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25C - AGMT GROUP INSURANCE
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25C - AGMT GROUP INSURANCE
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Last modified
2/1/2018 7:02:12 PM
Creation date
2/1/2018 7:10:52 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Personnel Services
Item #
25C
Date
2/6/2018
Destruction Year
2023
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ARTICLE 9 - TERMINATION AND RENEWAL <br />9.1 This Contract may be terminated for the following causes; <br />(a) By Delta Dental, if the Contractholder fails (1) to give Delta Dental a list of all Primary <br />Enrollees, as required under Article 2, or (2) to permit the inspection of the <br />Contractholder's records as called for under Article 2, or (3) to pay Premiums, In the <br />amounts and manner required in Article 3, provided the Contractholder has been duly <br />notified of such failure (and billed for Premiums, If applicable) and at least 15 days <br />have elapsed since the date of notification. <br />(b) By either the Contractholder or Delta Dental, upon expiration of a Contract Term. <br />9.2 If Delta Dental terminates this Contract under paragraph 9.1 (a), all Benefits end and Delta <br />Dental is released from all further obligations of this Contract, effective the last day of the <br />month in which written notice of termination Is given. The Contractholder will remain liable to <br />Delta Dental for the greater of: (1) the unpaid Premiums applicable for the period this <br />Contract was In effect before termination; or (2) the full amount of all Dentist's statements <br />paid or otherwise discharged by Delta Dental during the full term of this Contract, plus 25% <br />of such amount (to compensate Delta Dental for Its administration of the dental plan), less <br />amounts actually paid by the Contractholder to Delta Dental during the term of such <br />Contract. <br />9.3 A party choosing to terminate this Contract at the end of a Contract Term must give at least <br />60 days written notice of termination to the other party. If Delta Dental wants to change the <br />Premiums or Benefits effective at the beginning of the next Contract Term, Delta Dental will <br />give at least 60 days advance written notice of such changes to the Contractholder. Such an <br />advance notice will have the effect of a notice of termination as of the end of the Contract <br />Term, unless the Contractholder agrees to the new Contract provisions. <br />9.4 If the Contractholder notifies Delta Dental in writing of its Intention to terminate this Contract <br />as of any date other than the end of the Contract Term, such notice will be treated as a <br />failure to pay Premiums, and such notice will constitute a waiver of notification and billing <br />required of Delta Dental by paragraph 9.1(a)(3). <br />9.5 If an Enrollee believes that this Contract, or coverage hereunder, has been terminated or not <br />renewed due to their health status or requirements for health care services, they may request <br />a review by the California Director of Managed Health Care under California Health and Safety <br />Code Section 1365(b). <br />9.6 If this Contract Is terminated for any cause, Delta Dental is not required to predetermine <br />services beyond the termination date or to pay for services provided after such termination <br />date, except for the completion of Single Procedures begun while this Contract was In effect <br />which are otherwise Benefits under this Contract. <br />9.7 Within 30 days after the end of this Contract, Delta Dental will return to the Contractholder <br />any Premiums paid which are applicable to a time period after the termination date, together <br />with amounts due on claims, if any, less any amounts due to Delta Dental. <br />9.8 If Delta Dental accepts the proper amount of Premiums after termination of this Contract and <br />without requiring a new application, that acceptance will reinstate the Contract as though <br />never terminated, unless Delta Dental within 20 business days after it receives such payment, <br />either (1) refunds the payment so made or (2) issues to the Contractholder a new Contract <br />accompanied by written notice stating clearly those respects in which the new Contract differs <br />from the terminated Contract in Benefits, coverage or otherwise. <br />16 <br />25C-68 <br />
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