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DELTA DENTAL
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Last modified
3/27/2018 10:28:51 AM
Creation date
3/27/2018 10:16:23 AM
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Contracts
Company Name
DELTA DENTAL
Contract #
A-2018-021
Agency
PERSONNEL SERVICES
Council Approval Date
2/6/2018
Expiration Date
12/31/2019
Destruction Year
2024
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2,5 A dependent child may continue eligibility If; <br />a) He or she is incapable of self-sustaining employment because of a physically or mentally <br />disabling Injury, Illness or condition that began prior to reaching the limiting age; <br />b) He or she is chiefly dependent on the eligible employee for support; and <br />c) Proof of Dependent's disability Is provided within 60 days of request. Such requests will <br />not be made more than once a year following a two year period after this Dependent <br />reaches the limiting age. Eligibility will continue as long as the Dependent relies on the <br />eligible employee for support because of a physically or mentally disabling Injury, illness <br />or condition that began before he or she reached the limiting age. <br />2.6 Dependents in military service are not eligible. <br />2.7 Every enrolled employee and Dependent meeting the preceding conditions of eligibility Is an <br />Enrollee. However, Delta Dental will not provide Benefits for any employee or his or her <br />Dependents unless (1) the employee Is Included on the list of Primary Enrollees submitted as <br />required by this Article (or any revision or correction of such a list), and (2) the appropriate <br />payments are made as required by Article 3 of this Contract, for the months In which Delta <br />Dental provides covered dental services, <br />2.8 The Contractholder agrees to enroll all of Its Primary Enrollees in this plan, All employees of <br />the Contractholder meeting the eligibility requirements of this Article are "Primary Enrollees" <br />under this plan unless the Contractholder offers one or more alternate plans of dental <br />coverage. In that event, Primary Enrollees will continue to be eligible under this plan unless <br />they file a choice card with the Contractholder electing an alternate plan during an open <br />enrollment period agreed upon between Delta Dental and the Contractholder, <br />2.9 The Contractholder will compile and furnish Delta Dental with an Initial report of all Primary <br />Enrollees, showing their Enrollee ID numbers, their dates of hire and division codes. The <br />initial report shall be provided to Delta Dental or prior to the Effective Date of this Contract. <br />The Contractholder also agrees to report all persons electing continued coverage under Article <br />10, showing their Enrollee ID numbers and date of election. <br />2.10 The Contractholder may continue to submit subsequent eligibility reports monthly or may <br />report only additions or deletions to the initial report. If the report is not updated by the <br />Contractholder or has not arrived or been processed for the current month, Delta Dental will <br />extend the last report received to process claims. The extension of the eligibility report does <br />not waive the requirement that the Contractholder provide an updated report to Delta Dental <br />each month indicating additions or deletions from any previous report, The Contractholder <br />shall pay, as set forth in Article 3, all Premiums applicable for Primary Enrollees reported in <br />the updated report. <br />2.11 Enrollees are not eligible during a period the Primary Enrollee does not report to work on a <br />regular basis and is not actively employed as determined by the Contractholder. Eligibility <br />resumes on the first day of the month following the return to active employment If amounts <br />due to Delta Dental for Enrollees have been paid. Eligibility can continue without Interruption <br />If the Contractholder continues to report the employee as a Primary Enrollee and the amounts <br />due to Delta Dental are paid on the employee's behalf, <br />Coverage Is reinstated on the day employment Is resumed for Enrollees that are members of <br />the National Guard or a military reserve unit absent from work due to active military duty. <br />Any waiting period applied as a result of an Enrollee's absence from active employment due <br />to service in the National Guard or military reserve unit shall be waived. <br />a <br />25C-56 <br />
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