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AMENDMENT NO. 10 TO AGREEMENT <br />RENEWAL <br />GROUP #00599 <br />REVISED <br />AGREEMENT dated January 1, 2005, as amended, between CITY OF SANTA ANA and DELTA <br />DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2016, as <br />follows: <br />Paragraph 1.4 is amended to read: <br />1.4 "Contract Term" means the period beginning on January 1, 2016, and ending on December 31, <br />2016 and each subsequent yearly period during which this Contract remains in effect. <br />Paragraph 3.1 is amended to read: <br />3A Within ten days after receipt of Delta Dental's invoice, Contractholder agrees to pay the <br />following monthly, billed Premiums to Delta Dental, at the address shown on the first page of <br />this Contract, for all of Contractholder's Primary Enrollees and their Dependents who are <br />"Enrollees" as set forth in Article2 of this Contract: <br />$51.58 for each Primary Enrollee without enrolled Dependents; and <br />$127.04 for each Primary Enrollee with one or more enrolled Dependents. <br />Delta Dental shall use the plus stabilization existing as of December 31, 2015 to subsidize the <br />total monthly Premium in the following amounts: <br />$3.91 for each Primary Enrollee without enrolled Dependents; and <br />$9.62 for each Primary Enrollee with one or more enrolled Dependents. <br />The Contractholder is required to pay only the billed, monthly Premiums shown above. The total <br />monthly Premium, Including billed and subsidized monthly Premiums, Is: <br />$55.49 for each Primary Enrollee without enrolled Dependents; and <br />$136.66 for each Primary Enrollee with one or more enrolled Dependents. <br />Contractholder agrees to pay the Invoiced amount. Eligibility adjustments reported to Delta <br />Dental after the date the Invoice is prepared will be reflected on the subsequent month's <br />Invoice. Such adjustments are limited to the three -month period prior to the most current <br />month for which the Contractholder provides eligibility data. <br />Contractholder agrees to bear the cost 70% of such Premiums without withholding or otherwise <br />charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the remaining <br />30% of the cost of coverage for themselves and the entire cost of coverage for their enrolled <br />Dependents. <br />25A -8 <br />