ESBD_360338_1716477847667_Attachment Q - 2024 Dental Renewal.pdf
PDF 369 KB Posted
- Solicitation number
- RFp2024-P11
- Issued by
- Hays County, Texas
About this file
The document is a renewal for group dental insurance coverage for the County of Hays, Texas, provided by UnitedHealthcare Dental. The renewal is effective January 1, 2024 through December 31, 2024, with a rate guarantee of 12 months. The plan provides comprehensive dental coverage, including diagnostic services, preventive services, basic services, major services, and orthodontic services. The plan has a $1,250 individual/$1,250 family deductible, with an annual maximum of $1,250 and a lifetime orthodontic maximum of $1,250. The current enrollment is 25 members, with monthly premium rates ranging from $11.40 for employee-only to $28.23 for family coverage.
The document also references a related state and local contract opportunity, RFP 2024-P11 for Employee Group Health, Dental, and Employee Assistance Plans, issued by Hays County, Texas. This RFP is seeking proposals for a comprehensive benefits package, including medical, pharmacy, dental, and employee wellness/assistance plans, to be effective January 1, 2025, with open enrollment starting October 1, 2024. The county is looking to partner with insurance companies that can provide competitive, long-term, and stable financial solutions while offering a robust benefits package.
View the file
Other files
Show all 23
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Renewal for
COUNTY OF HAYS
Issued on: September 22, 2023
Legal Entity
Diagnostic Service Periodic Oral Evaluation
Radiographs
Lab and Other Diagnostic Tests
Preventive Services Dental Prophylaxis (Cleaning)
Fluoride Treatment
Sealants
Space Maintainers
Basic Services
Restorations (Amalgams or Composite)*
Emergency Treatment/General Services
Simple Extractions
Oral Surgery (incl. surgical extractions)
Periodontics
Endodontics
Major Services Inlays/Onlays/Crowns
Dentures and Removable Prosthetics
Fixed Partial Dentures (Bridges)
Orthodontic Services Orthodontia
Orthodontia Eligibility
Deductible (Individual/Family)
Deductible applies to Prev. & Diag.
Annual Max
Lifetime Ortho Max
Waiting Period
Out of Network Basis
PPO Network
CMM–Annual Roll-Over
ASO Fees Current Renewal 1/1/2024-
12/31/2024 ASO Fee PEPM 1007 $3.36 $3.36
Broker Commissions $0.00 $0.00
Total ASO Fee PEPM $3.36 $3.36
ASO Annual Premium
Renewal Action (before commissions)
Renewal Action (after commissions)
12 month Claims Projection PEPM $47.19
Daily Imprest Balance (1 Day) $2,281.06
Employer Contribution
Participation Requirements
Dependent Children Coverage
Contract Basis
Benefit Period Basis
Exclusions and Limitations
Broker Commissions
Rate Guarantee
$0.00 PEPM
12 Months
Contributory
75% of Eligible Employees
To Age 26
ASO
Calendar Year
Standard
$40,602.24 $40,602.24
0.00%
0.00%
UCR 90th
Options PPO 30
No
$1,250 $1,250
Child Only (Up to Age 19)
$50/$150 $50/$150
No No
$1,250 $1,250
50% 50%
50% 50%
50% 50%
50% 50%
80% 80%
80% 80%
80% 80%
80% 80%
80% 80%
80% 80%
100% 100%
100% 100%
100% 100%
100% 100%
100% 100%
100% 100%
100% 100%
United HealthCare Services, Inc.
Primary Plan
In Network Out of Network
UnitedHealthcare Dental Renewal for COUNTY OF HAYS
Effective Date: 01/01/2024 | Policy Number: 00912772
Dental Services
Passive PPO
4P648
CS0
Legal Entity
Diagnostic Service Periodic Oral Evaluation
Radiographs
Lab and Other Diagnostic Tests
Preventive Services Dental Prophylaxis (Cleaning)
Fluoride Treatment
Sealants
Space Maintainers
Basic Services
Restorations (Amalgams or Composite)*
Emergency Treatment/General Services
Simple Extractions
Oral Surgery (incl. surgical extractions)
Periodontics
Endodontics
Major Services Inlays/Onlays/Crowns
Dentures and Removable Prosthetics
Fixed Partial Dentures (Bridges)
Orthodontic Services Orthodontia
Orthodontia Eligibility
Deductible (Individual/Family)
Deductible applies to Prev. & Diag.
Annual Max
Waiting Period
Out of Network Basis
CMM–Annual Roll-Over
Assumed Enrollment and Rates Current Renewal
Employee 6 $11.40 $11.40
Employee + Spouse 7 $21.27 $21.27
Employee + Child(ren) 6 $22.55 $22.55
Employee + Family 6 $28.23 $28.23
Monthly Premium
Annual Premium Renewal Action
Employer Contribution
Participation Requirements
Dependent Children Coverage
Contract Basis
Exclusions and Limitations
Broker Commissions
Rate Guarantee
Fully Insured
Standard
0%
12 Months
Contributory
75% of Eligible Employees
To Age 26
$521.97 $521.97
$6,263.64 $6,263.64 0.0%
No
See Copay Schedule
See Copay Schedule
See Copay Schedule
See Copay Schedule
See Copay Schedule
In Network Out of Network
See Copay Schedule
DHMO
D094C
National Pacific Dental, Inc.
Primary Plan
UnitedHealthcare Dental Renewal for COUNTY OF HAYS
Effective Date: 01/01/2024 | Policy Number: 00912772
Dental Services
General Assumptions
Dental Assumptions
Please note that the summary of benefits in this document provides a brief description of coverage. State mandates may preclude certain benefit plan design features. This is not a policy, certificate of insurance or coverage document. For complete details on coverage, exclusions, limitations and the terms under which coverage may continue, please contact your sales representative.
Quote is based on total group Average Contract Size (ACS) of 2.02
Quote is based on total group of 1032 Employees and 2084 Members.
United Healthcare reserves the right to adjust the above rates should enrollment or ACS fluctuate by +/- 10%.
This quote assumes UnitedHealthcare will retain claim fiduciary responsibility.
Digital ID cards will be available on-line, upon initial enrollment, for employees enrolled in PPO, INO and Indemnity plans. Plastic ID cards will be issued, upon initial enrollment, for employees enrolled in Direct Compensation, Select Managed Care and DHMO plans.
Our contract covers only those procedures performed in the United States.
Please contact your sales representative for more details on the network quoted in your proposal.
Run-In Claims are not Paid.
Fees include 12 months of run out claims. Additional months are available at an additional cost.
The In- and Out-of-Network Plan Deductibles, Maximums and Lifetime Ortho Maximums are combined.
* Please contact your sales representative to confirm specific plan Restorations (Amalgams or Composite) coverage.
- Assumed contract situs is Texas.
- Employees must be U.S. citizens or residents regularly working and living in the U.S. Coverage for U.S. citizens working outside of the U.S. must be approved in writing by us. Approval depends on locale and length of assignment.
- Employer's assumed primary business is classified as 9111.
- Rates may increase on renewal in accordance with the terms of the policy.
This premium may include state and federal taxes and fees.
Rates listed above assume the plan designs quoted. Rates may change, if plan design changes.
UnitedHealthcare Assumptions for COUNTY OF HAYS
Effective Date: 01/01/2024 | Policy Number: 00912772
- We reserve the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than 10% before, on, or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed, found to be incomplete or incorrect.
- Rates assume no changes in legislation or regulation that affects the benefits payable, eligibility or contract.
- Rates assume standard administrative services including Claims & Data processing, Enrollment & Billing, Customer Service, Case Management, Provider
Relations, and Reporting.
UnitedHealthcare Disclaimers for COUNTY OF HAYS
Effective Date: 01/01/2024 | Policy Number: 00912772
This proposal is valid for 90 days from the issued date, unless otherwise noted within this document.
Brokers and agents may receive commissions, bonuses and other compensation for selling the products presented in this proposal.
The cost of this compensation may be directly or indirectly reflected in the premium or fees for those products. Contact your broker and/or agent if you have questions regarding their compensation relating to products in this proposal.
This proposal is subject to negotiation and execution of a written agreement, which will supersede the proposal contents. This proposal does not constitute an agreement, and is based on assumptions made from the written information in our possession and provided by you. We retain the right to modify our proposal if the information upon which this proposal is based is changed or is supplemented.
We consider much of the information contained in the proposal to be proprietary or otherwise confidential, and are releasing this proposal to you on the understanding that you and your representatives will only use it, and any data included in the proposal, for the specific purpose of evaluating its content. If this is not consistent with your understanding, please notify us before reviewing the proposal.
In addition, by accepting and reviewing the contents of this proposal, you and your agents or other designees agree, to the extent permitted by law, that certain information contained herein, or other information provided to you in connection with this proposal response or associated request for proposal (RFP), is proprietary and/or confidential to UnitedHealthcare and its related entities, and may not be copied, used, distributed or disclosed without prior written consent from an authorized representative of UnitedHealthcare, other than is necessary to evaluate this proposal.
© 2021 United HealthCare Services, Inc. All Rights Reserved 0004411-05 - 9/22/2023
File details come from the government source that posted it. Updated .