Exhibit 05a - Cal Yr 2025 City of Miami CIGNA Dental HMO Plan Certificate HP-POL890.pdf

IMPORTANT NOTICE: The group insurance policy in this PDF (the “Policy”) is validly issued by Cigna Health and Life Insurance Company in the state identified on the cover page of the Policy (the “Policy Issuance State”) and shall be governed by its laws. For your convenience, the Policy is hereby transmitted electronically to you, as representative of the policyholder, in lieu of physical delivery of a paper copy of the Policy in the Policy Issuance State. Your receipt of this electronic transmission constitutes official delivery of the Policy in the Policy Issuance State no less than if a paper copy of the Policy were physically delivered at a policyholder address in the Policy Issuance State. If you prefer, a paper copy of the Policy will be delivered to a policyholder address that you identify in the Policy Issuance State.

This notice is not part of the policy.

EXHIBIT 05a

Cigna Health and Life Insurance Company

HP-POL890 06-21

Mailing Address: Hartford, Connecticut 06152 Home Office: Bloomfield, Connecticut

CIGNA HEALTH AND LIFE INSURANCE COMPANY

GROUP DENTAL INSURANCE POLICY

POLICYHOLDER: City of Miami

ADDRESS: Miami, Florida

ACCOUNT NUMBER: 3202272

Group Insurance Effective Anniversary Policy and Policy Number Date __ Date______

CIGNA DENTAL CARE INSURANCE

3202272-DHMO

01/01/2013 01/01

This Policy contains the terms under which the Insurance Company agrees to insure certain Subscribers and pay benefits.

This policy is issued in New York and shall be governed by its laws.

The Insurance Company and the Policyholder have agreed to all of the terms of these policies.

HP-POL890 3

POLICY CONTENTS

Page

THE INSURANCE SCHEDULE

PREMIUMS

CANCELLATION OF POLICY

MISCELLANEOUS PROVISIONS

PROVISIONS

CERTIFICATE CONTENTS

DEFINITIONS...............................................................................................................................................................Certificate

HOW YOUR COVERAGE WORKS.......................................................................................................................Certificate

COST SHARING EXPENSES AND ALLOWED AMOUNT.........................................................................Certificate

WHO IS COVERED.....................................................................................................................................................Certificate

COVERED DENTAL SERVICES............................................................................................................................Certificate

EXCLUSIONS AND LIMITATIONS .....................................................................................................................Certificate

CLAIM DETERMINATIONS ...................................................................................................................................Certificate

GRIEVANCE PROCEDURES..................................................................................................................................Certificate

UTILIZATION REVIEW ...........................................................................................................................................Certificate

EXTERNAL APPEAL..................................................................................................................................................Certificate

COORDINATION OF BENEFITS.........................................................................................................................Certificate

TERMINATION OF COVERAGE .........................................................................................................................Certificate

EXTENSION OF BENEFITS ...................................................................................................................................Certificate

CONTINUATION OF COVERAGE......................................................................................................................Certificate

OTHER COVERED SERVICES...............................................................................................................................Certificate

THE SCHEDULE..........................................................................................................................................................Certificate

HP-POL890 4

THE INSURANCE SCHEDULE

The terms set forth herein and in the Certificate(s) listed below describe the insurance underwritten by the Insurance Company. These Certificates are included in and made a part of the Policy(ies). Each Certificate is identified by a Certificate Number (CN).

Any reference in the Certificate to "You" or "Yours" refers to the Subscriber.

A Subscriber in any of the classes shown below may be insured but only for the Policy(ies) listed for that Subscriber Class.

The Effective Date shown below is the date on which a Policy becomes effective for a Subscriber Class.

A Subscriber will become eligible and insured in accordance with the terms of the "Whos Is Covered" and "When Coverage Begins" sections of the Certificate.

GROUP POLICY(IES) ELIGIBLE CLASS

Certificate Number Policy(ies)

Eligible Subscribers

Effective Date___

CN040 CIGNA DENTAL CARE

INSURANCE

3202272-DHMO

Each Employee as reported to the insurance company by your Employer

01/01/2025

HP-POL890 5

PREMIUMS

PREMIUM PAYMENT. The first premium will be due on the effective date. After that, premium will be due monthly unless the Policyholder and the Insurance Company agree on some other method of premium payment. The Policyholder and the Insurance Company may agree to change the method of premium payment from time to time. Premiums are payable at the Home Office of the Insurance Company or to an authorized agent of the Insurance Company.

PREMIUM DUE DATE. After the effective date, the Premium Due Date will be the first of the month. The Anniversary Date will be the first of the month when the Policy becomes effective. If the Policyholder and the Insurance Company agree that premiums will be paid on a quarterly, semiannual or annual basis, the Premium Due Date will be at the appropriate regular interval, quarterly, semiannually or annually. Premiums must be received at the Home Office or by an authorized agent of the Insurance Company on the Premium Due Date or the Policy will be cancelled except as set forth in the Grace Period.

MONTHLY STATEMENT DATE. If premiums are to be paid monthly, the Monthly Statement Date will be the same as the Premium Due Date. If premiums are to be paid on a quarterly, semiannual or annual basis, the Monthly Statement Date will be the day in each month with the same number as the Premium Due Date.

MONTHLY PREMIUM STATEMENT. If premiums are due monthly, a Monthly Premium Statement will be prepared as of the Premium Due Date. This Monthly Premium Statement will show the premium due. If premiums are due quarterly, semiannually or annually, a Monthly Premium Statement will be prepared as of the Monthly Statement Date for the time from the Monthly Statement Date to the next Premium Due Date. This Monthly Statement will reflect any pro rata premium charges and credits due to changes in the number of insured persons and changes in insurance amounts that took place in the preceding month.

SIMPLIFIED ACCOUNTING. To simplify the accounting process, premium adjustments will be made on the Monthly Statement Date that is the same as or next follows the date that:

A person becomes insured.

The amount of insurance on a person changes, but not due to a revision of The Schedule.

A person ceases to be insured.

MONTHLY PREMIUM RATE FOR DENTAL EXPENSE INSURANCE. The monthly premium rate for Dental Expense Insurance is determined by written agreement between the Policyholder and Cigna Health and Life Insurance Company.

DENTAL EXPENSE INSURANCE PREMIUM. The monthly premium for Dental Expense Insurance will be calculated as follows:

Multiply the number of Subscribers insured on the Premium Due Date in each rate class by the premium rate in effect on that date for that class.

Add the results.

HP-POL890 6

CHANGE IN METHOD OF PREMIUM PAYMENT. If premiums are to be paid other than monthly, the method of calculation is the same. However, the rate for each class is first changed to quarterly, semiannual or annual rates by multiplying them by 2.9852, 5.9557 or 11.8227, respectively. All results are taken to the nearest cent. If the Policyholder and the Insurance Company agree to a change in the method of premium payment or to a change in the Anniversary Date, a pro rata adjustment will be made in the premium due.

CHANGES IN PREMIUM RATES. Any premium rate may be changed by the Insurance Company from time to time with at least 31 days advance written notice. No such change will be made until 12 months after the effective date. An increase will not be made more often than once in a 12-month period. If an increase in premium rates takes place on a date that is not a Premium Due Date, a pro rata premium will be due on the date of the increase. The pro rata premium will apply for the increase from the date of the increase to the next Premium Due Date. If a decrease in premium rates takes place on a date that is not a Premium Due Date, a pro rata credit will be granted. The pro rata credit will apply for the decrease from the date of the decrease to the next Premium Due Date.

The Insurance Company may change rates immediately if, following the latter of the effective date or renewal date, the enrolled population either increases or decreases by 10% or more.

As of any Anniversary Date after the Policy has been in force for 12 months, the Insurance Company may grant a credit in such amount as it may determine, based on experience. The experience under this Policy may be combined with the experience under other contracts issued by the Insurance Company or its affiliates and covering the Policyholder or its Subscriber.

The Insurance Company may change rates immediately if, in its opinion, its liability is altered by any change in state or federal law or by a revision in the insurance under the Policy. Any such change in rates will take effect on the effective date of the change in law or change in the insurance.

HP-POL890 7

CANCELLATION OF POLICY

The Policyholder may cancel the Policy as of any Premium Due Date by giving written notice to the Insurance Company before the date.

The Insurance Company may cancel the Policy due to the following reasons only:

with at least 90 days prior written notice, if the Insurance Company ceases to offer coverage of this type, in accordance with applicable state or federal law;

as of any Premium Due Date, if the premium is not received at the Home Office or by an authorized agent of the Insurance Company when due;

immediately, if the Employer has performed an act or practice that constitutes fraud or has intentionally misrepresented a material fact;

as of any Premium Due Date, if the number of insured Subscribers or if the number of insured Dependents fails to meet the minimum required per group participation rules; or for failure to comply with any other material plan provision relating to Employer contributions or group participation rules;

if the Insurance Company withdraws from the health insurance market with prior written notice and in accordance with applicable state or federal law;

in accordance with any applicable state law, if it is determined that the size of the Employer group has changed, making such group eligible for a guaranteed issued small group product;

in accordance with any applicable state or federal law, if prior notice is given to the Employer;

as to an Employer member of an association to which this Policy is issued, when the Employer’s membership in the association ceases, in accordance with applicable state or federal law.

IMPOSSIBILITY OF PERFORMANCE. Neither Policyholder nor Cigna shall be liable to the other or be deemed to be in breach of this Contract for any failure or delay in performance arising out of unforeseeable events beyond the control of either party. Such events are limited to include natural disaster, war, riot, acts of terrorism (domestic and/or foreign), epidemic, pandemic, cyber events (including breakdown of communication facilities, web hosting and internet services) or any other emergency or similar event not within either party’s control which may result in facilities, personnel, or financial resources being unavailable to provide or arrange for the provision of services in accordance with this Policy. Timelines for performance shall be extended to the extent necessary and agreed upon by both parties, provided that the party whose performance is affected notifies the other promptly of the existence and nature of the delay and the impacted party makes good faith effort to provide or arrange for the provision of service, taking into account the severity of the event.

Coverage will cease at midnight on the date on which termination occurs, unless otherwise stated above.

UNIFORM MODIFICATION OF COVERAGE. At renewal, the provisions of this Policy may be modified to reflect product revisions which have been uniformly made to this product.

GRACE PERIOD. If, before a Premium Due Date, the Policyholder has not given written notice to the Insurance Company that the Policy is to be canceled, a Grace Period of 31 days will be granted for the payment of each premium after the initial premium. The Policy will stay in effect during that time. If any premium is not received at the Home Office or by

HP-POL890 8

an authorized agent of the Insurance Company by the end of the Grace Period, the Policy will automatically be canceled at the end of the Grace Period; except that, if the Policyholder has given written notice in advance of an earlier date of cancellation, the Policy will be canceled as of the earlier date. The Policyholder will be liable to the Insurance Company for any unpaid premium for the time the Policy was in force.

HP-POL890 9

MISCELLANEOUS PROVISIONS

EXECUTION OF POLICY. The Policy is executed at the Home Office of the Insurance Company. The Post Office address of the Insurance Company is Hartford, Connecticut.

CONSIDERATION. The Policy is issued to the Policyholder in consideration of the application and payment of premiums.

INSURANCE DATA. The Policyholder will give the Insurance Company all of the data that it needs to calculate the premium and all other data that it may reasonably require. Failure of the Policyholder to give this data will not void or continue an Subscriber's insurance. The Insurance Company has the right to examine the Policyholder's records relative to these benefits at any reasonable time while the Policy is in effect. It also has this right until all rights and obligations under the Policy are finally determined.

ADDITIONAL PROGRAMS. The Insurance Company may, from time to time, offer or arrange for various entities to offer discounts, benefits or other consideration to Subscribers for the purpose of promoting their general health and well being. Contact the Insurance Company for details of these programs.

HP-POL890 10

PROVISIONS

ENTIRE CONTRACT. The entire Contract will be made up of the Policy, the Certificate, the application of the Policyholder, a copy of which is attached to the Policy and all subsequent versions of the Policy, the Certificate, and the applications, if any, of the Subscribers.

POLICY CHANGES. This Policy may not be modified, amended, or changed, except in writing and signed by Our Corporate Secretary. No employee, agent, or other person is authorized to interpret, amend, modify, or otherwise change this Policy in a manner that expands or limits the scope of coverage, or the conditions of eligibility, enrollment, or participation, unless in writing and signed by the Corporate Secretary.

STATEMENTS NOT WARRANTIES. All statements made by the Policyholder or by an insured Subscriber will, in the absence of fraud, be deemed representations and not warranties. No statement made by the Policyholder or by the Subscriber to obtain insurance will be used to avoid or reduce the insurance unless it is made in writing and is signed by the Policyholder or the Subscriber and a copy is sent to the Policyholder, the Subscriber or the Subscriber’s Beneficiary or authorized representative.

NOTICE OF CLAIM. Written notice of claim must be given to the Insurance Company within 30 days after the occurrence or start of the loss on which claim is based.

If notice is not given in that time, the claim will not be invalidated or reduced if it is shown that written notice was given as soon as was reasonably possible.

CLAIM FORMS. When the Insurance Company receives the notice of claim, it will give to the claimant, or to the Policyholder for the claimant, the claim forms it uses for filing proof of loss. If the claimant does not get these claim forms within 15 days after the Insurance Company receives notice of claim, the claimant will be considered to have met the proof of loss requirements if the claimant submits written proof of loss within 12 months after the date of loss. This proof must describe the occurrence, character and extent of the loss for which claim is made.

PROOF OF LOSS. Written proof of loss must be given to the Insurance Company within 12 months after the date of the loss for which claim is made. If written proof of loss is not given in that time, the claim will not be invalidated nor reduced if it is shown that written proof of loss was given as soon as was reasonably possible.

PHYSICAL EXAMINATION. The Insurance Company, at its own expense, will have the right to examine any person for whom claim is pending as often as it may reasonably require.

RIGHT TO KNOW. The Policyholder has the right to obtain information about how the plan operates the care delivery system and an explanation of the benefits to which participants are entitled under the terms of the plan. Additional information regarding the plan may be obtained by contacting the Policyholder's sales office.

LEGAL ACTIONS. No action at law or in equity may be maintained against Us prior to the expiration of 60 days after written submission of a claim has been furnished to Us as required in this Policy. You must start any lawsuit against Us under this Policy within two (2) years from the date the claim was required to be filed.

TIME LIMITATIONS. If any time limit set forth in the Policy for giving notice of claim or proof of loss, or for bringing any action at law or in equity is less than that permitted by the law of the state in which the Subscriber lives when the Policy is issued, then the time limit provided in the Policy is extended to agree with the minimum permitted by the law of that state.

HP-POL890 11

CERTIFICATES. The Insurance Company will issue to the Policyholder for delivery to each insured Subscriber an individual Certificate. The Policyholder will be responsible for distributing the Certificates to its Subscribers. The Certificate will show the benefits provided under the Policy. It will set forth any changes in benefits due to age and to whom benefits will be paid. Nothing in the Certificate will change or void the terms of the Policy.

NOTICE OF TERMINATION OF ELIGIBILITY. Written notice of the termination of eligibility of any Subscriber must be given to the Insurance Company within (60) days of the loss of eligibility. If such notice is not received by the Insurance Company within (60) days of the date of loss of eligibility for an Subscriber then the Employer shall be responsible for all claims for that Subscriber incurred through the (60th) day prior to the Insurance Company's receipt of notice of termination of eligibility for the Subscriber.

RIGHT TO AUDIT. We reserve the right to audit, once every 2 years, the Policyholder’s billing records and premium accounting practices. If We discover:

an underpayment of premium by the Policyholder, the Policyholder will be obligated to pay the underpayment amount, in a timely manner; or an overpayment of premium, We will return any overpayment amount in a timely manner.

CLERICAL ERROR. Clerical error or delays in making entries on the records by Us or Our designees will not void this Policy or any Covered Person’s insurance if it would otherwise have been in effect. Such clerical error will not cause any person to become insured if such person was not otherwise eligible. Such clerical error will also not extend any Covered Person’s coverage if such coverage would otherwise have ended or been reduced as provided by the Policy. If a clerical error is found, premiums and benefits will be adjusted based on the true facts and the provisions of the Policy.