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Reso 2009-1390
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Reso 2009-1390
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Last modified
11/6/2015 1:33:30 PM
Creation date
2/26/2009 10:37:28 AM
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CityClerk-Resolutions
Resolution Type
Resolution
Resolution Number
2009-1390
Date (mm/dd/yyyy)
02/19/2009
Description
Insurance Providers for 2009 (AvMed, Lincoln Financial, EyeMed
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<br />SUNNYISLES <br />5395246 <br /> <br />City of Sunny Isles Beach <br /> <br />PARTICIPATION REQUIREMENTS <br /> <br />If the dental plan is provided on a noncontributory basis (the employer pays the entire premium), 100% of <br />eligible persons must be enrolled in the plan. <br /> <br />If the dental plan is contributory, no less than 75% of eligible employees and 60% of eligible dependent units <br />must be enrolled. <br /> <br />There are two exceptions to these requirements: <br />If an employee and/or dependent is covered by another group dental plan, that person(s) will not be <br />counted as an eligible person, if a signed waiver card is submitted. However, if 30% or more of eligible <br />employees do not enroll because of other coverage, the plan may be reevaluated and new rates <br />illustrated. <br />When a husband and wife are employed by the same company and have dependent children to enroll, <br />then either the husband or the wife may be covered as a dependent of the other spouse. <br /> <br />In any event, a minimum of 10 employees must be enrolled. A minimum of 8 family units must be covered in <br />order to include - or continue - coverage for Orthodontics. <br /> <br />PREFERRED PROVIDER OPTION* <br /> <br />The dental Preferred Provider Option (PPO) allows each employee and each dependent to select the dentist of <br />his or her choice n each time he or she goes to the dentist. <br /> <br />In-Network benefits are payable when the patient receives treatment from a dentist who is participating in the <br />dental network. With the PPO, employers and employees can save in several ways: <br />Negotiated discounts from participating dentists may allow lower premium rates for a dental plan which <br />includes a Preferred Provider option, due to expected lower claim costs. <br />Those discounted fees can reduce the amount a participating dentist would charge the patient. <br />The PPO dental plan can include a higher level of reimbursement when patients visit a participating <br />dentist. <br /> <br />*inside Texas - Contracting Dentist Plan <br /> <br />DIRECTORY OF PARTICIPATING/CONTRACTING DENTIST <br /> <br />Directories can be provided to eligible employees at the time of enrollment. A look-up function is available at <br />www.LFG.com or through our member web site at www.jpfic.com by accessing Lincoln DentalConnecfM - our <br />online dental information tool providing health information, ask a dentist, and a dental cost estimator. Plan <br />participants can locate over 52,000 Lincoln DentalConnect Plan dentists by specialty. Copies of the directory <br />can also be obtained by calling our Client Management Department. <br /> <br />PRIOR CARRIER CREDIT PROVISION <br /> <br />To ensure continuity of coverage for plan participants during a change in carriers, 'prior carrier credit' is <br />available for employees and dependents who are covered on the policy effective date; but only if they were <br />covered under the employer's prior group dental plan on the day before the policy effective date. Except in FL, <br />10 and NJ, the employer's dental plan must have been in force with the current carrier for at least 12 months, <br />to be eligible for the credit. <br /> <br />The Lincoln National Life Insurance Company <br />7 <br /> <br />2/9/2009 <br />
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