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COMPLETED BOARD ORDER AND AGR
�41
Bef~re the Board of Supervisors in and for the
ounty of Monterey, State of California
Agreement No. A-12022
a. Approve and authorize he Contracts and Purchasing
Officer to sign an Agreement with Pacific Health Alliance
PHA) for Third Party Administrator TPA) Services for the
County's self insured Dental Program per Request for
Proposal RFP) #10254, with the initial Agreement term
beginning July 1, 2011 through December 31, 2015,
including the option to extend the Agreement for up to three
3) additional one 1) year periods; and
b. Authorize the Contracts and Purchasing Officer to sign
future Amendments to the Agreement where the
Amendments do not signifi antly change the scope of work
or cause an increase in the greement rates of more than ten
percent 10%)
Upon motion of Supervisor Sal~nas, seconded by Supervisor Calcagno, and carried by those members
present, the Board hereby;
a. Approved and authori ed the Contracts and Purchasing Officer to sign an
Agreement with Pacific Health Alliance PHA) for Third Party Administrator
TPA) Services for the County's self insured Dental Program per Request for
Proposal RFP) #10254, with the initial Agreement term beginning July 1, 2011
through December 31, 015, including the option to extend the Agreement for up
to three 3) additional o e 1) year periods; and
b. Authorized the Contra is and Purchasing Officer to sign future Amendments to
the Agreement where die Amendments do not significantly change the scope of
work or cause an incre e in the Agreement rates of more than ten percent 10%).
PASSED AND ADOPTED on this 28t'' day of June, 2011, by the following vote, to wit:
AYES: Supervisors Calcag o, Salinas, and Parker
NOES: None
ABSENT: Supervisors Armen and Potter
I, Gail T. Borkowski, Clerk of the B and of Supervisors of the County of Monterey, State of California, hereby certify
that the foregoing is a true copy of a original order of said Board of Supervisors duly made and entered in the minutes
thereof of Minute Book 75 for themeeting on June 28, 2011.
Dated: July 6, 2011 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
AGREEMENT TO OVIDE DEI T. LY BENEFI' FOR THE COUNTY OF
a.
This AGREEMENT is made and entered into by and between the County of Monterey, a
political subdivision! of the State of California, hereinafter referred to as County", and
Pacific Health Alliance PHA), hereinafter referred to as CONTRACTOR."
A. WHEREAS, Count' has invited proposals through the Request for Proposals
RFP # 10254) for mployee Dental Benefits, in accordance with the specifications set
forth in this AGREEMENT; and
B. WHEREAS, CON`11RACTOR has submitted a responsive and responsible proposal to
perform such services; and
C. WHEREAS, CONTRACTOR has the expertise and capabilities necessary to provide the
services requested.
NOW THEREFORE, County and CONTRACTOR, for the consideration hereinafter named, agree as follows:
1.1 After consideration end evaluation of the CONTRACTOR'S proposal, the County hereby
engages CONTRA TOR to provide the services set forth in RFP #10254 and in this
AGREEMENT on he terms and conditions contained herein and in RFP #10254. The
intent of this AG EMENT is to summarize the contractual obligations of the parties.
The component parts of this AGREEMENT include the following:
RFP # 10254 dated September 23, 2010
Addenda #I #4
CONTRACTOR'S Proposal dated October 13, 2020, including all attachments
and exhibits' to RFP # 10254
AGREEMENT
Certificate o' Insurance
Additional I~sured Endorsements
1.2 All of the above-referenced contract documents are intended to be complementary. Work
required by one of the above-referenced contract documents and not by others shall be
done as if required by all. In the event of a conflict between or among component parts
of the contract, the contract documents shall be construed in the following order:
AGREEMENT, General Requirements and General Provisions, CONTRACTOR' S
1
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
Proposal with all attachments and exhibits), RFP #10254, Addenda #1 #4, Certificate
of Insurance, and Additional Insured Endorsements.
1.3 CONTRACTOR warrants that CONTRACTOR and CONTRACTOR's agents,
employees, and subcontractors performing services under this AGREEMENT are
specially trained, experienced, competent, and appropriately licensed to perform the work
and deliver the services required under this AGREEMENT and are not employees of the
County, or immediate family of an employee of the County.
1.4 CONTRACTOR, its agents, employees, and subcontractors shall perform all work in a
safe and skillful malnner and in compliance with all applicable laws and regulations. All
work performed under this AGREEMENT that is required by law to be performed or
supervised by licensed personnel shall be performed in accordance with such licensing
requirements.
2.1 CONTRACTOR shall administer a self-funded dental benefit plan for eligible County
employees.
2.2 CONTRACTOR shall maintain a preferred provider network for use by the County plan.
2.2.1 CONTRACTOR shall be responsible for maintaining agreements with preferred
providers to include providing Contracting Providers with instructions regarding
their compliance with administrative, billing, and accounting procedures required
by County.
2.2.2 CONTRACTOR shall be responsible for recruitment of new Contracting
Providers used by enrollees to establish contractual relationships to include
determinatidn that provider meets established standards.
2.2.3 CONTRACTOR shall make provider directory available to enrollees.
2.3 CONTRACTOR sh4l1 establish Provider Reimbursement Rates for Contracting Providers
and Non-Providers.
2.3.1 CONTRACTOR shall be responsible for establishing the Uniform, Customary
and Reasonable UCR) fees to be utilized in setting reimbursement rates.
2.3.2 CONTRACTOR shall utilize local data County of Monterey) for establishing
UCR fees. JCR fees will be subject to annual review and possible adjustment.
Negotiations with providers to increase the UCR will not result in rates that
exceed the Bay Area CPI.
2.4 CONTRACTOR sha11 provide up to four 4) informational seminars per year as requested
by County staff on tjopics related to dental benefits.
2.5 CONTRACTOR shall be responsible for receipt of and processing of claims in
accordance with benefits summary in Exhibit A.
2
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
2.5.1 CONTRACTOR shall employ qualified personnel to ensure accurate processing
of claims.
2.5.2 CONTRACTOR shall be responsible for determining appropriate Coordination of
Benefits of enrollees prior to claim determination.
2.5.3 CONTRACTOR shall be responsible for determination of accuracy of claim
information 4nd eligible amounts payable.
2.5.4 CONTRACTOR shall be responsible for denial of inappropriate or incorrect
claims.
2.6 CONTRACTOR shall provide customer support services to enrollees to include coverage
information, provider directory information, claims status, and support related to denied
claims.
2.6.1 CONTRACTOR shall support an appeal process for enrollee dispute of claims
payment or coverage determination and participate, at no additional cost, in any
dispute between County and enrollees related to any benefit review determination
made by CONTRACTOR.
2.7 County shall maintain an account to facilitate self-funding of claims processed by
CONTRACTOR. Requests for funding of processed claims should be submitted by
CONTRACTOR toi County designees to include a list of checks processed and the
associated claim information. County shall be responsible for reviewing the request for
funding and, if appropriate, funding the account sufficiently to satisfy the request.
2.7.1 County is responsible for notifying CONTRACTOR immediately of any dispute
with or questions arising from request for funding.
2.7.2 Parties agree to modify funding process to a ZBA zero balance account) at such
time that County can make appropriate arrangements.
2.8 County agrees to abide by all terms of Participating Provider agreements entered into
with Contracting Providers.
2.9 County shall determine eligibility to enroll status of employees and obtain all pertinent
information from employee required for enrollment. County shall provide to
CONTRACTOR all information necessary to complete enrollment status.
2.9.1 County sha~l determine eligibility status for retirees. CONTRACTOR shall
administer benefits for eligible retirees as part of this Agreement.
2.10 CONTRACTOR shjall provide to County customized and routine reports as requested at
no additional cost to County.
2.11 CONTRACTOR shell be responsible for monthly bank statement reconciliations. Copies
of the reconciliation report and bank statement shall be submitted to the County on a
monthly basis.
2.11.1 Monthly reconciliation report and bank statement copies shall be provided to the
County within thirty 30) days after the statement end date.
3
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
2.11.2 Parties may agree to discontinue monthly reconciliation report and bank statement
submission at such time as a ZBA is established for self-funding of claims.
2.12 Pursuant to California Health and Safety Code Section 1366.25, the following section is
hereby incorporated into the Group Dental Care Plan, if, and only to the extent Cal-
COBRA applies to the parties of this Plan.
2.13 The California Continuation Benefits Replacement Act of 1997 Cal-COBRA) requires
health care service plans providing contracted coverage to employers with 2 to 19 eligible
employees to offer continuation coverage for purchase by qualified beneficiaries upon the
occurrence of a qualifying event. CONTRACTOR and County are subject to the
following obligatior4s in connection with continuation of coverage:
1. County agre s to provide CONTRACTOR with notice of any employee who has
had a qualifying evont, within thirty-one 31) days of the qualifying event. A qualifying
event means any of the following events that, but for the election of continuation of
coverage provided hereunder, would result in a loss of coverage under the group benefit
plan to a qualified beneficiary:
The death of the covered employee.
The termination or reduction of hours of the covered employee's employment,
except that termination for gross misconduct does not constitute a qualifying
event.
The divorced or legal separation of the covered employee from the covered
employee's pouse.
The loss of dependent status by a dependent enrolled in the group benefit plan.
With respect to dependent only, the covered employee's eligibility for coverage
under Title *VIII of the United States Social Security Act Medicare).
Within fourteen 14) days of receipt of the foregoing notice of a qualifying event from
County, CONTRACTOR will send to the qualified beneficiary's last known address, as
provided by the County, the necessary benefits information, premium information,
enrollment forms, 4nd instructions to allow the qualified beneficiary to formally elect
continuation coverage.
2. County agrees to notify qualified beneficiaries currently receiving continuation
coverage, whose continuation coverage will terminate under one group benefit plan prior
to the end of the period the qualified beneficiary would have remained covered under
Cal-COBRA, as specified in Health and Safety Code Section 1366.27, a minimum of
thirty 30) days prior to the termination, of the qualified beneficiary's ability to continue
coverage under a i*ew group benefit plan for the balance of the period the qualified
beneficiary would have remained covered under the prior group benefit plan. County
agrees to provide qualified beneficiaries subject to this paragraph with the necessary
benefits information, premium information, enrollment forms, and instructions to allow
the qualified beneficiary to continue coverage. This information shall be sent to the
qualified beneficiary's last known address, as provided by the plan currently providing
continuation coverage to the qualified beneficiary.
4-
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
3.1 The initial term shall commence with the signing of the AGREEMENT through and
including December 31, 2015, with the option to extend the AGREEMENT for three 3)
additional one 1) year periods. County is not required to state a reason if it elects not to
renew this AGREEMENT.
3.2 If County exercises its option to extend, all applicable parties shall mutually agree upon
the extension, including any changes in rate and/or terms and conditions.
3.3 County reserves the right to cancel the AGREEMENT, or any extension of the
AGREEMENT, without cause, with a thirty 30) day written notice, or immediately with
cause.
4.1 It is mutually understood and agreed by both parties that CONTRACTOR shall be
compensated under this AGREEMENT in accordance with the pricing sheet under
Exhibit B.
4.2 Prices shall remain firm for the initial term of this AGREEMENT and, thereafter, may be
adjusted annually a provided in this paragraph. County does not guarantee any minimum
or maximum amount of dollars to be spent under this AGREEMENT.
4.3 Negotiations for rage changes shall be commenced, by CONTRACTOR, a minimum of
ninety days 90) prior to the expiration of this AGREEMENT or renewal thereof.
4.4 Any discount offered by the CONTRACTOR must allow for payment after receipt and
acceptance of services, material or equipment and correct invoice, whichever is later. In
no case will a discount be considered that requires payment in less than 30 days.
4.5 CONTRACTOR shall levy no additional fees nor surcharges of any kind during the term
of this AGREEMENT without first obtaining approval from County in writing.
4.6 Tax:
4.6.1 Pricing as p0 this AGREEMENT is inclusive of all applicable taxes.
4.6.2 County is registered with the Internal Revenue Service, San Francisco office,
registration number 94-6000524. The County is exempt from Federal
Transportation Tax; an exemption certificate is not required where shipping
documents show Monterey County as consignee.
5
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
5.1 Invoice amounts shall be billed directly to the County of Monterey, Attention: County
Auditor-Controller.
5.2 CONTACTOR shall reference the RFP #10254 on all invoices submitted to County.
CONTRACTOR shall submit such invoices periodically or at the completion of services,
but in any event, note later than 30 days after completion of services. The invoice shall set
forth the amounts claimed by CONTRACTOR for the previous period, together with an
itemized basis for the amounts claimed, and such other information pertinent to the
invoice. County shall certify the invoice, either in the requested amount or in such other
amount as County approves in conformity with this AGREEMENT, and shall promptly
submit such invoice to County Auditor-Controller for payment. County Auditor-
Controller shall pay the amount certified within 30 days of receiving the certified invoice.
5.3 All County of Monterey Purchase Orders issued for the AGREEMENT are valid only
during the fiscal year in which they are issued the fiscal year is defined as July 1 through
June 30).
5.4 Unauthorized Surcharges or Fees: Invoices containing unauthorized surcharges or
unauthorized fees of any kind shall be rejected by County. Surcharges and additional fees
not included the AGREEMENT must be approved by County in writing via an
Amendment.
CONTRACTOR shall indemnify, defend, and hold harmless County, its officers, agents,
and employees, froth and against any and all claims, liabilities, and losses whatsoever
including damages to property and injuries to or death of persons, court costs, and
reasonable attorneys' fees) occurring or resulting to any and all persons, firms or
corporations furnishing or supplying work, services, materials, or supplies in connection
with the performance of this AGREEMENT, and from any and all claims, liabilities, and
losses occurring of resulting to any person, firm, or corporation for damage, injury, or
death arising out of or connected with CONTRACTOR's performance of this
AGREEMENT, unless such claims, liabilities, or losses arise out of the sole negligence
or willful misconduct of County. CONTRACTOR's performance" includes
CONTRACTOR's faction or inaction and the action or inaction of CONTRACTOR's
officers, employees', agents and subcontractors.
6
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COMPLETED BOARD ORDER AND AGR
�I
Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
7.1 Evidence of Coverage:
7.1.1 Prior to commencement of this AGREEMENT, CONTRACTOR shall provide a
Certificate of Insurance" certifying that coverage as required herein has been
obtained. Individual endorsements executed by the insurance carrier shall
accompany the certificate. In addition CONTRACTOR upon request shall
provide a certified copy of the policy or policies.
7.1.2 This verification of coverage shall be sent to the County's Contracts/Purchasing
Department, unless otherwise directed. CONTRACTOR shall not receive a
Notice to Proceed" with the work under this AGREEMENT until it has obtained
all insurance required and such, insurance has been approved by County. This
approval of insurance shall neither relieve nor decrease the liability of
CONTRACTOR.
7.1.3 Qualifying Insurers: All coverage's, except surety, shall be issued by companies
which hold g current policy holder's alphabetic and financial size category rating
of not less than A- VII, according to the current Best's Key Rating Guide or a
company of equal financial stability that is approved by County's Purchasing
Officer.
7.2 Insurance Coverage Requirements:
7.2.1 Without limiting CONTRACTOR's duty to indemnify, CONTRACTOR shall
maintain in effect throughout the term of this AGREEMENT a policy or policies
of insurance with the following minimum limits of liability:
7.2.1.1 Commercial general liability insurance, including but not limited to
premises and operations, including. coverage for Bodily Injury and
Property Damage, Personal Injury, Contractual Liability, Broadform
Property Damage, Independent Contractors, Products and Completed
Operations, with a combined single limit for Bodily Injury and Property
Damage of not less than $1,000,000 per occurrence.
7.2.2 Business automobile liability insurance, covering all motor vehicles,
including owned, leased, non-owned, and hired vehicles, used in
providing services under this AGREEMENT, with a combined single
limit for Bodily Injury and Property Damage of not less than $1,000,000
per occurrence.
7.2.3 Workers' Compensation Insurance, if CONTRACTOR employs others
in the performance of this AGREEMENT, in accordance with California
Labor Code section 3700 and with Employer's Liability limits not less
7-
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COMPLETED BOARD ORDER AND AGR
�I
Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
than $1,000,000 each person, $1,000,000 each accident and $1,000,000
each disease.
7.2.4 Professional liability insurance, if required for the professional services
being provided, e.g., those persons authorized by a license to engage in
a business or profession regulated by the California Business and
Professions Code), in the amount of not less than $1,000,000 per claim
and $2,000,000 in the aggregate, to cover liability for malpractice or
errors or omissions made in the course of rendering professional
services. If professional liability insurance is written on a claims-made"
basis rather than an occurrence basis, CONTRACTOR shall, upon the
expiration or earlier termination of this AGREEMENT, obtain extended
reporting coverage tail coverage") with the same liability limits. Any
such tail coverage shall continue for at least three years following the
expiration or earlier termination of this AGREEMENT.
7.3 Other Insurance Requirements:
7.3.1 All insurance required by this AGREEMENT shall be with a company acceptable
to County and issued and executed by an admitted insurer authorized to transact
Insurance business in the State of California. Unless otherwise specified by this
AGREEMENT, all such insurance shall be written on an occurrence basis, or, if
the policy is not written on an occurrence basis, such policy with the coverage
required herein shall continue in effect for a period of three years following the
date CONTRACTOR completes its performance of services under this
AGREEMENT.
7.3.2 Each liability policy shall provide that County shall be given notice in writing at
least thirty days in advance of any endorsed reduction in coverage or limit,
cancellation, or intended non-renewal thereof. Each policy shall provide coverage
for CONTRACTOR and additional insureds with respect to claims arising from
each subcontractor, if any, performing work under this AGREEMENT, or be
accompanied by a certificate of insurance from each subcontractor showing each
subcontractor has identical insurance coverage to the above requirements.
7.3.3 Commercial general liability and automobile liability policies shall provide an
endorsement naming the County of Monterey, its officers, agents, and employees
as Additional Insureds with respect to liability arising out of the
CONTRACT'OR'S work, including ongoing and completed operations, and shall
further provide that such insurance is primary insurance to any insurance or self
insurance maintained by the County and that the insurance of the Additional
Insureds shall not be called upon to contribute to a loss covered by the
CONTRACTOR'S insurance. The required endorsement form for Commercial
General Liability Additional Insured is ISO Form CG 20 10 11-85 or CG 20 10
10 01 in tandem with CG 20 37 10 01 2000). The required endorsement form for
Automobile Additional Insured endorsement is ISO Form CA 20 48 02 99.
8-
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
7.3.4 Prior to the execution of this AGREEMENT by County, CONTRACTOR shall
file certificates of insurance with County's contract administrator and County's
Contracts/Purchasing Division, showing that CONTRACTOR has in effect the
insurance required by this AGREEMENT. CONTRACTOR shall file a new or
amended certificate of insurance within five calendar days after any change is
made in any insurance policy, which would alter the information on the certificate
then on file. Acceptance or approval of insurance shall in no way modify or
change the indemnification clause in this AGREEMENT, which shall continue in
full force and effect.
7.3.5 CONTRACTOR shall at all times during the term of this AGREEMENT maintain
in force the insurance coverage required under this AGREEMENT and shall send,
without demand by County, annual certificates to County's Contract
Administrator and County's Contracts/Purchasing Division. If the certificate is
not received by the expiration date, County shall notify CONTRACTOR and
CONTRACTOR shall have five calendar days to send in the certificate,
evidencing no lapse in coverage during the interim. Failure by CONTRACTOR
to maintain such insurance is a default of this AGREEMENT, which entitles
County, at its sole discretion, to terminate this AGREEMENT immediately.
8.1 Confidentiality: CONTRACTOR and its officers, employees, agents, and subcontractors
shall comply with any and all federal, state, and local laws, which provide for the
confidentiality of records and other information. CONTRACTOR shall not disclose any
confidential records or other confidential information received from the County or
prepared in connection with the performance of this AGREEMENT, unless County
specifically permits CONTRACTOR to disclose such records or information.
CONTRACTOR shall promptly transmit to County any and all requests for disclosure of
any such confidential records or information. CONTRACTOR shall not use any
confidential information gained by CONTRACTOR in the performance of this
AGREEMENT except for the sole purpose of carrying out CONTRACTOR's obligations
under this AGREEMENT.
8.2 County Records: When this AGREEMENT expires or terminates, CONTRACTOR shall
return to County any County records which CONTRACTOR used or received from
County to perform services under this AGREEMENT.
8.3 Maintenance of Records: CONTRACTOR shall prepare, maintain, and preserve all
reports and records that may be required by federal, state, and County rules and
regulations related to services performed under this AGREEMENT.
BIB]
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B.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
SIGN-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
THE-U012
AGREEMENT-U012
THE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
THE-U012
SCOPE-U012
OF-U012
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OR-U012
CAUSE-U012
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INCREASE-U012
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10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
8.4 Access to and Audit of Records: County shall have the right to examine, monitor and
audit all records, documents, conditions, and activities of CONTRACTOR and its
subcontractors related to services provided under this AGREEMENT. Pursuant to
Government Code section 8546.7, if this AGREEMENT involves the expenditure of
public funds in excess of $10,000, the parties to this AGREEMENT may be subject, at
the request of County or as part of any audit of County, to the examination and audit of
the State Auditor pertaining to matters connected with the performance of this
AGREEMENT for a period of three years after final payment under the AGREEMENT.
9.1 During the performance of this contract, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment because of race, religious
creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, marital status, age over 40), sex, or sexual orientation. CONTRACTOR shall
ensure that the evaluation and treatment of its employees and applicants for employment
are free of such discrimination. CONTRACTOR shall comply with the provisions of the
Fair Employment and Housing Act Government Code, 12900, et seq.) and the
applicable regulations promulgated thereunder California Code of Regulations, Title 2,
7285.0, et seq.).
9.2 The applicable regulations of the Fair Employment and Housing Commission
implementing Government Code, 12900, et seq., set forth in Chapter 5 of Division 4 of
Title 2 of the California Code of Regulations are incorporated into this AGREEMENT by
reference and made a part hereof as if set forth in full.
9.3 CONTRACTOR shall include the non-discrimination and compliance provisions of the
clause in all AGREEMENTS with subcontractors to perform work under the contract.
10.1 Independent Contractor: CONTRACTOR shall be an independent contractor and shall
not be an employee of Monterey County, nor immediate family of an employee of
County. CONTRACTOR shall be responsible for all insurance General Liability,
Automobile, Workers' Compensation, unemployment, etc,) and all payroll-related taxes.
CONTRACTOR shall not be entitled to any employee benefits.
BIB]
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AGREEMENT-U012
RATES-U012
OF-U012
MORE-U012
THAN-U012
TEN-U012
PERCENT-U012
10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
CONTRACTOR covenants that CONTRACTOR, its responsible officers, and its
employees having major responsibilities for the performance of work under the
AGREEMENT, presently have no interest and during the term of this AGREEMENT
will not acquire any interests, direct or indirect, which might conflict in any manner or
degree with the performance of CONTRACTOR'S services under this AGREEMENT.
12.1 CONTRACTOR shall keep itself informed of and in compliance with all federal, state
and local laws, ordinances, regulations, and orders, including but not limited to all state
and federal tax laws, that may affect in any manner the Servoces or the performance of
the Services or those engaged to perform Services under this AGREEMENT.
CONTRACTOR shall procure all permits and licenses, pay all charges and fees, and give
all notices required by law in the performance of the Services.
12.2 CONTRACTOR shall report immediately to County's Contracts/Purchasing Officer, in
writing, any discrepancy or inconsistency it discovers in the laws, ordinances,
regulations, orders, and/or guidelines in relation to the Project of the performance of the
Services.
12.3 All documentation prepared by CONTRACTOR shall provide for a completed project
that conforms to all applicable codes, rules, regulations and guidelines that are in force at
the time such docunflentation is prepared.
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
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DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
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105-ADMINISTRATION-U08
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SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
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PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
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BEGINNING-U012
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FUTURE-U012
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TO-U012
THE-U012
AGREEMENT-U012
THE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
THE-U012
SCOPE-U012
OF-U012
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OR-U012
CAUSE-U012
AN-U012
INCREASE-U012
IN-U012
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AGREEMENT-U012
RATES-U012
OF-U012
MORE-U012
THAN-U012
TEN-U012
PERCENT-U012
10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
13.1 CONTRACTOR agrees that this AGREEMENT, and any dispute arising from the
relationship between the parties to this AGREEMENT, shall be governed and interpreted
by the laws of the State of California, excluding any laws that direct the application of
another jurisdiction"s laws.
13.2 Any dispute that arises under or relates to this AGREEMENT whether contract, tort, or
both) shall be resolved in the Superior Court of California in Monterey County,
California.
13.3 CONTRACTOR shall continue to perform under this AGREEMENT during any dispute.
COUNTY Signature
Printed Name
Title
Date
CONTRACTOR Afnature
Printed Name
Title
Date
CONTRACTOR agrees to operate its business in a manner as necessary to permit County
to comply with its obligations under the Health Insurance Portability and Accountability
Act of 1996, Subtitle F, Public Law 104-191, relating to the privacy and security of
confidential health information, and any final regulations or rules promulgated by the
U.S. Department of Health and Human Services thereunder collectively, the HIPAA
Standards").
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
JULY-U012
1,-U012
2011-U012
THROUGH-U012
JUNE-U012
30,-U012
2014,-U012
INCLUDING-U012
THE-U012
OPTION-U012
TO-U012
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THE-U012
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TWO-U012
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ONE-U012
1)-U012
YEAR-U012
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AUTHORIZE-U012
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OFFICER-U012
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AMENDMENTS-U012
TO-U012
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THE-U012
AMENDMENTS-U012
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COMPLETED BOARD ORDER AND AGR
�i
Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
13 OrLE DASPUTESe
13.1 CONTRACTOR agrees that this AGREEMENT, and any dispute arising from the
relationship between the parties to this AGREEMENT, shall be governed and interpreted
by the laws of the I State of California, excluding any laws that direct the application of
another jurisdiction's laws.
13.2 Any dispute that arises under or relates to this AGREEMENT whether contract, tort, or
both) shall be resolved in the Superior Court of California in Monterey County,
California.
13.3 CONTRACTOR shall continue to perform under this AGREEMENT during any dispute.
COUNTY signature
Printed Name
Title
Date
22011'17M-el 1MOC /WI
CONTRA CTOY,8'fgnature
l~ A vr0 1-1 +~
Printed Name
Title
Date
ws,
1~ INPOR A` l~T PO T Bl U CCO`[~NABILIT~'ACT
CONTRACTOR agrees to operate its business in a manner as necessary to permit County
to comply with itsj obligations under the Health Insurance Portability and Accountability
Act of 1996, Subtitle F, Public Law 104-191, relating to the privacy and security of
confidential health information, and any final regulations or rules promulgated by the
U.S. Department of Health and Human Services thereunder collectively, the HIPAA
Standards").
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
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THE-U07
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OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
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JANET-U09
MARCELLAC-U10
6/20/2011-U011
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THE-U012
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PROGRAM-U012
PER-U012
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PROPOSAL-U012
#10254,-U012
THE-U012
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TERM-U012
BEGINNING-U012
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EXTEND-U012
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
13.1 CONTRACTOR agrees that this AGREEMENT, and any dispute arising from the
relationship between the parties to this AGREEMENT, shall be governed and interpreted
by the laws of the State of California, excluding any laws that direct the application of
another jurisdiction's laws.
13.2 Any dispute that arises under or relates to this AGREEMENT whether contract, tort, or
both) shall be resolved in the Superior Court of California in Monterey County,
California.
13.3 CONTRACTOR shall continue to perform under this AGREEMENT during any dispute.
117
COUNTY, ignature
Printed NaPne
Title
Date
Printed Name
Date
1~ 0 I TFO t TI N PO TABI ITY D A.CCOUNTABILIT 4CT
46
HI,P4. COMPLIANCE
CONTRACTOR agrees to operate its business in a manner as necessary to permit County
to comply with its', obligations under the Health Insurance Portability and Accountability
Act of 1996, Subtitle F, Public Law 104-191, relating to the privacy and security of
confidential health information, and any final regulations or rules promulgated by the
U.S. Department of Health and Human Services thereunder collectively, the HIPAA
Standards").
i
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
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AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
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MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
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7/18/2011-U04
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16767-U05
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
15.1 Non-Assignment: CONTRACTOR shall not assign this contract or the work required
herein without the prior written consent of County.
15.2 Notices required to be given to the respective parties under this AGREEMENT shall be
deemed given by any of the following means: 1) when personally delivered to County's
contract administrator or to CONTRACTOR'S responsible officer; 2) when personally
delivered to the party's principle place of business during normal business hours, by
leaving notice with any person apparently in charge of the office and advising such
person of the import and contents of the notice; 3) 24 hours after the notice is transmitted
by FAX machine to the other party, at the party's FAX number specified pursuant to this
AGREEMENT, provided that the party giving notice by FAX must promptly confirm
receipt of the FAX by telephone to the receiving party's office; or, 4) three 3) days
after the notice is deposited in the U. S. mail with first class or better postage fully
prepaid, addressed to the party as indicated below.
Notices mailed or fhxed to the parties shall be addressed as follows:
TO COUNTY:
Mike Derr, Contracts/Purchasing Officer
County of Monterey, Contracts/Purchasing
168 W. Alisal Street, 3rd Floor.
Salinas, CA 93901-2439
Tel. No.: 831) 755-4990
FAX No.: 831) 755-4969
Email: DerrM@co.montere
TO CONTRACTOR:
Robert O. Mackler, Executive Vice President
Pacific Health Alliance, Inc.
1350 Old Bayshore Highway, Ste. 560
Burlingame, CA 94010
Tel. No.: 800) 533-4702
FAX No.: 800) 801-1200
Email: rmackler@pacifichealthalliance.com
AND
TO COUNTY:
Keith Honda, Contract Administrator /
Asst.County Administrative Officer
County of Monterey, Human Resources
168 W. Alisal Street, 3rd Floor.
Salinas, CA 93901-2439
Tel. No.: 831) 755-5295
FAX No.: 831) 751-9597
Email: Hondak c@co.monterey ca.us
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
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OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
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HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
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AGREEMENT-U012
RATES-U012
OF-U012
MORE-U012
THAN-U012
TEN-U012
PERCENT-U012
10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
IN WITNESS WHEREOF, the County and CONTRACTOR execute this AGREEMENT as
follows:
Contracts/Purchasing Officer
B
Signature of Chair, Prpfi4ent, or
Vice-President
Dated:
Approved as to Form:
Dated:
Printed Name and Title
Dated:
By: az 7/Wi Q
Signature of Secretary, Asst. Secretary, CFO,
Treasurer or Asst. Treasurer)*
Rlrson M-11t C'M
Printed Name and Title
Dated:
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40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
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OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
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INSURED-U012
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PROGRAM-U012
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REQUEST-U012
PROPOSAL-U012
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CHANGE-U012
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OF-U012
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CAUSE-U012
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RATES-U012
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PERCENT-U012
10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
DENTAL PREFERRED PROVIDER ORGANIZATION PPO)
PLAN DESIGN, ADMINISTRATION, AND PREMIUM COSTS SELF FUNDED
Usual, Customary and Current In- Proposed In- Current Out-of- Proposed
Reasonable Fee Basis Network Network Network Out-of-
Network
A. Co-payment Diagnostic 100% 100% 100% 100 %
& Preventive Deductible Deductible Deductible Deductible
Waived) Waived) Waived) Waived)
Other Basic: 80/20 80/20 80/20 80/20
Prosthodontics: 50/50 50/50 50/50 50/50
Crowns & Cast 50/50 50/50 50/50 50/50
Restorations
Orthodontics Not Covered Not Covered Not Covered Not
Covered
B. Maximum per patient, per $1,000 $1,000 $1,000 $1,000
calendar year
C. Lifetime maximum per Not Covered Not Covered Not Covered Not
patient for Orthodontics Covered
D. Aggregate Stop Loss No Stoploss No Stoploss No Stoploss No
120% of expected claims currently in place currently in currently in Stoploss
place. Ability to place. currently in
offer exists place.
through SunLife. Ability to
offer exists
through
S
E. Other: detail)
F. Plan Deductible $50/$100 $50/$100
COVERED EXPENSES
Subject to the Alternate Benefits section set forth above, Covered Expenses are USUAL OR
PREVAILING CHARGES by a dentist for necessary care of the teeth, gums, mouth or
supporting structures of the teeth furnished to a family member while covered under the Plan's
Dental Care Coverage. There are three types of Covered Expenses: Preventive Dental
Expenses, Basic Dental Expenses, and Major Dental Expenses. Not all expenses are covered.
See-WHAT EXPENSES ARE NOT COVERED?
A Covered Expenses will be deemed incurred as follows:
1. For Full Dentures or Partial Dentures: on the date the final impression is taken.
15-
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
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THE-U012
AGREEMENT-U012
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TO-U012
TWO-U012
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ADDITIONAL-U012
ONE-U012
1)-U012
YEAR-U012
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FUTURE-U012
AMENDMENTS-U012
TO-U012
THE-U012
AGREEMENT-U012
THE-U012
AMENDMENTS-U012
DO-U012
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CHANGE-U012
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RATES-U012
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TEN-U012
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10%).-U012
COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
2. For Fixed Bridges, Browns, Inlays, or Onlays; on the date the teeth are first prepared.
3. For Root Canal Therapy; on the date the pulp chamber is first opened.
4. For Periodontal Surgery; on the date the surgery is actually performed.
5. For All Other Services: on the date the service is performed.
A temporary dental service; will be deemed an integral part of the final dental service rather than
a separate service.
Preventive Dental Expenses are for the following services.
ROUTINE ORAL EXAMS-Charges for routine exams, including cleaning of teeth, but no more
than two every calendar year.
DIAGNOSTIC X-RAYS-charges for bitewing x-rays but no more than four such x-rays, twice
during any period of 12 consecutive months as part of routine oral exam), complete mouth
survey or panoramic x-rays, but no more than one during any period of 36 consecutive months)
as part of a routine oral exam.
SPACE MAINTAINERS-Charges for space maintainers for missing primary teeth to a family
member under age 16, but no more than one every calendar year.
FLUORIDE TREATMENT-Charges for topical application of sodium or stannous fluoride to a
family member under age 18, but no more than one every calendar year.
SEALANTS-Charges for the application of sealants to a family member under age 15, but no
more than once, per tooth, during any calendar year.
BASIC DENTAL EXPENSES
Basic Dental Expenses are for the following services:
ORAL SURGERY-Charges for surgery performed on the gums and teeth. This includes
removal of impacted or erupted teeth and preparation of the gums for dentures.
X-RAYS-Charges for any dental x-ray not provided above in Preventive Dental Expenses when
needed in connection with the diagnosis or treatment of a specific condition.
EXTRACTIONS-Charges made for extractions.
ANESTHESIA-Charges for anesthesia administered in connection with covered dental services.
PERIODONTICS-Charges for treatment of periodontal and other disease of the gums and tissues
of the mouth. Charges for periodontal scaling and root planing are limited to no more than one
time per quadrant of the mouth in any period of 12 consecutive months.
ENDODONTICS-Charges for root canal therapy.
FILLINGS-Charges for fillings, other than gold fillings.
16-
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
JULY-U012
1,-U012
2011-U012
THROUGH-U012
JUNE-U012
30,-U012
2014,-U012
INCLUDING-U012
THE-U012
OPTION-U012
TO-U012
EXTEND-U012
THE-U012
AGREEMENT-U012
UP-U012
TO-U012
TWO-U012
2)-U012
ADDITIONAL-U012
ONE-U012
1)-U012
YEAR-U012
PERIODS;-U012
B.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
SIGN-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
THE-U012
AGREEMENT-U012
THE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CAUSE-U012
AN-U012
INCREASE-U012
IN-U012
THE-U012
AGREEMENT-U012
RATES-U012
OF-U012
MORE-U012
THAN-U012
TEN-U012
PERCENT-U012
10%).-U012
COMPLETED BOARD ORDER AND AGR
�I Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
MEDICINE-Charges for medicines and drugs administered by a dentist.
PALLIATIVE TREATMENT---Charges for palliative treatment treatment to relieve pain) will be
covered as a separate procedure only if no other service except x-rays) is rendered during the
visit.
REPAIR WORK-Charges for repair and recementing or crowns, inlays and fixed bridgework; or
relining or rebasing of dentures more than six months after the installation of an initial or
replacement denture, but no more than one relining or rebasing during any period of 24
consecutive months.
MAJOR DENTAL EXPENSES
Major Dental Expenses are for the following services:
RESTORATIONS-Charges for inlays, Onlays, crowns, and gold fillings.
BRIDGES AND DENTURES--Charges for initial installation of dentures or fixed bridgework or
crowns if the existing denture, bridgework or crown was installed at least five years prior to its
replacement and cannot be made serviceable or cannot be repaired. The replacement will not be
covered if due to loss or theft.
Also, charges for replacement of existing dentures or fixed bridgework, or for the addition of
teeth to existing dentures or fixed bridgework, if needed to replace at least one natural tooth
extracted while the family member is covered under the Plan's Dental Care Coverage.
EXPENSES NOT COVERED
The following charges are not covered or are covered only to the extent stated.
CHARGES FOR WHICH TIDE INSURED IS NOT RESPONSIBLE This Plan only considers
reimbursement of charges that are the responsibility of the insured to pay.
Benefits will not be paid for charges the insured has no responsibility to pay. This may occur as
a result of recovery from a third party, from a dentist not billing waiving) deductibles and co-
insurance requirements of the Plan, etc.
The Plan may require proof of payment for deductibles and co-insurance portions of the bill. Be sure to keep
all cancelled checks or receipts of cash payments for at least one-year in the event the administrator requires
verification. Benefits may be reduced for any payment made by the Plan for which the insured was not
financially responsible.
OCCUPATIONAL INJURY Charges due to anon the job injury. On the job" means
employment with any Employer or self-employment.
OCCUPATIONAL SICKNESS Charges due to any sickness for which an insured person is
entitled to benefits under a Worker's Compensation Act or similar act.
GOVERNMENT SERVICES Charges for dental service furnished by or paid for by any
government or government agency would not have been required to pay for the services in the
absence of insurance for dental care.
17-
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40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
JULY-U012
1,-U012
2011-U012
THROUGH-U012
JUNE-U012
30,-U012
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OPTION-U012
TO-U012
EXTEND-U012
THE-U012
AGREEMENT-U012
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TWO-U012
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ADDITIONAL-U012
ONE-U012
1)-U012
YEAR-U012
PERIODS;-U012
B.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
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SIGN-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
THE-U012
AGREEMENT-U012
THE-U012
AMENDMENTS-U012
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP # 10254
COSMETIC DENTISTRY Charges in connection with dental services primarily for the purpose
of improving appearance. For example, the following are not covered:
alteration or extraction and replacement of SOUND TEETH.
any treatment of the teeth to remove or lessen discoloration except in connection with
endodontic treatment;
replacement of congenitally missing teeth; and
all appliances and restorations for the purpose of splinting teeth, except A-splinting and
provisional splinting in connection with periodontal treatment.
TREATMENT STARTED BEFORE COVERAGE BEGINS-Charges for the following are not
covered:
dentures, if the impression for the dentures was taken before the date the family member's
Dental Care coverage began;
crowns, inlays, bridges or gold restorations if preparation of the teeth was begun before the
date the family member's Dental Care coverage began;
root canal therapy if pulp cap was opened before the date the family member's Dental Care
coverage began.
SERVICES BY A HOSPITAL-Charges for dental services furnished by a hospital.
EXPERIMENTAL PROCEDURES-Charges for procedures that do not have uniformed
professional endorsement, or are experimental in nature. Charges for any related services
furnished in connection with Experimental Procedures are also not covered.
FRACTURES-Charges for treatment of fractures or dislocation of jaw.
LOSS OR THEFT-Charges due to loss or theft of an appliance or prosthesis.
IMPLANTS-Charges for tooth implants are not covered.
ATHLETIC MOUTH GUARDS-Charges for athletic mouth guards are not covered.
APPLIANCES-Charges for veneers are not covered except for those procedures that are not
done solely for cosmetic purposes.
TEMPOROMANDIBULAR JOINT SYNDROME-Charges for, in connection with, treatment of
temporomandibular joint syndrome.
ORTHODONTIA-Charges for orthodontic treatment and appliances.
OTHER COVERED EXPENSES-Charges for any dental services that are not Covered Expenses
under any part of this Plan.
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
JULY-U012
1,-U012
2011-U012
THROUGH-U012
JUNE-U012
30,-U012
2014,-U012
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OPTION-U012
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COMPLETED BOARD ORDER AND AGR
�Agreement between County of Monterey and Pacific Health Alliance
RFP #10254
THE COUNTY OF MONTEREY agrees to the terms set forth in this AGREEMENT to pay
PACIFIC HEALTH ALLIANCE, the following fees payable monthly in advance by COUNTY:
DENTAL PLAN
Claims Administration
Effective June 1, 2011 $2.95 per reported enrolled employee or retiree) per month
All printing and postage fees. Contractor will provide written documentation.
Dental Plan Network Access Fee waived
PHA shall review and reprice dental claims for dental providers who are members of the PHA
Preferred Dental Network. PHA shall not receive any additional compensation for savings
generated through the Preferred Dental Network.
A report will be provided by Pacific Health Alliance to Monterey County by the 20th day of each
month providing a summary of claims, savings and adjustments resulting from this program for
the preceding month.
COBRA Administration
Monthly administrative fee of $300 per month and $9.00 per enrollee per month.
All printing and postage fees. Contractor will provide written documentation.
BIB]
40742-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
AGREEMENT-U02
A-12022-U02
LI21329-U03
FO96183-U03
FO96184-U03
FO99828-U03
MG99940-U03
AS99966-U03
AS99970-U03
AI103323-U03
DO104260-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
7/18/2011-U04
MARCELLAC-U04
16767-U05
8-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
THE-U07
CONTRACTS/PURCHASING-U07
OFFICER-U07
TO-U07
SIGN-U07
AN-U07
AGREEMENT-U07
PACIFIC-U07
HEALTH-U07
ALLIANCE-U07
105-ADMINISTRATION-U08
SILVA-U09
JANET-U09
MARCELLAC-U10
6/20/2011-U011
THIRD-U012
PARTY-U012
ADMINISTRATOR-U012
SERVICES-U012
THE-U012
COUNTY-U012
S-U012
SELF-U012
INSURED-U012
DENTAL-U012
PROGRAM-U012
PER-U012
REQUEST-U012
PROPOSAL-U012
#10254,-U012
THE-U012
INITIAL-U012
AGREEMENT-U012
TERM-U012
BEGINNING-U012
ON-U012
JULY-U012
1,-U012
2011-U012
THROUGH-U012
JUNE-U012
30,-U012
2014,-U012
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SIGNED BOARD REPORT"�|E
1�MONIJEREY COUNTY BOARD OF SUPERVISORS
MEETING: June 28, 2011 Consent AGENDA NO.: Ll
SUBJECT: a. Approve a nd Authorize the Contracts and Purchasing Officer to sign an
Agreement with Pacific Health Alliance PHA), for Third Party Administrator
TPA) Se ices for the County's self-insured Dental Program per Request for
Proposal P) #10254, with the initial Agreement term beginning July 1, 2011
through De ember 31, 2015, including the option to extend the Agreement for up
to three 3) additional one 1) year periods; and
b. Authorize t e Contracts and Purchasing Officer to sign future Amendments to the
Agreement here the Amendments do not significantly change the scope of work
or cause an increase in the Agreement rates of more than ten percent 10%)
DEPARTMENT: County dministrative Office
RECOMMENDATIONS:
It is recommended that the Board of Supervisors:
a. Approve and Authorize t Contracts and Purchasing Officer to sign an Agreement with Pacific
Health Alliance PHA), for Third Party Administrator TPA) Services for the County's self-insured
Dental Program per Reque t for Proposal RFP) #10254, with the initial Agreement term beginning
July 1, 2011 through December 31, 2015, including the option to extend the Agreement for up to
three 3) additional one 1) year periods see attachment A); and
b. Authorize the Contracts and Purchasing Officer to sign future Amendments to the Agreement
where the Amendments d not significantly change the scope of work or cause an increase in the
Agreement rates of more than ten percent 10%)
SUMMARY/DISCUSSION:
Approval of the recommende
Services for the County's self
enrollment services for Cons
the current rate of participatio
or approximately $170,000 pe
and 117 retirees.
The TPA fees for the dental pr
monthly rate that should be cl
departments for employee or
COBRA participants pay 100�
OTHER AGENCY INVOL
actions will enable the County Administrative Office to procure TPA
insured Dental Program, available to all County employees) as well as
idated Omnibus Budget Reconciliation Act COBRA) participants. At
the monthly fee for all enrolled participants will be $14,055 per month
year. Current enrollment is 4,291 employees, 51 COBRA participants
gram are part of the costs used by the Benefits Actuary to determine the
targed for this program. The costs for the dental program are paid by
ly coverage), and employees for dependent coverage). Retirees and
of the premiums.
MENT:
Contracts/Purchasing, County Counsel and the Auditor's Office were involved in the RFP process and
have reviewed and approved ft contract which was submitted to the vendor for signature.
BIB]
40742-U01
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SIGNED BOARD REPORT"�|E
1�i
FINANCING:
The costs associated with this action are included in the Benefits Internal Service Fund specifically in
the Dental Unit).
Prepared by:
Terri Cook Keithonda
Management Analyst III Asst. County Administrative Officer
Human Resources
Date: June 15, 2011
BIB]
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