AttachmentA.pdf

ATTACHMENT A TO THE RFQ/P

SCOPE OF SERVICES

1 –Calendar Year Maximum at $1,000

1. The contractor shall provide the dental insurance coverage described below to all subscribers designated by the Authority during the term of the agreement.

1.1 The term "subscribers" shall include;

• eligible and enrolled employees, spouses and children until their 19th birthday;

• children age 19 to 26 years of age who are full time students, IRS dependents, or for two years after loss of IRS dependent status;

• eligible and enrolled employees hired or promoted during the plan year into non-union positions or positions which allow eligibility as a result of their collective bargaining agreement, and ;

• subscribers also include those eligible under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

1.2 Eligible employees may change coverage (e.g. individual to family, family to individual), enroll or terminate coverage during the open enrollment period or during the plan year if the eligible employee has a change in family status or employment status.

2. The term of this agreement, will commence January 1, 2014 and terminate December 31, 2014. The Authority, may, by amendment, extend this agreement for three additional twelve month periods at terms to be mutually agreed upon by both parties.

2.1 Upon commencement of the contract, the contractor shall assume existing lifetime maximums for orthodontic coverage documented under the Authority's current contract for dental insurance and shall utilize these to determine coverage and benefit levels for subscribers.

3. The contractor shall provide the following level of benefits to subscribers, with benefits paid up to a maximum of $1,000 per year per subscriber in Column I of the Cost Proposal attached as “Attachment C, Cost Submittal Form”:

3.1 DIAGNOSTIC AND PREVENTIVE SERVICES - Covered 100%

Diagnostic Description of Services Limits

Oral exam and diagnosis Once every six months X-rays (Bitewing) Once every 6 months Standard X-rays Once every 60 months Diagnostic models Once every 60 months Emergency dental care Three times every six months

Preventive

Teeth cleaning Once every six months Fluoride treatment Once every six months (dependents under 19 years only) Dental sealants Once every 48 months (dependents under 14 years only)

3.2 BASIC SERVICES - Covered 80% after deductible. (See 3.4)

Fillings Once every 12 months per tooth Extractions* Not covered in a hospital setting Perioprophylaxis Once every 3 months Gingivectomy* Not covered in a hospital setting Root Scaling Once every 24 months Root Canal Once per tooth Pulpotomy All members regardless of age Denture repairs Once every 12 months (same repair) Rebase or reline dentures Once every 36 months Recementing crowns, inlays and onlays

Once every 12 months per tooth

Anesthesia With covered surgical services only *Covered in an office setting

3.3 MAJOR RESTORATIVE SERVICES - Covered 50% after deductible. (See 3.4)

Description of Services Limits

Crowns, inlays and onlays when fillings cannot be used

Once every 60 months per tooth

Dentures, fixed bridges and crowns when part of bridge

Once every 60 months

3.4 A $25.00 deductible per year per subscriber up to a maximum deductible of $75.00 per family will apply to basic and major restorative services.

3.5 The contractor shall cover 60% of reasonable and customary charges for orthodontic services with no deductible and a separate lifetime maximum of $1500 per member.

4. The contractor's plan shall have enrolled approximately 2500 dentists with offices throughout the greater Boston area (to include Quincy, Framingham, Billerica, Danvers, and surrounding areas in addition to Boston locations).

5. The contractor shall pay the in-network providers directly for covered services. Subscriber payments for in-network services shall be limited to co-pays and deductibles.

6. The contractor shall bill the Authority on a monthly basis.

7. The contractor shall assign one account representative to act as day-to-day contact with the Authority's Benefits Manager.

8. The contractor shall provide the Authority with a sufficient number of brochures that outline coverage and facilities available in the program for all eligible subscribers. The contractor shall provide the Authority with notification of any increase in services and any necessary materials to be distributed to eligible employees as needed.

9. The contractor shall provide the Authority with enrollment/change forms and claim forms (if necessary).

10. The contractor shall provide the Authority with utilization information quarterly and at the end of the calendar year.

11. The contractor shall base the proposed costs on the following demographic and utilization information:

11.1 Demographic data on current subscribers including date of birth, sex, salary, zip code and individual/family enrollment is provided as Attachment F to the RFQ/P.

11.2 Claims and enrollment information will be provided in Attachment H.

11.3 The total number of eligible employees may change during the open enrollment period. Approximately 207 employees are eligible to drop the coverage offered by the MWRA and enroll in a plan offered by their union.

11.4 As of August 2013, the following insureds were covered under COBRA:

Individual Coverage 5 Family Coverage 1

12. Employees will contribute 10 percent of the premium. The MWRA will pay 90 percent of the premium. The following lists previous rates: (Note: The MWRA has been paying 90% of the premiums and employees 10% in these time periods.)

Time Period Total Monthly Rates* Individual Family

1/1/13 – 12/31/13 Plan A $50.41 Plan B $42.85

Plan A $123.54 Plan B $104.99

1/1/12 -12/31/12 Plan A $50.41 Plan B $42.85

Plan A $123.54 Plan B $104.99

1/1/11 -12/31/11 Plan A $50.41 Plan A $123.54

Plan B $42.85 Plan B $104.99 1/1/10 -12/31/10 Plan A $50.41

Plan B $42.85 Plan A $123.54 Plan B $104.99

1/1/09 – 12/31/09 Plan A $47.78 Plan B $40.61

Plan A $117.09 Plan B $99.52

1/1/08 – 12/31/08 Plan A $43.45 Plan B $36.93

Plan A $106.48 Plan B $90.50

1/1/07 – 12/31/07 Plan A $40.08 Plan B $34.07

Plan A $98.23 Plan B $83.49

1/1/06 – 12/31/06 Plan A $40.08 Plan B $34.07

Plan A $98.23 Plan B $83.49

1/1/05 - 12/31/05 $40.08 $98.23 1/1/04 – 12/31/04 $37.21 $91.21 1/1/03 – 12/31/03 $35.29 $86.49 1/1/02 – 12/31/02 $28.86 $70.73

*Please note the MWRA previously offered a lower cost option for its employees (“Plan B”).

13. After contract termination, the contractor shall continue coverage for subscribers if the subscriber has been to two or more visits for treatment excluding orthodontic services.

14. Information regarding calendar year deductibles, calendar year maximums and lifetime maximums shall be supplied to the Authority upon termination of the agreement.

15. The contractor shall not continue coverage under its agreement with the MWRA beyond the date of termination of coverage if the eligibility of the subscriber has terminated.

2. –Calendar Year Maximum at $1,250

Vendors provide a proposed cost for all elements described above but assuming a higher Calendar Year Maximum of $1,250 per year.

Diagnostic