DELTA DENTAL OF CALIFORNIA (EMPLOYEE INS. RENEWALS, DENTAL, VISION, EMPLOYEE ASSISTANCE, ETC.)

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A-2016-229-01 INSURANCE NOT REQUIRED WORK MAY PROCEED CLERK OF COUNCIL AMENDMENT NO. ii TO AGREEMENT DATE` �� ,- G RENEWAL GROUP #00599 AGREEMENT dated January 1, 2005, as amended, between CITY OF SANTA ANA and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2017, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on January 1, 2017, and ending on December 31, 2017 and each subsequent yearly period during which this Contract remains in effect. Paragraph 3.1 is amended to read: 3.1 Within ten days after receipt of Delta Dental's invoice, Contractholder agrees to pay the following monthly, billed Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of Contractholder's Primary Enrollees and their Dependents who are "Enrollees" as set forth in Article2 of this Contract: $52.56 for each Primary Enrollee without enrolled Dependents; and $129.44 for each Primary Enrollee with one or more enrolled Dependents. Delta Dental shall use the plus stabilization existing as of December 31, 2016 to subsidize the total monthly Premium in the following amounts: $2.93 for each Primary Enrollee without enrolled Dependents; and $7.22 for each Primary Enrollee with one or more enrolled Dependents. The Contractholder is required to pay only the billed, monthly Premiums shown above. The total monthly Premium, including billed and subsidized monthly Premiums, is: $55.49 for each Primary Enrollee without enrolled Dependents; and $136.66 for each Primary Enrollee with one or more enrolled Dependents. Contractholder agrees to pay the invoiced amount. Eligibility adjustments reported to Delta Dental after the date the invoice is prepared will be reflected on the subsequent month's invoice. Such adjustments are limited to the three-month period prior to the most current month for which the Contractholder provides eligibility data. Contractholder agrees to bearthe cost 70% of such Premiums without withholding or otherwise charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the remaining 30% of the cost of coverage for themselves and the entire cost of coverage for their enrolled Dependents.