9) Any other cause judged by the City Manager to be so serious and compelling as to affect the responsibility of the Contractual Party performing city Contracts. Agree. (c) Certification. All Contracts for goods and services, sales, and leases by the city shall contain a certification that neither the Contractual Party nor any of its principal owners or personnel have been convicted of any of the violations set forth above or debarred or suspended as set forth in paragraph (b)(5). Agree. (d) Debarment and suspension decisions. Subject to the provisions of paragraph (a), the City Manager shall render a written decision stating the reasons for the debarment or suspension. A copy of the decision shall be provided promptly to the Contractual Party, along with a notice of said party's right to seek judicial relief. Agree. 1.26. DEBARRED/SUSPENDED VENDORS —An entity or affiliate who has been placed on the State of Florida debarred or suspended vendor list may not submit a response on a contract to provide goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit response on leases of real property to a public entity, may not award or perform work as a contractor, supplier, subcontractor, or consultant under contract with any public entity, and may not transact business with any public entity. Agree. 1.27. DEFAULT/FAILURE TO PERFORM -The City shall be the sole judge of nonperformance, which shall include any failure on the part of the successful Copyright 2012 Page 28 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Bidder/Proposer to accept the award, .to furnish required documents, and/or to fulfill any portion of this contract within the time stipulated. Understood. Upon default by the successful Bidder/Proposer to meet any terms of this agreement, the City will notify the Bidder/Proposer of the default and will provide the contractor three (3) days (weekends and holidays excluded) to remedy the default. Failure on the contractor's part to correct the default within the required three (3) days shall result in the Contract being terminated and upon the City notifying in writing the contractor of its intentions and the effective date of the termination. The following shall constitute default: A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the time required or failing to use the subcontractors, entities and personnel as identified and set forth, and to the degree specified in the Contract. B. Failure to begin the work under this Contract within the time specified. C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to ensure timely completion. D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as nonconforming with the terms of the Contract. E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the successful Bidder/Proposer incapable of performing the work in accordance with and as required by the Contract. F. Failure to comply with any of the terms of the Contract in any material respect. All costs and charges incurred by the City as a result of a default or a default incurred beyond the time limits stated, together with the cost of completing the work, shall be deducted from any monies due or which may become due on this Contract. Agree. 1.28. DETERMIINATION OF RESPONSIVENESS -Each Response will be reviewed to determine if it is responsive to the submission requirements outlined in the Formal Solicitation. A "responsive" response is one which follows the requirements of the formal solicitation, includes all documentation, is submitted in the format outlined in the formal solicitation, is of timely submission, and has appropriate signatures as required on each document. Failure to comply with these requirements may deem a Response non -responsive. Understood. Copyright 2012 Page 29 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.29. DISCOUNTS OFFERED DURING TERM OF CONTRACT -Discount Prices offered in the response shall be fixed after the award by the Commission, unless otherwise specified in the Special Terms and Conditions. Price discounts off the original prices quoted in the response will be accepted from successful Bidder(s)/Proposer(s) during the term of the contract. Such discounts shall remain in effect for a minimum of 120 days from approval by the City Commission Any discounts offered by a manufacturer to Bidder/Proposer will be passed on to the City. Understood. 1.30. DISCREPANCIES, ERRORS, AND OMISSIONS -Any discrepancies, errors, or ambiguities in the Formal Solicitation or addenda (if any) should be reported in writing to the City's Purchasing Department. Should it be found necessary, a written addendum will be incorporated in the Formal Solicitation and will become part of the purchase agreement (contract documents). The City will not be responsible for any oral instructions, clarifications, or other communications. A. Order of Precedence — Any inconsistency in this formal solicitation shall be resolved by giving precedence to the following documents, the first of such list being the governing documents. 1) Addenda (as applicable) 2) Specifications 3) Special Conditions 4) General Terms and Conditions Agree. 1.31. EMERGENCY / DISASTER PERFORMANCE -In the event of a hurricane or other emergency or disaster situation, the successful vendor shall provide the City with the commodities/services defined within the scope of this formal solicitation at the price contained within vendor's response. Further, successful vendor shall deliver/perform for the city on a priority basis during such times of emergency. Agree. 1.32. ENTIRE BID CONTRACT OR AGREEMENT -The Bid Contract or Agreement consists of this City of Miami Formal Solicitation and specifically this General Conditions Section, Contractor's Response and any written agreement entered into by the City of Miami and Contractor in cases involving RFPs, RFQs, and RFLIs, and represents the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes all other negotiations, understanding and representations, if any, made by and between the parties. To the extent that the agreement conflicts with, modifies; alters or changes any of the terms and conditions contained in the Formal Solicitation and/or Response, the Formal Copyright 2012 Page 30 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Solicitation and then the Response shall control. This Contract may be modified only by a written agreement signed by the City of Miami and Contractor. To the extent that the responses in this RFP are mutually agreed upon, Cigna agrees to be bound by that language. In order to define the relationship, Cigna will require that our policy and ASO agreement be made part of this Contract. Cigna agrees to continue to operate under the existing ASO agreement and will agree to negotiate any additional provision if requested by the City of Miami. In the case of a fully insured arrangement, because the insurance policy and certificate are filed documents, there is very little flexibility to change the provisions and our policy must be used. As such, any conflict between the terms of the Contract and the insurance policy or ASO Agreement, the terms of the insurance policy and ASO Agreement shall govern. 1.33. ESTIMATED QUANTITIES —Estimated quantities or estimated dollars are provided for your guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the contract period. The City is not obligated to place an order for any given amount subsequent to the award of this contract. Said estimates may be used by the City for purposes of determining the low bidder or most advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities at the prices bid/proposed or at lower prices in this Formal Solicitation. This is inapplicable to the insurance services contemplated by this proposal. 1.34. EVALUATION OF RESPONSES A. Rejection of Responses The City may reject a Response for any of the following reasons: 1) Bidder/Proposer fails to acknowledge receipt of addenda; 2) Bidder/Proposer mistates or conceals any material fact in the Response;. 3) Response does not conform to the requirements of the Formal Solicitation; 4) Response requires a conditional award that conflicts with the method of award; 5) Response does not include required samples, certificates, licenses as required; and, 6) Response was not executed by the Bidder's/Proposer(s) authorized agent. The foregoing is not an all inclusive list of reasons for which a Response may be rejected. The City may reject and re -advertise for all or any part of the Formal Solicitation whenever it is deemed in the best interest of the City. Understood. B. Elimination From Consideration Copyright 2012 Page 31 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1) A contract shall not be awarded to any person or firm which is in arrears to the City upon any debt or contract, or which is a defaulter as surety or otherwise upon any obligation to the City. 2) A contract may not be awarded to any person or firm which has failed to perform under the terms and conditions of any previous contract with the City or deliver on time contracts of a similar nature. 3) A contract may not be awarded to any person or firm which has been debarred by the City in accordance with the City's Debarment and Suspension Ordinance. Understood. C. Determination of Responsibility 1) Responses will only be considered from entities who are regularly engaged in the business of providing the goods/equipment/services required by the Formal Solicitation. Bidder/Proposer must be able to demonstrate a satisfactory record of performance and integrity; and, have sufficient financial, material, equipment, facility, personnel resources, and expertise to meet all contractual requirements. The terms "equipment and organization" as used herein shall be construed to mean a fully equipped and well established entity in line with the best industry practices in the industry as determined by the City. DHMO We have specialized in dental program management since 1974, when Florida granted Dental Health, Inc. a Certificate of Authority to provide managed dental care. In 1984, Dental Health, Inc. became a subsidiary of Cigna Corporation, marking the first entry of a major national insurance organization into the managed dental care field. DPPO The DPPO plan coverage was introduced in July 1996. 2) The City may consider any evidence available regarding the financial, technical and other qualifications and abilities of a Bidder/Proposer, including past performance (experience) with the City or any other governmental entity in making the award. Cigna has been offering health plans to America's local governments and school districts for more than half a century. Incorporating this experience with new research, Cigna has been able to develop programs focused on generating results by improving health. Our innovative approach to improving health across the employee population saves the community money now and in the future. By creating meaningful value, local governments and school districts help stretch the community's budget to maintain, and even increase, the services the community needs and wants. Copyright 2012 Page 32 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 3) The City may require the Bidder(s)/Proposer(s) to show proof that they have been designated as an authorized representative of a manufacturer or supplier which is the actual source of supply, if required by the Formal Solicitation. Understood. 1.35. EXCEPTIONS TO GENERAL AND/OR SPECIAL CONDITIONS OR SPECIFICATIONS Exceptions to the specifications shall be listed on the Response and shall reference the section. Any exceptions to the General or Special Conditions shall be cause for the bid (IFB) to be considered non -responsive. It also maybe cause for a RFP, RFQ, or RFLI to be considered non -responsive; and, if exceptions are taken to the terms and conditions of the resulting agreement it may lead to terminating negotiations. Understood. 1.36. F.O.B. DESTINATION -Unless otherwise specified in the Formal Solicitation, all prices quoted/proposed by the bidder/proposer must be F.O.B. DESTINATION, inside delivery, with all delivery costs and charges included in the bid/proposal price, unless otherwise specified in this Formal Solicitation. Failure to do so may be cause for rejection of bid/proposal. This is inapplicable to the insurance services contemplated by this proposal. 1.37. FIRM PRICES - The bidder/proposer warrants that prices, terms, and conditions quoted in its response will be firm throughout the duration of the contract unless otherwise specified in the Formal Solicitation. Such prices will remain firm for the period of performance or resulting purchase orders or contracts, which are to be performed or supplied over a period of time. Confirmed. 1.38. FLORIDA MINIMUM WAGE -The Constitution of the State of Florida, Article X, Section 24, states that employers shall pay employee wages no less than the minimum wage for all hours worked in Florida. Accordingly, it is the contractor's and its' subcontractor(s) responsibility to understand and comply with this Florida constitutional minimum wage requirement and pay its employees the current established hourly minimum wage rate, which is subject to change or adjusted by the rate of inflation using the consumer price index for urban wage earners and clerical workers, CPI-W, or a successor index as calculated by the United States Department of Labor. Each adjusted minimum wage rate calculated shall be determined and published by the Agency Workforce Innovation on September 30th of each year and take effect on the following January lst. While we do not confirm compliance with any municipal living wage ordinance(s), we do offer fair and reasonable total compensation and benefits to our employees including offering health benefits to all of our regular employees and their dependents. Copyright 2012 Page 33 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions At the time of responding, it is _ bidder/proposer and his/her subcontractor(s), if applicable, full responsibility to determine whether any of its employees may be impacted by this Florida Law at any given point in time during the term of the contract. If impacted, bidder/proposer must furnish employee name(s), job title(s), job description(s), and current pay rate(s). Failure to submit this information at the time of submitting a response constitute successful bidder's/proposer's acknowledgement and understanding that the Florida Minimum Wage Law will not impact its prices throughout the term of contract and waiver of any contractual price increase request(s). The City reserves the right to request and successful bidder/proposer must provide for any and all information to make a wage and contractual price increase(s) determination. Understood. 1.39. GOVERNING LAW AND VENUE -The validity and effect of this Contract shall be governed by the laws of the State of Florida. The parties agree that any action, mediation or arbitration arising out of this Contract shall take place in Miami -Dade County, Florida. Agree. 1.40. HEADINGS AND TERMS -The headings to the various paragraphs of this Contract have been inserted for convenient reference only and shall not in any manner be construed as modifying, amending or affecting in any way the expressed terms and provisions hereof. Agree. 1.41. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) - Any person or entity that performs orassists the City of Miami with a function or activity involving the use or disclosure of "individually identifiable health information (11111) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the City of Miami Privacy Standards. HIPAA mandates for privacy, security and electronic transfer standards, which include but are not limited to: A. Use of information only for performing services required by the contract or as required by law; Agree. B. Use of appropriate safeguards to prevent non -permitted disclosures; Agree. C. Reporting to the City of Miami of any non -permitted use or disclosure; Agree. Copyright 2012 Page 34 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions D. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to the Bidder/Proposer and reasonable assurances that IIHI/PHI will be held confidential; Agree. E. Making Protected Health Information (PHI) available to the customer; Agree. F. Making PHI available to the customer for review and amendment; and incorporating any amendments requested by the customer; Agree. G. Making PHI available to the City of Miami for an accounting of disclosures; and H. Making internal practices, books and records related to PHI available to the City of Miami for compliance audits. Cigna cannot agree to a HIPAA privacy audit but would provide access to our privacy policies and procedures, a description of our privacy program and the applicable notice of privacy practices during an agreed upon onsite audit. Cigna can agree to an onsite security audit, however, dates and other factors need to be agreed upon by both parties. Cigna will select the person within our company to conduct the onsite visit. In addition, certain information may be considered restricted and cannot be shared externally. In those situations, we will work with other ways of getting the information you need without divulging restricted information. PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its privacy information practices including specifically, a description of the types of uses and disclosures that would be made with protected health information. Agree. This information is available on our website. Under a self insured arrangement, HIPAA requires the Plan Sponsor to provide their own privacy practices to their customers. 1.42 INDEMNIFICATION -Contractor shall indemnify , hold harmless and defend the City, its officials, officers, agents, directors, and employees, from liabilities, damages, losses, and costs, including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance of this Contract and will indemnify, hold harmless and defend the City, its officials, officers, agents, directors and employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought against City by reason of any such claim or demand, Contractor shall, upon written Copyright 2012 Page 35 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions notice from City, resist and defend such action or proceeding by counsel satisfactory to City. The Contractor expressly understands and agrees that any insurance protection required by this Contract or otherwise provided by Contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. Fully Insured Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the terms and conditions of the policy where such failure is not due to any action or inaction by the .City of Miami, its officers, directors, agents and/or employees. ASO Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the Cityharmless from and against extra -contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City's plan. Additionally, the City is responsible for defending against any legal action or proceeding brought to recover a claim for Plan benefits. The City may request, and a business decision may be made by Cigna, to provide claims litigation services in which Cigna is also responsible for handling all lawsuits alleging denial of benefits under the terms of the Plan. Our fee structure would be altered to reflect our assumption of additional risk and administrative responsibility. The indemnification provided above shall obligate Contractor to defend at its own expense to and through appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at City's option, any and all claims of liability and all suits and actions of every name and description which may be brought against City whether performed by Contractor, or persons employed or utilized by Contractor. The City is responsible for defending against any legal action or proceeding brought to recover a claim for Plan benefits. The City may request, and a business decision may be made by Cigna, to provide claims litigation services in which Cigna is also responsible for handling all lawsuits alleging denial of benefits under the terms of the Plan. Our fee structure would be altered to reflect our assumption of additional risk and administrative responsibility. This indemnity will survive the cancellation or expiration of the Contract. This indemnity will be interpreted under the laws of the State of Florida, including without Copyright 2012 Page 36 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions limitation and which conforms to the limitations of §725.06 and/or §725.08, Fla. Statues, as amended from time to time as applicable. Agree as applicable. Contractor shall require all Sub -Contractor agreements to include a provision that they will indemnify the City. The Contractor agrees and recognizes that the City shall not be held liable or responsible for any claims which may result from any actions or omissions of the Contractor in which the City participated either through review or concurrence of the Contractor's actions. In reviewing, approving or rejecting any submissions by the Contractor or other acts of the Contractor, the City in no way assumes or shares any responsibility or liability of the Contractor or Sub -Contractor, under this Agreement. Our subcontracted arrangements are in place to service our entire book of business and have not been specifically contracted to service this RFP arrangement. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami, notwithstanding that certain services may be performed in part by vendors with particular expertise or by affiliates of Cigna in order to help. contain costs and to make use of the their expertise. All such services will be performed with oversight from Cigna. 1.43. FORMATION AND DESCRIPTIVE LITERATURE —Bidders/Proposer must furnish all information requested in the spaces provided in the Formal Solicitation. Further, as may be specified elsewhere, each Bidder/Proposer must submit for evaluation, cuts, sketches, descriptive literature, technical specifications, and Material Safety Data Sheets (MSDS) as required, covering the products offered. Reference to literature submitted with a previous response or on file with the Buyer will not satisfy this provision. Understood. 1.44. INSPECTIONS -The City may, at reasonable times during the term hereof, inspect Contractor's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods and/or services required to be provided by the Contractor under this Contract conform to the terms and conditions of the Formal Solicitation. Contractor shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of the City of Miami Ordinance No. 12271 (Section 18-79), as same may be amended or supplemented from time to time. Agree. Cigna will be happy to arrange visits to certain facilities at mutually agreeable times. Cigna will give the employer reasonable access to claim records and data, subject to Cigna's standard confidentiality procedures and guidelines, and to a claim audit agreement or a confidentiality and indemnification agreement in a form acceptable to Cigna. Cigna will not agree to give the client the right to inspect written records, including telephone transcripts of member telephone calls. Those records and transcripts are considered highly Copyright 2012 Page 37 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions confidential, and protected by the member's privacy rights: Cigna would only agree to this request from a client if the member in question has provided Cigna with a written statement permitting the release of these records and transcripts. 1.45., INSPECTION OF RESPONSE -Responses received by the City pursuant to a Formal Solicitation will not be made available until such time as the City provides notice of a decision or intended decision or within 30 days after bid closing, whichever is earlier. Bid/Proposal results will be tabulated and may be furnished upon request via fax or e-mail to the Sr. Procurement Specialist issuing the Solicitation. Tabulations also are available on the City's Web Site following recommendation for award. Understood. 1.46. INSURANCE -Within ten (10) days after receipt of Notice of Award, the successful Contractor, shall furnish Evidence of Insurance to the Purchasing Department, if applicable. Submitted evidence of coverage shall demonstrate strict compliance to all requirements listed on the Special Conditions entitled "Insurance Requirements". The City shall be listed as an "Additional Insured." Agree. The following insurance policies contain a "blanket additional insured" provision, where required by written contract. Cigna will add the City of Miami as additional insured on these policies on a blanket basis: 4. commercial general liability 5. automobile liability (commercial or business auto liability) 6. umbrella / excess liability .(excess only to general and auto liability) In accordance with standard and customary insurance industry practices coupled with the insurance marketplace, Cigna is unable to grant additional insured status on any other insurance policies. Issuance of a Purchase Order is contingent upon the receipt of proper insurance documents. If the insurance certificate is received within the specified time frame but not in the manner prescribed in this Solicitation the Contractor shall be verbally notified of such deficiency and shall have an additional five (5) calendar days to submit a corrected certificate to the City. If the Contractor fails to submit the required insurance documents in the manner prescribed in this Solicitation within fifteen (15) calendar days after receipt Notice of Award, the contractor shall be in default of the contractual terms and conditions and shall not be awarded the contract. Under such circumstances, the Bidder/Proposer may be prohibited from submitting future responses to the City. Information regarding any insurance requirements shall be directed to the Risk Administrator, Department of Risk Management, at 444 SW 2nd Avenue, 9th Floor, Miami, Florida 33130, 305-416-1604. Agree. Copyright 2012 Page 38 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions The Bidder/Proposer shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in effect for the duration of the contractual period; including any and all option terms that may be granted to the Bidder/Proposer. Agree. 1.47. INVOICES -Invoices shall contain purchase order number and details of goods and/or services delivered (i.e. quantity, unit price, extended price, etc); and in compliance with Chapter 218 of the Florida Statutes (Prompt Payment Act). Understood. We do not use a purchase order number but we will supply an account number. 1.48. LOCAL PREFERENCE A. City Code Section 18-85, states, "when a responsive, responsible non -local bidder submits the lowest bid price, and the bid submitted by one or more responsive, responsible local bidders who maintain a local office, as defined in Section 18-73, is within fifteen percent (15%) of the price submitted by the non -local bidder, then that non -local bidder and each of the aforementioned responsive, responsible local bidders shall have the opportunity to submit a best and final bid equal to or lower than the amount of the low bid previously submitted by the non -local bidder. Contract award shall be made to the lowest responsive, responsible bidder submitting the lowest best and final bid. In the case of a tie in the best and final bid between a local bidder and a non -local bidder, contract award shall be made to the local bidder." Understood. B. City Code Section 18-86, states, "the RFP, RFLI or RFQ, as applicable, may, in the exercise of the reasonable professional discretion of the City Manager, directorof the using agency, and the Chief Procurement Officer, include a five (5%) percent evaluation criterion in favor of proposers who maintain a local office, as defined in Section 18-73. In such cases, this five (5%) percent evaluation criterion in favor of proposers who maintain a local office will be specifically defined in the RFP, RFLI or RFQ, as applicable; otherwise, it will not apply. Understood. 1.49. MANUFACTURER'S CERTIFICATION -The City reserves the right to request from bidders/proposers a separate Manufacturer's Certification of all statements made in the bid/proposal. Failure to provide such certification may result in the rejection of bid/proposal or termination of contract/agreement, for which the bidder/proposer must bear full liability. This is inapplicable to the insurance services contemplated by this proposal. 1.50. MODIFICATIONS OR CHANGES IN PURCHASE ORDERS AND CONTRACTS -No contract or understanding to modify this Formal Solicitation and resultant purchase orders or contracts, if applicable, shall be binding upon the Copyright 2012 Page 39 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions City unless made in writing by the Director of Purchasing of the City of Miami, Florida through the issuance of a change order, addendum, amendment, or supplement to the contract, purchase order or award sheet as appropriate. Agree. 1.51. NO PARTNERSHIP OR JOINT VENTURE -Nothing contained in this Contract will be deemed or construed to create a partnership or joint venture between the City of Miami and Contractor, or to create any other similar relationship between the parties. Agree. 1.52. NONCONFORMANCE TO CONTRACT CONDITIONS -Items may be tested for compliance with specifications under the direction of the Florida Department of Agriculture and Consumer Services or by other appropriate testing Laboratories as determined by the City. The data derived from any test for compliance with specifications is public record and open to examination thereto in accordance with Chapter 119, Florida Statutes. Items delivered not conforming to specifications may be rejected and returned at Bidder's/Proposer's expense. These non -conforming items not delivered as per delivery date in the response and/or Purchase Order may result in bidder/proposer being found in default in which event any and all re -procurement costs may be charged against the defaulted contractor. Any violation of these stipulations may also result in the supplier's name being removed from the City of Miami's Supplier's list. This is inapplicable to the insurance services contemplated by this proposal. 1.53. NONDISCRIMINATION —Bidder/Proposer agrees that it shall not discriminate as to race, sex, color, age, religion, national origin, marital status, or disability in connection with its performance under this formal solicitation. Furthermore, Bidder/Proposer agrees that no otherwise qualified individual shall solely by reason of his/her race, sex, color, age, religion, national origin, marital status or disability be excluded from the participation in, be denied benefits of, or be subjected to, discrimination under any program or activity. In connection with the conduct of its business, including performance of services and employment of personnel, Bidder/Proposer shall not discriminate against any person on the basis of race, color, religion, disability, age, sex, marital status or national origin. All persons having appropriate qualifications shall be afforded equal opportunity for employment. Agree. 1.54. NON-EXCLUSIVE CONTRACT/ PIGGYBACK PROVISION -At such times as may serve its best interest, the City of Miami reserves the right to advertise for, receive, and award additional contracts for these herein goods and/or services, and to make use of other competitively bid (governmental) contracts, agreements, or other similar sources for the purchase of these goods and/or services as may be available. Copyright 2012 Page 40 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions It is hereby agreed and understood that this formal solicitation does not constitute the exclusive rights of the successful bidder(s)/proposer(s) to receive all orders that may be generated by the City in conjunction with this Formal Solicitation. In addition, any and all commodities, equipment, and services required by the City in conjunction with construction projects are solicited under a distinctly different solicitation process and shall not be purchased under the terms, conditions and awards rendered under this solicitation, unless such purchases are determined to be in the best interest of the City. Agree. 1.55. OCCUPATIONAL LICENSE -Any person, firm, corporation or joint venture, with a business location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of Miami Charter. Others with a location outside the City of Miami shall meet their local Occupational License Tax requirements. A copy of the license must be submitted with the response; however, the City may at its sole option and in its best interest allow the Bidder/Proposer to supply the license to the City during the evaluation period, but prior to award. Cigna has attached an occupational license and business tax receipt electronically for this proposal submission. 1.56. ONE PROPOSAL -Only one (1) Response from an individual, firm, partnership, corporation or joint venture will be considered in response to this Formal Solicitation. When submitting an alternate response, please refer to the herein condition for "Alternate Responses May Be Considered". Understood. 1.57. OWNERSHIP OF DOCUMENTS -It is understood by and between the parties that any documents, records, files, or any other matter whatsoever which is given by the City to the successful Bidder/Proposer pursuant to this formal solicitation shall at all times remain the property of the City and shall not be used by the Bidder/Proposer for any other purposes whatsoever without the written consent of the City. Cigna agrees the proposal shall be the property of the City of Miami however; Cigna is providing this information with the understanding that it will not be used by the City of Miami, its representatives, or consultants for any purpose other than the evaluation of Cigna in connection with the services sought by the City of Miami. However, the City of Miami will not have an ownership interest in any claim or payment data recorded or otherwise integrated into Cigna's data processing systems during the ordinary course of business or, any information which Cigna reasonably deems to be proprietary. 1.58. PARTIAL INVALIDITY -If any provision of this Contract or the application thereof to any person or circumstance shall to any extent be held invalid, then the remainder of this Contract or the application of such provision to persons or Copyright 2012 Page 41 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions circumstances other than those as to which it is held invalid shall not be affected thereby, and each provision of this Contract shall be valid and enforced to the fullest extent permitted by law. Agree. 1.59. PERFORMANCE/PAYMENT BOND —A Contractor may be required to furnish a Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred percent (100%) of the contract price. This is inapplicable to the insurance services contemplated by this proposal. 1.60. PREPARATION OF RESPONSES (HARDCOPY FORMAT) —Bidders/Proposers are expected to examine the specifications, required delivery, drawings, and all special and general conditions. All bid/proposed amounts, if required, shall be either typewritten or entered into the space provided with ink. Failure to do so will be at the Bidder's/Proposer's risk. Understood. A. Each Bidder/Proposer shall furnish the information required in the Formal Solicitation. The Bidder/Proposer shall sign the Response and print in ink or type the name of the Bidder/Proposer, address, and telephone number on the face page and on each continuation sheet thereof on which he/she makes an entry, as required. Understood. B. If so required, the unit price for each unit offered shall be shown, and such price shall include packaging, handling and shipping, and F.O.B. Miami delivery inside City premises unless otherwise specified. Bidder/Proposer shall include in the response all taxes, insurance, social security, workmen's compensation, and any other benefits normally paid by the Bidder/Proposer to its employees. If applicable, a unit price shall be entered in the "Unit Price" column for each item. Based upon estimated quantity, an extended price shall be entered in the "Extended Price" column for each item offered. In case of a discrepancy between the unit price and extended price, the unit price will be presumed correct. Understood. C. The Bidder/Proposer must state a definite time, if required, in calendar days for delivery of goods and/or services. Understood. D. The Bidder/Proposer should retain a copy of all response documents for future reference. Understood. Copyright 2012 Page 42 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions E. All responses, as described, must be fully completed and typed or printed in ink and must be signed in ink with the firm's name and by an officer or employee having authority to bind the company or firm by his/her signature. Bids/Proposals having any erasures or corrections must be initialed in ink by person signing the response or the response may be rejected. Understood. F. Responses are to remain valid for at least 180 days. Upon award of a contract, the content of the Successful Bidder's/Proposer's response may be included as part of the contract, at the City's discretion. Understood. G. The City of Miami's Response Forms shall be used when Bidder/Proposer is submitting its response in hardcopy format. Use of any other forms will result in the rejection of the response. IF SUBMITTING HARDCOPY FORMAT, THE ORIGINAL AND THREE (3) COPIES OF THESE SETS OF FORMS, UNLESS OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE RETURNED TO THE CITY OR YOUR RESPONSE MAY BE DEEMED NON -RESPONSIVE. Understood. 1.61. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by reason of market change or on the part of the contractor to other customers shall be passed on to the City of Miami. Not applicable. 1.62. PRODUCT SUBSTITUTES -In the event a particular awarded and approved manufacturer's product becomes unavailable during the term of the Contract, the Contractor awarded that item may arrange with the City's authorized representative(s) to supply a substitute product at the awarded price or lower, provided that a sample is approved in advance of delivery and that the new product meets or exceeds all quality requirements. Understood. 1.63. CONFLICT OF INTEREST, AND UNETHICAL BUSINESS PRACTICE PROHIBITIONS Contractor represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Contract and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Contract. Confirmed. Copyright 2012 Page 43 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.64. PROMPT PAYMENT —Bidders/Proposers may offer a cash discount for prompt payment; however, discounts shall not be considered in determining the lowest net cost for response evaluation purposes. Not applicable. Bidders/Proposers are required to provide their prompt payment terms in the space provided on the Formal Solicitation. If no prompt payment discount is being offered, the Bidder/Proposer must enter zero (0) for the percentage discount to indicate no discount. If the Bidder/Proposer fails to enter a percentage, it is understood and agreed that the terms shall be 2% 20 days, effective after receipt of invoice or final acceptance by the City, whichever is later. Not applicable. When the City is entitled to a cash discount, the period of computation will commence on the date of delivery, or receipt of a correctly completed invoice, whichever is later. If an adjustment in payment is necessary due to damage, the cash discount period shall commence on the date final approval for payment is authorized. If a discount is part of the contract, but the invoice does not reflect the existence of a cash discount, the City is entitled to a cash discount with the period commencing on the date it is determined by the City that a cash discount applies. Not applicable. Price discounts off the original prices quoted on the Price Sheet will be accepted from successful bidders/proposers during the term of the contract. Not applicable. 1.65. PROPERTY -Property owned by the City of Miami is the responsibility of the City of Miami. Such property furnished to a Contractor for repair, modification, study, etc., shall remain the property of the City of Miami. Damages to such property occurring while in the possession of the Contractor shall be the responsibility of the Contractor. Damages occurring to such property while in route to the City of Miami shall be the responsibility of the Contractor. In the event that such property is destroyed or declared a total loss, the Contractor shall be responsible for replacement value of the property at the current market value, less depreciation of the property, if any. This is inapplicable to the services contemplated by this proposal. 1.66. PROVISIONS BINDING -Except as otherwise expressly provided in the resulting Contract, all covenants, conditions and provisions of the resulting Contract shall be binding upon and shall inure to the benefit of the parties hereto and their respective heirs, legal representatives, successors and assigns. Agree. Copyright 2012 Page 44 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 1.67. PUBLIC ENTITY CRIMES -A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a response on a contract to provide any goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit responses on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. Understood. 1.68. PUBLIC RECORDS -Contractor understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City contracts, subject to the provisions of Chapter 119, Florida Statutes, and City of Miami Code, Section 18, Article III, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable law. Contractor's failure or refusal to comply with the provision of this section shall result in the immediate cancellation of this Contract by the City. Understood. 1.69. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All materials used in the manufacturing or construction of supplies, materials, or equipment covered by this solicitation shall be new. The items bid/proposed must be of the latest make or model, of the best quality, and of the highest grade of workmanship, unless as otherwise specified in this Solicitation. This is inapplicable to the services contemplated by this proposal. 1.70. QUALITY OF WORK/SERVICES - The work/services performed must be of the highest quality and workmanship. Materials furnished to complete the service shall be new and of the highest quality except as otherwise specified in this Solicitation. Understood. 1.71. REMEDIES PRIOR TO AWARD (Sec. 18-106) - If prior to Contract award it is determined that a formal solicitation or proposed award is in violation of law, then the solicitation or proposed award shall be cancelled by the City Commission, the City Manager or the Chief Procurement Officer, as may be applicable, or revised to comply with the law. Agree. 1.72. RESOLUTION OF CONTRACT DISPUTES (Sec. 18-105) Copyright 2012 Page 45 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions (a) Authority to resolve Contract disputes. The City Manager, after obtaining the approval of the city attorney, shall have the authority to resolve controversies between the Contractual Party and the city which arise under, or by virtue of, a Contract between them; provided that, in cases involving an amount greater than $25,000, the City Commission must approve the City Manager's decision. Such authority extends, without limitation, to controversies based upon breach of Contract, mistake, misrepresentation or lack of complete performance, and shall be invoked by a Contractual Party by submission of a protest to the City Manager. Agree. (b) Contract dispute decisions. If a dispute is not resolved by mutual consent, the City Manager shall promptly render a written report stating the reasons for the action taken by the City Commission or the City Manager which shall be final and conclusive. A copy of the decision shall be immediately provided to the protesting party, along with a notice of such party's right to seek judicial relief, provided that the protesting party shall not be entitled to such judicial relief without first having followed the procedure set forth in this section. Agree. 1.73. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (Sec. 18- 104) (a) Right to protest. The following procedures shall be used for resolution of protested solicitations and awards except for purchases of goods, supplies, equipment, and services, the estimated cost of which does not exceed $25,000. Agree. Protests thereon shall be governed by the Administrative Policies and Procedures of Purchasing. Agree. 1. Protest of Solicitation. i. Any prospective proposer 'who perceives itself aggrieved in connection with the solicitation of a Contract may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the Request for Proposals, Request for Qualifications or Request for Letters of Interest is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer; or Agree. ii. Any prospective bidder who intends to contest the Solicitation Specifications or a solicitation may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after Copyright 2012 Page 46 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions the solicitation is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. Agree. 2. Protest of Award. i. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the proposer of the notice of the City Manager's recommendation for award of Contract, which will be posted on the City of Miami Purchasing Department website, in the Supplier Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. It shall be the responsibility of the Bidder/Proposer to check this section of the website daily after responses are submitted to receive the notice; or Agree. ii. Any actual Responsive and Responsible Bidder whose Bid is lower than that of the recommended bidder may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the bidder of the notice of the city's determination of non responsiveness or non responsibility. The receipt by bidder of such notice shall be confirmed by the city by facsimile or electronic mail or U.S. mail, return receipt requested. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. Agree. iii. A written protest based on any of the foregoing must be submitted to the Chief Procurement Officer within five (5) days after the date the notice of protest was filed. A written protest is considered filed when received by the Chief Procurement Officer. Agree. The written protest may not challenge the relative weight of the evaluation criteria or the formula for assigning points in making an award determination. The written protest shall state with particularity the specific facts and law upon which the protest of the solicitation or the award is based, and shall include all pertinent documents and evidence and shall be accompanied by the required Filing Fee as provided in subsection (1). This shall form the basis for review of the written protest and no facts, grounds, documentation or evidence not contained in the protester's submission to the Chief Procurement Officer at the time .of filing the protest shall be permitted in the consideration of the written protest. Copyright 2012 Page 47 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Agree. No time will be added to the above limits for service by mail. In computing any period of time prescribed or allowed by this section, the day of the act, event or default from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included unless it is a Saturday, Sunday or legal holiday in which event the period shall run until the end of the next day which is neither a Saturday, Sunday or legal holiday. Intermediate Saturdays, Sundays and legal holidays shall be excluded in the computation of the time for filing. Agree. (b) Authority to resolve protests. The Chief Procurement Officer shall have the authority, subject to the approval of the City Manager and the city attorney, to settle and resolve any written protest. The Chief Procurement Officer shall obtain the requisite approvals and communicate said decision to the protesting party and shall submit said decision to the City Commission within 30 days after he/she receives the protest. In cases involving more than $25,000, the decision of the Chief Procurement Officer shall be submitted for approval or disapproval thereof to the City Commission after a favorable recommendation by the city attorney and the City Manager. Agree. (c) Compliance with filing requirements. Failure of a party to timely file either the notice of intent to file a protest or the written protest, together with the required Filing Fee as provided in subsection (f), with the Chief Procurement Officer within the time provided in subsection (a), above, shall constitute a forfeiture of such party's right to file a protest pursuant to this section. The protesting party shall not be entitled to seek judicial relief without first having followed the procedure set forth in this section Agree. (d) Stay of Procurements during protests. Upon receipt of a written protest filed pursuant to the requirements of this section, the city shall not proceed further with the solicitation or with the award of the Contract until the protest is resolved by the Chief Procurement Officer or the City Commission as provided in subsection (b) above, unless the City Manager makes a written determination that the solicitation process or the Contract award must be continued without delay in order to avoid an immediate and serious danger to the public health, safety or welfare. Agree. (e) Costs. All costs accruing from a protest shall be assumed by the protestor. Agree. (f) Filing Fee. The written protest must be accompanied by a filing fee in the form of a money order or cashier's check payable to the city in an amount equal to one percent of the amount of the Bid or proposed Contract, or $5000.00, whichever is less, which filing Copyright 2012 Page 48 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions fee shall guarantee the payment of all costs which may be adjudged against the protestor in any administrative or court proceeding. If a protest is upheld by the Chief Procurement Officer and/or the City Commission, as applicable, the filing fee shall be refunded to the protestor less any costs assessed under subsection (e) above. If the protest is denied, the filing fee shall be forfeited to the city in lieu of payment of costs for the administrative proceedings as prescribed by subsection (e) above. Agree. 1.74. SAMPLES -Samples of items, when required, must be submitted within the time specified at no expense to the City. If not destroyed by testing, bidder(s)/proposer(s) will be notified to remove samples,at their expense, within 30 days after notification. Failure to remove the samples will result in the samples becoming the property of the City. This is inapplicable to the insurance services contemplated by this proposal. 1.75. SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES - Contractor shall not sell, assign, transfer or subcontract at any time during the term of the Contract, or any part of its operations, or assign any portion of the performance required by this contract, except under and by virtue of written permission granted by the City through the proper officials, which may be withheld or conditioned, in the City's sole discretion. Agreed, however while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna or by vendors with a particular expertise in order to help contain costs without prior written approval for such affiliate or vendor. Every such service will be supervised by Cigna, which will be wholly responsible and liable for the services set forth in the contract. 1.76. SERVICE AND WARRANTY —When specified, the bidder/proposer shall define all warranty, service and replacements that will be provided. Bidders/Proposer must explain on the Response to what extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable, should be submitted with your response. Agree as applicable 1.77. SILENCE OF SPECIFICATIONS -The apparent silence of these specifications and any supplemental specification as to any detail or the omission from it of detailed description concerning any point shall be regarded as meaning that only the best commercial practices are to prevail and that only materials of first quality and correct type, size and design are to be used. All workmanship and services is to be first quality. All interpretations of these specifications shall be made upon the basis of this statement. If your firm has .a current contract with the State. of Florida, Department of General Services, to supply the items . on this solicitation, the bidder/proposer shall quote not Copyright 2012 Page 49 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions more than the contract price; failure to comply with this request will result in disqualification of bid/proposal. Agree. 1.78. SUBMISSION AND RECEIPT OF RESPONSES -Responses shall be submitted electronically via the Oracle System or responses may be submitted in hardcopy format to the City Clerk, City Hall, 3500 Pan American Drive, Miami, Florida 33133-5504, at or before, the specified closing date and time as designated in the IFB, RFP, RFQ, or RFLI. NO EXCEPTIONS. Bidders/Proposers are welcome to attend the solicitation closing; however, no award will be made at that time. Understood. A. Hardcopy responses shall be enclosed in a sealed envelope, box package. The face of the envelope, box or package must show the hour and date specified for receipt of responses, the solicitation number and title, and the name and return address of the Bidder/Proposer. Hardcopy responses not submitted on the requisite Response Forms may be rejected. Hardcopy responses received at any other location than the specified shall be deemed non -responsive. Understood. Directions to City Hall: FROM THE NORTH: I-95 SOUTH UNTIL IT TURNS INTO US1. US1 SOUTH TO 27TH AVE., TURN LEFT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. FROM THE SOUTH: US1 NORTH TO 27TH AVENUE, TURN RIGHT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. Noted. B. Facsimile responses will not be considered. Understood. C. Failure to follow these procedures is cause for rejection of bid/proposal. Understood. D. The responsibility for obtaining and submitting a response on or before the close date is solely and strictly the responsibility of Bidder/Proposer. The City of Miami is Copyright 2012 Page 50 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions not responsible for delays caused by the United States mail delivery or caused by any other occurrence. Responses received after the solicitation closing date and time will be returned unopened, and will not be considered for award. Understood. E. Late responses will be rejected. Understood. F. All responses are subject to the conditions specified herein. Those which do not comply with these:conditions are subject to rejection. Understood. G. Modification of responses already submitted will be considered only if received at the City before the time and date set for closing of solicitation responses. All modifications must be submitted via the Oracle System or in writing. Once a solicitation closes (closed date and/or time expires), the City will not consider any subsequent submission which alters the responses. Understood. H. If hardcopy responses are submitted at the same time for different solicitations, each response must be placed in a separate envelope, box, or package and each envelope, box or package must contain the information previously stated in 1.82.A. Understood. 1.79. TAXES -The City of Miami is exempt from any taxes imposed by the State and/or Federal Government. Exemption certificates will be provided upon request. Notwithstanding, Bidders/Proposers should be aware of the fact that all materials and supplies which are purchased by the Bidder/Proposer for the completion of the contract is subject to the Florida State Sales Tax in accordance with Section 212.08, Florida Statutes, as amended and all amendments thereto and shall be paid solely by the Bidder/Proposer. Agree. 1.80. TERMINATION —The City Manager on behalf of the City of Miami reserves the right to terminate this contract by written notice to the contractor effective the date specified in the notice should any of the following apply: A. The contractor is determined by the City to be in breach of any of the terms and conditions of the contract. B. The City has determined that such termination will be in the best interest of the City to terminate the contract for its own convenience; Copyright 2012 Page 51 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is contingent upon the availability of appropriate funds. Agree. However, under our ASO arrangement the Employer is liable for its obligations to fund claims and pay the sums required to Cigna under the various contracts that will be required. In an insured arrangement, the Employer shall be liable for premiums due in accordance with the contract. In addition, the Employer will be liable for any other liabilities not assumed by Cigna in the terms of the contract. 1.81. TERMS OF PAYMENT -Payment will be made by the City after the goods and/or services awarded to a Bidder/Proposer have been received, inspected, and found to comply with award specifications, free of damage or defect, and properly invoiced. No advance payments of any kind will be made by the City of Miami. Payment shall be made after delivery, within 45 days of receipt of an invoice and authorized inspection and acceptance of the goods/services and pursuant to Section 218.74, Florida Statutes and other applicable law. Understood. 1.82. TIMELY DELIVERY -Time will be of the essence for any orders placed as a result of this solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made within the time(s) specified on their Response. Deliveries are to be made during regular City business hours unless otherwise specified in the Special Conditions. Understood. 1.83. TITLE -Title to, the goods or equipment shall not pass to the City until after the City hasaccepted the goods/equipment or usedthe goods, whichever comes first. This does not apply to the insurance product being quoted. 1.84. TRADE SECRETS EXECUTION TO PUBLIC RECORDS DISCLOSURE -All Responses submitted to the City are subject to public disclosure pursuant to Chapter 119, Florida Statutes. An exception may be made for "trade secrets." If the Response contains information that constitutes a "trade secret", all material that qualifies for exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE SECRETS EXCEPTION," with your firm's name and the Solicitation number and title marked on the outside. Please be aware that the designation of an item as a trade secret by you may be challenged in court by any person. By your designation of material in your Response as a "trade secret" you agree to indemnify and hold harmless the City for any award to a plaintiff for damages, costs or attorney's fees and for costs and attorney's fees incurred by the City by reason of any legal action challenging your claim. Copyright 2012 Page 52 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Noted. 1.85. UNAUTHORIZED WORK OR DELIVERY OF GOODS -Neither the qualified Bidder(s)/Proposer(s) nor any of his/her employees shall perform any work or deliver any goods unless a change order or purchase order is issued and received by the Contractor. The qualified Bidder(s)/Proposer(s) shall not be paid for any work performed or goods delivered outside the scope of the contract or any work performed by an employee not otherwise previously authorized. Agree. 1.86. USE OF NAME -The City is .not engaged in research for advertising, sales promotion, or other publicity purposes. No advertising, sales promotion or other publicity materials containing information obtained from this Solicitation are to be mentioned, or imply the name of the City, without prior express written permission of the City Manager or the City Commission. Agree. 1.87 VARIATIONS OF SPECIFICATIONS -For purposes of solicitation evaluation, bidders/proposers must indicate any variances from the solicitation specifications and/or conditions, no matter how slight. If variations are not stated on their Response, it will be assumed that the product fully complies with the City's specifications. Understood. Copyright 2012 Page 53 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 3363112 Terms and Conditions 2. Special Conditions 2.1. PURPOSE The purpose of this Solicitation is to establish a contract, for Employee Benefit Dental Plan, as specified herein, from a source(s) of supply that will give prompt and efficient service fully compliant with the terms, conditions and stipulations of the solicitation. Understood. 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/CLARIFICATION Any questions or clarifications concerning this solicitation shall be submitted by email or facsimile to the Purchasing Department, Attn: Maritza Suarez, CPPB; fax: (305) 400-5025 or email: msuarez@ci.miami.fl.us. The solicitation title and number shall be referenced on all correspondence. All questions must be received no later than Monday, August 27, 2011 at 5:00 P.M. All responses to questions will be sent to all prospective bidders/proposers in the form on an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER SAID DEADLINE. Understood. 2.3. TERM OF CONTRACT The proposer(s) qualified to provide the service(s) requested herein (the "Successful Proposer(s)") shall be required to execute a contract ("Contract") with the City, which shall include, but not be limited to, the following terms: (1) The term of the Contract(s) shall be for three (3) years with an option to renew for two (2) additional one (1) year periods. Flag UWx; Please Respond; (2) The City shall have the option to extend or terminate the Contract. Understood. Continuation of the contract beyond the initial period is a City prerogative; not a right of the bidder/proposer. This prerogative will be exercised only when such continuation is clearly in the best interest of the City. Understood. 2.4. CONDITIONS FOR RENEWAL Each renewal of this contract is subject to the following: Copyright 2012 Page 54 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions (1) continued satisfactory performance compliance with the specifications, terms a d conditions established herein and Understood. (2) Availability of funds. In the event the Contractor is unable to extend the contract for any subsequent period, advance written notice and explanation shall be submitted to the Chief Procurement Officer no later than ninety (90) days prior to the expiration date of the contract period in effect at such time and shall be subject to the City's acceptance. Failure to comply with these requirements may render the Contract in default of this contract. DI MO Depending on state regulations, our group contracts generally provide for termination by either party effective on any renewal date upon 60 days prior written notice. We also reserve the right to end the contract immediately in case of non-payment of premiums beyond the 30- day grace period. DPPO City of Miami may cancel the policy as of any premium due date by giving written notice to Cigna before that time. We typically require 60-days notice. Cigna may cancel the policy as of any premium due date if the number of covered employees is less than 25 or less than 65 percent of those eligible. Dependent coverage may be canceled as of any premium due date if the number of employees covered for their dependents is less than 65 percent of those eligible. If a premium is not received when due, the policy will automatically be canceled as of the premium due date except for applicable grace periods. 2.5. NON -APPROPRIATION OF FUNDS In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in any fiscal period for payments due under this contract, then the City, upon written notice to Contractor or his assignee of such occurrence, shall have the unqualified right to terminate the contract without any penalty or expense to the City. No guarantee, warranty or representation is made that any particular or any project(s) will be awarded to any firm(s). Agreed. Cigna understands that the City of Miami's obligation to pay under this contract is contingent upon an annual appropriation of funds. However, Cigna reserves the right to suspend bank account claim payments or immediately terminate this agreement if the City of Miami fails to properly fund the claims bank account or fails to pay fees or premiums beyond the grace period as described. 2.6. MINIMUM QUALIFICATION REQUIREMENTS Copyright 2012 Page 55 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions For .a. Proposer to be deemed responsive the following minimum qualification requirements cited below shall be satisfied. In determining said responsiveness, each such minimum qualification requirement shall be addressed in detail in the Proposal submittal. Failure to meet each such following minimum qualification requirements and/or failure to provide sufficient detailed documentation concerning the same, shall result in the Proposal being deemed non -responsive: A. All Companies submitting Proposals must be licensed by the State of Florida and have a demonstrated level of good performance with public entities of equivalent size, including municipalities, for a minimum of tv'o (2) years. Agree. B. Proposers must have an organization that has demonstrated the ability to deliver cost-effective service, and efficient loss control and claims processing. Confirmed. C. Provide sufficient telephone service, including toll -free and local service 8-5 EST, to handle inquiries directly from plan participants as well as authorized City representatives. Cigna chose to be the only national health service company to expand ouIr customer service hours to include the weekends, holidays, and overnight hours. Our toll -free customer service number, 1.800.Cigna24 is staffed 24 hours a day, 7 days a week to answer questions about coverage, DPPO claims, procedures, or any other concerns. D. Must disclose the following if broker fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a no -commission basis. The Cigna dental proposal is quoted on a no -commission basis. E. Must assume current policy benefit structure and provide a "no loss/no gain" assumption of risk and credit for all annual deductibles. Agreed. F. Must comply with all federal legislation including but not limited to HIPAA and COBRA. Agreed. Copyright 2012 Page 56 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 3363112 Terms and Conditions G. Proposer .must .agree to allow the City or its representative the right to audit all claims, financial data, and other information relevant to the City's account. Fully Insured. Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries all risk associated with such processes; therefore, external audits are not permitted. Cigna has an internal claim quality assurance program to monitor internal performance standards to ensure the accuracy of claims payment. However, when required by applicable state or federal law and in keeping with the standards of the industry and Cigna's standard audit and review procedures, Cigna shall cooperate with a required audit or review of applicable documents conducted by a duly authorized representative. ASO Claim audits are permitted in accordance with the following terms: Upon 45 days advance written request, documents relating only to claims administration services shall be made available to the City of Miami for its audit or inspection. The City of Miami will designate with Cigna's consent, an independent and a third party auditor to conduct the audit. In addition, the City of Miami and Cigna will agree upon the date for the audit during regular business hours at Cigna's office(s). The City of Miami may review payment documents relating to a random, statistically valid sample of 225 claims paid. The scope of the audit may include types of claims prone to overpayments provided the types of claims prone to underpayments are equally included and will exclude electronic analysis. Any claim adjustments will be based upon the actual claims reviewed and not on statistical projections or extrapolations. Such audits shall be conducted pursuant to the terms of Cigna's Claim Audit Agreement executed by all parties. In addition, if the City of Miami has 5,000 or more employee members, the City of Miami may conduct one such audit every plan year (but not within six months of a prior audit); otherwise, the City of Miami may conduct one such audit every two plan years (but not within 18 months of a prior audit). No audit shall review claims paid more than two years before the date of the audit. The City of Miami will remain responsible for all costs associated with an audit. H. The City requires that the pre-existing condition limitations and the actively at work provision be waived for the initial enrollment for those employees who have already satisfied the waiting period for pre-existing conditions under the current plan. Agreed. Copyright 2012 Page 57 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions I. - Proposer must have bilingual capabilities in the customer service and enrollment assistance areas as well as in communications materials. English and Spanish are mandatory. Creole is desired as well'. We will work with you to create an effective communications program in any language. There are standard collateral materials available in Spanish at no additional cost. Client -specific material created in Spanish or other languages is subject to additional fees. myCigna.com, our secure customer website, includes access to the Healthwise® online Spanish health guide. This guide provides Spanish- speaking -individuals with online information on more than 220 commpn health problems, 3,000 medications, and helps them obtain basic health information. Non -English speaking members can be assisted by customer service associates (CSAs) in Cigna markets. Spanish language calls are serviced by bilingual representatives. Members reach Spanish speaking CSAs vial a Spanish prompt selection on the toll -free customer service number. If a member needs help in another language, a CSA will set up a conference call with an interpreter through Language Line Services, a nationally recognized and certified foreign language interpretation service. Members access this service through our toll -free customer service number, 1.800.Cigna24. Language Line Services offers translation services for more than 1175 languages. J. Proposer shall have no record of judgments or pending lawsuits against the City and/or bankruptcy, and not have any conflicts of interest that have not been waived by the City Commission. In an industry where lawsuits are commonplace, Cigna is involved in lawsuits arising, for the most part, in the ordinary course of business. While the outcome of all litigation involving Cigna cannot be determined, litigation is not expected to result in losses that would be material to results of operations, liquidity, or fmancial condition. All litigation against Cigna related to managed care products is referred to a specialized unit of in-house legal counsel for review and handling. After thorough review of the facts and circumstances of each case, in-house counsel attempts to resolve the matter as expeditiously as possible, frequently achieving resolution through in-house administrative processes. Specific details of individual lawsuits and settlements are not available as they are maintained as confidential. We have not experienced any qualified financial statements, proceedings, or bankruptcies. bankruptcy Copyright 2012 Page 58 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions K. Neither Proposer nor any. member, .officer,or stockholder of Proposer shall be in arrears or in default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City. To the best of our knowledge and belief neither Cigna nor any member, officer, or stockholder of Cigna is in arrears or in default of any debt or contract involving the City of Miami, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City of Miami. 2.7: CONTRACT EXECUTION The selected Proposer(s) evaluated and ranked in accordance with the requirements, of this Solicitation, shall be awarded an opportunity to negotiate a contract ("Contractt") with the City. The City reserves the right to execute or not execute, as applicable a Professional Services Agreement ("Agreement") with the selected Proposer(s) ; in substantially the same form as the Agreement included as part of this solicitation (refer to Attachment B). Such Agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. Agree. Cigna has provided initial comments to your sample agreement. As the incumbel nt administrator of the City of Miami's medical benefit plan, Cigna's preference would be to add any applicable dental provision to the existing Administrative Services Only agreement already in place. Otherwise, Cigna will require that certain operational provisions be added to fully describe our services. Cigna reserves the right to request further modifications if we are selected as your administrator. Cigna agrees to work in good faith to negotiate this, or any other agreement, to be agreeable to the Parties. With respect to the fully insured plans, please note that our insurance policy and certificate will be issued and made a part of the Agreement as well. Since the insurance policy and certificate are filed documents, there is very little flexibility to change the provisions. As such, any conflict between the terms of this Agreement and the insurance policy, the terms of the insurance policy shall govern. 2.8. FAILURE TO PERFORM Should it not be possible to reach the contractor or supervisor and/or should remedial action not be taken within 48 hours of any failure to perform according! to specifications, the City reserves the right to declare Contractor in default of the contract or make appropriate reductions in the contract payment. Agree. 2.9. INSURANCE REQUIREMENTS INDEMNIFICATION Copyright 2012 Page 59 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Bidder shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of bidder's performance under the provisions of the contract, including all acts or omissions to act on the part of bidder, including any person performing under this Contract for or on bidder's behalf, provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Contract, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. Fully Insured Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the terms and conditions of the policy where such failure is not due to any action or inaction by the City of Miami, its officers, directors, agents and/or employees. ASO Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City of Miami for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the City of Miami harmless from and against extra -contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City of Miami s plan. Additionally, the City of Miami is responsible for defending against any legal action or proceeding brought to recover a claim for Plan benefits. The City of Miami may request, and a business decision may be made by Cigna, to provide claims litigation services in which Cigna is also responsible for handling all lawsuits alleging denial of benefits under the terms of the Plan. Our fee structure would be altered to reflect our assumption of additional risk and administrative responsibility. The bidder shall furnish to City of Miami, c/o Purchasing Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: (1) Worker's Compensation A. Limits of Liability Statutory - State of Florida Waiver of Subrogation Copyright 2012 Page 60 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions (2) Commercial General Liability: A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence: $1,000,000 General Aggregate Limit: $2,000,000 Personal and Adv. Injury: $1,000,000. Products/Completed Operations: $1,000,000.00. B. Endorsements Required: City of Miami included as an Additional insured. Primary Insurance Clause Contigent & Contractual Liability Premises and Operations Liability (3) Business Automobile Liability A. Limits of Liability Bodily injury and property damage liability combined single limits. Owned/Scheduled Autos, including, including hired, borrowed or non - owned autos. Any one accident - $1,000,000 B. Endorsements Required: City of Miami included as an Additional Insured (4) Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee $500,000 for bodily injury caused by disease, policy limit (5) Professional Liability/Errors and Omissions Coverage: A. Limits of Liability Combined Single Limit Each Claim - $1,000,000 General Aggregate Limit - $1,000,000 Deductible - not to exceed 10% BINDERS ARE UNACCEPTABLE. Understood. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the bidder. . Copyright 2012 Page 61 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Agreed. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The Company must be rated no less than "A" as to management, and no less than "Class V" as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and/or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Every Cigna insurer, with the exception of the captive insurers, are rated at least A- XVI, by A.M. Best's most recent rating guide. Due to the inherent nature of this request and potential changes in the insurance marketplace, Cigna is unable to comply with this City of Miami's request to approve Cigna's insurance carriers. It should be noted that some of Cigna's insurance coverage's have been in place in excess of 19 consecutive years and Cigna reviews its insurance carriers' ratings at least annually and more frequently, if needed. Certificates will indicate no modification or change in insurance shall be made without thirty (30) days written advance notice to the certificate holder. While Cigna's insurance policies contain the standard notice of cancellation endorsement, our insurers are unable to provide any notice of cancellation, non -renewal, or material changes to clients or third parties. NOTE: CITY BID NUMBER AND/OR TITLE OF BID MUST APPEAR ON EACH CERTIFICATE. Understood. Compliance with the foregoing requirements shall not relieve the bidder of his liability and obligation under this section or under any other section of this Agreement. Understood. --If insurance certificates are scheduled to expire during the contractual period, the Bidder shall be responsible for submitting new or renewed insurance certificates to the City at a minimum of ten (10) calendar days in advance of such expiration. Understood. --In the event that expired certificates are not replaced with new or renewed certificates which cover the contractual period, the City shall: (4) Suspend the contract until such time as the new or renewed certificates are received by the City in the manner prescribed in the Invitation To Bid. Copyright 2012 Page 62 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Understood. (5) The City may, at its sole discretion, terminate this contract for cause and seek re - procurement damages from the Bidder in conjunction with the General and Special Terms and Conditions of the Bid. Cigna agrees that, in the event of its failure to perform, the City of Miami may procure services from other sources; however, Cigna will not be liable for costs for re -procurement or the cost for an increase in price for services. Further, damages may not be deducted from any funds due and owed to Cigna. The Bidder shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in force for the duration of the contractual period; including any and all option terms that may be granted to the Bidder. Understood. 2.10. PRE-BID/PRE-PROPOSAL CONFERENCE None Understood. 2.11. CONTRACT ADMINISTRATOR Upon award, contractor shall report and work directly with Mr. Richard Kaufman, and Ms. Barbara Pick, AON Hewitt, who shall be designated as the Contract Administrator. Understood. 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) A Sub -Consultant, herein known as Sub-Contractor(s) is an individual or firm contracted by the Proposer or Proposer's firm to assist in the performance of services required under this Solicitation. A Sub -Contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City. Sub -Contractors are allowed by the City in the performance of the services delineated within this Solicitation. Proposer must clearly reflect in its Proposal the major Sub -Contractors to be utilized in the performance of required services. The City retains the right to accept or reject any Sub -Contractors proposed in the response of Successful Proposer or prior to contract execution. Any and all liabilities regarding the use of a Sub -Contractor shall be borne solely by the Successful Proposer and insurance for each Sub -Contractors must be maintained in good standing and approved by the City throughout the duration of the Contract. Neither Successful Proposer nor any of its Sub -Contractors are considered to be employees or agents of the City. Failure to list all Sub -Contractors and provide the required information may disqualify any proposed Sub -Contractors from performing work under this Solicitation. Copyright 2012 Page 63 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami, notwithstanding that certain services may be performed in part by subcontracted vendors with particular expertise. A number of the services under our contracts are performed by affiliates of Cigna. Cigna may also subcontract with vendors for performance of certain services in order to help contain costs and to make use of the expertise developed by those vendors. All such services will be per -formed with oversight from Cigna. It is not feasible for Cigna to obtain prior approval from each customer for such arrangements. Cigna will continue to be liable for the services set forth in the contract, even when an assignment is made. A list of Cigna's proposed subcontractors is included in this proposal. Proposers shall include in their Responses the requested Sub -Contractor information and include all relevant information required of the Proposer. In addition, within five (5) working days after the identification of the award to the Successful Proposer, the Successful Proposer shall provide a list confirming the Sub -Contractors that the Successful Proposer intends to utilize in the Contract, if applicable. The list shall include, at a minimum, the name, location of the place of business for each Sub - Contractor, the services Sub -Contractor will provide relative to any contract that may result from this Solicitation, any applicable licenses, references, ownership, and other information required of Proposer. Agree. 2.13. COMPLETE PROJECT REQUIRED These specifications describe the various items or classes of work required, enumerating or defining the extent of same necessary, but failure to list any item or classes under scope of the several sections shall not relieve the contractor from furnishing, installing or performing such work where required by any part of these specifications, or necessary to the satisfactory completion of the project. Understood. 2.14. TERMINATION A. FOR DEFAULT If Contractor defaults in its performance under this Contract and does not cure the default within 30 days after written notice of default, the City Manager may terminate this Contract, in whole or in part, upon written notice without penalty to the City of Miami. In such event the Contractor shall be liable for damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is determined for any reason that the Contractor was not in default or (2) the Contractor's failure to perform is without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a termination for the convenience of the City of Miami. Fully Insured Copyright 2012 Page 64 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Cigna reserves .theright to terminate. the . contract immediately in case of nonpayment of premiums beyond the grace period or if the number of insured employees is less than 70 percent of those eligible. Cigna agrees that, in the event of its failure to perform, the City of Miami may procure services from other sources; however, Cigna will not be liable for costs for re -procurement or the cost for an increase in price for services. Further, damages may not be deducted from any funds due and owed to Cigna. Damages will be assessed in accordance with the indemnification provision in the Contract. ASO Cigna reserves the right to terminate the agreement on the date upon which Employer fails to fund the bank account as required by the ASO Agreement or fails to pay Cigna any charges identified in the ASO Agreement when due provided Cigna notifies Employer of its election to terminate. B. FOR CONVENIENCE The City Manager may terminate this Contract, in whole or in part, upon 30 days prior written notice when it is in the best interests of the City of Miami. If this Contract is for supplies, products, equipment, or software, and so terminated for the convenience by the City of Miami the Contractor will be compensated in accordance with an agreed upon adjustment of cost. To the extent that this Contract is for services and so terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions of the Contract for those services rendered prior to termination. Cigna agrees with the City of Miami's ability to terminate the Agreement without cause, however, Cigna reserves the right to terminate upon the date which is at least sixty (60) days from the date that Cigna provides written notice; the effective date of any applicable law or governmental action which prohibits performance of the activities required by this agreement; or any other date mutually agreed upon by the parties 2.15. ADDITIONAL TERMS AND CONDITIONS No additional terms and conditions included as part of your solicitation response shall be evaluated or considered, and any and all such additional terms and conditions shall have no force or effect and are inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently, appearing separately in transmittal letters, specifications, literature, price lists or warranties, it is understood and agreed that the General Conditions and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that the bidder's/proposer's authorized signature affixed to the bidder's/proposer's acknowledgment form attests to this. If a Professional Services Agreement (PSA) or other Agreement is provided by the City and is expressly included as part of this solicitation, no additional terms or conditions which materially or substantially vary, modify or alter the terms or conditions of the PSA or Agreement, in the sole opinion and reasonable discretion of the Copyright 2012 Page 65 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions City will -be considered. Any. and. allsuch additional termsand conditions shall have no force or effect and are inapplicable to this PSA or Agreement. Cigna has provided initial comments to your sample agreement. As the incumbent administrator of the City of Miami's medical benefit plan, Cigna's preference would be to add any applicable dental provision to the existing Administrative Services Only agreement already in place. Otherwise, Cigna will require that certain operational provisions be added to fully describe our services. Cigna reserves the right to request further modifications if we are selected as your administrator. Cigna agrees to work in good faith to negotiate this, or any other agreement, to be agreeable to the Parties. With respect to the fully insured plans, please note that our insurance policy and certificate will be issued and made a part of the Agreement as well. Since the insurance policy and certificate are filed documents, there is very little flexibility to change the provisions. As such, any conflict between the terms of this Agreement and the insurance policy, the terms of the insurance policy shall govern. 2.16. CHANGES/ALTERATIONS Proposer may change or withdraw a Proposal at any time prior to Proposal submission deadline; however, no oral modifications will be allowed. Written modifications shall not be allowed following the proposal deadline. Understood. 2.17. COMPENSATION PROPOSAL Each Proposer shall detail any and all fees and costs to provide the required services as listed herein. Proposer shall additionally provide a detailed list of all costs to provide all services as detailed -in Section III Scope of Services, as proposed. The City reserves the right to add or delete any service, at any time. Should the City determine to add an additional service for which pricing was not previously secured, the City shall seek the Successful Proposer to provide reasonable cost(s) for same. Should the City determine the pricing unreasonable, the City reserves the right to negotiate cost(s) or seek another vendor for the provision of said service(s). Failure to submit compensation proposal as required shall disqualify Proposer from consideration. Understood. 2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD The procedure for response evaluation, selection and award is as follows: (1) Solicitation issued. Understood. Copyright 2012 Page 66 of 151 Cigna Improved Oral Health. Lower Costs. Terms and Conditions (2) Receipt of responses Understood. (3) Opening and listing of all responses received Understood. City of Miami RFP No. 336312 (4) Purchasing staff will review each submission for compliance with the submission, requirements of the Solicitation, including verifying that each submission includes all documents required. Understood. (5) An Evaluation Committee, appointed by the City Manager, comprised of appropriate City Staff and members of the community, as deemed necessary, with the appropriate technical expertise and/or knowledge, shall meet to evaluate each response in accordance with the requirements of this Solicitation and based upon the evaluation criteria as specified herein. Understood. (6) The Evaluation Committee reserves the right, in its sole discretion, to request Proposers to make oral presentations before the Committee as part of the evaluation process. The presentation may be scheduled at the convenience of the Evaluation Committee and shall be recorded. Understood. (7) The Evaluation Committee reserves the right to rank the Proposals and shall submit its recommendation to the City Manager for acceptance. If the City Manager accepts the Committee's recommendation, the City Manager's recommendation for award of contract will be posted on the City of Miami Purchasing Department website, in the Supplier Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. The City Manager shall make his recommendation to the City Commission requesting the authorization to negotiate and/or execute an agreement with the recommended Proposer(s). No Proposer(s) shall have any rights against the City arising from such negotiations or termination thereof. Understood. (8) The City Manager reserves the right to reject the Committee's recommendation, and instruct the Committee to re-evaluate and make another recommendation, reject all proposals, or recommend that the City Commission reject all proposals. Copyright 2012 Page 67 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Understood. (9) The City Commission shall consider the City Manager's and Evaluation Committees' recommendation(s) and, if appropriate and required, approve the City Manager's recommendation(s). The City Commission may also reject any or all response. Understood. (10) If the City Commission approves the recommendations, the City will enter into negotiations with the selected Proposer(s) for a contract for the required services. Such negotiations may result in contracts, as deemed appropriate by the City Manager. Understood. (11) The City Commission shall review and approve the negotiated Contract with the selected Proposer(s). Understood. 2.19. ADDITIONAL SERVICES Services not specifically identified in this request may be added to any resultant contract upon successful negotiation and mutual consent of the contracting parties. Agreed. 2.20. RECORDS During the contract period, and for a least five (5) subsequent years thereafter, Successful Proposer shall provide City access to all files and records maintained on the City's behalf. While Cigna's record retention requirements meet or exceed the five years requested by the City, no audit shall review claims paid more than two years before the date of the audit. Our standard is to allow audit one year after termination. Additionally, any claim or payment data recorded for or otherwise integrated into Cigna's data processing systems during the ordinary course of business, any information which Cigna reasonably deems to be proprietary in nature, or any information which Cigna reasonably believes it cannot divulge due to applicable state and/or federal privacy restrictions will be considered the property of Cigna. Cigna will give the City of Miami reasonable access to claim records and data, subject to Cigna's standard confidentiality procedures and agrees to transfer claim data to a successor administrator to the extent administratively feasible and to the extent the parties negotiate a mutually agreeable fee. 2.21. AMENDMENTS TO THE CONTRACT Copyright 2012 Page 68 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions The City Manager shall have the right and authority to amend this Contract on behalf of the City. Agree. 2.22. TRUTH IN NEGOTIATION CERTIFICATE Execution of the resulting agreement by the Successful Proposer shall act as the execution of truth -in -negotiation certificate stating that wage rates and other factual unit costs supporting the compensation of the resulting Agreement are accurate, complete, and current at the time of contracting. The original contract price and any additions thereto shall be adjusted to exclude any significant sums by which City determines the contract price was increased due to inaccurate, incomplete, or non- current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year following the end of the Agreement. Understood. Copyright 2012 Page 69 of 151 Cigna Improved Oral Health. Lower Costs. Terms and Conditions 3. Specifications 3.1. SPECIFICATIONS/SCOPE OF WORK 3.1.1. Background Information City of Miami RFP No. 336312 The City of Miami is seeking to qualify dental care providers for its Employee Benefit Dental Plan. The City currently has a total of 3109 employees and retirees eligible for the dental plan. The City currently offers a fully insured dental DMO (DHMO) through Solstice Benefits. This plan has approximately 2,525 participants. The City also offers a fully -insured PDO plan through MetLife for employees. This plan has approximately 467 participants. The City also offers a fully -insured Executive PDO (DPPO) plan which has approximately 117 participants. The managed dental plan and the preferred dental plan for the general employees are voluntary and supported one hundred percent (100%) by employee contributions. The Executive PPO is funded fully by the City of Miami. Please refer to the attached exhibits for details on the City's current dental benefits plan(s). Noted. 3.1.2. Dental Plan(s) Solicited It is the City's intent to offer their employees/retirees the following options: 1. An affordable dental HMO product (DMO) (DHMO. 2. An affordable dental PPO product (PDO) (DPPO). The City is seeking Proposals on both a fully insured and self -insured basis for the dental care coverage. The City is requesting Proposals to be based upon the current dental plan designs offered, but will accept and review alternatives. All alternate plans must clearly designate deviations from the current schedule of benefits. The City will be evaluating the Proposals to access the capabilities in each of the following areas: Cigna is providing a fully insured and ASO proposal. Fully Insured Dental Plans 1. Financial stability and experience 2. Network Disruption Report for both DHMO and DPPO 3. Plan design and benefits 4. Overall plan costs (fees, claims and/or premiums) and discount arrangements 5. Reporting capabilities 6. Communications and enrollment capabilities 7. Claims administration capabilities 8. Ability to offer requested plan designs/alternatives Copyright 2012 Page 70 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 9. Account management staff. 10. Banking A fully insured program involves no banking responsibilities for the client. 3.1.3. Attachments and Exhibits To assist you in the preparation of your Proposal, the City is attaching the following documentation: List of Exhibits provided as information/documentation to prepare Proposal 1. DMO (DHMO) Census 2. PDO (DPPO) Census 3. Listing of DMO Top Dental Providers 4. Current rates 5. Summary of benefits for current DMO benefits 6. 2008-2011 Voluntary Plan Claims Experience 7. PPO Plan Designs 8. Summary of Benefits for PDO 9. Listing of PPO Top Dental Providers 10. Executive Plan Claims Experience 11. Class I Executive Booklet 12. PPO Rate History 13. PPO Utilization Report 14. PPO Claims Experience 15. Anticipated Questions and Answers Noted. NOTE: Attachment A (Questionnaire) must be completed and returned with Proposal. Failure to complete and return Attachment A will deem any submitted Proposal non- responsive. Understood. Copyright 2012 Page 71 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 4. Submission Requirements 4.1. SUBMISSION REQUIREMENTS Proposers shall carefully follow the format and instruction outlined below, observing format requirements where indicated. Proposals should contain the information itemized below and in the order indicated. This information should be provided for the Proposer and any Sub -Consultants to be utilized for the work contemplated by this Solicitation. Proposals submitted which do not include the following items may be deemed non -responsive and may not be considered for contract award. Proposers shall submit responses in a hardcopy format, consisting of one (1) original and five (5) copies, and in an electronic format via a CD-ROM. On-line submittals, via the. Oracle System, shall not be accepted. Failure to do so may deem the Proposal non- responsive. Understood. PROPOSAL FORMAT The response to this solicitation should be presented in the following format. Failure to do so may deem your Proposal non -responsive. 1. Cover Page The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax Numbers, if applicable Email addresses; Title of RFP; RFP Number; Federal Employer Identification Number or Social Security Number. Understood. 2. Table of Contents The table of contents should outline, in sequential order, the major sections of the Proposal as listed below, including all other relevant documents requested for submission. All pages of the Proposal, including the enclosures, should be clearly and consecutively numbered and correspond to the table of contents. Understood. 3. Executive Summary: Provide an Executive Summary describing elements contained within Proposer's Proposal, including such factors as Organization, Qualifications and Capabilities; Proposed Network and Plan(s) Designs; Customer Service, Banking, Reporting Capabilities, and Benefit Administration; and Price and Cost Effectiveness. Copyright 2012 Page 72 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Understood. 4. Proposer's Organization, Qualifications, Capabilities & Financial Stability a) Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. Proposer should include the name of the organization, business phone/fax/email address, contact person and federal tax ID. Organizational History & Structure Cigna and its predecessor companies have a long history of supporting Americans' health care needs. Starting with the formation of Connecticut General Life Insurance Company (CGLIC) and Insurance Company of North America (INA), we have more than 200 years of history. In 1990, Cigna became the largest investor -owned managed care organization in the country, and still concentrates on meeting client needs for best -in -class health care and employee benefit plan coverage and services. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. It is an indirect, wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. Cigna's rich and exciting history reveals the foundation of experience that shapes our current plan coverage and business strategies. Today, Cigna companies comprise one of the nation's leading providers of employee benefits, health care coverage, and insurance products to businesses and individuals worldwide. No matter how much success we have enjoyed, Cigna has never wavered from its main purpose —to improve the health, well-being, and sense of security of the individuals we serve. Length of Time Offering Services DHMO The Cigna Dental Care® plan coverage is underwritten by Connecticut General Life Insurance Company (CGLIC), or the subsidiaries of Cigna Dental Health, Inc., depending upon state laws and licensing requirements. We have specialized in dental program management since 1974, when Florida granted Dental Health, Inc. a Certificate of Authority to provide managed dental care. In 1984, Dental Health, Inc. became a subsidiary of Cigna Corporation, marking the first entry of a major national insurance organization into the managed dental care field. Cigna Dental Health, Inc. is an indirect, wholly owned subsidiary of Cigna Corporation; its wholly owned subsidiaries, have been licensed in certain states at varying times as prepaid dental plan organizations, prepaid limited health services organization, dental HMOs, etc., (depending upon state laws), to offer the Cigna Dental Care plan coverage. Cigna Dental Copyright 2012 Page 73 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Health of Florida, Inc. was incorporated on November 29, 1973 and first received its license in Florida (under a prior name, Dental Health, Inc.) on March 11, 1974. DPPO The Cigna DPPO plan coverage is underwritten or administered by Cigna Health and Life Insurance Company (CHLIC). Certain administration and network management services for the DPPO plan coverage are performed on behalf of CGLIC and CHLIC by their affiliate, Cigna Dental Health, Inc. The DPPO plan coverage was introduced in July 1996, and licensed at varying times in states throughout the nation. CGLIC, CHLIC, Cigna Dental Health, Inc., and its' subsidiaries are operating subsidiaries of Cigna Corporation, our parent company. Plan coverage's and services referenced above are provided exclusively by such operating subsidiaries, and not by Cigna Corporation Previously Awarded Contracts We are the incumbent carrier for City of Miami's Medical, Pharmacy, EAP, and Stop -loss coverage. Name of Organization While we have various legal names depending on regulatory filing brand names are Cigna Dental Care® and Cigna DentalsM. The name of our company is Cigna Health and Life Insurance subsidiaries of Cigna Dental Health, Inc. Business Phone/Fax/E-mail Address Cigna Dental Health of Florida, Inc. Phone: 954.514.6600 Cigna Health and Life Insurance Company (CHLIC) Phone Number: 860.226.6000 Contact Person Yesenia Sanchez Federal Tax ID DHMO by market, our company Company and operating The federal taxpayer ID number for Cigna Dental Health, Inc. is 59-2308055. Subsidiaries providing coverage in different states have different ID numbers. For Florida, the federal tax ID number is 59-1611217. DPPO Copyright 2012. Page 74 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions The federal taxpayer ID number for Cigna Health and Life Insurance Company is 59- 1031071. b) Provide a list of all principals, owners or directors. Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. It is an indirect, wholly owned subsidiary of Cigna Corporation, a publicly traded corporation. CHLIC is licensed to transact the business of insurance by the insurance department of each of the 50 states and the District of Columbia. DHMO Cigna Dental Health, Inc. is an indirect, wholly owned subsidiary of Cigna Corporation; its wholly owned subsidiaries, have been licensed in certain states at varying times as prepaid dental plan organizations, prepaid limited health services organization, dental HMOs, etc., (depending upon state laws), to offer the Cigna Dental Care plan coverage. Cigna Dental Health of Florida, Inc. was incorporated on November 29, 1973 and first received its license in Florida (under a prior name, Dental Health, Inc.) on March 11, 1974. DPPO CGLIC, CHLIC, Cigna Dental Health, Inc., and its' subsidiaries are operating subsidiaries of Cigna Corporation, our parent company. Plan coverage's and services referenced above are provided exclusively by such operating subsidiaries, and not by Cigna Corporation c) Provide copy of current license to provide said services in the State of Florida. Cigna has attached a copy of its current license for the State of Florida electronically for this proposal submission. d) Provide (1) the number of years in existence of Proposer, both nationally and in the Florida market; (2) the current number of employees enrolled in the Proposer's plan, both nationally and in Florida, and (3) the primary markets served. Also, discuss specifically Proposer's involvement in providing dental care benefits, particularly in the South Florida market. 1. Number of Years in Existence Nationally and in Florida Nationally Cigna Health and Life Insurance Company (CHLIC) is a corporation, originally incorporated May 2, 1963, as Orange State Life Insurance Company. After several transactions, it was acquired by Cigna Corporation on April 1, 2008. The company was renamed to CHLIC on March, 5, 2010. Florida Copyright 2012 Page 75 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions Cigna Dental Health of Florida, Inc. was incorporated on November. 29, 1973 and first received its license in Florida (under a prior name, Dental Health, Inc.) on March 11, 1974. 2. Current Number of Members Nationally and in Florida DHMO — • Nationally — 1,347,239 • Florida — 152,381 DPPO — • Nationally — 9,315,550 3. Primary Markets Served As of June 2012 — DHMO Segment umber of.Clients ;i umber of Members{'.• National (5000+) 48 701,181 Middle (1,000 - 4,999) 155 343,345 Small (999 and below) 1,840 302,713 Total DHMO DPPO 2,043 1,347,239 Segment umberof Clien umber ifiMembers National (5000+) 344 6,712,567 Middle (1,000 - 4,999) 818 1,783,966 Small (999 and below) 3,001 819,017 Total PPO 4,163 9,315,550 e) Disclose whether broker's fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to. be awarded on a non -commission basis. Consideration will be given during evaluation of same. The Cigna dental proposal is quoted on a no -commission basis. f) Provide the current number of employees of Proposer; its depth and experience, and number and job classifications of employees anticipated to be assigned to the City's account, particularly in Miami -Dade and Broward Counties, including the overall qualifications of assigned staff particularly its experience with dental benefit administration in Florida. Include discussion of employees' diversity and ability of speaking more than one language. Copyright 2012 Page 76 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions We are the incumbent medical carrier for the City _ofMiami. The same account management team will also service the dental plans. We have included the account team bios with our submission. g) Provide a list of 2 clients of equivalent size who, for whatever reason, discontinued to use Proposer's services within the past year, and indicate the reasons for the same. Include contact name and number, as well as two current clients. The City reserves the right to contact any reference as part of the evaluation process. Also include your company's total enrollment for 2010 vs. your 2011 enrollment. Terminated References City of Coral Springs Benefits Provided - DHMO & DPPO Name of Contact — Dale Pazdra Telephone Number — 954.344.1152 Spring ISD Benefits Provided - DHMO & DPPO Name of Contact — John Brownlow Telephone Number — 281.891.6325 Active References Palm Beach County Sheriff's Office Benefits Provided - DHMO & DPPO Name of Contact - Hilda Gonzalez Telephone Number - 561.681.3286 South Florida Water Management District Benefits Provided - DHMO & DPPO Name of Contact - Linda Hayden Telephone Number - 561.682.6427 Total Enrollment 2010 & 2011 2010 — 11 Million 2011 — 11 Million h) List the subcontractors or sub consultants and include a brief history of their background and experience. Cigna will perform administrative, underwriting, and network management services. We use subcontractors for periodic DHMO on -site reviews, DPPO on -site reviews (where applicable), check and claim recovery, and claim imaging. We are fully accountable for the outcome of the services performed by subcontractors. We have one year agreements that automatically renew if no notice. of termination is given at the end of the year. There is immediate termination for cause and a 60-day termination Copyright 2012 Page 77 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions provision without cause. We review• subcontractor. operations and processes and visit sites annually to assess the quality of services delivered. Quality controls are monitored through monthly reports from the following subcontractors: Healthcare Review Services (HRS) HRS performs Cigna Dental Care network dental office reviews to periodically measure how dental offices comply with our quality guidelines. Clinical staff perform on -site assessments of the physical characteristics of the office and review selected patient charts. While initial on -site visits are conducted by Cigna prior to dentists joining the Cigna Dental Care network, Healthcare Review Services is used for most ongoing periodic DEMO site visits. Note: California auditors contract directly with dentists throughout the state with experience performing on -site audits. Cigna has worked with Healthcare Review Services since 1994. Accent Insurance Recovery Solutions Accent Insurance Recovery Solutions (Accent) recovers overpayments made by Cigna to dentists or members. Our claim offices and inquiry centers identify and refer overpayments to Accent for recovery. If appropriate, Accent may investigate additional overpayments or trends based on the original overpayment. They remit the entire refund to Cigna's claim overpayment recovery unit, which processes directly to the claim system at the member level. Cigna pays Accent a fee out of a managed expense account; we do not charge our clients for this fee. Cigna has worked with Accent since 1997. Affiliated Computer Services (ACS) ACS is a leading provider of business process and information technology, outsourcing solutions to world -class commercial and government clients. ACS provides mailroom, scanning, paper data entry, indexing, and image storage/retrieval services for Cigna. ACS captures the index fields required by Cigna and places the data and corresponding image onto the ACS Stored Information Retrieval (SIR) application. This system is a web -based application allowing Cigna to securely access and view images on demand. Cigna also conducts dental review activities using functionalities provided within the ACS SIR application. Cigna has worked with ACS since 2002. Resumes and Biographies Healthcare Review Services (HRS) HRS, established in 1994, is a managed care services company based in Nashville, Tennessee. HRS specializes in on -site quality assurance office reviews. Copyright 2012 Page 78 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions On -site reviews are performed by over 30 reviewers located throughout the United States. HRS only uses actively licensed clinicians. Most are or have been involved with several managed care networks. Interpersonal skills are a strong suit of the HRS reviewers, to go along with a keen sense of observation and objectivity. Reviewers are required to sign the attached "Reviewer/Consultant Non -Disclosure Agreement" before working with HRS. In addition, HRS has secured a professional liability errors and omissions insurance policy covering reviewers. The principal and founder of HRS is John Henry Spight, III, who spent the early part of his career in the data processing and computer industry, specializing in systems design/consultation. Seventeen years were spent in this industry with IBM, Digital Equipment Corporation, and GE Capital. While working in the computer field, Mr. Spight became more and more involved with health care firms, consulting with such firms as Humana, Hospital Corporation of America, HCA Health Plans, HealthAmerica, National Health Labs, Allied Clinical. Labs, Clinical Pharmaceutical, Inc., and Focus Healthcare Management Corporation. Through these associations, Mr. Spight recognized that the emergence of managed care led to the need for quality assurance monitoring and reporting. Merging these 2 disciplines for the benefit of managed health care seemed appropriate, resulting in the founding of HRS. Accent Insurance Recovery Solutions Accent Insurance Recovery Solutions is located in Omaha, Nebraska. Rebecca O'Hare, Senior Account Manager, has worked exclusively on the Cigna account since 2002. Rebecca works closely with Cigna vendor management to ensure strategic initiatives are implemented effectively and communicated nationally and that our portfolios of services are meeting Cigna's yearly goals. Rebecca also maintains relationships with Cigna contracting, the national overpayment identification team, the claim rework team, Cigna account management, and a variety of teams within the claim offices. Chris Joy, Account Manager, also works exclusively on the Cigna account and came to Accent with several years of insurance and broker experience. Her background in ASO group coverage management has proved to be extremely valuable. Her primary focus on training, trending, and project management for the Cigna field claim offices will be critical to our future partnership. Affiliated Computer Services (ACS) ACS is located in Dallas, Texas. Scott Bell, Division Vice President, has been with ACS (or the company ACS purchased "Unibase") for 18 years. As the division vice president, Scott oversees the four divisions dedicated to Cigna's business. This involves about 500 employees in the U.S., Ghana, Guatemala, and Mexico. Jason Hull, Sales Executive, manages the business partnership between Cigna and ACS. His responsibilities include contract negotiations and process improvements, and he serves as a liaison between ACS operations and Cigna. Jason has several years of experience in the Copyright 2012 Page 79 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions industry, all of which have been dedicated to managing business partnerships with ACS health care clients. Dale Kolvig, Strategic Business Unit Manager, coordinates the efforts of processing claims in the Cigna mailroom. Dale serves as one of the central points of contact for Cigna to resolve concerns and implementation of new business practices. He has been with ACS for over two years and has been in management in other companies for 10 years. i) Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non- responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) Understood. j) Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality dental care services to the City. Noted. 5. Proposed Network and Plan(s) Designs a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non- responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) Understood. b). Provide any other information which , the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. Noted. 6. Customer Service. Banking, Reporting Capabilities, & Benefit Administration a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non- responsive. (Note: Proposers may submit partial proposals based on the products offered through their company.) Understood. b). Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. Noted. 7. Price and Cost Effectiveness Copyright 2012 Page 80 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment and return same with Proposal shall deem any Proposal received non- responsive. (Note: Proposers may submit partial proposals based on the products offered throujh their company.) It is the intention of the City for all contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same. Understood. b). Provide any other information which the Proposer deems relevant to its organization and/or its ability to provide quality health care services to the City. Noted. 8. Local Preference For Proposers seeking local preference consideration in the evaluation process, the following information must be provided with proposal, pursuant to Section 1.49 of the General Conditions: a) State the Primary Office Location of the Proposer DEMO Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, Florida, 33323 Corporate Address Cigna Health and Life Insurance Company (CHLIC), a Cigna company, is located at: 900 Cottage Grove Road Bloomfield, Connecticut, 06152 b) Provide location from which the Proposer will be based to perform the work. Sunrise, Florida. 9. Performance Guarantees Performance Guarantees will be required regarding: a) Implementation b) Time to Process c) Processing Accuracy d) Financial Accuracy Copyright 2012 Page 81 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions e) Average speed of response f) Account management Confirmed. We have provided Performance Guarantees to include the above criteria. 10. List of Attachments to be completed and returned with Proposal (Submit Questionnaires appropriate to the products von are proposing) a) Attachment A b) Service Fee Schedules for all applicable locations Cigna has attached a DHMO fee schedule in the Executive Summary section of the binders. c) Copies of network directories (DadeBroward/Monroe/Palm Beach/Ocala/Orlando/Raleigh, N.C.) Cigna has attached network directories electronically for this proposal submission. d) Sample communications and ID card Cigna has attached sample communications and ID cards electronically for this proposal submission. e) Geo Access reports Cigna has provided GeoAccess reports electronically for this proposal submission. f) Disruption reports for DHMO, DPPO or both if applicable. Disruption report must .be based on current DHMO provider for proposed DHMO services, and current DPPO provider for proposed DPPO services Cigna has attached Disruption reports electronically for this proposal submission. g) Report samples Cigna has attached report samples electronically for this proposal submission. Copyright 2012 Page 82 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Terms and Conditions 5. Evaluation Criteria The City's Selection Committee will evaluate proposals and will select the proposer which meets the best interests of the City. The City shall be the sole judge of its own best interests, the proposals, and the resulting negotiated agreement. Proposals received shall be evaluated on the criteria noted below. In performing the evaluation, only information contained within the Proposal will be considered, unless otherwise stipulated and/or other clarifying information is requested by the City. Proposals from firms that do not meet the minimum qualifications set forth will not be considered further. The proposer granted the contract will be required to maintain the minimum qualification requirements during the term of the contract and any renewals. Each member of the Selection Committee shall independently review each proposal using the criteria listed below. Proposers meeting the Minimum Qualifications criteria will have their proposals evaluated and scored. The Selection Committee will rank and recommend proposer deemed to be the most highly qualified to perform the required services. The following criteria will be utilized to select the firms submitting proposals: CRITERIA PERCENTAGE Proposer's Organization, Qualifications, Capabilities 15 and Financial Stability Proposed Network and Plan(s) Designs 30 Customer Service, Banking, Reporting 20 Capabilities, and Benefit Administration Price and Cost Effectiveness 25 Local Preference, if applicable 5 Performance Guarantees 5 100 Understood. Copyright 2012 Page 83 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Financial Stability and.Experience 1. ' Please provide the full business name of your company, mailing and physical address, telephone and fax number, email address, and web site address. The legal name of our company is Cigna Dental Health of Florida, Inc. and Cigna Health and Life Insurance Company (CHLIC). Cigna Dental Health of Florida, Inc. 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, Florida 33323 Phone: 954.514.6600 Fax: 954.514.6905 Cigna Health and Life Insurance Company (CHLIC) 900 Cottage Grove Road Bloomfield, CT 06152 Phone Number: 860.226.6000 Our website addresses are www.Cigna.com and myCigna.com. 2. Which location would be the primary office to service the City's account and what services will be provided through this office? Your existing account manager, Yesenia Sanchez, will be responsible for your dental plans as well. She may still be reached at: Cigna — South Florida Sales 1571 Sawgrass Corporate Parkway, Suite 140 Sunrise, Florida, 33323 Phone: 954.514.6887 Fax: 954.514.6905 Customer service for City of Miami's employees will be provided by customer service associates (CSAs) located in our Denison, Texas; Moosic, Pennsylvania; and Visalia, California, customer service centers. Our DPPO claim service model leverages our technology to support a highly efficient virtual network of experienced claim processors. To ensure an optimal level of accuracy, claims are paid across the network based on processor expertise within specific claim categories. Our claim,processors are located in Visalia, California; Moosic, Pennsylvania; Denison, Texas; and work -from -home locations. DEMO specialty referrals are processed from the Visalia service center, located at: 5300 West Tulare Avenue Visalia, California, 93277 3. Please list other companies with whom you have financial interest (i.e. insurance companies, PPOs, HMO, MGUs, Brokerage operations, etc.). Copyright 2012 Page 84 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Cigna maintains information related to investments as proprietary and confidential. 4. In the last five years, has your business entity ever been involved in a merger or had a change of ownership? If yes, please describe. Yes. On August 31, 2012, Cigna announced the acquisition of Great American Supplemental Benefits Group, one of the largest distributors of supplemental health products in the United States. The new business positions Cigna as one of the largest producers, distributors, and marketers of supplemental health care and related products in the United States. The acquisition of Great American aligns with Cigna's growth strategy by: • expanding its portfolio of health solutions to customers in the United States individual and seniors business while strengthening its customer -centricity focus • enabling Cigna to offer greater value throughout all stages of life On January 31, 2012, Cigna announced it has completed its acquisition of HealthSpring, expanding Cigna's presence in the Seniors and Medicare segments. Through this acquisition, Cigna expands its capabilities and product offerings to better serve our members throughout their life stages. On December 1, 2011, Cigna announced that it has finalized the acquisition of FirstAssist Insurance Services Limited following regulatory approval from the United Kingdom's Financial Services Authority. The acquisition enhances Cigna's presence in Europe and enables us to offer an expanded range of products and services to our customers across our businesses in Europe and Asia Pacific. FirstAssist Insurance Services and FirstAssist Legal Protection will be part of Cigna International's Health, Life & Accident division. In August 2010, Cigna acquired Vanbreda International, based in Antwerp, Belgium, giving Cigna unmatched global reach in expatriate benefits and further accelerating Cigna's global growth strategy. Privately owned, Vanbreda International specializes in the provision of worldwide medical insurance and employee benefits to intergovernmental and non -governmental organizations, including international humanitarian operations, as well as corporate clients. Cigna acquired Kronos Optimal Health Company, a Phoenix -based health and wellness company that specializes in lifestyle management programs, face-to-face coaching, biometric screenings, and health education programs, in February 2010. This acquisition granted Cigna an extensive nationwide network containing approximately 13,000 health coaches, health educators, and screeners. Great -West Healthcare, the Healthcare Division of Great -West Life & Annuity, was acquired in 2008. This acquisition broadens our distribution reach and provider networks in key geographic areas of the country, particularly the Western regions, and expands our range of health benefits and plan coverage's. Copyright 2012 Page 85 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami - RFP No. 336312 Attachment A — Questionnaire Mid -South Administrative Group (MSGA), a third -party administrator of employee health benefits and services in Memphis, was acquired in 2007. We have not had a change of ownership in the last five years. 5. Within the last five years, has your business entity had a change of name, and/or used a d.b.a. or is it operating under an assumed name? Yes. In the last fives years, we have added Cigna Health and Life Insurance Company (CHLIC). 6. If an insurance company, what is your current rating with A.M. Best, Moodys, Fitch or Standard & Poor's? DHMO Cigna Dental Health of Florida, Inc. has an A.M. Best rating. of A- (excellent). The other agencies do not provide ratings for the health plans. DPPO Cigna Health and Life Insurance Company (CHLIC), a Cigna company, is currently rated by A.M. Best, Moody's, and Standard & Poor's (S&P). These ratings are reviewed annually. Rating; Organization Rating A.M. Best A Moody's A2 Standard & Poor's A We are not currently pursuing a rating from Fitch for CHLIC. 7. Describe any previous or pending lawsuits and/or bankruptcies in the last 7 years. In an industry where lawsuits are commonplace, Cigna is involved in lawsuits arising, for the most part, in the ordinary course of business. While the outcome of all litigation involving Cigna cannot be determined, litigation is not expected to result in losses that would be material to results of operations, liquidity, or financial condition. All litigation against Cigna related to managed care products is referred to a specialized unit of in- house legal counsel for review and handling. After thorough review of the facts and circumstances of each case, in-house counsel attempts to resolve the matter as expeditiously as possible, frequently achieving resolution through in-house administrative processes. Specific details of individual lawsuits and settlements are not available as they are maintained as confidential. Cigna has not experienced any bankruptcy proceedings or bankruptcies. 8. Have any of the principals in your firm or any of your employees (former or current), ever been indicted or convicted of mishandling/misappropriating any insurance company or client funds? If yes, please provide details. Copyright 2012 Page 86 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire To the best of our knowledge and belief, neither Cigna, nor any of its Principals, Officers, or Directors has ever engaged in any violation of a Federal or State Criminal Statute; or ever been indicted, convicted, or entered a plea of guilty, non vult or nolo contendere to any violation of a Federal or State Criminal Statute; or ever engaged in violation of any nature regarding work on contracts performed by it. 9. Describe your current procedures for handling client or insured complaints and State Insurance Department complaints. The response below is in regards to State Insurance Department complaints. Our business is a -heavily regulated industry: We are subject to numerous regular inquiries and oversight by various state and federal authorities. When one of our companies is presented with regulatory inquiries, it is our policy to cooperate fully to resolve any issues. 10. Has the company (TPA) or its principals ever been adjudged bankrupt? If yes, please explain. Cigna has not experienced any bankruptcy proceedings or bankruptcies. 11. Have you ever been involved in an audit by the Department of Labor (DOL)? If yes, please provide details. Several routine Depail►nent of Labor investigations of our business practices concerning ERISA-governed plans have been conducted in the past decade and each case resulted in no action being taken. 12. Do you carry a TPA errors & omissions policy? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? • What is the deductible or self -insured retention? • Is contract a claims made policy or a claims made and reported policy form? Yes. Cigna maintains professional liability errors and omissions (E&O) insurance coverage for errors and/or omissions that may have (or are alleged to have) occurred during the normal course of Cigna's business such as account set-up, claim processing, provider negotiations, utilization review, provider selection or claims services. The coverage and the extent of coverage depend on the nature of the case, and every case varies. This coverage is provided on a claims -made basis. A certificate of insurance evidencing this coverage is provided. &O Coverage Overviey nsurance; Carner;< olcy Pero Copyright 2012 Page 87 of 151 Cigna Improved Oral Health. Lower Costs. Attachment A — Questionnaire EB,OCoverage Overview City of Miami RFP No. 336312 13. Do you carry a comprehensive general liability policy? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? What is the deductible or self -insured retention? nsuranceCarner ol�cy Pero ACE American Insurance Company 7/1/12-7/1/13 $1 M/occurrence American Guarantee and Liability Insurance Company (1) 7/1 /12-7/1 /13 $25M aggregate Cigna's commercial general liability coverage insures Cigna for third party bodily injury, property damage, and personal and advertising injury allegations made against the company. The policy contains an additional insured provision that states: Additional Insured(s) - any person or organization that you are required by written contract to include as an additional insured The policy also contains a Waiver of Subrogation provision that states: Waiver of Transfer of Rights of Recovery Against Other - any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed before the date of loss Cigna also maintains an umbrella liability policy via American Guarantee and Liability Insurance Company that provides limits in excess of the primary commercial general liability policy. Both policies are on an occurrence basis. A certificate of insurance evidencing this coverage is provided. 14. Do you carry a fidelity bond? • If yes, who is the carrier? • What is the expiration date of the policy? • What are the limits of coverage for the policy? • What is the deductible or self -insured retention? • What are the total annual aggregate funds handled for all clients? idelityBond Coverage Overview rimaryInsurance Carrier;',' olicyjPeriod imit Copyright 2012 Page 88 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire ideht•yBond Co• verage Overview Chartis 4/30/12-4/30/13 $20M Cigna maintains a fidelity bond to provide coverage for losses resulting directly from dishonest or fraudulent acts committed by an employee acting alone or in collusion with others. Dishonest or fraudulent acts can cause Cigna to sustain such losses, and provides the employee or another person or entity with financial benefits. The fidelity bond is provided on a claims -made basis. A certificate of insurance evidencing this coverage is provided. 15. Have claims been made against any of the above policies in the past three (3) years? If yes, please provide details. Due to the inherent confidential nature of the claims data and Cigna's confidential relationship with its insurers, Cigna is unable to release claims history or loss data to third parties or business partners. However, publicly available claims and litigation information can be obtained directly from U.S. Securities and Exchange Commission filings or by visiting the Investor Relations page at Cigna.com for our most recent disclosures: http://www.cigna.com/aboutus/investor-relations 16. Provide a list of 5 references of clients of similar size, preferably in the public sector. Please include contact name and telephone number. J Palm Beach County Sheriff's Office Benefits Provided - DHMO & DPPO Name of Contact - Hilda Gonzalez Telephone Number - 561.681.3286 South Florida Water Management District Benefits Provided - DHMO & DPPO Name of Contact - Linda Hayden Telephone Number - 561.682.6427 Collier County Government Benefits Provided - DPPO Name of Contact - Alice Toppe Telephone Number - 239.774.8966 University of Miami Benefits Provided - DHMO Copyright 2012 Page 89 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Name of Contact - Jennifer S. Cohen Telephone Number - 305.284.6835 Lee County Sheriff's Office Benefits Provided - DPPO Name of Contact - Dawn M Heikkila Telephone Number — 239.477.1331 Adequacy of Network and Qualifications of Providers 1. Please provide the Geo Access summaries for employees who fall both within and outside the network. The City would like to use 2 providers in 15 miles as the access standard. Provide this report for General Dentists, Endodontists, Periodontists, Oral Surgeons and Orthodontists. Cigna has provided GeoAccess reports electronically for this proposal submission. 2. Complete the following tables regarding your network with both the number of unique providers and individual office locations separately: DHMO Number of Unique.Providers County General Ortho Endo Oral/Max Ped Periodontics Broward 345 34 38 45 50 49 Miami Dade 331 48 34 49 44 33 Monroe 2 0 0 0 0 0 Palm Beach 193 34 29 35 28 26 Number of Locations' Based.on Unique Locations County General Ortho Endo Oral/Max Ped Periodontics Broward 162 44 47 45 43 52 Miami Dade 169 55 27 41 28 36 Monroe 2 0 0 0 0 0 Palm Beach 81 44 37 44 29 27 u f Provi• ders Accepting l ased on Unique Providers mber:o County General Ortho Endo Oral/Max Ped Periodontics Broward 340 N/A N/A N/A N/A N/A Miami Dade 323 N/A N/A N/A N/A N/A Copyright 2012 Page 90 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Number of ProvidersiAccepting New Patients: Based on Unique Providers Monroe N/A N/A N/A N/A N/A Palm Beach 190 N/A N/A N/A N/A N/A DPPO umber of Unique Providers County General Ortho Endo Oral/Max Ped Periodontics Broward 969 72 70 66 72 90 Miami Dade 985 99 59 66 66 61 Monroe 25 2 4 0 0 0 Palm Beach 632 54 66 57 52 54 umberof Locations Based on Unique Locations County General Ortho Endo Oral/Max Ped Periodontics Broward 715 95 92 73 73 110 Miami Dade 828 127 63 67 53 82 Monroe 13 2 3 0 0 0 Palm Beach 510 76 89 73 54 73 Number of Providers Accepting New P,atients County General Ortho Endo Oral/Max Ped Periodontics Broward 100% 100% 100% 100% 100% 100% Miami Dade 100% 100% 100% 100% 100% 100% Monroe 100% 100% 100% 100% 100% 100% Palm Beach 100% 100% 100% 100% 100% 100% Cigna DPPO network dentists do not cap or close their offices. Members are not required to select a primary network dental office. 3. How often are provider contracts renegotiated? All Cigna dental network agreements with dentists expire on December 31st of each year and are automatically renewed, unless Cigna or the dentist terminates the contract. The contract may be terminated by either party with 60 or 90 days (according to state regulations) written notice anytime throughout the year. 4. Do your contracts include a specific clause which limits the amount of increase? Are there automatic annual increase provisions included in any of your contracts? A dentist's compensation is reviewed and adjusted upon request unless other arrangements have been made. There are no automatic annual increase provisions in our contracts. A participating dentist can receive additional .compensation if utilization patterns are outside expected' levels. There is no language in the contract that limits the Copyright 2012 Page 91 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire amount of an increase by either party at anytime over the life of the contract and the contracts do not have a maximum increase provision. 5. Are you able to service participants/dependents out of the Miami area through your DMO (DHMO) network? How? Our DHMO network is nationwide allowing each family member has the option of selecting a different network general dentist, so dependents living away from home can choose one in their area. If there is no DHMO network dental office available in the dependent's community, dependents should schedule routine and preventive care with their family's network general dental office. In the case of emergency treatment occurring out of town, we will reimburse the member for the cost of diagnostic and palliative dental procedures administered by any licensed dentist based on the patient charge schedule emergency care benefit. 6. What is your standard process and advance notification timeframe to notify the City and its members of network changes? DHMO National network changes are reported monthly and compared to current client membership locations. Depending on the membership impact, the City will be notified up to 60 days before a network dentist leaves the network. Members are then transitioned to another network dentist through written notification. For the latest information about additions or changes to the network, and for assistance in enrollment or dental office transfers, our automated Dental Office Locator option allows callers to enter their zip code and hear a list of nearby dental offices 24 hours a day. This list can also be faxed. Members can enter a dentist's phone number to see if he/she participates in the Cigna DHMO network. If thereare multiple dentists with the same telephone number, the system will speak back the name of each dentist that can be reached at that office. Only offices currently accepting patients are listed. To use the Dental Office Locator, members can dial our toll -free number, 1.800.Cigna24. Dental office lists are also available 24 hours a day on our website at www.Cigna.com. DPPO Since there is no need for members to select a primary care dentist we do not notify members if a dentist leaves the network. Members can verify the status of a dentist by calling our toll -free number, 1.800.Cigna24, or visiting our website at www.Cigna.com. 7. Do you have a system for maintaining credentialing information? How often is each provider re-credentialed? Yes. Modeled after the highest national standards, dentists must meet the following credentialing requirements to participate in the Cigna DHMO and Cigna DPPO networks. Credentialmg Requirements PrimarylSecondary Source Verification State license State Board of Dental Examiners (BODEX) Copyright 2012 Page 92 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Credentialing Requirements PrimarylSecondarySource Verification Drug Enforcement Administration certificate (except orthodontists) National Technology Information Services website, BODEX, applicable state agency, or copy of certificates Graduation from accredited dental school BODEX, copy of certificate from a school accredited by the ADA or directly from the graduating school Specialty training verification (if applicable) ADA Master File or copy of certificate Malpractice history National Practitioner Data Bank (DHMO only) Professional liability insurance Copy of declaration page or binder Controlled substance certificate (if applicable) BODEX, applicable state agency or copy of certificate Application and contract Both must be signed by the dentist Additionally, as part of our comprehensive quality management program, Cigna also verifies the following during the initial credentialing process. Additional Credentialing Requirements .. , ,.. ke ,'Checd Malpractice coverage ✓ Detailed malpractice history (For all DHMO and for PPO dentists as required by state regulations, and for all dentists with State Board Action or as requested by the Credentialing Committee) ✓ Detailed history of disciplinary action or litigation ✓ Detailed history of conviction for fraud or felony v Current CPR certification ✓ Handicap accessibility ✓ Adherence to accept and treat patients in accordance with the Americans with Disabilities Act and professionally recognized standards of dental practice ✓ At least one dentist, with one auxiliary staff member ✓ At least two operatories (DHMO) ✓ A recall system for ongoing appointments ✓ An emergency system including 24-hour telephone service ✓ Emergency treatment within 24 hours ✓ Available appointment times (initial exam within four weeks) ✓ Performance of the following procedures (DHMO): • Restorative - amalgam and/or composite restorations • Endodontics - anterior, bicuspid and first molar root canal . • Periodontics - scaling and root planning • Oral surgery - surgical removal of erupted tooth • Pediatric dentistry - routine care for children. v ✓ ✓ ✓ Convenient office hours (at least three full days a week) ✓ Full-time hours at one dental office only (DHMO) ✓ Ability to administer nitrous oxide (DHMO) ✓ Submission of complete encounter data (DHMO) and acceptance of assignment (DPPO) ✓ The credentialing department credentials the dentists and presents the information to the credentialing subcommittee for approval or denial. A dentist who does not meet these standards will not be included in our network. Exceptions require authorization from the Copyright 2012 Page 93 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire regional dental director: Denials of prospective dentists based on quality of care issues are reviewed for appropriate reporting to the regulatory agency, as required by state and federal law. Cigna's e-onboarding tool automates the credentialing process. It allows dentist to complete, sign and submit all required documents electronically; including uploading of required credentials to participate in the Cigna network. This tool drives efficiencies for network provider practices by eliminating the manual paper process and getting dentists upand running quicker. Recredentialing We re -verify the credentials of network dentists at least every three years, based on the highest accepted industry standards. During the recredentialing process, we ensure that the standards of initial credentialing continue to be met. In addition, we review complaint tracking reports, facility, and patient records (DHMO only). If all the credentials are current, and there are no unfavorable findings, the recredentialing process is complete. If findings are unfavorable, our dental directors review the information and make recommendations to the credentialing committee for approval or denial of the dentist's continued participation in the network. 8. Please list your 2010 and 2011 annual network turnover rates (percentages) for both voluntary and involuntary turnover. We have included the requested turnover rates in the table below. >2010=Involuntary 2010 Voluntary 201y1 Involuntary 2011 Voluntary DHMO 7.4% 2.3% 6.7% 2.0% DPPO 2.5% 1.7% 2.9% 1.3% 9. Enter the percentage of providers that are reimbursed by the following methods in the table below: Method+of�Reinbursement %hReimbursedby Method Salary Discounted Fee for Service w/Withhold Fee for Service w/Bonus Fee Schedule Capitation Capitation w/Withhold Capitation w/Bonus Percentage Discount Other, please specify Please see below. DHMO Network general dentists' compensation consists of the following four components: fixed monthly payments (capitation), patient charges (copays), office visit payments, and Copyright 2012 Page 94 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire supplemental payments for certain covered procedures. Network specialistsare paid based on a fixed fee schedule. DPPO Reimbursements for covered procedures performed by a network dentist are based on the contracted fee schedule for that area. Network dentists and specialists are also contractually obligated to provide a 20 percent discount off their usual fees for any covered service not included in the fee schedule. For non -covered services, members are responsible for payment of the dentist's contracted fee for services on the dentist's fee schedule.* Reimbursements for covered procedures performed by a non -network dentist are based on maximum reimbursable charge (MRC) levels or fixed schedules, depending on the plan design. *Payment at the dentist's contracted fee is not applicable in all states 10. Is your plan licensed by the State of Florida? Licensed in what States outside of Florida? DHMO Yes. In Arizona, California, Colorado, Delaware, Florida, Kansas, Kentucky, Maryland, Missouri, Nebraska, Nevada, New Jersey, North Carolina, Ohio, Pennsylvania, Texas, and Virginia, Cigna maintains a subsidiary which is licensed as a prepaid dental plan organization, Prepaid Limited Health Services Organization, or dental HMO, in accordance with the applicable state law. In Connecticut, the plan is offered through our affiliate Cigna HealthCare of Connecticut, Inc. In other states, the Cigna Dental Care® plan is offered through policies underwritten by Connecticut General Life Insurance Company (CGLIC). We have specialized in dental program management since 1974, when Florida granted Dental Health, Inc. a Certificate of Authority to provide managed dental care. In 1984, Dental Health, Inc. became a subsidiary of Cigna Corporation marking the first entry of a major national insurance organization into the managed dental care field. DPPO Cigna Health and Life Insurance Company (CHLIC) is licensed to transact the business of insurance by the insurance departments of every state, and is subject to the regulation of each of those states within the scope of applicable law. The Cigna DPPO plan is approved in 46 states (every state except Nebraska, Iowa, West Virginia, and Idaho). CHLIC is subject to applicable federal laws and regulations. 11. When physicians are eliminated from the network, what is the timeframe given to allow participants to elect a new dentist? What is done for those that require a transition of care? Copyright 2012 Page 95 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire DHMO Members generally receive notification of provider terminations 30 days prior to their general dentist leaving the network. They will be referred to other network general dentists in their area. If none are available, a search will be initiated and, in the meantime, members can visit the dentist of their choice. We will cover any additional cost above the member's patient charge schedule responsibilities once treatment is approved. We generally require a 90-day advance notice for termination of the contract with the dentist (or more per state requirements). Whenever a termination letter is received, our provider relations managers are responsible for contacting the dental office to fully investigate the reasons for the termination. Every effort is made to retain qualified network dentists. DPPO Members are not assigned to a specific dental office for the DPPO. Therefore, we do not notify members when dentists terminate from the network. Members may call our dental office locator at 1.800.Cigna24 to hear the most current network information in their area. They can enter their zip code and hear a list of network dental offices in their area, or they can enter a dentist's telephone number to hear if he/she participates in the network. Updated network information is also available at www.Cigna.com. Continuation of Care For services requiring multiple visits, the network dentist is contractually obligated to complete all services under the applicable fee schedule, within 90 days from the date of termination. 12. Can Employees nominate their dentist to become a part of your network? Yes. Clients and members are welcome to use the following methods to refer specific dental offices to be included in the Cigna dental networks. They can: • call our customer service department with the dentist's information • email the dentist's name, address, and telephone number through our website at www.Cigna.com Once we receive the dentist's information, we contact them to discuss participation in the Cigna dental networks. We make every effort to contract with any dentist referred to us. 13. When is an area considered a network? What is the minimum number of dentists and specialists required necessary to constitute a network? While specific access standards may vary based on the needs of each of our clients, we have established a target of providing 2 dental offices within 10 miles of an employee's home zip code. This may vary based on state or local geographic conditions, such as dentist and customer population in the area. Copyright 2012 Page 96 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire We define network access in terms • of miles; the targets are further defined based on the nature of the market where our members reside. For example: urban areas: 2 dental offices within 5 miles suburban areas: 2 dental offices within 15 miles rural areas: 2 dental offices within 25 miles 14. If a provider leaves the network and doesn't notify the participant, who is responsible for the claim payment? If a referral (DHMO)/claim (DPPO) is submitted and the dentist withdraws from the network during the processing of the- referral/claim, it will be paid if approved, incorporating applicable plan discounts. The referral/claim will be paid because the dentist was a participating network dentist at the time service was rendered and/or initiated. Dentists leaving the program for any reason are contractually obligated to finish dental procedures in process. For services requiring multiple visits, the network dentist is contractually obligated to finish each service under the applicable fee schedule, within 90 days from the date of termination. 15. How will your company interact with the medical provider on claims that are both medical and dental in nature? DHMO With the Cigna DHMO plan, it is suggested that specialists submit a treatment plan for preauthorization for all specialty care. For procedures not requiring a specialty referral, separate claim forms are not necessary; however, the specialist must provide a copy of the claim form submitted to the medical carrier. DPPO The explanation of benefit (EOB) for the member and dentist will show that a service is covered under medical and instructions to forward the claim to the medical carrier. If Cigna is the medical carrier there is no need for two claim forms, the same form can be forwarded to Cigna medical. If Cigna is not the carrier, a second or different claim form may be required. 16. Are your network providers prohibited from balance billing the patient for any excess of contracted amount, except for deductibles and coinsurance? DHMO Yes. Network general dentist and specialist contracts contain clauses that prohibit dentists from charging members any additional fee, surcharge, or other cost for services, other than applicable patient charges as defined in the patient charge schedule or contract compensation schedule for covered procedures. A network dentist will be counseled if Copyright 2012 Page 97 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire they balance bill a member. Failure to comply with corrective action may result in the network dentist's file being referred to our credentialing committee for review of future participation in the network. For benefits we do not cover, dentists may charge their usual fees. For certain orthodontic procedures, network dentists may charge incremental costs associated with optional/elective materials, including but not limited to ceramic, clear, lingual brackets, or other cosmetic appliances. DPPO Yes. Balance billing beyond the contract fee is not permitted for any service provided to the member. In the case of Cigna owned networks, balance billing for covered procedures is strictly prohibited. We will counsel network dentists who do not comply, and continued balance billing may cause the network dentist's file to be referred to our credentialing committee for review of future participation in the network. Cigna's network dentists' contracts include language to assure that members are only charged in accordance with the contracted fee schedule amounts. They are prohibited from balance billing patients. Network fee schedules apply for covered services even after members have reached their annual maximums or exceeded frequency limitations, or if missing tooth limitations or other similar limitations are imposed by the applicable dental plan. For non -covered services, members are responsible for payment of the dentist's usual fee or contracted fee for that procedure. For leased networks, Cigna would address any balance billing with the dentist or our affiliated network partner(s). In the case of dentist contracted with an affiliated network, the affiliated network contract would apply. Out -of -network dentists may balance bill the difference between the DPPO plan's reimbursement and their usual charges. 17. Are network directories provided on-line? Yes. Network searches can be conductedthrough our websites, www.CiQna.com and myCigna.com. Members can locate a network dentist by name, city, state, and zip code. Driving directions are also provided. 18. Are printed directories available? At what cost? How often are they updated? Printed state directories are available to employees upon request Directory updates can be arranged through your account management team. Printed state directories are updated three times per year (April, August, and December) for the DHMO plan and two times per year (August and December) for the DPPO plan, unless a state requires different frequency requirements. Our automated Dental Office Locator is updated nightly and our websites are updated weekly. Copyright 2012 Page 98 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire 19. What is the network access fee? Is this included in the administrative services fee or included in claims, or in other? This plan coverage is fully -insured and ASO; the cost of network maintenance is included in the premium. Overall Plan Costs and Discount Arrangements 1. Is a rate/fee guarantee included? For what time period? Flag ease esponl 2. If you are proposing a self -insured plan, will you administer run -out? For how long? At what cost? Cigna is providing a fully insured and ASO quote. 3. Are there any initial set-up fees? Standard set up or implementation charges for the Cigna dental plan are included in the proposed premiums. We can build any additional costs, for non-standard administration or structure, into the premium. 13. Confirm you will provide 120 days notice for rate/fee changes. Depending on state regulatory requirements and/or client specific requests, clients are generally notified at least 30 days in advance of any changes in rates; however, we can accommodate more advanced notice. This would be established during the implementation process. 14. Describe any programs that you have developed to address special areas of focus, in particular, detection of overcharges and overpayments. • How is criteria developed for these programs? Cigna's overpayment identification and recovery program is outsourced to a specialty vendor in order to maximize our recovery results. Our overpayment identification, verification, and recovery program consists of the following: Overpayment Identification Process • Overpayments discovered by claim offices (during quality audits, special audits, etc), inquiry centers (dentist or member phone calls), and health plans (special audits, phone calls), are referred to our vendor for verification and recovery. The vendor "up -values" these overpayments, meaning they investigate for additional overpayments or trends based on the original overpayment. • Our vendors also use proprietary databases that filter and query claim data to identify potential overpayments by category (coordination of benefits (COB), Copyright 2012 Page 99 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire duplicate payment, not paid according to the contract, etc). Analysts investigate and verify the resulting overpayments before pursuing recovery. • Our vendors are also assigned special projects when Cigna becomes aware of a potential problem or error trend. • Are outside dentists/consultants retained to review questionable claims? Dental consultants are an integral part of the quality and utilization management program. We employ more than 20 full- and part-time dental consultants who sit on the quality management subcommittees, act as advisors to our customer service claim center staff, and provide their professional expertise at every stage of the dental claim process. Our dental consultants have extensive industry experience and represent every dental specialty. Their qualifications include education and licensing, experience in clinical practice and managed dental care delivery, and knowledge of treatment procedures, codes and standards. Most have over five years working experience with Cigna. DHMO Dental consultants review specialty referrals from network general dentists to determine if the treatment is beyond the scope of the general dentist and if the care is allowable based on our payment criteria and guidelines. DPPO Guidelines have been established to limit certification for certain types of services. Specific dental procedures (including cosmetic work, experimental procedures, and alternate benefit recommendations) are flagged by our dental system for higher review by the dental consultant. We have 8 full-time and 18 part-time dental consultants. 15. Please respond to the following with respect to claim overpayments: • If errors that resulted in overpayments to providers were detected in such samples, would our client be able to recover these overpayments directly from your organization? • If not, how would such overpayments be recovered? • How would you keep our client apprised of your efforts to recover overpayments? Our vendors use letters, faxes, and phone calls to recover monies owed to Cigna and our clients. When a vendor receives a refund, they remit the entire refund directly to Cigna's claim overpayment.fecovery (COR) unit. The COR unit processes the entire refund back into the claim system at the member level. Copyright 2012 Page 100 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Cigna pays the vendor a fee out of a managed expense account. We do not charge our clients for the vendor fee. In addition to identifying and recovering overpayments on our behalf, our vendors are also responsible for identifying overpayment trends, performing root cause analysis, and recommending solutions to reduce or eliminate future overpayments. 16. Please complete the following Claims Administration and Member Services chart: Claim Administration.and Member Service: ;Additional,'. ,cost Atilt Toll free telephone access to claim and member services ✓ Cost Containment programs, specify DPPO plans include the Dental Network Savings Program Claim adjudication Production and distribution of standard drafts, EOBs Network Access Multilingual language line Coordination of benefits Member satisfaction surveys ,Plan Sponsor Service. ................._................ dditwnal ost Anit? Drafting of plan documents Fully Insured As a fully insured client, the City will receive a copy of the certificate of coverage (COC) electronically via PDF file at no additional -cost. However, there may be additional fees for the client if numerous non-standard modifications are requested. The copy contains federal and,state requirements that are needed for insured accounts. We contract with an outside print vendor to handle the printing and distribution of certificates at no additional cost to the client. However, additional fees may apply for shipping to multiple locations. or individual members. ASO Copyright 2012 Page 101 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire dditional ostAmt Cigna prepares and provides a draft of the SPD at no additional cost to the City. The draft contains federal and possibly state requirements that are needed for ASO accounts. Drafts are provided electronically via PDF file. The draft may be adequate to serve as the City's SPD; however, the ASO client is responsible for creating the final document that is tailored to the benefits they are offering to their employees, and for ensuring compliance with ERISA and other applicable federal and state requirements. We contract with an outside pent vendor to supply printed copies of the booklet or SPD. However, additional fees apply based on coverage and services provided. Printing /mailing of plan documents to employee homes Cigna will mail the DHMO/DPPO plan documents and ID cards to the employee homes. DPPO plan documents are provided . in bulk to the City for distribution. We can provide a copy of the certificate of coverage (COC) electronically via PDF file at no additional cost Counseling with respect to federal and state regulatory requirements Clients should seek the service of competent legal counsel for direction on what procedures are needed to assure compliance with the HIPAA privacy rule. In the event that Cigna is responsible for noncompliance with HIPAA/HITECH, ERISA, and DOL requirements, the following hold harmless language applies: Initial system set up and administration of plan year revisions Consultation with respect to benefits and plan design Financial underwriting for both new business and ongoing revision Copyright 2012 Page 102 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire dditional post Amt Initial and ongoing eligibility and enrollment services ✓ Production and issuance of standard enrollment forms and ID cards to employee homes Cigna will mail the DHMO ID cards to employee homes. The DPPO ID cards are generic cards provided in bulk to the City for distribution. The employees can also print ID cards via our customer portal, myCigna.com. Billing/premium collection Provision of expected costs for budgeting purposes Provision of information for 5500 reporting Schedule A is produced for ERISA accounts with 100 or more employees. Schedule A is not required for church plans, government entities (schools, state and city employees), ASO coverage's, Canadian divisions, assumed reinsurance. Claim fiduciary responsibility CommunicationlAdmmistrative Materials ditional ost Amt Production and distribution of standard provider directories Productions of standard claim forms Production of standard employee communication materials Shipping of communication materials to employees We can provide communication materials electronically to the City or ship to the City for distribution. Mailing to the employee homes is an additional cost depending on the materials. We can provide an estimate once we identify the materials/scope of the mailing. »Additiona_ ;iiCostAmt'; Outgoing wire requests and bank draft handling charge Fully Insured Not applicable to fully insured products. ASO The City can specify whether funds are Copyright 2012 Page 103 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Additional; Cost Amt transferred daily or weekly. The client is responsible for initiating the wire transfer. Citibank or JPMorgan Chase may also initiate the transfer. Bank reconciliation charges Other banking charges, specify Fully Insured Not applicable to fully insured products. ASO Please view Pg. 11 for ASO banking procedures. Additional Services Included in EPP Additional Cost Amt COBRA administration and direct billing Although Cigna does not provide COBRA administration, we will work with any COBRA vendor selected by the client. HIPPA certification/compliance Internet services 17. Please complete the appropriate section below: ag''-UW Please Respond DMO Third'Pa Employee Administrator Fees,,; otal Fee Family Fully Insured Premiums DMO Premiums Employee Employee + Child Employee + Spouse .Family Fully Insured Premiums Other Premiums Employee Employee + Child Employee + Spouse Family 18. If you have proposed a self -insured plan, please indicate projected claims: Fla g :Plan Option DMO ease: espon rojected Claims Based on Plan Designs Copyright 2012 Page 104 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire PlanOption Projected Claims`Based on Plan"Designs Other 19. Other than those listed on the administrative services chart, are there any other fees or charges that the City would incur if the City accepted your proposal? If so, please indicate here. Flag UW•Please Respond 20. Please complete the following in -network Negotiated Fees chart for the designated counties as it applies to the DMO: DHMO The City's in -network fees are based on fee schedules. Cigna has attached the P6XVO DHMO fee schedule into the Plan Designs section of the binders. DPPO The following table reflects the DPPO Radius in -network fees. Broward County (333) legotiatedFee (What Patient Pays) Miami Dade County (331) Palm Beach County (334) Monroe County (330) 0120 Adult Exam $28 $31 $30 $28 1110 Adult cleaning $58 $64 $59 $59 2150 Amalgam Restoration $75 $88 $79 $83 7110 Simple Extraction N/A N/A N/A N/A 3310 Anterior Root Canal $528 $488 $503 $447 2750 Porcelain/Gold Crown $657 $693 $685 $701 5110 Complete Upper Denture $799 $838 $777 $808 6240 Porcelain/Gold Bridge Abutment $649 $657 $644 $665 6750 Porcelain/Gold Bridge Pontic $654 $699 $652 $682 21. Please attach any corresponding fee schedules that will apply. Cigna has attached the P6XVO DHMO fee schedule into the Plan Designs section of the binders. 22. Is more than one fee schedule utilized on a national basis? If so, please explain. Yes. To achieve the best discounts nationwide, we offer 271 standard schedules which are assigned by 3-digit zip code and/or the provider level. In addition, we have the capability to assign custom schedules at the provider level. 23. Are you willing to offer the executive plans as standalone plans? At what cost? Copyright 2012 Page 105 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire The executive plan was priced assuming it will be packaged and sold alongside the Voluntary DPPO and DHMO plans. If the City would like to offer the executive plan as a standalone plan then Underwriting will need to re -rate the executive plan. Reporting Capabilities 1. Attach sample copies of your proposed reporting packages. Include proposed reports for financial, claims, utilization, billing, accounting, banking, etc. We have included the requested reports electronically with our proposal submission. 2. What reporting is available on-line? DHMO Cigna can provide utilization reporting in an electronic feed, if necessary. DPPO CignaAccess.com provides tools and information to support clients in the following key areas: Claim Inquiry - View DPPO paid claim information at the member level. Clients can also view deductible and lifetime maximum accumulation data at the member level. (The client must be a recipient of Protected Health Information per HIPAA). Eligibility and Coverage Inquiry - View DPPO eligibility and coverage information at the member level. Clients can also print temporary ID cards. (This feature does not require the client to be a recipient of Protected Health Information). Automated Eligibility Management and Reporting Tool - Clients that submit eligibility via our automated eligibility process can access and download fallout reports. You can review key file processing metrics that provide a historical view of file processing results, including file processing timeliness, member defect rates, and error resolution cycle times. Employee Enrollment and Maintenance - Enroll and maintain coverage elections and demographics for their employees and dependents. Transactions are posted immediately to the internal eligibility system. Clients can: - add/delete a dependent - end employee coverage - reinstate employee/dependent - process life status changes • Eligibility Reports and Statistics - Create and download eligibility reports that include member listings and census reports. Clients can tailor the reports to meet their needs. Data is available in real-time as it appears in our eligibility system at the time of the request. If clients submit electronic eligibility files, they can also use the Automated Eligibility Management and Reporting Tool to access and download user- friendly fallout reports and key file processing metrics. Copyright 2012 Page 106 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Premium/Fee Invoices and Online Bill Payment - Electronic versions (PDF) of the CARBS premium/fee invoices are available: - system generated notification when the invoice is ready - clients retrieve, view, save, or print the invoices at their convenience - ability to pay bills online Financial Reports - Review standard DPPO financial reports which include monthly experience reports (excluding premium) and lag reports. Reports are posted to the Web by the 10th calendar day of the month. 3. Is on-line reporting accessible to individuals designated by the City (and approved via HIPAA)? Yes. Cignaaccess.com provides tools and information to support individuals designated by the City. Clients control access to sensitive plan data for different employees based on their specific job position. Communications and Enrollment Capabilities 4. Describe your internet capabilities in regards to the following areas: • Customization to City of Miami plan design information • Enrollment • Forms • Change of status • Employee personal access information (claims, EOBs, dependent information, etc.) • Banking • Employer/consultant reporting • Comparative dental cost information • Other For Members The following member information and self-service functions are available through myCigna.com: • personalized coverage details lookup • DPPO claim status inquiry capabilities • DPPO electronic explanation of benefits (BOB) and explanation of payment (EOP) display • DPPO deductible, out of pocket, and lifetime maximum accumulation presentment • network dentist search with maps and directions • DPPO claim forms and submission information • dental prevention and wellness information, including WebMD articles Copyright 2012 Page 107 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire • glossary of dental terms • DHMO ID card requests • print temporary dental ID cards • dental claim office phone numbers and addresses and customer service contact information • frequently asked questions • dental Treatment Cost Estimator • information about our Healthy Rewards® discount program The following provides a brief overview of tools available to members: Treatment Cost Estimator (TCE) Members will have access to our consumer -driven tool, the dental Treatment Cost Estimator (TCE). The TCE is a user-friendly, extensive web -based tool that allows members enrolled in any Cigna dental plan to estimate and plan for their dental care costs, both on a procedure code level and a treatment level. The TCE uses a large national utilization database to provide geographically based dental fee estimates that, among other things, enables our members to estimate their out-of-pocket costs, view what their savings would be with Cigna for treatments and procedures, and displays what the treatment or procedure would cost without insurance. Cigna Dental Cavity Risk Assessment Tool Members can also access the Cigna Dental Cavity Risk Assessment Tool. This tool, which is available in both English and Spanish, measures the risk of tooth decay for members and their family members, and helps dentists identify their risk of getting a cavity. The assessment consists of 12 questions for adults and 16 questions for children under the age of 12. Periodontal Risk Assessment Tool (PRA) Our Periodontal Risk Assessment tool allows members to assess their risk for periodontal (gum) disease in minutes by answering 20 simple questions. Available in both English and Spanish, this online quiz provides the user with a score that helps forecast their risk for having gum disease. Users can print the results to share with their dentist at the next visit. Cigna Dental Oral Cancer Awareness Quiz This ten -question quiz is designed to help members test their knowledge about the basics of oral cancer: where it can occur, warning signs, common risk factors, and what members can do to help reduce their own risk. Please note, this quiz does not score members responses or evaluate risk as the PRA and CRA do; instead, this quiz is a fast, easy and fun educational tool. Members can take what they learn and ask questions at their next dental check-up. Copyright 2012 Page 108 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire To - take • a tour of myCigna.com, go to https://mv.cigna.com. The user ID is "userdemo123" and the password is "reviewl" (case sensitive). Please look for the various dental presentations throughout the site, and take a look at the myCigna.com tour offered on the main page. For Clients CignaAccess.com provides tools and information to support clients in the following key areas: Claim Inquiry - View DPPO paid claim information at the member level. Clients can also view deductible and lifetime maximum accumulation data at the member level. (The client must be a recipient of Protected Health Information per HIPAA). DHMO: Not available, even if bundled with medical, DPPO, DEPO, and/or Indemnity. Eligibility and Coverage Inquiry - View DPPO eligibility and coverage information at the member level. Clients can also print temporary ID cards. (This feature does not require the client to be a recipient of Protected Health Information). DEMO: Not available, even if bundled with medical, DPPO, DEPO, and/or Indemnity. Automated Eligibility Management and Reporting Tool - Clients that submit eligibility via our automated eligibility process can access and download fallout reports. You can review key file processing metrics that provide a historical view of file processing results, including file processing timeliness, member defect rates, and error resolution cycle times. Employee Enrollment and Maintenance - Enroll and maintain coverage elections and demographics for their employees and dependents. Transactions are posted immediately to the internal eligibility system. Clients can: add/delete a dependent end employee coverage reinstate employee/dependent process life status changes • Eligibility Reports and Statistics - Create and download eligibility reports that include member listings and census reports. Clients can tailor the reports to meet their needs. Data is available in real-time as it appears in our eligibility system at the time of the request. If clients submit electronic eligibility files, they can also use the Automated Eligibility Management and Reporting Tool to access and download user- friendly fallout reports and key file processing metrics. Premium/Fee Invoices and Online Bill Payment - Electronic versions (PDF) of the CARBS premium/fee invoices are available: - system generated notification when the invoice is ready - clients retrieve, view, save, or print the invoices at their convenience - ability to pay bills online Copyright 2012 Page 109 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Financial Reports Review standard DPPO financial reports which include monthly experience reports (excluding premium) and lag reports. Reports are posted to the Web by the 10th calendar day of the month. DHMO - Does not apply because DHMO is prospectively rated. • Monthly reports are available by the 10th business day of the following month; weekly reports are available the et business day of the following week; daily issued reports are available the next business day. Daily cleared reports are available two business days later. DHMO: Banking does not apply because DHMO is fully. insured Clients control access to sensitive plan data for different employees based on their specific job position. To tour CignaAccess.com; go to https://CignaAccess.cigna.com and click on the demo located on the upper right hand side or go to: http://www.maier.com/cig.na/cima-access/ A user ID and password are not needed. 5. What communication materials/assistance are included in your quoted fees/premiums (include materials, staffing and on-line capabilities)? Standard communication materials are included in the cost of the program. These are simple, easy -to -understand brochures that explain our plan coverage's and services. If the City would like additional custom materials, we have communication experts who will work with you to develop a custom communication strategy. Most of these materials can be provided electronically at no additional charge (email templates to forward to your employees, flyers to post to your internal site, posters to hang in high traffic areas, newsletter articles, etc.). Messaging may focus on benefit savings, prevention, using in - network dentists or enrolling in lower cost plans. These messages will be customized based on your specific needs. There may be an additional charge for high volume printing or direct mailing. We also recommend you schedule benefit enrollment meetings in your larger locations to communicate your Cigna plan options. Our experience has shown that employees benefit the most when they receive information directly from Cigna representatives. We will provide pre -enrollment event communications to generate excitement, as well as materials for your on -site event. This could include interactive games, quizzes, or presentations to help your employees understand their benefit choices. 6. Can the City's logo be included on these materials? Is there an additional charge? We would be happy to discuss customized materials with you. This may include adding your logo or including specific messaging that is important to your employees, or the plans you are offering. An additional cost may be incurred depending on the extent of the customization, or if there are print or mail costs. Copyright 2012 Page 110 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire 7. Describe your enrollment options (paper, on-line, recorded media, etc.). Up-to-date eligibility data is maintained in the automated client eligibility system based on enrollment information from the client's records, payroll system, online enrollment, or telephone enrollment. Eligibility files are submitted by electronic data transmission. Clients may submit eligibility information weekly, bi-weekly, monthly, or semi-monthly. We enter eligibility updates into our systems within two business days of receipt. Two types of automated eligibility feeds are accepted - total file and add/change. • Total File Processing or Positive Feed Update Process — A complete eligibility file is provided with each submission, and is then compared to our current eligibility files which are modified as needed. A positive file update is our preferred method as it provides an audit against current online eligibility with each update, helping to maintain consistent, accurate eligibility. • Add/Change Update Process - Only the changes for members and their dependents are provided, including additions, changes in information, and terminations. 8. Describe the communications that are available, and in what format for: • Enrollment • Network information • Claims information We are committed to educating members about their dental plans and how to maintain good dental health. Our standard pre -enrollment kit educates employees on dental benefits. This kit generally includes a product brochure, dental fee overview (DHMO), comparison of patient charges to national average charges summary of benefits (DPPO), and an enrollment form. Printed state directories are also available upon request. These materials allow benefits managers to conduct informative and educational enrollment meetings. Health fair assistance and materials are also available. For the Cigna DHMO plan, after enrollment, members will receive a consolidated booklet that communicates additional plan details, including their plan booklet, patient charge schedule, and other pertinent information. Members also receive an ID card under separate cover. For the Cigna DPPO plan, certificate booklets are sent to the City to distribute to your employees after they have enrolled in the plan. ID cards for the Cigna DPPO plan can either be sent to the City's main location or printed through our websites, myCigna.com or CignaAccess.com. In order for members to make informed decisions about their dental care, they need access to technology, information, and services that provide education and choice. Our website at www.Cigna.com provides additional information for members, including: • network dentist search with maps and directions Copyright 2012 Page 111 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire • - articles about.oral health for children and adults • glossary of dental terms • treatment cost estimator that enables members to estimate and plan their dental care needs • Once enrolled in a Cigna plan, members will have access to a wealth of information through our member website, myCigna.com, including: • eligibility verification • personalized benefits information • claim status inquiry and claim forms (DPPO) • deductible and lifetime maximum accumulation data (DPPO) • dental prevention and wellness information, including access to more than 200 medical and dental articles from WebMD • email form to request DHMO specialty referral status • DHMO dental office transfers • DHMO ID card requests and print temporary DHMO ID cards • print ID cards Memberswill also have access to our dental treatment cost estimator (TCE) through myCigna.com. The TCE is a user-friendly, web -based tool that allows members enrolled in any Cigna plan to estimate and plan for their dental care costs, both on a procedure code level and a treatment level. This on-line tool helps members objectively understand their estimated cost and scope of services for over 400 treatments and procedures. Our customer service center is staffed with trained professionals who help solve problems, explain dentists' treatment rationale or charges, and any other questions about the plan's operation. Employees can call 1.800.Cigna24 with questions about coverage, dental office transfers, procedures, or any other concerns. 9. Please attach samples (including ID card) We have included the requested samples with our proposal submission. Claims Administration Capabilities 1. How many months of historical claim data are stored in your claims system? DHMO Treatment history is maintained online indefinitely for use with plan limitations, such as the 24-month limitation on orthodontia. Specialty referral, billing, and eligibility files are also kept online indefinitely. Original forms and copies of materials issued to members are destroyed after we verify that the documentation was imaged correctly. Copyright 2012 Page 112 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire DPPO Our claim system maintains history online for 12-24 months; however, procedures with (needed to respond to inquiries or perform audits) that is older than 12 months is automatically transferred to our electronic archive and kept in the online retrieval system. The data is maintained an additional seven years in our claim center and the magnetic tapes are stored in our data center with a copy held for disaster recovery in another center. This ensures our compliance with ERISA requirements. Our claims system feeds from our reporting system, which holds five years of claims data for utilization reporting and client ad hoc reporting. Structure and eligibility are also kept online for 24 months and then purged from the system once per year. Original forms and copies of material issued to members are destroyed after we verify that the documentation was imaged correctly. 2. How far back in time can claims be processed on your system? DHMO Cigna requires network general dentists to submit encounter data when covered procedures are rendered to Cigna Dental Care members. In order to maintain the integrity of encounter data statistics, network general dentists are required to submit within 90 days of the service date. DPPO We do not have any contractual guidelines for the dentist about claim submissions other than our standard one-year claim filing limit. If the member or the dentist does not submit proof of loss within the one-year filing limit, the claim becomes no longer payable. 3. Is your system an on-line, direct access system or a plan/claims information storage and retrieval system? Provide a flowchart or brief description of its operation. DHMO Cigna's Webster claim processing system was developed in-house in the early to mid 1990s, to handle the specific needs of a DHMO plan. In December 2002, we began using Sun hardware and the Solaris operating system. The application provides online access to every service center 'supporting the DHMO plan coverage. Hardware upgrades are planned as appropriate based on business processing requirements and changes in technology. We also update applications regularly to meet new plan coverage needs and industry changes. Our system consists every module necessary to administer our plan, including account data, dentist files, specialty referrals, encounters, and eligibility. Specialty referrals are processed according to processing guidelines, and referral and encounter processing verifies eligibility. Dentist payment is accomplished directly by our system. Although we do accept paper eligibility, over 80 percent arrives electronically. This provides for an efficient and timely process, and eliminates errors due to manual data entry. Copyright 2012 Page 113 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire We offer 'a single eligibility feed solution and a convenient consolidated bill for clients who have more than one Cigna coverage. Our claim system automatically: • loads eligibility from CED electronic feed • verifies pertinent employee and dependent information • checks treatment history for tooth number, procedure code, and date of service • identifies any errors occurring during input to the operator for immediate correction • compares encounters against contractual limitations to avoid over utilization • verifies a match between treatment dates and the employees' and dependents' dates of coverage DPPO Cigna's DentaCom claim system was developed in-house in the early 1990s based upon our vast experience in the dental industry and the needs of our clients and members. It uses an IBM 9021.900 mainframe computer and is run under CICS (Version 4.1) with both macro and command level using VSAM file access. In 1996, when the Cigna Dental PPO plan was introduced, enhancements were made to support the processing of a DPPO plan. Major upgrades, since then, include the integration of data entry and auto - adjudication functions into an integrated health care systems environment; a central repository of eligibility and coverage/structure-related data; Cobol II upgrades; automated orthodontia payments; and a new explanation of benefits (EOB) system. Our system is updated with new CDT codes as well as HIPAA compliance enhancements. Dental logic prevents payment of duplicate submissions, assists with coding accuracy, and automates plan design features. The logic stores claim -adjusting parameters (guidelines based on dentistry standards), coverage exclusions and limitations, procedure frequencies, and dental plan information. This enables us to detect unbundled procedures and appropriate codes for payment and flags procedures needing further review. Dental history maintains the experience of each member to identify duplicate claims, deductibles, and maximum accumulators, and ensures that the status of the definition is accurate and current. Repetitive orthodontic payments are calculated quarterly and automatically sent without additional adjuster intervention until the maximum benefits are paid. Combined dentist checks/itemized explanation of benefits (EOBs) is calculated for payments being made to specific dentists on a given day. Flexible plan designs are administered based on usual and customary charges, percent off billed charges, or scheduled coverage. The alternate coverage provision allows for consideration of what is commonly performed for that condition whether it is less costly or more costly. Accumulators by plan year, calendar year, and lifetime maximums ensure that the correct amount is paid. Deductibles and out-of-pocket maximums are also tracked. Copyright 2012 Page 114 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Our claim system automatically: • loads eligibility files from CED electronic feed • tracks unprocessed mail/provides aged -mail reports • verifies pertinent information for each transaction • verifies treatment and coverage dates • protects against payment for prior procedures • checks history for tooth number, procedure code, and date of service • identifies any errors occurring during input • compares claims against contractual limitations to avoid over utilization • calculates payments according to R&C allowances and/or scheduled benefit amounts • identifies claims where potential COB opportunities exist for follow-up investigation by the processor • generates correspondence • issues checks and EOBs • produces biweekly bulk mailing of dentist checks 4. How long has your claims payment system been operational? Our DHMO system was developed in the early to mid 1980s and the DPPO system was developed in the early 1990s. 5. Can eligibility and claims transactions be accessed by the same person? Customer service associates (CSAs) have full "view" access to the claim system and are well equipped to handle member's questions including those related to specialty referrals/claims, eligibility, and network issues. Each CSA receives formal product, system, and network training to ensure a thorough grasp of our managed care philosophy. The following information is online and readily available to CSAs: Claim Information: CSAs have online access to up-to-date specialty referral and claim information. If there is any information they need that cannot be found in the system (i.e. purged information), they can obtain it within two weeks. Policies and Procedures: Claim and specialty referral files are automatically updated online following the completion of a transaction enabling claim processors/specialty referral reviewers and CSAs to access the current eligibility and claim history. Coverage Information: Plan features such as types of service, coverage limitations, amount of deductible, specific procedure exclusions, levels of coinsurance, and maximums are entered into plan specification databases, which drive the automatic calculation portion of the claim payment process for DEPO, DPPO, and indemnity claims. Copyright 2012 Page 115 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami REP No. 336312 Attachment A — Questionnaire Member Information: Part of the claim payment/specialty referral process is to verify employee and patient eligibility against information supplied on the claim/encounter form, by the policyholder, and by the plan specifications of the account. Dentist Information: Online dentist information includes tax ID or Social Security Number, name, address and telephone number, specialty, education, languages spoken, hours of operation, years in practice, board certification (if applicable), and fee schedules. 6. Describe enhancements made in the last 12 months and those planned for the next 12 months. DHMO Key large enhancements for 2011 include: 1. Revisions to electronic transactions - to comply with federal regulations and new 5010 format 2. Increase mailroom automation - in conjunction with the above, material changes to systems supporting the business process changes with our electronic mailroom. Key large enhancements planned for 2012 include: 3. Streamlined transaction processing and improved business activity monitoring. 4. New plan designs to meet changing market needs. 5. Completion of a new customer services desktop for improved customer service. 6. Improved Interactive Voice Response technology and applications to improve usability and customer service. 7. Other enhancements in support of regulatory compliance and business needs. DPPO Key large enhancements for 2011 include: 1. Revisions to electronic transactions - To comply with federal regulations and new 5010 format. 2. Increase mailroom automation - In conjunction with the above, material changes to systems supporting the business process changes with our electronic mailroom. 3. CDT 2011 - Upgraded dental transactions and code sets for CDT2011. 2012 plans are in finalization, however current possible projects include: 4. Enable EFT capabilities for provider payments on our platform. 5. Direct deposit information available on line for dentists. 6. Further enhancements to electronic transaction processing and information exchange with dentists. 7. Support Foreign Address mailings for our members. 8. Completion of a new customer services desktop for improved customer service. Copyright 2012 Page 116 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire 9. Improved interactive voice response technology and applications to improve usability and customer service. 7. Describe the mechanics/process of screening for duplicate claims. The system verifies that any claim being considered in the claim processing process does not resemble a claim previously submitted for that patient. If duplication is suspected, a message is instantly sent to the claim processor and the system displays the suspected duplicate charge. The claim processor can then verify whether it is a duplicate. The duplicate claim edit procedure applies to the same date of service, tooth number, and procedure code. 8. Can your system accept and track full eligibility data? Yes. 9. Can your system track each dependent by the dependent's name and social security number? Dependents are identified externally under a system generated number identifier and are assigned numerical suffixes. However, their plan information is maintained separately and not combined with the employee. Dependents must be under the same plan information as the employee. 10. What is your process for establishing student eligibility? Incapacitated dependent status? Cigna will not be verifying student status for the City. For a dependent over 19, the member will need to furnish evidence of the dependents' reliance upon them, in the form requested, within 31 days after the dependent reaches the age of 19 and once a year thereafter during his or her term of coverage. This definition of dependent applies unless modified by the group contract. 11. Under what conditions and by which individuals can your claims system be manually overridden? DIIMO A senior specialty referral processor or manager can override the system for extra - contractual exceptions. The referral system generates a variety of flags, such as suspected duplicates or patient ineligibility. The referral analyst cannot process an expense that has been flagged without taking appropriate action. Copyright 2012 Page 117 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire DPPO A senior claim processor or manager can override the system for extra -contractual exceptions, to, modify frequencies or age limitations, to increase or decrease coinsurances, to waive the deductible, or to make additional payments. The claim system generates a variety of flags, such as suspected duplicates, patient ineligibility, excess usual and customary charges, etc. The benefit analyst cannot process an expense that has been flagged without taking appropriate action. The benefit analyst cannot override certain flags (e.g., eligibility, payment approval limit, plan termination, and other critical coverage situations) that require a higher level of authority to override. As a control measure, our claim management staff closely watches the number of overrides. 12. How are manual overrides (if any) to your claims system are reviewed by claims managers? As a control measure, our claim management staff closely watches the number of overrides. The customer service claim center manager issues a report of all overrides weekly for review and verification by auditors and/or managers. 13. What are the minimum requirements for claims history transferred to your system(s) on a new account basis? DHMO Because the Cigna DHMO plan does not have lifetime claim history maximums or deductibles, converting from a prior carrier is not necessary. DPPO For plans with lifetime maximums, calendar/policy year deductibles or calendar/policy year maximums Cigna is able to accommodate prior financial accumulators, but we request at least 10 days for programming. An optional service charge will be applied. Dollars we can load, but are not limited to: • calendar/policy year maximums • lifetime maximums • carry-over deductibles • the amount satisfied toward the current year deductible The following list identifies the elements we would need for each employee and dependent to facilitate the transfer of dollars: • employee Social Security number • members name • relationship code Copyright 2012 Page 118 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire • date of birth • lifetime maximum paid to date • deductible year to date • calendar year maximum paid to date • orthodontic maximum paid to date 14. What system platforms are utilized for plan administration? Please describe. We utilize the Webster system for the DHMO and the DentaCom system for the DPPO. Our DEMO claim system automatically: • loads,. eligibility files by computer tape or electronic feed • verifies all pertinent employee and dependent information • checks treatment history for tooth number, procedure code, and date of service • identifies any errors occurring during input to the operator for immediate correction • compares encounters against contractual limitations to avoid over utilization • verifies a match between treatment dates and the employees' and dependents' dates of coverage Our DPPO claim system automatically: • loads eligibility files by computer tape • tracks unprocessed mail/provides aged -mail reports • verifies all pertinent information for each transaction • verifies treatment and coverage dates • protects against payment for prior procedures • checks history for tooth number, procedure code, and date of service • identifies any errors occurring during input • compares claims against contractual limitations to avoid over utilization • calculates payments according to R&C allowances and/or scheduled benefit amounts • identifies claims where potential COB opportunities exist for follow-up investigation by the processor • generates correspondence • issues checks and EOBs • produces biweekly bulk mailing of dentist checks 15. Will a direct claims payment system be utilized? Yes. 16. How long has the claims payment system been in place? Copyright 2012 Page 119 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Our DHMO system was developed in the early to mid 1980s and the DPPO system was developed in the early 1990s. 17. What percentage of claims are automatically adjudicated? DHMO Approximately 80 percent of specialty referrals and network general dentist encounter forms are auto -adjudicated. DPPO Our system automatically processes approximately 80 percent of claims due to the advanced dental logic in our claim system. While other companies may use only dental consultants to process alternate benefits or for less complex claims, our dental claim system does it automatically, which saves our clients money. Our claim system effectively processes eligibility, deductibles, maximums, reasonable and customary limits, pre-existing conditions, frequency limitations, and benefit exclusions. 18. What are the claims administration standards? We measure claim accuracy based upon the following categories/metrics. "Meth ndard Processing Accuracy 95% Financial Accuracy 99% Payment Accuracy 97°A) 10 Day Time to Process 92% 15 Day Time to Process 98% 19. How are non -network and out -of -area provider claims identified and paid? Based on our dentist file, the system determines whether the treating dentist is in the network. Our system automatically calculates the claim payment according to the member's eligibility, plan coverage, and services rendered. 20. What are the Eastern Standard Time hours of operation for the claims unit? Claim processing office hours are from 8:00 a.m. to 6:00 p.m., based upon the local time of the particular service center. 21. How are claims staffing levels established? In our customer service claim centers, we use a phone and claim (PAC) strategy. The PAC strategy refers to several customer service associates and claim/specialty referral processors who have been cross -trained in each location. They ensure, during times of either high absenteeism or higher than planned claim or call volume, that the PAC Copyright 2012 Page 120 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire strategy is implemented and that our clients and members receive no disruption of service. 22. Is there a dedicated claims unit for the City? DHMO Due to the typically low number of specialty referrals generated by any single group, we do not assign dedicated processors or units. Our standard process ensures the most efficient service for the City and your employees at a considerable savings. DPPO .,/ Due to the high volume of auto -adjudicated claims and the nature of our highly automated dental system, we do not assign dedicated claim processors or units. We are able to process claims most efficiently when all of our resources are available at a considerable savings. 23. How many bilingual customer service staff members do you have, and what languages do they speak? When calling the toll -free customer service line, callers are given the option to continue in English or Spanish. Callers requesting to continue in Spanish can speak to or leave a message for a Spanish-speaking customer service associate (CSA). We also use Language LineSM, an over -the -phone interpretation service that provides access to translation for over 175 languages. In addition to the language line, there are nine bilingual CSAs in our Visalia, California customer service claim center. 24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as requiredto date and for future scheduled compliance. Clients usually initiate the certification process for their plan members since the certification information originates from client records. The issuance of certifications usually coincides with the issuance of client COBRA notices. Clients must provide separate certificates for the member's active plan year, and for any COBRA plan year. Clients can send certifications along with the COBRA election and termination notices as part of the standard COBRA notification process. Clients should send certifications with termination materials no more than 31 days after coverage ends. Members may request certification of prior coverage at any time during the 24 months after either active or continuation coverage ends. 25. Do you maintain Performance Standards? If so, please describe the metrics and processes used? Is a third party independent auditing company used in the process? Yes. Copyright 2012 Page 121 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Ability to Administer Requested Plan Designs/Alternatives 1. Are you able to administer the dental plan designs as designated in this proposal? Yes, we have provided a DHMO plan, a Voluntary DPPO plan and an Executive DPPO as requested in the RFP. 2. If not, please indicate the deviations per plan. All deviations must be indicated in your response. We have provided our DHMO P6XVO patient charge schedule. The copayments vary from the current DHMO schedule. Please refer to the P6XVO for the member copayments. Account Management Staff 3. Complete the following chart with information on the management and service team you propose for our clients. ,.:Percent o of.`Miami: ime:Commitment aoC Through Implementation After Implementation Account Manager Yesenia Sanchez Senior Client Manager 50% 50% Day to Day Liaison Susan Martin Client Service Executive 10% 10% Implementation Coordinator Claudia Rodrigues Implementation Manager 100% 60% Customer Service Supervisor Jessica Chavez Customer Service Manager 10% 10% Claim Administration Supervisor Jessica Chavez Customer Service Manager 10% 10% Network Management Liaison Dawn Applewhite DHMO Kim Walker- DPPO Provider Contracting 10% 10% Other N/A N/A N/A N/A 4. Include the resumes of the above proposed team members. Yes. Cigna has attached resumes electronically for this proposal submission. 5. Is designated staff expected to maintain measurable client satisfaction standards? If so, please describe. Yes. Account management surveys and implementation surveys are conducted on a client -specific basis. Therefore, aggregated/overall results are not available. Copyright 2012 Page 122 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Cigna uses an account management report card to determine the effectiveness of our account management process. We conduct an account management satisfaction survey on a quarterly basis to ensure that our client's needs are being met on an on -going basis. Clients are asked to rate their level of satisfaction, from dissatisfied to completely satisfied, with their account management team in various topics. The report card is sent back to Cigna where results are compiled. If there is an unfavorable response, a meeting is conducted with the client to discuss the concerns. If necessary, a root cause analysis is completed and measures put in place to ensure continued satisfaction. Banking 1. What are your billing and premium payment procedures? Monthly invoices are automatically generated based on eligibility data provided by the City and maintained in our central eligibility database. Our Cigna accounts receivable and billing system is fully integrated with our eligibility system. As eligibility -related changes are processed, they are systematically generated to the accounts receivable and billing system throughout the business day. The City's billing representative will be able to view a pending version of your next invoice containing these changes to effectively respond to any billing questions you may have. Rate and structure changes are updated using the same approach. Our clients are able to receive a single, system -generated, eligibility -based invoice for all plan coverage's offered by Cigna on an insured, minimum premium, and/or ASO basis. There is flexibility in the date that bills can be produced and mailed. Dates available for bill production are determined on a client -specific basis, based on the plan coverage's selected and The City's timing preference. Bill timing options include: • Prior Bill - produce bills before the month of service (standard) • Current Bill - produce bills during the month of service • Client must agree to retrieve invoices and ad hoc reporting, if applicable, from Cigna access (PDF version). - Client must agree to remit payment via ACH or federal wire transfer. Client must agree to pay as billed. The print date of invoice must be no later than the seventh of the month. Clients may select one of the following calendar dates for bill production: • Prior Bill - recommended calendar date is between the 16th and 28th • Current Bill - recommended calendar date, if above requirements are met, is between the first and the seventh A case installation specialist will work with the City to determine the billing date and timing that meets the City's needs. The bill will be produced each month on the calendar date that is selected. Copyright 2012 Page 123 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire The bill reflects eligibility data in our system as of the close of business on the day the bill is produced. Additions, changes, and terminations processed through that date will be reflected on the bill. Eligibility changes processed after the bill is produced will be reflected on the next month's bill. The monthly billing package provides a summary page detailing the total amount to be remitted. The total amount includes charges for current month of service, retroactive adjustments, and any unpaid amounts from prior bills. Eligibility updates that were not processed in time for the current month's bill will be reflected on the next bill. Premiums and fees are due as of the first day of the coverage month and are considered delinquent if payment is not received by the last day of the month. 2. What financial reporting is included? DHMO Yes. We generate reports analyzing premium and income, as well as disbursements for fixed monthly payments, specialty referrals and administration. These reports are formatted for internal use only. Due to the nature of our prepaid plan coverage, and the expenses associated with production and mailing, we do not provide any standardized reports about this information to the group. DPPO Financial reports are also available to the City monthly that show premium, claim, in - force, penetration, and monthly check count. 3. What are the funding requirements (i.e., checks issued, checks cleared?) Fully Insured Cigna is offering fully insured quotes that do not require funding. ASO Our client's preferred method of funding is based on checks cleared (cashed). 4. Is bank reconciliation included in your fees/premiums? Fully Insured Cigna is offering fully insured quotes that do not require reconciliation. ASO Each month, the City will receive the following: • issued check register includes all checks issued, stopped, reversed, replaced, aged - voided, and refunded Copyright 2012 Page 124 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire • monthly reconciliation (statement) from Citibank or JPMorgan Chase includes outstanding and paid checks for each month; this report will also include stop payments, canceled, replaced, and aged -voided checks (an aged -voided check is any check outstanding over 15 months old) At the time the bank statements are posted to CignaAccess.com, the client financial specialist (CFS) will reconcile the account, balancing Citibank or JPMorgan Chase issued, stopped, canceled, and replaced checks to Cigna amounts. If any adjustments are made, the CFS will include notes to proof of reconcilement (POR) explaining the adjustments along with an expected timeline for incorporating the corrections. Citibank and JPMorgan Chase reconciliations must be completed and PORs posted to CignaAccess.com within three days of receipt from Citibank and JPMorgan Chase. 5. Please give the following information for your principal banking relationship (to be used as reference): • Bank name • Address • Phone number • Contact name and title Fully Insured The proposed plan is fully insured; banking will be administered by Cigna. ASO Bank Name Banking arrangements for our ASO programs are administered by Citibank, N.A., or JPMorgan Chase. However, The City may select any bank to fund the program account. Our clients incur no monthly banking fees for Citibank, N.A., or JPMorgan Chase as they are part of the cost of administering the ASO plan. The client is responsible for any costs associated with wire transfers from their local bank to Citibank, N.A., or JPMorgan Chase. Address Fl Phone Number ase esj on ease espond Contact Name and Title ease:Resnond' Copyright 2012 Page 125 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment A — Questionnaire Copyright 2012 Page 126 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Cigna is providing these initial comments to your sample agreement as requested. As the incumbent administrator of the City of Miami's medical benefit plan, Cigna's preference would be to add any applicable dental provision to the existing Administrative Services Only agreement already in place. Otherwise, Cigna will require that certain operational provisions be added to fully describe our services. Cigna reserves the right to request further modifications if we are selected as your administrator. Cigna agrees to work in good faith to negotiate this, or any other agreement, to be agreeable to the Parties. With respect to the fully insured plans, please note that our insurance policy and certificate will be issued and made a part of the Agreement as well. Since the insurance policy and certificate are filed documents, there is very little flexibility to change the provisions. As such, any conflict between the terms of this Agreement and the insurance policy, the terms of the insurance policy shall govern. PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and (TBD) Insurance Company This Professional Services Agreement ("Agreement") is entered into this day of , 2013 by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W. 2nd Avenue, loth Floor, Miami, Florida 33130 ("City"), and Insurance Company, ("PROVIDER") a Florida Corporation qualified to do business in Florida whose principal address is: . RECITALS: WHEREAS, the City of Miami issued a Request for Proposal No. 336312 on August 16, 2012 (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of Employee Group Benefit Dental Plan, ("Services" as more fully set forth in the scope of work "SOW" attached hereto as Exhibit B) for the Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof as Exhibit C), in response thereto, has been selected as the most qualified proposal for the provision of the Services. WHEREAS, the Evaluation Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements andrecommended that the City Manager negotiate with the Provider; and Copyright 2012 Page 127 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to perform the Services for the City; and WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and condition set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: TERMS: 1. RECITALS AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and made a part of this Agreement as attached Exhibit "B". The Provider's Response dated, , 2012, is hereby incorporated into and made a part of this Agreement as attached Exhibit "C". The Provider's Insurance Certificate is hereby incorporated into and made a part of this Agreement as Exhibit "D". The order of precedence whenever there is conflicting or inconsistent language between documents is as follows: (1) Provider's Professional Services Agreement ("PSA") with the Scope of Work; (2) Addenda/Addendum to the Request for Proposals; (3) Request for Proposals; and (4) TBD Insurance Company and, response to the Request for Proposals. To the extent that our responses to the RFP are mutually agreed upon, Cigna agrees to be bound by that language and to the language in the existing ASO agreement. Since our insurance policy and certificate are filed documents, their terms and conditions must take precedence over all other documents relating to that product. 2. TERM: The initial term of this Agreement shall commence on the January 1, 2013 and shall continue in effect for a term of three (3) years ending on December 31, 2015. Copyright 2012 Page 128 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Flag UW Please Respond 3. OPTION TO EXTEND: The City, acting administratively through its City Manager, shall have two (2) option(s) to extend the term hereof for a period of one (1) year each, subject to availability, allocation and appropriation of funds and satisfactory performance by the Provider in the opinion of the City Manager. The City shall exercise its right to extend the term hereof by giving Provider at least thirty (30) days written notice prior to the expiration of the previous term. City Commission approval shall not be required as long as the total extended term does not exceed two (2) years. Flag TW ; lease Respond 4. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special terms and conditions set forth in Exhibit "A" hereto, which by this reference is incorporated into and made a part of this Agreement. Agree. B. Provider represents to the City that: (i) it possesses all qualifications, licenses and expertise required for the performance of the Services, including but not limited to full qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, fees, occupational licenses, etc., nor in the performance of any obligations to the City, (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. Agree. Copyright 2012 Page 129 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B - Professional Services Agreement C. - Provider shall • at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, incompetent, insubordinate, or otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. Agree: 5. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhibit "E" hereto, which by this reference is incorporated into and made a part of this Agreement. Understood. B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. - 218.79, Florida Statutes, and other applicable laws. No advance payments shall be made at any time. Understood. C. Provider agrees and understands that (i) any and all subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by the City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. Understood. 6. OWNERSHIP OF DOCUMENTS: Copyright 2012 Page 130 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, or which is otherwise obtained or prepared by Provider pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Provider agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable law be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. Fully Insured All claim or payment data in Cigna's data processing systems, any information which Cigna reasonably deems to be proprietary in nature or any information which Cigna reasonably believes it cannot divulge due to applicable state and/or federal privacy restrictions will be considered the property of Cigna. Cigna will provide certain reports to clients to enable them to administer their coverage plans. If termination of the contract occurs, Cigna would transfer information toa designated carrier .upon receipt of a suitable confidentiality and hold harmless agreement from that carrier. ASO Cigna acknowledges that the City of Miami is the sole owner of all eligibility; claim and other Plan -related information ("Plan Information") provided, however, that: (i) the City of Miami shall make available to Cigna and Cigna may possess and use all such Plan Information' as Cigna may reasonably require for purposes of administering the Plan and that Cigna may maintain such information in accordance with its record retention policy; (ii) such ownership interest shall not extend to Plan Information recorded for or otherwise integrated into Cigna's data processing systems in the ordinary course of business so as to in any way prevent or inhibit Cigna from using such Plan Information on an aggregated and non -client identifiable basis; (iii) the City of Miami acknowledges that Plan Information reflecting the reimbursement rates under Cigna's agreements with Cigna's participating providers/arrangers of health care services/supplies is the proprietary information of Cigna and shall be used solely for the purpose of administering the Plan or as otherwise required by law and that such proprietary Copyright 2012 Page 131 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement information shall not be released to any third party without Cigna's written consent and subject to a non -disclosure agreement from the third party that is satisfactory to Cigna, and (iv) such ownership shall not be interpreted to require Cigna to divulge to the City of Miami any Plan Information that Cigna reasonably believes it cannot divulge to the City of Miami due to applicable state and/or federal privacy laws and/or regulations. 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees to provide access to the City or to any of its duly authorized representatives; to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to comply with, this condition shall result in the immediate cancellation of this Agreement by the City. Fully Insured Under a fully insured arrangement, Cigna is fully responsible for claims administration and carries all risk associated with such processes; therefore, external audits are not permitted. Cigna has an internal claim quality assurance program to monitor internal performance standards to ensure the accuracy of claims payment. However, when required by applicable state or federal law and in keeping with the standards of the industry and Cigna's standard audit and review procedures, Cigna shall cooperate with a required audit or review of applicable documents conducted by a duly authorized representative. ASO Claim audits are permitted in accordance with the following terms: Upon 45 days advance written request, documents relating only to claims administration services shall be made available to the City of Miami for its audit or inspection. The City of Miami will designate with Cigna's consent, an independent, and a third party auditor to conduct the audit. In addition, the City of Miami and Cigna will agree upon the date for the audit during regular business hours at Cigna's office(s). The City of Miami may review payment documents relating to a random, statistically valid sample of 225 claims paid. The scope of the audit may Copyright 2012 Page 132 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement include 'types of claims prone to overpayments provided the types of claims prone to underpayments are equally included and will exclude electronic analysis. Any claim adjustments will be based upon the actual claims reviewed and not on statistical projections or extrapolations. Such audits shall be conducted pursuant to the terms of Cigna's Claim Audit Agreement executed by all parties. In addition, if the City of Miami has 5,000 or more employee members, the City of Miami may conduct one such audit every plan year (but not within six months of a prior audit); otherwise, the City of Miami may conduct one such audit every two plan years (but not within 18 months of a prior audit). No audit shall review claims paid more than two years before the date of the audit. The City of Miami will remain responsible for all costs associated with an audit. B. The City may, at reasonable times during the term hereof, inspect the Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreement conform to the terms hereof and/or the terms of the Administrative Services Agreement, if applicable. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of Section 18-101 and 18-102 of the Code of the City of Miami, Florida as same may be amended or supplemented, from time to time. Agree. Cigna will be happy to arrange visits to certain facilities at mutually agreeable times. Cigna will give the employer reasonable access to claim records and data, subject to Cigna's standard confidentiality procedures and guidelines, and to a claim audit agreement or a confidentiality and indemnification agreement in a form acceptable to Cigna. Cigna will not agree to give the client the right to inspect written records, including telephone transcripts of member telephone calls. Those records and transcripts are considered highly confidential, and protected by the member's privacy rights. Cigna would only agree to this request from a client if the member in question has provided Cigna with a written statement permitting the release of these records and transcripts. 8. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. Copyright 2012 Page 133 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Agree. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable laws. Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. Agree. B. Should Provider determine to dispute any public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. Agree. 10. , COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City and Provider agree to comply with and observe all such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Provider further agrees to include in all of Provider's agreements with subcontractors for any Services related to this Agreement this provision requiring subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. Cigna will remain wholly responsible for provision of all services for which it contracts with the City of Miami, notwithstanding that certain services may be performed in part by subcontracted vendors or affiliates of Cigna with particular expertise in order to help contain costs. All such services will be performed with oversight from Cigna. Cigna contractually Copyright 2012 Page 134 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement requires our subcontracted vendors to comply with applicable federal and state laws and regulations. 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the City and its officials, employees, and its designated third -party administrator for claims (collectively referred to as "Indemnitees") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its employees or subcontractors (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive or in strict liability) of the Indemnities, or any of them, or (ii) the failure of the Provider to comply materially with any of the requirements herein, or the failure of the Provider to conform to statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or state, in connection with the performance of this Agreement even if it is alleged that the City, its officials and/or employees were negligent,. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider further agrees to indemnify, defend and hold harmless the Indemnitees form and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or requirement, related directly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all claims, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. This section shall be interpreted to comply with Sections 725.06 and/or Copyright 2012 Page 135 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement 725.08, Florida Statutes. Provider's obligations .to indemnify, defend and hold harmless the Indemnitees shall survive the termination of this Agreement. Provider understands and agrees that any and all liabilities regarding the use of any subcontractor for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. Fully Insured Cigna will indemnify and hold the City of Miami, its officers, directors, agents, and/or employees (acting in the scope of their employment and not as claimants under the plan), harmless from and against all costs, damages, judgments, attorneys' fees, expenses, obligations, and liabilities of any kind or nature, which occur as the result of Cigna's failure to pay valid claims within the terms and conditions of the policy where such failure is not due to any action or inaction by the City of Miami, its officers, directors, agents and/or employees. ASO Cigna shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the City of Miami for mistakes of judgment or other actions taken in good faith (including benefits erroneously overpaid). Cigna will indemnify and hold the City of Miami harmless from and against extra -contractual (non -benefit) costs, damages, judgments, attorneys' fees, expenses, and liabilities of any kind or nature which occur as the result of Cigna's gross negligence or intentional wrongdoing concerning the administration of claims under the City of Miami's plan. Additionally, the City of Miami is responsible for defending against any legal action or proceeding brought to recover a claim for Plan benefits. The City of Miami may request, and a business decision may be made by Cigna, to provide claims litigation services in which Cigna is also responsible for handling all lawsuits alleging denial of benefits under the terms of the Plan. Our fee structure would be altered to reflect our assumption of additional risk and administrative responsibility. 12. DEFAULT: If Provider fails to comply materially with any term or condition of this Agreement, or fails to perform in any material way any of its obligations hereunder, and fails to cure such failure after reasonable notice from the City, then Provider shall be in default. Provider understands and agrees that termination of this Agreement under this section shall not release Provider from any obligation accruing prior to the effective date of termination. Should provider be unable or unwilling to commence to Copyright 2012 Page 136 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement perform the Services within the time -provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re -procurement of the Services, including consequential and incidental damages. Cigna agrees that the City of Miami may terminate for default. However, the City of Miami is liable for its obligations to fund claims and pay the sums required to Cigna under the various contracts that will be required. In an insured arrangement, the City of Miami shall be liable for premiums due in accordance with the contract. In addition, the Employer will be liable for any other liabilities not assumed by Cigna in the terms of the contract. 13. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds Twenty- Five Thousand Dollars and No/Cents ($25,000), the City Manager's decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager's written decision, approved by the City Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents ($25,000), or (ii) a period of sixty (60) days has expired, after submitting to the City Manager a detailed statement of the dispute, accompanied by all supporting documentation ninety (90) days if City Manager's decision is subject to City Commission approval); or (iii) City has waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. Agree. 14. TERMINATION;OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, at any time, by giving written notice to Copyright 2012 Page 137 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Provider at least sixty (60) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. The Provider shall have no recourse or remedy against the City for a termination under this subsection except for payment of fees due prior to the effective date of termination. Agree. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to Provider, upon the occurrence of an event of a material default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. Agree. C. This Agreement may be terminated, in whole or in part, at any time by mutual written consent of the parties hereto. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Prodveir after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. Agree. Copyright 2012 Page 138 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement D. This Agreement may be terminated, in whole or in part, by either party if there has been a material default or breach on the part of the other party in any of its representations, warranties, covenants, or obligations contained in this Agreement and such default or breach is not cured within ninety (90) days following written notice from the non -breaching party. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. Cigna agrees that the City of Miami may terminate contract for the reasons described above. However, Cigna retains the right to suspend claim payment services or terminate the contract immediately with two (2) days notice if the City of Miami fails to properly fund the claims bank account when requested to do so. The City of Miami is liable for its obligations to pay the sums required to Cigna under the various contracts. In addition, the City of Miami will be liable for any other liabilities not assumed by Cigna in the terms of the contract. 15. INSURANCE: A. Provider shall, at all times during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this Agreement are attached hereto as Exhibit "D" and incorporated herein by this reference... The City RFP number and title of the RFP must appear on each certificate of insurance. The Provider shall add the City of Miami as an additional named insured to its commercial general liability and auto policies and as a named certificate holder on all policies. Provider shall correct any insurance certificates as requested by the City's Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled, modified, or changed during the performance of the Services under this Agreement without thirty (30) Copyright 2012 Page 139 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement calendar days prior - written notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the performance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the policies of such insurance with the City. Every Cigna insurer, with the exception of the captive insurers, are rated at least A- XVI, by A.M. Best's most recent rating guide. Due to the inherent nature of this request and potential changes in the insurance marketplace, Cigna is unable to comply with this the City of Miami's request to approve Cigna's insurance carriers. It should be noted that some of Cigna's insurance coverage's have been in place in excess of 19 consecutive years and Cigna reviews its insurance carriers' ratings at least annually and more frequently, if needed. While Cigna's insurance policies contain the standard notice of cancellation endorsement, our insurers are unable to provide any notice of cancellation, non -renewal, or material changes to clients or third parties. B. If, in the reasonable judgment of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000) of professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to such additional amount of professional liability coverage, and shall afford written notice of such change in requirements thirty (30) days prior to the date on which the requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of additional coverage within thirty (30) days following the City's written notice, this Agreement shall be considered terminated on the date the required change in policy coverage would otherwise take effect. Agree. C. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's subcontractors for. Services " related to this Agreement shall be borne solely by Provider throughout the term of this Agreement and that this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each subcontractor providing Services related to this Agreement shall be Copyright 2012 Page 140 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement maintained. in . good standing and approved by. . the City Risk Management Administrator throughout the duration of this Agreement. Agree. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to the City's Risk Management Administrator at a minimum of ten (10) calendar days in advance of such expiration. In the event that expired certificates are not replaced, with new or renewed certificates which cover the term of this Agreement and any extension thereof: (i) the City shall suspend this Agreement until such time as the new or renewed certificate(s) are received in acceptable form by the City's Risk Management Administrator; or Understood. (ii) the City may, at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. Understood. E. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. Agree. 16. NONDISCRIMINATION: Provider represents to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider's performance under this Agreement on account of race, color, sex, religion, Copyright 2012 Page 141 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement age, handicap, marital status or national origin. Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. Agree. 17. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which may be withheld or conditioned, in the City's sole discretion through the City Manager. Provider may not change or replace sub -contractors performing work under the Services Agreement identified in Exhibit "B" without the prior written consent from the City Manager. Agreed, however while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna or by subcontracted vendors with a particular expertise in order to help contain costs without prior written approval for such subcontractors. Every such service will be supervised by Cigna, which will be wholly responsible and liable for the services set forth in the contract. 18. NOTICES: All notices or other communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested, addressed to the other party at the address indicated herein or to such other address as a party may designate by notice given as herein provided. Notice shall be deemed given on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: TBD Johnny Martinez TBD City Manager TBD 4 44 SW 2ndAvenue, 10tFloor Copyright 2012 Page 142 of 151 Cigna Improved Oral Health. Lower Costs. Attachment B — Professional Services Agreement TBD Miami, 331F3L 0 -1910 Agree. 17. MISCELLANEOUS PROVISIONS: City of Miami RFP No. 336312 A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami - Dade County, Florida. Each party shall bear its own attorney's fees. Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and irrevocably waive any objections to said jurisdiction. The parties irrevocably waive any rights to a jury trial. Agree. B. Title and paragraph headings are for convenient reference and are not a part of this Agreement. Agree. C. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. Agree. D. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provision, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then the same shall be deemed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. Copyright 2012 Page 143 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Agree. E. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. Agree. F. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole authority to extend, to amend or to modify this Agreement on behalf of the City. Agree. 18. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. Agree. 19.. INDEPENDENT CONTRACTORS: Provider has been procured and is being engaged to provide Services to the City as an independent contractor, and not as an agent or employee of the City. Accordingly, neither Provider, nor its employees, nor any subcontractor hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to employees of the City are not available to Provider, its employees, or any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Copyright 2012 Page 144 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. Agree. 20. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written notice. Agreed. Cigna understands that the City of Miami's obligation to pay under this contract is contingent upon an annual appropriation of funds. However, Cigna reserves the right to suspend bank account claim payments or immediately terminate this agreement if the City of Miami fails to properly fund the claims bank account or fails to pay fees or premiums beyond the grace period as described. 21. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event. The party seeking delay in performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay shall extend beyond the duration specified in such notice, additional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. Agree. Copyright 2012 Page 145 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement 22. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on account of any delay(s) for any cause over which the City has no control. Agreed, however the above does not relieve the City of Miami from their financial responsibility under this Contract. 23. USE OF NAME: Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Commission. Agreed, however Cigna would like this provision to be reciprocal. 24. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2- 611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that individual member of Provider, no employee, and no subcontractor under this Agreement nor any immediate family member of any of the same is also a member of any board, commission, or agency of the .City. Provider hereby represents and warrants to the City that throughout the term of this Agreement, Provider, its employees and its subcontractors will abide by this prohibition of the City Code. Understood. 25. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. Agree. Copyright 2012 Page 146 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement 26. SURVIVAL: All obligations (including but not • limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or attributable to the period prior to expiration or earlier termination of this Agreement shall survive such expiration or earlier termination. Agree. 27. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force and effect, the wage rates and other factual unit costs supporting the compensation to Provider under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions thereto to exclude any significant sums by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or noncurrent wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. Agreed as applicable to the services contemplated under this RFP, however, we would like to discuss this language further. 28. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall constitute an original but all of which, when taken together, shall constitute one and the same agreement. Agree. 29. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreement of the parties relating to the subject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. IN WITNESS WHEREOF, the parties Copyright 2012 Page 147 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement hereto have•caused this instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written. Agreed. "City" CITY OF MIAMI, a municipal corporation ATTEST: By: Priscilla A. Thompson, City Clerk Johnny Martinez, City Manager "Provider" ATTEST: TBD Insurance Company By: Print Name: TBD Title: (Corporate Seal) (Authorized Corporate Officer) APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: REQUIRE MENTS: Julie O. Bru Calvin Ellis City Attorney Risk Management Director Copyright 2012 Page 148 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Attachment B — Professional Services Agreement CORPORATE RESOLUTION WHEREAS, Humana Dental Insurance Company and CompBenefits Company, a Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; This Resolution needs to authorize the signatory to sign. Copyright 2012 Page 149 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Exhibits The following exhibits have been printed or placed electronically on a CD: 1. GeoAccess Reports (CD) 2. Disruption Reports (CD) 3. Resumes: (CD) • Account Manager — Yesenia Sanchez • Day -to -Day Liaison — Susan Martin • Implementation Coordinator — Claudia Rodrigues • Customer Service Supervisor — Jessica Chavez • Network Management Liaison — o DHMO — Dawn Applewhite o DPPO — Kim Walker 4. Insurance Certificates: (CD) • CHLIC — o AON o Marsh o Marsh (2) • Cigna Corporation — o AON • Cigna Dental Health of Florida, Inc. — o Marsh 5. Tax Exhibit and Florida License: (CD) • Cigna Dental Health_Perpetual License • Business Tax Receipt (Renewal Notice) • Tax Exhibit 6. Provider Directories: (CD) • DHMO— o Florida Directory o North Carolina Directory • DPPO — o Florida Radius Directory o North Carolina Directory 7. Communication Materials: (Printed) • DHMO — o DHMO Product Brochure o Know What's Important Flyer • DPPO — o DPPO Radius Brochure Copyright 2012 Page 150 of 151 Cigna Improved Oral Health. Lower Costs. City of Miami RFP No. 336312 Exhibits o • Know What's Important Flyer o DNSP DPPO Flyer Customer Service 24_7 Flyer Oral Health Integration Program Flyer Treatment Cost Estimator Flyer 8. Sample ID Cards (CD) 9. CAP Reporting (CD) Copyright 2012 Page 151 of 151 Cigna CIGNA Dental P.O. Box 12345 Anytown, PA 12345 Member Name Role Dental Office Assignment Phone Number John SU Dental Associate 1.800.123.4567 Jane SP Dental Clinic 1.900.123.6578 Davis CH John Smith DDS 1.888.123.1234 Kevin CH Harry Jones DDS 1.800.222.2222 Sam CH ABC Dental Associates ' 954.123.4567 Joe CH ABC Dental Associates 954.123.4567 692 111111 2222 44444 528 5 John Q. Sample 12345 Anywhere Street Anywhere, US 12345 A 1,,,-1 11 *Only members residing in Georgia will have their Dental office information displayed on ID card CIGNA Dental Digital DHMO ID Card Personalized with member's info Front Dental Office: ABC Dental Associates Call this number to schedule an appointment: 954.123.4567 Front of ID Card CIGNA Dental Digital DHMO ID Card Personalized with member's info Back Welcome to the CIGNA Dental Care plan. Enclosed is your ID card. Although this card does not guarantee eligibility for benefits, you may present it to a participating dental office to communicate important dental plan information. If this is not the dental office you chose, your original selection was not available. If you would like to select another dental office, you may do so by calling the number on this ID Card. You can locate a provider by visiting www.cigna.com. Your benefit descriptions will be mailed to you under separate cover. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx we give you more reasons to smile Back of ID Card Cigna Accessibility Analysis A report encompassing the providers from Cigna Dental Radius DPPO Network for: City of Miami Cigna Dental Radius DPPO Network - City of Miami Accessibility Overview 1 ,m ,.`� .. L174 :t 3'.i�"'t €..-:-.:,.S 4Rr✓.. .:-ki ✓.., . _. ;;'stt".. ....: "4m„. 3.. A,. .. R �;,�. . , ^3 .:� .vi' _?-�{,: ."i �4., e'S'Y {�.Y!r_:k �Y� .. r.. r .--F::-i"5�i'+'.�" 5. F.-a.::: -b „-.,.. ,+,faa ii �,y e...::�, $. ,. . ,,ay - _ .. . .- . , f ..3'^. f^ . ✓,.< .. e aX...i Y,• : ... P. k�"LT• :. -:Yx, - -` .�, 4 , ...:: •. u{• • .si{..: � {' F d r� � x,a.'i'.x... .. ccesslve>iiet� s tY :^e ..,zx T-" �r P. '.3ti ..:;$�!{u�`�`�i m,:Y �'. i^ `g �:,...o - Yts tS v.. i •`K' H, xP✓k v�'§`"bx"+f' aS ISy A.k%C-v'- . N 'r' 3• .', e +£ y 3.2, ":i, ' �,?, ^afs!3--� .. ";�S � i 4', iJ .t �"^ "'�.� P.. ;i:,.-�J�-°"y,{i'kM y -Ya �2 e3rF .} ,�5;.3iL. - .,.... - xa'b' _.._ I 1 s ..:. ✓,,.........E,nl (n l.l. .:: <� ,,., .. p J q ✓ � .T+,-.,;xi.. n...;.y«hi'_,.w. s A: ...: -. y,t'.v a ..: .- 'sS ::, -� , .. :.�.. � ,:;.,. € ltcessstandaids a� 2 Dentists within 15 miles r :• ta�;�. ,, .:.. .r �: -" .:4 2.Dentts�s-��.�thuz.l smile � �» � ,.. , � �� ��� �,. � �x u:� r.��, 2 Dentists within 15 Miles : ,. ._ -. , ... ... s' ,..- � . r �,<«, s 2.Denttstrthm:.]5-miles, �-,u, ,..�,, ,�. -�_ : 2 Dentists within 15 Miles . .. �.-E-;E: ... .:_m. F.•�,.. ;:.,. ,,,vx ,, ...... -r^. .r. �:.. _ � ,E�. � _i W '}� r `�Y -,.., ::, v.:,>.E,..,. .,.,f„ � se.::' ..... cr i ,. .''. Denta n; ' �� � is All General Dentists .r..�w ¢..;. :� .,. �/111:Cndodo�atis�t5 :.: , , _ - , ,n.. All Periodontists • , � � ���j• . 1 ,.�. Ora_ SUtgcons All Orthodontists :V+ Ya»u z.%.z.. Y w:^vJ t.r h �..i`nr a ,...,� . E .:�a'<�'"� .'sS y.,:P ,..,.- ,fir �. �. y x b �,t !111 ot'i fig: >,, x. Z. S`tf � d{zz, T .., k. �` ,n .,. E 7 em lo��es� 1 700 :ti. 1 700 1,700 ....,, ;t .f,,,w„t,. ., „'r--- ?:,>.:,. r..e ,:z.. ... .. .:. qq --_>sA tlta�,,.�, Z .. .'-#> ...: ,� grp :„� .. ,.. ..,..:� �. , �clenttsts � ..Nufr►cr•.. 179,725 sue:. rzg. 7,962 14,872 t', .':-,o, �. sz.:i.l .n .�.. - ., q n _ ,-, er ee+, S.X,. ,e.,.fn ,:: { ' � : �A eht ...0:&'.4� :.. .. -,,. - rr y ::Ls{ lovices ._• ..,-.. w.J.�..... R'.3'd.�Fs;srs..�. . _..» ..� .-,..-�k�,aav S 1�'ith �t�ce:.ditttt�iCi ,. 5 _,.a �: .r ems,. 1,700 . fax • 1,697 1,697 n,.., v s„ t Pct�; � 100,0 ^r.. .w.. 99.8 99.8 .n". a .x. sl�'un3t � 0 3 3 .s. .,...».... �•: s- ,.t 0A . �<v. 0 2 0.2 i., +.msx. All Employees ;tea ��-z,,> .,. ...- pr.;.,: „. Ic, ees .� .:: _ �. a�� -�� ,,. Rr,y ��� �: � All Employees r,,., .. ¢A�Itt : s ,_, v. � i to cc ,.�. ,, .,� , ,1�',.,y ._<.���' All Employees . ,.. _E_:`. a .....: e: ..t , Cigna Dental Radius DPPO Network - City of Miami 2 Accessibility summary eess>I All General Dentists 179,725 dentists al 57,193 locations (based on 179,725 records) All Employees 1,700 employees 2 Dentists within 15 miles 1,700 (100.0%) .HOLLYWOOD, FL HIALEAH. FL. • FORT LAUDERDALE, FL OPALOCKA,:FL HOMESTEAD; FL :MIAMII GARDENS, FL .MIAMI.BEACH, FL NORTH MIAMI:BEACH, FL PEMBROKE: PINES,_ FL eslreel acce 1.185. 141 98 62 54 • 43 35 1,185 .100.0 141 • •:100.0 98 100.0 62 .100.0.. 54 100.0 43 100.0 35. 100.0 32 .100.0 11 100.0 100.0 C:criArrrs Cigna Dental Radius DPPO Network - City of Miami 3 Accessibility summary All General Dentists 179,725 dentists at 57,193 locations (based on 179,725 records) All Employees 1,700 employees 2 Dentists within 15 miles 0 (0.0°%o) NO: EMPLOYEES MEET THE SPECIFICATIONS Cigna Dental Radius DPPO Network - City of Miami 4 Accessibility summary ces'si ecifIca tis) All Endodontists 8,473 dentists at 4,111 locations (based on 8,473 records) All Employees 1,700 employees 2 Dentists within 15 miles 1,697 (99:8%) MIANII, FL :: HOLLYWOOD, ,FL HIALEAH, FL FORT LAUDERDALE,: FL OPA'LOCKA, FL. HOMESTEAD, FL :MIANII GARDENS, FL :MIAIVILBEACH, FL NORTH MIAMI BEACH, •FL PEMBROKE:PINES; FL 1,185 141 98 mpo}, 1vrth desired 100.0. 141 100.0 98 100.0. 62 62 100.0: 54 54 100.0 43 43 100.0 35 100.0 .` .32 . 100.0 11 100.0 5 100.0 Cigna Dental Radius DPPO Network - City of Miami 5 Accessibility summary :ccessi All Endodontists 8,473 dentists at 4.111 locations (based on 8,473 records) All Employees 1,700 employees 2 Dentists within 15 miles 3 (0.2%) Cigna Dental Radius DPPO Network - City of Miami 6 Accessibility summary ccess bilrt3an'alys><sspec <ficat�ons; All Periodontists 7,962 dentists at 4.726 locations (based on 7,962 records) All Employees 1,700 employees 2'Dentists within 1.5 miles 1,697 (99.8%) i���l Ke3 geograplucareasx� �fr 1, vm Em Io ees;witthh desired access flTotal 7 d v h t q gCit}; numher of employees Number S Percent r�tierage distance , l to 2 dentists MIAIv11,:FL •:1;185 j.. 1,185 100.0 1.8 HOLLYWOOD; FL 141 :: 141 100:0 • :1.4' 1-IALEAH,: FL . 98 98 100.0 ].5 .FORT.LAUDERDALE, FL : `62 62 100.0 . `1.8 OPA LOCKA, FL 54 '54 100:0 '3 0 HOMESTEAD, FL 43. 100.0 2.7 MIAMI GARDENS; FL :. 35 35 100.0 : 8 •'MIAM1 BEACH, FL 32 32 ,. :100.0 1.3 NORTH MIAMI BEACH FL I 1 l l .' 100.0 . 1.4 PEMBROKE PINES; FL 5 5. 100.0 : ... 0.7 �-< Cigna Dental Radius DPPO Network - City of Miami 7 Accessibility summary ayees> i 23.4 ana><ysis)1 eta rstie :.t?:e All Periodontists 7,962 dentists at 4,726 locations (based on 7,962 records) All Employees 1.700 employees 2 Dentists within 15 miles 3.(0.2%) 23.4 24.7 31.4 cg �--.�+`�'``Ea. e�,� a v� �"''�T� ? .3ic�i '?� ',31�'' '�''f. 5'S`� �/�r�C� �'+y ���t a,'�x.s� >jX+ �' 'z� �u�i��`,a •m` 5�,. cam'= . � �� a � �"� ��. r - ✓ys,� 9 ``` <„s,a .rx �� 3 ,�� .� �. Totdl number of employees �� ,.. �'" F i >�§', y € ,fi Number s � � Percents t A� erage distance t 2 ^dentists" t KEY LARGO, FL > 3 3 .d :' . :100.0 23.4 Cigna Dental Radius DPPO Network - City' of Miami 8 Accessibility summary" All Oral Surgeons 15.506 dentists at 6,705 locations (based on 15,506 records) All Employees 1,700 employees 2 Dentistswithin 15 miles 1,697 (99.8%) acres t, �r x,: Ivey, geographic areas �� ��F ri m to ees vv� h desired acC,- ,' Totaiinin l .. ediscc tan C,h a `� employees Nurnberg Percent to 2 dentists k t. MIAMlFL :: 1,185 1,185 100.0 �0 _ HOLLYWOOD, FL 141 141 ' 100.0 . 1.8 HIALEAH, FL :98 98 100.0 2.1 FORT LAUDERDALE, FL 62 62 100.0 1.8 OPA LOCKA, FL 54 54 100.0 . 27 HOMESTEAD; FL 43 43 100.0. 2.3 MIAMI GARDENS, FL. 35 35 100.0 '- 8 MIAMI BEACH, FL 32 32 100.0 1:7... NORTH MIAMI BEACH, FL : 11 .. 11 100.0 1.5 PEMBROKE PINES, FL 5 5 100.0 0.9 ;6' .;X '..d. Cigna Dental Radius DPP() Network - City of Miami 9 Accessibility summary teessStan+ 23.4 cccessl All Oral Surgeons 15.506 dentists at 6,705 locations (hard on 15,506 records) All Employees 1,700 employees 2 Dentists within 15.miles 23.4 24.3 24.7 Cigna Dental Radius DPPO Network - City of Miami Accessibility summary 10 (:5rW1�1 cessl<an Ana All Orthodontists 14,872 dentists at 7,999 locations (based on 14,872 records) All Employees 1,700 employees 2 Dentists within 15 miles 1,697 (99.8%) . esire rate ' �r —t�" 44 iPw> r: � k ��,° if � � y�-s. �y:} � . ev � r :. °� a h><c areas . �`.•r s3 a B+�'�-'� y'v, �'�' ...� � f T �� .. ees vvv4 des►red accessz� ; Total. �, .� �,a �� �, ��f.� �-�«� ��nnmber�of Aemplt.tees Numbers Perot: :. 'to2,dentists MIAMI,FL :: 1.185 ; 1,185 100.0 :. 1.6 HOLLYWOOD, FL 14.1 141 100.0. 1.4 HIALEAH, FL 98 .98 100.0 ; ' 1.3 FORT LAUDERDALE, FL : 62 .. 62 100.0 1.9 ..: . . OPALOCKA, FL 54 . 54 100.0 . . 1.8 HOMESTEAD, FL , 43 '' . 43 100.0 2.1 MIAMI GARDENS, FL .: 35 35. '' :100.0 1 .3 MIAMI BEACH, FL • 32 32 100.0 NORTH MIAMI BEACH, FL 11 ; 11 100.0 : 1 PEMBROKE PINES, FL. 5 5 100.0 #.x,.G f;': 1:� x➢. @ ',YE ..:Yc li. Rh ^iva s�. .�, Ik's-tiY`. ','�,'r `$; ..e::..:.a ..a `H rv: ,. f, r 'N... , : •• Cigna Dental Radius DPPO Network - City of Miami 1 l Accessibility summary cessibi All Orthodontists 14,872 dentists at 7,999 locations (based on 14,872 records) All Employees 1,700 employees 2 Dentists within 15 miles 3 (0.2%0) Accessibility Details All General Dentists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 12.1 ti, r r -., ti .. _'x .. _, 3_ � i%+, #.l�;-,, .. .. 5<„R4 ,Allmployee� `+e .. C^x.+`o ..�.. y,�•,i{e� ,, 5,.,x�� '�,'"�r 4 n ��.ue `: �4 s Y `4 a t : <r• 9 d k-- } ' 'Yk+�yx'� „'�� a+ a -P°Sa ^f3 v-C tit ^., a- - -a^+^ C'! �,3 ,� 7'qR ,( ky � � ;'.H { t�,. "n d: .i N {9 desired access � .: TOtal=.;r otal-.:� Ai era edistag k. :��,�.. �. �� r�� ,, � � Y�`t��,��x2 :• u�nber of . �?number of a� -�- 3� � �, io dent►sts "�::5 ' �'A ., ; a. :. , ;s � ty MT�� �-� ,r ��G; �- S'i<v5. ��i` t� e< ,<�Cotl.-,� ��`u �.,b�a-v.c-.4A�`f'�. �4.em lovers' ,Pw-:,„�,,K dentists � �.ak. Number �s3 s� P,ct �1 ��:� =, �2, BOYNTON BEACH, FL 33437 1 24 . 1 100.0 0.7 0.7 'ORM GABLE AFL DANIA, FL 33004 1 . 17 1 100.0 -'°w�•"'. 1.7 1:7 s x,ii�`:TiT;Y:G. Ta---.-.,,-'�!.. ,. a 'T. .*.., ': ,'Z"'"" c' FORT LALTDEl3:17„ =EL'4= .'i;'ii. "-Sf S.4`e7Ai��'v'h:u ., 5:,�'-S: , �S'." - < .:2Fi. _ _ fd 4.." 5, ,�R�'C`"�.L-�,s :,'4. 33304 2 12 2 100.0 0.5 0.5 it 33311 2 14 2 100.0 1.0 1.0 c' t ...3::> 33313 2 31 2 100.00.2 0.2 .?'r. "L-` :. <'a'"%�..t ."�" :1. 4 '-:�`,o-.'.'��73;.fr`'- .-S. a,+i is=G�R9" z_':•�•�'fi' ,-.x: :} o-.,n,',;:_„cxvm >' - s>w. X,. 33316 .1 9 1 100.0 0.2 03 33319 1 30 1 100.0 0.2 0.2 1 �� � z .%e..afiu assu #:xtntxN'.x far.wta w � a3a�1 .,n• . k:@ k£fix$ a:��."Fzx�v'a 33322 . 2 30 " 2 100.0 0.3 0.3 :vi-s�-��.-ti..`�:' s:..�,..ia :.L.-`s-e>ez�:z�..s.._i4�.' 33325 v 3 1 3 100.0 .. 1.1 1.5 33328 6' µ 36 6 100.0 0-5 _ 0.6 �, ^� �`y." n'o-•C � .� F ^T:. d, $, ' � a3330 33331 ^ Yti'^5 ' S Z 1 4 11 d �' g15 22 �, . ?°1 �4 4 11\^ y i000 100.0 ""�: ,�" -� .: D2 0,9'. . xd C � :,Vf 07 1.'1 t 33334 1 5 ' 1 100,0 0,5 0.6 ; HALLANDALE, FL 33009 30 100 0 0 7 0 7 ` HiALE�i,�L���a 33012 l5 104. 15 100.0 0.2 0.3 �ra.»;�.�r�.�`�i"�.z�°r.__. Mx ..may .. '3�a .�>s>F,.i�z � z.<M_ �..,..,....a.«.,x,:... '.•t .:. z. 2", ..Y m .,,.t'�"a:.u........:. :y 33016 9 ~ 35 9 100.0 0,4 w 0:4 �� 330lJ 1 0 7 0 Q ; Q1 03 33018 10 9 10 100 0 1 1 1 4 H" :.-m OD k33020 33021 7 3� 52 1�1r,,3t 7 100.0 1t700 0.5 Qb 0.5 ' �p6 33023 33024 a 1 30�5 24 E31 R 24 10,0 0 0 5 0 7 33026 11 114 11.; 100.0 " 0.3 . 0.3 k 3i 3d } r tt5s ..Y."44 Access standard: 2 Dentists within 15 miles Dentist group: All General Dentists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 12.2 Y i f°.y„ k ? 4 h ti^ "; � Z l •Q rsn mgployees � .L f ,�• �k - �. `•K ,T`� Y.�� ti � € : II :, '"••.. 1`,o-.. 'iYa'.y a. .•kRi'":�i:i r£':�>^,'•,,°-.. ,�.L: .r:'.•;;?% F:.,.}°.: 1'' Phi i:'u#S. •4;�2 �'^: Y. .>; k, k"�'.:t�`+2" y\i '.CY t+��S. 1*.:;,.��+c K•+",,a+f..,'•,.< .' vh'yu'10 CGS {i'iti� itl ,,xc arxry ,E Sett �, 'Ya 3C'�' 3" -���esiredacees '?:jei;^ „Z ..C`a�: n.�,,yb-%p, •> +,.�aa^q, 5,�v�Ts±,.:2'+`R}'"i.'.'. � �� Zl(P otaltat. �roumberof To�Asera M� �umberof �� f edistance: , gu, odenttsts.« iPct C�,. f Cotle .,s•»A�,: ti employees a ;S. �r,:,-ro ..« , � - -..,tea - dentists ..54.-+.. -,. .rorr ..>.:... Number � HOLLYWOOD FL 33027 25 45 25 100.0 0.7 0.9 33084 1 0 1 100.0 0.0 0.0 i@MESTEAD AA �' y . 3030:�10 i$ � a X� , iA0 0 . p 9 33031 1 0 1 100.0 3.6 3:9 �. i�'.n':A.2"e= .. �': .g,..... '."? S� - is°.-nf". '6"^:.?T.t :'a`r,..♦.e:-!YA.'�' >�+w.�o-»"a,;+i�^.°w?%`i' �.". r,:�,yl�'�w 3"tAxB"' ^.3•.v".�.. 4 .:'�. �'�# r�_�t.. ,330 - s_68100Ok..v0 7 n flz 33033 17 : 24 17. 10.0.0 "3; 0.8 0.9 MR;t.'_�Sfa.*U`� ' -,,, vw:x;Grg!^ _v , 3 '£-"..';-OP>['-'�- -: NN _ .. ,_.M.,,, y« ri._,:-7a---• ,.�7.4,.:�..��1.4, ..:: : 33092 1 0 1 100.0 09 0.9 r. 701-111;R FL ^ ,.. w. k; 'ter . 334D8 KEY BISCAYNE,.FL 33149 1 1 1 100.0 0.0 4.9 < ' qua. LOXAHATCHEE FL 33470 4 5 4 100.0 1 6.1 „ .V at' S S ` -Y •' C w5' `x , - 33125 39 25 39 100.0 0.3 0.4 tj 'u -1f - - -s.,n -�LQtn .i�:t+t £ - 2 -=�F-�=�_ �� � f � .. ^: :'=�:- 'Y[y �,�k:� 33127 33 3. , 33 ". 100.0 . `"5'' 0:4 ... 0.6'. ^'s?'h�, " w--'v�:"':T"Yi •r F °`s- -u ex`c.u�G -Y yR� }'!".2 'Fd�',.q�"s `.'i> i }.� y 1 y' 4. �'ti ? y-1 4 �T ��+'� 1' /} �00 V"U & d,'�.a. ✓(+.,-,'�.�'=-,... 1's.�'� C(a� n w 14 k k 'V 2 33129 ; 23 I . 23 100.0 0.4 0:5 33131 :: 5 : 7 . 5 100.0 0.1 0.2 33133 . 41 : 12 41 100.0 0.4 .0.5 $134 33135 30 30:::: :: 30 100.0 0.2 0:2 331.36 rz2�R4 s;. ?2 33137 12 8 12 : 100.0 0.4 `0,4 7 6 100 0 0 a �p6 33142 50: 5 `50:: 100.0 0:7. 0.9 331 3 33144 14 29 14 100.0 0.2 0.4 331.40 �,..�..�s. 3 c.3a 'Yc ,z.....4� 15 ., ..S?.. . ,. - ,5 ..�.'��`�. ��,� ,.,., �100 0 0 3 0 33146 4 7 4 100.0. 0.6 0:7 "> x ?3 47 3 s 47< � xi47 1000 09 09 33150 41 0 ' 41 :: 100.0 0.8 0.9 �11�,1 33155 39 33 39 100.0 0.3 04 �3156 33157 42, 26 ::42, '100:0 0.9 1.0 Access standard: 2 Dentists within 15 miles Dentist group: All General Dentists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 12.3 3l?.4 R•fi�4Z Si 1 1"+' .Y i'4' °dfi4A -i<}\ kV«e? �'' Caa i "� >, t'(ia ".4 N:h "�2" N ram` fr i�,1,L, 3Y:\'i'. ](UnulO al � 'o`S yt�. , 1 `�rf ��"44 �. rim. � � � � �`k}. �.'�.i S � �•�� �,�'h' � 'S � ' . ,. � �< s w 3^rR3 j4 - .' 'tis `� :fi . c 4. i'F�+'{- a: '. � '.�� ': s,„ �q':�y ;s .� i �. ,.od. s £ -' "„?4�� - � v s" `'>1F+'A, :, vz ,� F3.s:.."� E; ,,; , 1 .. :,�.'a�'�+n -...� 5 yR r r Ya ue i q..� 4 ,ia, Y aC 4S ^t` F „� ` °`deS�redaccesst '�'^ a 7� ' ,R . lt,, Employees vnth d3 :3i4�i,`h m 4f 3"".f.1✓Rid.' }�rv,*- '�� +•i' k S 4'C�^'•4.. S. i �,^ 4 F Total, :a=Total,.t:.�_`E�Azeragedistance R .q!', 9i'"%4$3�.�. # "Ju ;?. 4fi .f f ly ,'�Q. -K, k .fir. ' .Xiq f i,' `� r.,,,y,�y 4 ..r, i _ . ^2 s� to s �,rass zi;1 xe�{,, �y a- number of ' ,.,' ° n amber of :Qhq w.d u,k�'m' a E+, i � a .� ? �#o dentists ;.,,.g... '. ' City a:F ....,., . .i i Code K 2 ': ,,',¢5..' emploYefs ;f dentusts 'iyx : ' Number Pct MIAMI, FL 33161 27 11 27 100.0 0.6 0.6 _, _ 1 33162 20 ; 35 2Q 1:O0 D 0 33165 44 44 44 100.0 0.4 0.4 -€ � .�v.,; K I T,:�;- � - �E'�,.:..3...�„M '3 �:rr� �11 _ �- � �15 33167 14 6 14 100.0 0.8 0.9 �,..Szp..,,.. �4' .. ,t �3768 7^"'-:.Y.nei,... ,..<Fa. Ci : '�'i.. ? ` ? � �� � �-"Rls,� r✓E�``z �%'`- fr.- ��3 :.,�C.�. ; i00.0 Ay w`� 07����07,�i ^='^aC%.- r - ^tea`.. !y; 7^; w��?,?-u,.Z'�'-?`;. ,,..nsr 2, :" ., ,-.. 1�='i=Ea-.�.F ,d +F"- .'.W, .aw-x,3 :`<•Ce �K�i:s sz :=:ce. �"�'a=.Et ���.����„��:�:.��_,�_._`����_�_:�� � �`•��`���.�"`�' "';fir`-•r_ ,y��'.tF.?.'..`: '"= "+''Y - - � 33169 55 14 55 100.0 0:5 0.7 ' cZ'+'". +, ...-.�-:, i..='s`r�.?•,is a.: fi.S- .,h-fit"- a-� ?G --}�i' ,fir n,} 4 i; �.;kr�_�t'.0 33 172 17 19 17 100.0 0.5 0.6 i73> �2 � � � i 32 I00 . 4' 100.0 33174 ': 12 24 12 0.3 0.4 �s } � x3fi� 29 100004�:0 33176 45 87: 45 100.0 0.6 0.9 33178 i 9 10 9 100.0 0.9 0.9 „_a.., 67 .. 0:4 33180 1 1 100.0 0:4 �qa.- �' � ' .{ •-`p-i �-. 7 .. -a-rt `R 3 . � tk-.��ia YF' � 'i 3 Y ". f 2��.�� f� . k d y-�"-' �k'e 'e`i^ FL .:7.: t "i"" 33182 12 0 12 100.0.. 1.0 :1:0 : w a318� 1 00 0� 5 05 33184 .' ^ 10 13 10 100:0.: 0.3 0.3:'' x i 331$0 �71 3 u" 21 100 0 0"7 1 33186 47 44 "E 47 '�-"'E 100.0 'FSssF.s 0.5 0.6 9 ?'�' � A rt ' ' F� � -rst 5.. �- ? a ' � .,•-�`�"� £� . � `,-'may 's.&�' 33189 . 18 18 18 100.0 : 0.5 0.5 a 33193 '. " '16 3 : 16 : '.100.0 0.5': : 'mm0:5 33196 24 . 9 : 24 100:0. .. 0.9 • 0.9 33242 2 ' 0 2 100.0 0.6 : , 12 .....� F ,:i���wl� 33247 2 0 2 ' 100:0 1:1 1.1 r xr i 33 33261 1 0 1 100 0 .0.2.: 0.2 3398� MIAMIBEACH,.FL 33139 9 33 9 100.0 0.2: 0.3 33141 : 5 9 :: 5 100:0 ` 0.8 0.8 :. ,.-:_3"Y$i :.: ,y-r,, y'' K .. 6" k Y >�'`. 4.' Si-&`u...F ti R'. �,, 5i .. •4 4j . T4 ' ,.'.4 d :. Access standard: 2 Dentists within 15 miles Dentist group: All General Dentists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 12.4 ''`x �� .���1 v§ N�;a``Ri�:t ��ti� t�t Y�,.,_�`"�y� `'�^M�.�"x'l�e`�$w' yy'y��" � K S :.. R vrY rS ,`+i' ,..,. k...t�..k' �� '� YYrt �''�. 43..�. �,�.�'k. �'.. �y... 3�s ::�'+1,y.�aP''4'4'l � b � ti �2��L �:.,<°.�.� k"rlax�����.a�'�b'�e�� �f�•y,_��¢"T �3L��. =v* �ryxNY distance zc ag,��� � �Y ¢ � � �a . � ' z �� � �. w V, xw.�', �,� ^: Su. .h {) , � ',� ,<F � � � � �: � � ` r.Ss �.? r"a � '�d�:* '.< ., � ��� �-� e � �. eVeimlovesr c�s,�x�sz � �,.� � R,^v` .. i :'.r " 2 �"�� Total -� . + �a ev;.. ' number of �, �`� `y� ? E i Y�" '+ Y > `'F "., zy �R `S. � �Totat ,, z ��""' n mberof eufl sd.. . , g�,a r� � lRa 2 h A ?„� S " 'k''c ..,:b Em 10 eeskmth p Y YS ,k4"1'�E51t'Cf) $ �' b �,� �� „ �',,. '"� t 3 P,S h E vqA'`� 3CCCS >>� '� 1\s' Average �� . ��u'toentlst$,. ;_)h iFd : ,] �,� � � �� ��. � f= �', 3. d 1�, ubiP l2r . MIAMI BEACH, FL i rq "'RM1 .' k '^ " { _ ;. F MIANIIGARDENS F1 :._.�� ' u _.__.._ -* NAPLES, FL A9 "AS L ''' "�, •a 41c e x ate' -ram i •F`q:d � � " r ,:t�. NORTH MIAMI BEACH, FL OP LOCKArt' I sf f3} SL: � 33154 T T 'N 330�d 34113 F F;^' ?4120� 33160 33054 6 } ? 2 > x 1 CA..:, w� s 11 . yx 29 9 , ...., t....18 6 ✓',u ^' . 3� 2 3 C i m 1100 � uX'.�.�+L�.3 .F 3 11 9 100.0 +t 100 0 ks0 100.0 9 ..::b.n 100.0 100 0 0.2 hM- A" 0.9 { 0:5 .... 0 7 0.3 3 'iF 4++Z y_ s'i a �. ,.�s3� -R 14 1 ::: ,1: 1.0 l'i0„.„6_ q 14 ,T'n`3 PALM BEACH=GARDENS. FI- , ' PALM CITY, FL PEIv1BROKErPINES FLU ._ POMPANO BEACH, FL �:- IPAINRLUcIE, FL .. s WELLINGTON, FL WESTEPALM BE?11CH kZ*`t 6 ._. -.. 33055 33418 34990 . 93Q28 33063 3 .$,. 33073 4S53 34983 .33414 ,, 3341.1. 25 , _ 1 ? 2 �,m3 --` 1 1 2 1 k 2 .. ;`,1. 4 f 10 9 w4s, 24 s<: "16':' 91 >7 E ` 10 118 .;:b .:. 25 1 1 5 100.0 . 100 0 100.0 . 190O• .m 100.0 ' X. 0 m. 100.0 ,100 0 100.0 100.0 .. 1,00 0.5 �, 4 1 1.3 `.. 0.4 0.0 1.1 0.6 0.9 �11� 1.3 ..�.w 0.6 Ci c . "? 2 , ' 1 1 � . �. 2 1 l 2 : 0.1 1.1 0.6 TOTALS i3 �� 4.- .�i;'3 &ask, Str;� �w�,.� :1,700: 2,931 1,700 100:0 0.6 i 0.7 Access standard: 2 Dentists within 15 miles Dentist group: All General Dentists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes not meeting the access standard 13 � z v � � �* y11:4111 LT' s8 �...... t+t� ^; �3` h �enploy i K $it cf3� '3 f �5��`u �'' �} RE?`4E v'"�' ees ithout 4 3 : y+C.F4 'w� yin �,�: ,;.v �, "' ."# v., 3�+ w,2£F n � ay�,"3w4�. {3 a', �7 g $9 e -C Sk �+ a "` „T `"'' tlestretl access ., = � � �; v ` ��.`��+�� g 5 ���,�� �, t �TOtaI � b �numberFof � �.�a����Otal numher of � �� ,� ���,� �- � �.;� � �,, �£� e r +,a � � � �AAet"dgez st9nee � c , to dentists � � 4 1 1 .e.-:::.. a<rs. ,,..e . �£ �... .�.:.....„.: de Code �. ,,� employees ar.„ra en i dent sts . i�'umber �:.r. �.nre.�'x s3�a. Pct ✓�____�+�:nis NO EMPLOYEES MEET THE SPECIFICATIONS Access standard: 2 Dentists within 15 miles Dentist group: All General Dentists Accessibility Details Endodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 14.1 y`x'y. L .'+, 2 �°S } { ¢ k:',' �u tr,�^,4j'^t- : f ,b1'" ?Vp S . �' i "r -3 ^F :a:'C ' : .� ' " � £t� F' .. a.. Z ? `� �� k�. 44 di `v, '3 l df 4 i'"u 4 '� �'�� r.E�->: a 1�`y ''T4•b ,}� �`- b x�'c r,� z.�a - s.��, kn g„- A,oL y A ,�'� S t��sa. �'�' t i ¢, i `1 ��. � �Emplbyecs,with, ceyr- � � .�..a�.�a: �;S- A desiretl access •s, �° F;,s't k; 4.r FTi.' ,_v T 4': z�"'.K: 'AJ . f•Y:xY+o T:,??Y PSy r,;€s ("., a ,+i ' ..>� X� Y.N N4al;s,.:.x:otalt^ y ,t �"'` 7-J >,.trs"•��ws-4'.<„,, . ; , , 1 ..'.},, ;,c � '' ntar,' bec9 ,�, . . Y^' Total-.h h� 3` .. JJa, .. ',i;.-. 2T number of� ply a &.,$,c 3 C'T 4, yi;_ Aim Y ice. r ^G:S,u' �f «. ! Mk �;Aterageiiismnce "\ ,fir Q{ $i u1« b'r+ , o en ,1 t yt s �' ��.�Code � t ��emplovee�� -dent+stsr�-a: Number �, .�.. BOYNTON BEACH, FL 33437 .1 1 1 100.0 0.8 1.3 �- ,CORM DANIA, FL 33004 1 2 1 100.0 1.7 2 TO, RTT4 13DERDALE Fl r 33301 33304 2 1 2 100.0. 0.8 0.9 t 33308 2 $ „. 00 Q Q ] � x, . -. __r s 33311 2 1 2 100.0 2.1 2.6 _ 33313 'i^w1A'%` 33314 1 - '+^•T2 2 # 2 . �' "'i ."yr'x�?e��^,�i2`*"uCkc 2 's" { i �'^:.�_ 100.0 A mi,}a^'n-t:A'u-?j/�C�h' 0.5 :+'T; 'tT;;2!FS:: 2.0 XC p'F""< t 33316 1 1 1 100.0 0:7 1.7. .&.. ::,; :''�� 33319 1 5 - 1 1.1 18 100.0 i_'C:n-.'v'>.?:� : . ,k - _.''-:. _ T^. .,,�.��• v'§i�T'-�':,H iz�a�< �„4.xM�.x�£_ `„.>n?,';�Y"t'���.o`�"- :}.w,,��=_-x� --z�5,. -,. FM s� � ::✓ is /..'_�', �,'.Z :.: n Y 5 :rr-.;P'��f�-«:r,S Qanr...%�.n7F ,,. „<,.�rr� 33322 u.��;'���',.•. 2 7 2 100.0 05 05 ^at ...�w*�... � v� ..o-. ,,.�18" v t - a ..-r -tl. �, rr � '�'....k Ja324� ...r,»� _..,.._�{�� &:.w.. - 33325 3 0 3 . 100.0 1.6. 2.2 rm?3x4r £'rzrs,-v�3>:^G i-S« .tf ..i5T5' i2; a .v"' '.c`• x �:.`?G - r 33328 . 6 3 6 100.0 0.9 1.1 33331 11 1 11 100 0 2.1 2.4 ��� z 1 �, �0 4 1ti0 0 �. 7_ �2 8 33334 1 0 1 ' . 100.0 1.1 1.1 ->>1,�nC... HALLANDALE.'FL . 33009: 2 2 2 : 100.0 1.3 1.5 ITI Et1H MFLx .7 3,0°lb1 8 100Q16 �X "^•« 33012 ,i3013Ef�:� 15 l 15 100.0 0.9 1.9 33014 18 2 18 100.0 0.8 1.6 r.32.. 100 as 33016 <... 9: 5 :. 9 100.0 1.2 1.5 33018 10 0 10 1000 2.6 2.7 EHOLL`I'WQ D .5 33021 "7 . 5 7 : 100.0 0.7 0.7 K",.`L'y }' "` y, kX M ni" $ TM` "` a,,i"EX S .: :. e a3,023 4 ,• „-j. ,,« 31 �� 0 °t�. P ��rX �a°' 1QOQ •N ""? ��15 i`" 33024 7 5 7 100.0 0.9 12 �3U15z Z �.:,< � ..1 33026 11 10 11 100.0 0:6 0:9 s t3 .:: • ... ; :.''',.: 3 '., a N:.;,`� -.. ^.:.:.'. k- F's�p k a �� ., �.i �'� j.,x Access standard: 2 Dentists within 15 miles Dentist group: All Endodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 14.2 - M - . Sr. 4LL nt ,CU �.'i "'E•-;EY• Y,a 7 d t2it }`tS'.g�" : Y f. '. r .Oi : g+, xt } : a ;A'c'3 }`�Z, � AT .. �'.., P S.-,.- l h L 4 k'� � •$ ' t� 5Em to ees with ; '3 s gtegir.y 4s. x�. `' ,1`�`j 5 `t G '4 �Mt'x.1'� �`" ' ' y „�ie��'"Z'i a i 1• R, : yx4 .YR Totaifi tM � ^3 Total < nt.., �xF ia'�i �',� ' ia" y s �. � �k ti _' A� erage d>stance. y' - rc is ,,, Y`"sa>F` Y ,Yg'.^ 4 r - 3y E r Gifu t - a«Y^3 Code : s.. r .- 0 numberof � emplotiees. '. 4. s}' numberof � dentists t �4 zi h� Number a 4' ,�'� ,:.Fet o dentists Ala }�; HOLLYWOOD, FL 33027 25 6 25 100.0 1.3 1.3 : 3 029 25 2 zz 2� 1.00 0 1 7 1 8 33084 1 0 1 100.0 0.0 1.2 1HOMESTEAD 33031 1 0 1 100.0 >;�W_... _ ^ 33033 17 3 17 100.0 . 115 1.6 as at 33033 t 0: ° . ( 33092 1 0 1 100.0 4.9 4.9 - :-fi .. �� .v,visi- .;.-�,.;�m�-.., �� �, � � 7UP11hRA. L �.. .,.<. ,.... xw�334o8,A.... 'k � � -,:a,5v.,-i.� � 1<r19i� � 2 xi '•=�i":,a^-:..'x� ,:1.., 700 sY KEY BISCAYNE FL 33149 1 0 1 100.0 5.3 5.9 �LOXAHATCI37;E II, 33101 10 0 10 100.0 0.6 0.6 MIAMI; FL r 33126 22 0 22 100.0 1.3 1.7 . J�.:�,..�..� 33128 " .3 2 . -�. 0 .., 2 100.0 1.3 1.3 Db x V 33130 14 ; 0 14 100.0 1.1 1.2 x s :M, 33132 6.. 0 6 100.0 0.7 0.7 33134" 21 . 4 : 21 . 100.0 :. 0:6 . 0.8 33136 :; 22 : 0 ' 22 :.::100.0 '1:3 ' 1.3 .33138 26 ......:0 .... 26 100.0 :. 2.6 2.6 .,�J31F42iL 4 x�3. k�Q ..iv.. .�e.e �ta .. M 5 f, �u°` �11..44 .atv�.1 QV. V51A. ', -„ 2 ,.. ..3 . . 33 143 14 2 � 14 100.0 07 x 0.8 33145 35 1 35 100.0 0.8 1.5 JJ1�46 4 �r © 4100.0 . , 33147 ': 47 :. 0 , 47 100.0 2.8 3.8 �J3150 33151 1 0 1 100.0 ... 4.0 4.2 {�`.' 31» : ?91 . �"1 C _...: : 5 .n 39 f 704 33156 17 6 17 100.0 14 1.7 r: 1.3 42-� 4�1 OQ 0 1 b� r2 0 33161 27 1 p 27 100.0 0.8 1.3 Access standard: 2 Dentists within 15 miles Dentist group: All Endodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 14.3 ,t' `i 4,5"r �5,: �i �.' v.,; y:1',11 :JUJU XV, FR.GJ ~ $��:wr ` iA,i'y�",t^d r iw ': �,`�<G st,Ys'k^''h m?Kf�' sx„ tt: i:! ,�,,- ;�aea��'' ,+F,'#`EdE.i2�. R' si' y4P r,'#?;��'4.ti£�;"�RnY""�>. R ^'.. a -A R+. ' .i. 9 t i §�ja-iT ��i � C' hS vyA Y ti"Y '. ?Y� '•' SZ �f . eh: J� ' 4 k1.� ' �.y ,S ,� ?°�'' `v{ \ b4�:�. �?,p .Y .:^.. "SW 2' fah �':�`S'� �Employees with ,. '+a ' },S;, wer.. a���x� S .k 'F hh fr.�'t'•s££s'-` ,y 3F r(�eSITel18CCCSS ills nee, y��, y�t';>•'ieide P+.�£iiy W �J'""�e'F :Aue: 'a4a-.".,�? .' `s �•`Ta kry .'�rpzY .+...dl.ol'2I' - .a.�- zZIl' :;4 numberof £ . ?x'�11,Uta� > :ato znumberof a, 4 }. en ` Y C, A Pet �yZ,.� .-Code -. > employYeec p dentists :: Nurnberx _,.� MIA1vII, FL 33162 20 1 20 100.0 0.7 1.4 r2ro s331 £ ..__z 33166 11 3 11 100.0 1.1 - t 1.8 "any: `' °' ✓"'#�"`v Tea &"a .. ,°'+ ?v .:,; . ,, .. ar x:3 t# t f .- ; ., 33168 23 : 0 23 100.0 2.1 2.6 z. .ems -cc ..;;< ,ye. .;".>.e^�,;-:-,•-i%"'R'Y', az.�8ma _..ry-.�z4'v.^ ..<.s...0 �... ...,'zrY:ea?ex?.' _'+C"'L ems.'^ r~E??^23Y:' ,5 "�.ii. 33170 5 0 5 100.0 2.8 5.4 i s � .... �s�3172� r tJ >� ., �'{y�yzxqq,' 4�7 �1!)fl fl � fl $ � ...... _x .....,.....>.6..L.. s...Y ..l� . ...2 v.. .._.Se�..t�raE.'".w'C3.w�v_-. _..... ....... .. ..''+Aa .�S: .-f ....,ca,! ...�5 'i ;...n a�.o_ .a ., es.� T.w�v,..aaf✓w,..>-..::,C nk.-+c. ", ....k.�- r } _ ,e '"=F_T,'e' 33173 32 : 2 .. 32 100.0 0.8 . 1.5 : "":'-''T ✓! s_.?'i-'v �^t+.�'-"'r+vv"�•, �`T:',^',--:T::: '%t..T'::...z • "V.^-,�£ Ls.,. _:.$`s .. >k�� M+.-.^_`• 33175 . 29 v.Ci-�'C%. mprv�r. .x.�",•e: 2 .a.`J'.'..,e^.t-:n_'eh+;�•5iM 29 100.0 .^tr.'.....^y' • �",yZ'i.y«`T."t 1.1 2.1 : E .',=; A."-- Y ^�" ,a�H E4,n,.",:`ctvF`''t¢,'TC9>e'"!.y Xar..?'-= ,'.e' 331765,<� -" ..X: iX-'< 745,�.100 0„ �12 _ �_3 33177 18 : 018' . 100 0 3.9 . 4:8 ?� < ra, t €: l- 0 O 7 3;8 33179 16 12 16 100.0 <.0.8 0.9 r ,... -� ......w-,..,:.-,: .. ..xs y...,Ya;+�'^`X•�'y"t, W'•; n.,.y..,-m ...t....>..-,s-.,: T"�z 2:�":xz.__,.. v, m'.#i: 'S7.",. - '<r#nrc. Fi'':"5'. _in Us'xd`a's' .M"v e�;�,j-.'S'; ^,"'vw^d 33181 5 2 5 100.0 .0.9 1.1 =.' yy�"e'$ :T0.,V'f'Y: .. .. }4' 4'.-3•.. tA,' S" # ?i "." ._T3-✓.sr' "� ✓C § 4. 3 "�98. "' `'i x�"v' C 33183 19 0 : 19 100.0 1.2 2:5 33185 .:: 21 ' 0 21 . 100.0 22 3.8:, T ✓c mP" a�nT^ 5KT" A .. ?�': 7. fr. ,. 33187 8 0 8 100.0 6.7:: 7.0 33190.:. 5 0 : 100.0 1.3. 4.8 �� 33193 x 33194 - 1 0 1 100.0 3 3 - 3 7: ^YF'*'•Z*s ixz-,. g "'Y's .�, £. r,?.,�.,.� �::, muas.we. �a,,.�>,�:s.�.,x.-s....., �,r.,.,.<M.�„».a,,.,�,.,�.;:t.�.�... �,... ,%�.,#.;,,.�, J�.AJ'U .,,,-....w..,«r r, i" Y .25.£a x«.u...,�,.�.M,.....,�,�..:.�. 0.<' :', ...�.,.u�..,;�:,� ,.-�-,.,.. q^+ f3<Y, � ✓M„�,,....: .,k «., ... R '',a.:.., .4#.># � A .. rc�:. , u w. .: 33233 100.0 1 9 1 9. 33242�....: 33243 1 0 100.0 0.3 03 ,o- W 33255 1 0 ; l " .100 0 ; 0.8 0.8 3261 33283 2 0 100 0 0 9 1 7. KM-i; 33140 12 8 12 100.0 0.6 0.6 1O0.0 0.6 2.0 dJ#X` '„-'; .> .>.X,.. 4>:r.-.. L1 .. ,45 ,: za. .z.�,F �.b'..: ,3,',<.',8, :"Y'.' _, -. ,•`£ki .,.<:. 'h :.s `ai -':i.o... N.". '£;z# .«..:,�•#.^,�',.�":' ..'.S 4?:>...? ...,. Access standard: 2 Dentists within 15 miles Dentist group: All Endodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard l 4.4 .,.,'„'�{ `5°-'" 7a8 4� d: e,, ..; a y�'� �#4`kY FCC j l �F ��, r\ A. '>'�, a'"^' 1:°-s'1td,: �All,Emloyees� �yy3`�l'}:"�c &`3b S•:S�j,: ��Yh\'� _l�sa+Y•G����"'S�La�".�`��p` ��-$i1?�,F4M'�..S�.P� ������n.....+..��.����e..��n�•})��v,,C.r°��T�j'.:�.•`Mt�t'�.,�_"n�:la bi3T.�'.�,�w'C.Sin;?ild .�-AL9�'l :-�'d•�ye -., •i'•°u' ' va.��„�`5„:a�c.<rCb;�:�i��.. <.:?� ;a:.�'y'4• with �ss� aeces$ Aa g� r q •'ut�' ` "iX�,2�k�,C :tx 4 .}R�".ii^ 4 r`<- T.-L,.•!'X -'�-: Aka �t saa� iS•{'fra i � , ), { 2 a f + daag^d *§"-{ "�. -¢},r'"z'C v&''+ r` }'S;id {'cb .a"a-ir' tin'y {'� �, 'yti•, 1 ~i'9`, {'�^}. k t ��, . .,,.Code \ �� r y �{ &3� ezin+ 1' k7 Zips aemplovees: ':"n"�: N. X b§P. R ' pi;?�F!'"A$•"' `v ^Fi°aR',5�`f "5,'� ="iF 'PC otalfi� numberxof # -.' '�. Q� �� R. `'i,,3 "Fe- ' ,,ix: aip 'l i < z� _ Employees e• desn•ed .. 1.^'..* �z�' �5afr.: "' � �Totat number of : xdenhsts,a. p t�4 "_ '" a �� � r � r x fNumberPcts„ ISe {``.` 5�A' z�'°� Y. •, a r Aver e id►s, . a. �� � to dentists r . ..1 ftz MIAMII GARDENS, FL 33056 35 2 35 100.0 1.3 13 R'u ixr , 3�1APIS FLU �; ur ar .+r 34113 r , 2 ; , 0 _, 2 3U0 0 y51 34120 . 1 . 0 1 100.0 11.6 11.6 , y 11 �"f'.}ya� S$ 0 .�•"�.,...� ezk.tr .. .. r8.'£ps �'rca"_ a ..�a11 .� i... y�i. 7000- �. .�, -£"ii b" .z-4 :1 5 :�"""::"' f �"3'Tsay^,, ,.•ww4 .?t NOR7�1 MIAMII;BEACH, �F? � � ���,.,,,.M..s�,�...�w�. w �..__ 331��.... .� k OPA LOCKA, FL 33054 29 0 29 100.0 1.5 16 .F x .vY"i ., a' Y" _. 55 4 d'. .. t xr� I-., ,ySO 0 ? 34'5t ,< PALM BEACH GARDENS,FL 33418 I 0 1 100.0 AnT 2.1 2 1 1'A> M1' CLTI' k j t x � r� _r._ 34990 � 1 a 3 _ -.1-.E _�._,_. 100 0 w; _,..:. PEMBROKE PINES, FL 33028 5 l 5 100.0 0.6 0.7 POMPA3`IQ BEA FLn ; ,� .;3063 °2' 41s 2100 0.� 0 9 0 9 ,..}r^„^' 33068 1 1 1 100.0 : 0.5 1.0 : y; F _. - .. r ,-, Y`"'i 1 t 1 �s�-_�......R-�sS_'•.�.Lu i'" r� 13 .�3,�., `. . � �. '., �•"e Gi '"'x8• 1 5:.�_.su§a.�'h:_:L _....s_ '' .)D t 100 0 •.y...w.a .,ssn.._� ""3` 0 � :"'w.�..a.._ f 0 9 ',vz..�w_Ga'°..-.. ..�.q t3073 .ss , :s:�`-:._3�.i -.r ":.�^+JYu-a�.axs�c..+.._._iw.-.....,...mavM. yt;2k�vl......._.,.. PORT SAINT LUCIE, FL 34953 2 0 2 100.0 1 1 1 1 X4 :34 ER x , : : Aza T ,n. t10 0' :- ; 2;7 spa. ^^ 34987 'i=° "1 "tee .. 2 1 ` ", _- 100.0 "Z. a "�y.^p 3.3 `.3 •A 3.3 Y +: "-.-' -4,, , 2' ..z _ ^z f". �+, `+�!. ,� s°Z'y v n LLiNG`CO�FLx.. ar.�.�.xu � � � _._.�;���; c--2' 1'�e c�;� ���„�414...� ..g m 3::,� � �� _ i ? i' _ur.�: _�. 13� 2 , �,�m�a 1000 s� "- _,_�€ -y.�� �.., 16 WEST PALM BEACH, FL 33411 5 6 5 100.0 1.4 1.7 x _ F i 697 ' �238 , al Y f ,,.. ,� ,,., ,, x, ay::+c` ,�x.*a c't, 3..s. -. _. .. ., ...i .:. le .. ,. P *, ,.+ •,.- v;.4 (a •'. Access standard: 2 Dentists within 15 miles Dentist group: All Endodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes not meeting the access standard 15 F.0 '* @,; iv"^�E.. y....jja Y�'VW4t §}yyV. kt �b�. R` ,bN 3 \>':,,1 �33 \ y4 Y ll .. �•:::�a .Sv.f,d.A x'4i3 : �. Empo A �, S?'.: '� e'C. ts" ^"WPq 'sy\i4 Y. ' C t 4 i i N @ a �' Yf�� �� "h ��'.z�-�a,x..4 .n+yC„. 'y'2�Y��a�3 aa+ _�� \o- �'$rK $,� • L Yy `h YT k a d a:5` 3 � y i ''� 3£•T��'R,y q> gb.' 1 bkyf� -4a � y h U � L � R C #i••Y. W b i.'� { '�wS `C�C_:.4 5� 5 i �aLd.5g" n• Fy'� 4g4 �.'S'i'S'' `t csa `S ��,��sTotal � 7 �� I>, �,� E �� �..,s.,.r_ va.. ., u.r .. - v. •,..r _. .vw ,,.. r ��s7aw 4 -L 4 'ry a 7 t .S F £�i�' 7.IP�berof Code <. ....-��n 9 iv i1 �`�;u.•'•5 a'-'�I"a•ffi��`.?r2 ik.�,p� Y '�a[ t�'rar ,AE P �,) '. M•q.",. Y '�.s �..^} R.`� "v R3�1 +i>Se nnum temployees° . ..#. .,. 4 ^d� .. �'R� "Xa k 4' is k '§. £ 2 S �' 'T 4ii1.,t vh v^1:. eG'��'.isai .=,.�v'r'�F .:� .�4i�E'III ^fi -a . XX 'v5 c#'k ^. 'ikS'F' �U CCS .i t �I'.S{Ied 4 '. i. M�t�IUIIt tFa� aqe 5 4•'p�s �Ceiiss -e, Y✓ '+• kZ„ N! ��✓ iy� e 4:•'>"+ z K-t3 u`"' 7e Total+ umberof� deutlsts'Number ,u .. 3�� 'v,�3'r, £Yk g (� ?� a x � e _ ;4 7n#. •t`g4,t4{. F , " 'iT�'^ _='.`t:{' Average .. i.... :�.'qYe, r'C' distance ; �: r KEY LARGO, FL 33037 3 1 3 100.0 3.3 23.4 ���1 �U_,._s v� ..us.....s F'r r A• � v. �. ...�.•3b .L_!�'...._.b._� „ 5 -a '& A4 si�ia' `` ...s �...>: ._. F _...>.•. y�ii s`ro�y �;i _. 'i � �J _..cam--w.-r '� ',x`r xE $A� � ,: .,.._�.--.,.v..� � .5Y3 a ..s�.p., L..Si.....n A.,..«....� �oV V .J«..v.u.. a4 <...�. a'.,.._.... ':t '• 23�-F� •. Y>" Access standard: 2 Dentists within 15 miles Dentist group: All Endodontists Accessibility Details Periodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 16.1 S '4 Kil. .., � �. `i �YR ?--�� y't' 'xk' 'K•'-h'a':, \� K Sa �y"r a. ....,._ '�.. �`'��, Si .Y.. �" x�.3, J� � 7 �'� '4t ��%M^i�'�y,., AllEmtoYees P .y�� w.. `�° .+ .t • ar s _. A�=,r..._..,.•....�a Y'wj,�� "",a �'C+ \}-y.Sr� M,`..n,�t iYbf. �'�r,.e:-�e3'� �,�,El ;� k v ��,3' E£'s ,, .«�?'' �iz's`Y..�._'�, <sa Spa 1 �,�,��'',{� 3d 'x�.+�if?±::i'� _ _ r. �-�' ""2• �, a � �$:�. �-« ,5...�.�.- .. S ,h °t '@?'an:' .-i::� A'�r', ..:@+; r=tis;., _ `iu�e� _ .at,e."•'= 'I' :yv .iv'.* r`k:� .�z'�" :-c. ��:. �i�^ �o- a 'r. 'S''Y'a, .,;tea`:<'�;.wi x�' + : =:,Z," .�:>�"*•`.4 ,.�4: .`$i�` .,� , '�; .; .'+* a `�` � �, - .�>'.i?.. ,;�, mployees with ,.: 4 esira eT a c'd e0„ •k �+ .. L .l k a� t ZIP Total �� nprriber of �� Total , number of �3 s r .'Y.r yerage to�denhsts snee. F: ditas x� , :. r ... ._b Codc r employeesw dentists ' Number Pct BOYNTON BEACH, FL 33437 1 6 1 100.0 0.8 0.8 ,t . '»n ...'» ,�'�'�`' --�.s. `CORAL ES FL ? � ��+' ^§ 3 a114 a? k 1 s.•.o - p Et `..'�` v+n• f , d ' 1 *"�'� 100 0 f �f s"f, ^.� 03 � 'e^Yta^.ere+ 0 DANIA, FL 33004 1 2 1 100.0 1.2 1.2 SORT LA2mrUDERDALE 33304 2 1 2 100.0 1.3 1.6 33311 2 0 2 100.0 2.9 3.3 <s,. , x,....f: - � ,ram ;�� ;�?:��':-�• � � `�;��..��v�,.�r,._ � ' r.. u,azw. :R��uiu.F.,.X c,u{iw,. L v3�fr.,, Y- v�?. 4•c . � 3' V ?.. _�i .,. ..b ��� .,_-����....�.�W....w RT ....,. T'y+f'4. ,....... T' gi"rv+w. a ,.`+ " Y:`".P,;"..4'+"?' •.'+'i _. �_--^'� il�i .:£"S'T' �.�# � � � 33313 2 .: `.T'r`W°'-._C'�,., :£ �.'4 � � 0 .m,Pv" .!+`.q.:" L� �� o 2 l`,.�`w.tii. sl 100.0 wx:�',+r� Elooa�.8� 2.7 2.7 .. 33316 1 1 1 100.0 0.7 _ 3,2 ..'...+., 2 ..�-3000_m�_?.�12- 33319 1 3 1 ' 100.0 ` 3.0 3.0 't ;.1xn«,,..sE.w ;.$Y:2au" ^',�..:i%:x.,., ivy S° .'.�GPo.rt „n 33322 as� >�.. ,wiF ii._w�. 2 -. 5 2: . .s., .v. 100.0 it?..: w,ew . ., 0.5 F.r ...Aa��.i,�a_^.:.Y� 0.5 ,kr. ,,..Y. .'.�•+.�i#'.�li..i.,.v-sF�..,Fn.aS_:,�e' 1 324 .3 4 1 � 4�' 't`a......c.: � `" 14 33325 3 . 0 3 100.0 . 1.6 1.6 .)....1.c 33328 6 9 6 100.0 0.8 1.1 33336 3 33331:. 11 4 11 100.0 1.2 2 1 �v.,,_ �`' _,... 333� 4 �»� ..,.. ,1 . 1 ` `:1 ,. .�.... 100.0 �w� ',.. M 0.2 :' ,«�`% 3.:;,o._.<vv�..�_<-_..:c,:3....___.�-:.�•:. ,..,._:._._...,__.cv,.a.....wz..as.�._-„nr,:*ay.».� ;1:4 ,33 HALLANDALE, FL 33009 2 1 2 100.0 1.6 1 7 "' w.,.sum.':.._....�,$ ..� ° .,�'.;;L. , ' E` 1 '..;«.'�__° ,3. 3O 1 Oaf,. �:.", :�'� . 8 .,___` �•. -_..$`��"�`: " �.'° '� . „mx_c?� 8 J �� 0 ..:� .a.42 ..,_�'�a.2.,�.:m: . 33012 15 8 15 100.0 07 0.7 -.)013�'�, 330.14 18 7 18 100.0 0.8 0.8 33016 9 9 9 100.0 0.8 0.8 33018 10 0 10 100.0 2 2 2.3 HOLLY'ViCT1 AFT ,st � 33020 s<3 � 10 F ' 10 100 0 1'3 33021 7 11 7 100.0 0.7 0.7 :33024 . 7 8 7 100.0 0.8 1.4 .)30�� 24 2 24 ],00 0 1 2 z12 33026 11 14 11 100.0 0.4 4 05 '•-+d �'i'S.. n; �,':�. . -'F >g .$.s'::':! ', «' 3� .: ,ni:;.;. ,,, $., :": id %` .... :',.,.,„Y.� 9. "3'.k. ., ,d..J!,.s,.. ,. . Access standard: 2 Dentists within 15 miles Dentist group: All Periodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 16.2 Hoye -.;- Xfx Ww.^rv,. , �`i '£ i.: . �* � 't.`;NF.wr?S �cl:':�C�~'�'��` "' .i.'5�,' }, ...:.���l�k?..,,EFak,�'?.`Nt`,.if. ;,.,-a -3.. ;.o:h�° F $ ��.\^' �.S � ';. Y:-«er?sic�C# .'R...Y: V -. SlS'V tam 'FpaQ3'P'. A. ?. # y ;� L .'?v+ t . ads „ , � �� Emph, ees with � y ..:��:r 2' fi...•� ',o, ..i`�° S 'Ly?'<'" E �`•SE' �"`cC�'S`y''x'Y'F �'.iY �'� ��'iSk`u Si' 9 .,' Y .6 S 1.'14 'r ``"�:s. r ,. ',° `'i 5 { . :vE h" Qi' `t 1 .. 'Niw . ,]itL...��' g'q 'txiE ' 'UCSi �i'E(1 J'leeCSS..',. .. x s `St Y. `��`y,�i�+4e CF d '-<• ."jA 'i RS h, ,. ie� a %y4 r3 y ; 'l;« A;'Cis s_Slg>n .ji\ ..�i'v� erage ti (3 -., J sxb tjlStance q+A�'. nyyvP�• 4 +. 4�}x. n f-'"}h-i �i.��:�RrE`>-Fas„ M.� b,.. p a �'... Sx,.d, � k Sy'-<'1'i ,y �''v Total :I Lam: �e"5 .4i5. otdl r �` y,j °S '1 ''' '� 3 ZTl y "`F� Cale number ofnpmberof 'x-t empoyees, iientists �. -P �*�t.,a Number3, �r �o ants :..w. HOLLYWOOD, FL 33027 25 8 25 100.0 1.1 1.3 �302925��12� K`�`�., vr10Q0 11 21�" 33084 1 0 1 100.0 0.6 1.2 2,7?x;'r i' A, r'�}';� :;�:E v-c.. v fi:: f'N::_-- wn^'�`'� "ti'•y�. Tz 2 :.F . Y ?, . ^'ryz` .Ey'y rHOM13STEAD FL Y 33030 F 4 10 ,,.r 10 ©0 0.N 1` . i .A 9 33031 1 0 1 100.0 4.2 6.4 33032 33033 17 2 17 100.0 1.6 1.6 .33Q3. 33092 1 0 1 100.0 : 4.9 4.9 NP_I=TER �>< .A� KEY BISCAYNE FL 33149 1 0 1 100 0 5.3 5.4 xLflXAT3ATCHEE FLU` `__ _, ` 33470 o-; MIAMI, FL • 33101 10 0 1 w ?3 �� � ;µ,. � r�� � 0� �` �� 39 �700 0 � ��w`� 33126 • 22 0 22 100.0 . 1.4 :1.8 X+ Z<r3Y"3-'„r„y... v` -w.,�:-: .:� a..JJ� ,.S.. .-d =3=':^;4 .3>' � � � � E ,>�qa,t ..._.�.::..-.� s.r,,,,-. o �: 'mowJ'�`» Q-��J3;�: `_;�.;. �. <.. 33128 7 0 2 100.0 0.7 0.7 33130 14 0 14: 100.0 : 0.5 0.5. r :' _.: :, _3om•,' _ r k,, ^3, 33132 : 6 0 :6 100.0 ' 1:1 : ;1:7 33134 21 6 2'1 " 100.0 0.7 0.9 33136 22 2 22 :100.0 0.8 0 8 �26 33138 26 0 26 '100:0 2.5 2:6 2 33143 14 3 14 1000 0.7 08 33145 35 4 35 100.0 0.4: 0.5 � 3 33147 47 0 47 100.0 3.6 3. i ,. ...� '&� b..Y '� .. � .. .4 .. : :. sYF.F ,r , M. ... ..a[•.icx,..., ,F�ai ,.<: a,.d '.. 33151 1 0 1 100.0 29 3.1 �'�39 rj39 100 0� 4 1�q 33156 17 5 17 :100.0 13 1.9 •. .: & r.l ?J31.a7 '42 3 w Q 4�_ 'loQ0. 16 24 33161 27 0 27 100.0 1.2 1.2 :� § a>'u ;; rw.xi]x, '.. }:v } , s L., - . r' S x• ......,T x, ,:: i :..?:: .'� ,' h . ; A x � .�..• Y i Access standard: 2 Dentists within 15 miles Dentist group: All Periodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 16.3 <S.'. w z10 o3�e , es s F x z S? •W"t' . y <iR Y,,�?. .xx ^'Rir`k, c'w": '?l P'.A :s'>'i-•7,1t. w.f R:'�h i;.-:; i3,3F_ X1i ��i '.'�£�. 5. S-a': ,�` . 4�v2k. F�: pg Az+v't g3<�.,>,.3'� �`` � -FF# K+- `3k �''s, .. +1... .. t,a!r�a?w�p'���Ft,S�t�i.s'�'.v'�i'..y... ,i .•��..e_-,..1k�i..W<x; a:-.. �a>�'s£.4:-s• :.':..: ett'd�1,Y....A.�i =., . '.. }. .i t 4 F '3. �•. ) <` ~?�' k 1: a^ ,3} � 4 `"$ S .i 4� a �yt., _,s*�a Employes.w�ith�i� '> �h�.E`, fix?,. 'x-ba�,* �{ �*sa'�*�*'Sv"��2s....;&P`�}';�c°�F: ��.v ��i• x : { e41:ed 1ce,07 .3 � �, <,� ; q: 'h �`' A aµd �. � -,� r iA^ `� '� 5{ R �fr.' :J � .�4 'N c��- ` a s "C'v,'�- '� 32 i " n. 'r5s. ' 'may` y a ,`y. , f+y r "�- :! Y1 era Av a distance otal�,� g - � to,dentists ZIP.i 'numer of number of . � 1? .ate X `�•��5 4i- ..`^ (,� T 3ry.: x'S "`X�' {..`>F`� f Cttr 'r ` ':'Code employees, dentists Numbers Pct.Y Y . MIAMI, FL 33162 20 4 20 100.0 0.6 0.7 ,; .k.'srnxY., ." "�"F•r%?�^ J-. %, 4 3 . "i m; r2se^',iY'W..i., ,ryn,�^^ x+s.ie.i+p �r r.. .yy,C +i• ..•ti k,5:''�i�"X §:.i £1-.d ,x 0 Y.v t' a e'i XY `S 1 33T65��44 . ���m,...�.�� 44 � �1"00 D�� ��, 33166 11 2 11 100.0 1.8 1.8 --_. _�,.�.r<. ....->:.,,.Y.r.�.-,:_A.-� s2.._.,:<„� _ �. a. :.>,:-r .-p ,, .TH>.� --E,. R•.:.s� .;:;r;.xs...-.-.,,,,�a .�sz, =s: :•,;ate'"-" ----;r-s'��;� -: � 3167T�4. ,R„fl. m1470000_31,.37 33168 23 0 23. 100.0 2.5 2.6 55 i �$ 1000 _ 16 19 ,�..::.�.�..._. w.�a..m � � u h ....,w,. �.�..,� ._ _.�Y - 33170 5 0 5 100.0 ' 2.8 2.8 '? 5&,-,,---- I= y 3a 72 37, A 17k100.0 ,z� , uz_M�... i k+s�,,... 33173 32 4 32 `.;'...��,�.-rc�;q�.;< .e:•,~; a .M:,�.m. �� . z`K"?ri:.r. vyy,.k.�.ys �i„ �ro' ? :s'�" .e;100.0 0.8 ei- s 1.3 Ri '3 33175 29 4 29 100.0 1.2 1.4 33177 18 0 18 100.0 3.8. 3.9 3317$r:._ 33179 16. 9 16 100.0 0.8 0.9 _<. .. � �..�K: 33181 5 5 5 100.0 0.7. 0.7 ;x �; 3152 g,. 1�' 0;100`012a 1'2T x ,�.i>. -..� ..k:...i .. m,. r.-.€'x3✓d� ,.,.:.xc ,„......,a.,.,w .�•..s. . a.u. ....,.a.,. ...._ -.w..v .._�_a.._,..,.,.0 _,,..... ._- ., i,.� �.... .;:..,>-�, >.,,.�.. _,:...W._ '. 33183. 19 1 . 19 100.0 1.2 1.3 5 5 {�:. J�x <5 J S'S'x �k : ,fi.. , . .-"` � ��" 4. � Trtx'""e ..'i';✓+:-'�Tffij.� •€'°'-3 Y~'� . ^Y" - � _ a 33184 33185 . 21 0 21 k .. 100.0 ... 2.9 2.9 T,t F k ! IY` F 5'. .y aa"' i ., 'Ea` f 4 .>:� 47100 0 19 0 33187 8 0 8 100.0 5.9 6.3 .aa'Sceo.="p: .,.. e'..'.r - :3i,4... ':ay, "4c :'`1:F?'Ta',,,,.o .•"" _ -<: �;=%�2�Ti�s-^_ri{i,%tib�,v'gT.<,r�"Y .}�+'. ,,& --:f :3>'! q' �� '�,t j.-. 3.. '3 Lr7000 1�12° 3189�� ��18 : 33190 : 5 .. 0 . 5 100.0 1.3 :. 1.3 .' '..' .. 33194, 0 Access standard: 2 Dentists within 15 miles Dentist group: All Periodontists Cigna Dental Radius DPPO Network - City of -Miami ZIP Codes meeting the access standard 16.4 m 1 p � 111�1yVerJ��� F..:,_...._..ua..: _h .0 d.a aii �. r.. ..;.°s ...�"R t�7? F 4 -'b : BM it z'w � ��'-'.k qaR 4'$ t•.#it'�•u,¢as�gA 5 �k 2� 4£ 4 tR "te !YY t ,f-.e�..F f l g;s § t ; �C4 $' +k � S �x2"£' ^a 6�. k Sys S'�rz�� a� s� ,'.pi )vit, - C¢.- - Aih desired �.� ,1., iJ'`'j f',d„:.£'\..eL'}n $, t,•; v ,-, ?w access �ft.°��..F.y-'t`.Fen Y Z ! Y ! � � r � \ �sY^ �c,}' -::t. '$'$i 'Total � ,l�kl, 34 �" � 4R"' Ef �a `?�'9. } ,f V trT A Average distance �• � f, �� `��� � �p s Ciiy z1 » �Z1P Code`, instotdentists��a� �Rnumberof ' employees• � numberof dentists �'�'� �# Number i4 � � � ��� #'ct. a MIAMI GARDENS, FL 33056 35 1 35 100.0 L2 2.8 ,1%13 NAPLESFLU# .:_, x =. * t 34 r' :' 11€ 2 I00.:0, ,,5 1, af 102 _ 34120 1 0 1 100.0 14.0 14.5 NO Tt3 MIAMI BEACF3 FL L .X r,.m,....:.....«...eu...,s..,...tJ:'..+.L.x.,.aa�`^ 33;60 .:... 1`1 'L'"„�r. >.,.,. �] s '" l l 100 0 G'a.Fu�...ar..,..., 1 0� ,,..a:>..,....m.�..Si 14 OPA LOCKA, FL 33054 29 0 29 100.0 1.6 3.4 Y,� l ". �^�' ¢ •� 3 ",.., $ 2'�: � �';,� S. �. ^�.4 ,�� �,.; x7�-3''. #. _. � �'g�r".. �;.* � "4;'xF'"{ _ R� 330�525z.z�� � �.� ._,_M:.=�5'1000 _:_�25 z: PALM BEACH GARDENS, FL 33418 1 2 1 100.0 2.1 2.8 ;r, ip Y ,.*.......,.... 34990 .its., ._. ...»: 1 �.. .rm:. .>? xa _ _ u eas. ' ,. i 00' 0 . ...�..._ it 1 8 xa,m,...m.18,, • t 2, PEMBROKE PINES, FL 33028 5 5 5 100.0 s 0.5 ? 0.7 POMFANOTBEACI EL � � :ate. - 330b� _.? .,.,m K 2 10 0 0 6 : 10 33068 1 1 1 ; 100.0 0.5 1.0 { w1_1 0:"'wz 27_'°€� i? PORTSAINT LUCIE FL 34953 �49s3 2 n _ E 1 0 "' 0 2 i 100.0 1ti0021.�27 1.8 3.6 34987 1 1 1 100.0 3.3 6.1 W£LLINGTOI?i,,: r 334143 2, :_, 12 x � 20 0, 0 7 ; �si _: WEST PALM BEACH, FL . 33411 5 3 . 5 100:0 1.7 1.7 1, 6,7 a 100 4_ 1• 1 Access standard: 2 Dentists within 15 miles Dentist group: All Periodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes not meeting the access standard 17 £ \'�' L �' in A'� 4 �' 1 $ F 4 `�$„e,' LY `Y,ai `'`p'1 L ix y . �C A R+ "� R All <,.. +� d LS 7E11.1pl0yees�r �j xG 'F'J -^' 1 k -; a ,a h k S �., "H 2 t ��' - 't. 'L '� th a 4 i; L I �^bG. -ram �3�`i.ai ` AL 'N" w 1 '`' n' vd"�`.➢� "�f 4 `w �'� ? a *�" '�' t 'T �� P+ ti§lli '�L. �� i �' ii � .yy£� t F'".. N. °>�z Cock a^N 3 "^' § rE y �, z� �ri'� \,� �z^ yore °F "�T.13 k Total �F �numberof ' employees K x&3""' -, $ a '� a t^�-� ^a <ru r � � � � � �.:� � 3 a., c% ' e aim' S-9H,Ak , 3 3 : k'�s' ,Y g, ��� �� ��des�rcd:access k ��' F d �aTo�al� numberoi dentists - Afi v'- s �, . N i e ^� ,'.Y''S` is Average distance, :If l 2 23.4 KEY LARGO, FL 33037 3 0 3 100.0 23.4 t1k'de3 st 3i 3`s Access standard: 2 Dentists within 15 miles Dentist group: All Periodontists Accessibility Details Oral Surgeons Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 18.1 hf :2� - h cJ'Y+T' 'aa4h`':R�- z .._ .x. 4e,`f5_` ....ta1,,..Y mployeesvAit eitlae� sl a-,c2` +--'.. ,$3'3 :.tz.� Y.xf„+1'a .fir$ 3,3. .M._ '.*a''*.x;;�,'y,`.�'- `�N•a�-JZ�w �� 3 < s t�s�sa; < �sF�. •�u.� ;'»s �number d'y`'x':h r sr rode yet^"' �a Total a t f� skein loNees P.., �..,, Total'x�2� numbcrof n detists r.._ Nber> . um >„ten f ; Pct Average distance �; #o bent rsts I - BOYNTON BEACH, FL mg.- U x 33437 1 1 1 100.0 1.0 2.5 COR44 GABLES Fi ex Y , � - x ._,w_^...,...s..,.....:.._....... �_.,.,._May.,.�v„a._...._...:x.,, 33114 1 0 P 1O0Q 3�0 03 DANIA, FL 33004 1 0 1 100.0 2.8 3.4 ;FORT I AUDERDALE 33304 2 0 2 100.0 2.1 2.1 �' ^�^FSr`i•Ht:''. Y. t "i? '� b. .. J S 3 y .m1' ,je..1 �`(+ 33311 2 0 2 100.0 1.9 2.0 nrsn... _ << .R, "'i':'d.''rc y .. Ts'}'" �."'"y„n�*h,.�.&t sa. `l'LL^.''^"+Svc' ..., ',F `! '•.,h ,- ".�'�f'� �.:i4 1 viy_:Y+'-a�.�n,�r3. 1 �����s�� �...�..�,.xx�._�„_. __tip ._•_��..� ��, - ,_'F,`cv 33313 2 0 2 100.0 2.3 2.6 :: +v:ks t a5a-_--9+3 �>✓. J=+. 1�, ,&'a : y'Il. S`. . K :C :-'.`,; _ e`�.r�.:✓s'.�:3�^::.;."':`�C !x S,R ,�i�Ss k '>f':. =f, 33316 1 2 1 100.0 ., 0.4 0.4 '�•,•r <`+i,.: 33319 "- s 1:. Ar-s. � 0. r � :., u'ir- 1 100.0 •,;",�'.. -� 2.7 '-�., 2.9 +Z¥x a�j3�13 xa.:ew. 33322 2 14 2 100.0 0.3 0.5 ; 332A 33325 3 0 3 100.0 1.7: 1.7 lw�_�� �xs��26 26�100U 09.�� 09 33328 6 1.. 6 '�' 100.0 ^�'� �1.5 1.9 : K` � 'R"+�; s �`-�' •�"`. � � ,� ... �"' . � ' a �' �,-�-"-'Si^. '. �^+_� e �r SAS"n � �< ',Y 33331 : 11 "1 11 100.0 1.3 2.3 t�-� ��' �- .� r€ < ``• 3�. � � � �F � 3�3a2 4 � .< � 0� z �;�`4� .i�0�0�� � x� Z � ,� `'�.9'� 33334:' 1 2. 1 100.0: 02 0.2 f „a j S 333'ci 2 1 �w l0U0t ^ 07 18.. HALLANDALE:FL 33009 •2 0 2 100.0 1.6:. 1.6 1' y�x�8 01:U0Q �1 �25a 33012 15 5 . 15 100:U : 0.7:. 0.8 33014 18 0 18 ` 100.0 1.5" 1.9 1.5 _✓ �,� .� � � � �� _ ��� ����©?._�� ��. ��. ,��� �� � ...✓ , � .. .. _-� :tea . o�•� . �:�� ;',�:. � � . 33018 30LLIOOD,:s3020� ,....A,..x,F. 33021 : 33024 . 7 7 7 100-0 1.0 1.2 5 o25 24 ao o t > 1 �`14. 33026 11 6 11 1000 0.8 1.0 Access standard: 2 Dentists within 15 miles Dentist group: All Oral Surgeons Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 18.2 .....t�:4,i;..����� EIii 0j'eeSr te+- < _ 'F -`q, ;, _ & ?a• .i; ��; � "s�� .ry{ r?,g ' � `". - n,.� ��` ��;,.: '. - � 5� .£.'F`i' i'l` . ice` `' ".yi . 1. £T•x y-{5,!j"h i� e` "'yi i . 4,�-y�[ii'ta�r�. • s.1:�dz `r.n} �5m',$' ML1Y ,..5>.i.0..... , .w z: .. a:8=.' �.' �t .; €fi .`,�,�'ex`i "-ki 9�'� Yam L�''� Yz�i: xF.i s., ,, .{v '"'3 x ..,..vv.�'px "L`#'="'g°''':i`'„`�g+•;��t'x 4;x,:n,.,s .:;<#'�,i.-'s;.. ;� 1 ' .2 ' mployetht� �. r � °�- ije81l'Ctd accFis��-- ; •M- A t" �otal � .numero bf 1 Sea mP�Ot1� Totals �.nuniberf enits ., °� umbcer ..: ,. .. �.. s, �� �� c ,... , .. .%i Q Avers a #o denti distance n sts 't ; 2 ail ff HOLLYWOOD, FL ..;.�� +:s? �� 33027 �e: ''aa.' Q29v+:a. 179 33084 33031 33033 33035 33092 3�4�8 33149 s3470 33101 33126 25 +�• ���..�.....�;��.- 'Y:.I��::."--"4'3 ? �5. 1 1 n:.�r."'' r:,::x-+"-^.'?"T:" - ,17 -. (' 1 .. 1T .� �: �" � ? 1: f 1 � :10 : .22' 2 8 f.�'t+ •t�`a�°� 0 0 .-'� :ilia �;;„"2r'.`,':"..�.: '�,{,,,��gg 3 � a i 0 0 25 . :�-�:r �s ..=ri,e. ... F.� 7���0 1 1 zt?«; 'rr_:---- ..s `�'�T,``' 17 ? fi 1 �H - - , , .: .� 1 10 22 � � �� z 2 100.0 ��-<� %};.Y fl'.�.: 100.0 100.0 1.0 .gin-•-�g5� 'G '.."; 1 7 0.0 4.2 i �- w 1.2 �a.30 0.6 4.6 'M _^'.y:. 1.6 4.9 - ' 7.0 HOMESTEfiDr x,..*w..,....;'+-'r _• '1,..;"-"','_;".:..;;.C_i?E�^r.'...,^. ,ate,:,. `` �- -A4; .;ar�"s`- .. .*'x ... -+v';_--_f=k'"-.":•'„:-�r�;.'^;...x-�'.- ..r.r3,�;...2 .. 100.0 00 0 100.0 . w 100 0„ ; 100:0 100.0 : 100:0 100.0 s ..... fi.,:2.�e -•`xie°�M .:r:- 1.5 4.9 xy . , � 6.��, 6.9 1.2 1.8 7� �� I iiit? :; : ;,.�.;_.. M :: u . F <; KEY BISCAYNE, FL hLOXAHA'£CHEE _. n" � 2 kka •:+J:zm`-'� :7...- ,. %F ?„ 0 0 : • 0 0, MIAMI,.FL 1.2 :2.0 33128 0 '..:0.9 :0.9; M .. -: - ° 3 739 E 33130 : a3131 33132: 133 33134 ... .33136 : 331381: F : . '^"Z9 33143 33.145 ��:' 146 33147 •3_13O 33151 .. Y)''«„r:`Y 33156 33161 ... .z.".;. •_ 3, 3 14 .: 5 :6:' ,r .`� 1 2 1 22 . 26 � �^y, W .. '14 :. 35 :. �4 : 47 . 1 �° Sys 4 17 ...27: _ .. . 5 0 0 a . 0 .:x © 6 0 .... 11 0 v.�3'.4i�cs' fi, .� 5 � A 4 0 1 0 :0 i'%%F.F% . ; . 6 : 1 � 2� j 14 : 6 �41 .. 21 30 '.. 22 M J.00 0 100.0 100:0 I000 ;•-� . 2 1.4 1:7: >• 14 0.6 z-1 0:8 : ,2i •1.4 1.7 lea37p� �� s���w _.16 . '0.7 1 0:8 100:0 i000 100:0 ..100.0 1t`� --cm 100:0 100.0 1000 :100.0 ..100.0 :iv'E 100:0 "5 "i" y 7+°f":'% �'Tx.✓ ?y,' M'� �s,ax� . ,,,g 26 C�� �'. � 14 35 .�W�u W 14.w 47 :1 •x �"£.'ik., w ""°a-. 17 .:. 27:I00:0': 2:5 �'x�J:Syx v W"�'^-�� 0.7 • 1.3 lH��� 2.5 2.9 1.9 0.9 * :. .: 2.5 � :. :0.8 1,4 1�6 3:5 2.9 `:1.9 :< .1:5 *h"tC "£�, Zi �° fi +�F" k ��3311lk, Access standard: 2 Dentists within 15 miles Dentist group: All Oral Surgeons Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 18.3 M. Oj'Qes abs�',:-.Yrx,t5.ax-:,.'k.>3"a'�-.�.--_T.;r�' ?'t�.'c_E.:t'srt,,a-,",'.'-z-*.:".a�.•`.�a'`Ta,;".�a:,...v..: �y>-�x„*:ei?x`=-`+.:�z«aaa°'ir,.`T±�3*t''r:;A`^:s..4..2?.t,:�.-,i-w'0.,..,.t ` .. y y ..�, y E r�{�s r -� �''t,. a- �',��-�'? rw..'xs'=^Ty'is..'x -,'., .fii'L. &kg,a' �:desiredaccesS ..;. ii_`•";' .•F p'f.. { `ctT'i R, j.�Z'. , �' S £���� t' ` w '�r r Y. d `i.. .,GF;i fib... :\.`e�ev k, •& A$:. X J Employ ees iwIth� k , ri-4 �"'. .' Y. ' �2 % rY Y. i � l � ta`' "i h � '}• }' � '.�C fi-a��5�L43}'`t?n,F.�,.��tt3•''^�w'.z s r F gyp.- F W"s•4 K�€ea atgs',S`i �-'se'. �Y:: M � +ley i' . � m d, 25 �o�l.: ���A�eraged>stauce $ 7 - @i - i t 4 `'S {F ZIP S Code °�•�X%lA�� { � " number,, , w fs d Lcm to . -d ,4 .vv �i6` number�of9 deutIsts i� y 5 X � ?l. F Number q d � i ,' ; Pce > to'dent sts .,i� l f Z MIAMI, FL 33162 20 0 20 : 100.0 1.9 2.1 .. �, . 33165� t� 44' � J 44 100 0 1 U �• . 14 33166 11 0 11 100.0 2.2 3.1 <'-"^' .,a'+i'3 .+sxp^+ .t..._...,._>. >-,: ,..r: �316?., 14� u74 10004� 71 ;Ms3U 33168 23 0 . 23 100.0 1.2 : 2.1 �::"�•,-.N"r.. .>n-.*_-.w..r.,.?.:-;;.=:;P,;::.-a-.-_-:;-:-<;�;.';T..':,r.":i:�"„ _ ,...:. _'<..;:a4:. �^:^=...:,_=�-^ ; . + a„'zz; `>:t" �s ^�':'=;:rv:.-',� 33170 "33172 33173 32. 0 32 100.0 1.2 1.3 f•K as �-.*-�'v�= - 1`.YR,4"ar,:�-.r a;5 v"J:?.,siYs " 'e.'3^�-A-� '"v.!'� �£ .3�'^.,�, . �F s<. ^$: ".�r5 .fa 'rT"�',ir "*,��, 'g''Y f � %$v ,g-. `> E`5 . 33175 29 . 2 29 100.0 1.7 1.7.. -, 33177: 18 0 18:: 100.0 2.8 4.0': .�.,..�,u.?3w,...id.PC..�...A.t,>.. ...,.%.,.,..5_.ILh-.�....�..Y•-...:.ws.�A.,�,..&\:V�,,..Y.YY'S� ....� � _ .i� .. ...w<:�Sn ..�,L ...w.: ..� +wez .,we:» V'.:. ww. ."..-� _�>. /. :,wx>3. .,?.+R w..w..ab,Ra:bn, .'i,..:,rK.. .:-�:-r;.�..-.`mow.-�., �.�=�-2=::�> ..�_,- - :,:�-r ,.-�• --� >_:. 33179. 16 �.=�:_---� 7 ,.�� � 16 Y �: 100.0 0.8 - �;=-„-;�-,, 0.9 >....�.M..,��. � � ,�� _ Sn�-... '«S''v..us...._._v,, w.b''].. .: �.t�,«�.a- e °,� �..."•'a:Y2� � ....-.,.5 � .-, >tiAia%s..a r.w...,.�.i.�,.'�',k ii,?3...�._,...,.a.x ."....,. -i. .�Y�,>P' w.....P.:.YSl'.�L�,�:3.tw.aa^�._.-�4 W..a ..v,#`"s� 33181 5 3 5 100.0 R 1.1 1.3 33183 19 1 19 100.0 1.8 2.0 Yoh -�.._�.`, , �2 6s a �.. ���. T: • � � ..1.�� �� �,. ��..��kY .�`Y �.� <��'� �,,�.� � ._� 3,184 � ��.;:__>.� �:10.. , � �0� ,.. �'�'` 1Q � „`� QO*0� .�,..��w��`2 6 , 33185 -F., r f w ��186x47 3 47 1000 �13 tea- ] 3; 33187 8 0 8 100 0 4 8 � 1 _ :.. S"' „f,,,,R-•%^�' .4 t' x ''"""P?2 L y+ 4 f'e'k + eY F i "..%,'T`'s SaT,i`'''{m-Y "§ <'-x'Zk,v3 33190: 5 0. 5.; :100.0 2.8 4.9 a t 33194 3.8 t' .�.. E � •w� �'"�Ss � d '��s" x"i.`�-�-'�z ' `,x Faea, �� +� ;'� �, � y"�' .� ,-+ .. ,�. r '�.�z-':�' �:r "a""� ;' �,"s'- K 33233 9t 2 a 0 100 0 1 2 1.5 3� 32 4 m 33243 .-fix .. �4*agpi�-*x a'r +�, =`s c S' rn „' '. mr'-a >�: „•r ..., c y- •P4v r� : k,� t $ 33255 33283 2 0 2 .100.0 0.3 0:8 h' .,.,,t` .. " 1"' "x a .� A.pro I `• ✓A`ma N ) „, { .... i.. F Y "�Y""... i, .3°$^S,"N'" NIIAlvII.13EACFi'FL 33140 . 12 8 : 12 ' 100.0 0.6 0.6 33154 . 5 6 0 6 100.0 2.2 2.2 Access standard: 2 Dentists within 15 miles Dentist group: All Oral Surgeons Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 18.4 . b� �` g."'" �,'w^� S� �`�#� '� �� 'E '�L � 3�"�✓ a g �'*e x. - ��, � '"3>y....: � AllxEm to ees , `!• : iiS '!i uh +y.N ie� $ 3 # £ �. 1,",. mplo'ees nth y�,-� l�* C kZS 'L� .i �'K yYi��S f `F !?. .a ? � �@<:?x,.'s'i 3`� Iz .-. C . �4 s�Y n4 ; a. ,Tt£<u F 'S�p' '�'+f . 'E�i # .7.4, i ,i,,, xo- . rdestred aceess xt ?. 4 t �'i` Y+Y$�Sk� � 3 �� ��. � ,,� � ;x��'' �� Total �, pd*1 uer .nmbof ?? ' .L< �otatF , number of Averageistence ge to [ienhsts y e Cale em to ers dent sts r : Number Pet r .. . MIANII GARDENS FL 33056 35 1 35 100.0 1.7 2 8 s. za .. " ' - gNAPIES FL r ` c 34113 , r 2 t �0 ,. �2 TM 1000 `. 4.6 5.1 .. 34120 1 0 1 100.0 14.1 14.6 IOR 11�MI BEAC .... M 5.s2k.33160 1 s �a ' ..... t l w100 0 z ?may ,. 5 OPA LOCKA FL 33054 29 0 29 100.0 1.5 . 2.8 o3 � � 5 ` . 0 �# z � � PALM BEACH GARDENS, FL . .., _- 33418 : 1 . 0 1 ' 100.0 3 2 32 $., 3y.e 3'k'_t'�4<'h S'� ? i. ✓ `"3,, : 1G �" PALM.C1TY F ,>, .. i _..tr5 _<, u.?&.. ...u,',:la.1 +w....`.., s, ... ..s2uaxm `Vk'.,.7.a�.i.v ink 34940 :. :vu�zxn -1 3�^."f.-,.i`y' h 1� uaiYm...xurai ���t �zw A+:a1 'ac< 'wn#:inaaSaC+i`a�v::riras.... . t#�2-1:. ..a.-..vaw'.� r... PEMBROKE PINES, FL C xe - ^, ','M 1,°"d°` e"..,,Z 'Su' 4 POMPANO BEAC$, FL �q r a ' � 33028 33063 5 " 2 1 ~ �1 5 " .P 100.0 3 00 0 0.7 0.9 0.9 % 2 �, i "3Yd �' �v,.33068 1 0 : ... ` 1 : 100.0, 1.5:. 1.6 a�073� F ' .,�.`' ° 9" 7f100 �09 12 PORT SAINT 'LUCIE, FL 34953 2 3 2 100.0 2.0 2.0 43...,.a. i, ..a .,� .."...".k+ _„ :4, 34987 1 0 1 100.0 : 5.4 5.4 Y WEL1 GTON FL r 2391�1 y_. .._mod .2 ' 10 ; , ' ._. 2. FSC2F^ WEST PALM BEACH, FL : 33411 5 :: 2 5 : 100.0 1.5 2.5 1697 . „,, '2�5 1697 100 0 1 6 2..1 n . � �„ *�a••� s?�, � . ... '�::•d�,r. . tea:' .. �-Y:.,"_ ID, w "'. �'-.�'.�',.e; . 'g. . # z�'.:�,xw,1'„;�. ,.... s,:...k nn. Ta,.� �...� . ��,� ;i., i� . wa ,,� s". <xr ,.. �a�a ., , .. _ Access standard: 2 Dentists within 15 miles Dentist group: All Oral Surgeons Cigna Dental Radius DPPO Network - City of Miami ZIP Codes not meeting the access standard 19 tie �«v � lj � : a.;� 5 �� lg 'R. � �` � a. ` } �...s e� All Employes }iv.._,n a �s.4�3"oA,ii: �. F,t. ,..5'ad'Resn. ;>.zx+..,.An,.i'.� ti _.3`5✓�_ ; v�_iay. �1.h.`: m. �}wd•r ros. i S� z n".w,3' ''> ,� 3:Emplojeevmithout ghi5r�4Y f 8 s' r~c�^F e SL ''n � d ``' 3Yi3�': i ,3F �, .„, a $. �Z1!'n? Codes R xi' .rc- 5 C 'S 7 � �� Total z=k�,to number of employees x €x1`.: "� '� Z 4 -k ® �ri�¢' `�C�'` t?f 2 .3„C 4 '�,. 3'2fr Y'. •: E '£ §h '``: � . f3 '`L�° - � x dewe' aeee.45 "' Totals numberoP ... dentists Number d ��. � A� erage distauce dentists KEY LARGO; FL 33037 3 0 3 100.0 23.4 23.4 'TOTALS e _ ..h...w rra� <��' zx . s TR R -''f,�N N' k ^l:C "2x +ar i'.. �'.'Ei � °'b �.x)4 iz �xz s.T Access standard: 2 Dentists within 15 miles Dentist group: All Oral Surgeons Accessibility Details Orthodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 20.] .,2"Z'i i. u,3^¢e3;y, L��m '`,£,�A x'9�"�k4' ('�� -3 5 5 "�Y MC" `�: s �£� All Employees4. �^`y 3}+ $'"v ,a•'�v, > .y,w" kl'�+t�{aF�'.,,��,, <<.� :y. t S•{f."Y�Y IS�R.?{�,y �h,}"3 R 5 �y h$,^•vs ,t}�i� mix �`tt °c '„F. .iS ''";st i�`C4 ~Li'4 i` Y' y: dt,,"x a"`AL�:;'`'i lo m'i „.,es .Epye .L`Jn�•3 i wth ;� #,�;. ,.t; #p FC � , p, � � d� ..: cj},, r: . k y a t,'$ 0. .'.. ��, �'`i� . t`r•Y.f � '.�, E '3 {¢� r Fa`� i#,. ,i(?`h "�1` ��.� . V' " A+, 13 ��U C desired access t fide t4S$ 5' Y .''^. x �� , ix t r7otal i 7 otal ,� 4Azerage is nee F s ttz a ZIP ' numberf numberto dentists . } -!'G. _ \FC '^!� p..g .. y Y =._ _,. r R' elk' : Ca1e yn X�d .e.5:t., :04)11 ees e � tl9ntists,... �4�" �4Number ,..} .c BOYNTON BEACH, FL 33437 I 1 1 100.0 0.8 1.3 �✓•.�"SL CORA`CGABLES FL z � °`� k �33114 S- ? "� s t � �. l ,< av xs r 0.;, �,i,as'. � � 7 H`5^a-.a�: 100 4•?.., -.,^.:;,......, DANIA, FL 33004 1 .0 1 100.0 3.8 4.4 FORTS s ..,,._„I.�4Y7DERDALE; s 0 F 2 100 0 1 'tom 33304 2 0 2 100.0 1.6 1.9 •c � .,�� �nX6. .__�3..f E_.�3330$� 33311 2 0 2 100.0 1.6 2.4 33_ . 33313 2 2 2 100.0 10 1.7 { x . 33� 14 1 : pub 1$,. 100 33316 1 0 1 100.0 2.2 4.2 . s +--<:.�,s .�,�x•Z z �. �... V. Xm . "K .:.'i`: RY.. a..�. :.._ �. �;.i i:�s`,h*"R ; � . Y "�^:K:`�. :c �n.,:,w°S .,'�^>:r.. `",4-r. '.e�"e'�`,vEi E'�`c'£".:s'3�.i:_ ..-..x....,......vt�...,.._..s...,....,.:�.......�...................._.:x'.ai....=.� ...2ulw'•�"`,__x._w.:�.r, ,.:_ ..Y. ..tie.. »R.�.-,.. � ._ :r�'%cx�. ....,. ..v._ 33319 1 fl 1 100.0.. 0.8 2.3 33322 .2 5 2 100.0 0.3 0.5 33325 3 2 3 100.0 1:1 '. 1.1 S `3Q�f � � e �Y 2h{;. tY*4 9"f' .. -v � � Y„P.r' S S iL •Y± Y } .,. '•�Z' �^ �n„..� .Fyn � ,�.' ,�c ,f ..`mow.. s�3.2{�x�09' �� ;.,..:1 14 33328 6 10 _?1000F� 6 1000 08 11 3333.1 11 1 11 100.0 2.0 2.2 '•. ��.�r"":. �� - � �2 � 4. . .w4k�� i . '� � G,, 1'}' `f"� �332,�-_ ?�y f X f : �."cS �-. . l` . ,A'^"" .. '.� "% f 3 . : - �"" P .. -'�f L '� it 33334 1 : 0 :: 1 .' 100.0 0.8 1.0 iALLANDALE FL 33009 2 1 2 100.0 1.6 2.0 -1... fl FL 3�010 r 33012 15 11 15 100.0 04 0.6 ... .. � � � � .. -33013 33014 18 6 18 100.0 0.7 0.8 32 33016 9 4 9 100.0 0.7 0.9 33018 ; .10 . :. 0 10 ~.. 100.0 2.0 . ': 2.2 [94TrTfooji. 33021 7 4 7 100.0 0.7 1.1 3l..w100fl._,?`.?..sue 33024 7 7 7 -100.0 0.8 0.8 ` 33026 11 : :. 7 11 100.0 . 0.5 0.6 } Tnn..'":tomiiri....< . Access standard: 2 Dentists within 15 miles Dentist group: All Orthodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 20.2 �����, - ,�.����. ;7u,.Y '�'�.�'. Y �. Y'L "� 'i�` 1`M�' �oa�'C 1'.�,.,� 1 1* ..Q'y, \ t �r�r, F � 'Li+` :1 _ ��"`� d`� i,E.S.a��'• 3W" �a�t: 1�'"e'Y� ...,, k,•'.a_'1- 'T'bi. 'u ���`� 7,�<�...v'PJ�'�' x';.. Y ., k� 'i . ^i8 �' ��' � � 1 �r'x, � .A,. �'� .,. � �,,. .s:.L4 Via,. ,�'x `F�•... .v., ..... �?..... .. .�a'E:�F a.,,.,.�xfi1. .... s. c �� ������ �` .}i+',d;: `'t.,,Y� �°v . -: Xa...... v .p . � {'.Y ia. i���'�' •2�.:�Ghi.sF`3., 1r.3.a-. 'h'•�a�x <, � `! '{�R?� i` 'f' r kR 1N . A. . ."`u,. .. 1::'..:=fif' S'"4L+." i - 4d . 0 - Mt'RS^.,, '•:... ec:?F: `ll°'• h eCS{n�W7.. t- a� L A� a0es.b,GA ±2.a Total k,r r Totals fix, ,,;fit<, ,TA;erage distance rF F .< '} sq ¢�4 «' .:. -t . [.��is? n S'T4 i }at .}. . 5' 'Z�,A< ,<.a_ � x. a �p F" ids � ZIP hCaod�L�,t L e numbero � r'�` .x A { ,� ' '8 emoY,,ees numbeo L'5°��.v', d' .�•i?t€�`k' fa.:* entsf " �' v .`i�. Y�.,' y% kp ti} umber � �'� '� `o d. enti : s 33 , , : .: �y��`. 2,y� ' HOLLYWOOD, FL 33027 25 4 25 100.0 0.9 :f%F."-�"': 33029:��.....���.;3�25���:_��._:�:�Sr7,��y���25�'��1�000��;�;,,<��.�:,.�.�,<:��15� .M 33084 1 0 1 100.0 1.2 iIN1ESTEAD33030.:10 33031 1 0 . 1 100.0 4.3 ..-, 33032S_-.,_ 33033 33092 I 0 1 100 0 4 2 4.7 JUPiirbR KEY BISCAYNE FL 33149 1 1 1 100 0 0 4 5 7 LOXAHATGHEE, MIAMI, FL ����� 33101 ��R'�''".'r"'�'-.TA.' C ..P, :-�'-"»ts '$�# §e�,Tr'"'.. .y t �" '� 4: �!'.=^,-�^;f`: �;,.n�. •::"�:. D 4. s,x e�!�"vs^�n..,.._ ,..;; �"5. r;�'"�'`':�".�; .� S hiµ 33128 �. 0 2 1000 07 10 33130 14 ". 1. 14 100.0 0.5 0.8 12 � 2.1 =r 33134 21 5 21: .100.0 0:6. 0.8 t "�'�`� :�rz�.,�.-c�- ,. F: '�� '-;- ,�... -fir - �;�—F.. - --_,- ��.: r�s ,.,. 'F-�; .: �:�,� .F. „s •-�- � � : r 33138 26: 2:.. 26'. 100.0 1.0 1.1 33145 35 0. .35 100.0 0.9 12 {'�'�'•3 •.�,. } 4 "� 3 � t:....xl » ?� .: ... � Eh$� � � ' b . �, > .. ,,,� �, ,� ..4 ., $ mil' ) � � � � 5�. 331.47 ` 47 0 47 100.0 : 2.4 2 7 jYt q .`s ,KY^'. t : Fq .. ��h. q' ✓�"e i £ .bza� 5�•„w'"w�r t$' v 1 '^AA ';ka5 h":SE 33156 'Wj;�xG r'S�fh •:1 Ct„ ?-L"[E.' 4-"sl�•i "" '.:�,..,��._a��.��...i31o7�v>n���..� �j�x £ :,�42 5���;;.:»��a'�10,�:s #' ,_ V _ 3'«c 'r,^' x ,`� ��.<�� �:'}x- �]OOQS.w��.;��•.1'.: S i,£,`•.. 15 is r . 33161 27 0 27: .100.0 1.1 1.2 . _: ".:�. ::.:., �„,•fit', F s..L z+ .,., ',,, ,v. ''o: kz� .. ':� � e� a. 3., ,x„ Access standard: 2 Dentists within 15 miles Dentist group: All Orthodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 20.3 • "cn�E�T�I,z�r`.�. ryT}��'V �.E„(� R '#. \o 1 � �� t C{ .' Y. "i .^ �. b3 . L -Y', . tEm Io eeil ��M Ux k �; S'��{.alb � "+r , �ry 1 >� ✓L r� .: '1�.'.v�R 6� 1F��k U.S� .Yi"a t�',E-. Z•. �,� �i �"S d, k °i$.u'a°�. �,� ., 'P.:����R'_`;a. u:.. �;,_x'�a_-c'�r' 4zr�...i,fi.,-3- �';3 "-w. ''<-:pzef:k kkck•'.';x�N�..'it..,,:,3>,',",:',h°Q'':�L,"s*•-,�•za.",-,:i'�a'�a3;�'"x'�;`,'v. 3 l'`'� x� :; '4'i�' �• K ..�'- .. fi. 'i".. "3 S.' a' k� . "'`" , ,M w,,�R `i, F x x :>.F _.u'<� x W;a X-.. t ea �� � :: k.. �y m,.' :Gbn3,.��,. a�Einployees �t�th�,r. '. r . ` f ",� } r1..{ t s ;�:� a� :'t'ta^'a t i +�? (�eS1I'ed.�CCC.SMS,Et''� • �+ i, Rss 3. { "& i'� S '> �ke te�F, J � �' :'h'S' 4C s*!^ x -'lT`x".is. ? Total�� "fie] number o,, �� �"�7`otal�;2�, number off ; � > ��� � s `�5� .. g . $� ,,, Average d�stance; � �' 'to dental s s:`k..-�»k�.�.h,.a ���s-.. n. �..�`a .n,`�+.:,b .,uz✓r..?�k,a,. o..,a. .�,., . _ Code (employees _ �F.z tletitis. s�,... �.,.m�- n _z.d.� �4 Number, ; x Pct 1 3 T MIAMI, FL 33162 20 6 20 100.0 0.5 0.6 W k a"iit"� � .X✓ ar. tv�Wk k*. ,x�. i'.iis - 'S"'�' fi" J'iC 't ,Sfi-'.., ,�.. . x� PR. 7,. Lr*' �yi �'" .. 33166 11 2 11 100.0 1.0 1.9 :13167 ... ... �,. 5,.,14S0 <. �.�a', 1'�} 7000 27M2pgk 33168 23 0 23 100.0 2.1 2.1 E ` � :� �_ .._ _..--_:._. _ s��� ,��I - � ; 33:169 33170 5 0 5 100.0 2.1 3.1 33173 32 •. 3 32 100.0 0.6 0.8 ';:7.'-F. .yeY;:,F`�:T .Y;Z'=�i+,.z_.=•�T,;T"y. "�'-?ie`4: .:-'I.:`e �M k m '€. •;�`., .�..�.t`cE -w i;'i.-r -s � �,.�-,.:ti�,,r:r fr�c;%g..� ;",,.*,,..'. ' ?.,=,^.;=.Y,=- 33174 's`�,',":;<'}:...^'F � 1.2 ",Fi;'^,"�r' I"- � L °A"',r-�"'" g12 ,"} . F i000� .A' : i�'7 L4 . x,Ti"�=iR=. a� 16 Y 33175 : 29 3 29 ' 100.0 ' 0.8 . 1:4 '133"1"76 45- 9 zt �45 i00O F 'i0 13 ': 33177 - 18 ,•--;�-_. _� 1 . :---- 18 - 100.0 �e,-;� 1.7 ..: .�� 2.4 ::,��.Y-: Sri: ;n�-;��- �:; w=-_ ri> 3 x T..33178 33179 16 3 16 100.0 0.9 1:5 Zx v. ..- ,....,. a,.... ,,... ..yv-�.y..�n, ., .�..+e,'.S', ia.-s-..s. , S�..t s .,e�.._z�a.. -. _ �„�-.+n -.�. u, d.i�-_ a-ie�, i�,`''�r.H]ise @- 3�i' h'+�.-i�t{d---, _•.-•.v ��»ecin�'.,_x •mow-'w- � -,�^.-a'..1ti� �}: 33181 . 5 3 5 100.0 0.7 0.8 , 33183 19 3:. 19 .:100.0 0:7 1 1 =_ �*y • 33185 21 ..1.: 21 100.0 0:9 2.0 33187 : 8 . 1 , 8 >100.0 2:4 3.4 r. �3189 33190';. :5• 0 5 100.0 : ': 2.2 2:8 Yx 33'19�1� � �� 6 �, 0 . x > 16 160 0 � ��. 1� -��j 33194 1 0 . 1 :: 100.0 2.0 �,17 2.2 r 4. '3'�£-- •+� ?,'c` 5 t ' ^��jS f ,� - { Y. x-7i '-'"'��-',T" ^,g-• '� '6 ` § '-�sv` psi { J K3a+r<' C . ?'"€ 1. *°a 33233 2 0 2 100.0 1.1 1 9 2 2 s 0 1000 r 2,8 29s 33243 1 0 1 100.0 0.3 0.3 .2247 R'a� ,yytl 33255 : I ' 0 ' l - 100,0 0:9 '' 0.9 33283 2 0 2 100.0 0.0 0.8 MIA(:,,,, E 33140 12 3 ::: 12. 100.0 :: 0.6 :0:8m "33a1?�15 - v 33154.... 6.: 0 6 100.0 2.0 2.2 .4 .<.,a:7 Access standard: 2 Dentists within 15 miles Dentist group: All Orthodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes meeting the access standard 20.4 �`� ��•�'..B T �) g �\°.ii ��.).< �`5{�.'nh k�, .h G � � o ��. \ ;�_.=All�Employees.r ' �vli k YR�"4N' ..* �•� �_ `s C► � �� tJ . _, FY... ^ca . ., �e:�Wz �c�-„ ..�. � L „f6 �t<s vr1'..-z-m Code Total; numberof * .employees C - EIII to m 1 tlesired access d�a� TUta1t numberofen ut�sts _,,. ,- . rc _., Numlier �. , . r ! �Pct tie erag e distance W , MIAMI GARDENS, FL MAPLES AFL ? �. K _ i't T k NORTH MfAivII BEACH'�`FL � ��� �- t OnPA LOCKA,' FL - "..�•�x'<y�. 4��%< � �Lfd` k;i :. Y�R ..:_: PALM BEACH GARDENS, FL PALM CPTX, __.. r a by <:. PEMBROKE PINES FL VPOMPANOBEACH FLU ,r PORT SAINT LUCIE FL 33056 34J 13"g 34120 35 z ` 2,A 1 1 ' zy.,� �` f� 29 ..._.:..�.25 1 ? 5 , <r tk' 2 � 1 s k 2 1 3 2. 5 5 � . 0 �.,�5 �,:� 0 ,� 4 d 2 7 � �-� � 0 .CEN f 0 0 ; _ ? 2 t 5 0 Y 1 0 �,.7 0 3'<,,. #'"" w" 9 6 35 2 _ 1 3` ,£` �� 53,,, - 11 29 pz�<�� _-� ?� 1 ) 5 7 •1 1 2 1 -;�*'.,i' wa.' 2 .5 100.0 100 0 _...��___._.�.-ti�-_,�.�-,:.� 100.0 A - S xl(l0 i. 100.0 'b< lUO 0. 100.0 . k<„1ti0 0 100.0 000 100.0 a100 0 100.0 '''1. 0 100.0 100.00 100.0 I.3 10 3 12.1 '� l 1.6 2w"^4 '?,: 2.1 n R 1.0 -O 1.0 t � 1�0 2 ,_ _ j,? _, : 6.1 a 0£7 2.3 1.3 I 0 9 14.0 1.6 1; 3lx ^Y kk 1.9 Yn 1.1 t 1.5 2.2 6..1 3.1 s E aCgy WEL_LINGTON FL 4 w � z� WEST. PALM BEACH. FL 33411 i- sk,S^"%s( ... `'c,..,"`, .a L Y;y'ze � p� • S3.n4'u r.:�'?i�•. ? c, �,�, i i �ti'' Tc d '4 4,£.�s.J 'E.z:. �faBa - 3. � aY ' , hs�j ... Y - lr v�4�£�!3:,Y5aT'3 .YrxYi;K _ . , .. _ , .. 7�c Access standard: 2 Dentists within 15 miles Dentist group: All Orthodontists Cigna Dental Radius DPPO Network - City of Miami ZIP Codes not meeting the access standard �1 �� � YE f �•Rl Y` �!�� > Y `{ 'S� ��'? k fi'� � '�'4" 4' gad '8 3 � I ''ey4..k � %G kiy�`3 `^��^� �'T �4- _ g�.�.b a'F��3,*.� �'�.�.�`� a,.,i��h,� �'��'�� t, S ��"� �;� .,. r ,.., 'a*p P w. �� � ' g �� ����� �� �.,��z� a v "C y,aS a R ' f�r1 rr 5,�'4'+"4 `d 32 "t. �.^ City e.. s,.s . ' h �� . ,� srs y ZIP `.. Code n# �: .�- $ �OY2Iz number of GA. '�Y `,:1`F , employees �y 5 ��' at *,number of hK, ' .e dentists , desired �TT access, ju]'`l° Number y, ,RaFet to dentists 2 KEY LARGO, FL 33037 3 0 3 100.0 10.9 TOTAI,S ff�ry� Access standard: 2 Dentists within 15 miles Dentist group: All Orthodontists Cigna Accessibility Analysis A report encompassing the provider offices from Cigna Dental Care Network for: City of Miami Cigna Dental Care Network - City of Miami Accessibility Overview 1 J �.:nN�� n���fi ,..-✓t "� .,: � :a� i. �`\, �� , .°� � �", d - S'�c , 4s ! % -. �: 'y. °+�. .t�`' 3r�::: F'` :,,. 7 .'i' J. :-:u "i &v N� 3, -.s., ,.tz.• :(• • ...a. u .s £.:.� �'. ..-, y :. k ... ,a . .,.....:C:v„;s.... � f3 P.� Ac.cesslbil>< " ;'s . 'e ✓ ouehl�v>!erv�.s �'. �,._ [ to .. :..> `� L:-.. ✓.< k;'.. � 53 S -., ps�t.'- P {$. 'c R- ✓:,.2, - - ri: ,x � a�p �i. S>.�. �:>a. �... -... .x;. j-g :1. '�' .d .. Z �.,� r-. rz�i `t ?TdT. � bf�'- 3�..'r .s{ i ",, . , >^`-�.. R- xs'. �.. ✓. `'Fi` v't'�' ,.' ),�.y. .^cf:.....,,s 3` N'•'}�- R�,g �i .::� - -• v41 f w. 4 .. :.,.' ,:.«. � <� :.j.. � _: %?' �" E'., a % ,.. ..:„'x rs: ,-:... . .� „r.....a 4 ... m to 6:10§: , " p y f:� ^`:; A'z' x>✓.:. ,. � Y. � �:..,, ..t.z;,;r az..�.:,� �' P' : s .:'. :•' ry �....i. sr - . }i. .. -:, , ,. �...: a � .:-.. ,. ,. . z... to .. � _- a.. 4 .: : ..,, . Acccss standard _, ,:.. p .� r- 5�s r ra e -,, Pxi . t:r � C3 '"i.,-.. e. £ ".. a , ..�✓ :J., ,F.." I ,- .:. S. 'k`: s i ,, ",:.zYi#�:' i )�`.ts T � '...;i� &>r '..5, -..., .. �".._ � � ..d- .. .. ..�,P ..':'.: ', �.>... . J . , s,.,,; ^ .. cnta►laofficcs4 a E �:. ,..a. s ,.�. ..�: ;:,"Mic .. :{'b" ..fix. �p' a:S - 5' -:: '. SS�,i�T>+rr4 _,. 'F'w 'xh--..x... fxr ✓ Et_: -: .:.. -em�rloyccs :..:5, o , .... 3 ., .> -:ks`F $ S' .-... .`£, "A' t �i - 'ill".etn v, : ..r'r<+ '?� -,,:�. ,4_.: .,.s 4- ti' 'M'-.., � N � M . E aN y, -a `�'W: s��: :' -, ..v,.zsw,w:>✓..�t- .k.,...zi"'.. .£- I s -� '•R' '� ht;�� . _.K.'Zi'✓ gee %'w14�i'l� ss .AF'�thb�tta`ccesaF,��w .- ii :' a. nluniterrof �, .f. yY i ....... : .. . :uF.: tdcn�a iTticeq ,,,. __.zt , ,+4''-✓G. r"' r. p All Employees All I m Io .ees . s U .Y �.,._ �..F_.,:..._ All Enployees Al1.Eu1 10 e 5.,.. � P y ..., .� .. .���..��� All Employees • 2 Uental Offices within 15 miles p= ,.>. , a t .: ent�tl t7f(icesw�utthm ,1 . .�� .,.. � 5 nt� les � � :.:fir i� ...,,, ..,::,� , a s.,a.,u .: 2 Dental Offices Within 15 miles J " 2 >., «; _ L�cntal.0lfces�wrthm:l5 _nil _. > . � .::; :�_...�,..� � �s �' � .,, ".. �� 2. Dental OFlic es within.IS•miles , .: i.�...H,.a.t Open General UenUst Offices P � • n .: - a'. C c�vdo�if�stOFGues z.,. ....._.__ ,✓..�,., . ,,..:.: ; Periodontist Offices ,, rg .. g1 it Oral Sur eou'�f1'iecs �, ; � , fi�� , ..A.. Mxg, Orthodontist Offices 1,700 ..., ,.<�� �, �...w>>7UO. 1 700 i,ra r-r � � � 1,700 6,398 . ,.m,.�. �....n.��y��.::�.t��,„��,�.,> 3,150 9 . ,�, k� �.+, 6,1 17 1,697 1.696 �..,<� � 1,697 99.8 ��.,.�t3� 6 99.8 •* y 99 8 3 .��, �;>� . ✓� 4 Teti 3 ,nR:. �.. � 4 0.2 � r ' x p 2 e`3 ,lam Cigna Dental Care Network - City of Miami Accessibility summary 2 cessi MTAMI, FL HOLLYWOOD, FL HIALEAH, FL FORT LAUDERDALE, FL..: OPA LOCKA, F1 HOMESTEAD, FL MIAMI GARDENS. FL. MIAMLBEACH, FL NORTH MIAMI.BEACI-L FL PEMBROKE PINES, FL sins Open General. Dentist Offices 6,398 dental offices at 6.274 locations (haced on 6,398 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 1,697.(99.8%) 1.185 141 98 62 54 1,185 100.0 141 .100.0 98 :100.0 62 100.0 54 :. 100.0 . 43 100.0 35 100.0 32 100.0 11.: 100.0 5 100.0 sftmt 's•- ;mot ageance entalioff us"' 1.3 :1.3 1:2. 1:5 1.7 3.0 1.1. 1.3 1.1 Cigna Dental Care Network - City of Miami 3 Accessibility summary MAW ees g rr! ccessi catiic Open General Dentist Offices 6,398 dental offices at 6,274 locations (based on 6,398 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 3 (0.2%) esi red .aece; Cigna Dental Care Network - City of Miami 4 Accessibility summary ccessi esirc 3acces Ana Endodontist Offices 2.959 dental offices at 1.585 locations (based on 2,959 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 1,694 (99.6%) esire e1p��y� ogra � gephic 'S r"v`s areas .F` Employees with desired access a { Atieragc distance • r aCity<A employees Numher Percent tb 2 denaa i office s MIAMI, FL 1485. 1,185 100.0 4.2 HOLLI'WOOD, FL 141 141 100.0: . 2.1 HIALEAH FL ` 98 98 100.0 : 2 FORT LAUDERDALE, FL 62 62 .. 100.0 2.9 OPA LOCKA,:FL' 54 54 100.0 4.1 HOMESTEAD, FL 43 43 100.0 '3.8 MIAMI GARDENS, FL .: 35 ':.. 35 160.0 .. 3.7 MIAMI BEACH, FL , 32 32 ' 100.0 1.7 NORTH MIAMI BEACH; FL 11 11 :. 100.0 1.5! PEMBROKE PINES, FL 5 5 100.0 . 0.9 Cigna Dental Care Network - City of Miami Accessibility summary c;G sstht3T wired acre ccessnaiury analys><s speeu><canons Endodontist Offices 2,959 dental offices at 1.585 locations (based on 2,959 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 6(0.4%) ;acres; ees riitti utdesice Cigna Dental Care Network - City of Miami 6 Accessibility summary ccessikiility*ai iattfaeR Periodontist Offices 3,150 dental offices at 1,948 locations (based on 3,150 records) All Employees 1,700 employees 2 Dental Offices within.15 miles 1,696 (99.8%) • MIAM1, FL. HOLLYWOOD, FL HIALEAH, FL FORT •LAUDERDALE,'FL OPA LOCKA, FL 'HOMESTEAD, FL MI AMI GARDENS, FL MIAMI BEACH, FL NORTH MIAMI BEACH, FL PEMBROKE PINES, FL:.:: 1,185_ 1,185� �141' 141...' :100.0 98 98 62 54. 43 35 32 100?0' 100.0 .100:0 100.0 100:0 100.0 100:0 100.0 100.0 Cigna Dental Care Network - City of Miami 7 Accessibility summary �a fi-y,7=.�'"`'} �*`'` �.`P'� :-�,E .' �r��'4`r','.;: l; \S - "�, ;C`C' ty ..*t A t;LP..�... ^ h ccessibllity analysis specificat><olns Dentakoffice ou• � p�� s 4 Periodontist Offices 3,150 dental offices at 1,948 locations (bused on 3,150 records) 1p16 rE� All Employees 1,700 employees ,Access�standar�d� g, ., 2 Dental Offices within15 miles �1xlployees96thout .fdeslred access �'.. '� `' m--c•C� �fi' 2 4t der.# �,..yT %`" '� 4(0.2%) - .. . esuea. dental"offices .31.4.. .15.3> Cigna Dental Care Network - City of Miami 8 Accessibility summary Oral Surgeon Offices 5,619 dental offices at 2,698 locations (hard on 5,619 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 1.694 (99.6%) vacces MIAMI, FL HOLLYWOOD, FL HIALEAH, FL FORT LAUDERDALE, FL OPA LOCKA, FL HOMESTEAD, FL, MIAMI GARDENSFL MIAMI BEACH, FL NORTH MIAMI BEACH, FL PEMBROKE PINES, FL access; 1,185 1,185 ; 100.0 141 141...::. 100.0 98 100.0 62 62 100.0 54 4 100.0 43 43 100,0 . 35 .: 35 .. 100:0.. 32 32 100:0 1:1 11 100.0 5 100.0 98 %eiagedistance 2. dental offices 2.4 2.4.. .2.2 2.5`. 2.8 2.9 2.8 2.1 Cigna Dental Care Network - City of Miami 9 Accessibility summary cessi ccess s r acce as Oral Surgeon Offices 5,619 dental offices at 2.698 Locations (based on 5,619 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 6 (0.4%) :hut! rapJnc dred� � to 4�,i,@, E I� js .. A T { Rf yf�„„..'�. y .L` % fn Yy'cs'�"S" `�'.: Xp',`9 ei x ..y„ uT ,�✓ 5.. c, Y M ?0 # �� i' ➢ ,R�' JmY&`Stgs{ T-?a "fie 3 head xi' :�' 4 f f �$ .'Z. { ��C Sb �� �� � �"Y,' i.G.�(5` irk'° ,Dotal 's', � �d Em to 'Y Le3.�,�"r�+� `l"i�'✓ tvc&�.3 ��i f�. �7 '. Tf� 3�". k� �s ees w thout desired access Y } k sF S> F,G,' �� ���: ��2?S'� it-.. �'* h .e number of; em to ees I` � � s Number SS �F = 1'erecnt r3rerage distance to 2 dentaloffices KEY LARGO, FL NAPLES. FL .?,'` 3 3: . 3: .. 3 100.0 : 100.0 : '.: 23.4 31.0 Cigna Dental Care Network - City of Miami Accessibility summary 10 �ccessik *hi Orthodontist Offices 6,117 dental offices at 3.260 locations 0-vist.d on 6,117 records) All Employees 1,700 employees 2 Dental Offices within 15 miles 1,697 (99.8%) MIANII, FL HOLLYWOOD, FL HIALEAH, FL FORT LAUDERDALE, FL OPA LOCKA, FL HOMESTEAD, FL MIAMI GARDENS. FL MIAMI BEACH, FL . . •NORTH MIAMI BEACPI; FL. PEMBROKE PINES, FL 1:185 ,ercent 1,185 100.0: :141 ..:141 ;100.0.:: 98 98 100.0 62 62 100.0 54.: 54 100.0 43 43.: 100.0 35 35 100.0 :.: 32 • 32 • :100,0 _ 1I 11.:.:100.0 :5 . 5:.... .100.0 Cigna Dental Care Network - City of Miami 11 Accessibility summary cessibi Orthodontist Offices 6,117 dental offices al 3,260 locations (based on 6,117 records) All Employees 1,700 employees 2 Dental Offices within.15 miles 3(0.2%) Accessibility Details All Open General Dentists Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 12.1 t ,e a�K. �4� �, ���_ x�� ��e �� :� f�� All Employees '^Sh3' ees w�}rr+S , <` 4CCe55 a\ { �3.•r2'•.�,'„;-�.`a iu `Sa1 � �4'<Z+r§'� S,v``"- ��'YYR,,xx ��' ``.:k'TS.i �,�� „y ,x�. � ...�uv`.45. �. � (' :. � i �,� �'.t?"'aaa�RRR��u�-�.�c ��f�@�, y,F�Et"E m Yta1 des �, a F �i �'GC-M1 �R< �•� ��LL � k yy.3�:S°s�..^x t.s a IOt21 d Averagedtstanee; 5 ZI1' number of �TOtal number of a s nto dental offices CiW Cbtle em to ees .dental otTices Number t 1 2 ' BOYNTON BEACH,' FL "xa "� �i iT7ft S +^'v'P ni' h""& .. s, hCORAL; GABLES, FL 33437 1 0 1 100.0 2.5 3.5 en DANIA, FL 33004 . 1 2 1 100.0 1.7 2.2 .,,,,,,, ^2-- q,4Tye p- ---�i IF.C) 12.,ERDAiE >:, � s, .. _. . ,.�,:�.r� a....w„..«..0 ...,.<,......., 1 33�01 .az �✓, 1 b �, f 3 ..�...,..;:��k.er-_..,.s'i:.�zn.s.. . � � � „ aDy .-elf'# 100 0 r 0 r � I gw 33304 2 1 2 100 0 1.1 1.4 33311 2 3 2 100.0 : 1.3 1.5 . -. 33313 2 8 2 100.0 0.5 0,8: ^T.',v P 33316 1 2 1 100.0 05 0.6 33319 1 6: 1 100.0 0.2 .0.7 °P"^.", 'i•. .�i:*:; F:`'�':_��. .awpi, J� ?4^"+.�" _T �S �.X<.,. .,�'�'S'z �����7000 ..,•��W. i,' ? %�'. 091 ,,+,*.E^.::'Sa • x 33.322 .2 .8 .2 100.0 0 4 0.5 33325 3 0 3 100.0 1.7 1.7 , .,� a"'4 "X "'� . : sx„,. rZ- xti:'£ 8• �� ';:;a.. _:�.,,, R7r•',. a?= a.; a ss ..,� 33328 6 2 6 100.0 1.0 .1.3 33331 11 2 11 100.0 1.2 2 1 ...,•~ ,,,_ z ,: 3333� 0 4 1000 2 2 _ 33334 11. 1 1 100:0 0.6 1.0 3ALLANDALE FL 33009 2 2 2 ;100.0 1.4 117 1lAT EAE1 33012 15 11 15 100.0 0 4 0:6 33013Y r .. ,. `� ,� w�.::,,...�d€..�A - �, a>..::..µ T � `' :«<....w::,.k 9 �.�wra'..,,a,.�, Q� .� 33014 18 2 18 100 0 0.8 1 0 E3301� �e � 1� f 3200 33016 9 8 9 100.0 0.7 1.1 33018 10 0 10 100.0 1.6 4 IOLLY�TT Ti � <h�"z ? �.,� �....v� 3020=, ,�����«.. .�,�r�����u 33021 7 5 7 .100.0 0 6 0.8 s?302, �,w 31 2 31100p 0a9_�1.y' 33024 7 7 7 .100.0 0.7 1.0 a 33026. 11 9. 1•1 100.0 0.4 0.7 -.:r 0;s`Ri Access standard: 2 Dental Offices within 15 miles Dental office group: Open General Dentist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 12.2 T�}� ��" r � �`��RE `� l 3� � .f �` �' �£����:'k}, �., � q _w4 ; _?. i xv i ig d x%1 ��:,o'�il s'a yik R '�"�p��"3-'�`"tXQ� � ta, ,:2 �"£'.i�'�+�4•�'° 'S ., Se `i,,,�E..+�` z+•i� pep '. �E:�«7. ..y��;, ^a •Q• `S \ C 1.Y. '• 6''`' t ,y Y �°.° -t A �` ' �' '� A g.i'�i� .z"" '� i. �� $ l °� b l* �3 ,u., � h :4• .� 1 „z'le•+,.� 4 p.. g?��, s z 4i' �� gasp Employees with �r gK'�`'sOL� - Y3°f -v3 'tea Z -.�S ;. : '>s- E n•z ^. ^+� s-�' `c zfi� 'fin a} .,� Y � t. �, '.'.S ' � W � 'L'jrv, � � ?r'�``'t`��'�XE �"t'�� 5, ;� »K, «.�' F i �� k -Y'•' k4 `�, A"'^',''�`� .' '-^' X�,a�� �� � Lu+ � .�5 .. ?h ' �` ` ,£ z "' - ; . rk.Y ,�K,�+� § e- ° r : des*red zi it 'fit' A•2L (access', M ?� 1� : S '� 4 •"k`'�@ � � Y t Toal otal" x�a+Avers a distance t?.':'Code, ZIPfnumb et: of wmployees `Mini er'ij deatat offices Number yPct zE1 3 HOLLYWOOD, FL 33027 25 2 25 100.0 1.1 1.7 '� ��. .•4�:�,:-. �. � .:2: - '^�;, s�. :�.. "K�a=.ram;. . f '-c.. 33029 25 3 x 1 25 100 0. `1, .5 � 4 '8 33084 1 0 1 100.0 0.0 0.0 =HOMESTIADFI * .. , :� ., i, 33030 q r;a 10,1: ,. 10yF100 0: 1 2h R 38 v 33031 1 0 1 100.0 4.2 4.4 . ai ' ,n-s-.._ -..-, ,,,,, .,.,,,;,,.:-•z,,„,;,:*-.M„- 5 w; „"fM, .,:'�„"'. ,-�.: !�'... 'a",' ram. -'3 t.,33932`, 7, »��„r-q.1<.."fi:;M r4^zv :'?.'E sYm <*.v xnx�"-. 33033 17 1 17 100.0 1.0 2.3 T' r Y a j k `=: :33030 6 0 6 100 0 r 7 2 3 �r--;, m*- 33092 . 1 0 1 100.0 . 2.2 4.5 J[JPTLEiL EL33458r, KEY BISCAYNE,. FL 33149 1 0 1 100.0 :... 5.8 6:1 LOXAHAVRtf FLF; > � �� e � x�3470 ^Mn I'fAML:FL - 33101 ��31� 33126 22 2 22 100.0 .. 0.5 0.8 33128 . 2 1 2 100.0 : 0.2 0.5 :.. .•..w- = .zis� .....:.t -.. -' i � ...,...3.: -. - .. .? .s ;:...�:..,:. �'...i�•,,. .-.-__ - .: :.' : �.. ..., .., .. _,..:_,w:xvuu,.s.�. .:.,, _.,�: ,f._sa_. +;:,. -,. ..:_.c ,.- ,�v' 'c'-'n n 4> 2 '"Xt p (9 m:. '•" A. Ef i '"�` ''�`," . '^� cee �,�.5 `4 "Y y �,4 � $'Y"YUE "v'�' t i��"Y*�aa: `c„i i'�+ i . Y�jE ��'"r %a � k� .. �' +M✓a �v � �Ci#r��t ARE �, �' f r}i'�. ` s •. :� .. _ 33142 .. .i'3�` 33143 14 1 14 100.0 0.8 1 3 �� 33144 w. '. k b... ,„ ,;..a �14 ,.100°,• _x 0 7 0 b h 33145 35 l 35 `: 100.0 0.5 0.8 [ .n fl ) . �v"Sa i'Y4T� "z F &' 3 5 S ^, .. .: 33147 1` 5,7 f �',- '.;�. �c� .fi S , ` k. ,yf ,•' "'t' � 33151 1 0,, 1' 100.0 1,2+> 1,5 .,,�r«�,.,�,��.:�,:�...� _ .mow. �..•ti..>.�..�.�,..�„� �a.s�.�.r,.w.,.,,,�;..�,.,.,.���x.�,..,,,,,. ��.�,.._....,_._,.M,.� f4Y dc, »1�7 542 k5��� r1000��1 1`w 4' '< 33161 27 2 27 w< 100.0 :: 0.8 1.0 t °�' .ffi5 ., '>,:+ .2.'E t,,:vi• ....e 'b >aa .�' ..':�� �n'.f.i, +:' rY+^..s E r,. ,,.%S�'i.tx�,..w'�'1 _a, ,,c Y'�,• ,'. �` ,�`z 3,';':�Z'^ .. 5. >'�..�. vkr �'' .:.'X ,5., "... > ,a'� .. Fy :.,'.J} ..Re. x=:x:;^` _ Access standard: 2 Dental Offices within 15 miles Dental office group: Open General Dentist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 12.3 }� 'l. ''�..:'ff'i'`�'% ^`Yt:i' ::` i'�.. 'y3°^�.'':'e^"� v,Y "��•.�'l: -ZY, �° a?R' t<...K "�^^Ja , vR. .iS t3�. ��h�?l..s.1 in R t°€. w,...^ x l�1>'`._. �.`� �r1: <:�''i.--. .R;.-.z �_.�:>PR "�_ .>.�'.v`%r'A.a.�t..':.._-vcv �dPi.�...�,..,,,.�+.��,�. :v4n'Et�3. .4�,'S���i+Yh,4 �? 1,\7 jcT„�y�,� .s6' 3 Si.�'�� �^iT���d�. �itai`°v ,�-��• ;y d : v+.i'il:.'v:-��`x`�'.+::'r:':c .rs; : 5ma�.'+.: ".4 �...,.-�_.:.,.a.--..,,-.3„ � •.e _ ....K >: ae .. <e-r : -� _.2�1u" SRw .v ,y. x.�.e:,..'.,Y. �e 4 .F,>l.. F 3, ^ is *�5 ,a >;s�� .t* ....,.�_._.. 'n•::x ' x<;. , �... -..� tt"v. .r, w :�-.gyp'.. .'�:... .. ,v5-;:yu:, 'p•' �"..'Le�y Y:,':-^h ��i..TY.< :.',.!4.'i.::_}^c?f�•..�nv�,i.'^,:';v a.1,-,�:..vs5� f`: , ^C St.d''�y.y:'+:±T�'I.Z,., g'e'n•'%u'%`�'or ^,�S�Yv"5.g .t_" '^'v±f`� .o. },C .r � ._., ":^'.fF`,i iv'r a1;>, S . -4x.. �s • �`.`�`•iT$.. .v.gxi._iR 5 ^i `h Sk ` �£��� .•t3'<'-. °'''4%4-•";:'L✓}a`,(('�:*:.'t ,F ". 'i �"�� �• �>��� .yY'i:"ya,..y �'h"'":�b .. `h" v` "�. £. 6f`. 'q,"M�� � &� � 3 „ .r -' Rs`3.£'.2u4'-�i� mployee.aith T x„33ie ¢vii .N '�s $ s h'"u _''. ,� s ,y': : .�, �', 3'z 5 sL r �'i'�x }! ?$ t $ i< "`+�`1.F�"j $`/Fy� `n.Y g EyR.. R � > - :` a h •� bar k . `,•:.a ,.�.�` '� fi`?t r '�,ht"�" .a r .:�' �. 7� :: `+� `��5�^t-. dCSlretl ac J., s 4}'' '• :$' h. i- '3`S ;„�J' ,,,rT �i :-32i5 P{ ,a` 3. � 9r'^mi Z� ^_.,;:s,'>- ^k.,..,='-� xY � A ` liotal_ _°Total:: '�'��'4' .k Y .� ., :{x -:`:Cy i^ef 4' � 4.w�..ar K i •s< '?'k-'+"-�EFYI 'IYZ` ate%, „,.,�>-i}'� ; era a distance! g,,, i rp."+'7 "�Y>�xh'i @' °�"(A, f ` •, �.., �<. , 3 .c dpw `Y . 3( k ? I �j'p'-e.\ denial ?� offices } �., za �t,number R yF Vlt1 b"a„'- 3"• ?��* Code r,- of e f . ;employees �oumber RY dental offices 4 u ,yq` .:FNumberP ""�. 1 :,tea f MIAMI, FL 33162 20 7 20 100.0 0.5 0.6 ..:t. ,.A`..�+M`'"�`'%. F� 44.w ,z1o00x07F 1a0 33166 _:44.Sg . 11 3 11 100.0 1.2 1.3 4 ^"1'c iati '.rC..� 4 ,� y>%'"{« T �' �y h•, �i .eg-- "5 Fsi ����;a4 y :"i a"" 5"v'r�'� �� 1 �„ �'xv ��14� .`??y""5 �1ao�� .gin a>�.'��?az�s� 33168 23 0 23 100.0 1.1 1.9. < �100 0, .4 •i _... 33170 5 0 5 100.0 _ 2.2 ,.,Y._w_,..,....,'$✓.0 2.3 .,C-;.-ice;: - zq. ,.?Y,.','^,. ',r; "s.£Y.,£, i"- € a..,. ra. ao ... J.e. ail.V,.w...,.....xeue.�e.iw. �w +=a:v^..t�."a lh ::: "r,f>. -. ^E<TC. 4"ry i;;<i' .iS:.i''e`a',i:`_'.' _ ^•"::', +`Scr^z.', 33173 32 1 32 100.0 0.7 12 -.. .. < .vt e,.r .- .e•, . � ^,^`,-a. ,�'.^.�%:'?7:_:'ii'-�' v =Xs"-'=.-__......-.,;� '. �.:u2fr�: :E'` � �..''.,"_fi_:e�':. n>a>zR % ="3`:".�,sstfei- .4 :n '.•i£-T;,,.v=:>:f,:Fy' S waY. �" '..�'»n� ,.�:. �.m r `f° : �. ' ue✓,. :w'•m4S r F w'.L„; co .w . � ,w �u . .�^ J 33175 ' 29 7 29 100.0 0.6 0.9 33177 18 1 18 100.0 1.1 1.8 ! `3i$'4,..� ,xi^,: `Fyk K.. �{N x;E ,.J . "v�'sd :'R'2y:.^ns �iAvA: "K:.?' �s ^: {,A j..:- 'y-•= ==Y-- .,vt.. k'`i L k+ ^v' 4 33179 .. 16 5 'e: 16 100.0 0.8 :. 0.9 - x.�.,"X.t�z^v;`-rt2"n�.,Xn.•<^.��nv�.'_:�,-s•s.� du3r4,...:x .....::5 3wvr 2.e �}'i000�"��>�:,�07 �`� 07� i� .�s.G..:..»k:;.:itz..s_:,,.._,i..dw.v...,........,..:. .. 33181 _..:w�.....�. 5 ,a .a- 1 ..mun_•, � 5 100.0 0.8 0.9 -T*K;,- `qk:.y -" 9�}.*>=-Kfeer•: <•£--v ..n'.i4- :--�%'T"k`%5'::.e'a,sS-a .,F:': t`:�..,�.�+� . ^ 33183 . 19 .w 3 19 100.0 0_7..�� .._1.0 ;.,,, 3.' i' G ,�.. �� E��.� ..�;3184�° ' ' � k LO ^m',-�!'t' S�-• �`0 ems'. ! `�10 IOC)0c7�619 : S 33185 21 0 21 100.0 1.8 21 'S � 1 A § �tPi%'."` 33187 8 0 8 100.0 3:1: 4.5 { � �� � ��€...� - 3:189 _ 33190 : .. 5 0 5 100.0. 13 2.8 i R,'i> 3.. 'vf%`' S "i°.y ... : : t •4.�K . .} f '.: i-�, R �g "^jt . 3 C 'y '.E 2: S, £', 33194 .:.: 1 . 0 1 : _ 100.0 : :2.2. 2.6 33233 . ; . 2 : 0 .; 2 : 100.0 1.1 `1.4 33243 1 0 1 100.0 0.3 1.9 33247�" ? fi,^.0 �2 100 0 ; lo 33255 ; 1 0 .. 1 : . 10U 0.. 0.0 .. 1, .0 33283 2 0 2 100.0 0.6 0.8 x� ��NII�BEACH,FT.,-.���a1¢'��.'..,.c:�'��"��33;139��� 9` ���:a���� �.:�� 9 i 00 0 � 0 4 0. 33140 12 3 12 ::100.0 0.6 ' 0.7 `. 33154 6 0 6 100.0 2:0 2,2 ::`� �.; a .. ,_S`.;g £ .. �';£. i, d -Z„ . `� ,. .. �• " ... , .. ,bk .:r ,k. c3x': `� �° < E. ... x cx i 7.:.. °. Access standard: 2 Dental Offices within 15 miles Dental office group: Open General Dentist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 12.4 �: y k..i. A% -Aa 3�' ] �1 } ?, .. L#C �t 3:' ti j� ?• ,> ,,,. a 4 S 1 Sk 't c� ..,e.�EFfi.'"i �� 4, .. .....�.u3^+,9 _;'&..., eF:.'�• ? :'t:. x^_ .,h�`l�.:,. C '''a�M y@`y t�' �F:AllEm10ees .'i.<a'.''�`,c.K> 1-. `Y. 1 .� F. Zq•4k; ;,y. }M °v >'y,F, ice` <^Yxi, A V 2!' y 3. ••,tty h....� ,. -:.xi ,s.,_:,._ y�, 3... ,y�; e.' :'.?h "�P"..t 'h.R`ygY E• ,�., L Ak^'4f.- `4 l i 3 'N" @?, `5 i +4 " y '<,\ ar�.i•-s : �K 5�? z "y�`,y �r. r Y3y :.C'Y. .e�'ry"aws� a a r �`'''?�y-s:, . f.`C'`x d�'.:Y...r,+c�, L� 4iKi_,; wxi`i 'k',ai'.a�, ": z'. �•a�''�y3. .,� ct,,,, �3�$�@^a.:y,. S�i< � '3" .a .� tia E h r x x� � € t : �` O�tv .-,.Y� .�',: � i..D.,,h�,. .'.at-.-.. s z<f+t`. 7-FS.#. �. .,e✓t, d ° YaY i, y��� '� �a h; ZIP , MCode . ..-X �'P 3 '«C'• �.' x , .#�iL 4 •�b3. ��Set La'a,.=: i s , Totai number of em lo�ees ::�. P 4<:=`.FT :}a-`� t 5{.� ..7ddki. "Fna�%'i`�. r3't3"yi,^ rSV Y �y '.R y,M 5 i��-�'Y '':o-�' "r�rv�r-'.0 ^i .'� '^S }.. L £ t lt- +i �'�'\ S � �z�, ,^�g=5a `Erin 10 eei.$.�{'�tfl!"M 1> Y ,y .'.. , desrQd aeee� 1. 4• offices h 3 yFfiAveragedistance Total number of - (dental offices 4cKa ,>�vw..} FY ..`d � .Number :- Srw.' i,•�<r$,F @, r �` Pct1' �-��,.w ..r ,.,.. todental `}`<s,. Z �' MIA1v11 GARDENS, FL 1.�__ .�.�._x_��•..� , - � �.,.,..�. 33056 34113 _ _ .<_ :,�._,...z..:....�s 34120 r-,- 3: 33054 33Q�5 33418 34990 33028 33068 3�0 34953 .. � 44$3 34987. 33414 33411 35 2 , 1 0 0 :c:c;�cu;c-'x•-*' .r � ,. 1 .._'i : I 1 a yy- � E -��� 2 ; H<i 2 0 : k s ` � 0 2 3 35 ^ 2 � � , � 1 100.0 100 0 _,._, � 100.0 ,.,'^;.-• Es 100 0 100.0 .1t 0 0 1.00:0 1 100.0 100 0 100.0 : 100.0 100 01 100.0 1.1 .:.� 3 6 14.3 A $' 0.8 u : f a.�. 2.1 4:2'�� 0.6 rf 0 6 0.5 3.7 l'<1 6.1 1 9 1.3 2.0 5 1 .14.5 1.8 2.8 1.1 NO 6 0.6 3.7 6.1 21 3.0 1 ,fir �: 29 . 25 1 , � � � �> 1 5 r ..0 2, 1 ->� 2 1 1 5 a._.v:..r:r7:arzr .;-..-- �s�._ <�.::-,.,t,>:z:,;, -<»,r ,�--., N{JRLAYMIE� BGH; TH M OPALOCKA.FL � PALM BEACH GARDENS. FL •-:?. �PALM�CT)��FL� ��, � ��3 � � � � � � @ PEMBROKE PINES, FL FE.' �PONIPNfl BEACH FL ... .. =u .. ..3060 -rt< a . .11,._ 29 x T : 2? 1 a :.,i: :..o : �� �� i ` 5 � a 2 1 2 <...� 1 5 PORT SAINT LUCIE, FL :a�.'-'<„ � . ' h•'" . t .3'x' 1 b . ^s-ro �,s �, : "xi. .. s� �,.,_.. .:gym-<�. ..;� .a___• r il'ELLINGTO 100 0 100.0 , WEST PALM BEACH, FL 'm ;+.. s% 31;699 .. _. . _.., '`� ;:.3kf . 4 xk,?' a .` ,,�, ' '?r ..u, :c -.� e ^:R ',Ks"'s ..'•�`".. i ..'�4:..`: . ,'...:::. ;a.' 'xY;. ,.� .,r .,� L -:`a,. gs< .::; Access standard: 2 Dental Offices within 15 miles Dental office group: Open General Dentist Offices Cigna Dental Care Network - City of Miami ZIP Codes not meeting the access standard 13 ,x,�'�. ��..� au"+..5 _ „� �.� �� � e ''�r� ` '�� ,,.' '� � n z, �,�s, '�� '�'�" aw `� � '�, L k,�,Y,a�i�a .I.,,'F' y''+ � B e �?, � '� � ti � � �e'� h � a �. �_� 3 2 % � *�`'� � �� �f � �s ; �•c' 4 �f1��� �'�� a y.,, dC` x„ '""..�mr �k �',:' � %'�•� �,.: 5�ix*;y �� �' �',� ��' s�k' ""' `� + '° �� y� �"'s t 's 3 t h 1 z b a n '':2� . r5s a ' 'v€6u e n_ 7Y" 7-kG � sr ._. �� F, .�w ��a, eu ,�s "y,:x,,y(I�CSII'C(� Y��a�' �s 3`' �,c� t - f*,� ' °s .�i+^ .�` ,� ' � 4 Z.a 'fig, � �" � �, A .� i, F tip�� .(waft♦, u :.� � �,� ^Y I�'�'" ixA +° € .,. 'k,+ 7 �� �.' ZIP i Cale i'R'e�V 'aS"` �£' "�iT �' � " � Total %' f s :x a '' number of a - a �. .�' employees Em to eestit�thout� 3CCCSS.a �'k- tt 1 s - F 'Y.. �,� Total 8 ram' f number of �,� s dental offtees: 'rN-';.•cs ' .k,r'z. - t� '�� � �� t ✓- n h ,�' v Number °`'t'fi � � �� i Rom' tF 2c Aver9 �� g 3 to dentalsoffices' a dist:a is Y KEY LARGO, FL 33037 .3 1 3 l 00.0 1.4 23.4 � �' b ,e�sk ..e �x� , .�n��, X..�ir �.•.=#s k � �4°r t .t, f "�:,,� 'hMtY „?� ��4., 4 : �"� vfii� $� 0 ;: 3.,,. � ��, � �vX 3 A Dental office group: Open General Dentist Offices Accessibility Details Endodontists Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 14.1 .-' ik4t� ' , }y '\: a" i. \ �. "i 2=i?�mt !2" 'u4 ^t >iY G3.R7~' � Y^�`:: 21 2a �� mployees , .. `i` �{' . '. ix", .' G ro"R 4 T 4 .11 Ri.�,5+ ? �.. S ! ? 9^' ti r � .a T k xt G k e Emplb p ,r�th rdao-h_saes tes fierage d, e tstat s���� Qti:ZIPx Tv nutuber of o number 3 o: dental offices' e C►t em to eesk dental offices Mil et BOYNTON BEACH, FL 33437 1 0 1 . 100.0 2.5 2:5 oCORALGABLES FL 33114 Q I;� 0 2,Fat 1000 �37 37 ~ DANIA, FL . 33004 1 0 . 1 100.0 6.0 6.3 ' LAUDERDAI E AFL A ate,A.k.�x33307_� ,, ? � x � �,.r.>:Ma m.,O:M.x,�,M.�IOQ�.._-u:�...,. �3 f H 40 : 33304 2 0 2 100.0 1.8 3.1 +; :+-g=: i$Y- : . ' 'S }' "_ 3 d 4 330$ £ : .T". W'xF �9„'� 3'_� '"F £'tee' 100 0 :.. 0 Y 3,...:0 4 :. 33311. 2 1 2 100.0 2.1 3.1 , ?n.,,..,.y.�..�: ;,e-;r::.�.+i.:•r'ri:.e_r:S",:', a *"Y _.:q--x.:-r:.;{x v:.me _.,-: - ±,��._ %2-, �. Q',. Yy::.- ::y .;S.j. t,� ? h� xa�y' '_ ?�'✓.?-'�+.'+T f. =e.T;:.`.v:.3 .,,�„ - X,r�` `^', ,:�y,.. ;"F. &�r:. e"S�,j',`'hi TYi '.",^: fbe=L", ^n- - �%JY=ii y--irc`.' .:._Sx.. 33313 2 1 2 100.0 0.5 2:3 33316 1 . 0 1 100.0 4.3 5.4 as'9..xa��:L.sw �w�- "A-°� x'dr_„ s��,�w"�fi'f.,sl.Y-�r.'.'_as_ Y 0014 x. _:..,"�._ _ ti 1 7 •emu ,'�.:.L..._Si_.�::.:_.a».3..:a-:aV .4_.....tu-x....-.e__..._.-..:..�T..�. 33319 1 2 _.__....z._.__z�.�__..._.., 1: 100.0 1.1 .z�._ 1.8 : >' �� .� � `�,'`.�a � `�, e� ?�,�3�. �\ „•, _ .� ,., ... .�a�It 0 33322 >._... � 2. ..,s.�,.::,..:x��H 3 gym- r a2`3.: 2 100.0 �,,�•.M � "sue" 0.5 >:"= '0.5: .:3 .. N+g=^ y "'T 33325 33328 -'a. 3 6: "3,.2iC� 0 3 c ", . 100.0. 2.3 2.8 2.2 ">.= 0 pz 6 100.0 .1.3 4'piY c,.+„ s� �4 "{- T J000 ��e' hd �, 26 Y. =' :Y¢�. 3 r6. 4 �'Y .-Y,��➢ J3330 •y,: §EY �4 �x^�ZE? 0 .; r%' 23 33331 11 : 0 : 11 100.0 3.1 . 3.7 ' 33334.. 1. 0 : '1 100.0 11 : 1.5 HALLANDALE;:Fi. :: 33009 2 ? 0,• ," 2 100.0 :: 1.6 2.1 4 V 33012 15 0 15 100.0 23 21 Y. �> 33014 18 : 0 18 '. 100.0 ` 1.9 .. 2.0 �100 33016 9 2 9 , 100.0 ..:.. 1:5 r: :. 1.5 JO17 3 1 p �Oy`7�OO:O J 0 33018 10 • 0: 10 .100.0 2.7 2.9 3OLLYWOOD FLk r .r .,? 3020 _ 1 . Y 3� x 3Q_ 10 ` 100 0 2 8 . 3 `l.. 33021 .:.:';.., ,,7 ... 1 ....::.. 7 "..100.0 <1.2:.. - 2.9 _,�T�-. �L..y 4 �'h',Ti x'� vi:A. R'S �' v,..,�T"�`X��,y+TXx 1 �'$�+�.i � � �33023 i` Y C"' .3��^a= TM3•��nm�rn.5 v"�R. .P � ail" :. �- :;, yC•"Y' °?3 33024 7 3 s 7 100.0.. .... 1.1 1.8 33U95 33026 11 6 11 100.0 0.9 .1.0 Access standard: 2 Dental Offices within 15 miles Dental office group: Endodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 14.2 9-t'2 £ ., � A � Y�,S �� �`C "•��' �;�`„ � �� � %•�.- ��CS,•-.; tr�3�F-�t�h'. �t r�'F..,`�,.<.t;-?�-'.+�^�`�..xt .. .::n*�z+P.a��P�': � � i � � 2a`h �£,�`,,. ..v�'.�n~x'-�'*'-x Y```i�� & .� . ��.A� �F ; f ��� _�. tYes m oe � J �. n.. W` '3F K � ''1£1� ,x 3-1 �x.l i? ,�k �^..y1 k k. ): !7 { �.:�F ��" 3 ._p�.(g� l � � y •tl ,��.,o.. Y u. o,.c..,-:..t'..,�� . �.�;�. -., �'i: ;sa `�.3� �Va����.';k£T,c.. *u;ii`�� zF"?rc��-S � .,�� '�S J y F;'i: g \ "'1RS•s''- . A., k 'i!. t' '� :'T �. i - F t .{" k.. ! 0.4 #a V . S.?. !, «$. d S`Y' .F y� -.}` c Sys "`Yic "Y' <}'" .9' .. �., fi A „£ �+t Y @ £ T S ;a �. .S fi" MS 3>, F< eT K 1y,r y^. 2y <Y {^ 3:k .. YA4 V"�` £IC-k=t N+ `Y S' F h G Y��-•F. V �v 'y. i 3.. ``,t' h`,..3t �tnloyeeS.�{lt� b� "<' aAd i " y $ "kl` .. vaxxT'•+ 4 S £ _ . 3 a'a yh�'`�:' ,1yZ �S ._; d t�<t .�i (� '92`^ .k.r�2v' , a'k' .43Nx'•-`+k: k/.''� 3 9 desires access �` `�ar •,_.a.-,., -.:.. _� , a� .€ " .��� f f a ZIP � I otal ar 5 mumber of 17: ..z. nuuiber of'u� �f k �� � c xy�-'zcx.� a �� � .,�� Aiera a distance g ._a; to dentaloffic �� ,Codes erpi4cs dental§ofFes * Number �.,Pct -..,.1 2z HOLLYWOOD, FL 33027 25 4 25 100.0 13 2.2 33029�� 2g 1�251000 1:,7. �3 33084 1 0 1 100.0 1.4 1:4 13 MESTEAD; ,r. � `' '.'••'% 33031 1 0 1 100.0 4.2 6.4 <'."',L,q^..:,.„.,,"„;•^tv..'.'.'�"".�'•,."""'-...,S.n k-3`.n�.'`' '.3ir'�. h<-e � �r .x..:4 -w.,m,"a-'-:..n.'t�r„>.:. ' ? ^3r "`� !'' wF. "�c- - �'+`'%' .`.� . Y -@ `°�k . ^^'^`•.'e^ " . 'f, •5,x�ij -Ysc':�=<.., r.�s^�r-fie. ;-.: •. '€ ' 33033 . 17 1 17 100.0 1.6 3.1 _ -,- } == , . - ... s - 33092 1 : �•.�,.< 0 . .ten... ,. 1 ,._.... 100.0 4:9 5.3 ".IUP11 hR« �k F o f t' s 33458 1 '8 e F 1 g 1000 KEY BISCAYNE, FL 33149 1 ' 0 :1 100.0 8.1 - 8:1 1,9)AI3ATCHEE,, MIAM , FL 10 0 10: 4.6 33101 : 100:0 4.6 33126.. 22 0 22 100.0 2:8 3.3 3_P 3? 33128 2 0 2 100.0 5.4 5.4 ..' o:9ic 33130 14. 0 14 100.0 5:5. :5.6 z �3131 k 0= ? 1000 -4 8 4 8 33132 .. .. 6 0 6 100.0 4.0 4.0 21. 0:: 21 100.0 ; 3.8 4.1 33134 33136 : 22 0 :. 22 . 100.0 4.7:: 4:7 ..;: �.��•�Y.<,�;ot5 'C ":5sjr3"7. 33138 :26 0 26 100.0 2:6 .. 2:6 .Sv �- 4• .' Cy ;. 4` } ': ..), 33143 14 2 14 100.0 08 0.8 . w. 33145 , . 35:: ::„ 0': 35 : 100.0 5:0: '5.0 33147 :47 . .:.?. 0 47 100.0 4:5': 4:7 a3100 r.9 yx 33151 1 0 `: 1.. .100 0 4.5 4.5 6. 33156 17 4' 17 100.0 1.5, 2.0 s� o ti:h 1�7"47 0 4 33161 27 1 27 100.0 1.0 1.5 } Access standard: 2 Dental Offices within 15 miles Dental office group: Endodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 14.3 . a.�h:��,.,,r.xs. �•'�€:-�.inr...n...4..,a4 ,�,"�t,.-ram-a �i'��u..�.;�,k'af.�: x.A.az. ke s.�, _c_,., mployees�� .- ,.}t.._4 v:K,:"5:�� ,_....a .3?'�s�.,�: �,3., S 4`L, �.: 3, LV 4'" .�"i� T �k K 3'Y AZkr . 4 i`'�.+ A' p.'`rv4;k s'. 7,e { 4' 4 :£. : \^ " Y . `ter �yv ' ' s ;'i_.: ,vx; _`..''. �''"c 'cei+k,M2c'i "`'' �£ ,.-: L 3L'Y.a 3 � ".zYs.` ` � G`^y .'�'?�:M sty- 9. wi'.!•1`'v ,4. v.^P.-£. . a., m€e u)j`i `'--ii'�. ^k:.. _ �. �--t:eh:'Y"'�3 S{ 4'S�..h},_.. te' T3'Lnt 10yee. h'itl] -'.Y:,•1 ii f - q `l 4- '• „„ � ;s�" '1`d a' �� G ih .&: Al 1 S� „`..`r. ?o+ i F �.Y Y''4S•` Y"-�^..,_2.IX ��� .-. � "��x '`":> � « •�v "�''..�. �` "k��~a�tes + -- ."4'a ,� �''` �z�- ,x:..,�S!ts •},y�AktF4 o number, �-' 4 '1"`,_k.i''i£L o numbereo ` :. ::'?;:.a .o r��k �s'.o. ��z�1 t`a� 4� �'o� Ah"Qi�"r" ea� e dia- cn�,rSe°•�c-.s se entaloi � � a � a €n��- �h' � � �� � - Code,. .t �m Io ces P 3 ..-...> ..s ,nx�r.,-„ �� deotalofFces ,>�,. .�.,. i3O ; �Aiumber "¢,i 'Pct Ys � - 1 � " 2 5�4 k��_ �``�� MIAMI, FL 33162 20 0 20 100.0 1.9 2.2 g w M ._,�asw. ...» sad£.�......�,,.-.i....s,.oe.,..w......"�_:.:1Z@x..3'.u.._.._.a.. ..,.,x ,.,.....d+�. 3336� m ..u�.. ,.,ty. __M: 44 __ a x d 0 _.sl................�....ala.:..: M C......_.4*..._... ,........ l00 0 ....._ 2 6 ... ....,:..,......,. 3 6 a ,_,� _ 33166 11 1 11 100.0 1.8 3.9 33168 23 0 23. 100.0 2.2 2:7 rmG.,,<; �..,. ,.. .. ,. ,•7.: ,:. «:tea .4 2.2 33170 5 0 5 100.0 2.8 7.3 `! 33172 33173 32 0. 32 100.0 1.9 2.2 `'xs -' "' k'^� .r2". A ., . Yy3'" ! ".' k• Y'.." T+ "C " M L'+ "RR' '""S ,--- 33175 29 0 29 100.0 5.0 5.5 31176 .w 33177 18 : 0 : 18 100.0 .. 42 7.2 r 33179 16 5 16 100.0 0.9 0.9 33181 9 5 2 .: 5 : 100.0 1.1 1.3 rkQ,�.� 33183 19 0 19 100.0 4.5 4.8 J'✓w'�`p�''�'T`-¢eu+„v�-ie"". i 'M,' µ,.�X„�.� l5 . lil4 tz"f�"'- -Z rc'� x ps_-{..,_rt^•'.- fY e'•''#. .."2' ,-'}'R 'f'v-ti iw,C, a P�.� --Y `..="•.�"'j i:_£"�i.,H .�£§ 33185 21 0 21 100.0 71 74 �_•0y T + 3"J... YX _ a .o-5b"' "' e'-`b:iF-.� i •,FA' .� ... �� 33187 8 0. 8 100.0 .. 7.1 8.3 31i9 ...,.6... 1000.,.12:..x,..�x . '° 33190 5 0 5 100.0 13 8.0 • rr'rr € .a.x� '&"..' Y, '. fr . - 3a19a� .. 16 4: : ' � 16 1000 ... 6� 6. 33194 :. .. 1 0 <:: 1 .100:0 : 6:7 . 7:8 ��� "§vf .X �'��, 3��yro d�,T. '��F's"a � `�`f "£c^. c�+� ^�T' SSE2n5 Y•' . r �,.r. � A_". ram,• +e-R'� Y ✓� ,� ' 33233 2 0 2 1000 35 35 < 33243 0 : :1 100.0 03 ' . :03 33255 - 1 0 1 100.0 2.2 2.2 =,a�61 �1 0 1' ,. 1000 06 15 33283 : 2 0 100.0 2:7 3.0 &ter„ AC s91AlUlI BE 33140 : 12 5. .; 12 ; 100.0 .. .: 0.6 0.6 '°=a'xuus..r:S;:..,.,2_..�..&[w,.. ��.:�f...w2......:�.z�.`�:-nz�:,..s..r�.,..,.x,..,,'�•'�"'•M.z,. u''�.tt�rt ��,r`,rar,+z.'�, ,,,..c*w.S��� .... ,...:.^ia .�. .P.�.. ....,.. 1� �«.ra��'4' Via. .xe....:._. .b 33154 :.: 6 .. 0 6 100.0 2.0 2.2 Access standard: 2 Dental Offices within 15 miles Dental office group: Endodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 14.4 .ev °a_v. •_ -} . _.?=. + .. - s � 'ws.� _ '"q�,,.'. A � .1,, s`�r'n." All E�.mployeers ro4 `'Z'"!o`2 „,2'=£ ids{'nb,4L ��:.41�j'i�yh $. �T�, q_ fi'�`„R`�x.anw X7'� b,k2•.4YY..," ?2w'_..Y+: �F y.."i k ,4 .:�f-Ya.'::Aj.S III. 10 ecs ii p � Zl, v 3 Lh^h^`Stl` 4rdtyY U4g's 'f_l: �.d3' 1 desired access s �Sk� 6,a2 i T^y`S t+ Fnf $ F u 12� H a'-s .n^ .j•, t'% T':�.'j :�`Y TDial �� Toial>,� 4 �C' ` a yS 5. ` `'' S''.3, '`6ve . nee Avera a drstance number of !PIP erof Ito dental of#icesE C�tv e, emplovees , dental offieess:: Nnmber'�kt MIAMI GARDENS, FL 33056 35 l 35 100.0 1.3 3.7 ORTII M1 l1IMIBEACH„ L.. 331150 . r, _" _ 1 0 '> 1l 100Al X ? ,..: .5 __ .__. ..L _, OPA LOCKA, FL 33054 29 0 29 100.0 1.6 4.3 $ K 2, b ✓ h 2 ' � £ ,o# �30o Y•*F,9 Sv' Ss, 25 T _ f ., 0 r 7� ^ 3.00 0 s $3' PALM BEACH GARDENS, FL 33418 1 0 1 100.0 2.1 3.2 .It"'�r"^e ,b r"'" -_ she 'i , : "' '3•' :: tis^Y 'y.., y .7. "�3` ; x "T°.ea. 4 #PALM eff'4'z FI ._< � 3: .9: > c 3 x i � 1 r 100 0 r 2 8 ?:9 PEMBROKE PINES, FL 'E `M1.•. 33028 5 . , _. 0 . .t 5 100.0 0.7 0.9 _ .� POMPANO'BEACH FL y .�. _�v _..:�. ..,._.:, �.�:.� �_,...y 33063 �� r �,��...,��:_. "° � �1 Z'., � �'�sr � 2.._a�0(10 ��a�09z��'�� 19� 33068 1 0 1 100.0 1.5 1.7 F._�.�.,...�.•��...��,A��:; ..- , .. � . �,�_��..�,w.�;•�..�-.zx< � � M �'307��� 1 x� ,;.., + a- �`,?��s�,�...�� 2 !Fr'fC ^2� � �w �? .:1400. Fjss ��_.� PORT SAINT LUCIE, FL 34953 2 0 :: 2 100.0 4.0 4.4 r3983��� 5 0;. 1 �1000 ' �r41�41 34987 1 0 1 100.0 9 6.3 i . ----- i k "L ? "-'�'*I �YKY .`y` WELLINGTON f 'a - 3341'4 Yam'T"* „ I' z F % Yt 1 s b 100 0 TV¢/ 1 1 "F+i• WESTPALM BEACH, FL 33411 5 1 5 100.0 1.7 4.1 Tt3TALS a1b94; x� LO 1 169' 104 0 31 *!%'z, id:.ui..�3`•k..d�'.'�;;e'.i �-...... �.. . . .,F.: r, �'....,�"�""#,..zSw�'a �'ks•+sx' tiz..3S� ..S:,F.�.,�. ,',•fa.?...?� "r.:, d�• '?3 '4S A;^�.E Access standard: 2 Dental Offices within 15 miles Dental office group: Endodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes not meeting the access standard 15 ° d 2.1". �^1q ',, .? a = •Sr ` �� q... � .y,.,: `3 t� : ,�' . S°`f' �� �'� E�.� ➢$kq� t�dn°a. i i_':_ +-S� ��,@y'Ys.'�Q ,�P 4' .+�F'x $��Lli { *,,..'•f C c' T 'r.`°R i 'E x 'L ;.*tip' ....".£��..�- �4 ,': "� _,:, :: i`¢i, �.: ti.?.`�•�' )C'c.i � , h � � : �* �` x^'.�T�..>\.�:...?xl; � S a �'� S, � '>fr,� Y � s Y ' �p`3 's '.a,,%, xul 4 s: � �E 5'�'� +7 P"�'� p �> �, +Ms r ,�,� `3 �St: ;� ;e - ?..-. S $'�S i�,5�5 �.� v3 �� '�'F'- � i� E qt �'., E 5 S � � t �, Y d �'a�.. \. ?� Ka e�h':'_ �i S.� - 5 Y!'� Y �,sw:. i �t �...>.....� fv �w � �� `<f "Pw� 'tt '?k 'nL� a'F *�.� d per^ +'^x..4? �` ,s�4'S `�y(\ C.?`' .._ ` x£' Y' '� � s � � � �ti: '� �, ���,� � �' ���w`�`°;e�'� } tl { if+^ `�.K "'"`4 "�' F �� � ,�� ', F � $,. _ � � � � � � "a 5S �z ZIP �t Cale � , � ��; 4";, x � < g,� ''; r � a-:�� Em to ees wathout , ,,,�a o- � � � � �� P Y . � desired access a sy� i Se ,xvm�`"A H'.k..(T' t � Tota`l �� number i 'ta 4 emploveesyt � � «� �T 4 numberi dentalaffices ��� �a, � �� a . Numbers ; ��,�g * Pct 'Average°d►stance Ito dental offices €� KEY LARGO, FL NAPLESS L W w 33037 34113 34120 3 9 1 0 r k 0 3 2 1 100.0 100 0 100.0 23.4 ' ,x 8 9 17.0 24.7 17.9 �'TOTAI S fir,' a '.��. � ,, ;iz< �:'�'i �$,�.'� s` ,x�3x � tt'c,�` . n_va':Y'�6,., i� � 4k �i �.'^''?� 60 �-;fiery '«,� is a0. ':A'•�'4i'�i"'�.3 6 _ 1*,. P' s 1'00 0 - b f 7 5 *f`.'� � j 22 5 . � q's � _ Access standard: 2 Dental Offices within 15 miles Dental office group: Endodontist Offices Accessibility Details Periodontists Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 16.1 Emg1gyees Iwar ;dumber of jugs 118ntalo1Tices N r- �: Employetisvith *sired tens Avetsgedistance .to dental o1flces 1 ,.. :.: BOYNTON BEACH, FL CORAL G ,13 11, DANIA, FL FORT A'UD RDALE.FL 33437 .1 0 1 '11000�0.0 2.5 - ��2.5 RR 33004 1 0 1 100.0 3.8 3.8 01 0 �` ;2' •30D.0 E; : ..30 3 0 33304 2 0 2 100.0 1.9 1.9 308 • .. LL: ff.l 33311 2 0 2 100.0 3.5 3.5 i2-Y,_ 'k � 5 1f.y : . � 000� 3:9 3.9 33313 2 33314 33316 1 $33.17 0 0 2 100.0 2.7 2.7 •>200 0 . ., : i2 9 3.2 1 100.0 4.2 4.2 33319 1 •2 1 100.0 3.0 3.0 33321, , . 3< '. 3 r `10 0 " .1.2 33322 2 4 2:. 100.0 0.5 0.5 33 24` ` .,.. 4 ..-1M0 1.6:`, L7 33325 3 3 100.0 1.6 1.7 33326 '�. � ti 2. `100.0 1.8 25 33328 6 0 6 100.0 2.4 2.6 33330 :. _ .: 4 1: 4 100.0 0.9 . 2.0 33331 11 1 11 100.0 13 2.6 13p ' 4 0.:. .: 4 -WO ; . 2.8 3:5 33334 1 • 0 1 100.0 1.4 I HALLANDALE, FL. 33351 � :0 2 1000 1,3 13 33009 s. 2 1 2 ':100.0 . ,1.9 ' 2.1 33010 8• 0 • 0 100.0 25 3.0 33012 15 .. . 4 15 100.0 0.7 12 • 33013 5 ' .. 0 ?. 100.0 •2.1 2.6 33014 . 18 2 18 ; 100.0 0.8 1,1 Bo .YwooD,: 33015 32 0 . . 3 ' 100:0 2.0 2.1 33016 9 2 9 ` 100.0 .. 0.9 1.3 33017 1', .. 0 . ' 1 100.0 1.8 33018 10 0 10 1.00.0 24 2.6 33020 la '' 0 < .. . 10" 100.0 .1.9 :: 2.5 33021 . 7 4 7 :. 100.0 . . 1.1 12 "3.071 „ 31 , fl 31 •1000 1.7 2.1 33024. 7 3 : 7 100.0 1.7 .. 2.1 33025 24 ` °1' 24 1004 ` 14 1.5 33026 I1 6 11 ' 100.0 0.9 .0.9 Access standard: 2 Dental Offices within 15 miles Dental office group: Periodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 16.2 Z �r?R h�F„ P'"� .. b �:'9k'S ,A. A'" v �'r7.. • �, L.�, tE w� Yam,: g,ia.aY�1j";.i y -y � -K`v.#4 2,a. FCSSR� h R d�.a as,..v P-�•.4 ..�.'F,ia s.�3: xe::�::�'x.. �',v.,�?.+:,',`�£3.�,.srh.a'.£2��fa�i._. :�:°x�:•';':`��,�.��3';a._ .- " "R, a' 3 "r ti 7, aS ` : i� L $ krY' _.� +?'E ,2Y 44 b <.;'4': -s .,'� .����•Y �i' :.� 'A :'',- <` .:�"n � t ' SM" F '�AllEmployees,re �5s�w� t •. ii ti'Xt ...5 tiS, vhe.`S i:.ah `�S4 Yi e]",Ti^.,rS•:'� k'''�9,�N 7�U ��-S'AL4�<fa7e „�W' ,K'. ��+,,.�.".. `� u. Rr ,xz.r �. ,3:r: 4 .'.<'�' > &.. x,y^s A eR `5\ ,, .�. '.+� �., h „r4,`y' X..: .T'e�ai' ., �. k �... ,u s' 2 ^:"i'R•"`u"'a�.°eh' r x� r �Ta 9 Cxx r- ` �`.1#.K°s•�, .,° roployeeswtthe q`„z`YY=. `�,+: v� 3, '1 s.#iR�"kY•'ta"� $:nt .zY7 RY". i, �C 0. 3 K.�r.Lzi `�", Y +„ 'L, A . .: ' :A F.� N;t.:. ,v.v r<n i*Tt P dewe ' access Vr 4'dy4'\•tl- y'�`K4€ � 4�' � i �S ��.'Fota1 4 otal La f h 1 ... i "¢ S., a"el'age A,,L. dustancea 4..;,� ... i �^� y � Z% ,,, c Code z numbCO �emplo .ees number off e , dntal offices ? ���<. � Numbe � �x Ito dental,,offices rs ,. Pet... �.a.�,k � ,� , . � "i HOLLYWOOD, FL 33027 25 4 y �,'�"" 25 100.0 1.3 1.3 ` < 3029h 251 052a ` ,3 40 0 '3w0 3"0 33084 ,303Q10 1 ?.� ,-'�<. -?� 0 s, � .� .. �:: a ..,,,10ltIQO 1 � 100.0 1.4 . r e .__ 3:"� 1.8 '�-r ,..z.a'15 �`;° ace`==� ��:�x�.0 .;�:.; - ,,max-f�;;' 130MESTEAD,FL ;< ...M -� . . � 33031 1 0 1 100.0 6.4 10.0 33033 17 17 R�vM 1.6 8.5 1 100.0 33092 1 0 1 100.0 4.9 53 n:.rr:.-...�._;,. ,>�,...�; .^:,;.,,��".,.G,;:�^=vr.�rc'r>;-�. �,"^�s�. � . tv do". JIIP 4:::, _ L : . .... �' ,..: ,.. ,.. a � NY ..,. .....« 33458 �<ar-.a �,�.`«'�'y�'�"s" '»a."'-<,•fR~", -: �f �`� '; .�"' �c-�;;� ' KEY:BISCAYNE, FL 33149 1 . 0 1 : :100.0 5.3 6.0 E NsAidA c, 33101 : 10 ;. _ 10 1.2 1.4 MIANII, FL 0 < 100.0 e iwN s ? Y ��312j 39 (i i 39 100 da : 1 0 1 6 33126 22 0 : 22 100.0 1.9 2.6 :y .' -rn,.r3 `-.;,u.:'-:.,- y#�J12� '-•__...+.-.,' -. , , �^.�„�._.._.a�,-•___ .v.aG.._.T.�v..�:�^':�G .,....<.ehs o - � u'-'3 �,'0�t .�..,, �u_,�.aa A ay.... l� ............< 1QQQ �: -' ':...... � ..,..., l'8 a a.3, .,..: Ga3a:w.;c�,a 33128 2 0 2 100.0 0.7 0.7 t 33130 .0 14 100.0 0.5 0.5 14 ..� K n31�1 33132 6 0 6 100.0. `T .1�0.-;ir...�.. 1.7. 2:1 , h 33134 3 21. : 100.0 : 0.7.._ 0.9 71 ''d ::.33136 22 .1 22 100.0 0.8: 1:6 k Y.: gj. "�•, . $ ,p, N 4 a 1 ? T 3 . F �r f X� 33137 "wry E 12 +,ui + 2 C} , 0 .. C "`S'`" lx2 ^A`i" t1;40 0 „^ ,,' 2 7 -,9 i '* 6 33138 "G h L�""'"G � � ." 4 : Ty. `Xt: '£`• Ya r' �4 � S iSi s:.-�T�i- �' ,.�"�'£',';� :� £+. :,4 � 33.42k 3'- 4 33143 :: :14 3 14 : 100.0 • 0.7 0.8 x � c � 331 s xc": J � 14 0 �a ' 14 100 0 a 21 3 1 '' 33145 ;:.:35 : 3 35 100.0 : 0.6 ': 0.7 :. ..:.. s� 146 �4 0 G4� 00 0 R 43 33147 :: 47: 0.' ' :..:.. 47: l00 0 3:7 4.3 �o 41 Q 41 100 0 3 33151 1 0 . 1 100.0 ' : 3.1 4.5 :9 331=5 9� 33156 :: 17 :. 3 :17 100.0 :...: 1.3 1.9 , 33161 27 .:. 0 .. 27 :100.0. • 1.5 : 1.5 Access standard: 2 Dental Offices within 15 miles Dental office group: Periodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 16.3 "" :. �5 � �' 4 � '��Z � 'a� �� � .. s � � � �•�6 �,��;=v �% i Ste; 2 k�� d'i:� k � T,AZP y�t` fa"a.` Y L�a"`a� k � '>, ' <y. : �. d.n;:".ix*}.'H«::.:�^=t.:s: :iitC;,?.":.'•fix^--"�"'k . '`z -.1''`: Fes, .`�T�? �-� ', ti` �4 � a�t)'y4ki:!?:�.ie;a`U€ 'Y`�` Tiw � -�•S � S� a'ae �� �'�(.� 4 ti" R .rY-€ � "a �'a 'xdZ ''4 �•<^'i' °' R'`1' k7 w, j. �@@k,,: "�.Y 14ia'Y.e.„-q;a'e,3*`l"•:l>>:`�=uk".:.},Ci-.iaN y'< .Fa"i`c�°�-v.'...pmY-�+ :'T2 -e ?F 3 b "n aS'e Ty'�yy�ztfiy*'. aL.K.s�La'y£Fa�4a kS .'-»'ar3'*k`..jL=��4 � .5� > 5 i* ya i'�x ii�'z'z•, m A' a ' ,�'. 5� =°'T�>Y•f, R B €,.k.� /'eL se\ r 4 i*' �q}�N 't. 4 Y�".�^a"�11i�+'fi�a.'A <R S F' .a*�T` +`MS' .-.��^-r y �.3�� L'�: �,c-::J_C ` r d • 'k�y4k,4sk' z : L ,(� .,cf iL�-'' Code ,<i:;a�S:y:x9.'1§7?ua+'•-.,`dace 2 � �l .�;c �� ;&:r''�:.z4, ri:.T:"u�'cxaE ��L:• N'jC^1v:: �.�a Par t� -N `+5 tz i, �Total < R ` number of- s 2 Lam'^ ;% :� Yt.'S "^ < i femployees, `fit3'f: "i`i?:., e`$.�"f�?Y'i�Y:'Y' � � ' <a� l� J<k•`Simnv- {..ice `iII Ei a}„ _.2T`-'�..-_-L.<<-9 :'ait-.,vY.s.� Fk@ e. 3 a .+ &. _ •d i� r Total . number of ^ dental of feces, a�`.i•Yx _�,' 3u ` •e..i- v».k z k i t+a +Y'SD "h'^� 1': 5 < 3. .5,:#5 h`•.',eAM1a-?.- .h^' .,m Sgvx 'M" -'^f",iFBx �' t � �3 Em toffees ��th £<? j '.' ''. -� >u+»•. p�S .,. 'rles�retl aceess<_ �'y;•.^*,,( �- : a.5 uY.e,H.i'"i ?. +a j� S t L'aSR ' x ; i Number xki,$� %y< F� 3 , 4 , Pct j.'`♦ W - „} .. „�'.4 r»' 711 erage dicta ce`*T to dental offices x 2.2 _�'� Ea'x: •at+ 3.6: !� 2.9 MIAMI, FL . �.'-��-.�--�:>,:>:.. „ .,::.,,�,>:...�Y�-,n„ �....,,•,.,n.�..<.;>.�-::.4.�a.:--�� ,'�:�; .=�?,.:c „v.R a �i •; .£ Y ' F"':. )- k�,4 -ss�R .i,r2","NJ {'�': `4Saa ..�x�.�,��v�:� � �� _� �_ `� �: 33162 .m,�:�. 33166 ".u+' ... :3167,_`�:_,:� 33168 33170 �. ?17Za17ae 33173 ..+exy"'�'r`-`.ror 33174 33175 20 -�>� � .,�,x, i� ;d :. v.,i 11 �. t1v Y '?�.'.'2 23 5 �i� �ia�`.c.� � _� 32. 0 ,tangy '�ze <... S 0 "�^. ..� z` - 0 0 .�uo,w �'v- _ .. 1 -F "'a" 3 20 100.0 ei 100.0 " ✓�"r`_F 100.0 : 100.0 a.a..z•. 100.0 r..,-ry<,r"e' 100.0 2.1 �� .m�«=� 4< ii '�` 3.4 q "k+- 2.7 2:8 1.3 Y%' a. 1.4 �:._--� - } k" 11 .. '_�i "":�`� "�SY 23 5 171000�28 _ m.-. i'�'...£'��r�..a 32 ate. y<w,,,•;�.r 29 •,�`� t4 - ,A�.' � 4��` t$2 S@'" .,'^E�.'k."e'� ,L 2.8 : 1.6 'ry-. 116 -' �' >*✓_.- rz�� aP`^Lk�.a,... '� Yie aura .a�:�'c?m�m_K_.«ti..'2a. rr..�c._ _�4� ....£ ,T'"Ts •F '" F- :?>` "k .,:'iP>:'(' 29 h rT. �-�e-... �....._»v- 'cx��;'f. JII 3 _. Y"'� <`' ^ •.L6 R -.�. '�- '�•`Y, ' 33177 Y'i:.";' i]T:�'ey a� 17R��, 33179 c` 18 =.1 •g�;.^ .a a�?:ci-? 16 e 'a ' �: 0 :. ,='�^�- _"..-"3+',Y'-��.-» F 7 . � x .�r 18 :100.0 : ;'<�e'S` .. 100.0 .: r : ^ram 3.8 =l"_Y 3;- 0.9 � :.�rz^a�^ 3.9 <''FiV - w, �vx' fio.-'�.g -0.9 m ', .�a^Ye'k 'i',.�Ei 16 .... „�' ��, - . . �.: �'�... S^ 3 : r�, ,r�• a .. 33181 5. 2 5 100.0 1.3 1.3 y2r.f ?''."x T ..:: ,, ....'r.s.. a,..?,y <rm Y ° � ,IIy w+�+�,5°w...<..h1.X•i;,'... �1' �+.% _ '& .+� } ..' ,k. i IF i biC ? 3l82 33183 . »q.�..;e.Fm,TNC :.:e ' •rvY 33185 •3:�186"47 33187 031891,3 .0 MII,a>.wry 33190 331.94 : 33233 33242 12 19 . YiF«h a a0 .. 0 45 Y�7 .2 n ... 0 8 3 "Y ✓a"�"� 0 _19 1 ^:A'?`=Y'� €.' S �i*'o s?'2 :,air ��.�.'`,z..�:�.&.f 5 l00 0 100.0: �a'Y.%6 10000 ��.1UQ Q+z 100.0 100 O k 100.0 32 2Z :1.3 1:6 :: �`-q �{,' �v��� '.�'wn •�D'•�a;:.dui-�-cu,�k..:zv..-xis.R?:di�i'' '...utt�F'�b't<�wx�i ,., ^�;..:�"s,.,'"7. $z:. 5 : 19£; x,a 1.3 .< .''x' `1 ? :1 1.3 2:4 gnw�y,� :"`""'°A yu' . +. 12 +.n.. ..'�i,K. ,. _ uw, .' 0. � 6 b.»mOt6, .,.., P b 2.2 ,,.., a.: "} T y^` 'f'4# .. :. 1.1!M2.1_ 0EACH u Y• '.. Ki 33140. a3141a :3315 ''#n '� z=•,yy. : 5 x t ah ?...!4 Access standard: 2 Dental Offices within 15 miles Dental office group: Periodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 16.4 --V.:4'4 -',KP,,-"Z, 6. i s,„'• , :•-•• '''")' . '- : ... ,,, , . - ,•,... . , - , , ''''''' - ,,,, • , $,, •-•,.- A •-*'-.# ..'.,,•-' -, -t• •"`" - .. ','• g' .C.L. , f %`,;4,,, ZEP ,... . N 0660tlloVEd'dentdUbfces ..:4 '''' ., -.... , ...um er,-.„ i.im.• ' '''." ::•-, ... -,-.- , m loye'64ii -•-- q„--1.:-.R.,..ilm !•pi esured•faceigs. ,..-- ,•",.-i.: „. , r.., i„„..nb, eP„r„ '•1,'..e„g k4" ' ' ' ; Number Praae,distance' wdRentaf4ffite0VsV•t ' f-12CI ". '''''',,,'':•• MIAMI GARDENS. Ft IVAPLESIFI NORTH MIAMI BEACH, .1-1%:,c' r.::::7,,,,,-::,•,••0-,,,,r.z.,-g•,-•,m-:,-mv,,e•-r,,,..,1,,-1,,..-,.v.,-,11,".-....,•i,-r FL ,,ISZ,S7S1s,,.. ,„.7SMS,"71, .;.',,-1,. ,fr ''xil'AVA'6'F&.;,:giial 4•T - ' -",'„?.,W11-0.4.'g- . 33056 • 341.P..rO-13I.W-.., 33160 '..,,. 330M..7„,.."7:arfstT4„7,`,..•'7S. 33055 r7A7-1.-"?,!•••-7,- '4334187# 34990 ,-.-f.....-•-.,,,,7 ?4,33018:A 33063 • - 7""MMT 33068mI 33073 .• z„,-.-"7-"-z-,- 30Jp 34983 3498,,,...„..,w„.t.,,,,.., 11Z 33414 ?,,;'-.R4741.,.4 35 o,:.•= • . 11 ,‘•-, - .-''29',, 25 -,- -- - ,., 1 .-z.:.-4,---,-;1.-5.7y.„ -,-, .......„..„.•vx,'..s?.- iginz,26E,1,"A 2 • • 1 ,I•ip . :1 , • 5, , '-r . 2 ;cm .---: ,1-„,---,,,, 1 , 0 :'''1' ' ..e• ; 0 "-is... - . •0 -- ••-t;-;*.i, 4-l'i•-:A)„i--. 2 ,,,,,,w, -,--4 :-....-w. ''''".a 1 -0 ' ,l41"10014 4 : r ',,,,r,,,,rm-,:,.3 0 0 . " ;ge.N5FfiqZr431 • ' 9 !-.7,famlili7JZZ :35 -r..•• ...-,.,,,a...,:..,,.7..,T.r::2,.o..,.. 11 ,.r..m . 1, -.. 2 -,;..ea ''': '::d. 25 .Ty.1---1-,----, •-".=-.,....ii4 , 1 %-i-,-,•-•-r—, ....W , ,,,,,,,,3t„..,-„. „ VAS,S„h'' a, 2 - 1 • ,, -I ,„1000„ : • . • 1 WifiWRINF1Tai' a . .2 yllixirm'At, ' ' 100.0 41-,.r.•,00m--i0m=4"x,•4:.z.::-.,. 100.0 - el"'".'14'W • ,. • Sk 100:0 ,r,.e100i0.;'.,t 100.0 :'' w.-•-•-----"g,'• - " - -100.0 100:0 rpr,,,,r11r 100.0 • grIVARE .):za„Y.M. .1000 • rre4..! ..•,v'vr'rvi :1.3 1:5 zr,,WW — • • 2:1 2.9 3.5 n 10M 'A' 1.6OP4LGR P;f1:7,TAK74'7" ,!'l 2:7 :•'': 2:9 1'4 r — . - 2:8 1.2 44 • .. .4.1 !:::•? 7.47;.A.T.T' , l'i-ii e...1,R63 ,,,...., :1.9:. :3717‘B!:;,i1k1„,... .-PALMIBEAGFROARDENS•gFk,v,41.!.-10., PALM CITY,'FL - 5,-----------'-,..,..._.:,,,,,m-,l'-•,r,"'---:--•-„„-n'-',P--,•-----v.,,---,,,-7- TEmiscROus&TliszEs,.:: .',;?-tikU:M2',M4aVffAlaYA.,i.:', • POMPANO.BEACH,•FL •7-4--oz..-?,w--- ,-.-7-Tru.---..mi.7.7 ,,-aw ,.;,„,r.,k,,,,,2,w55:4,V,Wrrrt.:,;,:,,trr.r.,),: .,,,-„,g . • • Tr...,-,-,,-7''''''- :,,i'=,:.•,,,,.:•- a.:41=-•,' • 1:0 • no. 1:2 •• 3.9 WigiErZST-i 3n.‘.71- .1.9 P,)F41'.;*7:%?iirEi;41 TiEIEFA,,,,_ kiigWEEblg . ... , .. ix4;g74741,00Mzc:741,rm-XWORP-WRriFFI WELLINGTON, FL. 71-er..-77.44,1Y.7:777'. .7:7'5 ,, . ... ....- T : . • .= • : • • • • . = 1171; ,,,,„ ^',':,, :-, ,?4,56, ,,7,ialfi TOTALS • - iimegotioviAt4Ativoigmoinchimms:R004•00.maimiliv•AiliiigEignuoig:'momminnyominatigMViiiiNiiiin,•4gif.:ij:-,5:41,Al4fiS40iiet:Ska:Oi;-,,-T - • .1,696 - .1. • . . .131 1,696 . -100.0. : 1.8 • • 2.5 ::!•T:t. ..... . , • - .... ..- .•,:!.,,:i ::. . , ..,... i!v.•, i!•A .... „.„ . -. ... ...... !,,:,:•.:..'1.,.=.,.,=,:;l: ...„ ..„, . . Access standard: 2 Dental Offices within 15 miles Dental office group: Periodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes not meeting the access standard l7 `:. ..+e.: '. � c '�. Fg s`•C nr ,� s �.gF' �x � .. � �, �! � �'x s`� � 3 iy* mom' „}:.'• >�, �v"' t Pg ` ` '� a5,3 "x"rf ..,`.� s� � 'r'a'.+ City �+ r°>., .* x a 2 "�y v 's b +'FrX a 'y : YvnyyL "�`` rrs a 'z, v-k ?� i Yaa'�F "` £''p�,£ i $ d$ �• "�'� �' Total number of s ern oxees i h u" ti5 , Zvi a`. Q`' Total number of dental offices' `� t K i +✓€`',#' +c'�y � 1 '>+ - Employeesn�th0ut `t desired access a �'' % : b t Number x _: °sc �r - s.� ys r :. �..�, Average distance dental oices to l t� �Z.iP � Code Pct Y 2 KEY LARGO, FL NAPY : ss.'a� x LS,�:Q.-,. x� i� y 33037 '%dT^ R34120....- 3 9 -'^'� 'Y 'ti.-_1L 0 ix'" i0= 3 t.g1M1 L C K"•3 �-v#' 1_ 100.0 TOQ• _ 23.4 �«°` �� 7r 31.4 'T'� J TOTALS 4 0 4 100.0 21.2 27.4 Access standard: 2 Dental Offices within 15 miles Dental office group: Periodontist Offices Accessibility Details Oral Surgeons Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 18.1 :-, `��� ��x?,+. �`^. �-C ,;� y�`L. ..1.,� �.a xz ,�'^.., y'}'r✓' wSa��,�?'u`�. :. wF Z �. ' iY L. i R'a; z•'a Yirj �. �" :'�Y nF? k'a'`�'3�' ?g,,a#$�`'r.`l ,�,e�,La � 1 `*.fib 4F gS`ai':�•"�{g S �k Y / Emplo3 �-`.- ees _�yt4t". y Y'am�3_.mtY _S,v,..- xa.lk$-. ...�V". <an 'w'�`k-i?k.. �,S . : YK'�. _�,t,. �`✓':: k �'�,""�,,�3 .Y4�.•.'s�'�'..^N`- 3, ^.. L: .0 ii?.YFj��1S`2#4 �: ��h t'1 : `§ > Y \#a� q�•S'°,, Cfyysy� � �+.F'' �"S a, y,.,mCx� fi"E'.� �✓�'S`@ 1 ^i. q .' . � i' t \Y;l '"a t �c. �'C' �'? "�' d ! t� C �a� :�` F 'My ,t Tp �.,E. dot �"3 �' -P,.' , g ^;:¢ `tq& hF .4 i Q :'�. ,,,.. i'A " a i. E '+�., »-�� rz; � ?z, . ,�,� «� :;s';: a.,,.. �.}V<'.n'�.°` ez :..v„°. #+ 4 - 2"' ? W,.krg5 �kkj 2 kq•� �?; Y � f`L #'`tr74... L 'R ,,y� "+.'r`.-_;� •Y'3 . y "7SF( ,, ��n F 7'� . i` 4f'(.` "F�L'f';• j,} ii 4' 'dig Vj4' l? x" <1' A 4.'' `.��yy- �, Y !#u � "v�. �, .1 '3 h-v ' �i' .,s'3 # � ��*3 7�`p r'y ��'�'``�. a�+�,.. al',m 10 eL`s,*1 °r �. �"`?��2��«�' "� 9]qy �U ,�- l�:ellAeee'sS$Sk x .0 � >.c, ..,y„ ,r;a _& •_.7� � � x� z � �a , :�, : ;,> Total ' a .. Total , � k } Average d►stance dis .: nee' \ a . K �ijmY'i - 4i `i...,�,.�:., yyh !e st' '. $ ZIP' "L. w -9. Yi numberii ek. S: iLv^vi#'.�f.-.�""c»+4 number oft„ \W gto dental offices ., ., .. ate; .:�'i',._.: �.-i3:1 3 C �� ' } � Code employees dcntaltoffices 5."�f,Y`-A"w.a'4 Numb' ct :. BOYNTON BEACH, FL 33437 1 0 .1 100.0 2.5 2.5 $0ORA1,7,G'" 't, FL a 331f14? I 0• 100 0 0 3 Y: 1 2 :' DANIA, FL 33004 1 0 1 100.0 3.8 5.0 ,FORT i,AUDERDI 1.3 6 � ���� .��.,� � �. �.�� �`:�:•-- Q.;:,�,.w� ... 3 : 4 Ff- - %a`s;'F'a+<' . ca'":'_r 33304 �=�:.:z.�; 2 - _:�,-Y�;;���.> 0 r-- _-;�.� •W.- 2 y -» _ram 100.0 2.4 2.4 ...:_3,ro3....3.:0,,..8-..$x 33311 2 0 2 .100.0 -.....z.�a......c_u.3 3.7 .., .. 3.7 41 43 1 : 33313 2 . 0 . 2 . 100:0 2.5 2.9 33316 1 0 :1 100.0 : 4.2 4-.8' �Fy 3331'T 2;3 oa�:� as "'�'" � 33319 .. 1 0.. 1 100.0 .. 3.2 3:6 .` :. a c� r L r 33322 2 11 2 100.0 0.5 0.5 :✓�. `\ ._.. �> 4-`.L�-,:,-uZi, S_�-�'''. ? - ^-.., - b .......u.,.., _.. ....�.,... . JJJ�4..r; _..._ : d�'i u� ia, ._., ... / 'cLa._.,,._s'L °6'._-o...x3 4m^Yw_.,.a'h�a.....,..-.y d'_ IQU_Qi` .....__ ':..1'�sa:.USxc.».ae..uu� �..:_ •u.3 33325 ..3 0 . 3 100.0 :.. 1:7 : ; 2:5 s''aa4.7-_, ,;•:,'*--: � r,---;sr.r>;'�" -r-. z -.:'�- ; zr ;.,:- -;; -zr -,.-- - -, ..." ~'tx-_^ '.,,.;e.,;r<!�*, .-.'.'': :•: .,� ,,,:.::,-�'- 33328 •6 : 0 6 100.0 .. 1:9 . 2.2 33331: :1•1 1 11 100:0 1:3 2:7 ,Y 8 ',L ,' .. 'T`^/ "Y y£Rl� ad 1" } Y -f ijT�'ri:'• _t ';`✓.4 G :: "^l".,",' sC T .' ny � s 33334 :1 0 1 100.0 :. 1.3 : .:1.5 �'�f,,:a`'£`� `"S«" a3'' w¢� .E' �5 Vie`'. "F.''�''. 't�,'�"s: rt Zv'�'C:< :6..t" '.: "€ s'E,'-n. ?S yv-_y^l :• ':.�-'i:.,.�"n„S; 3•��.�T'" ..£t^` y HALLANDALE, FL ':33009 : 2 .:. 0 : : .2 100.0 > 1 6 .1::6 tHIAI.,E'AII, FL ',I, .33012 -15:' 3;: 15. :1000;'. 0.8: ,:09 ,),U13;, 33014 18 0 18 100.0 1:9 1.9 �' s 33015 32 fl s 32 ax� 100Q 28 30a 33016 9 5 . 9 100.0 1.5 1.5 , ..,, .,�.,� 33018 . 10 10 .. 0 :::: 10 .100.0 : 2.7 . 3.0 HOIZ�YP�'OOD#�c� a,.1©00�.:.2? ..,� '.33021 7 : 2 :. _ 7 100.0 : .. 1,11. 2.0 :33024 7 5 :.: 7 .. 100.0: ..1.0 1.3 -3 4 1i00 a ` 1 i s ' 33026 11 ; 3 11 100.0 p1.0 g : 1.0 '. Access standard: 2 Dental Offices within 15 miles Dental office group: Oral Surgeon Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 18.2 ?v:..cg� ^.�a;:gs,�'y�.,-_J. .,,� 3 � " `?�?� "� ��� Y E'+. .44 �t .�Sy. d� � :� . k tS"s•` v � .' 9� . 'y' `q. 3 .'o..`�"�. k�;<i_=:>n^%: :,•weL�3;s,�_ F .1 .R, in-NiaE:i �4,xrc �A.11�TC1p10)'eeS ;� � t � � ��� ` � ; �� ` � � �, ����e � x* i � � . ! f. �, ? S si ^v'. 'V _ 'i M ix .'. A 3x.,:.... _ !� . k � 4 A 3 Yk�^,Ee. 't`c 'i � .^lY '`. c,�C^• Y'T e4'i-�`4�5 ...�v�§R.K ^G"i* .rsk'i"k", '°'.'fF�U " i4i � -,. -- }.' Y '¢ 'r 9 t , s ;4 YT `E F p� �, 'i4 "" �E}.'� . <v�`#.E�,� 1'lE g4 "a �y's ` y"F' .' r� 4 ?�" Y .: P ' � ,.E E , U - �•1 s, Em Io ees ut £44 ; A R � ., NC s x F" <�. 3 ?'>� tadesired'access '.. .. 4hk .: 1 a`a ' ' -yy kQ C ;, 4 T Y<°' `n $ '... w, ' 3 S S° . s{: 32 K :i' adusta 4 ,ZP To umbeo 4To umlberto bs 4 A F Se g ? 4 CE toti edra nce ental offices .. i e Y e,ro019ye. nR e, nl.<cf 4 .r m P4xY`te>`i . ✓ .<.4 . a n„>, ,: <i zz� .�Z , HOLLYWOOD, FL n, f 33027 25 5 25 100.0 1.1 2.5 ,a,l! ,�L . ... � G ¢ C a..w_._:.-.�xs.aw: 133029 ;C:G.�uSw£•_ - #A a......: c.._...,, 's'f+' 9 .. s.,.cu......... �'it e...w, ..r,:L "'2. 3�:?. ..,., ..,s. <_u` ....a..«.a.......w.� ,.a, .� ...:.._.. .., 33084 . 1 ..<m,u. -. ..._..._, 0 - 1 100.0 0.0 'i^,c3�i�.7>".ti 0.6 .,r;:s:Y ,'s;��.z'-r-r.!^<>; '"'<.ew-� . ,, x,,.. :..,. �: .3�."*`?a.,, .; .r>-a i. QM STEAD, _na,:; a,.. 33031 ':3. - 1 "'yX?'v 0 r'n..: %�C,"?, 1 100.0 �`•2. 4.2 ,'«�p��rtn'*=^v,;'' 6.4 <,....„.�........':a.:'..,-,, _nT-. t.",:y......�.�:•;^-'1,.�„<4..:<5`:�. �N .. C' "�f?",: ag_� k a ^..yk. `y�E.. 33033 17 2 17 100.0 1.6 1.6 33092 1 0 1 100.0 4.9 4.9 .¢'^y^ : ..»,CR'C',. '=+�%'�3.,C`'n" -.b n:T"^.'^F''F�"s"� ' ..E:F<N ^K'. .•<�"{^ 'S"'�",%L•,e{ 0.., 'f•,, »' :A. 'SY'. >`MEf,'.';%::��2 :WM... TZ x u � .s, a .__ ,A3,_� 354, 5 KEY BISCAYNE, FL 33149 1 0 1 100.0 7:4 7.4 L aXxaHATCHEE MIAML FL 33101 :. 10 0 10 100.0 1.2 1.2 33126 22 0 22 100.0 1:9 2.3 ��_w�,,._._ s_s.Az=-�.�'_:��m vxi;�.,r` t`�,.<.:_....�..z�.. aW__ , _sm'x,-.-., - �. �r :�-..--�..x� .r ,E. �r z�;S.. >.,aa. ,_...:..-_ Q �•rc.. fir. �__ � 1 g - 33128 2 0 2 100.0 0.9 0.9. 33130 x33 31 14 0 0 14 0 100.0 100 0 21 2 1 33132 6 .. .: 0 6 100.0 1.7 1.7 S '.< - 5 �� g ,:ryF'< z .:Ya .,.<v x n":,£Y.T+�. ., ''e• ''F,3 'A` ,f? 'lefr d:, yam,; '.�i "'"'E, "* : '3' %c<'i�"Ea s ; 'P' 3.. "'s 33134 4i uo I3...... s #�a.x.... _...2_ .a..,.,r*. �i�...., �e.�_ ..;., ._ ,�' P.f.<,.. ,.. �.�•w. ,,< 33136 22 ,r. 22 100A 0:8. 0.8 33138 'L'a•'�^. ,,: 'z S�',''"C'K"� L 3 nE'� , S+TP�fA� a }�J a1142x,. iwix.. :,4..,au,i 33143 13314 14 0 l4 0 100 0 , 2 1 3:1 f F ' ¢ a 33145 : 35 0 35 100.0 1.5 1.6 -e' .' 4" 1' '4'-T,u''-zrdE 4 `` v' 4 'Z° 3.6 , ?Y� '' � s ' "; 'sLi T' F `•" "'' 33151 1g 0 p 1 100.0 ? 3 1 3.1 33156 ` 1.7 4 17T r '100.0 1:9 1:9 <. ..F, <a<,.�. ..., .< .,., .. �.,,+....<,....,m ,.,..� ...W..�.x,..,._a...Y �., .«..,,wa., ... ' '.. .... .: ..,. 33161 ,.�e„a:�. a.w.�......,.;,v. 27 .„„A«.,.,:,..t:.. ... .. 0 . .•,., C«.., .,...,.•wE�:.exaeaa<.. ' 27. f.., ti.. „ .x. . 100.0 .:..... ... .:... ... 1.5 �.,. ,..... �,., 2:5 Access standard: 2 Dental Offices within 15 miles Dental office group: Oral Surgeon Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 18.3 c � : ' '� . " y •�'� s�' � : 8' Fi's � a . <rz ['�,�' �� � �x,�s , iaa 1h4' •h -:z.4 i�. mr£., q ',,.-u.`4¢„ ,>., r t t. R.. ^rjt. ��1� �3: i�.:w`'. s ��� ��y}`?x`��Excln �.:t F T ; . y" ,v +.Y.. kn�."Y F? a � Fa . � � "a 'c,!. �' s i fir4e3 . yC' . t3 .,e`$ "�: F,F+zs.: €,;y�'3.y„ zd Y ��' jN . ;'-. 'ioQ.�`' F1'"', :<"�,..`t.``�,neL �: t'��,?':i..,'t.^y'�„m gyp, `.:vim. D � ��'• ?y�, �_ ;�y�'� ;a. ".i+ �`' E�L�y,."+a, �$ ks�3- ?.'X,t, i ...F u. C � 'ate sw`�.w 44w.,xL-.4�'�<..,. r+:t ,^'� :.� �i�y. �t�3 .: ss a,yya iMl� � ; 5t£,� '�` �' L ? a s*` $ 6✓ �jR# y .k,,f'' �yq .ale ..0 '2L`a,.��'E ,i �,�{,A�' �M."W � } "� '* e C5�. ,i : 9 . ' n . .k ��,,,�� � ��e �^ ��.�� �,�:.��'� ��,k Lam, -f^'� .sxk+ Z .S5S. �a 'F `3 i >.+ 8 i'?fig pk d {8 l'b . 1 .^ad�MV- .`'•'T��'M'ti. b' . K d R rcy 8 - a...,it � .T .$ �. � L & iYet,-ti �p�;� �;�� T^ i 3 -xi, �k�q^,':dy-�F k, d F'� y1 S `> *_,'snei,�'"y. xSa Y �iS� � .} - � a fi k �,7otal ,� number of i'•. .� � �'� :K k � L.e g �T'� tE.'dCSIrCd Employees with 9CCeSS,- cc ' - ,y�. . { kV 1k�.� yyr'� ,cy thff f .9.� hi �`�Total � � . n:..umber ofr< .. � . ,. :�- R� ,t„iM 'Y . �,�� $ i4i erage d►stance _ �-r h :x.l 1. ...<., ;^za.3�`v„ . �'�� ' Cbtle 4, a. .-ra, r . employees -..a ,.. z„ ,ev v.... dental ofTiees n,.� o. ...M......* :fit Dumber a Pct L MIAMI, FL 33162 20 0 20 100.0 2.1 2.4 33166 11 0 11 100.0 2.4 3.5 � � a �,-� .gin '%. £'"-,::'L:y.i .£Ft,...4'• .3^'._„ ,=f.:'Fti:. �'^:ir- :i's .�.� � � �- ti.�;-- 33168 23 0 �� ':`a`W-^ 23 100.0 �v7 1.2 2.7 ,� ,x 'f,'- �� 5�� 33170 5 0 5 100.0 5.3 ''+!a. 5.3 "': ?.: +YT"�t rat `. 'nF+'S: RTi a372 •^c.s'e`^w'.,. L 17 'Ah. 315 :�Y_^,R.�.'_3,. µ 17 �,;--r',''^:?„'ff. 0 100 0 <_ _x8 33173 32 0 32 100.0 1.3 1.5 sa^ ~t..;,.,•4;...,;,....;,:^i;.;,>,,,...x..,._.:�..�.,,.„;:,.;,;i..�, . , .,,.:� '�aA a :...x.,�F,..,s..L:u,..,,�i:+..:.��:a�• �„ .. -,.�.Ka : 4 .. .0,31,5.. :.. 12 F�O`x 12 100 0 17 2 8 r 33175 29 1 29 100.0 1.7 3:5: ...�`� ..::i3�::.�:.' z. ��m�tm.� �:">....esd�.� �._.<.�.:.,..c °` .� :. ....,w.:m.:. rxc.t .'�,:ts..a�....,._._ ,.w;.*au,..w...,.„,:.x...:�.,..o: .x._,...�« �:• _s.�, c:... ..�.: ._. _ .*� " 33177 .18 9 0.. Q m� 18 , 9 100.0 tlQQ0 4.0 �42 4'.0; 3 33178 33179 16 4 16 100.0.. 0.9 0.9 :'".So '�, .,-f��. & 7 `�=-„a': e%. +x. •FL,- ^'>a::tik »9 `;r..': : ,�.,.'<,; <.c 'e'--yvv5`, i31 :.. :s=Ta� '^�a''';v'F' _. �.,""dA"'�..L�. -kasr: ,a„'-•..�..�?�`--�$,x::'..�_�£ s.�,.�� g�$ ,,"�s�,..a,,.�_� ��':.,..._..::°.i. ',.r�, ..._.. _ a....an' �..: ^„'F, .,,,._ 33181 5 1 5. 100.0 L3 3:6 .i: r F£¢ 3 k12�3y0"�� �1400 32`fi'42 _ ' 33183 19 0 19 100.0 2.0. 2.3 n. 33185 ;21: 0 :21 100.0: 3.9 4.9 � > { '�`' _ ",�'. '�,' �. " 7 w€Fr �s � . '.,'sees � az','�ss,' ' a' :' '7r . r� a ✓"" `,;: : � a 33187: 8.' 0 8 ".'100.0 5.0 5.3 33190 5 . 0 5 1Q0.0 4.9 4.9 '.. 33193 1;6 16n.. 100 0 i= 3A7 r 3 7 ; 33194: 1 0. 700'0 ... 3.8 5.9 ., �196 �4 2.6 5 332422x 2 &�0 � 5100 3F4 s4 33243 1 0 1 100.0 0.3 0.9 ' 0 0.9 "•ttr-«n :�:�„: 'r - �rna�,�r �""'"'"'"�"`. 1 x "�- n� '4 r-,�� � ,, «��«u`< �, ".�"",`....�.x".� � � -� x �s .,�*' � TLBE2.CH;FL� 33140 ' 3 S •,z�-,»y�.`*` .E^ er`.'. w', 33154 6 . 0 : 6 100.0 2.2 4:5 :1 i 0. ' ': F 4 :'� i. f'�x<s6 _ .:. •. �.r ,.:::.va '... ?. ". :W 'a 1. P' k� y{'?:> ,e.., ....., .x ....� 3 . , Access standard: 2 Dental Offices within 15 miles Dental office group: Oral Surgeon Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 18.4 it"'a e.'' ; ^'t•...s'y'y 4`v x�,.e�4rry �.s,x ,;t..�'Ma..� .._ _..�d��� '�.__'.''t���{ `�__,5y�s�..w�..» ��:,'�e �5�4F ".�S3s.�i` s.yy�'3�` y. F'T�, o� Y 1� 1� -'� R'q?< L 1 '., 4 �`•8`*' "L q S '`�a ,, use '.}� 0 2'r �°fivi at �'a5ti P ,Y4 ems,.; mp}loyees Rx�C�z�y .,. ,..�s., ....��P...t,.... `P....... �,�._RTMt•`S;1>_ �'�.i �'?..r.;.>. '.:'�.r,+;#».. ,.x x._ S, �0 5�,nf?}¢� �.3•Y� ..}yO,�sCi ,r�v'� �A�.3>'�a4 ��5.r 'cytt11 k-44���"Qe?�... 1�`�'N �� r .7, a ro, i t ! �'^'s 3.a-f a sx54 ��i ' �a�- �d�' i�' oYr,+'y '.�' y ` •' f f w"`^ h `. u' f '1i '` '*' y i } 'Y ^SA•i>4 »may-3i* 3' ` � Z1P Cale <'. pae 'y 7�-•'. ti �� s t n'. t •'.`*ej�'3^�ar� 5'� . £ � � s �,.""' T}S ,�w ' Total �' -i� „ - m ^2 s snumber' em lovees' �°�" +� raY �� , � k a s x a i' L WY'L.4C� k. r� 4""'c S � ,' � v °�' a✓ - 3� �tai''t^ .eFt hta-%� y9 'a. . mployees'nithr iiCSli'C(i 9CCC3. �, �✓ a e ��� . `�S £ s + � ;v otal -1� » L '� K number of d4.ental offices ''':�i r'.'� .� �,.v� `eR t `i '.��.i 'w s:k Y Number `*�f "�s�""1�, x ,¢ - 'f� *era 3 ,j 1 to den-_, fix . 2 rar es 4Pct1> z M1AMI GARDENS. FL •,"z3�"•' 1-ram' �'y�" .L" MNORTEi MIAMI�BEAGH L OPA LOCKA, FL ""„ �s.'�4'� ts"` ;Y �v; _... .._. � y< .. �' � r 33056 35 4x_ I: 29 r 25 1 5 � � ,� � ' ,.#?,.-_ 1 1 --:., , �- 0 35 T 11 29 25 1 i100 � s � � � s 1 2 _r :�I 1 a1000 5 100.0 " I00 0,., 100.0 ' 100 0 100.0 0 100.0 i00 0 100.0 100.0 0£0 100.0 ` 100:0 1.2 1.5, 1.5 . 2 0' 3.2 2 0.9 ,0 9 � 1.5 ; 2.0 ,111;x 5.4 3 �1 ...�:<.� 1.5 2.8 2.9 2 6 f ,........uo,..- i. 32 1.0 ` 2 0. 1.8 -° 2.0 fib, 5,4 .. 2.5 'rs , 331'6Q 33054 �30�a 33418 34990 33028 �3063 ,.,.�.uv <.. 33068 3307� Y 34953 3?1983x1W 34987 3�414 33411 PALM BEACH GARDENS, FL PALIvI_el:711 I .., y _ems " 0 0 4 1 05 PEMBROKE PINES,FL OI�4PANO`BEACH, FL #x > PORT SAINT LUCIE, FL i+ TF k Y h" S,�. tS15 uUl7ELi INGTON ,FLh 3 'WEST PALM BEACH: FL ���, 1 �..Y���a:.,. ,_,. 0 x^' crvfTq' '5 3 0r 0.. 6� ,��.M,`,.».sue,,: 2 lrt -2 .1 ‘2 �, 5 a 5 ..r;... �:..:� .. �aa�y ?w s ,..�': .` .vs� ..r; r� »,.rr•...'` ,� h'5 ."`,.y.3 e ?` '3-^k'•°f" �,'i .= . ,,..; zdz�.'?.x; . £F;F?: .A'k , r �.,,-...,b: a;t. ° »-i , ..,. ;:..?a a'Y , Access standard: 2 Dental Offices within 15 miles Dental office group: Oral Surgeon Offices Cigna Dental Care Network - City of Miami ZIP Codes not meeting the access standard 19 mnio t� v3.?zi.a'....�„�.. ;£ �7"La ✓' ',d sr'^�'sbE�' P'w.vX. .. X.'R�_U ..u� .'dnS'.. �:" ". � cr.e,1 7..!+. ' ''•e 3J' 'i,j f - ''�4'� =9 F""'�-"��� `• '�z. in 4} ��� 1 � � g `, , , f���" �F, � r..�,.:.Gotle k�� � A ZIPS; . e c 'i Total number of J eropoyees. � � . 1 �c . a .; Erapto ees ro�lthout° dmired°access 'Si. i? _ T 1' t Total � ��number of��, dentaloees h �• 'K'�°" Y,t . C a'f Number,.aP , � � 'Ci ..._�.,,�...ri, -q at F ' Fa Average distance to dental offices KEY LARGO, FL e' ?. t7 NAPLES_FLy__ . �:; '0 '� ..i' 4:°7 l h� 33037 3411"32 34120 3 ., $ 1 0 a'}fiF'ae` 0 0 " 3 2 1 100.0 '`-,,1; 1;00 OBE 100.0 23.4 ..' Pre'{ Yi 33 1 26.8 23.4 5 S E 331 26.8 TOTALS x�£ �a R�z 6 0 6i00 0 27 27 2 , t)? Access standard: 2 Dental Offices within 15 miles Dental office group: Oral Surgeon Offices Accessibility Details Orthodontists Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 20.1 Ki, ��^ " '!.k'-� °+A43< .� C„e�aei" ..tl4N A". if,: L +>bk,:.��.£.4', -;.<�,'s. �f■■ � � v. .:'aa k �,'.,av"'.--, �<,�*��'`�w.:����r>a§,a, .".��k 'a:..,� .:�':,:,..;, ��,. � 1 0! 1Vper` y, Al l1eJ� p•$.3 .y`>h ., �� �i' ��'&. v «z r�,.. T Z� ` ...�. '��, w'a..'.,i .�� �epc L" t� 2.� ;�y �"Ai SF :� o � � � C' ft `Total a 3, .., �..<_..�.��..,,� � � ar `5`<�E42} �1'� 3�,Code � 2�.;,.„i.'., � � e.' l 2 y � y.,?il,�'}` s rahEmploy d�''SP?. ees ..1 Y>7' 01,1:*e access -'"•Y�4 £1 :t number of.i �:cmplo�ees Tbtal < , t r unumber of dentaieoffices' ��s �� A'umbcr��� ,: ,' - Pct� Aterage fl'stance ? o dental off►ces , '���Ic .2 BOYNTON BEACH, FL 33437 33:11a 1 1. 0 ra 1 ,>r 4 .a 100.0 * 1.000 2.1 s 0.4 2.5 6.8 '?> 3.0, 1.9 cOrZP,LGABLES°l.: DANIA, FL ,FORTLERDALEz FL " 33004 33�0]M2 33304 33311 1 2 0 ; ;0a 0 1 u:rw2 2 100.0 1,fl00 100.0 100.0 4.4 N 3 0u.. 1.9 2.4 2 0 2 3.5 ... q' ?".m. sL^. ^'.`ro i' m �'%'§e.: �� ..t. ,. � -�'. ^.�,.: <US..-: w: -`P" E :4:j�£''les xxv..•2�'W7 ry�" R're ,.`,. ."X<a"f SP vztwh � � �r i k HALLANDALE, FL . .... .. 33313 � 33316 ,.�;.., 333.19. 33322.. 1=="P;c'".e 33325 e :"1�- -a3?6µ 33328 M 33 30 33331 � 33332 33334 33009 33012 33014 33015 33016 •"to'� 33018 302 33021 33024 ? 25 ;;o2s: 33026 2 1 : �x.•'o^.+'. `.Afi�- 0 ,�;„ .0 S". 1 .,-3., 2 �'.!.•: 1 i::>r . -~ 1 3'^4ry, �'`E _ e , 2 : >•t•-t".-,�fez�,m".i.'�'y': � 3 '{.?-�,q W:' 6 s 4 11 1 : 2 0.33 100.0 !.l" New 100.0 ,n'�.•�>-... 100.0 100 0 100.0 .,!"€F.»j".,.. 100.0 �. Ti r�.. `100.0 y f '-, 10 0 100.0 3fl0 0 100.0 100.0 100.0 :; 1000 JZ1' Q.Q 100.0 p^" u�> fi • 100.0 1 0.0 0� '100 0 ' 100.0 h : 100.0 .. 1.0 "`r "Yh'.? 4.3 c< 0.8. g 2 i 0.5 ,�<_.�,M -'�. 1 2 � ' 1.0.. 2 :2 2 : 2 1.0 2.2': s 40 2.9 e'„^.sSryrW^r-^..e. 4.3 �:= ^'-:�;s .'.:3.6 7 1;.4 _.7s---' %--; 1 2 <t Z.�: 1.5 .3 2 2.3 ' 23 2.4 2.2 ':::1:2 13 _ ? � 16 A -- 3.2 '>' 2.6 1.4 t ;1.2 �y-.,. _.y.r-.;�;> .-.�� 1 ;,:� - 1 ,-+,^". 2 �4� 3 f✓X"+'.hY:xn Y ''m< 6 4 11 �M 1 2 7�: k �-i`�t`r 2 ?".�'.'J�,a::t Y'':.N :A ""'l`"�'",' 3 it df � 4 0 2 : p 0 : .: 3 : 3 , � �a 0' 0 h s` 2° �+ 0 0 3 - 4` yy 2 15; 18 � � s 32'> 9 V '; 15 18 ,.. : 32, 9 i H., : C" 10 0.8 08 •: a _ '2 0'> 1 4 • ^ 2.9 1.7 . 0.8: x 0.7 % . , � :.._ i'^ �' .y, ^Yi+"T"SG' 93' Y"R 3` 'fi".A' 'a�'�' ",y °Y:3, 'S d, fir.? . TOOD FL �� �, a :; c"" 5 ' 4i ..: "t" x.'+%i € x&'S. G,! ',a ..'`°s 3• `T . M +: r� �° ' 10 7 7 ; 11 7 : 7 `xR`.F r,?s • 11 Access standard: 2 Dental Offices within 15 miles Dental office group: Orthodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 20.2 'Lx ^'. -1.�y 3"5 �,�i 'f, v^T. �' J..IlLLployl.4J ��Ebl � 5.. �' \w'� q'p i ',��,.,@.>S. u4 H li2 d1'.. SL. J'. �14 Z1 cc�� A`• h` h. i":���i�:. �:Y31�., :�....!�s,.x�--`Ss: a,%.:'s. �.. ,��n, ;:.bah ,'&''...�A..��.�, '��..,..'Cvx:�4`x<-n�s. w,`�•so,.+-'.�."�+`�,.�i. xl\ �.���� J Z'3 i6e'�!C•GiFz`:=�`�:x 'w��s�,�f`. 44�}� ��: x r� F.- l '+ e _....,..'i,"'. .'..(r^3 ,{ .:��' e'e�'u"6F+:i� �-s.Lw.:i ra[��. y�"SwSY, 3.'!,S r`• �`'v, �. kY+l3 .' - ' %. 4 ?�" ,y?£ 1 'T` .' 'w4 ,v4R �""''1Gm 1.0' eee')'i �,x �'� .: •?,�'e'k. •��� ,�"^ '+, .x^�.: %;��'`�4$R'zy .i t k �•*, �' � e. ..c ��+*� , i'� ,v,A ., ,«�, eSi d1'CCC (1,�C55��: ." '.-tp p' lo-ry _"�.a pt'R* 2`£F; ,, *ramp , ''•�., _c, .. A�eragedistance ,,� 'numberof Total= bf E Total bnumber'ofK>n3�totlenta(offices 1 f3 g ,+ F i � Citr x §°n„ �.,'rT.�> _. :._�^ , .;,Y,,. 5,_, ...,�. _ a ,� 2__,.h__ -.r3. .,- _ <.�. .,-..,.. d.„„ 4 Code .x�•xax-�. ,.. :+i"o1: }e �r'a. ' S employees ,. xi a, <.a, H n� r' .0 'fit '^S dental offices � ar � r.•..�?ya�e:.x<.:6s7.'u!Y.,tiHOLLYWOOD. z 2 '' 4<Number 1 S`Yp �> .ct :�Tf 1 2 FL 33027 25 .1 25 100.0 1.7 2.2 33029 33084 1 0 1 100.0 1.3 1.3 vas.,:".u:^'.4.. `-a `;"s: F,'.44--_'.._.."4 Y"?Yn".�,.- ___" S'..4.,..'i^;-'e;. "4?�'�'Y:"rT.r';'??%4X%rs x-F -J IOMEST AD FL R rs ,F:=�C{•.-- 33030 33031 -':�+i 2 4444'. i. 1 �r ?Y.�.<-+�n- 0 "yTib£4. :gi4kM�', 1 ..._ 100.0 .m'£Tjh' 6.4 . .^-�` 6.4�,.> 33033 17 . 3 n-v�-ns.,, -.� 't" ., 17 1£ 100.0 1.6 1.6 , 33092 1 0. 1 _ 100.0 4.7 4.9 JUP,TTF.1 . ..�.e...,Px _.x, ..SA ..,s.i�i,,... r�...}S,oz�.., w��....nw•.. A..4.Y. 1«� .,: .+.w ..i,., .��..... .x+..kx a..� S:�+n,5.^o�.�. 'fia��..er, Mx tab i..e,.x..'A.<� .....,.,,. k �u.. ��...o.: ..., ua.,.'i ... .�,A`i.em.... ...e».. ��.... .:. KEY.BISCAYNE, FL 33149 1 0 1 100.0 : 5.6 5:8 4LOXAHATCHEE r.... _..._?.lb"2+.,C,a._1�c�ie.. u...._.".. J".c..._._.�su`� :1.+Y '��3.,'ra^• - -�a. _s�'�z,Ym' c_'iK'Pu�:.eu...•LiC;.xu_�35.._,-- ._.-.._ MIA MI FL 10 33101 10 0 100.0 0.8 .: 1.4 . "x 51'�'�-. % � 37?o 33126 22 0 22 100.0 13 1.8 3 L izs e "a:�:,f--"..;`.ef - ,. -4 . r W �r� , X ,OO 4 .�ES•'A" c�` J . . a �w 33129 33128 : 2 hf �~ 23 0 .`•,'.�'...,..=^r 0 2 23<<100 100.0 . 0 0.7 0<8 1.4 1 4 33130 14 0 : 14 100.0 . 0.5 .. 1.2 • 33132.. 6 0 6 100.0 L0 . -may . 2.1 a,' ,. �q 2` '-e"` t!• �f,?- . �5°'"?i" i 3�11_ Z-xr S r m, 4Q.' . $'7,.�" _ �. ;:�-41_1d00182"1 3"''. r. T„b 33134 : 21 4 21 :. 100.0 0.6 . 1.0 400 33136 22 0 22 100.0 1.4 1.8 33138 26 1 26. ..100.0 1.0 3.7 33143 14 1 : 14 100.0 . 0:7 1.5 te141Q0 0` 1 2 " 213g 33 145 35 0 35 100.0 1.1 15 '.x��� 3o14f4 y x 0 4 000 1Z 23R 33147 47 0 47 100.0 2.5 3.3 ,. .,.<... , .,,.. x &.wf � .k..,... ...:. .:.:.a.� .4�Fa ... :,.ia s bw �3100 ... nu ....rr.., .,,�,.hi. &. do , ....� K.IA. "Y, w.,, . .: ...� . .r resat n• . . _ :.. ., ,.4'u, re"�u.�i'N"&fi Mi ,. C.. .Y.....ar..a �. 33151 1 0 1 . 100.0 2.6 4.0 33156 17 : 6 17 :..100.0 1.5... '..1.8 gg, .331D� 33161 27 0 27 100.0 1.6 2.5 Access standard: 2 Dental Offices within 15 miles Dental office group: Orthodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 20.3 am ra�ni�unc i^3vin h b A N' trY �^- r• ! ��Ai . to .i ` ''a ,£i b h,$M1`N ���� - ���.� � �� � 3� � . Tu' �` � : F.-{'.. 5-. "teF `�'�� € '� T : 24'�. v '-�l.1 � � �� o-J.�'2` {.K` ,� ` ,•. }�p�'^` � k.vii E G '.a�o ;5'a� .SS .s'� �5�+ I�T�,SF��.yy��� Y .C` �,. Ki# "?' S! `"t Y -f T i i4� 6 S'.. ��red P, ai q, .i ., , .Y. Z y 3'S� F�: R. T'i' > ^4 .P l �' � .�`' `�� ��� �`�, a.,wTe. ���� -' t F 4 Sd- �` „�� �'�<� tTC?„ �ei't4• S S'�{ C � � � Total . `� ..5�- y 4g fr ��n� Average dzstanee � h P oumber:of 5number of� r a to dental offices Codes employees dentoloffius, Number Pct. MIAMI, FL 33162 i,-cvv. 20 2 20 . 100.0 0.7 0.8 3365 ... 33166 11 : 2 11 100.0 1.0 2.0 .arm -.,� -'�;�'-W��a-- u�.a.-, ,:..�..-W.:.r�-...�• ,. , w„ .-.�.:f- ; . _.. .�,-,...,�-:-,�, .-.�r:'..�<r= ,xx .. "kYq;z,: r.> <N�e. _"-'' rwR+,.%-�". %,:5,?: ,+E,`'�r:Y¢i _v,S.7.-,..:"C?:-y.- S xy -"?Y� ;_ .'•F... X "' ,��{"?�-<,:... ,"^f i3rt«.. p.hF. -JeE'R ^?; 33168 23 0 23 100.0 2.2 3:4 .' .::.: xc- J.. ,, ._.�:.,�.,: ;:?.. :`_.. -. .S':�? _:.? �, r;:.�: �.�: �: �� .;�" -{^fi.-, _:.rV'•n G. %? . "`Q �_Cl _ .5 ;9' :f:v.tu^.: :P. 331.70 5 0 5 100.0 2.1 3.1 �a 1 r 17 i000 �1 s �6 33173 �33174 32 0 32 100.0 1.3 1.4 e�..w.�m�,ArW e.r �,T,....wvS1,•; aiE w.,:-....3-�.�::��''-- a#_ 4 f ;> Ze SyG Pa'.' dh ' �� . �, �� � -'� �' 33175 29 3 29 .100 0 0 8 1.4 33179 16 1 16 100.0 . 1.4 2.0 33181 5 0 5 100.0 1.8 1.8 ems 33187 8 0 8 100.0 q 33190u 5:. 0 5; . 100.0 ` 2.2 2.8 331.94 2.2 x4 tig �z 7 .i,?'.), 33233 2 0 2 7 00 0 f 9 2.6 z ' '-�', +�� xs„ ` �.:� 4,aar� - d �+t 33243 1 0 1 100,0 ` 0,3 2.0 33255 :. .. 1 0 ::: 1 100 0 1.1 :' 7.2 �3261 1 0 1' 100 0 2 , 2:5 33283 pry €,. i �^' "�,. ; :n �e•^ .5 ��. �""w' r �«° :�" �.�, 5�w,�+d�'.�" ��`�" .`` 6".`�. ��. r � "�,""'"L „ �'I MTAMDBEAGH FLU s 9 z 100 0 .,"" 9 z.2 2.5 Viz,, ?100 0 pig 29 33154 .. 6 • 0 6 100.0 2.2 3.5 :''n .; •, �. .3.. ;?ix ,. , ..;. f .>w,` a.. .:,;'' F,. :,�F,-,u a°a ., :.: 3x, , ., ,.� '.:a:'. -f^c y.�:,.a #x5- .. k�: :T:£-i',3 :wi 8:N, �. °fie>:. . Access standard: 2 Dental Offices within 15 miles Dental office group: Orthodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes meeting the access standard 20.4 R y '5,t-". �� �.{�11 M yt � . . 4 ..M .., i hwf mil' { r,. i -�" '4 �` Y, + kYr' S ti ��„. +eta.'. i'•'1. 'x 2'X� �riT t?"av�}-���S Ssi' �s v. x z{ frA11 4yyp, 4 ai 4'a�'3-:?±- �"��':. X•§`9..-urc-F,.:3.�..m`.e 5�.:":. 3fc� "•� "�,-.S�11a+.i» ` �`Se ii��' 3. �^ qjq. ��. ,' � �1�n �'f �.�'� '����,,\�. 'Y� #„ I� �1�.� ' �''vt'�.q�`�iw m, .{ ' ,i,''i , '}: , ..,.i+. ^.;"' `a S�,' f?,Y •t *�,.,' i'•� y Fytr` is iw x ,! lElmployees �. "r�Z".; 4'". *i ,.,,,. Em to cps, with Y. �� r d n b 4�� f x �des�recl access ; 's ?n fi; L''. 3 : EF - Wig F S say i '"z 4 �'j i Tt31 ,F'• y. j 'e :v- aT tv . M' 1 �, r �' k P Average dist�nee s�x"{.'+ ` Otal *°- wad ,..,. 7z =� r Y Y `*,. r �' ...�, -`,Z1P e.� number of �mPloti,„` ; numberiof? data oce,s � j Nnmber � a .et to{dental of ices . + MIAMI GARDENS, FL 33056 35 4 35 4.,.1 100.0 1.3 1.3 ar , 3, 4"; .. ...s.__ 2 0 ...,..�.a�.,a^...__....�..,_ 123:^'i 34120 . 1 0 1 100.0 14.0 14.1 ,� ;tK+BEAC NORTHM[AMIHp�� 6 3310'`... 11 B. d'R � . •A: � .` 1 1 1000, . 14..xXl,`1 OPA LOCKA, FL 33054 29 0 . 29 100.0 1.6 1.6 305 5 • f 18, d , PALM BEACH GARDENS, FL 33418 1 0 1 100.0 2.3 3.2 /j --rzi .:. F'xv, Y3- ' $ .:, `PAL y .. '` V=(2R'f^'!-:r.ci.:^ "n"£4y. "�'., Frx' F 3 : ,�+,-.:..Yt,`.',??'':%"_ Ivi CTTY L r � 34990 : _ 1Y x._ t. 3 ....._. 7 100r0 PEMBROKE PINES, FL 33028 5 1 5 100:.0 '.� 1.1 1.7 =x' `^ „,, a9 a�.a. Ir i POMPAhiO EAC]L` -y- C-` -°*'R axr a306� �: 2_.,P 1 '2:-. 100 0 - 10 a 2 9 33068 1 0 1 .: 100.0 1:5 2.2 .. :. , �33073� .�__�;.:�.,.� .�1 4 Y�4 ''l ; �..�_t� � 1 1001£ _0 �� 23 � ._. Z3 PORTSAINf: LUCIE, FL , 34953 2 0 2 100.0 3.2 . 7:5 4983 . J 00 9 2 7 34987 :1 0' 1 100.0 7.5 13.0 WELL.INGTON FL a. 3 434 y 7 2 100 0 1 1 1 `4 3 WEST PALM BEACH, FL '33411 • 5 :6 5 : 100.0 2.3 3 2 TOTS x::� 697��137 697 700 0y 1 Access standard: 2 Dental Offices within 15 miles Dental office group: Orthodontist Offices Cigna Dental Care Network - City of Miami ZIP Codes not meeting the access standard 21 L ,'h ..?$ ' "SY .w„C RS':`i 'i 4i' 3,#7 c1 S..f m 4 • *y8S §� .S -�: s"'fJ '�` i All c� ,�' s»K � '. 9 &? fi'S o EmDlrees� ✓ + F 4 `Cotic ������e F 3 w .:,ts-l�st .(', Total umbes r�of gem lovees` � a h 4? ° f ID1110j CES :i1t.�lOnt r l y sd es.iedaecess�v � ��Total�� hum berof dental offices F r Number g Pct� Ai era a distance g Ito dental offices i '2 KEY LARGO. FL 33037 3 0 3 100.0 23.4 23.4 OMS_ s.: Access standard: 2 Dental Offices within 15 miles Dental office group: Orthodontist Offices 595894 d 10/11 know what's important to you _ Regular dental visits may do more than brighten your smile. Research shows receiving regular dental care often catches minor problems before they become major and expensive to treat. Every $1 you spend on preventive dental care could save you $8 to $50 in restorative and emergency treatment.' Review your plan materials to understand how your plan works. We are,here if you have questions or need more information call 1.800.Cigna24 (1.800.244.6224). Take advantage of your plan's preventive care services — most are covered at low cost or no cost to you. Enjoy discounts on health -related products and services with Cigna Healthy Rewards®.3 Get smarter about ways to stay healthy Did you know that healthy gums may: Help reduce the risk of pre -term birth. Pregnant women with chronic gum disease may be more likely to give birth prematurely."5 Lead to a healthier heart. Those with gum disease may be at greater risk for heart disease and stroke.' • Help control blood sugar. One study' found that when diabetic patients' gum infections were treated, it was easier to manage their blood sugar. Studies also show that patients with the following conditions are frequently prone to dry mouth, a condition associated with a higher risk of dental cavities: head and neck cancer radiation, organ transplants and chronic kidney disease. As a result, we've enhanced the Cigna Dental Oral Health Integration Program® to reflect the latest medical and dental research. If you have any of the following medical conditions, you qualify for 100% reimbursement of your out of pocket costs for certain related dental procedures: pregnancy, heart disease, stroke, diabetes, head and neck cancer radiation, organ transplants and chronic kidney disease. There's no additional charge for the Program — if you qualify, you get reimbursed! To learn more, visit myCigna.com or call the number on your ID card or 1.800.Cigna24 (1.800.244.6224). O "oH?,,I„ used to ref:: to product, designs that may differ d„ state of residence of enrollee, including but notlimited to, prepaid alms, r,managed cafe plans and plans with open access features. 2. www.adha.!crg (American Dental Hygienist Association). 3. Healthy Rewards discounts and services are not available in all state: A discount programis NOT the ,`rinsurance,af?o ^vU must pay discounted charge 4. American Dental Association News Releases, Seat. 2001. 5. journal of the American Dental Association:July 2001' ''al Health During Pregnan y: An Analysis of information." • 6 e.my f'Le od a v,ar e; orFeb.200 . American ?SedC ... _:I �"Ja; ,l 'aY 11�, ti,.per;�.�• yl, i il_�,_. 7. journal of thAmerican Dental Association, 0ct.2003. oetworkkGenera) Deiiti ou;require specialty:care(exceptpediatric`:or hodontie) your network.g'eneral:dentist will` :r„yousto a network specialist .. ou:'don't'needacre "You doti`t need a;referral.to'receive care from a network orthodtist (checky our ''Ian ma`terialsy Ito;dtr etermine-if=you: have; or.=thodontic'coverrage). If yourcurrent•dentis'ttisnnttpart=ofthe:DHMO; network we'�e`happyto consider,•recominend:ations for'`�additionstoburnetwork In the meantime you; ustselect;a dentist who:participates„in ttie,'. DHMO=networkfor..cover`edservicesto,a M f?P Y.• ;gat ;K yS '. ";s r `,>: eau SF` i ' < ;, ao•- 3 '„Remember if oureceive`coveredservicesfr`om a dentist who;does, not- participateanrthe.Cigna' D"x t3rr w ,ental;CareiDHMQ_netuvorkyourplan will not`°` pay>except;fn the case"oflanjemergency ou will: receive an;ID'Card,,aPatien't Charge checlules(PCS) and`other;plan materials:.`; ,ftheetimeof service;-youarerespole;for. Ham ��: ems: �.nsib aying the'copayfor:the coveredservices es,' escribed:on your;PCS:' s, , "You' may. change your dental• office forany`reasor Thectiange will:become eifective,the fifst of. S,tit ttie following,month. To make the,change;,visit; myCigna.com or call the: number: on, your ID.carc - • ..kr. . -: ,.`,a �= .ti.51yh3y•3p-:�-.�,.. �, `r" .u. may;`,:.;. „-. or 1.800.Cigna24 (1 80D.244.6224) tospeak wits •a repr"esentative or Fuseour automated', Quick;; =r You can:`get;a second'opinion"bycali ng"„-' N;fz customer service;:they will help you make <ihe=necessary;arrarigements- rr Vo deductibl evel of out7i nsurance kic `.yoi don=t pocket No;dollar_max mums h' .ou don'thaveitosivo_r_r.-y .+:.: ` i ' - '? s rz.�:; Y,rn,-s^:r^" .: z . r.. 4"`, ,�."k .-. about, yourrcove`ra"ge�ruunning.out'fafter,,your<<',,' coverrred'expenses`reach=azcertain dollar`arriount: ^ ;.;yaa-` ..•`nS"'s��-`r,"- 1, Easyt ndei•stand;plane='the fees youµ pa are 'r '�.. x aY`%r�.'i'.`,,,--v�. 3'ac ,, ' �7v'4 h` �` clearly listedVellour PCS: There,are:no claim_kformsto1Ie'andino'waiting eriodsffor coy a' e`zx"' ere arpeno;restrictidnson°preexisting: - rt ..,mil (... II Cigna. na. make sure you read this important information What's covered You can save money on a wide range of services, including: Preventive care — cleanings, fluoride, sealants, bitewing X-rays, full mouth X-rays and more. Basic care — tooth -colored fillings (called resin or composite) and silver -colored fillings (called amalgam). • Major services — crowns; bridges, dentures (including those placed over implants), root canals, oral surgery, extractions, treatment for periodontal (gum) disease and more. Specialty care — many plans include specialty care with an approved referral. Check your plan materials to see how specialty care is handled. • Orthodontic care — some plans include braces for children and adults. Check your plan materials. • General anesthesia — when medically necessary. Age and frequency limitations apply to some covered services. Alternate benefit provisions may apply for covered services if noted on your PCS.9 Review the rest of your enrollment materials for more details. What's not covered* Your dental plan covers services that can help you maintain a healthy mouth and treat or manage dental conditions. But no plan covers everything. Here are some examples of services not covered: Services provided by a non -network dentist without prior approval from Cigna Dental (except emergencies). Replacement of fixed or removable bridges, dentures and orthodontic retainers that are lost, stolen, or damaged due to patient abuse, misuse or neglect. Cosmetic dentistry unless specifically listed on your PCS. Dental implant surgery or services associated with placement, repair, removal or restoration of a dental implant. *This is not a complete list. Fora complete list of services not covered, refer to the rest of your enrollment materials or call 1.800.Cigna24 (1.800.244.6224) if you have questions or need more information. egrster on myCigna com for access to information'.tl Covered services costess than alternative icessuggested the nts` You:,dc 9. �_sends-rti:.esmay�..:lit:aal._rn3ti.�seru.c__, the dentist. procedureofyour choice; hcweve,ifyou choose the cos: higher ocedureouwillc_responsibleCdifference " procedure, for paying the Patient Charge for the tpa red procedure plus da=: ain cost between the dentist's usual charges for the less costly procedure and higher cost procedure. .., :: n a r aregistered serviice [of `e" loano an ri Dena re s� ice marks o� Intellectual Property, ! use by :aservice mark, and t;t "Treeis �a,..lc; Dental" are rt� marts.: ; f Tana n:_ �..tiaj sty, Inc.,n;ict:ised for Cigna Corporation and Its era' subsidiaries. All products services a ovided exclusively hv's such o erating subsidiaries including c � :.,,, and operating _,,..,,,, c... I p c. ut � and t are �r� r .. , . p � Coriatiiut General Life Iny,CignaCorporation. i U na 'Dental re refersfollowing surante Company and Cigna Health and Life Insurance Company, and not by_:�.:- Cigna ..: fe. to he operating f efcTag subsidiarits ,f Cigna Corporation: Connecticut General I?a insurance Company, Cigna Health and Life Insurance Company and Cigna Dental n s e; (a, provided by CignaDental Plan of Arizona, a D n Hea , Ira; a-d it af:rainc �i�sidiaa_. a"� 3'Ili3teS. jl'e ,igna Cenral _�r_ p,u i i�,_r_ IL.0 D, ra. ,:,alti a inc., Cigna H_..h of California,'iInc.,Cigna Dental c. Colorado, Inc., CioaDental Health of Delaware, Inc., G1na Dental Health of Florida,Inc., a Prepaid Limited Health S^rsl";s Organization licensed under _ 3�SJ; Florida`IStatutes, Cigna, Dental Health of Kansas, Inc. (Kansas -1`Nebraska), Cigna 'eL:,: Health :-i Kentucky, Inc.,Cigna Dental of Maryland, _'tiI rt .sey, �t F, _r,tutky; ,n,_ Ci;;;i�: C,:�:al Hea.... ...;z;; la::d, Inc, Cigna Dental Heath p Missouri, Inc.,Ir:cCigna Dental Health of t>t�,:,�,>,. ,.;,Inc., Gana Dental H.aln of fioftNorthCarolina, . Inc., Cigna Dental Health of Ohio,, Inc, Cigna Dental Heap.:: of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental :aal Saes : CCareunderwritten (on:c ol1i Health af'� Virginia, Inc. In tither _tit.. the Cigna Dental play .> und�.,aittrnn by Connecticut General Life Insurance Company, Cigna Health and Life Pa InSUrilnce: ofrpanyCrCir.naHealthi.are ofC nnecti.t �t. and administered ereJvCicra Dental Health, ', Inc.inthIlmodels are used for iu>trty; purposes only. .595894 d 10111 0 2011 Cigna. Some content provided under license. The tools you need for better oral and overall health nowwhat s inportarit to*you Learn more Nothing is more important than your health. That's why there's myCigna.com - your online home for assessment tools, plan management, dental health information and much more. Once you've enrolled in a Cigna dental plan, you can use myCigna.com to: • Choose dentists and create, download and print a personal directory. Verify plan details such as coverage, coinsurance/ copays, and deductibles (the amount you pay before your plan starts to pay). • Print a dental ID card. • Get the forms you need. Access dental health information through WebMD® Dental Health Resource Center. • Estimate your dental costs before your next visit. Get to know your oral health Are you at risk for gum disease? Knowing the answer to this question could help your overall health. That's because research shows an association between gum disease and other health conditions like diabetes, heart disease and stroke. Pregnant women with untreated gum disease may be at an increased risk for delivering preterm and/or low birth weight babies. Think cavities are just for kids? Think again. Many adults have untreated cavities (27% of those 20-39 years, 21% of those 40-59 years, and 1g% of Y those 60 years and older).' And tooth decay (cavities) is the single most common chronic childhood disease - it's five times more common than asthma and seven times more common than hay fever.2 Assess your risks The Periodontal (gum) Disease and Cavity Risk Assessment Tools are designed to help you and your dentist identify factors that might increase your risks for gum disease and cavities. The quizzes are quick and easy. The Periodontal Disease Risk Assessment is just 20 questions. The Cavity Risk Assessment is just 12 questions for adults and 16 questions for children under age 12. And when you complete the quizzes, you'll get detailed score sheets that tell you whether you are low risk, low to moderate, moderate risk or high risk for gum disease or tooth decay, depending on which quiz you've taken. Take the quizzes today and share the results with your dentist at your next dental checkup. Please note that these tools serve as a guideline to assess your risks for cavities and gum disease. It's important to visit your dentist on a regular basis to discuss your oral health. dip JO a(z. Ce•n 592684 h 071]2 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Prevention is key Regular dental visits may do more than brighten your smile. Research shows receiving regular dental care often catches minor problems before they become major and expensive to treat. Every dollar you spend on preventive dental care could save you $8 to $50 in restorative and emergency treatment.' Practice prevention and take advantage of your plan's preventive care services - most are covered at low cost or no cost to you when you visit a network dentist. Covered services may include, but are not limited to: Oral exams Cleanings Fluoride treatments X-rays Oral cancer screening We're here when you need us We know that sometimes you need us at odd hours - late at night, on the weekend or during a national holiday. Sometimes your questions just can't wait for "normal business hours." "My son is away at college. Can you help me find a network dentist close to his school?" "My dentist told me I need a root canal. Does my dental plan cover this?" • "My husband has a painful toothache, but he's in Phoenix on a business trip. Can you help me find a dentist?" That's why our Customer Service hours include weekdays, Saturdays, Sundays and holidays. Call us at 1.80o.Cigna24 any time you need us - we'll be there. We're on the clock for you 24 hours a day, 7 days a week, 365 days a year. Health and wellness discounts Save money when you purchase health and wellness products and services through the Cigna Healthy Rewards° program.' Programs include: Weight and nutrition management Fitness Tobacco cessation Vision and hearing care Vitamins, health and wellness products Altemative medicine • Anti -cavity products - Healthy lifestyle products 1. v?.cdcgov!ora health/ acts'iee side italiaries 2. _Surgeon General's Report. on Oral Health in America z. www.adha.org (American Dental Hygienist Association). ' Some Healthy Rewards programs are not available in i states. if your Cigna plan includes coverage for any oath^ e services,this ' g1 .I s� �_, program Is In addition to, !lot instead of, your plan coverage. A discount program is NOT insurance, and you must pay the emit°' discounted charge. Cif:gin "Cigna," "Cigna Dental Plan" and Healthy Rewards are registered service marks, and the ''free of Life' logo, 'GO YOU" and are service marls. of Cigna intellectual Property, Irlicensed for .r use by Cigna Corporation and its operating subsidiaries. �l productsuc : and services are provided exclusively by surf? operating subsidiaries, .a.ie: , including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna lealttCare of Connecticut,Inc., and Cigna Dental Health, Inc. and its subsidiaries, and not by Cigna Corporation. All models are used for illustrative purposes only. - r1, 592684t i:;.'2 . ��;_Cgra.Somecontent preyideuunder licens:. The tools you need for better oral and overall health Learn more Nothing is more important than your health. That's why there's myCigna.com - your online home for assessment tools, plan management, dental health information and much more. Once you've enrolled in a Cigna dental plan, you can use myCigna.com to: Choose dentists and create, download and print a personal directory. Verify plan details such as coverage, coinsurance/ copays, and deductibles (the amount you pay before your plan starts to pay). • Print a dental ID card. • Get the forms you need. Access dental health information through WebMD® Dental Health Resource Center. Estimate your dental costs before your next visit. Get to know your oral health Are you at risk for gum disease? Knowing the answer to this question could help your overall health. That's because research shows an association between gum disease and other health conditions like diabetes, heart disease and stroke. Pregnant women with untreated gum disease may be at an increased risk for delivering preterm and/or low birth weight babies. Think cavities are just for kids? Think again. Many adults have untreated cavities (27% of those 20-39 years, 21% of those 40-59 years, and 19% of Y those 6o years and older).' And tooth decay (cavities) is the single most common chronic childhood disease - it's five times more common than asthma and seven times more common than hay fever.' Assess your risks The Periodontal (gum) Disease and Cavity Risk Assessment Tools are designed to help you and your dentist identify factors that might increase your risks for gum disease and cavities. The quizzes are quick and easy. The Periodontal Disease Risk Assessment is just 20 questions. The Cavity Risk Assessment is just 32 questions for adults and 2.6 questions for children under age i2. And when you complete the quizzes, you'll get detailed score sheets that tell you whether you are low risk, low to moderate, moderate risk or high risk for gum disease or tooth decay, depending on which quiz you've taken. Take the quizzes today and share the results with your dentist at your next dental checkup. Please note that these tools serve as a guideline to assess your risks for cavities and gum disease. It's important to .visit your dentist on a regular basis to discuss your oral health. o� O'er ®cz6Edm n.)0(.1" Ci nay. 5926i4 h 7/ 2 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Prevention is key Regular dental visits may do more than brighten your smile. Research shows receiving regular dental care often catches minor problems before they become major and expensive to treat. Every dollar you spend on preventive dental care could save you $8 to $50 in restorative and emergency treatment 3 Practice prevention and take advantage of your plan's preventive care services - most are covered at low cost or no cost to you when you visit a network dentist. Covered services may include, but are not limited to: Oral exams Cleanings Fluoride treatments X-rays Oral cancer screening We're here when you need us We know that sometimes you need us at odd hours - late at night, on the weekend or during a national holiday. Sometimes your questions just can't wait for "normal business hours." "My son is away at college. Can you help me find a network dentist close to his school?" "My dentist told me I need a root canal. Does my dental plan cover this7" • "My husband has a painful toothache, but he's in Phoenix on a business trip. Can you help me find a dentist?" That's why our Customer Service hours include weekdays, Saturdays, Sundays and holidays. Call us at 1.800.Cigna24 any time you need us - we'll be there. We're on the clock for you 24 hours a day, 7 days a week, 365 days a year. Health and wellness discounts Save money when you purchase health and wellness products and services through the Cigna Healthy Rewards° program.4 Programs include: Weight and nutrition management Fitness Tobacco cessation Vision and hearing care Vitamins, health and wellness products Alternative medicine Anti -cavity products Healthy lifestyle products 1. ,;'w':.cdc.Gov oraIhealt"actsheets%dental caries 2. Surgeon Genera's Report 011 Ural Health in America _. ^;w.ad^a.ora (Art erican Dental Hygienist Association). 4. Some. Healthy Rewards programs are not available in all stases. if your Cigna plan includes coverage for any of these services, This program is in addition to, not instead or, your plan Coverage. A discount program is NOT Insurance; and you must pay the entire discounted charge. • 1 6n "Cigna, —Cigna Dental :elan" and Healthy y Rewards are registered se"`Ice marks, and the 'Tree of Life" logo, ''GO YOU" and are service marks, of Cigna intellectual Inc.,licensed .y Cigna operating C bsic : products ?e p provided ex , operating ; Property, ....1.�..Ls..d 1Gr UST. by ...gna Corporation and its G,...:a.:nt: _u.,.J,l�aTies. All ,.rit7 services art: T;:J......1 exclusively ��y such ; ,:a.nQ sUCSlija'I:^s, including ConnercrGeneral Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Healfhiare of C cnne:ticu, Inc., arid Cigna Dental Health, Inc. and its subsidiaries, and: not by Cigna Corporation. All models are used for illustrative purposes only. 592684 h 07/12 012 Cigna. Some content provided under license. - Veit 04. GonnediciVenerat, .rowew asviKancetwortipany-a„-900,ttottage, ove, oa Fs, e Cigna. 817026 e 09r1 (DPP)) Gt‘,16000 F.i.1288 gular dental;visitshmaydo`more tl%ari brigfiferi yo „-:gin-:� _ .. :� ._..���� n Ie.Rese ch showsreceivingrregularr dental care ten. catches minorproblems�before'they become° ajorarid:expensive to=treat ; on preventive dental-care:could inestorative aid emergency 4nd researcti`also shows.a link'between per odontal; disease` calied'gum disease and.ott er condittions, uch,as pr`e ,termrbirtf heartdiseaseetroker.diabetes iridFother health ssues.3So=,a:healttuer,moutli ran iceprevention and-takeadva itage Ian's- preventivecare,servicesarzostan costorno,,cost,to:you. se'lmyCgna.corn or ca iat yo illus at 4'8QO r ` >' ut}wkram, need to know a ouf yours timate your;dental."care;costsand mea sk forcavities and gum.diseaserwitfiea: Enjoy discounts on health;relatedprodu and services,through`CignaEHealthyRewaids+ The.Cigri`a Dental,,Oral Healt}iAnte ratioryProgr'a offers<enhanced dental coverageandrrniorehr for=dentalcustomeisrwith,anyof=tFiefollawin medical conditions diabetes,'heari diseasesro maternity,tiead ancl,,neckcancer raon,Arga transplant. ,and'chrronic=kidney:disease Theres,r additional chargeifor,tfeFpr'ograria `5ttiosewh`o qualifyget reimbursed OQ•perrrcent-ofcvthsrztan for;.certain°related:deental proceduresx n i are" eiiyi6le or Ot er4erks! s t understand your Cigna Dental PPO How your plan works Whether you choose a dentist in the Cigna Dental Radius Network® or outside the network, your coverage includes a wide range of eligible services after you satisfy any waiting period and meet your deductible: Preventive care (cleanings, X-rays and more) Basic care (fillings, basic restorative work) Major services (bridges, crowns, root canals and more) Orthodontics (some plans may include orthodontic coverage for children and adults) And there is more: Some diagnostic and preventive care procedures are covered at no cost or low cost to you. For other services, you will usually pay a percentage of the cost — or coinsurance amount — to the dentist at the time of service. You don't need an ID card to receive dental care. • If you visit a dentist or specialist for a second opinion, we will reimburse you according to your plan coverage. • You don't need to select a primary care dentist. You don't need a referral to receive care from a specialist. Select a dentist or specialist from the Radius Network Pay less for covered services because the dentists in the Radius Network have agreed to offer our customers services at lower negotiated rates. You may save on out-of-pocket costs for many services not covered under your plan. Dentists in the Radius Network have agreed to offer our customers discounted fees for all procedures on their fee schedule.' Dentists in the Radius Network will submit claims for you. All dentists in the Radius Network have been screened through a process modeled after the highest national quality standards and we repeat the process every three years. Select any dentist or specialist • Your out-of-pocket expenses will generally be higher because out -of -network dentists have not agreed to offer Cigna plan customers negotiated rates. • Depending on your plan design, out - of -network dentists may bill you for the difference between the payment they receive from Cigna Dental and their usual fees. You may also have to file your own claims. Please refer to your Summary of Benefits for specific plan details and any age and frequency limitations, including out -of - network coverage and a complete list of exclusions and limitations. Save more with in -network care 90 )0(0 9 plan to enroll today Follow these simple steps • Review your plan materials • Complete and sign the enrollment form and return it to your employer If your employer has a different process, follow those instructions. After you enroll Register for myCigna.com and dick the link to view your personalized dental plan information • Print an I.D. card • Search for claims The Cigna Dental :_ . 3U, underwritten r, administered byConnecticut General Li I. rl, vica Dental it .. .: .r. management ,i t ...;�, a��idQ�':.,.....it:.._ provided Cigna ..lain. Inc..,an referred to as the :ign a Dental Choice. Pith!. 2. r,.,..dha.u.c (American ,r_61yy'a„ht Association) 3. American Dental Association, Science in the News 7-20 ICI Sornc Healthy Rewards programs -: 1 states. I. tin` ;fuis ea: .rCi"Ci :^.u4_rdge,discount program is .:;..;n.,and youma�: __entire discounted charge. 5. i. ruf1tS MI non -covered ervir._, may not be in all states Access easy -to -use tools to learn more about your oral health Enjoy discounts on a variety of health and wellness products and services Find a dentist in the Cigna Dental Radius Network® or call 1.800.Cigna24 (1.800.244.6224) ce-. mpa Cigna Health and Life insurance Co. certain apes. subbdiar ea. in Texas, the Dental PPO nrt. :Tier plan includes coverage wt any of Mese serviCeS, this bKigTaiTI is in add i- `'iona° - .. a e. service' iC ` . ' ,. of Life :i' :,n Dental' re. s of i r. eye. Prop . U c iP:,.�i � �,: d ; and t is c .;.� � � .: are ,_rrlc is a d �J3 ' .v,. :,, i"c., .!�E^�?:�'Ci �i>" by stibsidiariesA prockicAces are provided '.,,.._ r anoperating >.. b>id:a: sjricitici avmeclicul :�.-...-..2: ::t;>: lEf: ;:-: .1 i:. ., �.]! Ir n,.. �, is iZ. - v�.:�:....: : 1. !.. - 1". ilk' �: : rFt � . _ ('._:a�l.. ,._ ;}, �It: .:'liar..: c... �:.� .!'SJ:"a^�..,, i�':d Picai......� _ �...,:'11,,.iiCUi; f?�., d:'� �.1�!ia ;,�..i,.i f:''"" !1C ai:,, .,_ suNdiarie�,c riot by Cigiv mode:,modeisxe u.,e:::..,::ill:,.ive yiii::V,..." .. 1 , f 24 e . , © I i qna. sine went J! `ind I ense. Ayenta Estimate and plan your dental care costs. You can estimate and plan for your dental care costs using Treatment Cost Estimator on myCIGNA.com. This user friendly web -based tool allows you to get dental estimates based on your specific plan design and geographic location. This tool is flexible, enabling you to get estimates at a procedure or treatment level. A treatment level estimate is usually more accurate because it represents a group of procedures used to treat or resolve a specific dental condition or disease. This gives you a better understanding of what you may pay when you visit the dentist. With the Treatment Cost Estimator tool, you can: • Estimate the approximate cost of treatment prior to the actual treatment. • Compare the financial impact if you visit an in -network vs. an out -of -network dentist. • Understand how much money you are saving as a result of your plan membership. • Search by key words, procedure codes, treatments, dental categories and much more. Access the dental glossary where you can find descriptions of key dental terms. View (DPPO and Dental Indemnity) your specific plan information such as annual maximums, annual deductibles, and much more. G View (DHMO) your specific plan information such as Patient Charge Schedule, age and frequency limitations, and much more. Our Treatment Cost Estimator makes it easier and more convenient for you and your family to learn about your oral health, dental benefits, and the costs associated with receiving dental care. !A<Dental refens ti o-_ra...:s:':s..-:I;h!:,,!C:....orpoI?:;o..,o:....:-:t.en:•_....nu:..,-_. .:,, Dental Health, .n:a;...-.inc., .- ..��.a. ,..n.,. affiliates. The _..,, Dental Care plan ...::<.,h.lr>-,'ri....::t:....,t -..�I ,..:�w:...,.i,.lr_Inc.,iI{"a '3L: ..!!r of Colorado.Inc.. Health, ....:.::. ... Dental Health.::,,::,rr�;t':Health , Organization u:,,...=I .., :a�� �idi.l.i `!' - Dental L. r: a!:_ 3 Kansas,.. __. _, ._L.ska), CIGNA !J:.I:I Health_ !;•r anilMarviarld, iniL, CIGNAE.ri_. .cii3� ;vs; ,i��:,CIGNA Denrai c&- New Jersey, Inc.,•.nl:.::Dental Health cif North Carolina, Ifl°,., .r ..:...+:tiio: 'dealt of Ohio,:'}:., CIGNA Dental Health of Pennsylvania, . ';j:'1. Dental Health of Texas, inc., an„; CIGN Dental Heal: •, Virginia,:,, other the ` -underwritten- -' _ I .., ;, .. .. '�!ir'= 3i'ir ..ate. i'� . ..r.i:5:: i:;.:l;G.. r:.4::.3 '-. , ...13r. , Inc. r.. .....,: �.�.......:. �i.,.,.. Dental �.. „i.?.ri �.. Connecticut i.t!t :.� ... � i_��� (:ilr. ... ... �;j:` .. .. v...,.... !'. ..Ii,.nir__...}. Inc.and admiilisiered ,; :.I.u Dental SIGC:f', :..! The term ,.L.: t.> i.used J ::o p:':fr. designs tiLat may .�.,e:.e.r; n .enrollee, ,rhlvi'fnbur nor i'rriired to prepaid plans, marnidei,.. plans, and plans ;I:'J�:IL..n]>:C::re ,. The CIGNA Dente! PPO is unde.rmitteri andfor arinlinisrer Connecticut General Life Insurance Company Dent !Heal,., Inc.or r:-..:.:Lonisien.. e.:,;;,,•, '!?�',,,; "rler:` - In Texas, i:h;! Denial's ilei:.?;i-...i.'e:i ':ir:; nl..;,: .0 .I.�. ,.,L;, ,J ., r.51..1. ",•r:':i:d F ..>.d. SI(�,., ..,....,..::.i''�. ril �::?�,ic ;... I' ..,......:..... ........hJrl13.: , .:i:: : 'its For .. .. . ,. .. ? known as ;rJ Dental Cat if al./097 For eligible Cigna Dental customers. The Cigna Dental Oral Health Integration Program was first to enhance dental coverage for people with diabetes, heart disease and for pregnant women - because research shows that oral health may have an impact on overall health. And as the associations between oral and overall health continue to grow, so does our program. We've added certain procedures for specialized dental needs at no additional cost to you - and other perks too! 830527 09; i More coverage — medical conditions associated with oral health Cigna Dental continues to follow current clinical research indicating associations between oral health and medical conditions. As a result, we've enhanced our Program to Maternity reflect the latest medical and dental research. If you have any of the medical conditions below, you qualify for 100 percent reimbursement of your copays or coinsurance for certain related dental procedures. There's no additional charge for the Program — if you qualify, you get reimbursed!* One study showed that pregnant women with untreated chronic gum disease during the second trimester were up to eight times more likely to give birth prematurely.' Stroke NEW! & Cardiovascular Disease 80 million, or one in three, adults in the U.S. have cardiovascular disease. Those with gum disease may be at greater risk for heart disease and stroke.' Diabetes Gum disease can be a risk factor for complications of diabetes, and it can also put diabetics at a higher risk for additional gum problems.' Some studies show that gum disease may also make it more difficult for diabetics to control their blood sugar.4 Head and Neck Cancer Radiation NEW! Head and neck radiation can harm normal cells, including cells in the mouth such as the soft, moist lining of your mouth, jaw bones, and glands that make saliva.The radiation could cause the mouth to be dry which in turn could cause increased risk for tooth decay and gum disease.' Organ Transplants NEW! Organ transplant patients need specialized dental care.The compromised health - and immune system of transplant patients could place them at increased risk for systemic as well as oral infections, including tooth decay and gum disease.' Chronic Kidney Disease NEW! Researchers found that subjects with gum disease and those with missing teeth were nearly twice as likely to have chronic kidney disease compared with those without these risk factors. Patients with acute kidney disease may also have an increased risk of tooth decay because of a dry mouth' .ie d'cal .' doe:, not an :. journal of the American DertiiAssociation,J?� _.0."Orali.,During rC�"a" An Analysis of.p.Jiaii;r. 2. American Academy Cf: erlcdont&oov. w'!'J.pe`il.;lf'a,'eb. 2002 + American Academy of Penodontolog, April 2006 4. journal oft.:_ American Dental Association,`toter 2003 5. 'Head 'rudiment ivetn C i ::^rl Ie"" i'. �.;:.n.�J�: Ica;::,;:::..::, lvt:; 'r�al:: 'v..:.:,a::ai.. (1 .,.::...t:: and HumSc .:....;'Hal rinu Lae( f F ai.h, ! tior;:a nn[it f ier cal find C,u('lioMc a 3esear% ...Mv 2008 Den, Management < ,..,,, t Pa ea.:... N!a. onal Institute ,. ,,..I::a: .,; ;a,. ;)rya:: rc�`'slida: Patient. National ; institutes Health. National J iDent l and Craniofacial Research. Mid PublicationNo.. ReprintedOctober 2009. ,.i, _ a o: �': University ft er•ecf Medicine. tree - 09 .. f,J;. Y.U:'.:, Cale. Reviewed bv the _. .. �Jlc _. :_.5� ., Dental .;:I ,... sdtlere..e instoward maximum for DPPC 0ideemr!i,' `cr!s More coverage - dental services for customers with associated medical conditions The table below shows covered dental services by medical condition. Covered Dental Services Periodontal Treatment & Maintenance (D4341, D4342, D49101) Periodontal Evaluation (D0180) Oral Evaluation (D01202, D01402, D01502) Cleaning (D11103) Emergency Palliative Treatment (D91104) Fluoride — topical application & varnish (D12035, D12045, D12065) Stroke Maternity Chronic Organ Kidney Transplants Disease.: Head & Necks Cancer Radiation Sealants (D13515) 1. Four times -. On:, additional evaluation. uatio. .'One additional cleaning. 4. No limitations. .:nQ'lints remc+oeo,all riiiei is apply. More savings Your dental care doesn't just happen at the dentist's office. You floss, brush and rinse. But sometimes you need more. When you submit a Reimbursement Form for a covered procedure, we'll give you up to 50 percent off average retail prices on the following prescription dental products through Cigna Home Delivery Pharmacy — no matter who your pharmacy carrier is. These products are specifically made to treat and reduce the risk for gum disease and tooth decay. - Chlorhexidine Prescription Anti -bacterial Rinses • Fluoride Prescription Toothpaste - Fluoride Prescription Rinses • Fluoride Prescription Gel Program participants can also request free samples and discounted non-prescription dental products developed for patients with a higher risk for gum disease and cavities. More wellness Your oral health and your overall well-being are connected. Stress, tobacco use and fear of going the dentist can all negatively impact your oral health. When you submit a Reimbursement Form for a covered procedure, you can choose to get information on how these behavioral conditions can affect your oral and overall health. But more importantly, we'll tell you what you can do to overcome these destructive behaviors. Using the Program is as easy as 1, 2, 3! 1 Simply visit your dentist for the covered service and pay the dentist your usual copay or coinsurance amount for that procedure. 2. Fill out the Reimbursement Form. Be sure to check off any additional information you may want about Cigna Home Delivery Pharmacy discounts and/or behavioral articles. You can find the form on myCigna.com, Cigna.com or by calling 1.800.Cigna24. 3. Mail in your completed form AND required documentation (proof of payment, itemized receipt from dentist, EOB, OR dentists' completed claim form) to Cigna at the address listed on the Reimbursement Form. 006 oe Cigna:, ;....et ,;red; service mark ,he 'free fe ��iCt. ... S�n _. mark, and The .. �. ....:,.. Vtil, a ., "Cigna i:a are service ma..,� .'li..r Y. inc., ... .. I ation and its operating subsidiaries.All .d r lid are ded exclusively by sucn operau .3uosidiaries,Irnnnecticut Life 1 - Company„ Cigna Health and Life insuranceEy lealthEaie Cor• 3nd its subsidiaiies, and ..J: by Cigna Corporation. .:^, iexas, tne (Ana Dental PPO pioduct....L...,....... as the pa De � c ia�l .....,eels are u.... for illustrative purposes ,";iy. 830527 ..., •. 0 2011 CIS:".. Some content provided unde.r license. What is DNSP? The Dental Network Savings Program (DNSP) gives Cigna Dental PPO (DPPO) customers access to dentists who are not part of our network, but have agreed to offer discounts to our customers. Save money when you visit a Dentist or Specialist in the Cigna Dental Network or in the DNSP. You'll always save the most when you choose a dentist who participates in the Cigna Dental network; however, the DNSP lets you get discounts for out -of -network services received from a dentist participating in this cost containment program. Additionally, there is no balance billing for services covered on the DNSP dentists' fee schedule. Below is an illustration of how the DNSP works. ' You can find a Cigna Dental network or DNSP dentist online at Cigna.com or myCigna.com (details on reverse). Remember, you save the most on out-of-pocket costs when you visit a Cigna network dentist. "For illustrative purposes only; Average discount percentage: are calculated by comparing nationwide average contracted rates to national average charge data. Actual savings will varybased upon procedure,geographic location and theindividual dentist's contraaed tees. Y Cigna. .S38312 a 06/12 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Find a DNSP dentist 24 hours a day, 7 days a week! Go to the online directory on Cigna.com You can search the online provider directory on our website. Click "Provider Directory" at the top of the page. • Click "Dentist." Enter your search criteria — location, name, etc. - Selecrout-of-network savings program." Already enrolled? Go to myCigna.com — the easiest way! myCigna automatically knows which Cigna Dental plan and network you belong to. lithe in -network availability is not the best option for you, select the "out -of -network savings program"option to search for dentists in the DNSP. Call us at 1.800.Cigna24 (1.800.244.6224) You can use the automated Dental Office Locator or speak to a customer service representative for help locating a DNSP dentist or specialist. If your dentist is not part of the Cigna Dental network or the DNSP, we encourage you to nominate them for participation. Simply email DentistEnrollment@Cigna.com and provide us with the dentist's contact information.? Cigna 1. "MRC" is "Maximum Reimbursable Charge.' The MRC is the usual charge for a given .orocedure charged by most dentists in a pen area with simiiar training and experience. Cigna collects claim data to determine what is customary in a geographit.diCd [OT each covered procedure, a, id Lies itat average to calculate what yew dental plan will pay when you visit a non -network dentist. Each dentist decides what to charge patients for dental cam. Some dentistswid charge less than the MRC in their area while others will charge more. Whenyou visit a non -network dentist, you are responsible for all charges above what your plan pays, even if that dentist's regular charge is higher than the MRC. 2. Cigna contacts all nominated dentists in an effort to recruit them into the network. However, we cannot guarantee that they will join the network. Please visit myCigna.com or call 1.800.Cigna24 to find out it a dentist you've nominated has joined the network. "Cigna" and "Cigna Dental Plan" are registered service marks, and the ree of Life" logo and "GO YOU" are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by sUCh operating subsdaries, inchiding Connecticut General Life insurance Company, Cigna Health and Life Insurance Company, Cigna flealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, and not by Cigna Corporation. Ali models are used for illustrative purposes only. 838342 a 0711 i) C 2012 Cigna. Some content provided under license. avc a uesti n? Ca=1 us at your convenience ... 24 hours a day, 7 days a week! We're here when you need us. We know being available when you need us is important to you. We don't want to make you wait until "normal business hours"for answers to your dental plan questions. The fact is, sometimes you need usat odd hours — late at night, on the weekend, or during a national holiday. Sometimes your questions just can't wait. • "My son is away at college...Can you help me find a network dentist close to his school ...?" • "My dentist told me I need a root canal. Does my dental plan cover this ...?" • "My husband has a painful toothache, but he's in Phoenix on a business trip. Can you help me find a dentist ...?" That's why we have extended Customer Service hours to include weekdays, Saturdays, Sundays and holidays, 24 hours a day. This change is effective July 24, 2009. This is a natural progression in our expansion of Customer Service availability to you in recent months. We heard you when you asked for 24/7 telephone access to our representatives. At a time when other companies' services are being trimmed to lower costs during the recession, we're delighted to be able to offer you more. It's all about being there when you need us. Thank you for choosing CIGNA! We're an e dock for you, 24/7 ICN: .nd free of Life'loa • are service marks o'.. _,;Ilr_ , Corporation and its opera -,a subsa;;e�, . ,.. products and ;.,_ are provided exclusively by such opei.atings.Js:i;.;jt and not ,I �, �. )€x�+,ating subsidiaries indude t::;tt.:e'.''.e'.i: Life insurance Company, Iel-iDrug; Inc. and its affiliates, CIGNA it-if California,and aSi'ilA DenIal Health, Inc. In Arizona; HMO plans are offered by CIGNA HealchCare of Adzona„ Inc. In California, HMO olans are offered by CIGNA klealtriCare of -d Great-West Healthcare of California, Inc. .:._....n_cu,. ,f,l', Mans are .?e'..,!CIGNA '°a"d'`:n'')rl^ei."'ti3,..M; plans are offered by CEN.; i-lealthCare Mid -Atlantic Inc. In North Carolina, HMO plans are offere,i by CIGNA HP,Iithr...arP. r•ar.r1. !RC Ail medical ..,in these .rareti'. !(�,`'U s administered (,:,:31 LI? ...j u:ii"%;:... (lii;<i n Dear CC One or r continuE that the Use & B may imp For.Busi Receipt To avoid portion o' changes 33130. If you haN days of rE Treasury Finance E invoice Number 1008995 1064896 {CUSTOMER NUMBEF'' 90691. MAILING ADORE CONNECTICt COMPANY TAX DEPART.;: HARTFORD f Qdt Please note that this Business Tax Receip�expires r'15September s the respons bity of effective year listed herein. Ensuring renews y Octobee the business entity. For further information you may ca11: (305) 416-1570 or (305) 416-1918. Favor de tomar nota que este Recibibo de lmpuesto para Negocio se vence el 30 de Septiembre .de ano indicado. Asegurar la renovation para el 1 ro de Octubre es la responsabllidad del negocio. Para mas information puede ilamar al: (305) 416-1570 o (305) 416-1918. Souple pran not ke Resi Enpo you Biznis-sa ap exspire 30 Septan-m ane sa men-m nan lis la. Se responsablite dirijan Biznis sa poul i ennou` I --I e P emie 4 6k o 0 b aop vini. Si ou bezwen plis enfomasiyon sou zafe sa , pay e byen (305) 416-1918. a• ,��; : pu � CONSPICUOUS :•',;:PLACE:; DvaT:,.S;::,;•DOCUMF;,Nf7ll?1,-?'l1;�:..... � , .. -- ; OTHERRADDRESS; OT-',:TRf!.f±fSFERi2ABLE;OR�tVALiD"�AT>r 11N..'.�. ..., ':, N ESS; APPROVED*;,(THEt �FiNANGE^;DEPARTMENT TrY:OF ,MIAMI'449_S:'W 2`9VEG „-kibok,MEAML'FL 33130 HONE(3D5)418-"i918<:, FECTIVE', YE T GENERAL,LI D575_007400034`<'' x ` )i1NEC IC,l1T,GENER;AL: Vl ogo;o;;o:;o:;o;:o;;o;:0:.: ;o:;o:;o;o::;o;;o;;o:;o: .:0::*:**:;0 o;q,;oo;oa;ono;;ob••p•b;o;;eA{eo•�0'oyo;•,b;o roo•;c o ;off A do ;op b ,b• C•3eC•A :e;:o;.o'p:{o ie:toia •� :'ro"o;oto'o: ore•o•^o'^0:06 ^or'.+or'.yr•:p•'p:e: •:e•ip':e .e:e.er•:: •.ONCONe. •.o. •.o .e . ..Rt ....... R......A .. k...... A... A.. R..R...... A.......tt:......9 ..SL.. .....:Cti1k..:�:R•Is ..�k ... � �. . " V.Y. ¢;•t;•Xie':' Ccr.i4MX0 YgieM:0 Te::4:ro' }ti • •*a;°a;•+e� o"e,;o;Q� ;o:ro ;o r ti Y eti ;o •Y •ti Y,•+o;•+o •b; *� • .ti •ti �et,Uftcate of Amity, STATE OF FLORIDA OFFICE OF INSURANCE COMMISSIONER AND TREASURER THIS IS TO CERTIFY THAT: CIGNA.DENTAL HEALTH. OF FLORIDA INC 1525 NW 167.ST/SALES ADMINi/4TH FLOOR MIAMI . FLOR IDA 33169 HAS DULY QUALIFIED PURSUANT TO CHAPTER 636. FLORIDA STATUTES FOR A PREPAID: LIMITED -HEALTH SERVICE. ORGANIZATION CERTIFICATE • OF AUTHORITY AND I5 HEREBY AUTHORIZED TO WRITE THE FOLLOWING .LINE(Si OF•BUSINESS.. 0451 DENTAL . PLANS 06 01 94 10 36 ISSUE DATE TYPE LASS 31• "If*'.41C,X •AY •XIX(i.. ii.N. ;•A:orebr•:oreyord.v:e :fib► :kW: WV . 7:: ' :•'e:f* *A' re:l€i.Ci 45091501 .500a 00 66007 TREASURER APPLICATION TAXES SFEES COMPANY EXPIRATION DATE INSURANQgCOMMISSSIONER : CODE FIRE MARSHAL AA o:e+obo:oro:e.o:o.oro•ovoyo-0,0-i::o ioeio .KR;o:•7pCorAAAio;{ofo:''9'{2{o;•'A:A:oxoA?oA:{o;i4to-•A :o••,b•.0.A .A.A:e;o:•pioy3::c:{9A,Ai;f :0:0Fe;(e:;e(e;•xx:ox.:• AANAA AAieriRiA ieAAi►•A"Ards. ;e:;eAAAA;e;{e;••b;re;;o;{p;e;:o.b;•A•utb:io;{o;;o:rg;o;rp;o;�A;e erme-.- AL00455 AA AA s•� 0y PLEASE RETAIN UPPER PORTION OF THIS. NOTICE FOR YOUR RECORDS BUSINESS TAX R E C'E. I..P T RENEWAL NOTICE Tax Receipt Number: 12-00014786 Business Classification: BUSINESS OFFICE BUSINESS TAX PENALTY Additional Charges. Breakdown ADMIN;FEE ANNUAL FIRE. INSPECTION EXPIRATION DATE: September 30, 2012 Control Number: 0016696 136.69 0.00 50.00000 X 1.00 = 50.00 486.53000 X 1.00 = 486.53 TOTAL'DUEUPON RECEIPT .673.22 A 10% penalty will be assessed on all payments: received after September 30, 2012. If this business: hasclosed, please return this farm and include the date it was closet. m******** xx*** .*.******* 'FIRST >ti 0`TICE ***** ****" IF ALREADY PAID: PLEASE'DISREGARD '#***4- RENEWAL DUE BEFORL OCTO$:ER 01; 2012 PENALTIES APPLICABLE ON OCTOBER 01, 2012 ********* .MAKE CHECKS PAYABLE TO:.CITY OF. SUNRISE PLEASE SUBMIT UPDATED 1NSURANCECERTIFICATE INSURANCE. N/A FOR fOYIE,L ASED OR POSTAL BOXES FOR ASSISTANCE :PLEASE CALL (954) 572-2352 LLIJOC. I I/3U/LU' Couuecticut General Life Insurance Company IGlll (hc+Uwl Slr_el I'llilaitrlhhia, i'.\ i9192-21.4I Cigna I�1II111II���IL1,IrI�J1��1LI1��I���II��1�I�LIr,l l II 1 CITY OF SUNRISE 1607 NW 136TH AVE BLDG B SUNRISE FL- 33323-2835 Please direct any questions to the following attention: Accounts Payable TI.14C Customer Service. 1,877,434.2729 (CPAY) P 49 e 000000? 01 INVOICE NO. ALONG THIS PERFORATIQN ANp DATE VOUCHER NO. DESCRIPTION NET AMOUNT 0016696 2012AU001 0007461212 673.22 CHECK NUMBER CHECK DATE VENDOR NO. VENDOR. NAME TOTAL AMOUNT DJ085248646 y 4, 08/03/2012 L. Tr) RFMCSVF 478998 r'�ECK rr i D ANp TEAR CITY OF SUNRISE -- 673.22 ASH IMMEDIATELY 4. PLEASE RETAIN UPPER PORTION OF THIS NOTICE FORYO.URRECORDS BUSINESS TAX RE•.CEI:PT RENEWAL NOTICE Tax. Receipt Number: 12-00014785 Business Classification BUSINESS OFFICE BUSINESS TAX PENALTY Additional Charges ,Breakdown........... ADMIN.FEE ANNUAL . FIRE INSPECTION COIN OP MACH $.O1-I.00 EXPIRATION DATE: September 30, 2012 Control Number: 0016695 136.69 0.00 50.00000 X 1.00 = 50.00 19545000" X 1.00 = 195.45 5.36000 X 4.00 = 21.44 TOTAL DUE UPON RECEIPT 403.58 A.10% penal,y will he: assessed cited! pay::*nts receiue l after September 30, .2012. If this business has: closed. Please return tlzisform;and include the:date: t was closed ****r ****** FIRST NOTICE 4*;**.,- ,� �* ** I1:.ALIZEADY.PAID PLEASE DISREGARD ***'`* RENEW_ L DUE BEFORE OCTOBER01, 2012 PENALTIES APPLICABLE ON'0CTOBER 0 ., 2012 MAKE CHECKS PAYABLE TO: CITY SUNRISE *********. PLEASE. SUB 1IT U:P,D'ATED.INSURANCE'CERTIFICATE INSURANCE FOR.EIOMVIE BASED.OR. POSTAL BOXES 'FOR ASSISTANCE PLEASE CALL (954) 572=2352 _20 95Ut_::1• LL!!1/Su/LUII Connecticut General Life Insurance Company 161)1 ciicsinut Street Cigna. I'I))L1dclphi , I';\ 19192-2I-11 MIL►,II1►►1111►1►1111Ln1►ILJ11111111►1 l lII IIL►►1 CITY OF SUNRISE 1607 NW 136TH AVE BLDG B SUNRISE FL 33323-2835 Please direct any questions to the following attention: Accounts Payable T1.14C Customer Service 1.877.434.2729 (CPAY) e ye INVOICE NO. l DATE VOUCHER NO. DESCRIPTION NET AMOUNT 0016695 2012AU001 0007461216 403.58 CHECK NUMBER CHECK DATE VENDOR NO. VENDOR NAME TOTAL AMOUNT 0085248645 4, 9 08/03/2012 9 TO REMOVE 478998 CHECK =0t r anin TEAR CITY OF SUNRISE 1,1 A O 403.58 C3 THIS re r�rtmAl ICN ANO CAS1 IMMEDIATELY ". PLEASE RETAIN UPPER .PORTION OF THIS NOTICE FOR YOUR RECORDS BUSINESS TAX RECEIPT RENEWAL NOTICE Tax Receipt Number: 12-00014787 Business Classification: BUSINESS OFFICE EXPIRATION :DATE: September 30, 2012. Control Number: 0016697 BUSINESS TAX 136.69 PENALTY Additional Charges:Breakdown........... ADMIN FEE ANNUAL FIRE INSPECTION 0.00 50.00000 X 1.00 = 50.00 501.08000 X 1.00 = 501.08 TOTAL`DUE UPON RECEIPT 6237.77 A10% penalty will beassessedon all payments received after S'eptem.ber 3(L .2012. Ifthis business has closed please return this form_ and include the date it was closed. **************** ***********4* FIRST: NOTICE "'"'*::IF ALREADY PAID PLEASE DISREGARD **"** RENEWAL DUE BEFORE OCTOBER'01,:2012 PENALTIES APPLICABLE ON OCTOBER 01,;2012 MAKE CHECKS PAYABLE TO: :CITY 'OF SUNRISE PLEASE SUBMIT UPDATED INSURANCE CERTIFICATE INSURANCE N/A FOR BONE BASED OR POSTAL BOXES FOR ASSISTANCE PLEASE CALL (954) :572.2352 C2'56C 11 /30/2011 Connecticut General Life Insurance Company ihoi (.IILSI11111 Street �1I ihidellill l 1, 11:1 I91 `)2-2 P l I Cigna.. (11II111II111II111I{ 101II111I1II11I{ilIll-IIIIII/IIII III1 II111I CITY OF SUNRISE 1607 NH 136TH AVE BLDG B SUNRISE FL 33323-2835 Please direct any questions to the following attention: Accounts Payable T1.14C Customer Service 1.877.434.2729 (CPAY) Page 0000003 01 INVOICE NO. DATE VOUCHER NO. DESCRIPTION NETAMOUNT 0016697 2012AUG01 0007461221 687.77 CHECK NUMBER CHECK DATE VENDOR NO. ' VENDOR NAME TOTAL AMOI !NT 0085248647 --r 08/03/2012 . 478998 •CITY OF SUNRISE 687.77 TO REMOVE C01 CK, FOLD AND TEAR ALONG TfiIS PERFCRATION AND CASK IMMEDIATELY UPS CampusShip: Shipment Label Page 1 of 1 UPS CampusShip: View/Print Label 1. Ensure there are no other shipping or tracking labels attached to your package. . Select the Print button on the print dialog box that appears. Note: If your browser does -not support this function select Print from the File menu to print the label. 2. Fold the printed sheet containing the label at the line so that the entire shipping label is visible. 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FOLD HERE • :s https: /www.carpusship.ups:com/eship/create?ActionOriginPair=default_PrintWindowP... 8/9/2Q12 EXECUTIVE BIOGRAPHY .6, 1)y.:: Cigna • 1571 Sawgrass Corporate Parkway Suite 140 Sunrise, FL 33323 Claudia.Rodrigues©CIGNA.com 954-514-6834 CLAUDIA A. RODRIGUES Implementation Manager Cigna HealthCare, Regional Market Accounts Client Advocacy Team Claudia A. Rodrigues is a Regional Market Implementation Manager based in Sunrise, FL. As an Implementation Manager, Claudia works directly with the Account Sales team as well as the Service Operation's various departments to ensure client satisfaction with the implementation of the products and services of Cigna. Claudia joined the Cigna HealthCare organization in October of 1999 in the role of a Client Strategy Specialist where she assumed overall responsibility for the entire Select Market Book of Business. She then moved on to the Implementation Department where Claudia's primary responsibility is to facilitate the installation of new cases into the Cigna systems in an accurate and timely manner. In addition, she coordinates the intemal revisions needed if major benefit/structure changes and renewals requested by existing clients. She is the primary source of contact with the customer during the implementation process. Prior to joining Cigna, Claudia has worked as Account Manager, Benefits Consultant and Service Representative of a well -recognized Health & Life Insurance company bringing together over 17 years of expertise administering group benefits. Claudia holds a Bachelor's degree in Information Technology from Barry University in Florida. In addition, Claudia is continuing her education through participation in courses to realize her Certified Employee Benefits Specialist (CEBS) and Project Management Profession (PMP) designations. EXECUTIVE BIOGRAPHY na 81 r.849.1689 DAWN APPLEWHITE Senior DHMO Network Development Specialist CIGNA Healthcare Dental Division Dawn L Applewhite is a Senior DHMO Network Development Specialist based in Dallas, TX. As the development specialist Dawn works directly with the National and Regional Account Sales Team to ensure.clients and their.employees have access to the Dental DHMO network throughout the United States via the development and execution of DHMO recruitment. Dawn joined the CIGNA Healthcare organization in March of 1995 in the role of a Provider Relations Manager where she developed and managed the professional relationship of the DHMO networks in So TX. Dawn then moved on to the role of Regional Network Manager where she managed a staff of seven field recruiters and internal provider relations managers who were responsible for the recruitment and retention of DHMO providers within the Central Region which was comprised of seven states. Dawn is a Six Sigma Yellow Belt, with vast experience in the development and execution of DHMO recruitment on a national level as well as client specific recruitment in certain markets. Dawn has strong experience in the strategic planning, financial negotiations, building and maintaining excellent external client relationships. EXECUTIVE BIOGRAPHY n-T 4.`"F-7" Ci m° a 60 Cign Jessica Chavez Client Advocacy Director, FL and Caribbean Education Graduate of the University of Tennessee; Bachelor's Degree in Human Services/Education-1995 Work Experience Client Advocacy Director, Cigna HealthCare, Florida and the Caribbean 2006-Present Implementation Manager, Cigna Healthcare, Southeast Region, 2001-2006 Implementation Consultant, Cigna Healthcare, Mid -South Region, 1999-2001 Jessica has worked in the healthcare industry for 17 years. The past 14 years have been spent with Cigna Healthcare in the Implementation and Service department and with the past six years in a market leadership role. Jessica leads a highly skilled and tenured team with extensive experience working with large multi -site national accounts that work closely with all clients to assist in all levels of service but not limited to; product/plan design, plan installation and updates, eligibility/billing, and all escalated service and claim issues. Jessica has a strong sense of customer focus in the market, works to empower her team enabling them to provide the best possible service to the clients, and organizes cross - functional partnership to realize the best outcomes for the markets. She is committed to developing and maintaining a long-term and mutually beneficial partnership. EXECUTIVE BIOGRAPHY t..,e C• igna:: 7269 Chantilly Court Douglasville, GA 30134 Kim.Walker@CIGNA.corn 770.949.5022 KIMBERLY WALKER Sr. Contract Manager Cigna HealthCare, Dental Division Client Strategy Team Kimberly G. Walker is a Senior Contracting Manager based in Atlanta, GA. As a Contracting Manager, Kimberly works directly with the National and Regional Account Sales team to ensure client's and their employees have access to Dental networks throughout the U.S.,, Kimberly joined the Cigna HealthCare organization in June of 2000 in the role of a Financial Analysis Manager where she assumed overall financial responsibility for the Service Operations located throughout the Southeast region.. She then moved on to the Dental division where Kim's primary responsibility was to oversee provider compensation for the DHMO book of business. Later Kimberly relocated to the Atlanta, GA market as provider contracting manager where she is actively in the marketplace recruiting dentists into Cigna's PPO network.. Kimberly holds a Master's in Business degree in Marketing from the University of Phoenix and is actively pursuing a Master's degree in Informatics. EXECUTIVE BIOGRAPHY y= Liana Charlotte, NC 28277 Susan .Mari un`acigna.eain 704.540.3018 SUSAN MARTIN Client Service Executive CIGNA HealthCare, Customer Advocacy Susan Martin is a Client Service Executive, based in Chattanooga, Tennessee. Within this role, Susan works directly with internal service departments and the Sales team to ensure client satisfaction with the products and services of CIGNA. Her current clients represent multi -site employers with multiple plan options. Susan represents, owns and manages all areas of operational service, as it relates to the successful plan administration of her accounts. Her primary functions include customizing service delivery to meet your needs, researching service inquiries, and negotiating with internal and external partners/customers to resolve highly complex service requests. Susan proactively trends service issues, acts as a key benefit resource expert, monitors on -going processes related to implementation, and develops service plans for continuous improvement. The Client Service Executive incorporates the role of the prior Client Service Partner knowledge and responsibilities, with a new vision of expanding the role into a holistic approach to service and manage the needs of our Customers. This role will take ownership of all operational service related issues, making it easier for our Customers. Susan is a cum laude graduate of Wofford College with a Bachelor of Arts degree in Business Economics. Susan began her career with CIGNA in 1987 as a Benefit Analyst and served in this capacity for three years. From there, Susan served as a Quality Reviewer, Claim Team Leader and Cost Containment Consultant responsible for stop loss re -insurance for the Southeast region. In 1993, Susan was promoted to a Technical Support Manager where she managed quality, training and cost containment functions. In 1993, Susan became a Claim Manager and in 1995, accepted the position of Call Center Manager for National Accounts. Susan joined CIGNA's Customer Advocacy department as a Claim Service Consultant in 1997 responsible for CIGNA's Indemnity and PPO book of business. In 2000, Susan joined the Charlotte Sales team as a Client Strategy Specialist with responsibility for a regional book of business. In 2001, Susan returned to her roots in service operations and accepted a position as a Customer Satisfaction Liaison. In July 2005, she became a Client Service Partner. In July 2008, Susan accepted the Client Service Executive position. EXECUTIVE BIOGRAPHY tit •a g % " C Yesenia Sanchez Senior Client Manager CIGNA Sunrise, FL Yesenia is a Senior Client Manager who joined the CIGNA Florida sales office in August of 2005. She has overall account management responsibility for CIGNA assigned customers including responsibility for persistency results, membership and revenue growth, and the cultivation of customer and producer/broker relationships. Yesenia began her health services career with Neighborhood Health Partnership in 2002. She held several positions within Provider Relations area as a contractor for ancillary and hospital providers. Additionally, she is an Adjunct Professor at Florida International University in the Health Services Department. In specific as an adjunct professor she taught classes in the areas of Epidemiology and Health Service Administration. Yesenia received her Bachelor of Science Degree from the University of Miami and her Masters in Public Health from Florida International University. She is an accomplished author, publishing books in the arena of Health Service. Re ort Pre ared: No. of providers Note: City of Miami (Exhibit 3) CIGNA Dental DHMO & DPPO RADIUS Disruption 9/11/2012 199 145 72.86%y Dental Network Savings Program (DNSP) is Cigna's out of network cost containment program. The Dental Network Savings Program (DNSP) gives Cigna Dental PPO (DPPO) customers access to dentists who are not part of our Radius network, but have agreed to offer discounts to our customers. Additionally, there is no balance billing for services covered on the DNSP dentists' fee schedule. City of Miami (Exhibit 9) CIGNA Dental DHMO & DPPO RADIUS Disruption No. of providers Dental Network Savings Program (DNSP) is Cigna's out of network cost containment program. The Dental Network Savings Program (DNSP) gives Cigna Dental PPO (DPPO) customers access to dentists who are not part of our Radius network, but have agreed to offer discounts to our customers. Additionally, there is no balance billing for services covered on the DNSP dentists' fee schedule Cigna's matched % for participating providers is 94% (444 matched dentists out of 470 in network with MetLife) Cigna's matched % for non -participating providers is 46% (141 matched dentists out of 307 out of network with MetLife). These dentists are part of Cigna's Radius network. GUARDIAN RESPONSE TO THE CITY OF MIAMI, FLORIDA RFP NO. 336312 Employee Benefit Dental Plan GUARDIAN` September 25, 2012 Presented By Shawn Afeld, Senior Account Executive The Guardian Life Insurance Company of America 1511 N. West Shore Boulevard, Suite 600 Tampa, FL 33607 813-472-6110 I shawn_afeld@glic.com DENTAL DISABILITY t LIFE VISION CRITICAL -ILLNESS CANCER ACCIDENT The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025 What You'll Find in this Package TABLE OF CONTENTS PAGE Executive Summary 2 Recommendations for the City 4 Answers to Your Questions (Attachment A) 7 Plan Design, Pricing & Performance Guarantees 42 Attachments: • Attachment B • Certificate of Authority for Florida • Certification Statement • City of Miami Geo Access Report-MDG • City of Miami Geo Access Report-PPO • Dental Claim Experience Report • Disruption Report for City of Miami • Provider Online Search Flyer • Sample Dental Letter • Sample Guardian Anytime Member Flyer • Systems Integration Diagram NOTE: We have received and responded to all updated Addendums as of September 24, 2012. GUARDIAN" 1 Executive Summary It used to be that government jobs were jobs for life. That's no longer the case. More and more public employees are leaving the government for private sector jobs with better pay and benefits. In addition, all public entities face the prospect of providing more constituent services with fewer resources due to budgetary constraints. Guardian offers competitive benefits and solutions that maximize coverage options and ease the City's need to balance its budget. We are an experienced carrier with solid expertise providing employee benefits to city, state and local governments. We are in sync with the unique needs of this market. Our customized solutions can help reduce administrative hassles, maximize your insurance dollars and give your employees the benefits they want. Your Business Issues Guardian understands your industry; more importantly, we understand the City. We recognizethe fact that selecting the right carrier is an important decision. In making that decision, some of the key challenges you're dealing with include the following: Administrative Burdens Waste Time and Energy You and your employees don't want to spend time and energy searching for information, filling out forms, working through complex online systems or tracking down answers. You expect your carrier to make it easy to implement your plan, enroll your employees and answer your questions without a runaround. Insufficient Network Access Causes Dissatisfaction A major obstacle for employees is simply getting to a provider they want. No one wants to learn that their dentist isn't in the network. If employees have to go outside of the network, they may incur higher costs and may change jobs to get the care they need. Rising Costs Challenge Benefits Coverage Every year, employers struggle to adjust their benefits program. They need to manage cost without sacrificing quality and value. In today's fragile economy, we know it's increasingly difficult for the City to find budget dollars to maintain the benefits your employees depend on. Your Business Outcomes Guardian empathizes with your business challenges. We can help the City achieve its employee benefits goals. Here are some outcomes you should consider: Gain Wider Access to Providers You want your employees to be able to go to the providers they want. You also want your plan to feature a large network of providers who accept new patients. These are important factors in choosing a carrier. Guardian constantly evaluates and strengthens its networks, which can increase the City's employees' satisfaction with your benefits plan. We ensure your employees will always have a wide choice of providers as their needs and lifestyles change over time. Manage Benefits Costs The City wants to manage the cost of its benefits program. Guardian helps you achieve that goal in two significant ways. First, we drive efficiency in our internal processes (e.g. claims management, underwriting and billing) to save money that we pass on to our customers. Second, we offer a variety of products and services which you can tailor to create cost-effective plans. GUARDIAN" 2 Executive Summary Achieve Flexible, Affordable Services without Compromising Quality You need a carrier that provides a full -service package of non -medical benefits — tailored to your unique needs. To maximize coverage options and convenience, the City would like the ability to choose from a variety of innovative solutions such as voluntary benefits, employee assistance plans and administrative services -only plans. Your solution should include multi -product discounts with value-added savings. Increase Employee Satisfaction The City has three vital goals for increasing employee satisfaction through competitive benefits packages. You want to retain your existing, valued employees; you want to attract new talented workers; you want to improve the productivity of your entire workforce. Guardian provides quality benefits programs and flexible options.that.drive employee satisfaction and allow you to achieve your organizational goals. Solutions Summary We evaluated the City's current employee benefits, considered your objectives and developed a thoughtful approach to help you accomplish your goals. The next section of our proposal provides more detail about our solutions. GUARDIAN' 3 Recommendations for the City While Guardian offers a full package of non -medical coverage and innovative services, this proposal is designed to meet the City's immediate needs. This customized approach ensures your benefit plans will help drive your productivity and profitability. Our Product Solutions Innovative Dental Benefits We give employers choice and empowers employees to make the right decisions for their dental health needs. In fact, according to 2002-2011 LIMRA/NADP US Group Dental Plans Annual Sales and In -force studies, we offer one of the strongest dental programs in the nation. #1 in total in -force dental cases for of the last 10 years #1 in in -force PPO cases for 9 of. the last 10 years #1 in voluntary in -force premium in 6 of the last 7 years These rankings demonstrate that when people choose Guardian, they stay with Guardian. Some of the primary reasons planholders stay with Guardian are as follows: • Commitment to oral health and wellness: We focus on preventive care with online tools and education that help employees stay healthy. • Easy access to care: We have large networks and constantly recruit new dentists. • Efficient claims management: We pay claims quickly and accurately, with an average turnaround time of two business days. • Flexible plan design: We design our plans to help meet your needs. GUARDIAN` 4 Answers to Your Questions Proposer's Organization, Qualifications, Capabilities & Financial Stability a) Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. Proposer should include. the name of the organization, business phone/fax/email address, contact person and federal tax ID. In 1860, Hugo Wesendonck founded the Germania Life Insurance Company of New York. Within two short years, the company began opening agencies across the country, serving policyowners in Colorado, the Dakotas, New Mexico, and Arizona. Eight years after its founding, Germania expanded to become the first U.S. insurance company to start an agency in Europe. In 1917, Germania changed its name to The Guardian Life Insurance Company of America, and in 1925, Guardian converted from a stock and mutual company to a full mutual company. As such, we have no stockholders or private owners. For over 150 years, Guardian has paid dividends consistently.' Today, Guardian is one of the largest and oldest mutual life insurance companies in the United States and is listed among Fortune magazine's top 300 businesses. We have approximately 5,000 employees in the United States and a network of over 3,000 financial representatives in more than 80 agencies nationwide. Guardian and its subsidiaries are committed to protecting individuals, business owners, and their employees with Life, Disability income, and Dental insurance products, and offer funding vehicles for 401(k) plans, annuities, and other financial products. Guardian operates one of the largest dental networks in the United States, and protects more than seven million employees and their families at 115,000 companies. We have not previously been awarded a contract with the City. Our Federal Tax ID Number is 135123390. The contact person for this proposal is: Shawn Afeld, Senior Account Executive Phone: 813-472-6110 Email: shawn_afeld@glic.com b) Provide a list of all principals, owners or directors. We are a wholly owned mutual company. Deanna M. Mulligan is President and Chief Executive Officer of The Guardian Life Insurance Company of America. She joined Guardian in 2008 as Executive Vice President in charge of the company's Individual Life & Disability business. In this role, she was responsible for developing and leading Guardian's product and business strategy to drive the company's continued growth in individual life and individual GUARDIAN' 5 Answers to Your Questions disability products and markets. She also had oversight of Guardian's Berkshire Life Insurance Company of America subsidiary. c) Provide copy of current license to provide said services in the State of Florida. A copy of our current license in Florida is attached. d) Provide (1) the number of years in existence of Proposer, both nationally and in the Florida market; (2) the current number of employees enrolled in the Proposer's plan, both nationally and in Florida, and (3) the primarymarkets served. Also, discuss specifically Proposer's involvement in providing dental care benefits, particularly in the South Florida market. We have been providing dental benefits, both nationwide and in the Florida market for over 50 years. Guardian has 66,740 inforce dental cases nationwide, of which 4,886 are in Florida. We do business in all 50 states, with a primary market served in the greater New York City area, but also a very strong presence in South Florida. d) Disclose whether broker's fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same. This is not applicable as the proposal is quoted on a no -commission basis. e) Provide the current number of employees of Proposer; its depth and experience, and number and job classifications of employees anticipated to be assigned to the City's account, particularly in Miami -Dade and Broward Counties, including the overall qualifications of assigned staff particularly its experience with dental benefit administration in Florida. Include discussion of employees' diversity and ability of speaking more than one language. We currently have over 5,000 full time employees, and have been providing dental benefits for over 50 years. Our process is to denote specific resource assignment after the dale of the account. Detailed information and backgrounds for other proposal team members appears in the Account Management sections, as requested in questions one and two. Guardian has not collected data for the number of employees who are bi-lingual. However, In order to accommodate all callers to Guardian's customer service hotline, Guardian employs Spanish-speaking representatives. GUARDIAN` 6 Answers to Your Questions In the event that these staff members are unavailable, or that the caller speaks a language other than Spanish, we offer over 150 foreign language translations through AT&T's Language Line. g) Provide a list of 2 clients of equivalent size who, for whatever reason, discontinued to use Proposer's services within the past year, and indicate the reasons for the same. Include contact name and number, as well as two current clients. The City reserves the right to contact any reference as part of the evaluation process. Also include your company's total enrollment for 2010 vs. your 2011 enrollment. 1. Kforce Elizabeth Grimes (813) 552-2203 2. Al Contract Staffing - Cindy Fowler (813) 620-1661 3. Boar's Head Provisions - Robbin Haynes (941) 955-0994 4. Moffitt Cancer Center - Lee Ann Corbin (813) 745-7889 5. The Seminole Tribe of Florida - Linda Gorneault (813) 716-8925 Plan Membershi. As of 12/31/2011 As of 12/31/2010 PPO 5,330,958 5,273,266 h) List the subcontractors or sub consultants and include a brief history of their background and experience. We will not subcontractors to provide dental benefits for the City of Miami. GUARDIAN` 7 Answers to Your Questions ATTACHMENT A Questionnaire for Employee Benefit Dental Plan(s) This Questionnaire must be fully completed, in the order stipulated, and returned with Proposal. Failure to answer all questions and provide with Proposal shall deem Proposal non -responsive. Financial Stability and Experience 1. Please provide the full business name of your company, mailing and physical address, telephone and fax number, email address, and web site address. Our company's legal name is The Guardian Life Insurance Company of America. Our Home Office is located at: 7 Hanover Square H-26-E New York, NY 10004 Home Office Phone: 212-598-8000 Sales Representative Phone (Shawn Afeld): 813-472-6110 Fax: 813-472-6090 Email: shawn_afeld@glic.com Website: www.GuardianLife.com 2. Which location would be the primary office to service the City's account and what services will be provided through this office? Our Group Dental Members Service Department is located in Spokane, WA. Hours of operation are from 8:00 a.m. to 8:30 p.m. Eastern Time, Monday through Friday. Services provided through this office include customer service functionalities such as fielding general questions, eligibility, and claim status and benefits information. GUARDIAN" 8 Answers to Your Questions In addition, our Interactive Voice Response Unit (IVRU)—which can give claim status and a faxed verification of benefits —is available 24 hours a day, seven days a week. Our administrative web site, www.GuardianAnytime.com, is also available 24 hours a day, seven days a week for eligibility, benefits information, claim status, and several other self-service functions. 3. Please list other companies with whom you have financial interest (i.e. insurance companies, PPOs, HMO, MGUs, Brokerage operations, etc.). We are a wholly owned mutual company and we own and operate the DentalGuard Preferred PPO Network as well. 4. In the last five years, has your business entity ever been involved in a merger or had a change of ownership? If yes, please describe. We have not had a merger or change of ownership in the last five years. 5. Within the last five years, has your business entity had a change of name, and/or used a d.b.a. or is it operating under an assumed name? No, we have not had a change of name or operated under any other name in the last five years. 6. If an insurance company, what is your current rating with A.M. Best, Moodys, Fitch or Standard & Poor's? All four of the Major rating agencies have affirmed Guardian's very high ratings over the last year, citing our investment performance, capital position, risk management, and operating performance as reasons for their affirmation. Our company was the only major life insurer to be upgraded by two rating agencies in 2008, and our very high ratings also were affirmed in 2009 and 2010, providing evidence of the stable view the ratings agencies have of Guardian. GUARDIAN' • 9 Answers to Your Questions Rating Agency Rating Category A.M. Best A++ Superior Company (the highest of 15 ratings) Moody's Aa2 Excellent Investors (3`d highest of 21 Services ratings) Fitch AA+ Very °d (2 highest of 21 Strong ratings) Standard & AA+ Very Poor's (2nd highest of 20 Strong ratings) 7. Describe any previous or pending lawsuits and/or bankruptcies in the last 7 years. The Guardian Life Insurance Company of America and its subsidiaries do not have any governmental, criminal, or regulatory proceedings pending against it, nor are there any debarments. We are a mutual insurance company established in 1860 and do insurance business in all 50 states. We have never had a governmental, criminal or regulatory proceeding against The Guardian Life Insurance Company of America for fraudulent or wrongful acts. Obviously, as an insurance company we have litigation in the ordinary course of business; however, no pending litigation is germane to this proposal. 8. Have any of the principals in your firm or any of your employees (former or current), ever been indicted or convicted of mishandling/misappropriating any insurance company or client funds? If yes, please provide details. No. None of the principals of our firm and nor any of our employees have not been indicated or convicted of any type of mishandling/misappropriating of any insurance company or client funds. GUARDIAN 10 Answers to Your Questions 9. Describe your current procedures for handling client or insured complaints and State Insurance Department complaints. Any written grievances related to contractual benefits, such as plan limitations and exclusions, are handled by Guardian's claim processing staff in accordance with state regulations. Written grievances involving a claim determination may require professional claim review by a dentist consultant. First, Guardian compiles all claim data necessary for these reviews. Next, the appealed claim is forwarded to a dentist consultant for review. Dental consultants are licensed general dentists or specialists, and adhere to recognized standards of dental practice to determine the appropriateness and necessity of the dental service; the dentist consultant usually completes the claim review within forty-eight (48) hours of receipt of all required documentation. Finally, the claim is returned to Guardian for processing. The majority of the time, a new explanation of benefits (EOB) or letter is processed within four (4.) working days. 10. Has the company (TPA) or its principals ever been adjudged bankrupt? If yes, please explain. No, we have never been adjudged bankrupt. 11. Have you ever been involved in an audit by the Department of Labor (DOL)? If yes, please provide details. No, we have not been audited by the Department of Labor. However, to maintain accuracy, we review claims on both a pre and a post disbursement basis. 1 12. Do you carry a TPA errors & omissions policy? Yes. o If yes, who is the carrier? The carrier is Willis of New York, Inc. o What is the expiration date of the policy? The expiration date of the policy is October 1, 2012 and is renewed annually. o What are the limits of coverage for the policy? The liability limit is $50,000,000. o What is the deductible or self -insured retention? The deductible is $10,000,000. o Is contract a claims made policy or a claims made and reported policy form? The contract is a claims made and reported policy form. GUARDIAN'' 11 Answers to Your Questions 13. Do you carry a comprehensive general liability policy? Yes. • If yes, who is the carrier? The carrier is Willis of New York, Inc. • What is the expiration date of the policy? The expiration date of the policy is October 1, 2012 and is renewed annually. What are the limits of coverage for the policy? The liability limit is $50,000,000. • What is the deductible or self -insured retention? The deductible is $10,000,000. 14. Do you carry a fidelity bond? Yes. • If yes, who is the carrier? The carrier is The Federal Insurance Company. • What is the expiration date of the policy? The expiration date is July 9, 2013. • What are the limits of coverage for the policy? The limit of coverage is $7.5 million. • What is the deductible or self -insured retention? The deductible is $100,000. • What are the total annual aggregate funds handled for all clients? The requested information is not available. 15. Have claims been made against any of the above policies in the past three (3) years? If yes, please provide details. No. 16. Provide a list of 5 references of clients of similar size, preferably in the public sector. Please include contact name and telephone number. 5. Kforce - Elizabeth Grimes (813) 552-2203 6. Al Contract Staffing - Cindy Fowler (813) 620-1661 7. Boar's Head Provisions - Robbin Haynes (941) 955-0994 8. Moffitt Cancer Center - Lee Ann Corbin (813) 745-7889 9. The Seminole Tribe of Florida - Linda Gorneault (813) 716-8925 GUARDIAN` 12 Answers to Your Questions Adequacy of Network and Qualifications of Providers 1. Please provide the Geo Access summaries for employees who fall both within and outside the network. The City would like to use 2 providers in 15 miles as the access standard. Provide this report for General Dentists, Endodontists, Periodontists, Oral Surgeons and Orthodontists. Geo Access reports are attached as requested. 2. Complete the following tables regarding your network with both the number of unique providers and individual office locations separately: Number of Unique Providers County General Ortho Endo Oral/Max Ped Periodontics Miami Dade 858 81 44 53 64 59 Broward 769 51 48 50 61 77 Monroe 9 1 0 2 0 0 Palm Beach 490 50 48 52 45 56 Number of Locations County General Ortho Endo Oral/Max Ped Periodontics Miami Dade 1,123 123 90 90 117 91 Broward 1,242 88 130 121 126 130 Monroe 9 1 0 2 0 0 Palm Beach 1,171 100 167 141 97 128 GUARDIAN' 13 Answers to Your Questions Number of Locations Accepting New Patients County General Ortho Endo Oral/Max Ped Periodontics Miami Dade 1,122 123 72 90 117 90 Broward 1,242 87 130 121 126 129 Monroe 9, 1 0 2 0 0 Palm Beach 1,170 100 167 141 97 126 Please note that we are unable to provide unique (individual office) location counts. However, we are able to provide "provider locations" which are counts of all providers at all locations. In addition, the third table reflects our number of locations accepting new patients instead of just "Providers". We do not track this type of information on specific providers; rather we track on office locations only. We simply do not close a dentist to new patients, only the location in which they practice. 3. How often are provider contracts renegotiated? Dentist participation agreements renew automatically each year. Fee schedules are updated passively, meaning the new schedules are distributed and considered accepted by the dentist unless he or she contacts Guardian to reject the new schedule and terminate participation. 4. Do your contracts include a specific clause which limits the amount of increase? Are there automatic annual increase provisions included in any of your contracts? No, our contract does not include such a clause. Automatic annual increase provisions are not included in any of our contracts. 5. Are you able to service participants/dependents out of the Miami area through your DMO (DHMO) network? How? Yes, our DHMO plan is available throughout Florida (as well as other select states). To ,increase network accessibility, we can develop a targeted recruitment plan for the City of Miami. During GUARDIAN' 14 Answers to Your Questions the implementation process, we would initiate a series of discussions to establish a strategy around the City's network recruiting goals and how we can best work with you to accomplish them. We can also adopt standardized dental recruiting techniques. With the City's permission, we will use its name in a solicitation letter to employees' current dentists. The solicitation letter identifies the incentives of joining the DentalGuard preferred network, and reminds dentists with a patient base from the City that they will need to join the network to retain the patients. Finally, we can provide members with referral cards to nominate their dentists to the network after the plan is written. This card is also included in the printed directories. Upon receiving these completed cards, we will act immediately by sending the dentist a solicitation package that mentions the City of Miami and the referring patient. 6. What is your standard process and advance notification timeframe to notify the City and its members of network changes? Because of the stability of our extensive network, we do not directly notify employees of provider additions or terminations. However, current information is easily accessible to members via our website or toll -free customer service number. 7. Do you have a system formaintaining credentialing information? How often is each provider re-credentialed? Yes, participating dentists are re-credentialed every three years. During re-credentialing, each dentist's dental license, malpractice history and DEA certificate are evaluated. 8. Please list your 2010 and 2011 annual network turnover rates (percentages) for both voluntary and involuntary turnover. Our PPO turnover rate for 2011 was 3.29% and in 2010 it was at 3.34%. GUARDIAN` 15 Answers to Your Questions 9. Enter the percentage of providers that are reimbursed by the following methods in the table below: Method of Reimbursement % Reimbursed by Method Salary 0% Discounted Fee for Service w/Withhold 0% Fee for Service w/Bonus 0% Fee Schedule 100% Capitation 0% Capitation w/Withhold 0% Capitation wBonus 0% Percentage Discount 0% Other, please specify 0% For our PPO product, 100% of our dentists (general and specialists) are reimbursed based on fee schedules. For DHMO, it's capitation without withhold or bonus for generalists, and fee schedules for specialists. 10. Is your plan licensed by the State of Florida? Licensed in what States outside of Florida? Yes, we are licensed in Florida, as well in all 50 states. 11. When physicians are eliminated from the network, what is the timeframe given to allow participants to elect a new dentist? What is done for those that require a transition of care? Under the PPO plan, members are not required to select a primary care dentist, but can see any dentist they choose — in -network or out -of -network -- at any time. When a PPO dentist leaves the network, he or she is required to complete any services started but not completed before his or her termination date under the plan's terms. The PPO plan provides benefits for network and non - GUARDIAN' 16 Answers to Your Questions network services, so the member can choose to continue to see a dentist that has left the network and still receive benefits. Under the NAP plan, the proposed plan provides non -network coverage at the same coinsurance levels as for network services. 12. Can employees nominate their dentist to become a part of your network? Yes, we can provide members with referral cards to nominate their dentists to the network after the plan is written. This card is also included in the printed directories. Upon receiving these completed cards, we will act immediately by sending the dentist a solicitation package that mentions the City of Miami and the referring patient. 13. When is an area considered a network? What is the minimum number of dentists and specialists required necessary to constitute a network? We consider that an area is covered by our network when we have contracted an adequate number of dentists to provide coverage, and in some cases, when the state insurance authority has approved our network. The number of dentists necessary to constitute a network varies widely based on general population density and the number of dentists practicing in the area. 14. If a provider leaves the network and doesn't notify the participant, who is responsible for the claim payment? Participating dentists are not required to notify their patients if they leave the network. We encourage members to verify that their dentist continues to participate in the network at each new visit, as they will be responsible for any charges. For an NAP plan, non -network reimbursement is offered at the same coinsurance levels as network reimbursement, but the member may be responsible for amounts in excess of reasonable and customary charges. 15. How will your company interact with the medical provider on claims that are both medical and dental in nature? If a service is eligible for coverage under the patient's medical plan, he/she should submit the claim to that plan first. Coverage terms under a medical plan are usually as good as or better than those under the dental coverage, and plan maximums are higher. We request documentation of the medical plan's payment or denial from the employee and the provider. After the medical plan has GUARDIAN' 17 Answers to Your Questions made its payment, we consider the charge in a coordination of benefits approach to assure that the member receives as much coverage as possible, without overpaying the incurred charges. 16. Are your network providers prohibited from balance billing the patient for any excess of contracted amount, except for deductibles and coinsurance? Yes, under the terms of their participation agreement, network dentists are prohibited from billing members for any amount other than the deductible, coinsurance or charges for services over the plan maximum applicable to the discounted fee schedule amount. A dentist can also bill for non - covered services up to the fee schedule amount. There are some states that have approved legislation that prohibits Guardian from requiring a contracted dentist to accept Guardian's fee schedule. 17. Are network directories provided on-line? Yes, network directories are available online at www.GuardianAnytime.com. 18. Are printed directories available? At what cost? How often are they updated? We do not provide printed directories. However, directories may be printed from our website at no cost. 19. What is the network access fee? Is this included in the administrative services fee or included in claims, or in other? Please see our pricing exhibits for details on the network access fee. This rate is included in our standard rates. Overall Plan Costs and Discount Arrangements 1. Is a rate/fee guarantee included? For what time period? Yes, our rates are guaranteed for three (3) years. GUARDIAN" 18 Answers to Your Questions 2. If you are proposing a self -insured plan, will you administer run -out? For how long? At what cost? Our proposal is fully insured. 3. Are there any initial set-up fees? No, our rates are all inclusive and there are no additional set-up fees. 4. Confirm you will provide 120 days notice for rate/fee changes. Confirmed. Our standard notification of renewal terms is 60 days prior to the effective date. However, if the City would like more than 60 days notice, we can accommodate this request and arrange for it at the time of implementation. 5. Describe any programs that you have developed to address special areas of focus, in particular, detection of overcharges and overpayments. • How is criteria developed for these programs? • Are outside dentists/consultants retained to review questionable claims? We advise claimants of any overpayments by letter. The claimant then has 30 days to remit full payment or contact Guardian for a repayment schedule. After 30 days, the file is referred to our internal collections area. 6. Please respond to the following with respect to claim overpayments: • If errors that resulted in overpayments to providers were detected in such samples, would our client be able to recover these overpayments directly from your organization? Yes. 19 GUARDIAN` Answers to Your Questions • If not, how would such overpayments be recovered? Not applicable. • How would you keep our client apprised of your efforts to recover overpayments? We provide notification by letter. GUARDIAN' 20 Answers to Your Questions 7. Please complete the following Claims Administration and Member Services chart Plan Sponsor Services Included Additional Cost Amt Drafting of plan documents X Printing /mailing of plan documents to employee homes X Counseling with respect to federal and state regulatory requirements X Initial system set up and administration of plan year revisions X Consultation with respect to benefits and plan design X Financial underwriting for both new business and ongoing revision X Initial and ongoing eligibility and enrollment services X Claims Administration and Member': Service Included .: Additional Cost Amt Toll free telephone access to claim and member services X Cost Containment programs, specify X Claim adjudication X Production and distribution of standard drafts, EOBs X Network Access X Multilingual language line X Coordination of benefits X Member satisfaction surveys X Production and issuance of standard enrollment forms and ID cards to employee homes X- ID cards are printed online for free; not mailed Billing/premium collection X Provision of expected costs for budgeting purposes X Provision of information for 5500 reporting X GUARDIAN 21 Answers to Your Questions Claim fiduciary responsibility Communication/Administrative Materials Included Additional Cost Amt Production and distribution of standard provider directories X — available online Productions of standard claim forms X Production of standard employee communication materials X Shipping of communication materials to employees X Additional -Cost Amt Outgoing wire requests and bank draft handling charge X Bank reconciliation charges Other banking charges, specify Additional Services :Included • in<EPP `' Additional Cost Amt COBRA administration and direct billing HIPPA certification/compliance Internet services DMO Third -Party Administrator Pees Total Fees Employee Not applicable Family Not applicable Fully Insured Premiums DMO Premiums Employee $8.60 Employee + Child $17.20 Employee + Spouse $20.07 GUARDIAN` 22 Answers to Your Questions Family $28.66 Fully Insured Premiums Other Premiums Employee Not applicable Employee + Child Not applicable Employee + Spouse Not applicable Family Not applicable, 9. If you have proposed a self -insured plan, please indicate projected claims: Plan Option Projected Claims Based on Plan Designs DMO Other Not applicable. Our quote is fully insured. 10. Other than those listed on the administrative services chart, are there any other fees or charges that the City would incur if the City accepted your proposal? If so, please indicate here. No, please see our pricing exhibit for full details. 11. Please complete the following in -network Negotiated Fees chart for the designated counties as it applies to the DMO: GUARDIAN"' 23 Answers to Your Questions ADA Code Procedure Description Negotiated Fee (What Patient Pays) Broward County Miami Dade County Palm Beach County Monroe County 0120 Adult Exam no charge no charge no charge no charge 1110 Adult cleaning no charge no charge no charge no charge 2150 Amalgam Restoration $27 $27 $27 $27 7110 Simple Extraction No longer a valid ADA CDT code No longer a valid ADA CDT code No longer a valid ADA CDT code No longer a valid ADA CDT code 3310 Anterior Root Canal $126 $126 $126 $126 ADA Code Procedure Description Negotiated Fee (What Patient Pays) Broward County Miami Dade County Palm Beach County Monroe County 2750 Porcelain/Gold Crown $430 $430 $430 $430 5110 Complete Upper Denture $580 $580 $580 $580 6240 Porcelain/Gold Bridge Abutment $400 $400 $400 $400 6750 Porcelain/Gold Bridge Pontic $430 $430 $430 $430 12. Please attach any corresponding fee schedules that will apply. Fee schedules are attached ' 13. Is more than one fee schedule utilized on a national basis? If so, please explain. No, we use one fee schedule. GUARDIAN' 24 Answers to Your Questions 14. Are you willing to offer the executive plans as standalone plans? At what cost? No, we have not classed out executives. In order to keep pricing fair and consistent, we have based our plan design on the inforce design, with respect to economies of scale. Reporting Capabilities 1. Attach sample copies of your proposed reporting packages. Include proposed reports for financial, claims, utilization, billing, accounting, banking, etc. Samples are attached. 2. What reporting is available on-line? The following reports are accessible online through Guardian Anytime, our online benefits administration web site: • Dental Charges and Payments by Category --Total charges and payments by category; • Dental Charges and Payments by Category by Department/Division--Total charges and payments by category by department or division; • Dental Charges and Payments by Category Summary --Total charges and payments by category summary broken out by employee/spouse/child; • Dental PPO Usage Report by Category --All payments to all providers, including PPO providers by category; • Dental PPO Usage Report by Department/Division--All payments to all providers, including PPO providers by category by department or division; • Dental PPO Usage Report by Category Summary-- All payments to all providers, including PPO Providers by category broken out by employee/spouse/child; • Dental PPO Discount Report by Category --Displays discount for using a PPO provider; • Dental PPO Discount Report by Category by Department/Division--Displays discount for using a PPO provider by department or division; • Dental Savings Report --Displays Dental Review Logic, contract provision, ee schedule and R&C savings; • Dental Savings Report by Department/Division-- Displays Dental Review Logic, contract provision, fee schedule and R&C savings by department/division; GUARDIAN* 25 Answers to Your Questions • Dental Month by Month Summary Report --Total charges and payments including number of claims and patients on a monthly basis; • Number of Dental Services Paid In vs. Out of Network --Total charges and payments including the number of claims and numbers of patients; • Number of Dental Services Paid In vs. Out of Network by Department/Division-- Total charges and payments including the number of claims and numbers of patients by department and division; • Dental Charges and Payments by Type of Service --Total charges and payments by type of service; • Dental Charges and Payments by Type of Service by Department/Division--Total charges and payments by type of service by department or division; • Dental Charges and Payments by Type of Service Summary --Total charges and payments by type of service broken out by employee/spouse/child; • Dental Claim Turnaround Report --Total claim turnaround in calendar days; • Claims Analysis Report-- Dental charges and payments for employees and their covered dependents by level of coverage for alternate funded plans; • Detailed Claims Analysis Report-- Dental charges and payments for employees and their covered dependents by level of coverage for alternate funded plans including the date of service; • Maximum Rollover Renewal Detailed Report --Estimate of each member and dependent reward amounts as of report date; • Maximum Rollover Renewal Summary Report-- Estimate of how many members and dependents would receive reward as of report date; • Employer 45 Day Report-- Actual statement/summary of rewards earned by members and dependents during the previous benefit period. 3. Is on-line reporting accessible to individuals designated by the City (and approved via HIPAA)? Yes. Communications and Enrollment Capabilities 1. Describe your internet capabilities in regards to the following areas: • Customization to City of Miami plan design information - available online • Enrollment - available online • Forms - available online • Change of status - available online GUARDIAN 26 Answers to Your Questions • Employee personal access information (claims, EOBs, dependent information, etc.) available online • Banking — payments are accepted online • Employer/consultant reporting - available online • Comparative dental cost information - available online. • Other Our website allows customers to: • Access & manage benefits • Review benefits • Enroll or make benefit changes • Update contact information • Update dependent's student status • Estimate cost of dental care • Find a doctor, dentist or vision care provider • Check claims status • Receive email alerts when a dental claim has been processed • Print information • Forms and plan materials • Review certificate booklets • Create customized provider directories; and • Access discounts on goods and services, from home office supplies to flowers 2. What communication materials/assistance • are included in your quoted fees/premiums (include materials, staffing and on-line capabilities)? All communication materials and assistance are included in pricing. 3. Can the. City's logo be included on these materials? Is there an additional charge? Yes. There is no additional charge to include the City's logo on these materials. GUARDIAN'' 27 Answers to Your Questions 4. Describe your enrollment options (paper, on-line, recorded media, etc.). We offer four complimentary options for managing enrollment and eligibility information: • Our award -winning benefits administration website, www.GuardianAnytime.com, enables the City to enroll, terminate and update benefits information for employees. The advantages of using Guardian Anytime to manage enrollment and eligibility information include: all updates are fully processed and ready to view online within one to two business days; staff can manage eligibility updates online or allow employees to make their own updates; easy access to history of online activities; and ability to email questions directly to Guardian. • Enrollment and eligibility data can be automatically submitted from the City's data system to Guardian on a regularly scheduled basis. The advantages of using electronic eligibility feeds include: high volumes of changes are sent quickly at one time; all updates are fully processed and ready to view online within one to two business days; a range of formats are supported, and connections can be established within three to four weeks. • The City can submit eligibility and enrollment information in a spreadsheet or census file (in Excel) to Guardian via a secure email. This option is ideal for employers with limited web access or lack of electronic eligibility feeds. When using this method, updates are processed within two to three business days. To help you submit the data, ,we can supply an Excel template specific to your plan. • A final option is to complete paper enrollment forms and mail or fax to Guardian. 5. Describe the communications that are available, and in what format for: • Enrollment To help educate employees about their benefits plans, we provide customized enrollment packages, including detailed plan benefit summaries, during the enrollment period. A sample enrollment package is provided with this response. Traditional summary plan descriptions, however, are not provided. We produce standard certificate booklets for all employees, as well as other administrative documents such as enrollment cards and forms. Employers can access detailed information about their Guardian benefit plans via our fully -automated self -administration website, www.GuardianAnytime.com. GUARDIAN' 28 Answers to Your Questions • Network information Customized provider directories from our network are available online. • Claims information The following claim reports are available on our website. • Dental Claim Turnaround Report -Total claim turnaround in calendar days. • Claims Analysis Report -Dental charges and payments for employees and their covered dependents by level of coverage for alternate funded plans. • Detailed Claims Analysis Report -Dental charges and payments for employees and their covered dependents by level of coverage for alternate funded plans including the date of service. 6. Please attach samples (including ID card) Sample communication materials are attached. To. best meet the needs of today's dynamic workforce, member ID cards for Guardian Dental Plans are available online. Employees covered under these plans can visit www.GuardianAnytime.com to quickly and easily print out an image of their card to bring with them to their first visit with a provider. When visiting a provider, employees simply provide their Group ID number (for dental visits) or unique ID upon their visit. A sample ID card appears below. • AVAX : LA`TX.=AV::: tr•v. `aSux iv* leans.•nc• pvtl.'b y..n...�U„a, `-,Sw.zati au:w+Ve:;. ca-0144.amP+Ves nya: tact a warn..vvar:.asm:pro.nr:.'aoirVvb.,.. Frwa.n y.:naxq . 0wv.WW1V MOM 1Y2 OtoW940a0.stilt.lrwrs a:2 GC.LL3a,. Lr Vemmaxasc.m a.a..uga. Treat," l.WViS1.'PAy8.l. pavan MI ape 6W.F'R. l ama.resal a. r.o.rs vNiw. Cr`u and ianAnytirmcaan. GUARDIAN 29 Answers to Your Questions Claims Administration Capabilities 1. How many months of historical claim data are stored in your claims system? The same information is maintained online for 36 months, before it is stored off-line and filed. 2. How far back in time can claims be processed on your system? We do not have a set limit. 3. Is your system an on-line, direct access system or a plan/claims information storage and retrieval system? Provide a flowchart or brief description of its operation. Our system is a direct access system, not merely an information retrieval system. The following data is maintained by our claim processing system: co -payment levels, co-insurance levels, scheduled benefit amounts (by ADA procedure), managed dental (in- and out- of network), days/visits or other treatment maximums per plan design, accumulators (dollars), individual deductible, annual maximum, orthodontia lifetime maximum, potential COB opportunities, and tooth chart. An operation description and chart is attached as requested. 4. How long has your claims payment system been operational? Our claims payment system has been operational since 1993. 5. Can eligibility and claims transactions be accessed by the same person? No, eligibility and claims information are not accessible by the same person, unless his or her job requires access t such information. Our systems security is a centralized corporate function that requires each system's user to have a personal user ID and password. For each user ID, a security matrix is created assuming role -based access controls, and passwords are changed periodically. Customer service representatives and claims processors s would have access to data provided by the client. GUARDIAN' 30 Answers to Your Questions 6. Describe enhancements made in the last 12 months and those planned for the next 12 months. We continuously modify and enhance our system. We also update the system annually to comply with ADA's routine Current Dental Terminology (CDT) codes system revision. 7. Describe the mechanics/process of screening for duplicate claims. Our claim system is built with duplicate protocol that either identifies a claim as an exact duplicate or as a possible duplicate. The claim approver reviews possible duplicate claims. Exact duplicates are automatically denied by the claims payment system. 8. Can your system accept and track full eligibility data? Yes. We offer four complimentary options for managing enrollment and eligibility information: • Our award -winning benefits administration website, www.GuardianAnvtime.com, enables the City to enroll, terminate and update benefits information for employees. The advantages of using Guardian Anytime to manage enrollment and eligibility information include: all updates are fully processed and ready to view online within one to two business days; staff can manage eligibility updates online or allow employees to make their own updates; easy access to history of online activities; and ability to email questions directly to Guardian. • Enrollment and eligibility data can be automatically submitted from the City's data system to Guardian on a regularly scheduled basis. The advantages of using electronic eligibility feeds include: high volumes of changes are sent quickly at one time; all updates are fully processed and ready to view online within one to two business days; a range of formats are supported, and connections can be established within three to four weeks. • The City can submit eligibility and enrollment information in a spreadsheet or census file (in Excel) to Guardian via a secure email. This option is ideal for employers with limited web access or lack of electronic eligibility feeds. When using this method, updates are processed within two to three business days. To help you submit the data, we can supply an Excel template specific to your plan: GUARDIAN' 31 Answers to Your Questions • A final option is to complete paper enrollment forms and mail or fax to Guardian. 9. Can your system track each dependent by the dependent's name and social security number? Yes, our system can track each dependent by name. Our plans contain unique identification numbers. Because we understand employees' privacy concerns, we don't include Social Security numbers. However, our system can track an individual by this unique identifier number. 10. What is your process for establishing student eligibility? Incapacitated dependent status? When a dependent, whether a student, incapacitated, or otherwise, is nearing the limiting age, we send a letter three months in advance requesting student verification. If the verification is not received, the dependent's termination date is entered as of August 31st of that year. If a dependent is no longer eligible because he/she has graduated from school, this date becomes the date of benefit termination. Our dental coverage will cease if the dependent is no longer a student or verification for that year was not received. If the dependent is the last covered dependent child and verification is not received, our system will drop coverage for that dependent, and the member's coverage is changed from member/dependent to member coverage, or family coverage to member and spouse. Some states do not require student status to continue to a higher dependent age, so in those states, we do not require student status verification. 11. Under what conditions and by which individuals can your claims system be manually overridden? Our claim administration practices are governed by the actual plan of insurance currently in force as well as all applicable state legislation. We abide by these rules first and foremost. Our claim system is built with duplicate protocol that either identifies a claim as an exact duplicate or as a possible duplicate. The claim approver reviews. possible duplicate claims. Exact duplicates are automatically denied by the claims payment system. GUARDIAN' 32 Answers to Your Questions 12. How are manual overrides (if any) to your claims system are reviewed by claims managers? Manual overrides are rarely warranted, as we have built in checks and balances. Our claim system is built with duplicate protocol that either identifies a claim as an exact duplicate or as a possible duplicate. The claim approver reviews possible duplicate claims. Exact duplicates are automatically denied by the claims payment system. 13. What are the minimum requirements for claims history transferred to your system(s) on a new account basis? Upon implementation, we require the completed, signed and dated Master Application and Additional Information Questionnaire covering case set-up and administration issues. We also request final enrollment eligibility information, and any required state or legal forms. Our dental claim submission process is simple and straightforward. The dentist fills out the form and includes all patient, group and provider information, as well as services rendered, dates of service, ADA codes and fees. Then, the dentist signs the form and files it with Guardian on behalf of the insured either electronically or by mail. We process claims for network and non -network services on the same claims payment system. Benefits are automatically calculated based on the network status of the provider at the time the service is rendered. 14. What system platforms are utilized for plan administration? Please describe. We employ an Erisco ClaimFacts system to process indemnity, network access, and PPO claims. In order to support new product options and improve efficiencies for our customers, we continuously modify and enhance the system. We also update the system annually to comply with ADA's routine Current Dental Terminology (CDT) codes system revision. Our claims are batch adjudicated overnight, and are not processed in real time. The following data is maintained by our claim processing system: co -payment levels, co-insurance levels, scheduled benefit amounts (by ADA procedure), managed dental (in- and out- of network), days/visits or other treatment maximums per plan design, accumulators (dollars), individual GUARDIAN' 33 Answers to Your Questions deductible, annual maximum, orthodontia lifetime maximum, potential COB opportunities, and tooth chart. The system is built with duplicate protocol that either identifies a claim as an exact duplicate or as a possible duplicate. The claim approver review possible duplicate claims. Exact duplicates are automatically denied by the claims payment system. 15. Will a direct claims payment system be utilized? Yes. Our billing and claim payment systems work together to provide group and member eligibility information and adjudicate claims accurately. We continually enhance the system to meet clients' needs. We also use a subsystem programmed with all of our dental logic. Both systems allow us to change processing procedures and standards, add new codes, and enhance claim payment abilities. We accept electronically submitted claims from two clearinghouse agencies and use batch processing/adjudication and scanning of submitted claims. 16. How long has the claims payment system been in place? Guardian has used the Erisco ClaimFacts system to process dental claims since 1993. 17. What percentage of claims are automatically adjudicated? Our claim system automatically adjudicates 58.6% of all claims without approver intervention. Approximately 73% of dental claims received electronically are auto -adjudicated (without human intervention). Approximately 60% of Dental claims received by mail are auto adjudicated (without human intervention). GUARDIAN` 34 Answers to Your Questions 18. What are the claims administration standards? Our claim administration standards are as follows: 19. How are non -network and out -of -area provider claims identified and paid? All paper claims from network and non -network dentists are mailed to the same post office box for our Spokane, WA office. Mail is opened on a high-speed extractor and sorted. All mail is imaged and stored within a secure electronic storage platform. Claims are data -entered manually within 24 hours of receipt. We also receive claims electronically from dentists through the Emdeon claims clearinghouse. Once claims are entered into the system, the auto -adjudication program is run and the results are further sorted into two categories: claims processed for payment or denial via auto -adjudication; and claims rejected from auto -adjudication. Pended claims are forwarded to approvers for review and release. Once processed, all claims are held in hard copy form for 45 days and then shredded on site. 20. What are the Eastern Standard Time hours of operation for the claims unit? Our Dental Member Services Unit representatives are available for assistance via a toll -free number from 8:00 a.m. to 8:30 p.m. Eastern Standard Time, Monday through Friday. In addition, our Interactive Voice Response Unit (IVRU)—which provides claim status and a faxed verification of benefits —is available 24 hours a day, seven days a week. Our administrative web site, www.GuardianAnytime.com, is also available 24 hours a day, seven GUARDIAN'. 35 Answers to Your Questions days a week for eligibility, benefits information, claim status, and several other self-service features. 21. How are claims staffing levels established? We do not assign claim approvers to clients. Instead, we use a full -team approach in which all claim approvers can handle all cases in order of receipt. To facilitate this strategy, our claim system contains all of the necessary data to process most claims, including benefit provisions, eligibility, provider data, and allowable fee data for network and non -network dentists. We believe this approach will serve the City in the most efficient and effective manner possible. To evaluate the effectiveness of our staff, we send annual touch point surveys and have consistently scored well. 22. Is there a dedicated claims unit for the City? We will provide a designated claims team for the City. 23. How many bilingual customer service staff members do you have, and what languages do they speak? Guardian has not collected data for the number of employees who are bi-lingual. However, in order to accommodate all callers to Guardian's customer service hotline, Guardian employs Spanish-speaking representatives. In the event that these staff members are unavailable, or that the caller speaks a language other than Spanish, we offer over 150 foreign language translations through AT&T's Language Line, which helps hearing -impaired callers and offers translations of over 150 languages. There is no additional cost for this service. 24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as required to date and for future scheduled compliance. Copies are attached as requested. 36 GUARDIAN" Answers to Your Questions 25. Do you maintain Performance Standards? If so, please describe the metrics and processes used? Is a third party independent auditing company used in the process? Yes, we maintain performance standards for turnaround time, procedural accuracy, and financial accuracy. Our internal audit staff tracks and monitors these standards and reports metrics on a quarterly basis. We do not use the services of an independent auditing company. 97.3% within 15 calendar days Ability to Administer Requested Plan Designs/Alternatives 1. Are you able to administer the dental plan designs as designated in this proposal? We have matched the dental plan design as closely as possible. 2. If not, please indicate the deviations per plan. All deviations must be indicated in your response. Deviations are detailed in our pricing exhibit. GUARDIAN' 37 Answers to Your Questions Account Management Staff 1. Complete the following chart with information on the management and service team you propose for our clients. Role Name Title Percent of Time Commitment to City of Miami Through Implementation After Implementation Account Manager Eddie Aspiro Key Account Manager as much as needed as much as needed Day to Day Liaison Nikki Mauthe Account Service Manager as much as needed as much as needed Implementation Coordinator Jillian Anfuso Implementation Manager as much as needed as much as needed Customer Service Supervisor designated team designated team as much as needed as much as needed Claim Administration Supervisor designated team designated team as much as needed as much as needed Network Management Liaison designated team designated team as much as needed as much as needed Other Senior Account Executive Shawn Afeld as much as needed as much as needed 2. Include the resumes of the above proposed team members. Our policy is not to offer resumes as part of the pre -sale process. However, we do provide biographies as listed below. Getting to Know Your Key Account Manager, Eddie Aspiro Eddie has almost two decades of insurance industry experience. During his 12 years with Guardian, he has worked as a Sales Support Associate, Benefit Advisor, and Client Relationship Specialist, giving him a good understanding of what employers need to set up plans, and what GUARDIAN' 38 Answers to Your Questions employees need to access their plans. Eddie will help you optimize the value of your coverage, and will be your strategic partner in creating a successful benefit program. Nikki Mauthe, Account Services Manager Nikki has been with Guardian in various positions for more than 20 years. She understands your service needs and will answer your day-to-day questions. She works closely with your benefits administrator to provide you with easy enrollment, excellent customer service, hassle -free billing, consistent eligibility, and streamlined claims services. Nikki's prior roles include Customer Service Broker Specialist, Customer Service Planholder Specialist, and in System Development. Jillian Anfuso, Implementation Manager, As an employee of Guardian for over 12 years, Jillian has extensive knowledge of the company's processes, systems and products to help ensure a smooth and successful implementation of your account. She has held roles as Case Installation Specialist and Large Market Renewal Underwriter for the West and Northeast regions which give her a strong background to support key accounts. Her prior work as a paralegal and contract manager helped her develop strong analytical skills. Jillian is a graduate of Lehigh Carbon Community College. Shawn Afeld, Senior Account Executive, Shawn has over 20 years of client management experience. He's held leadership roles at several Fortune 500 insurance carriers where he consistently delivered quality customer solutions by using strong problem -solving abilities, a consultative sales approach and relationship -building skills. Based in our Tampa office, he will work with you to design a comprehensive benefits program that meets your needs. Before his sales career, Shawn served as a non-commissioned officer in the U.S. military and graduated from the University of South Florida. 3. Is designated staff expected to maintain measurable client satisfaction standards? If so, please describe. Yes, to track member satisfaction with our dental PPO, we send 500 member surveys out each month to members who have seen a PPO dentist in the previous 90 days. The questions are answered with `Strongly Agree', `Agree', `Disagree', `Strongly Disagree' and 'Not Applicable'. The questions are worded so that 'Strongly Agree' and `Agree' are positive responses. The survey results are 97% favorable, meaning that 97% of the respondents strongly agree or agree that they are satisfied with their network dentist. GUARDIAN' 39 Answers to Your Questions Banking 1. What are your billing and premium payment procedures? Every employer has unique administrative needs, so we offer you a choice as to how you would like your billing handled: • List -billed: The City alerts Guardian on a daily, weekly, or monthly basis of any employee additions or terminations. We then process the changes and produce a monthly bill approximately 10 to 15 days prior to the due date. The City typically receives the bill by the 23`d at which time payment is remitted. • Self -Administration: The City controls the billing, and every month sends to Guardian a check accompanied by a paper or electronic file listing of the current employees. As an experienced leader in group insurance, we've developed an efficient monthly billing process. We provide one consolidated bill for all plans, both worksite and non-worksite. Bills are payable upon receipt, and payment may be made by check, electronic funds transfer, wire transfer, or via our Guardian Anytime website (www.GuardianAnvtime.com). 2. What financial reporting is included? We include the following financial standard reports on an annual basis: premium claims history, claims listing, and loss ratio. 3. What are the funding requirements (i.e., checks issued, checks cleared?) Funding requirements are based on checks cleared. 4. Is bank reconciliation included in your fees/premiums? Our rates are all inclusive. 5. Please give the following information for your principal banking relationship (to be used as reference): • Bank name GUARDIAN' 40 Answers to Your Questions • Address • Phone number • Contact name and title JP Morgan Chase Bank Hector Varona Executive Director, Corporate Client Banking 270 Park Ave 43rd Floor New York, NY 10017 212-622-6936 hector.varonaajpmorgan.com 41 GUARDIAN` Plan Design & Pricing Guardian knows that the overall value you get from your insurance carrier is not simply based on premiums. Our efficient claims administration, quick response times and positive satisfaction surveys testify to the strong value we deliver to you and your members. When it comes to rates, the City wants to ensure that its employee benefits investment supports the company's growth and profitability. Guardian is committed to helping you produce quantifiable results. This section highlights cost considerations for our recommended solutions. Dental Pre -Paid RATES plan a s� Pre -Paid Rate Census Employee Only $8.60 154 Employee plus Spouse $17.20 2 Employee plus Child(ren) $20.07 0 Full Family $28.66 339 Monthly Premium $11,074.54 Annual Premium S132,894.48 Rate Guarantee 3 years Rates and premiums are based on the employee data submitted. Final rates and premiums are based on the plan and employee/dependent data provided on the enrollment forms. Rates Notes Rates and premiums were determined using a census of all eligible employees and dependents. We reserve the right to adjust rates if actual participation is belowassumed level. We further reserve the right to withdraw this proposal if actual employee participation is below 25% or five enrolled employees, whichever is greater. Contributory Status - Contributory Participation Assumptions - Participation of 50% of eligible employees GUARDIAN,`. 42 Plan Design & Pricing PRIMARY BENEFITS In -Network Office Visit Cnpay $5 None Non Orthodontia Deductible Individual Deductible None one Period Not Applicable Family Limit Not Applicable Waived for Not Applicable Coinsurance Pnaxonbtke Not Applicable Basic Not Applicable Major Not Covered Wafting Period None Child Age Limits Toage 2G Claim Payment Basis Member Responsible for Patient Charge ` Not Applicable Annual Maximum Unlimited Waived For Not Applicable Network ManogadDenta|Gunnd On _1_1112H Onu| Exams $O Cleanings $O PehoMaintenance Procedure $28 CombinedQeoningo/pario Maintenance Not Applicable ' X-rays oO Full Mouth GUARDIAN" 43 Plan Design & Pricing Fluoride Treatment $0 Sealants $8 Space Maintainers/ Harmful Habit Appliances $78 Fixed Bilateral Space Maintainer (Harmful Habit Appliances Not Covered) Oral Cancer Screenings (includes ViziLite) $50 (age 40 or older, once every 24 months) Fillings $20 One Surface Amalgam Repair & Maintenance of Crowns, Bridges and Dentures $130 Denture Reline Chairside $186 Denture Reline Laboratory General Anesthesia Covered with surgical procedure Root Canal $126 Anterior $192 Molar GUARDIAN 44 Plan Design & PAcing BENEFIT DETAIL continued... 111� &111-11141,111 1"$", PahoSurgery $210 Scaling & Root Planing 842Per Quadrant Simple Extractions $23 Complex Extractions $62 Soft Tissue Impacted $QG Full Bony Impacted Bridges & Dentures $580 Complete Denture $620 Partial Denture Single Crowns $430 Porcelain with Metal $430 Cast Metal Inlays, On(aya ' Vanoom $388 2-surface inlay $400 3-surface inlay $250 Veneer Orthodontia $2,500 Comprehensive Orthofor dependent child toage 18 $2,800 Comprehensive Orthofor other members Orthodontia inProgress Covered Bleaching $165 Per Arch Ponce|oin/CenymioCovenage - Covered onaU� baat (antehor,bicuspid, molar) |frecommended bythe dentist 45 Plan Design & Pricing PLAN HIGHLIGHTS Pre -Paid Dental Plan The pre -paid dental plan combines broad dental coverage with a number of cost -saving features. • No annual maximums. • No deductibles. • No claim forms. • Specialty services available by referral. • Member always knows out-of-pocket costs. • No exclusions for pre-existing conditions. • No participation requirements. • No employer contribution required. IMPORTANT NOTES Primary Benefit Notes If your pre -paid dental plan includes an orthodontic takeover treatment -in -progress benefit, as indicated in the BENEFIT DETAIL section of this proposal, a new member is allowed to remain with his or her treating orthodontist through completion of comprehensive orthodontic care. The benefit only applies only if the member was covered by another pre -paid company plan at the time of Guardian's takeover of the group that started comprehensive orthodontic treatment under the prior carrier. It will not apply if the member was covered under a PPO or Indemnity plan. The benefit will be calculated based on the remaining months of comprehensive treatment up to the maximum of $500. Benefit Detail Notes Many of Guardian's dental plans cover one ViziLite Plus exam in any 24 consecutive month period for covered persons age 40 and older. The ViziLite Plus exam, in combination with a regular visual examination, provides a comprehensive oral screening procedure for patients at increased risk for oral cancer. The ViziLite Plus exam is painless and fast, and could help a covered person's dentist to identify abnormal tissue that might develop into oral cancer. SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS Pre -Paid Dental Plans • Except for limited emergency services, benefits will be provided for services provided by the primary care dentist selected by the member. The member must pay the primary care dentist a patient charge for most covered services. No benefits will be paid for treatment by a specialist unless the patient is referred by his or her primary care dentist and the referral is approved by the plan. • This plan provides pre -paid dental benefits through a network of participating general dentists and specialty care dentists. • All covered services must be provided by the member's Primary Care Dentist. Specialty care services are covered only when referred by the member's Primary Care Dentist. • Only those services listed in the plan are covered. • Certain services are subject to annual or periodic limitations. GUARDIAN' 46 Plan Design & Pricing PRIMARY BENEFITS WINE Contributory Status Voluntary Non-contributory Network Access Plan Network Access Plan Individual Deductible $100 Deductibles for In -Network and Out- of-Nobworkoneino|uuive $50 Deductibles for In -Network and C)ut- of -Network are inclusive In Network Out ofNetwork In Network Out ofNetwork Calendar Year Calendar Year Calendar Year Calendar Year Family Limit s300 $150 Waived for Preventative Preventative Coinsurance Preventative 10096 100% 10096 10096 Basic 80% 80% 00% 80% Major 5096 50Y6 80% 80% Orthodontia 50% 5096 8096 80Y6 Waiting Period Non* None None None Child Age Limits Toage 2G Toage 2G Claim Payment Basis QDmPercentile ofUCR 9O"'Percentile ofUCR Annual Maximum $1.000 Maximums for In -Network and Out- of-Nebworkare|nu|uoive $1.500 Maximums for In -Network and Out' of -Network are Inclusive Waived For Not Waived Not Waived Not Waived Not Waived Orthodontia Lifetime Maximum $1.500 $1.500 Network DentalGuard Preferred DentalGuard Preferred 48 Plan Design & Pricing BENEFIT DETAIL mom Preventative (Twice/12months) Preventative (7wice/ 2mont n) Oral Exams Cleanings Preventative (Twice/12months) Preventative (T\wm/12months) Perio Maintenance Procedure Preventative (nnce/3months) . Preventative (onoa/3months) Combined C|em»inQu/Peh» Maintenance 4ina12consecutive months period 4ina12consecutive months period X-rays Preventative (Fu||-mouthseries once/60months Preventative (Fu||-mnuthseries once/80montho Fluoride Treatment Preventative (to age 14) Preventative (to age 14) Sealants Preventative (to age 14.onneX6O months) Preventative (to age 14.onoe0U months) Space Maintainers/Harmful Habit Appliances Basic Basic Oral Cancer Screenings (includes Vizi|do) Not Covered Not Covered Fillings Basic Basic Repair &Maintenance of Crowns, Bridges and Dentures Major Major General Anesthesia Basic Basic Root Canal Basic Basic Perio Surgery Basic Basic Scaling & Root Planing . Basic Basic Simple Extractions Basic Basic Complex Extractions Basic Basic Bridges &Dentures Major Major Implants Excluded But PPODiscounts Apply Excluded, But PPODiscounts Apply TN1J Excluded Excluded Single Crowns Major Major |n|oyo. C>n/ayo. Veneers Major Major ` . GUARDIAN' 49 Plan Design & Pricing ilane433 Type ��, ', g c �. " - ".y' ��Y _� �a x...[ f tir Plan 9 �' �'�'�''� .�' y kli � � s, 'i`„i �4� ik i ,fin ^°s+ . '. a' s au ,n��`,5'L� cyTa Uolunta Plane �� �n Plan T3k g � y +/' '� ��s. � ' 4 Y ^c� a� d x �• m Executrve Plan Orthodontia Orthodontia Orthodontia Orthodontia in Progress Covered Covered Bleaching Not Covered Not Covered Porcelain/Ceramic Coverage Covered on Anterior and Bicuspids Only Covered on Anterior and Bicuspids Only Replacement Age for Prosthetic Devices and Appliances 10 Years Old 10 Years Old Primary Benefit Notes Orthodontia, when covered, is for dependent children who are Tess than age 19 when active appliance is first placed. The list of dental services shown is not exhaustive. Final plan documents will show exactly what is covered and excluded. Benefit Detail Notes Many of Guardian's dental plans cover one ViziLite Plus exam in any 24 month period for covered persons age 40 and older. The ViziLite Plus exam, in combination with a regular visual examination, provides a comprehensive oral screening procedure for patients at increased risk for oral cancer. The ViziLite Plus exam is painless and fast, and could help a covered person's dentist to identify abnormal tissue that might develop into oral cancer. PPO Discounts on Non -Covered Services With our PPO plans, employees and dependents can save money on many dental services not covered by their plan by using a DentalGuard Preferred dentist. For example, network dentists provide significant discounts on: • Orthodontia, when not covered by the plan (average of 25% off of usual charges.) • Implants, when not covered by the plan (average of 40% off of the 90th percentile of the UCR and 16% off of usual charges.) • Services not covered due to plan limitations such as Annual Maximum and frequency limits (average 30% of usual charges.) GUARDIAN': 50 Plan Design & Pricing SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS • Coverage is limited to charges that are necessary to prevent, diagnose or treat dental disease, defect or injury. Depending on plan type, deductibles, waiting periods, per service frequency limitations and payment limits apply. • This plan does not pay for: • Any restoration procedure, appliance or dental prosthesis used solely to: a) alter vertical dimension; b) restore or maintain occlusion, except to the extent that this plan covers orthodontic treatment; c) splint or stabilize teeth for periodontal reasons; or d) treat a condition caused by abrasion or attrition. • Cosmetic or experimental treatments, unless specifically listed in the BENEFIT DETAIL section of this proposal as a covered cosmetic service. • Replacing a lost, stolen or missing appliance or prosthetic device; or making a spare appliance or device. • Treatment needed due to: a) an on-the-job or job -related injury: or b) a condition for which benefits are payable by Worker's Compensation or similar laws. • Treatment for which no charge is made. • Replacing an appliance or prosthetic device with a like appliance or device, unless: a) it is damaged while in the covered person's mouth in an injury suffered while insured, and can't; be fixed; or b) can't be made usable and meets the replacement age criteria indicated in the BENEFIT DETAIL section of this proposal. • Overdentures. • Maxillofacial prosthetics. • The replacement of extracted or missing third molars/wisdom teeth. • Treatment of congenital or developmental malformations, or the replacement of congenitally missing teeth. • Evaluations and consultations for non -covered services; detailed and extensive oral evaluations. • Any procedure performed in conjunction with, as part of or related to a non -covered procedure. • Any procedure not specifically listed as a covered benefit. Performance Guarantees Guardian's service commitment: A promise to provide the highest level of service When you put Guardian to work for you, you can be assured that an excellent customer experience is our highest priority. To demonstrate this commitment, we offer an array of service guarantees that support our promise to meet your needs. (Unless otherwise noted — the guarantees are measured annually based on data from all groups and are not case -specific) Product/Area Our Promise .l f we don't meet our romise, you get GUARDIAN` 51 Plan Design & Pricing Dental: Claim Processing 90% of all fully documented claims will be processed within 15 calendar days of receipt. $2,000 There will be a combined 97% claim financial and coding accuracy $2,500 Dental: Member Service At least 75% of all DHMO and PPO member calls will be answered in 30 $1,000 for non-DHMO $500 for DHMO Less than 2% of all DHMO and PPO member calls will be abandoned. $1,000 for non-DHMO $500 for DHMO At least 70% of member situations will be resolved within 24 hours, $1,000 Dental: Cost Savings Members will not be balanced billed by in -network providers (case -specific) $200 per occurrence GUARDIAN` 52 Sample Guardian Anytime Member Flyer The following is a sample Member Flyer which may be distributed to plan members in the course of ongoing administration of your plan. DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025 Access helpful, secure information about your Guardian benefits instantly — at www.GuardianAnytime.com. You can do it 24/7, without picking up the phone. • Review information about your benefits • Update your contact information • For dental plans, estimate dental care costs and get tips for a healthy smile • Check the status of a claim' • Receive e-mail alerts when a response to a dental or medical claim is available online' • Find a specific doctor, dentist or vision care provider or create a customized listing of providers • Print forms and plan materials' • Access significant discounts on goods and services, from home office supplies to flowers4 • And so much more! Register in two minutes at www.GuardianAnytime.com GUARDIAN ANYTIME 1 All products except Life. 2 Not available to members with Guardian pre -paid Dental/DHMO plans (including First Commonwealth and Managed DentalGuard plans). 3 Does not include member ID cards. 4 Certain exclusions apply and availability may vary based on company location. Pula 3959D 2009 — 8599 (9/09) The Guardian Life Insurance Company of America, NewYork, NY 10004 Sample Dental Letter ~ The following iS@sample Dental Letter which plan members may receive iOthe I course of ongoing administration of your plan. DENTAL ` LIFE ^ DISABILITY ` CRITICAL ILLNESS ` SECTION l]S ` VISION The Guardian Life Insurance Company ovAmerica rHanover Square, New York, wY10004-4o2* GUARDIANt November 12, 2009 JOHN SMITH PO BOX 1000 CITY, ST 11111 Important information regarding the below referenced claim. GROUP CLAIMS DEPARTMENT P 0 BOX 2459 SPOKANE, WA 99210-2459 W W W . GUARDIANANYTIME. COM Page 1 of 1 Claim Number. To Whom It May Concern: We have received a claim for the above patient. In order to process a claim for services performed on 11/09/09 ve need the following information: For services: SCALE & RP,1-3 • Please submit the quadrant(s). Please attach the requested information to this letter anl'return both to the above address. Upon receipt of the information, we will continue our consideration otthe chi n ., rP To complete the review of this claim -you -ma} either return this letter along with any attachments to the office address listed above or you may contact us bye mail: ,our secure welosite is at www.GuardianAnytime.com. If you are not already registered for access, the registration process is easy to complete Once you have accessed the website click on "contact us" to respond to this letter. Please reference the above claim numbe when responding. If you have any further questions regarding this letter please contact our Member Service Department at 1-800-541-7846. Sincerely, GROUP DENTAL CLAIMS DEPARTMENT Toll -Free: 1-800-541-7846 Fax: 1-509-468-4590 DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025 Sample Provider Online Search Flyer The following is a sample Provider Online Search Flyer which may be distributed to plan members in the course of ongoing administration of your plan. DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025 GUARDIAN® Go oniine — t takes justminute- It's easy to find dentists you can trust. Whether you're looking for a fist of dentists that serve your plan (in -network) or trying to locate a specific dentist, it takes just minutes through Guardian's Provider Online Search. Guardian's Provider Online Search is available to you 24 hours a day, 7 days a week. Here are just a few things you can do online: • Customize your search by specialty, languages spoken, gender and more • Get side -by -side comparisons of dentists' information (ie. office status, distance) • Create a short-list of "favorite" dentists — for quick reference online • Get maps and directions to a dentist's office location • View your results online or have them faxed or emailed to you • Save your search criteria for easy access when you revisit Provider Online Search • Create a customized directory of dentists • Nominate a dentist to be included in a network • And much more! .dust go to www.GuardianLife.com. Under "Resources", click on "Provider Online Search". 2007 — 7669 (10/07) Dental The Guardian Life Insurance Company of America, NewYork, NY 10004 Dental PPO Network Disruption Analysis National Matching... Utilized providers - Dental Against... PPO Network Providers - All Current Networks Created for... City of Miami Created by... Guardian September 13, 2012 Created with the Quest Analytics Suite Copyright O 2003-12 Quest Analytics, L.L.C. Dental PPO Network Disruption Analysis Contents 1.1 Utilized providers - Dental National epdit CbHteh September 13, 2012 Disruption Summary by State 2 Created for... Disruption Detail by Zip Code 3 City of Miami Provider Disruption Listing 4 Created by... Guardian Matching... Utilized providers- Dental Against.. PPO Network Providers - All Current Networks Dental PPO Network Disruption Analysis Disruption Summary by State 2 Utilized providers - Dental National September 13, 2012 Created for... City of Miami Created by... Guardian Matching... Utif¢ed providers- Dental Against... PPO Network Providers - Ai Current Networks Matching Passes: Match on TIN, Name Address & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Faulty, Address & Zip 7 Match on Faalty & Zip e Match on TIN 9 Match on TIN to SSN MatChon;TiN NameAddrgss,&ZIF Match on Name, Address & Zip Matcl%ort%paitial fast Atliiress.&; Match on Name and TIN Match oiii i d TIpij Match on Facility, Address & Zip Match on Faeaty'.&Zip j'' Match onTIN :MalchoNtoSSIJ: Totals ::.,:,,:-..�':'�.: r>•:,,, Fa,b�.-raidwa�..,..�-.r..^.•`-:r-,r:,.f-,:.n .0 .t ., ".��v«. �.:..,a-..a..>,� _�ry: ..s�-._...._._,_....,x...:,_..,...;..-.:._:,;e�>...:„. ::.,,.., ���»'...a.^_,..y,,..^.,�.::4::,'oar.�.<_,......o-.^...e::.-.,,A....<:2>*!--._.<„-».:,,i'.� >r« i.. -,. z;.<„ "-,•.:a, �, .:r.....,x 4_.'r�µ.:t,"_,�x�.r,�a,'. 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PPO Network Providers -All Current Networks Matching Passes: Match on TIN, Name Address & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip 7 Match on FaaTily & Zip e Match on TIN 9 Match on TIN to SSN © 2012 Quest Malyfics, LLC Fort Lauderdale Hallandale Homestead Jupiter Lai Woiiti;`'. Miami 33306 317u': 33321 33324 33009 33013 33015 33018 33023 33025 33026 33027 33030 33033 33477 33125 33127 33128 33130 33138 33143 4 100.0 2 100.0 OOA 100.0 100.0 ioo.o 100.0 0 Continued on next page... Dental PPO Network Disruption Analysis Disruption Detail by Zip Code 3.2 Utilized providers - Dental National September 13, 2012 Created for... City of Miami Created by... Guardian Matching... Ult¢ed providers - Dental Against... PPO Network Providers - Ai Current Networks Matching Passes: 1 Match on TIN, Name Address &Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip 7 Match on Faa1ity & Zip 6 Match on TIN 9 Match on TIN to SSN © 2012 Quest McVics,, LLC r iami Gardens. Ocala Palm Bay antieast Gar e s Pompano Beach Sarasota �rk1g try Tampa Wilinglan West Palm Beach 33155 33156. 33157 ;33161 33162 t�s�331(i5` 33166 41411,674: 33172 33173 33174 33176. 33179 33180 33183 33189 �.33139x 33140 33056s 33060 062£s 33063 33076 34239 3 :0 33612 3�d 33406 100.0 ado 100.0 2 100.0 2 100.0 2 100.0 N1000`" 0 ,} 0.0 1 100.0 1�000, �, 1 100.0 11000 1 100.0 2" ' 100ri 1 100.0 1 0 0 20.0 Continued on next page... Dental PPO Network Disruption Analysis Disruption Detail by Zip Code 3.3 Utilized providers - Dental National September 13, 2012 Created for... City of Miami Created by... Guardian Matching... 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PPO Network Providers- Ai Current Networks Matching Passes: 1 Match on TIN, Name Address &Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip 7 Match on Faality &Zip e Match on TIN 9 Match on TIN to SSN 'A�OLF�O �riARES ,_. AICMEE MARTINEZ ALBERTO M SILBER ;' ALDO BENDANA ALDO LUJAN JR,x„ ALEJANDRO DE LA CRUZ ;ALEX DRADGRERBALI ALICIA D CARROLL ANA.MhRIA; GALLEGOf_,- ANITA PANDEY BEA FUL SMILES N,MIAMI BILTMORE DENTAL GROUP BIPINIJ S� � HE H_ BRUCE LEIN BRUCERCOHN �f���q CARLOS J RODRIGUEZ-FEO CAROLI NA AKERMAt, CATALINA P CARRILLO 'GHI 1ivLR EC NTER CHINARA GARRAWAY COMMUNITY HEALTHOF rSOUTN DADS COMPLETE FAMILY DENT CARE OC NCEPC 01 N FERNANDEZ COPE SOUTH CO.J,S.PENTAL CORP DARREN SNOW DAVID J CABAN ON` DAVID PYNER �n�rw DEL AMO & MELLADO LLC DEMETRICK LECORN DENTAL CARE CENTER OF HOLLYWO DENTAL CENTER AT AVENTURA :DENTAL CENTER AT 8AP11ST' DENTAL CENTER OF HOMESTEAD ��..a saw ..�^� t DENTAL GROUP O:04, I PA . DESPINA ANGELAKIS DIANA�WOHLSTEIN, DINAVARON DIPAS CA?PEL , - DIRK L FLEISCHMAN 0 2012 Quest Melytics, LLC 7150 W 20th Ave Ste 103 SW$tliy5t#'A 8500 W Flagler St Ste B-205 Alfa F'agler,6i#8201, '' 7380 SW 40th St k B laml Labs 7171 Coral Way Ste 509 318 S,Unfversigr,Dt�,�,.,. 8353 Sw 1241h St Ste 202 1075 NEi125 ;St Ste.20i 11300 NW 87th Ct Ste 166 5 32 9C nu CreekPkv'- 825 S Us Highway 1 Ste 250 6504a al Hw Sle 10� 6601 SW 80th St Ste 125 ,�l9086 IJ mm291h Aver 13876 SW 88th St 810 W MoV�ry Dr ? 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City of Miami Created by... Guardian Matching... Utilized providers - Dental Against.. PPO Network Providers - Al Current Networks Matching Passes: 1 Match on TIN, Name Address & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip r Match on Facility & Zip a Match on TIN 9 Match on TIN to SSN DONALD KANE x DR ALAN 8 RICHTER DR LEQNARD:A. ,„ DWIGHT E WILSON E[IGAR PQRRAS ELIZABETH ROTHFIELD ENRIQUEACOS AA`.' ERIC ALVAREZ ERIKATUGENDHAT ESTEBAN RODRIGUEZ ESTHER LEWKOVNCZ EVELYN ALDAMA ESPINOSA FEDERALDENTALLCENTER FELIPE R MARTIN FL-ORALBAVNELTA FLORIDA DENTAL CLINIC FRANCISCAtv10 RO FRANCISCO OLIVER FRANLIX FAMILY DENTALCENTRE' FREDERICK G KLEPES FREDERICKJ NIN GABRIELA A ROLLAND-ASENSI yGLICKSMi & MARS DENTAL GREGORY BARFIELD GRETGHEN HEI}JSEN GROSMAN PEDIATRIC DENTISTRY & ORTHODONTICS HARVEY CAPLIN HECTOR 1 PRIETO �� HERNAN RODRIGUEZ HIALEAHDENTALBUILDING%� ;i HIALEAH DENTAL HEALTH CENTER HOWARD LEVINE�X IGNACIO ITURRALDE INGRIp PELMAtJ IRA FREEDMAN JACK L WBACOFF JACQUELINE COGAN JACQUELINE GARCIA-CASTELLANOSr �. JAMES SAINSBURY r- �10511PorlkMalabar Btvd.Ne 6720 Holywood Blvd ;10019 Cleary Blvd. 4301 NW 7th Ave r 't 2251 Taft SfOle 404� ^; 4601 Holywood Blvd A264 S5 D ugasl .RdSte703P 6240 Coral Ridge Dr Ste 107 17301 NVJ27Ave'x 11352 Qual Roost Dr 665 Mole Dr St€ 10)7 1250NW119IhSt G1600 E Atlantic BIAI 17868 NW 2nd-St r15819 bG Ie Hwy 8260 W Flagler St Ste if a 237 EIn emat1674,4edwayA:CO 8353 Sw 124th St Ste 202 ' 1 .S 32tl 5W:109th Ave � ;�, 1060 W Busch Blvd Ste 105 9425 NE 6tl1 AVe xr�� 1261 SW 8lh St -- TiirfAtthTySl Ste 200 , ° 1370 Washington Ave Ste 201 17 9 UnlverSfty,Dr 5le 108 „* 4401 S Flamingo Rd Ste 109 7420;NW 5ih�S�le 101 �:� 6600 W 12Ih Ave Zgal,: Cen ah Ste 205 2645 S Douglas Rd Ste 702 269E 49th St ` k . 930 W 49Ih St 127 W.1211. Ave, jr 5711 SW 137th Ave a *y r .1.645 Biscayne 6lvd Ste 20A : 2� v.: -1. 11440 Oliechobee Blvd Ste 106 780tlW0a a Park BlvdBJg.E 4. 16235 NE 11th Ct ty1880 S1K40 St Ste 3U2 7737 N University Dr Ste 204 Fr- Pai ii Bi Holywood FortLaudr_ Miami avwood:. Holywood #AINXItig Pompano Beach MlamIGardens %,Y Miami "'FaiNTAT Miami 1/R0ll Holywood Miami Miami Tampa Miami Miami Beach Fort Lauderdale Fort Latidertla ~ Hialeah Mlam Miami Hialeah falam Miami West Palm Beach Fo°r'1 Lauderdale Miami Fort Lauderdale FL FL FL ._ FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL 33024 Y 33127 Y 33021 3133�F� 33076 33029 33144 33156 33174i; 7� 33612 33135 33180 33139 33330 33012 33133 33C 33183 33181' 33411 38351 33162 33321 1 1 Y 1 Y 1 Y 4 Y 8 Yx 8 . Y 2 Y Y vh Y Y Y as Y Y Y Y Y Y Y Y 7 4„!U 2 4 2 1 8. 1 4 7 1 8 1 © 2012 Quest Melyfics, LLC Continued on next page... Dental PPO Network Disruption Analysis Provider Disruption Listing 4.3 Utilized providers • Dental National September 13, 2012 Created for:., City of Miami Created by... Guardian Matching... Utilized providers- Dental Against... PPO Network Providers - AI Current Networks Matching Passes: Match on TIN, Name Address & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on FaaTity, Address & Zip 7 Match on Faclity &Zip 8 Match on TIN 9 Match on TIN to SSN n ` lie ,,•,, �.!,, ',w &ttw:p,�(a��j lied PfyVkkleit t eft '.! S',i'.i� 'y "�.n 4'�{ v u3b'i � '.� SiT �JE :a�i` 5"f��,&Tki.`I..:,,€^".'.a��i'" � k C 'iy9� .. ..�"",1. S ��LF '!`�[H' J�'�.FL �. ..✓°)k rx et: :• � �, ,3�.,. ^ ZsLu'Ys1..FJ' .LX .�.�. .ik'°' dG '�' x, �.`..u„a,.,!S.� ✓ M,e w. .: a y5,,...,, 5{.R •iIPIG G _: 7 � �� V � ., : ..a�s�<,».s ygg t �y1.�,I {rSGV a r '�- $ ,: .. ... . ... 'ASON HRSHma. tery _., JEFFREY WEISS ._._ >..3AurfeRd Se 813.$ .=,� o 333 Arthur Godfrey Rd Ste 818 MIamFBeah�� Miami Beach FL �33140� 33140 ...:,.,,. � xg Y eg: 2 z^ ,IEIDY D MARTINEZ :; w: Y t 5x z S f r a q' �5t A m rr 3 zit aa,r, a4D0 SWZI� Ave^ ...,:�z.;,: Miami : ;F ?.x fL M 33135 JENNIFER ADELSON 501 Golden Isles Dr Ste 202 Halandale FL 33009 Y 1 JESSICAY.BAIiNERX' .. �t t= .; t.. �����.,. - i : r7rr':h 1730{}NW27IhAva �_.,.''� Miam(rG,aMens#.��`#,...,... FL' ;; '-,x r � 3056�� �s m ` JOELLE M BALMIR-THEVENIN 10621 N Kendall Dr Ste 102 Miami FL 33176 Y 1 JOHNGKEMENY.� M� y Y -..:.z %!,,„. E : � �, 11254 9Vi i 7th A e ? ' ' .t . Miami v 88 33186 JOHN P CLAXTON 1605 S Cypress Rd Pompano Beach FL 33060 Y 2 1 gi ERIDQN< .: s a' - xW...-:....,<rx. __;: �.. . 5 e� :r "; ?" . ;� . �.5> :Al "' y %7 20S.Semoran vd . <,� .ss 4 " e Orlando., +w F1''. 32922 t Y•> 1 JON ROBISON 13876 SW 88th St Miami FL 33186 Y 1 JORGEVAZQUEZ �',: ss�'a ,.,��ti.. �._ �... �, _ W � f_� . � ��� � a�y.t�: , ���r „ � � „„ -34b AlhambYa C(r - � �. ���.,�. .��_ _ MIam1 �-�G, �,�� � �- ro 3313d xh - of JUAN CARLOS ARROYO 333 Arthur Godfrey Rd Ste 818 Miami Beach FL 33140 Y 1 ., ". R :; .... ':. i. r�, ='" .., i : ;'^;r,r ,,"-,,;r;- 4 NCUTINO;r 4 ? �_�F�..: ��....,. � � ,,., :,:i" 1�SW62nd�Ave ��^' ; '�.�u ���..._ _.Y'^ • {•�" ,w i "' I arnl�� A ,Fl§ s` 2 rra:, �33id3� ��tY:�a._ .,, JUAN M GARCIA 6450 W 21 st Ct Ste 300 Hialeah FL 33016 Y 1 KATHERIiJE I.RODRIGEZII r x'. f -1330"Cifi :Ste408 x �*���:,Rw.�. ,r„ - ��- . :,���ne.n F .<.�����r:�b'"a'� Mlaml *. ;y s'= FL' '�k'..o::-�:...q,.�� a ,31,, %. s „Y x.� �.- �, t1 < ... , KENNETH COHEN-SASSON 7500 NW 5th St Ste 107 Fort Lauderdale FL 33317 Y 1 "a%�i�"^i:Ti�'r'r,.!sKl,F'-, .,,< 'i ; 4.,�,_z N`'"`_'.i nei j✓.gna+� �4fvi i�"''w:�• t�x--t �W�'y�3'£.-'s�.a'::?"M Ci]�a: ;J.�.GM, KENNET , H KNOPF ._< -, -fY .1545QNew;01 Rd 0 10 1 Hialeah ,: ? ? 7 FLU 33014 r �s,' a�FY KENNETH S LISZEWSKI 1880 Arlington St Ste 205 Sarasota FL 34239 Y 2 ' a.._ ., ,�� , z` ,n' z ,F f(EVIf31CJAMES ��" - y + '`� i`- i:rv;..n;,;;,,rv.d r�:xr .: a 685Ro a Paim Beach Blvtl Ste 2lkl rWest t:. ., en a 'S .. 4 - Palm �eac .,v; > L ,�: " +2 ri 33d11 z x s ,4 g KEVIN L PAYTON 1 SW 1291h Ave Ste 400 Hollywood FL 33027 Y 1 � � .s.:.;x*,a',�s .' KHADtlEALST,ON._.: .:,.=m,_.�' ,. � .a,: �`�. a w•� e w '� i,:�� Ste' 4fi; :;C =:`9 4 17301N11 7thAva _r�:.„x ��.„ ;:, '.�T.t.• aidens R,`.':,'',i IamiGardens .i ; calir 33056ge? p 'v�fn �.. �;:Ya n y,Y,r, i ; 1; KINGA E ROGOWSKA 5740 Hollywood Blvd Ste 400 Hollywood FL 33021 Y 2 EO:UTF.-� SU` x s „...,. . 90EkitAv,r ,R' ._ MI "�Xr331- �a KRISTEN IGUALADA-HEINE 8585 SW 72nd St Ste 101 Miami FL 33143 Y 1 .ts jai, Kl1R3FRIEDMAN: d " „ k .- .„,:z� <...: x< LADYS CABRERA s• : m�zrsn>::;n ..y ;,}• �,hy� ...;:-'MYc<=�+;,z B Arthur (?odhey Rd Ste 204?� 6500 Cow Pen Rd Ste 203 . < Ft FL 3314 :.. 33014 ?`Z x ,Ys... Y 1 Miami Beachz Hialeah ,^4,,, j�C✓:vi+'�R: ?rs.E'fl` .w�..i;:...,�.. a^. .':'m .r..:r.,*.::.<,rx,e.,;x.;a;�.?i tAGUNADENATALGORP:08ADENTALAMERICAN CLINIC .1072t .n:ti.�. :.......,x. ':�,., ..-.,.. ,M,,. s.x.n,.,.....r. :: ..._ ... .,-,..,.. k,fa•%�.� ..>„s.;,,.ka ,. .,>, WElagierSt , r, .. ,.,.-,.-, �. �..', k:,.. ,,. �llaml -, x.;,.�....... .. ....m.. _,__z 33174 w.-.. `..s,v>✓'.'.. ,/ ..,>, .. IAMYA MANZUR n, 20335 Old Culler Rd Ste 200 m .y 'x Mlarni FL 33189 Y 1 t20d23 Slate Road 7 Ste FiBoca Raton �� FC: 3349� F Y LAUREN MITCHELL 7000 W Palmetto Park Rd Ste 504 Boca Raton FL 33433 Y 1 tURENCE:FENDRIG 18311MIramarPkvry �lywood FL 733029 E Yr1.. f LEONARD S OSTROFF 17301 NW 27th Ave Miami Gardens FL 33056 Y 1 '' .` .... t r UCETY ORDEHI� ...�.>,,.. .�......,�.;i.�x'• �..__.�.,__�,_ __, x�ta a.��+. � . �M, .a� f'�'""fxw'.""nn..tis 'Y 90XI1AUs 27 Ste 6b h y> . :., - -... ,..,w��..�>a+€n:�..,.,, '. ,.t { Sabm ., g..��;>",+�'�>.,,'�..,. , - c FL -li... -+'i:F 33870 .....,�;'ws'.;z.,.,�„ PIT `s�-x 6Y, i ^' : 1 r. ,3 w. LILIANAANGULO .•trn v: LY:C.gs'kH.;'", C"..:.,'S4 " f ,'9^' '!:"" N f"" : P LINDA'YIJSMAN WIRTH :' s x � emu, �:,e„..._.•,.�„�, �.., � l x.. �...,P. �� � f..,�8728SW126th 614 E49th St ;^',R ,,m tiv .4-A ,. � ` Hialeah Miami=� _�^� �;� FL ��+ 33013 178��; Y4 N. 'i s,�; .Y��. 1 LISAYOUNG 9900 Sliding Rd Ste 100 Holywood FL 33024 Y 1 LIZA'AGUILfAR x: r s .....� � :: ��� � �?�... �x a x [ ;17301NW27th Avis :. ,~a �,.:,��'�� .,.�:..Miarnl !, ens,�._�.;`w..� � FC� t ,z �33059.:..� r✓� LLOYD A SIPKIN 2655 E Oakland Park Blvd Ste 3 Fort Lauderdale FL 33306 Y 2 p£`?? rc; °5' ` i? L ' -' '' "A - 5' '" 3 ? .: tOUIS G SPELIOS � ��,n .. , '.:... � endr. -;,5 y+ C2:' +" 't 9595(enda�i Dr Ste 201`. �"� � � �� ,� ,,,v.,! "".` :Miaml�� �.y ,u. Fl y .5v t1' 331f8�"!K` LUCIE CASTHELY 160 NE 82nd St Miami FL 33138 Y 3 0 2012 Cues) Melytics, LLC Continued on next page... Dental PPO Network Disruption Analysis Provider Disruption Listing 4.4 Utilized providers - Dental National September 13, 2012 Created for... City of Miami Created by... Guardian Matching... Utilized providers - Dental Against... PPO Network Providers - Al Current Networls Matching Passes: 1 Match on TIN, Name Address & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip 7 Match on Faclity & Zip 6 Match on TIN 9 Match on TIN to SSN LUIS A GOt' LUIS A TORRES LUIS ECARDENAS LUIS SANTAMARINA `MAIRELYS,RODRIS, MARC SIEGEL MA R6E4GAii610O12F MARIA ALVAREZ btIAbHATANI MARIA YAZJI M9RIANNA�F(Al1FM� MARK D BLUM MARTIN GLAS _ MARTIN H FRANKL MARTIN N GI.AS 1. MATTHEW FREEDMAN bYRA G 6ET i� MCLEAN & ASSOCIATES OF SOUTH FL PA MIGHAEL MAUCK W MICHELLE SMITLEY MILAN L KHAKI RI MOISES CABRERA. N NCYMEDI8 , NEW DENTAL CARE ;NEW SMILEDENTAL CENTER; NICOLAS G AVALOS NIGEL �RANDISON ��� NORBERTO J HERNANDEZ aORTF DADEDENTAFT" NORTH WEST DENTAL CENTER ORAL KLINIC ORLANDO DOMINGUEZ P ILM DENTALGENTEE PAMELA NIELSEN PdUL Ft=LDON,; PAUL H TANNENBAUM RIERO G AIACI05 QUINTON L HEDGEPETH RAMIRODELi1M0 S RAMON ZARDON 00 W 12thyAve Sie 17301 NW 27th Ave" 1 SW 129th;AVei J 406 330 SW 27th Ave Ste 602 74Fi th St,S 205 15833 Pines BNd Ives Deity RtlrS 11336SW184IhSt 8805SWW',, tt%St` 3911 SW 107th Ave 1035:S State Rbad 7 S etet . 7800 W Oaldand Park Blvd Ste 301 b 0576te 107 7887 N Kendal Dr Ste 205 l960Avenitil7= 3027 Forest Hit Blvd Ste A3 70iNW 78the�:.. 9001 Pembrole Rd `d765 S`Coiigress 7150 W 20th Ave Ste 103 18503nerBNd'e 092092 14609 SW 104th St Ceifi�t 34 S Douglas Rd 1079dAy6NdiS 1L 1470 NW 1071h Ave Ste G 01 7th 157 NW 36th SI i SW 2d li St" 20 9280 SW 1501h Ave 750W20i A e{Ste fi02 7755 SW 871h Ave Ste 110 E87505Wt44`thsiSte. 9777 SW 72nd St oprgyrgw 2375 SW 27th Ave I Alha b CIS 5Le 5864 NW 183rd St Miami Gardens FL Miami FL vtlaml"$' Holywood FL "laml Miami � � FL F1F4 Miami FL eft ngto i Fort Lauderdale FL Marnly a� ;FL Miami FL ligiat West Pdm Beach FL 7r Holywood FL Laie Wor(hgrj $ '>; - Fl Hialeah FL Miami FL fw9iami r Ft MIAMI FL larrii Miami FL l of odd r J F ,AFI k 3 Miami FL Miami FL Mlamf Miami FL Miami FL Miami FL Miami FL Hialeah FL •33012, 33056 33 33135 33027 33157 31767^ 33165 ti31414; 1 33351 I�33166�, 33156 33406 33025 O46 33016 33186 00000 333t30' 33134 33172 33127 33196 1336{6y 33173 33173 33176 33145 33015 Y Y Y Y Y Y Y Y EWE Y Y Y Y Y Y Y Y Y 4 8 4 2 8 4 2 e 2012 Qje l M9Mics, LLC Continued on net page... Dental PPO Network Disruption Analysis Provider Disruption Listing 4.5 Utilized providers - Dental National September 13, 2012 Created for... City of Miami Created by... Guardian Matching... Utilized providers • Dental Against... PPO Network Providers - Al Current Networks Matching Passes: 1 Match on TIN, Name Andress & Zip 2 Match on Name, Address & Zip 3 Match on Partial Last, Address & Zip 4 Match on Name and TIN 5 Match on Name and Zip 6 Match on Facility, Address & Zip 7 Match on Faaiity & Zip 8 Match on TIN 9 Match on TIN to SSN RANDAL ekLIF RANDY SACHS RENE F CEDENOti RICARDO ROMAY ',RI7A�A`F.IELDSHELLER RITA STEINER ROBERT COMORN ROBERTJGORAL RaBER7 MIANSTER RODOLFO CARBALLO Fl ODRIGO ROMANO) I ry ROGER SPOTT ROIAND HERNANDEZ RONALD E LEVENTHAL ROSA MENDFZ SANDRABRENER SAl3A,RNESHPAt), SEANICA M HOWE 8FI,4RLENE YAP STARKMANy SHIRLEY F SIMMONDS STEP NEN tAl GAJ , m SUNGHEE AHN IpA„ T MARTINFZ TANIA SAINT AMAND fr ASIEGEL TEDDI I LITMAN TESSA SCOTT � � " x. THEODOREGROSSMAN i TiMOTIiYhCIiEN �T TIMUR SEKERCIOGLU TINWHU DMDi. TOTAL DENTAL & DENTURE CARE ;VALERIA SOLTANIK DMD VASALLO DENTAL OFFICE IIICTOR CHRI370PH VIVIAN DIAZ ;WIILIAM PO5NER! YURI GOLDVASSER ZO 2A P.I.M.CNEZ 0 2012 Quest Malyfics, LLC 0 i6890 M44.4,L , 2263 S University Dr 924o,Sun�sel brvSfe �1" 5' 6437 Bird Rd 17'301 NW27thve' 19080 NE 29th Ave 7i 50 W 20th Av"e Ste102 9595 N Kendal Dr Ste 201 399.CoFal PO: 18503 Pines Blvd Ste 208 326 A8tig4:. 1650 N Federal Hwy Ste 105 00 W 49l,- Ste 400 7400 N Kendall Dr Ste 312 3e22W16thAve rr 18503 Pines BNd Ste 209 ERT0R4M, 8750 Sw 144th St Ste 205 �•;- zs�-ter;-, c �� 1001 Ives:Daired LSteni 03 9000 SW 152nd St Ste 208 9595N:KendallD�St�201 1650 N Federal Hwy Ste 105 7.15owaouiAvehste�o2; 11645 Biscayne Blvd Ste 204 17301 NW27lhAve 'A ,. 7887 N Kendall Dr Ste 200 3876 SW 88th Sl 11645 Biscayne BNd Ste 204 7160201h Ave Sl 103 18044 NW 6th St Ste 103 17 0 NW5thSlSte208 7076Taft St� 2999 NEg9 sf St Sle 35a .y' 8782a SW 8th St 2905 SW 160th4 e 13400Sw120thSt#310 337ifthur Godfrey RdiSte'818 3365 Burns Rd Ste 209 1619 NE 8ih'Str� Holyw iptAg ,", l Fort Lauderdale Miami MIamI Garde Miami Hollywood Miami Pompano Beach Hlaleaah Miaml Hollywood HolPN9RqgiaW01 Miami Miami Miami Pompano Beach Miami MIanit Gardens Miami Miami Miami iilakah Hollywood Hollywood Miami Miami Wahl Be Palm Beach Gardens `Hbmes'te 33023�' FL 33324 33173 FL 33155 FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL s=t 33180 33176 33029 33135�, 33062 33012; 33156 33029 33176 k 33179 33157 1167T 33062 33181 330561 33156 33181 33016 33029 ' 33029 33024 318o 33174 �33027� 33186 33410 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y ABC COMPANY Group Plan #: 111111 Dental Claims Experience Reports ABC COMPANY STREET CITY, ST 00000 To help you better understand how your Guardian Group Dental Plan is being utilized by those enrolled in the plan, we are pleased to provide you with the enclosed package of claims experience reports. These reports offer a snapshot of your claims activity, providing helpful insight on how your claims dollars are being spent. After reviewing these reports and better understanding how members are utilizing their coverage, you may wish to make some changes to your current plan design. Claims may have a direct impact to your plan's renewal premiums, so if you would like to make benefit design changes to potentially help reduce your premiums in the future, Guardian will gladly work with you and your benefits broker to make such changes upon your next plan renewal. As a leader in innovative and flexible dental plans, Guardian offers an array of dental coverage options to help meet your specific benefits needs. Add in Guardian's large network of dental providers, our commitment to superior service, and our easy plan administration and you can see why Guardian remains a smart choice for your group benefits provider. If you have any questions about the information presented in these reports, we encourage you to speak with your broker or contact your Guardian Group Sales Office. We greatly value your business and look forward to continue meeting your benefits needs for years to come. GUARDIAN" DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 1 of 15 ABC COMPANY Group Plan #: 111111 Table of Contents • Plan Summary Page • Monthly Claims Review Page • Cost Management • Top 25 Current Dental Terminology (CDT) By Paid Amount • Top 25 Current Dental Terminology (CDT) By Frequency • Benefits Category Claims Comparison • Network Overview • Claims by Membership Type • In Network. Submitted Charge Comparison • Out of Network Submitted Charge Comparison • Glossary GUARDIAN/ DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 2 of 15 ABC COMPANY Group Plan #: 111111 Plan Summary Page Current Data for Claims Paid January 2011 - December 2011 Prior Data for Claims Paid January 2010 - December 2010 beTOR a sties- iimfna . us • er, C rren 'aY' Fitt ilk homer %qC n Prlo �� FromiPrlor Y'. 'eR G a sia B do ofBusInes Average Number of Employees 206 189 9.0% 1,127,428 Average Number of Members 287 262; 9.5% 1,608,268 Ratio of Members to Employees 1.39 ___ 1.39 0.0%m ___ ___,_ 1.43 W ♦as ♦#g eyi �R`�H� StatiSflCS [�.` .��➢ w �msewwK lsL4 Y°C{J "� J M+. Total Dental Paid Amount $84,760 $67,619L $549,071,217 Per Employee —a --..,.— .. - $411 WM1 m�^ `R25.3% $358? 14.8% . 4 . $487 Per Member $295 ,,:_ $258 14 3% ...,. a..a �... .._M.. ,n� �: $341 ,. Preventive Paid Amount Per Member $152 $1521 0.0% $160 Preventive Number of Services/1,000 Members 3,589 3,5501 1 1 % 4,236 Basic Paid Amount Per Member $91 $691 31.9% Basic Number of Services/1000 Members 1,052 825i 27.5% 1,376 Major Paid Amount Per Member $40 $31 � � �29.0%.. m,. . M ._ , „ �$57 Major Number of Services/1,000 Members 213 149 43.0% 392 Orthodontic Paid Amount Per Member �.... . ,.r �,. ... .. ..,,.. $12 $6i 100.0% ,._ , ... ___ $11 __...._..-. Orthodontic Number of Services/1,000 Members 139 ° 96 44.8% 143 Other Paid Amount Per Member $0 $01 0.0% $0 Other Number of Services/1,000 Members 0 4 -100.0% 1 PPO Fee Schedule Savings $14,327 $9,739 47.1% % of Dental Paid Amount in Network 28.9% 32.1%iy -9.9% 41.9% Reasonable and Customary Savings $2,016 » $1,5251 32.3% .__ GUARDIAN' DENTAL • LIFE - DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 3 of 15 Plan Summary Page (continued) ■ Customer Current El Customer Prior Block of Business ABC COMPANY Group Plan #: 111111 II Customer Current Block of Business GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 4 of 15 ABC COMPANY. Group Plan #: 111111 Monthly Claims Review $48 $44 $40 $36 $32 $28 $24 ; 6_ TO a1 361104 �� : t. C aims I b er o ,� e a of f s �Mohth, aid ° � E p dyes pep Km:I .a _ jai .. Glai s pe Cl m January 11 yyLL $7,217 185 .74 $39.01 $27.86 78 $92.52 wm February 11 $5,635 195 77 $28.90 $20.72 38 $148.30 March 11 $6,784 200 78 $33.92 $24.40 49 $138.44 April 11 $6,128 204 77 $30.04 $21.81 45 $136.17 May _ $5 161 203 78 $25.42 $18.37 41 $125.87 June 11 $9 368 205 82 $45.70 ............_.._ ...._... $32.64 _�.._... 51 _.._ $183.68 July11 n $5 902 209 85 .... $28 24 __.� .._. ..._..__..., . _ .... $20.07 ..__._._ 46 $128.30 August 11 $9,426 211 85 $44.67 $31.84 71 $132.76 September 11 $9 826 213 84 $46.13 $33.08 66 $148.87 October 11 $7,973 218 85 $36.57 $26.31 47 $169.63 November 11 $6,001 217 83 $27.65 $20.00 40 $150.02 December 11 $5,341 214 82 $24.96 $18.05 42 $127.17 Total $84,760 614 Average $7,063 j 206 81 $34.27 $24.60 51 $140.15 Per Employee Per Month Claims Paid �. Z. L •C T a) ai C W N u_ E 0 a51 15 0 a) u) November 11 GUARDIAN DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 5 of 15 ABC COMPANY Group Plan #: 111111 Cost Management Reporting Period: Network Usage: „ � jan' a2 ` ° Seemlier 20, ti Ne, "o _ ;v O I of NI k eof r: � �����; �a°!o ofr _ DESCRIP>�71ON . '�° ,�� � Artionil Wail , esg'QmoLnf�`�'�,Sta iiaidees STANDPifb�FEt:Sy :-• ��`� ''�.�'�`- '� -� � _ � � ear 1.s� .-. _ ... � 53" 689. 1 p6% . ; f � .. � �92�g35j - li'0' 0 % P'��LMIV�i,1.,_A V;IIY�.N�Y, .,yx',�.F"e�Ptn� m�.�,., ..'��� ,u�.•"-v.` *m:��". .. ''. w� �'• Savings from PPO Fee Schedule Reasonable & Customary . ? PPO Fee Schedule __. $0 $14 327 26 7% ___._.____._____.. 0.0% Rbl Reasonable & Customary Fees $0 0.0% $2,016 2.2% Total $14,327 26 7 °/o i $2 016 2.2% _-.. Savings from Contract Provisions EligthiIit 0 5% } $579r 0 6% Service Waiting Period/Deferred Services _,$246 $0 0 0%0 ' $0 0.0% EnW Late trant aiting Penod $0 0.0% $0 0.0% on Se Covered rvices $203 0 i $898 10% Duplicate Claims .._ $1 091 — 2 0% $2 146 2 3% Coordination of Benefits $241 o -$14 %_�__, Total 1.1.781 3.3% $3,609 3.9% Savings from Dental Review Logic $634.. 1•2% $4 111 4 4 /o . o Fre uenc /Time/A e Limits .9 y. ., 9... History Check m. $348 0 6% 9 $695 0 7% Alternate Treatment Provisions ° $8681' 0 9% Service Considered a Component of a More Comprehensive Procedure -...... $63.,a... ° 0 1 /o $172 o Ok2 /o .an ... Professional Review $0 ° 0.0% $0 0.0% Total $2,003 3.7% $5,846 6.3% Savings from Plan Provisions Maximum '� _A __ Ar $2 352 L. 4 4% 3.F%�� £ $7 t302. _�_ 8.4% 3.8% e uctib a 12,100 3 500 Coinsurance $6,860 12.8% j $12,2791 13.2% Total $11,312 21.1% $23,581 25.4% TOTAL PLAN SAVINGS $29,422 54.8% 1 535,052 37.8% Manual Adjustments $680 1 $11 GUARDIAN PAYS $24,532 45.7% GUARDIAN` DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 6 of 15 Top 25 CDT Codes by Paid Amount 0 e D1110 !Prophylpxis - Adult D0120 ;Periodic Oral Evaluation 1 D2150 !Amalgam - Two Surfaces, Primary Or Permanent 11 381_ 36 60274---faite;Engs — — D1120 I Prophylaxis - Child 1„ Apt ABC COMPANY Group Plan #: 111111 odc e D2792 Semi -Precious Metal (Full Cast) 1 D2140 lAmalgam - One Surface, Primary Or Permanent $2,897 $613 63320---TEndC4OhticT1;rapy 131k of MnYrs tif- • ervces'per ,Q.P.OVVIP..mb# $14,989 $4,5591 30.4% 238 8291 I 1,007 $9,5714, $2,277 23.8% J. 279 972 1,031 $5,399 $754 14.0% t' 59 2061 166 $3,986 1 $1,6661 42.3%1 $3,972 L $13211 33._ 3%1 92 3211 394i Clistoiner. Variac&fr&p GLiirdiah Bloc Mob.. VISMIRATO s re.$ -17.68% -5.75% 23.72% 7.36% -18.55% $3,127 1 $746 I 23.9%! 66 2301 204 12.90% $2,0701 $4441 21.4% 31 108 122 $1324.93% 504 $808 $0 53.7%1 19 661 101 , 84 8 -21.52% 0.0`)/Ot , . , $1,466 I, $222 15.2% 17 59 60 -1.79% 13.89% 14.46% -25.72% -47.91% 3.90% -11.26% _ . D2740 !Porcelain 1 $1,298 L - $453 34.9%1 5 17 1 23 D0150 !Comprehensive Evaluation • $1,247 $8021 64.3%,1 D2331 !Composite Resin - Two Surfaces, Anterior $1,0831 $95 8.8%! 13 451 43 D7210 !Extraction Of Tooth - Erupted $1,083 L $440 40.6% 12 421 „..... . .„ . , 65 D0220 IX -Rays - First Film $$254% 1 23.6j 54 1881 288 — --. ---------.„—.— .-------.1' 078 1— D7140 Extraction, Erupted Tooth Or Exposed Root 1 $1010 $550 54.0/01 14 --- —.— -- --,__ 491 112 D1351 Topical Application Of Sealants - Per Tooth $920 $2491 27.1%1 28 981 119 D4910' 1PerIOrionial Giilienance $879$221 2 5% I 17 59 61 Sub -Total I 871,099 I 819,634 28.9% 1,194 1 I % of Grand Total 83.9% I 80.0% 83.2% 1 $2,536 1 $3651 14.0/2J 5 17 ; 14 64341 Periodontal Scaling And Root Planing $2 375 $373 I 15.7%1 20 70 94 D3330 —1—EnTodoniicTherapy 1 $2,227 $680 _„---- _ 30.5% 4 14 1 L .., . 27 ....-.,"...,........ ,•3•`-',.' D8080 , Comprehensive Orthodontic Treatment $2,182 $1,0631 48.7%1 27 94 91 D0330 !Panoramic X-Ray D0210 Complete X-Rays Endodontic Therapy j $1,480 D2160 1Amalgam - Three Surfaces, Primary Or Permanent D1203 Child Fluoride $1,396 $404 28.9%1 52 lei 159 D0272 I Bitewings - Two Films $1324 1 $454 L 34.3% 43 150 168 -10.60% -24.93% 36[ 1251 190 -34.11% 6.55% 82% ...„, -34.78% -56.32% -17.74% -2.76% GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 7 of 15 ABC COMPANY Group Plan #: 111111 Top 25 CDT Codes by Frequency D0120 = Periodic Oral Evaluation D1110 , Prophylaxisz Adult D0274 I Bitewings Four Films D1120 ; Prophylaxis - Child D2150 (Amalgam Two Surfaces, Primary Or Permanent D0220 X Rays - First Film D1203 IChild Fluoride D2140 Amalgam One Surface, Primary Or Permanent D0272 Bitewings - Two Films D0150 !Comprehensive Evaluation D0330 £ Panoramic X-Ray _. D1204 j Adult Fluoride D1351 iTopical Application Of Sealants Per Tooth D8080 Comprehensive Orthodontic Treatment D0140 Limited Oral Evaluation D4341 Periodontal Scaling And Root Planing D0210 Complete X-Rays �. D4910 !Periodontal Maintenance D2160 Amalgam - Three Surfaces, Primary Or Permanent D0230 IAdditional X Ray D7140 Extraction Erupted Tooth Or Exposed Root D2331 1 Composite Resin - Two Surfaces, Anterior D9215, i Local Anesthesia ,,._•__ D7210 Extraction Of Tooth Erupted D9230 !Nitrous Oxide 1 11 12_.. 1 1 2 5 4 9 10 7 6 14 13 15 18 12.... 17 _ 19 23....., 24 GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 8 of 15 Benefit Category Claims Comparison Diagnostic Preventive Restorative Endodontics Periodontics Prosthodontics - Removable Maxillofacial Prosthetics Implant Services*- Prosthodontics - Fixed Oral/Maxillofacial Surgery Orthodontics Adjunctive Services Cosmetic Services Miscellaneous Services $22,259 $20,917 $21,794 25.7% $6,643 7.8% 26.3% 24.7% $3,490 j 4.1 % $564, 0'� $0:, $4,022T $3,411 $1,661 $0' 0.7% 0.0% 0.0% 0.0% 4.7% 4.0% 0.0% $0 0.0% 24.4% 22.4% 27.1% 7.2% 4.6% 1.2% 0.0% 0.7% 1.2% 6.4% 3.2% 1.5% 0.0% 0.0% ABC COMPANY Group Plan #: 111111 a" pa .0 ecne 2b1w0• Guardlanli3jock- slits :Catego AmounRaid of Claims oBsa% fusines 'aa Diagnostic $20,025 29.6% 24.1% Preventive $19,809 29.3% 22.2% Restorative $17,814 26.3% 27.4% _ Endodontics __._ $3,539 5.2% 7.3% Periodontics $1,281 1.9% 4.7% Prosthodontics - Removable $139 0.2% 1.2% Maxillofacial Prosthetics $0 0.0% 0.0% _ _ . ��ry0.6% Implant Services*� $0 0.0% Prosthodontics - Fixed $0 0.0% 1.2% Oral/Maxillofacial Surgery $3,074 . 4.5% 6.4%0 Orthodontics $1,469 - 2.2% 3.3% Adjunctive Services $469 tl0.7% 1.5% Cosmetic Services $0 0.0% 0.0% Miscellaneous Services $0 0.0% 0.0% *may include miscellaneous services on implanted teeth even if implants are not a covered service. GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 9 of 15 ABC COMPANY Group Plan #: 111111 Benefit Category Claims Comparison (continued) January 2011 - December 2011 Percentage of Claims Paid by Benefit Category Adjunctive General Serv. ig Diagnostic Endodontics Oral/Maxillofacial Surg Orthodontics Periodontics Preventive Prosthodontics-Removable Restorative Total: 2.0% 26.3% 7.8% 4.7% 4.0% 4.1% 24.7% 0.7% 25.7% 100.0% January 2010 - December 2010 Percentage of Claims Paid by Benefit Category 26.3% 0.2% 29.3% 0.7% 29.6% 5.2% 4.5% 2.2% 1.9% ■ Adjunctive General Serv. Diagnostic Endodontics Oral/Maxillofacial Surg Orthodontics Periodontics Preventive Prosthodontics-Removable Restorative Total: 0.7% 29.6% 5.2% 4.5% 2.2% 1.9% 29.3% 0.2% 26.3% 100.0% GUARDIAN" DENTAL LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 10 of 15 ABC COMPANY Group Plan #: 111111 Network Overview Huai In Network Out of Network Total ecembere 2 i $24,5321 28.9% v $60,228„mW..._ 71.1% i $84,7601 100 42.6% 57.4% 100 Em Guardian % of Claims Paid anua In Network ____ Out of Network Total $21, 725 $45,894 $67,619 embe• 200 100 % GuardtanABlock- ofAusines % of Amoun 100% Block of Business % of Claims Paid GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 11 of 15 ABC COMPANY Group Plan #: 111111 Claims by Membership Type Employee �....Spouse .,,.xrc.,< Child Decembe i20j $38,239 $15, 256 $31,265 Employee Spouse M Child 45.1% 180% 36.9% Employee 45.1% Child 28.5% 17.0% Employee 54.5% Employee El Spouse M Child GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 12 of 15 ABC COMPANY Group Plan #: 111111 In -Network Submitted Charge Comparison Preventive Basic Major Other Total (Excl. Ortho) anti aryil20 Ogg, ° er $20,730 $13,298 $14,506 $0 $48,534 custortie 380 [ $55 84 $158 29 $500 ■ Customer Avg Per Svc El UCR Avg Per Svc ariance� A e'ra 2 roeIJC er Service {{ Ave $57 i $160 • $492 -1.7% GUARDIAN" DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 • Page 13 of 15 ABC COMPANY Group Plan #: 111111 Out of Network Submitted Charge Comparison Preventive Basic Major Other $35,377 $36,172 $16,646 $0 650 218 32 0 $54 $166 $520 $o $60 $197 $633 • $o -8.6% Total (Excl. Ortho) • $88,196 900 $98 .$113 -13.4% GUARDIAN DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 14 of 15 ABC COMPANY Group Plan #: 111111 Glossary Term Definition Basic Services A grouping of services which includes the following services (but not limited to): Fillings; Crowns, Bridge & Denture repair; Endodontic, Periodontal, Periodontal Surgery, Extractions, and Other Services. Block of Business Guardian's Dental block of business which has been segmented to compare specific customer's plans with similar benefit designs and in similar cost areas. CDT Codes These are the codes assigned•by the American Dental Association for dental procedures Coinsurance After the member has satisfied the deductible, the dental plan pays a portion of the covered charges, called 'coinsurance'. Deductible Each year, members must pay a certain amount of the dentist's bill upfront, before they receive any benefits. Dental Review Logic A coded set of "user maintainable" rules that is used to process dental claims on Guardian's dental claims payment system. The rules are used to determine if dental services being submitted conform to "generally accepted standards of dental practice" and that they are processed in accordance with our contract language and administrative guidelines. INN Abbreviation for In -Network Major Services A grouping of services which includes the following services (but not limited to): Crowns, Inlays, Implants, Bridges and Dentures. Manual Adjustments Payments or recoupment made to previously processed claims. Typically a result of receiving additional claim information. Maximum This is the limit that Guardian will cover which is typically on a per calendar year basis Member(s) Number of Employee(s) plus Number of Dependent unit(s). If the Plan is self administered and we do not have the dependent data available, the Employee and Member data will be equal. OON Abbreviation for Out of Network Orthodontic Services Dental claims categorized as Orthodontic services PEPM Abbreviation for Per Employee Per Month PMPM Abbreviation for Per Member Per Month. This includes employees and their dependents. PPO Fee Schedule Savings The total savings to the plan sponsor due to the application of negotiated discount arrangements with contracted providers. Preventive Services A grouping of services which includes the following services (but not limited to): Prophylaxis & Fluorides, Office Visits, Evaluations & Examinations, Space Maintainers, X-rays, Sealants. Reasonable & Customary This is the plan's allowable payment limit for any given service. The R&C level is a dollar amount deemed to be an appropriate amount to pay the dentist for the services he or she provided. The amount varies based on the type of service and geographical area based on the dentist's location. Standard Fees The fees customarily charged by the provider. UCR Known as Usual, Customary and Resonable. Please refer to Reasonable & Customary definition. GUARDIAN' DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION I25 VISION The Guardian Life Insurance Company of America, New York, NY 10004 Page 15 of 15 THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA CERTIFIED. RESOLUTION - CERTIFICATE OF INCUMBENCY STATE OF NEW YORK ) ) SS: COUNTY OF NEW YORK ) Faith M. Drennan, being duly sworn, deposes and says: That she is the Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem of The Guardian Life Insurance Company of America (the "Company"), a corporation duly organized and existing under and by virtue of the Laws of the State of New York: That Sections 1 and 2 of Article II of the Company's By -Laws, amended as of March 14, 2012, provide that: SECTION 1. The Officers of the Company shall consist of a Chairman of the Board (the "Chairman"), if the Board in its discretion elects such Officer, a Chief Executive Officer, a President, one or more Vice Presidents, a Corporate Secretary, a Treasurer; a Chief Financial Officer, a Chief Investment Officer, a Chief Actuary, a Director of Internal Audit, a General Counsel and such other Officers as may be appointed by the Board. All Officers shall hold office at the discretion of the Board, the term of office being for twelve months, or until their successors are elected or appointed, unless they be removed or suspended. One person may hold more than one office (except that neither the Chief Executive Officer nor the President shall hold the office of Corporate Secretary). SECTION 2. The Board shall designate the Chief Executive Officer. The Chief Executive Officer, subject to the authority of the Board, and to the extent not otherwise prescribed by these By -Laws shall have the general control and management of the Company's business and affairs, supervision of all Officers and custody of all property of the Company. The Chief Executive Officer, at his discretion subject to the authority of the Board, shall delegate to the other Officers and employees of the Company such duties, responsibilities, and authority not inconsistent with any which may be vested in them by the By -Laws, the Board or any appropriate Committee. That Section 1 of Article V of the Company's By -Laws, amended as of March 14, 2012, provides that: SECTION 1. Except to the extent otherwise provided in these By -Laws, documents necessary or desirable in the transaction and management of the business and affairs of the Company shall be executed on behalf of the Company by Officers or employees duly authorized by the Board, or 1 otherwise when so required by law as follows: any Executive Vice President, Senior Vice President, or Vice President may act for the Chairman of the Board, the Chief Executive Officer, the President or the Corporate Secretary, and the Treasurer or any Assistant Secretary or Secretary pro tem may act for the Corporate Secretary. Any Officer or employee so authorized by the Board may affix the Corporate Seal of the Company to any document when required, and acknowledge execution thereof on behalf of the Company. That the following individual is authorized in accordance with Sections 1 and 2 of Article II and Section 1 of Article V of the Company's By -Laws amended as of March 14, 2012 set out above, as a duly elected, qualified and acting officer of the Company, with the title set forth below his name and that his specimen signature appearing opposite his name is his genuine signature: Name Anthony Perez Title Signature Vice President & Chief Underwriting Officer, Group Insurance I, Faith M. Drennan, Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem of The Guardian Life Insurance Company of America, do hereby certify that the foregoing By -Laws were duly adopted and have not been modified, amended, rescinded or revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the corporate seal of The Guardian Life Insurance Company of America this 12th day of September, 2012. SEAL Faith M. Drennan Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem 2 THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA CERTIFIED RESOLUTION - CERTIFICATE OF INCUMBENCY STATE OF NEW YORK ) ) SS: COUNTY OF NEW YORK ) Faith M. Drennan, being duly sworn, deposes and says: That she is the Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem of The Guardian Life Insurance Company of America (the "Company"), a corporation duly organized and existing under and by virtue of the Laws of the State of New York: That Sections 1 and 2 of Article II of the Company's By -Laws, amended as of March 14, 2012, provide that: SECTION 1. The Officers of the Company shall consist of a Chairman of the Board (the "Chairman"), if the Board in its discretion elects such Officer, a Chief Executive Officer, a President, one or more Vice Presidents, a Corporate Secretary, a Treasurer, a Chief Financial Officer, a Chief Investment Officer, a Chief Actuary, a Director of Internal Audit, a General Counsel and such other Officers as may be appointed by the Board. All Officers shall hold office at the discretion of the Board, the term of office being for twelve months, or until their successors are elected or appointed, unless they be removed or suspended. One person may hold more than one office (except that neither the Chief Executive Officer nor the President shall hold the office of Corporate Secretary). SECTION 2. The Board shall designate the Chief Executive Officer. The Chief Executive Officer, subject to the authority of the Board, and to the extent not otherwise prescribed by these By -Laws shall have the general control and management of the Company's business and affairs, supervision of all Officers and custody of all property of the Company. The Chief Executive Officer, at his discretion subject to the authority of the Board, shall delegate to the other Officers and employees of the Company such duties, responsibilities, and authority not inconsistent with any which may be vested in them by the By -Laws, the Board or any appropriate Committee. That Section 1 of Article V of the Company's By -Laws, amended as of March 14, 2012, provides that: SECTION 1. Except to the extent otherwise provided in these By -Laws, documents necessary or desirable in the transaction and management of the business and affairs of the Company shall be executed on behalf of the Company by Officers or employees duly authorized by the Board, or 1 otherwise when so required by law as follows: any Executive Vice President, Senior Vice President, or Vice President may act for the Chairman of the Board, the Chief Executive Officer, the President or the Corporate Secretary, and the Treasurer or any Assistant Secretary or Secretary pro tem may act for the Corporate Secretary. Any Officer or employee so authorized by the Board may affix the Corporate Seal of the Company to any document when required, and acknowledge execution thereof on behalf of the Company. That the following individual is authorized in accordance with Sections 1 and 2 of Article II and Section 1 of Article V of the Company's By -Laws amended as of March 14, 2012 set out above, as a duly elected, qualified and acting officer of the Company, with the title set forth below his name and that his specimen signature appearing opposite his name is his genuine signature: Name Anthony Perez Title Signature Vice President & Chief Underwriting Officer, Group Insurance I, Faith M. Drennan, Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem of The Guardian Life Insurance Company of America, do hereby certify that the foregoing By -Laws were duly adopted and have not been modified, amended, rescinded or revoked. IN 1.ESTIMONY WHEREOF, I have hereunto set my hand and affixed the corporate seal of The Guardian Life Insurance Company of America this 12t' day of September, 2012. SEAL Faith M. Drennan Second Vice President, Assistant Corporate Secretary and Secretary Pro Tem 2 MDG Network Accessibility Analysis City of Miami MDG ALL Created for... CITY OF MIAMI August 30, 2012 Created with the Quest Analytics Suite Copyright 0 2003-12 Quest Analytics, L.L.C. MDG Network Accessibility Analysis Contents 1.1 City of Miami MDG ALL August 30, 2012 Created for... CITY of MIAMI Access Overview - All Employees Access Summary by City - All Employees Access Detail by State - All Employees Access Overview - All Employees Access Summary by City - All Employees Access Detail by State - All Employees Access Overview - All Employees Access Summary by City - All Employees Access Detail by State - All Employees Access Overview - All Employees Access Summary by City - All Employees Access Detail by State - All Employees Access Overview - All Employees Access Summary by City - All Employees Access Detail by State - All Employees Radius Search Results by Zip Code Employee Map - All Employees 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 MDG Network Accessibility Analysis - All Employees Access Overview 2 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2in 15 Provider Group Managed DentalGuard General Dentists Comparison Graph Percent of empbyees with access to a choice of providers over miles. ❑ 1st cbsest provider 2nd closest provider 3rd cbsest provider The Access Standard's defined as having: 2 (Managed DentalGuard General Dentists) Providers within 15.0 miles empleyeeS 05:providers atr3;8841ocations 0 2012 Qlesf Malyfics, LLC fared Nees AVetag4.bietehces veragellistance;to ' stclosestprovlderr 1.3 miles ver'agedista 't to " `'{` 2ndreiosest;`liovitler. 1.7 miles verage,dA,' istafce.to',;;:,' rdkclbsest provider 1.9 miles �Y,�z-�•q�K;�%xxy��? S;*��y,."�,v'�'�i.�:`�~"`E.f;�,i�::,�.,'z,'" MDG Network Accessibility Analysis - All Employees Access Summary by City 3 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2in15 Provider Group Managed DentalGuard General Dentists Areas With Access Top 15 cities in the marltet, sorted by the number of empbyees with access. Areas Without Access Bottom 15 cities in the market, sorted by the number of empbyees without access. 1 The Access Standard is defined as having: 2 (Managed DentalGuard General Dentists) Providers within 15.0 miles 'Mianl,°FL t >' M Hollywood, FL :H Ieafi FLx3 Fort Lauderdale, FL Opal Locla,FL_'' Homestead, FL <Miami Gardens FLU-. Miami Beach, FL North Mainl6each;F'P Pompano Beach, FL Pembroke Fines, FL West P.ahn Beat FL ' Loxahatchee, FL 51 26 8 5 4 3 3 487 ' ;Key LargoFL �rl R� of . .. . �.�a ,a. " � r:,. r .$ � ,�`�„ .x �..; r :_��� ...,:1�- ' �'n Totals , � $.,�, 3,r� 3 t< ��,� 0� 0 ,�ti��00 0.0 ��R.. 3� 3 �00 100.0 { ,�� _:d6 4.6 � 2�3, 25.3 259 25.9 ".- ;�.0 3 d { f �#t' '' ay[i'�`' U: g �R . 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CITY OF MIAMI _ Access Standard 2ii 15 Provider Group Managed DentalGuard Endodontists Comparison Graph Percent of empbyees with access to a choice of providers over miles. ❑ 1st closest provider 2nd closest provider 3rd cbsest provider The Access Standard 's defined as having: 2 (Managed DentalGuard Endodontists) Providers within 15.0 miles 0 2012 Quest Aialylics, LLC itiaije blsteiice'x iii,4re •''.J b '' --,fi!.--''•fa'.a�hy'%.+.`i',';A" fsF Average'_dlstance fo : sesbjotovlderder >" - Matdoses 3.0 miles am AveFae, Istanee .to sest=provid o provide y 4, : 3.6 miles verage;: fste ce:to`<,. 3rd-ciosest,proyider- 4.7 miles MDG Network Accessibility Analysis - All Employees Access Summary by City 6 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Endodontists Areas With Access Top 15 cities in the marlet, sorted by the number of empbyees with access. 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'l.,hY'hv ,nii'.?, <K �,;:� .'ts r�,'3YY'i�'*-2.'.,,. ,.,�., i�fl-.r,,..; f,. `.�c'"".+ .' ,>" ... Yf�+,. a '*" w " .:�� , ..,iv F::h' ���r-z . ;.sy,�*- >, § K,m<..-_C "'�-?.;,,%:f;�- x.N.. rru%F"v,..N, `Si'�erij, , r.<., iR.,. .r'�"%'�' d : �,; �✓Xa„< Y', i':f'?" . .g:: 7,Mr,,. '.S "'�__- `a.r..s'•<sb�x .. <-<r<.ea,. �::'3'��'�:.,,,,.u�a�3:a:a;a... a_:�G. ,.<,.,ua'i��':"'�+,: rt,�A>v^. u eS.a < x., ,a..:,.w.� r ,.. ., s . .�., "%=e�'�. , .. ,, x .. ,. ., - , . ,. 0 2012 Quest Malyfics, LLC MDG Network Accessibility Analysis - All Employees Access Detail by State 7.1 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Endodontisls The Access Standard is defined as having: 2 (Managed DentalGuard Endodontisls) Providerswthin 15.0 miles 0 2012 Quest Melytics, LLC MDG Network Accessibility Analysis - All Employees Access Overview 8 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Periodontists Comparison Graph Percent of employees with access to a choice of providers over miles. 0 1st closest provider 122nd cbsest provider 3rd cbsest provider r The Access Standard is defined as having: 2 (Managed DentalGuard Periodontists) Providers within 15.0 miles 495employees' 546'provIrlars at-1;252`locationsb 0 2012 Quest Malytics, LLC �;�:'•��,-;'.t<:F�bii'aia a4ta lyerage.stance'to: 'r ,.k „ ;. 9stclosest provlderu fl�Sa-,r;iAri�'' t1%v .gsa%r"' 2.6 miles i4verage tliatance to _ 2nd=glosest;provider1. 3.2 miles 3rAverage.aistance to u- P R :a; 3ti closest%provider. 3.7 miles 'w'e", �. .r.S: r�'` .,�- Jx,;+:�';�'::�i✓;jam 'k MDG Network Accessibility Analysis - All Employees Access Summary by City 9 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2in15 Provider Group Managed DentalGuard Periodontists Areas With Access Top 15 cities in the market, sorted by the number of empbyees with access. Areas Without Access Bottom 15 cities in the marlet, sorted by the number of empbyees without access. 1 The Access Standard b defined as having: 2 (Managed DentalGuard Periodontists) Providers within 15.0 miles fialeah�FL�� Fort Lauderdale, FL Opa Lo k FLFz.; Miami Gardens, FL Homdstea ; FL?' Miami Beach, FL Pompanojeeach FL North Miami Beach, FL HPenibrdniFins;;FL 1y West Palm Beach, FL Lo),iahatchee Fl` Naples, FL Y 90 N��; � �� ! �� '� Y¢�� �r Homestead,FL „� 3 z f ^ vcY �9sw^G fir' . 2^z w •'N` Nagle$ FL ,�..,.�..��.Q.�. � ' r��t��. �;, , ����,...i,,�.��>M!"�� �`,-. �".4 .NRs�,t � ,�. �.�, N'�.�;��.,• « Totals � 3 8 S^ fl ,�° � w5�� 15 000. 6 �. _. , . Q� 3 9 75.0 ^.m, H75 0 60.0 f 3 2 !. X . ''�,..��; 6 {00 25.0 ma � Ors 40.0 ' 3 8 x T � . 1d8� 17.0 1. 15.5 �,163; 24.4 31:: 15.5 rm �: 24.4 t=v� �.. � ': .a� �:�:ia'a^� ..'..�..�..::..'*.•!',, �..a', ;x, z` �'S �C"-.;� ,...,-,:� .:.,,��, � a�,k �.>;.k.;». �., n....., ,_��,. �..», ?Y�5'. �..f-.w',>7.ay.; : x �: A,,., �.,.:.�1� ^�i:�'�"i{a�u:':'T^�-"'S,. �.. r..��,%4:�s . ��,�:�,.._.r Sis ��'.� -�-.`�,��in.,. �r�;"u'.,' ��h�� =3rYi �" � ~.x. ° -'. r'�?F,a'H, 'T ..,T � ��3 ��iC4a�"�i �+',r+rr �^ Y',' � y XC' V � .«n.��".fir .`v4�x.<<...-,.„.. ..._ .. a_��$�kr�:�'..`•ai. .. �aP�.$:'.ruJ�'�:.....�.� W.�-, .. ��z., �'A. $...;� z .:.w`�.> ..3'.. ^�.�� x�� 3�i �"�. ;4a'�"a°z ..??.S.T � .. �'«�.'�'a:�� ..�e'z•..�1� .,h�� ,y�, `' - "' i' ."� hfk h Y�i� ? Y""'.wp i*- "' z+.hC' yy"'G Uy✓` 4 7j' ,1..` i~ r.,: �'€ '� 3 ^^•!r ' i'-q,rx� i d b r . s. s ,, i?s .-. ..s.•�, kw�.�art?e.w .4�^s..., ,...,«.. Lo .>..a.. 5�'.n.N ,.t..«, ..e`+.^ ..sC.._... `� .J rv<.r��� ® 2012 (.Lest Malytics, LLC MDG Network Accessibility Analysis - All Employees Access Detail by State 10.1 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Periodontists The Access Standard is defined as having: 2 (Managed DentalGuard Perbdonists) Providers within 15.0 miles 0 2012 Quest Aalytics, LLC MDG Network Accessibility Analysis - All Employees Access Overview 11 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard tin 15 Provider Group Managed DentalGuard Oral and Maxilbfacal Surgeons Comparison Graph Percent of employees with access to a choice of providers over miles. ❑ 1st closest provider i] 2nd closest provider 3rd closest provider 1 The Access Standard is defined as having: 2 (Managed DentalGuard Oral and Maxilbfadal Surgeons) Providers within 15.0 miles 5 employees;" 6 provlders at 1 54 location aeis dai- Stistiii ¢¢��?�77,,,,yy {.�...,... _j: Otago blatati " '. �. M'•Y 'r+1Y. Average:distance toY = 1stclosestprovtder 3.0 miles ".'Vara ei dlstancet '' 0.:..3.,.:�;£°� F nd=tigseei provide 4.2 miles Avers a dlse anae`to rdclosesi;provlder 4.8 miles 100 90 80 70 N I 60 O n E `L 50 0 40 a 30 20 10 0 1 2 3 4 5 6 7 9 10 11 12 Miles to a Choice of Providers 13 14 15 16 17 18 19 20 0ton Cued Melyfics, LLC MDG Network Accessibility Analysis - All Employees Access Summary by City 12 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Oral and Maxilbfacial Surgeons Areas With Access Top 15 cities in the marlet, sorted by the number of employees with access. Areas Without Access Bottom 15 cities in the market, sorted by the number of employees without access. 1 The Access Standard is defined as having: 2 (Managed DentalGuard Oral and Maxibfacial Surgeons) Providers within 15.0 miles Wirnr Hollywood, FL Hialeah FL ., `x ' r Fort Lauderdale, FL 1Opa I174ft Miami Gardens, FL Hoinestead,,FL ,` Miami Beach, FL ,Pompano 6eacli;-FL. North Miami Beach, FL P; ricbTokTPiniesit West Palen Beach, FL �Loiiahalcfiee�FL' :: Naples, FL :.: .Lg0,.,<..,...s. :,.�>7.s..;., ?^a'-""^'•"-:> Naples, FL :�.x•?.;i?"G�,�i -:*, '3_ ..1.,„ 4 0,- 3 `3 . 75.0 %,«.m3 MaFw3x. 1 ?a0m0> 25.0 16.3 ,7,x-. 16.5 19.4 ^M'n3',.;.,,_.... ,. ..i"-r«-, _..,,.--',.£"",.,•.v-..,-�+. :r-.xlinwvx'C6'TYR,,.>". >�'✓ .r✓._.... .: � -`+�e ,' „ . .. 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'��: �r'i. � ;-. .,x x`aY e #.n+n? < ,. f.a F r r 0 2012 Cues( Malyfics, LLC MDG Network Accessibility Analysis - All Employees Access Detail by State 13.1 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Oral and Maxilofacial Surgeons The Access Standard is defined as having: 2 (Managed DentalGuard Oral and Maxlbfadal Surgeons) Providers within 15.0 miles 0 2012 Quest Malylics, LLC MDG Network Accessibility Analysis - All Employees Access Overview 14 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 2in 15 Provider Group Managed DentalGuard Orthodontists Comparison Graph Percent of employees with access to a choice of providers over miles. ❑ 1st cbsest provider 2nd closest provider 3rd closest provider r The Access Standard is defined as having: 2 (Managed DentalGuard Orthodontists) Providers within 15.0 miles 495 employees y6131fprovidersat 196l°cations 0 2012 Quest Melylics, LLC 9 10 11 12 Mlles to a Choice of Providers O%age'bIstafices:;...;.:.' ;�. AYveeiragezdt.3l(st� aiicir.e'�"'-'�'ixl<i,`�,� stclosespovlderters Fa , 2.8 miles verage dt§tance t6 nclosestprovldef yr ' z. ; 3.5 miles Avenge', !stanee'to=°°•• '^3rdclosest:provfder � 74=- ° 4.' 4.7 miles MDG Network Accessibility Analysis - All Employees Access Summary by City 15 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Access Standard 211115 Provider Group Managed DentalGuard Orthodontists Areas With Access Top 15 cities in the market, sorted by the number of employees with access. Areas Without Access Bottom 15 cities in the market, sorted by the number of empbyees without access. The Access Standard is defined as having: 2 (Managed DentalGuard Orthodontists) Providers wfhin 15.0 miles t95:emjiloyees;.;°`'`'` P`r a92 (9,9,4%) employees with acres ; 0'6%) employees wit(ioutaccess'= _ ,�:.. k'Yyh°M. .,.�*�b:��:�_:.<„"•i€�,`,`rkrx=rises. ��<'. Mia5 FL r- 3 Hollywood, FL HaafiFL Fort Lauderdale, FL ;Opa Locka FL Miami Gardens, FL Romestead;iFl Miami Beach, FL Pompano Booli FLU North Miami Beach, FL :Naples; Pembrole Pines, FL ;;Nlest P,airti; 6each;FL Loxahatchee, FL _3.. : ,- > s 2 1 r) .R ... x.:x. lxm.- .Sk::" .�Y,s.`,.; .,:'iY�-+, ��k'3,:-�uk';,"' . , "hy RJ, .,G�?"'-:r.FR�f. s�xJ: L'. ,. 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CITY OF MIAMI Access Standard 2 in 15 Provider Group Managed DentalGuard Orthodontists 1 The Access Standard is defined as having: 2 (Managed DentalGuard Orthodontists) Providers within 15.0 miles 0 2012 Cued Malylics, LLC MDG Network Accessibility Analysis Radius Search Results by Zip Code 17.1 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Provider Group Managed DentalGuard - AI Dentists 1 Zip code geographic centroids were used as the search points. u1 2012 Q/esl Matytics, LLC coward Gouni Collier Coiirity, Martin County 33317 33321 33328 33331 33025 3026'. 33027 23020. 33028 33068 �3307�1;; 33073 34113 120s.x` 34997 33014 1330,15 33016 '33017 33018 tovideFeNeitZi ilpie, 6s dar 2.i0 Cotia IV cod 6 153 150 278 230 282 156 453 454 603 585 385 5_t75h 237 1,162 4.71-1 1,095 4 600 924 971 040 975 877 430 823 1,169 1,058 1,043 3. 1s333 Continued on next page... MDG Network Accessibility Analysis Radius Search Results by Zip Code 17.2 City of Miami MDG ALL August 30, 2012 Created tor... CITY OF MIAMI Provider Group Managed DentalGuard - All Dentists f Zip code geographic centroids were used as the search points. Miam Nomesfeai Miami 33031 3i35, 33136 33147 33150 33155 �-z^rrx a : 33156; 33157 33,16 33162 3315 33166 �33167<xe 33168 33169 33170 33�72 33173 3�17g 33175 18 484 „Elk 694 1,146 ® 20f2 Quest Malylics, LLC Continued on nexd page... MDG Network Accessibility Analysis Radius Search Results by Zip Code 17.3 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI Provider Group Managed DentalGuard - All Dentists t Zip code geographic centrals were used as the search points. 012012 Quest Analylics, LLC Morirae Courityry . Palm Beach County St. Lude County 19v 29 M m Garden North Miami Beach Opa.ioclr�: Loxahatchee Palm Beach Gardens rq Wellington WestPalm Beach Port Sant Lude 33177 33179 33182 33184 33185, 33186 33233 33283 33140 33160 33055 33037 33470 308 5li6 458 425 277 303 133 287 259 294 ii 506 334 537 '�h 574 596 966 0 368 652 G62 172 589 1,257 249 1,025 "921' 182 MDG Network Accessibility Analysis Employee Map 18 City of Miami MDG ALL August 30, 2012 Created for... CITY OF MIAMI City of Miami 495 employee bcatbns All Empbyees Service Areas MDG ALL 1 in. = 375.76 miles © 2012 Quest Melyfics, LLC Certificates of Authority Guardian provides a variety of employee benefit programs in the United States. While offered across a broad geographical range, certain products and programs may not be available in all states. Guardian offers benefit plans in the states where we are licensed and have obtained all required approvals. Copies of the state approval documentation including licenses and certificates of authority are available upon request. DENTAL • LIFE • DISABILITY • CRITICAL ILLNESS • SECTION 125 • VISION The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025 GUARDIAN LIFE INSURANCE COMPANY OF AMERICA Is hereby authorized to transact insurance in the State of. Florida. This certificate signifies that the company has satisfied all requirements of the Florida Insurance Code for the issuance of a license and remains subject to all applicable laws of Florida. Date of Issuance: September 1, 1991 No. 91-13-5123390 Tom Gallagher Treasurer and Insurance Commissioner Managed DentalGuard - Plan Schedule Enhanced Plan Schedule CDT Codes ++ Covered Services and Patient Charges Plan Schedule - Patient Charges Plan U20 D0999 • Office visa during regular hours, general dentist only $5 / $10 Evaluations 0 0 0 0 0 0 D0120 Periodic oral examination established patient D0140 Limited oral evaluation —problem focused D0145 Oral evaluation for a patient trader three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation— new or established patient D0170 Re-evaluation — limited, problem focused (established patient, not post -operative visit) D0180 Comprehensive periodontal evaluation — new or established patient Radiographs/Diagnostic Imaging (Including Interpretation) D0210 Intraoral — complete series (including biewings) Intraoral — 0 D0220 periapical first film 0 D0230 Intraoral — periapical each additional film 0 D0240 intraoral — occlusal film Bitewing — 0 D0270 single film Bitewings — two film 0 D0272 Bitewings — three films Bitewings — 0 D0273 four films • 0 D0274 Vertical bitewings — 7 to 8 films 0 D0277 Panoramic film 0 D0330 0 Tests and Examinations D0431 Adjunctive pre -diagnostic test that aids in detection of mucosal abnormalities including premaligoant and malignant lesions, not to include cytology or biopsy procedures 50 D0460 Pulp vitality tests 0 D0470 Diaimostic casts 0 Dental Prophylaxis D 1110 Prophylaxis — adult, for the fast two services in any 12-month period + Prophylaxis — child, 0 DI 120 for the first two services in any 12-month period + Prophylaxis (adult or child), each 0 D1999 additional service in same 12-month period + 60 Topical Fluoride Treatment (Office Procedure) D1203 Topical application of fluoride (prophylaxis not included) — child, for the first two services in any 12-month period + 0 D1204 Topical application of fluoride (prophylaxis not included) — adult, for the first two services in any 12-month period + 0 D 1206 Topical fluoride varnish; therapeutic application for moderate to high caries risk patients, for the first two services in any I2-month period + 12 D2999 Topical fluoride (adult or child), each additional service in the same 12-month period+ 20 Other Preventive Services D 1310 Nutritional counseling for control of dental disease 0 D1330 Oral hygiene instructions Sealant — per tooth 0 D1351 (molars) Sealant— per tooth (non -molars) 8 D9999 35 Space Maintenance (Passive Appliances) D1510 Space maintainer — fixed - unilateral Space 59 D1515 maintainer— fixed - bilateral Space maintainer— 78 D1525 removable - bilateral Re -cementation of space 78 D1550 maintainer Removal of fixed space maintainer 13 D1555 20 Amalgam Restorations (Including Polishing) Amalgam — D2140 one surface, primary or permanent Amalgam — two surfaces, - 20 D2150 primary or permanent Amalgam— three surfaces, primary or 27 D2160 permanent 32 D2161 Amalgam— four or more surfaces, primary or permanent 40 Resin -Based Composite Restorations - Direct D2330 Resin -based composite — one surface, anterior Resin -based 25 D2331 composite — two surfaces, anterior Resin -based composite — 30 D2332 three surfaces, anterior 41 D2335 Resin -based composite — four or more surfaces or involving incisal angle (anterior) Resin -based 46 D2390 composite crown, anterior 57 D2391 Resin -based composite— one surface, posterior Resin -based 30 D2392 composite— two surfaces, posterior Resin -based composite — 40 D2393 three surfaces, posterior 47 D2394 Resin -based composite — four or more surfaces, posterior 57 Current Denial Terminology (CDT) ® American Dental Association (ADA) + The patient charges for codes DI 110, DI 120, DI203, D1204, D1206 and D4910 are limited to the first two services in any 12-month period. For each additional service in the same 12- month period see codes D1999, D2999 and D4999 for the applicable patient charge. ++ Covered Services are subject to exclusions, limitation and Plan provisions as described in Member's Plan booklet and the Manual (including the Quality Managemem retrospective review). Other codes nay be used to describe Covered Services. • The Member will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is an "M". The Plan will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is a "G". The Eligibility Report will indicate if the Office Visit Fee is $5 or 510. •• If high noble metal is used there will be an additional patient charge for the actual cost of the high noble metal. GUARDIAN* Page 1 of 10 V.08199 Managed DentatGuard - Plan Schedule Enhanced Plan Schedule CDT Codes ++ Covered Services and Patient Charges Plan Schedule - Patient Charles Plan U20 Inlay/Onlay Restorations D2510 Inlay — metallic — one surface ** Inlay — $326 D2520 metallic — two surfaces ** 368 D2530 Inlay — metallic — three or more surfaces ** Onlay — 383 D2542 metallic — two surfaces ** 383 D2543 Onlay— metallic — three surfaces ** 400 D2544 Onlay — metallic — four or more surfaces ** Inlay — 420 D2610 porcelain/ceramic— one surface Inlay— 326 D2620 porcelain/ceramic — two surfaces 368 D2630 Inlay — porcelain/ceramic — three or more surfaces 383 , D2642 Onlay—porcelain/ceramic—twosurfaces 383 D2643 Onlay—porcelain/ceramic—threesurfaces 400 D2644 Onlay — porcelain/ceramic — four or more surfaces 420 Crowns — Single Restorations Only D2740 Crown—porcelain/ceramic substrate 450 D2750 Crown — porcelain fused to high noble metal' ** Crown — porcelain 430 D2751 fused to predominantly base metal Crown — porcelain fused to 430 D2752 noble metal 430 D2780 Crown — % cast high noble metal ** Crown —'34 cast 420 D2781 predominantly base metal Crown —''4 cast noble metal 420 D2782 Crown —'/ porcelain/ceramic 420 D2783 Crown — full cast high noble metal ** Crown — full cast 420 D2790 predominantly base metal Crown — full cast noble metal 430 D2791, Crown —titanium 430 D2792 430 D2794 430 Other Restorative Services D2910 Recement inlay, onlay, or partial coverage restoration Recement 16 D2915 cast or prefabricated post and core Recement crown 16 D2920 Prefabricated stainless steel crown— primary tooth Prefabricated 16 D2930 stainless steel crown — permanent tooth Prefabricated resin crown 110 D2931 Prefabricated stainless steel crown with resin window Prefabricated esthetic 125 D2932 coated stainless steel crown — primary tooth Sedative filling 132 D2933 Core buildup, including any pins 132 D2934 Pin retention— per tooth, in addition to restoration 142 D2940 Cast post and core in addition to crown Each additional cast 16 D2950 post — same tooth Prefabricated post and core in addition to 113 D2951 crown Each additional prefabricated post — same tooth Labial 24 D2952 veneer (resin laminate) — cbai side Temporary crown 160 D2953 (fractured tooth) 50 D2954 Additional procedures to construct new crown under existing partial denture framework 130 D2957 29 D2960 250 D2970 100 D2971 125 Pulp Capping D3110 Pulp cap — direct (excluding final restoration) Pulp cap — 12 D3120 indirect (excluding final restoration) 9 Pulpotomy D3220 Therapeutic pulpotomy (excluding final restoration) — removal of pulp coronal to the dentinocemental junction and application of medicament 33 D3221 Pulpal debridement, primary and permanent teeth 32 D3222 Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development Pulpal 33 D3230 therapy (resorbable filling) — anterior, primary tooth (excluding final restoration) Pulpal therapy 37 D3240 (resorbable filling) — posterior, primary tooth (excluding final restoration) 38 Endodontic Therapy (Including Treatment Plan, Clinical Procedures And Follow-up Care) D3310 Anterior (excluding final restoration) Bicuspid 126 D3320 (excluding final restoration) Molar (excluding 148 D3330 final restoration) 192 D3331 Treatment of root canal obstruction non -surgical access 0 D3332 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth 126 D3333 Internal root repair of perforation defects 63 Endodontic Retreatment D3346 Retreatment of previous root canal therapy — anterior Retreatment 285 D3347 of previous root canal therapy — bicuspid Retreatment of previous 335 D3348 root canal therapy — molar 400 Current Denta Terminology (CDT) C American Dental Association (ADA) + The patien charges for codes D1110, D 1120, D1203, D1204, D1206 and D4910 are limited to the first two services in any 12-month period For each additional service in the same 12- month period, see codes D 1999, D2999 and D4999 for the applicable patient charge. ++ Covered Services are subject to exclusions, limitations and Plan provisions as described in Member's Plan booklet and the Manual (including the Quality Management retrospective review). Other codes may be used to describe Covered Services. • The Member will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is an "M". The Plan will be responsible for the Office Visa Fee when the Plan Schedule suffix . listed on the Eligibility Report is a "G". The Eligibility Report will indicate if the Office Visit Fee is $5 or $10. ** If high noble metal is used, there will be an additional patient charge for the actual cost of the high noble metal Page 2 of 10 V.08199 Managed DentalGuard - Plan Schedule Enhanced Plan Schedule CDT Codes ++ Covered Services and Patient Charges Plan Schedule - Patient Charges Plan U20 Apicoectomy/Periradicular Services Apicoectomy/periradicular D3410 surgery —anterior Apicoectomy/periradicular surgery — bicuspid (first 8137 D3421 root)Apicoectomy/periradicularsurgery — molar (first root) 147 D3425 Apicoectomy/periradicular surgery (each additional root) Retrograde 155 D3426 filling — per root 63 D3430 Canal preparation and fitting of preformed dowel or post 46 D3950 20 Surgical Services (Including Usual Postoperative Care) D4210 Gingivectomy or gingivoplasty — four or more contiguous teeth or bounded teeth spaces per quadrant Gingivectomy or gingivoplasty— one to three contiguous teeth or bounded teeth spaces per quadrant 105 D4211 Gingiva] flap procedure, including root planing — four or more contiguous teeth or bounded teeth spaces per quadrant 30 D4240 Gingival flap procedure, including root planing — one to three contiguous teeth or bounded teeth spaces per quadrant 121 D4241 Clinical crown lengthening — hard tissue Osseous surgery (including flap entry and closure) — four or more contiguous teeth or bounded teeth spaces 73 D4249 per quadrant 147 D4260 Osseous surgery (including flap entry and closure)— one to three contiguous teeth or botmded teeth spaces per quadrant 210 D4261 Surgical revision procedure, per tooth Pellicle soft tissue graft procedure 137 D4268 Free soft tissue grafi procedure (including donor site surgery) 0 D4270 Subepithelial connective tissue graft procedures, per tooth 147 D4271 170 D4273 187 Non -Surgical Periodontal Service D4341 Periodontal scaling and root planing— four or more teeth per quadrant 42 D4342 Periodontal scaling and root planing— one to three teeth per quadrant 25 D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis 27 Other Periodontal Services D4910 Periodontal maintenance, for the first two services in any 12-month period + 28 D4920 Unscheduled dressing change (by someone other than treating dentist) Periodontal 25 D4999 maintenance, each additional service in same 12-month period + 60 Complete Dentures (Including Routine Post -Delivery Care) D5110 Complete denture — maxillary Complete 580 D5120 denture - mandibular Immediate denture — 580 D5130 maxillary Immediate denture — mandibular 620 D5140. 620 Partial Dentures (Including Routine Post -Delivery Care) D5211 Maxillary partial dentine — resin base (including any conventional clasps, rests and teeth) Mandibular 580 D5212 partial denture — resin base (including any conventional clasps, rests and teeth) Maxillary partial denture 580 D5213 — cast metal framework with resin dentre bases (including any conventional clasps, rests and teeth) 620 D5214 Mandibular partial denture — cast metal framework with resin denture bases (includi g any conventional clasps, rests and teeth) 620 D5225 Maxillary partial denture — flexible base (including any clasps, rests and teeth) Mandibular 675 D5226 partial denture — flexible base (including any clasps, rests and teeth) 675 Adjustments to Dentures D5410 Adjust complete denture — maxillary Adjust 27 D5411 complete denture — mandibular Adjust partial 27 D5421 denture — maxillary Adjust partial denture — 27 D5422 mandibular ' 27 Repairs To Complete Dentures D5510 Repair broken complete denture base 69 D5520 Replace missing or broken teeth — complete denture (each tooth) 66 Repairs To Partial Dentures Repair resin D5610 denture base Repair cast framework 80 D5620 Repair or replace broken clasp Replace broken 80 D5630 teeth — per tooth Add tooth to existing partial 96 D5640 denture Add clasp to existing partial denture 62 D5650 Replace all teeth and acrylic on cast metal framework (maxillary) Replace all 81 D5660 teeth and acrylic on cast metal framework (mandibular) 102 D5670 223 D5671 223 Denture Rebase Procedures Rebase complete D5710 maxillary denture Rebase complete mandibular 230 D5711 denture 230 Current Denta Terminology (CDT) C American Dental Association (ADA) + The patien charges for codes Dl 110, D1120, D I203, D I204, D1206 and D4910 are limited to the first two services in any 12-month period. For each additional service in the same 12- ninth period, see codes D1999, D2999 and D4999 for the applicable patient charge. ++ Covered Services are subject to exclusions, limitations and Plan provisions as described m Member's Plan booklet and the Manual (including the Quality Management retrospective review). Other codes may be used to describe Covered Services. • The Member will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is an "M". The Plan will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is a "G". The Eligibility Repot will indicate if the Office Visit Fee is $5 or 510. ▪ If high noble metal is used, there will be an additional patient charge for the actual cost of the high noble metal Page 3 of 10 V.08199 Managed DentalGuard - Plan Schedule Enhanced Plan Schedule CDT Codes 1 1 Covered Services and Patient Charges Plan Schedule - Patient Charges -Plan U20 Denture Rebase Procedures (continued) D5720 Rebase maxillary partial denture $230 D5721 Rebase mandibular partial denture 230 Denture Reline Procedures ' D5730 Reline complete maxillary denture (chairside) Reline 130 D5731 complete mandibular denture (chairside) Reline maxillary 130 D5740 partial demure (chairside) Reline mandibular partial denture 125 D5741 (chairside) Reline complete maxillary denture (laboratory) 125 D5750 Reline complete mandibular denture (laboratory) Reline 186 ' D5751 maxillary partial denture (laboratory) Reline mandibular 186 D5760 partial denture (laboratory) 186 D5761 186 Interim Prosthesis D5820 Interim partial denture (maxillary) Interim partial 175 D5821 denture (mandibular) 175 Other Removable Prosthetic Services D5850 Tissue conditioning maxillary 55 D5851 Tissue conditioning, mandibular 55 Fixed Partial Denture Pontics D6210 Pontic — cast high table metal ** 400 D6211 Poetic — cast predominantly base metal 400 D6212 Pontic — cast noble metal 400 D6214 Pontic — titanium 400 D6240 Pontic — porcelain fused to high noble metal ** 400 D6241 Pontic — porcelain fused to predominantly base metal 400 D6242 Pontic — porcelain fused to noble metal 400 D6245 Pomic— porcelain/ceramic 410 Fixed Partial Denture Retainers— Inlays/Onlays D6600 Inlay — porcelain/ceramic — two surfaces 368 D6601 Inlay — porcelain/ceramic — three or more surfaces 383 D6602 Inlay — cast high noble metal, two surfaces ** 368 D6603 Inlay — cast high noble metal, three or more surfaces ** Inlay— cast 383 D6604 predominantly base metal, two surfaces 368 D6605 Inlay — cast predominantly base metal, three or more surfaces 383 D6606 Inlay — cast noble metal, two surfaces 368 D6607 Inlay — cast noble metal, three or more surfaces 383 D6608 Onlay — porcelain/ceramic, two surfaces 383 D6609 Onlay — porcelain/ceramic, three or more surfaces 400 D6610 Onlay — cast high noble metal, two surfaces ** 383 D6611 Onlay — cast high noble metal, three or more surfaces ** Onlay — cast 400 D6612 predominantly base metal, two surfaces 383 D6613 Onlay — cast predominantly base metal, three or more surfaces 400 D6614 Onlay— cast noble metal, two surfaces 383 D6615 Onlay — cast noble metal, three or more surfaces 400 D6624 Inlay — titanium 368 D6634 Onlay — titanium 383 Fixed Partial Denture Retainers — Crowns D6740 Crown—porcelain/ceramic 450 D6750 Crown — porcelain fused to high noble metal ** Crown — porcelain 430 D6751 fused to predominantly base metal Crown — porcelain fused to 430 D6752 noble metal 430 D6780 Crown —'4 cast high noble metal ** Crown —'4 cast 430 D6781 predominantly base metal Crown — '4 cast noble metal 430 D6782 Crown —'/, porcelain/ceramic 430 D6783 Crown — full cast high noble metal ** Crown— full cast 430 D6790 predominantly base metal Crown — full cast noble metal 430 D6791 Crown — titanium 430 D6792 430 D6794 430 Other Fixed Partial Denture Services D6930 Recement fixed partial denture 26 D6970 Cast post and core in addition to fixed partial denture retainer Prefabricated post 160 D6972 and core in addition to fixed partial denture retainer Core build up for retainer, 130 D6973 including any pins 113 D6976 Each additional cast post — same tooth 50 D6977 Each additional prefabricated post — same tooth 29 D6999 Multiple crown and bridge unit treatment plan— per unit six or more 125 Current Dental Terminology (CDT) C American Dental Association (ADA) + The patien charges for codes D1110, DI120, D1203, D1204, D1206 and D4910 are limited to the frost two services in any 12-month period. For each additional service in the same 12- month period, see codes D1999, D2999 and D4999 for the applicable patient charge. ++ Covered S rvices are subject to exclusions, limitations and Plan provisions as described in Member's Plan booklet and the Manual (including Quality Management retrospective review). Other codes may be used to describe Covered Services. The Member will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is an "M". The Plan will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is a "G". The Eligibility Report will indicate if the Office Visit Fee is $5 or $10. ** If high noble rmtal is used, there will be an additional patient charge for the actual cost of the high noble metal Page 4 of 10 V.08199 Managed DentalGuard - Plan Schedule Enhanced Plan Schedule CDT Codes ++ Covered Services and Patient Charges .Plan Schedule - Patient Charges Plan U20 Extractions D7111 Extraction, comnal remnants — deciduous tooth S16 D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) 23 Surgical Extractions (Includes Local Anesthesia, Suturing, If Needed, And Routine Postoperative Care) D7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth 46 D7220 Removal of impacted tooth— soft tissue Removal of 62 D7230 impacted tooth — partially bony Removal of impacted tooth — 82 D7240 completely bony 96 D7241 Removal of impacted tooth — completely bony, with unusual surgical complications 116 D7250 Surgical removal of residual tooth roots (cutting procedure) Primary 51 D7261 closure ofa sinus perforation 250 Other Surgical Procedures D7280 Surgical access of an unerupted tooth 82 D7283 Placement of device to facilitate eruption of impacted tooth 35 D7285 Biopsy of oral tissue — hard (bone, tooth) Biopsy of oral 70 D7286 tissue — soft 65 D7288 Brush biopsy — transepithelial sample collection 65 Alveoloplasty— Surgical Preparation Of Ridge For Dentures D7310 Alveoloplasty in conjunction with extractions — per quadrant 53 D7311 Alveoloplasty in conjunction with extractions — one to three teeth or tooth spaces, per quadrant 26 D7320 Alveoloplasty not in conjunction with extractions — per quadrant 92 D7321 Alveoloplasty not in conjunction with extractions — one to three teeth or tooth spaces, per quadrant 65 Surgical Excision Of Intra-Osseous Lesions D7450 Removal of benign odontogenic cyst or tumor — lesion diameter up to 1.25 cm 165 D7451 Removal of benign odontogenic cyst or tumor — lesion diameter greater than 1.25 cm 240 Excision Of Bone Tissue D7471 Removal of lateral exostosis (maxilla or mandible) Removal of 215 D7472 torus palatinus 215 D7473 Removal of torus mandibularis 215 Surgical Incision D7510 Incision and drainage of abscess — intraoral soft tissue 44 D7511 Incision and drainage of abscess — immoral soft tissue — complicated (includes drainage of multiple fascia] spaces) 48 Other Repair Procedures D7960 Frenulectomy (frenectomy or frenotomy) — separate procedure 100 D7963 Frenuloplasty 168 Unclassified Treatment D9I 10 Palliative (emergency) treatment of dental pain — minor procedure 20 D9120 Fixed partial denture sectioning 15 D9215 Local anesthesia 0 D9220 Deep sedation/general anesthesia — frost 30 minutes 195 D9221 Deep sedation/general anesthesia— each additional 15 minutes Intravenous 75 D9241 conscious sedation/analgesia — first 30 minutes Intravenous conscious 195 D9242 sedation/analgesia — each additional 15 minutes 75 Professional Consultation D9310 Consultation (diagnostic service provided by dentist or physician other than practitioner providing treatment) 34 Professional Visits D9430 Office visit for observation (during regularly scheduled hours) — no other services performed 0 D9440 Office visit — after regularly scheduled hours 50 D9450 Case presentation, detailed and extensive treatment planning 0 Miscellaneous Services Occlusal adjustment D9951 — limited Odontoplasty— one to two teeth 23 D9971 External bleaching — per arch Broken 23 D9972 appointment 165 25 Current Dental Terminology (CDT) ® American Dental Association (ADA) + The patien charges for codes D 1110, D1120, D1203, D1204, D1206 and D4910 are limited to the first two services in any 12-month period For each additional service in the same 12- month period see codes D1999, D2999 and D4999 for the applicable patient charge. ++ Covered S rvices are subject to exclusions, limitations and Plan provisions as described in Member's Plan booklet and the Manual (including the Quality Management retrospective review). Other codes may be used to describe Covered Services. " The Member will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is an "M". The Plan will be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the Eligibility Report is a "G". The Eligibility Report will indicate if the Office Visit Fee is $5 or $10. '" If high noble natal is used, there will be an additional patient charge for the actual cost of the high noble metal Page 5 of 10 V.08199 GUARDIAN' Managed DentalGuard - Plan Schedule Plan U20M5 CDT Codes ++ .Covered Dental Services Patient Charges D0999 .� ,.'�'�t .., s •s. .. .n, x, x3 , ...av�.x. a sc4�, �a3'v , ;.z ,.at�3*•,a S z>'z V. `tAT`` 'i'�3.K �'�+. � .. ., Evaluaflnns ...`�S'e�s.-$G. Y�»„:<,rs z. ..x.t;:.�L;...s 9..,.a >an�h,, zF.. x._+'Ch�..:..eo� 4.xtx..,..m'?,3 �.�.� y it during regular hours, general dentist only' D0120 ' Periodic oral examination — established patient D0140 Limited oral evaluation —problem focused D0145 }Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation — new or established patient D0170 Re-evaluation — limited, problem focused (established patient, not post -operative visit) D0180 Comprehensive periodontal evaluation new or established patient .... eaM ... RadroarapDtagnostic Ima. pinQtncludmgInt.::._fi x <�-_--,, „0';: x D0210 Intraoral —complete series (including bitewings) D0220 Intraoral — periapical first film D0230 !Intraoral — periapical each additional film D0240 I Intraoral — occlusal film $5 0 0 0 0 0 0 D0270 IBitewing — single film D0272 jBttewings — two films D0273 (Bitewings — three films 0 0 0 0 �i--u ati 0 0 D0274 Bhewings — four films D0277 Vertical bitewinss — 7 to 8 films D0330 Panoramic film , a:i. r"` t'aS✓Ca .1;"'" i b, x^x 3„N a v�^ % . s c�. �' �u.e,' r�'*r it -, € a;H �,,: Tests andEtramrmahons �'�,.e� ...�..�.. �S s� ... � + � � ;� � . � err _ � ;�^�.... � .... ........ D0431 Adjunctive pre -diagnostic lest that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures 50 0 0 0 D0460 Pulp vitality tests D0470 Diagnostic casts 0 xz., - }s Dental, h axli*O `rdd't ; .s.,e ��"i' 'a. ` . a.K..:a X`-.�u4;nw_ :ro.-:.' ' - ge �i, �'s: .j.- 1 f, "g ,P }'..,x:�.:?� ,k` �--P_: -a , QA,FAN- , Xs":�n , - t D1110 Prophylaxis — adult, for the first two services in any 12-month period + # D1120 Prophylaxis — child, for the first two services in any 12-monthpenod + # D1999 Prophylaxis adult or child, for each additional service in same 12 month period + # 60 °'-; TOP cal,Ffirorfde.Treatment;Office:Procedure)rW: k __,.. c ,F. ....., r 'Ylti.. Vie. _ .._ D1203 Topical application of fluoride (prophylaxis not included) — child, for the first two services in any 12-month period + = 0 D1204 Topical application of fluoride (prophylaxis not included) — adult, for the first two services in any 12-month period + = 0 D1206 Topical fluoride varnish; therapeutic application for moderate to high canes risk patients, for the first two services in any 12-month period + = 12 D2999 Topical fluoride (adult or child each additional service in the same 12 monthpenod + 2 u i Other. PreventiveSer"vrces ._ram, _:.: c o-nr= ^ ti` ---^ .cis„ ' ,. ''h f,, 4g_aiz N'-.... 'x:a ' :.., 0. D1310 Nutritional counseling for control of dental disease D1330 Oral hygiene instructions D1351 Sealant — per tooth (molars) ^ D9999 Sealant per tooth (non molars) ^ 35 attrata (.pace Maintenance (Passive Apptrancesl 'f ....... : g ...... 5 ik ....:??;: ; , :....: ` ' D1510 Space maintainer — fixed - unilateral 59 78 0 0 D1515 ( Space maintainer —fixed - bilateral D1525 (Space maintainer — removable - bilateral D1550 IRe-cementation of space maintainer D1555 (Removal of fixed space maintainer 7; Amalgam Restorations (frieluding;Polishiny1 D2140 Amalgam — one surface, primary or permanent D2150 ?Amalgam — two surfaces, primary orpermanent D2160 !Amalgam — three surfaces, primary or permanent 8 78 13 20 ORM D2161 Amalgam four or more surfaces primary or permanent r; ,v sue. « Resm Based Composite Restorations Direct amc ro € ' s vt 4"... ..`. D2330 20 27 32 D2331 Resin -based composite — two surfaces, anterior D2332 Resin -based composite — three surfaces, anterior D2335 Resin -based composite — four or more surfaces or involving incisal angle (anterior) D2390 !Resin -based composite crown, anterior D2391 Resin -based composite — one surface, posterior D2392 Resin -based composite — two surfaces, posterior D2393 Resinbased composite three surfaces, posterior Resin based composite four or more surfaces posterior Inla-y/Onlay)Restoiations ^^„,.?��, �, '. D2510 Inlay — metallic — one surface D2520 Inlay — metallic — two surfaces D2530 !Inlay — metallic — three or more surfaces " D2542 Onlay — metallic — two surfaces"' D2543 Onlay — metallic — three surfaces " D2544 Onlay - metallic — four or more surfaces " ................... D2610 Inlay —porcelain/ceramic — one surface D2394 D2620 Inlay -porcelain/ceramic — two surfaces D2630 Inlay —porcelain/ceramic — three or more surfaces D2642 Onlay —porcelain/ceramic — two surfaces D2643 Onlay —porcelain/ceramic — three surfaces D2644 Onlay —porcelain/ceramic — four or more surfaces Page 1 of 5 30 41 46 57 30 40 47 57 326 368 383 383 400 420 326 368 383 383 400 420 V.08254 f GUARDIAN' Managed DentalGuard - Plan Schedule Plan U20M5 CDT Codes ++ Covered Dental Services Patient Charges r����;�,�,�, Crowns=:Siri�le°Restorations":Only!M^"�3,<,,* ;v,� D2740 Crown—porcelain/ceramic substrate D2750 Crown — porcelain fused to high noble metal " D2751 Crown — porcelain fused to predominantly base metal D2752 Crown —porcelain fused to noble metal 02780 Crown — 3/4 cast Mph noble metal " D2781 Crown —3/4 cast predominantly base metal D2782 Crown — 3/4 cast noble metal $450 430 430 430 420 420 420 D2783 Crown —34 porcelain/ceramic D2790 Crown — full cast high noble metal " D2791 Crown — full cast predominantly base metal D2792 Crown —full cast noble metal D2794 Crown - titanium Other Restorative sernces , k a: 4 s...... .. t, D2910 Recement inlay, onlay, or partial coverage restoration D2915 Recement cast orprefabricatedpost and core D2920 Recement crown D2930 Prefabricated stainless steel crown —primary tooth D2931 Prefabricated stainless steel crown —permanent tooth D2932 Prefabricated resin crown D2933 Prefabricated stainless steel crown with resin window D2934 Prefabricated esthetic coated stainless steel crown — primary tooth D2940 Sedative filling D2950 Core buildup, including any pins D2951 Pin retention —per tooth, in addition to restoration D2952 Post and core in addition to crown, indirectly fabricated • D2953 Each additional indirectly fabricated post — same tooth D2954 Prefabricated post and core in addition to crown D2957 Each additional prefabricated post — same tooth 02960 Labial veneer (resin laminate) — chairside D2970 `Temporary crown (fractured tooth) D2971 Additional procedures to construct new crown under existing partial denture framework ',.!' .a° r, Pit Ca m z� .5.•sm ; a rh s x ; ' .: ? .; :.. atiWit.4 _'�'r . -7 D3110 Pulp cap —direct (excludin9 final restoration) D3120 Pulp cap indirect excludin final restorafion ( g ) D3220 Therapeutic pulpotomy (excluding final restoration) — removal of pulp coronal to the dentinocemental junction and application of medicament D3221 Pupal debrdement, primary and permanent teeth D3722 Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development D3230 Pulpal therapy (resorbable filling) — anterior, primary tooth (excludin9 final restoration) D3240 Pulpal therapy (resorbable filing) posterior, primary tooth (excluding final restoration) .. ..y . . , .... fie .m .o n e ... ...... �,,.,.: ErrdoddnticTherapy�(includingTreahneritP,landChnrcal,?rocedures=M'dFoUowCarellpit,„` D3310 Root canal, anterior (excluding final restoration) D3320 Root canal, bicuspid (excluding final restoration) D3330 Root canal, molar (excluding final restoration) D3331 Treatment of root canal obstruction; non -surgical access D3332 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth D3333 Internal root repair of perforation defects <:` �, '_ FJtdodorbcaRetreatmentr" ,--.�: - , � ��` � -rgrRErE D3346 Retreatment of previous root canal therapy — anterior D3347 Retreatment of previous root canal therapy — bicuspid 13 48 Retreatment of previous root canal therapy -molar Aplcoectdmy/Perradicular Services `7; 4. D3410 Apicoectomy/periradicular surgery — anterior D3421 Apicoectomy/periradicular sur9ery — bicuspid (first root) D3425 Apicoectomy/periradicular surgery — molar (first root) D3426 Apicoectomy/periradicular surgery (each additional root) D3430 Retrograde filling — per root D3950 Canalpreparation and fitting ofpreformed dowel post ...�,<. or �� Sur�rcal:Servrces�(Incliidiri�'AJsuatPostoperatrve)Care),..`�.,<,...'� ;gta,sfER4Ntoia� D4210 Gingivectomy or gin9ivoplasty — four or more contiguous teeth or bounded teeth spaces per quadrant D4211 Gingivectomy or 9in9ivoplasty — one to three contiguous teeth or bounded teeth spaces per quadrant D4240 Gingival flap procedure, including root planing —four or more contiguous teeth or bounded teeth spaces per quadrant D4241 Gingival flap procedure, including root planing — one to three contiguous teeth or bounded teeth spaces per quadrant D4249 Clinical crown lengthening — hard tissue D4260 Osseous surgery (including flap entry and closure) — four or more contipuous teeth or bounded teeth spaces per quadrant D4261 Osseous surgery (including flap entry and closure) — one to three contipuous teeth or bounded teeth spaces per quadrant D4268 Surgical revision procedure, per tooth D4270 Pedicle soft tissue graft procedure D4271 Free soft tissue graft procedure (including donor site sur9ery) D4273 Subepithelial connective tissue graft procedures, per tooth - Page 2 of 5 420 430 430 430 430 16 16 16 110 125 132 132 142 16 113 24 160 50 130 29 250 100 125 12 9 32 33 37 126 148 192 0 126 63 285 335 - 400 137 147 155 63 46 20 105 30 121 73 147 210 137 0 147 170 187 V.08254 GUARDIAN' Managed DentalGuard - Plan Schedule Plan U20M5 CDT Codes ++ Covered Dental Services Patient Charges D4341� MoriSurglcal;Periodorital Service Periodontal scaling and root planing — tour or more teeth per quadrant D4342 [Periodontal scaling and root planing — one to three teeth per quadrant D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis Othet,PerkiddtiltaSee!iiCeSN743.4MiniAlfMa2WWWnet Periodontal maintenance, for the first two services in any 12-month period + # D4910 wgingg .............................. $42 25 27 .............................. 28 D4920 (Unscheduled dressing change (by someone other than treating dentist) D4999 Periodontal maintenance, each additronal service in same 12 month pared + ..- ,t�..; Completeoenturesilncludtn9Routine):Post-DeliveryCare� D5110 Complete denture — maxillary D5120 Complete denture — mandibular D5130 Immediate denture — maxillary maximaimimPauk D5140 }Immediate denture mandibular PartraIDentures;Shictudifi Routtne:PostDelivery'Care) ,,,..,x.....�',rg.h_.`�' : °r. `.'4 '�a....,s'""..._, ' 65211 Maxillary partial denture — resin base (including any conventional clasps, rests and teeth) D5212 Mandibular partial denture — resin base (including any conventional clasps, rests and teeth) Maxillary partial denture — cast metal framework with resin denture bases Qtncluding any conventional clasps, rests and teeth) Mandibular partial denture — cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5213 D5214 D5225 D5226 D5410 Maxillary partial denture — flexible base (including any clasps, rests and teeth) Mandibular partial denture flexible base (including any clasps rests and teeth) Adiustiueots,to:Dentures,.. : F` M _<N; F- Adjust complete denture — maxillary ................. D5411 Adjust complete denture — mandibular D5421 Adjust partial denture — maxillary D5422w Adjust partial denture mandibular RepairsTo>Complete— Denturesr ..,. D5510 [Repair broken complete denture base YAMUtilfigi5;0 D5520 [Replace missing or broken teeth complete denture (each tooth) ReparrsToParhatt)entunis"kAM3 NfMMYDMSVK4SA P102-4-VWXi:PR.RMIZMV.Effltrag D5610 Repair resin denture base D5620 Repair cast framework D5630 Repair or replace broken clasp D5640 [Replace broken teeth — per tooth D5650 IAdd tooth to existing partial denture D5660 !Add clasp to existing partial denture D5670 [Replace all teeth and acrylic on cast metal framework (maxillary) D5671 Replace all teeth and acrylic on cast metal framework (mandibular? Denture"Rebase Procedures§F.r < ..; . D5710 1Rebase complete maxillary denture D5711 1Rebase complete mandibular denture D5720 1Rebase maxillary partial denture D5721 Re.basemandibularpartialdenture :SN ,r _ DetittireFteline;Prod'edures.,.a D5730 Reline complete maxillary denture (chairside) D5731 [Reline complete mandibular denture (chairside) D5740 [Reline maxillary partial denture (chairside) D5741 Reline mandibular partial denture (chairside) D5750 Reline complete maxillary denture (laboratory) 25 60 580 580 620 620 580 580 620 620 675 675 27 27 27 27 Wes, �P .............................. 69 66 80... 80 96 62 81 102 223 223 230 230 230 230 130 130 125 125 186 D5751 Reline complete mandibular denture (laboratory) D5760 [Reline maxillary partial denture (laboratory) D5761 Reline mandibular partial denture (laboratory) IntenrnProsthesrs' D5820 tInterim partial denture (maxillary) D5821 Interim partial denture (mandibular) ;LDther Removable Prosthetic Services` x , D5850 Tissue conditioning, maxillary D5851 `Tissue conddionmp mandibular Fixed Partial Dnture: Pontics ...t k' ' g D6210 Pontic — cast high noble metal " D6211 (Pontic — cast predominantly base metal D6212 Pontic — cast noble metal D6214 Pontic — titanium D6240 Pontic — porcelain fused to high noble metal " D6241 Pontic — porcelain fused to predominantly base metal D6242 Pontic — porcelain fused to noble metal D6245 Pontic porcelain/ceramic .a,,,gym.,, Fixed;P,atttal<DentuieRetainers` Inla /Onla s 2MAgEMMSV.Ta ��� D6600 Inlay —porcelain/ceramic — two surfaces D6601 Inlay —porcelain/ceramic— three or more surfaces D6602 Inlay - cast high noble metal, two surfaces " D6603 Inlay — cast high noble metal, three or more surfaces " D6604 Inlay — cast predominantly base metal, two surfaces Page 3 of 5 186 186 186 175 175 55 55 ......::..: 400 400 400 400 400 400 400 410 368 383 368 383 368 V.08254 GUARDIAN' Managed DentalGuard - Plan Schedule Plan U20M5 CDT Codes ++ Covered Dental Services Patient Charges _ Fixed-i?aitial 0entue;Retairieis fnlaaisiOnlays?"^ (continued D6605 Inlay — cast predominantly base metal, three or more surfaces D6606 Inlay — cast noble metal, two surfaces D6607 Inlay — cast noble metal, three or more surfaces D6608 Onlay—porcelain/ceramic, two surfaces D6609 Onlay —porcelain/ceramic, three or more surfaces D6610 Onlay—cast high noble metal, two surfaces" D6611 Daley —cast high noble metal, three or more surfaces " ......................................... D6612 Onlay— cast predominantly base metal, two surfaces D6613 Onlay —cast predominantly base metal, three or more surfaces D6614 Onlay —cast noble metal, two surfaces D6615 Onlay —cast noble metal, three or more surfaces D6624 Inlay — titanium D6634 Onlay—titanium Fixed Partial Derrture'Retarners Crowns D6740 Crown —porcelain/ceramic D6750 Crown —porcelain fused to high noble metal " D6751 Crown — porcelain fused to predominantly base metal D6752 Crown —porcelain fused to noble metal D6780 Crown — 3/4 cast high noble metal " D6781 Crown — 34 cast predominantly base metal D6782 Crown — 3/4 cast noble metal D6783 Crown — 3/< porcelain/ceramic D6790 Crown — full cast high noble metal " D6791 Crown — full cast predominantly base metal D6792 Grown — full cast noble metal D6794 Crown titanium s.. othafli ed Partiaibenture4Servrces ;° .' ,,. s7 rr `w, .< .44 x • : "' •, . w ° , -- _... s .: A. 4WiRyiltpT 5383 - 368 383 383 400 383 400 383 400 383 400 368 383 187+ 450 430 430 430 430 430 430 430 430 430 430 D6930 Recement fixed partial denture D6970 Post and core in addition to fixed partial denture retainer, indirectly fabricated D6972 Prefabricated post and core in addition to foxed partial denture retainer D6973 Core build up for retainer, including any pins D6976 Each additional cast post — same tooth D6977 Each additional prefabricated post — same tooth D6999 Multiple crown and budge unit treatment plan per unitsix or more units per treatment plan "^ � s EXtrectrons s ... . , ' r s .. zr'' : " ..... r 1 X .. ....... D7111 430 26 160 130 113 50 D7140 Extraction erupted tooth or exposed root (elevation and/or forceps removal) SfirgD7210 Surgical reittr removal erupted tootrequiring elevationtomuu pedotstedal flap and removal nOraCare? = .. and/or section of tooth D7220 Removal of impacted tooth — soft tissue D7230 Removal of impacted tooth —partially bony D7240 Removal of impacted tooth — completely bony D7241 Removal of impacted tooth — completely bony, with unusual surgical complications D7250 Surgical removal of residual tooth roots (cutting procedure) D7261 Primary closure of a sinus perforation trif-Miar Other Suryrcaf Procedures D7280 Surgical access of an unerupted tooth D7283 Placement of device to facilitate eruption of impacted tooth D7285 Biopsy of oral tissue — hard (bone, tooth) D7286 Biopsy of oral tissue — soft D7288 Brush bwpsy transepithehal sample collection -•_�4 ��Alveolopla"§ty Sut;�Icat Pre�aratron Oflidye for,Rentures� •..,... ,.,,..._. ,,,;,; ,, ,,,,,,,,,,,,,,, ......... ......... D7310 Alveoloplasty in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7311 Alveoloplasty in conjunction with extractions — one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions one to three teeth .. tooth spaces per quadrant Surgical Excision Of infra -Osseous Lesrons'r ...',,, m�'; ' t _ fir£°?:--.-. �... ? r� D7450 Removal of benign odontoyenic cyst or tumor — lesion diameter up to 1.25 cm D7451 Removal of benign odontogenic cyst or tumor lesion diameter greater than 1 25 cm ;; Excision Of Bone Tissue ''.r c a < E D7471 Removal of lateral exostosis (maxilla or mandible) D7472 Removal of torus palatinus D7473 Removal of torus mandibular s Surgicalltricrston - . >.: D7510 Incision and drainage of abscess — intraoral soft tissue D7511 Incision and drama9e of abscess intraoral soft tissue complicated (includes drainage of munip a fascia] paces] Other Repair Procedures ... x : ° 2....... D7960 D7963 Frenuloplasty Page 4 of 5 29 125 16 23 62 82 96 116 51 82 35 70 65 65 53 26 ' 92 65 ......::....was 165 240 215 215 215 44 48 :...... 100.. ..... 168 V.08254 GUARDIAN' Managed DentalGuard'=°Plan Schedule Plan U20M5 CDT Codes ++ Covered Dental Services Patient Charges -.. �.:. ' UICid9SifiedTrea tn_eni0 —�il 1i.» '0,* a ,.„ ._.,.,. D9110 Palliative (emergency) treatment of dental pain — minor procedure $20 D9120 denture sectioning 15 D9215 ................... D9220 _Fixed.partial Local anesthesia Deep sedatioNyeneral anesthesia — first 30 minutes +++. 0 195 D9221 Deep sedation/general anesthesia — each additional 15 minutes +++ 75 D9241 Intravenous conscious sedatioNanalgesia —first 30 minutes +++ 195 D9242 Intravenous conscious sedatioNanak�esia each additional 15 minutes +++ 75 ill: r 2 .� a m Professional Consultation a vd O ', oar ''g k . t a` .:� .: ... *-,vE .....: 4 ....::. D9310 Consultaten (diagnostic serviceprovided by dentxt or phyla ran other than practdionerprovidm9treatmert 34 V .b ,, D9430 Professional Vtsits ' a , W r . Office visit for observation (during regularly scheduled hours) — no other services performed : , .. � tt .... ... .. : D9440 Office visit — after regularly scheduled hours 50 D9450 Case presentation detailed and extensive treatment plannin 0 1. n-;. Misce1Ianeoui'Services f_? r:�",k .4.m >*.._x. �., 'w.,.3.?S ,,, _3s-;,= n .yam gyfa >a _ ..:.;-. ,' ,...3i?rs`5- D9951 Occlusal adjustment - limited 23 D9971 Odonioplasty — one to two teeth 23 D9972 External bleaching —per arch 165 Broken appointment 25 Current Dental Terminology (CDT) © American Dental Association (ADA) + The Patient Charges for codes D1110, 31120, D1203, D1204, D1206 and D4910 are limited to the first two services in any 12-month period. For each additional service in the same 12-month period, see codes D1999, D2999 and D4999 for the applicable Patient Charge. ++ Covered Services are subject to exclusions, limitations and Plan provisions as described in Member's Plan booklet and the Manual (including the Quality Management retrospective review). Other codes may be used to descrbe Covered Services. • The Member wit be responsible for the Office Visit Fee when the Plan Schedule suffix listed on the ID Card and Eligibility Report is an "M". The Plan will be responsble for the Office Visit Fee when the Plan Schedule suffix listed on the ID Card and Eligibility Report is a "G". The ID Card and Eligibility Report will indicate if the Office Visit Fee is $5 or $10. # Routine prophylaxis or periodontal maintenance procedure - a total of four services in any 12-month period. One of the covered periodontal maintenance procedures may be performed by a participating periodontal Specialist 11 done within three to six months following completion of approved, active periodontal therapy (periodontal scaling and root planing or periodontal osseous surgery) by a participating periodontal Specialist. Active periodontal therapy includes periodontal scaling and root planing or periodontal osseous surgery. ▪ Fluoride Treatment - a total of four services in any 12-month period. A Sealants are limited to permanent teeth up to the 16th birthday. If high noble metal is used, there will be an additional Patient Charge for the actual cost of the high noble metal. AA The Patient Charge for these services is per unit. +++ Procedure codes D9220, D9221, D9241 and D9242 are limited to a participating oral surgery Specialist. Additionally, these services are only covered in conjunction with other covered surgical services. Underwritten by: (IL) - First Commonwealth Insurance Company, (MO) - First Commonwealth of Missouri, (IN) - First Commonwealth Limited Health Services Corporation, (MI) - First Commonwealth Inc., (CA) - Managed Dental Care, (TX) - Managed DentalGuard, Inc. (DHMO), (NJ) - Managed DentalGuard, Inc., (FL, NY) - The Guardian Life Insurance Company of America. All First Commonwealth, Managed DentalGuard, Inc., and Managed Dental Care entities referenced are wholly -owned subsidiaries of The Guardian Life Insurance Company of America. Limitations and exclusions apply. Plan documents ere the final arbiter of coverage. The Guardian Life Insurance Company of America, New York, NY 10004 2008-6567 Page 5 of 5 V.08254 2.6. MINIMUM QUALIFICATION REQUIREMENTS For a Proposer to be deemed responsive the following minimum qualification requirements cited below shall be satisfied. In determining said responsiveness, each such minimum qualification requirement shall be addressed in detail in the Proposal submittal. Failure to meet each such following minimum qualification requirements and/or failure to provide sufficient detailed documentation concerning the same, shall result in the Proposal being deemed non -responsive: B. Proposers must have an organization that has demonstrated the ability to deliver cost- effective service, and efficient loss control and claims processing. The information provided in our questionnaire response as well as in our pricing demonstrates our ability to deliver cost effective service, efficient loss control, and claims processing. We have provided a competitively priced package, and are able to provide this service through efficient loss control. Guardian knows that the overall value you get from your.insurance carrier is not simply based on premiums. Our efficient claims administration, quick response times, and positive satisfaction surveys testify to the strong value we deliver to you and your members. Our claims processing abilities are exceptional. Our average turnaround is within 2 days for all claims. Over 99% of dental claims are processed within 15 calendar days once all information necessary to evaluate the claim is received. Our financial accuracy and processing accuracy are at 99.4%, a strong claim industry benchmark that represents dollars paid correctly in claim processing. C. Provide sufficient telephone service, including toll -free and local service 8-5 EST, to handle inquiries directly from plan participants as well as authorized City representatives. Our Dental Member Services Unit representatives are available for assistance via a toll -free number from 8:00 a.m. to 8:30 p.m., Eastern Time, Monday through Friday. Representatives handle inquires directly from plan participants as well as from authorized representatives of the City. In addition, our Interactive Voice Response Unit (IVRU)—which provides claim status and a faxed verification of benefits —is available 24 hours a day, 7 days a week. Our administrative web site, www.GuardianAnytime.com, is also available 24 hours a day, 7 days a week for eligibility, benefits information, claim status, and several other self-service features. We previously answered this in question 2 on page 8 of our proposal submission. D. Must disclose the following if broker fees are paid: (1) Name of agency and address; (2) Name of agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a no -commission basis. Broker fees are not paid. This question is not applicable to our quote, as the proposal is quoted on a no - commission basis, per the intention of the City. We previously answered this in letter d on page 6 on our proposal submission. E. Must assume current policy benefit structure and provide a "no loss/no gain" assumption of risk and credit for all annual deductibles. Confirmed. Our proposal assumes the current policy benefit structure and is quoted on a no loss a gain basis. F. Must comply with all federal legislation including but not limited to HIPAA and COBRA. Confirmed. Guardian as a company is fully in compliance with all federal legislation including HIPAA and COBRA. However, our stand-alone dental plan is not subject to these HIPAA requirements. COBRA regulations require you to notify all employees in your health plan of their rights under COBRA. As individuals lose coverage, within 30 days, you are required to offer them coverage continuation. The individual has 60 days to respond from the date the election packet was mailed. If coverage is taken, the initial bill will be sent and the individual has 45 days to pay the first premium. Subsequent premiums are due on the 1st day of the month with a 31-day grace period, taking into account weekends and federal holidays. The length of COBRA coverage depends upon the reason the coverage was lost. Disabled employees are charged more for certain months and are allowed an extension of the normal COBRA continuation period. Each step must be documented and maintained for seven years. Most employers do not have the time or resources to keep up with the law, the court cases that affect administration, and the cumbersome administration and documentation procedures. And, most employers would choose not to have to communicate with terminated employees. We can take on this burden and provide you with expert administration. G. Proposer must agree to allow the City or its representative the right to audit all claims, financial data, and other inforation relevant to the City's account. Agreed. We are willing to submit to an audit conducted by the City or its agents. Such a request should be submitted in writing 30 days prior to the start date of the audit. H. The City requires that the pre-existing condition limitations and the actively at work provision be waived for the initial enrollment for those employees who have already satisfied the waiting period for pre-existing conditions under the current plan. There is no pre-existing limitation for dental products, and the actively at work provision is not relevant to dental insurance. Therefore, this question is not applicable to the coverage we have quoted. I. Proposer must have bilingual capabilities in the customer service and enrollment assistance areas as well as in communications materials. English and Spanish are mandatory. Creole is desired as well. Confirmed. We do have bilingual capabilities in the customer service and enrollment assistance areas and in communication materials. All marketing materials are available in both English and Spanish. We contract with Transperfect, a language translation service, to provide interpreters for our Customer Service department for both voice and text. This service assists with numerous international languages. During a call, our trained representative can simply bring an interpreter onto the line and create a 3-way conversation. We also offer language services through AT&T's Language Line, which helps hearing - impaired callers and offers translations of over 150 languages. There is no additional cost for this service. J. Proposer shall have no record of judgments or pending lawsuits against the City and/or bankruptcy, and not have any conflicts of interest that have not been waived by the City Commission. Confirmed. The Guardian Life Insurance Company of America does not have any governmental, criminal, or regulatory proceedings pending against it, nor are there any debarments. We have no pending lawsuits or judgments against the City. We are a mutual insurance company established in 1860 and do insurance business in all 50 states. We have never had a governmental, criminal or regulatory proceeding against The Guardian Life Insurance Company of America for fraudulent or wrongful acts. We have no conflicts of interest with the City. We are financially solid and have not filed bankruptcy. In fact, all four of the major rating agencies have affirmed Guardian's very high ratings over the last year, citing our investment performance, capital position, risk management, and operating performance as reasons for their affirmation. Our company was the only major life insurer to be upgraded by two rating agencies in 2008, and our very high ratings also were affirmed in 2009 and 2010, providing evidence of the stable view the ratings agencies have of Guardian. A.M. Best Company Moody's Investors Services Fitch Standard & Poor' s A++ (the highest of 15 ratings) Aa2 (3rd highest of 21 ratings) AA+ (2"d highest of 21 ratings) AA+ (2nd highest of 20 ratings) Superior Excellent Very Strong Very Strong K. Neither Proposer nor any member, officer, or stockholder of Proposer shall be in arrears or in default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City. Confirmed. We are not in arrears or in default of any debt or contract involving the City, nor have we failed to perform faithfully on any previous contract with the City. Section 4.1. SUBMISSION REQUIREMENTS reflects the following: Proposers shall carefully follow the format and instruction outlined below, observing format requirements where indicated Proposals should contain the information itemized below and in the order indicated This information should be provided for the Proposer and any Sub -Consultants to be utilized for the work contemplated by this Solicitation. Proposals submitted which do not include the following items may be deemed non -responsive and may not be considered for contract award. 4. Proposer's Organization, Oualifications, Capabilities & Financial Stability g) Provide a list of 2 clients of equivalent size who, for whatever reason, discontinued to use Proposer's services within the past year, and indicate the reasons for the same. Include contact name and number, as well as two current clients. The City reserves the right to contact any reference as part of the evaluation process. Also include your company's total enrollment for 2010 vs. your 2011 enrollment. Terminated clients include: 1. Beall's, Inc. Contact Name: Arne Lemke Phone number: 941-744-4197 Reason for termination: Beall's was facing a significant medical increase and packaged their dental with the medical carrier to mitigate that increase. 2. Connextions, Inc. Contact Name: Jeff Tuttle Phone number: 407-926-2400, ext. 10421 Reason for termination: Connextions, was acquired by their largest customer and went to their benefit package. We previously responded to references in question 16 on page 12 of our proposal submission. Two current references include: 1. Kforce Elizabeth Grimes Phone number: 813-552-2203 2. Al Contract Staffing Cindy Fowler Phone number: 813- 620-1661 We previously answered with total enrollment numbers in letter g on page 7 of our proposal submission. PPO Plan Membership as of 12/31/2010: 5,273,266 PPO Plan Membership as of 12/31/2011: 5,330,958 10. List of Attachments to be completed and returned with Proposal e) Service Fee Schedules for all applicable locations Our Service Fee Schedule is provided as an attachment. f) Copies of network directories (DadeBroward/Monroe/Palm Beach/Ocala/Orlando/Raleigh, N.C.) (This can be provided in electronic format via a CD-ROM) Our network directories are provided as attachments.