HomeMy WebLinkAbout20033451 RESOLUTION
RE: APPROVE WELD COUNTY GROUP MEMBERSHIP AGREEMENT AND AUTHORIZE
CHAIR TO SIGN - BETA HEALTH ASSOCIATION, INC.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Weld County Group Membership
Agreement between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County and Beta Health Association, Inc.,commencing January 1,2004,
and ending, with further terms and conditions being as stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement,a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Weld County Group Membership Agreement between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County and
Beta Health Association, Inc. be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 22nd day of December, A.D., 2003.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
7> ,
ATTEST: late# ; ' / ; 4\ EXCUSED
David E. Long, Char
Weld County Clerk to t B.:` F
RA per
Robert D. sden, Pro-Tem
BY: mottle Cam.
Deputy Clerk to the Bpi` N �I
J. eile
O D_AS RM:
William H. Jerk,
11 �
ounty Attorney �
Glenn Vaad
Date of signature: /'2
2003-3451
AirPE0021
Beta Health Association, Inc.
"Dental Plan Specialists Since 1990"
9725 East Hampden Avenue, Suite#400
Denver, CO 80231
303-744-3007 or 1-800- 807-0706
Weld County GROUP MEMBERSHIP AGREEMENT
This Agreement is made by and between Beta Health Association,Inc hereinafter referred to as"PLAN",and Weld County_ hereafter referred to as
"GROUP". This effective date of this agreement will be_January 1,2004 . The Beta Health Association,Inc. product which applies to this agreement
will be the Alpha Dental Plan.
The combined monthly billing fee which applies to the agreement shall be$1 per employee/ per month not to exceed$10. The monthly costs for the Alpha
Dental plan participants(through payroll deduction)are as follows:
$11 for an employee only
$22 for an employee and one dependent
$29 for an employee and two or more dependents
L GENERAL PURPOSE:Plan was established to provide a wide range of dental care services to Members participating in its programs.
II. DEFINITIONS:
A. "Plan"shall mean a discount,fee-for-service network dental plan. This is not insurance.
B. "Group"shall mean the organization or employing unit with which the employee is associated and which has executed this Group
Membership Agreement.
C. "Employee"shall mean an individual associated with Group and in whose name enrollment is made.
D. "Member"shall mean any individual employee or eligible family member entitled to receive services by reason of this agreement with Plan
and the payment of appropriate membership dues as listed above.
E. "Participating Dentist"shall mean a licensed dentist contracting with the Plan to provide dental services for members.
F. "Designated Dental Centers"shall mean those centers selected by the Plan to provide dental service for members.
G. "Membership Dues"shall mean amounts payable on a monthly basis by or for the Member of Plan as set forth in this Agreement.
H. "Member Cost"shall mean those amounts payable by members directly to the Participating Dentist at the time service is rendered as set forth
in the Schedule of Covered Services.
I. "Open Enrollment"shall mean on the anniversary date each year,as open enrollment is held to enroll non-enrolled employees.
IL ELIGIBILITY AND MEMBERSHIP: Following the effective date of this Agreement,enrollment is open to full-time and part-time employees.
Eligible family members include spouse unless legally separated and unmarried children from birth to 19 years of age. Children from 19 to 23
years of age are also eligible as dependents if their time is principally devoted to attending school and their primary support comes from employee.
At the attainment of limiting age,coverage as a dependent shall be extended if the child is and continues to be both(a)incapable of self-sustaining
employment by reason of mental retardation or physical handicap and(b)chiefly dependent upon employee for support and maintenance,
provided proof of such incapacity and dependency is furnished to the Plan by the employee within 31 days of the child's attainment of the limiting
age.
III. TERM OF AGREEMENT: Coverage under this Agreement shall be for a period of three years from the effective date and shall be
automatically renewed from year to year thereafter unless a 90-day written notice has been received.
V. EFFECTIVE DATE OF AGREEMENT:Employees who have applied for enrollment and paid the appropriate Membership Dues
therefore prior to the 25'"day of the month,shall be eligible for benefits commencing on the first day of the following month.
Applications and Membership Dues received between the 25th day of the month and the last day of the month shall be eligible for
benefits commencing the 1"day of the second month thereafter(unless approved otherwise by the Plan Administrative
office).
VI. MONTHLY COSTS PAYABLE TO PLAN AND AMOUNTS DUE TO PARTICIPATING DENTISTS:Billing statements are sent one month in
advance,as all monthly monies billed to Group by Plan each month are payable on or before the 20th day of the month prior to the month in which
services may be rendered by a Plan Participating Provider. All costs to members which are associated with any services which have been provided
by a Plan Participation Provider are payable directly to the Plan Participating Provider at the time services are rendered.
VII. CHANGE IN SERVICE:Plan reserves the right to change the service or Member Costs to members without notice.
VIII. SERVICES PROVIDED:Plan provides for benefits to members as described in the Schedule of Covered Services. Dental services provided by this
Agreement are limited to those licensed dentists who are contracted with the Plan. No services performed by a non-participating provider
will be paid for by Plan. Members will be assigned to a specific dental office as selected by Member and Plan reserves the right to re-assign
member at any time to a different Designated dental office if necessary.
IX. DENTAL RECORDS:Participating Provider may charge a fee for the duplicating of any x-rays.
(over)
2003-3451
Group Membership Agreement
Paee 2
X. TERMINATION: Benefits shall cease with respect to a Member upon any of the following events:
A. On the date of the expiration of the period for which the last payment was made(30-day written notice required).
B. Upon the date of entry into full-time military service.
C. If,after reasonable effort to establish and maintain a satisfactory dentist/patient relationship with any Member,a Participating Dentist is
unable to do so,then the rights of such Member and other members of his family under this Agreement may be terminated effective the
last day of the month during which termination notice occurs.
D. In the event Membership Dues are delinquent,services and benefits under the Plan shall be suspended effective on the last day of the
month during which membership dues are paid in full.
E. On the date of contract expiration.
F. Employee no longer meets eligibility requirements.
G. Permitting unauthorized use of membership card.
H. Failure to make required co-payments.
XI. CONTINUATIONS OF SERVICES:Plan coverage will terminate for group employee(s)and their family members when employee is no longer
eligible for group benefits. Thereafter,employee may continue benefits by enrolling with Plan on an individual basis through Beta Health
Association,Inc. Benefits,Member costs and possibly the Network of participating providers may vary on an individual plan.
XII. SERVICES NOT COVERED: Services,which in the opinion of the attending dentist,are not necessary for the patient's dental health,
or are contrary to dental ethics. Restorations,splints or other appliances used to increase vertical dimension or restore occlusion.Oral surgery
requiring the setting of fractures or dislocations. Treatment of malignancies,cysts or neoplasms or congenital malformations. Dispensing of drugs
not normally supplied in a dental office. Hospital benefits for any dental procedure. Any dental procedure of experimental nature. Service for
injuries of conditions with are covered under Worker's Compensation or Employer Liability Laws. Services that are provided without cost to the
member by any municipality,county or other political subdivision. General anesthesia when not available by your treating office. Services that
cannot be performed because of endodontics and oral surgery requiring the services of a non-participating dentist. Those procedures requiring
appliances of restorations that are necessary for full occlusion,including without limitation,treatment of temporomandibular joint. Diagnosis and
treatment of myofacial pain dysfunction syndrome. Any services performed by any dentist who is not a member of our provider group. The
liability of Plan is limited to the return of the actual premium paid for one year's services under the plan.
XIII. COORDINATION OF BENEFITS: Other dental benefits and coverage the member will be considered as the primary
coverage and will pay as if the Plan coverage did not exist. The member will never benefit more than 100%even if he or she has two plans. All
third parties will be billed. After the Insurance Plan has paid their benefits,the member is responsible for any difference between the Insurance
allowance and the fees listed in the appropriate Plan fee schedule.
XIV. GENERAL PROVISIONS:
A. This agreement and any exhibits hereto constitute the entire contract between the parties.
B. Any provision of this Agreement,which on its effective date is in conflict with the statutes of the State of Colorado,is hereby amended to
conform to the minimum requirements of such statute.
C. In the event of any controversy between Group,Member or the heirs-at-law or personal representative of Member,as the case may be,
and the Plan,its agents and its employees,as participants of the Plan,as individuals or otherwise,shall be conducted and governed by
the provisions of Colorado Code of Civil Procedure shall be binding upon parties hereto.
D. This Group Membership Agreement is a summary only of the Group Dental Care Services Agreement. In the event of conflict between
the provisions hereof and the Group Dental Care Services Agreement,the provisions of the latter shall control.
E. This benefit program does not constitute dental insurance and is not a Health Maintenance Organization contract. Plan does not
reimburse any contracted dentist or indemnify the member for the cost of dental services received by the member.
GROUP CONSENT AND AGREEMENT
XV. IN WITNESS WHEREOF,the parties have caused this Agreement to be executed this 22nd day of Dec ember ,20 03
s/s j rr r-szt,t0 sC'� t ` )
Plan Representative(Agent/Broker)Signature Group Rep esentative(Em l yer)Signature
12/22/2003
s/s
Beta Health Associa n,Inc. ignature
Beta Health Association,Inc.
"Dental Plan Specialists Since 1990"
9725 East Hampden Avenue, Suite #400
Denver, CO 80231
303-744-3007 or 1-800-807-0706
FAX 303-744-2890
EMPLOYER GROUP APPLICATION
Please complete this application and the Group Membership Agreement and return to the Beta Health Association,Inc.
Regional Administrative Office(at address above) along with the first month's payment.
1. Company Name:
Address:
City and State: Zip Code:
Telephone: Fax:
Address Correspondence to:
2. Affiliated Companies,if any:
3. Nature of Business:
4. Proposed Effective Date:
5. Next Open Enrollment Period: (12 month from the effective date shown on#4)
6. Waiting period for new employees:
7. Total number of eligible employees:
8. Total Enrolled:
9. Employer Contribution(Employee): % Employer Contribution(Dependent):
10. Beta Health Association,Inc.product line is: Alpha and Choice Dental Plans
#of Enrollments Rates Totals
Employee x$11 $
Employee& I dependent x$22 $
Employee&family x$29 $
Amount required for first month $
Applicable to all Beta Health Association,Inc.group clients is a$1 per employee per month billing fee. This fee will not exceed$10 per
month and is NOT due with the first month's payment shown above.
PLEASE MAKE CHECKS PAYABLE TO: Beta Health Association, Inc.
This application attached with the Group Membership Agreement is subject to all terms and conditions and approval of Beta Health
Association,Inc.
Dated on this izad day of December ,20 03
Beta Health Association,Inc. Agent#
an Rep sent (ag t/bro er)Signature
Employer R resentative ture
Beta Health Association,Inc.Signature
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