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08/16/2016
B A K E R S F I E L D Staff: Committee Members: Steven Teglia Councilmember, Ken Weir - Chair Assistant City Manager Councilmember, Terry Maxwell Vice Mayor, Harold Hanson SPECIAL MEETING NOTICE PERSONNEL COMMITTEE of the City Council - City of Bakersfield August 16, 2016 12:00 p.m. City Hall North – Conference Room A 1600 Truxtun Avenue, First Floor Bakersfield, California 93301 A G E N D A 1. ROLL CALL 2. ADOPT SEPTEMBER 18, 2015 AGENDA SUMMARY REPORT 3. PUBLIC STATEMENTS 4. NEW BUSINESS A. 2017 Health Care Plan Renewals - Teglia 5. COMMITTEE COMMENTS 6. ADJOURNMENT ________________________________________________________________ S:\Council Committees\2015\Personnel\09_September\September 18 ASR.docx Page 1 ST:al B A K E R S F I E L D /s/ Steve Teglia Committee Members Staff: Steven Teglia Councilmember, Ken Weir, Chair Assistant City Manager Councilmember, Terry Maxwell Vice Mayor, Harold Hanson SPECIAL MEETING OF THE PERSONNEL COMMITTEE Friday, September 18, 2015 12:00 p.m. City Hall North – Conference Room A 1600 Truxtun Avenue Bakersfield, CA 93301 AGENDA SUMMARY REPORT Meeting called to order at 12:00 p.m. 1. ROLL CALL Committee members: Councilmember, Ken Weir, Chair Councilmember, Terry Maxwell Vice Mayor, Harold Hanson City staff: Steven Teglia, Assistant City Manager Chris Huot, Assistant City Manager Caleb Blaschke, Management Asst. – City Manager’s Office Nelson Smith, Finance Director Joshua Rudnick, Deputy City Attorney Christi Tenter, Human Resources Manager Mari Blowers, Benefits Technician Retired employees Florn Core, Fred Baugher, Margaret Ursin, Bryan Eidenshinil, and BCARE: and Bill Descary Others present: Tom Morrison and Johnny Wu, Segal Company Members of the media ________________________________________________________________ S:\Council Committees\2015\Personnel\09_September\September 18 ASR.docx Page 2 ST:al 2. ADOPTION OF AUGUST 18, 2015 AGENDA SUMMARY REPORT The Report was adopted as submitted. 3. PUBLIC STATEMENTS There were no public statements. 4. DEFERRED BUSINESS A. Continued Discussion regarding 2016 Health Care Plan Renewals Assistant City Manager Teglia made comments and introduced Mr. Morrison with the Segal Company. Mr. Morrison distributed information to the Committee and gave a summary overview. Key points are: A Request for Information (RFI) was sent to Aetna, Blue Shield, United Healthcare and Healthnet. Aetna, Blue Shield and United Healthcare submitted proposals. The information from Aetna was not received until after the deadline, and their proposal was not deemed to be financially competitive. Anthem Blue Cross was approached, but they declined to submit a proposal and refused to lower any of the rates. The proposed rates for the Blue Shield plan are 5.1% higher than the current rates for active employees and 7% higher for retirees. United Healthcare’s proposed plan is 2.2% higher than the current rates for active employees, which includes an increase of 3.9% under a narrow HMO network and a decrease of 14.7% for retirees. Comparatively, Anthem Blue Cross had previously proposed an increase of 17.8% for active employees and a 14.1% increase for retirees. In addition to a PPO, Blue Shield has two HMO plans, a full network and a narrow network. Their overall proposal matches the current benefits, with only minor variations. The hospital network matches that of Anthem Blue Cross, with the exclusion of the Bakersfield Heart Hospital. However, Dignity Health is attempting to acquire the Bakersfield Heart Hospital; and if that is approved, it would then be included in the Blue Shield network. United Healthcare offered either a full network or a narrow network HMO. The proposed benefits on the PPO plan differ significantly from the current plan, and are considered less than optimal. Segal Company asked Blue Shield and United Healthcare to provide a maximum amount that they might increase rates in the second year of a contract. Blue Shield would cap the increase at 9.9% for the full network HMO, 7.5% for the narrow network HMO and 9.9% for both the active and retiree PPO. United Healthcare would cap the active plan at 9.9% cap, but declined to provide a cap for the retiree plan. ________________________________________________________________ S:\Council Committees\2015\Personnel\09_September\September 18 ASR.docx Page 3 ST:al To summarize the financial aspect: Plans for active employees - The current premiums for the HMO plan are $3.4 million and $9.7 million for the PPO plan, for a total of $13.1 million. The proposal by Anthem Blue Cross would have increased those amounts by $2.3 million, for a total of $15.5 million. The proposal from Blue Shield would increase the total cost by $672,000. The proposal from United Healthcare would increase the cost by $291,000 when factoring both the PPO and full network HMO plans, and it would be reduced by $517,000 for the narrow network HMO. Plan for retirees – The current premiums for the HMO and PPO plans total $19.8 million. The proposal from Anthem Blue Cross would have increased that amount by $3.2 million. The proposal from Blue Shield would increase the total premiums by $1.1 million, and the proposal from United Healthcare would decrease the premiums by a total of $690,000 for both the PPO and full network HMO plans, and by $1.4 million for the narrow network HMO. On September 1, 2015, the Insurance Committee received and discussed the same information that was provided at this meeting. Assistant City Manager Teglia reported that after careful consideration and thorough discussion, the Insurance Committee voted unanimously to recommend the Blue Shield plan. Staff also recommends approval of the Blue Shield plan as does Segal. If the Committee approves, the item will go before the City Council for consideration on October 14, 2015. Committee member Hanson said that this is a challenging issue to deal with, and it is one that the City Council will continue to watch. It is possible that in the future a modification of the current City/employee contribution ratio may need to be examined. The goal is to reduce the unfunded liability. The subsidy currently provided to eligible retirees is very expensive. Assistant City Manager Teglia stated that the contribution ratio is a topic in ongoing labor negotiation meetings. They are also discussing the possibility of a tiered, defined contribution. Brian Eidenshinil, a BCARE representative, said that the contribution ratio for retirees is approximately 70/30, as opposed to the current 80/20 for active employees. He asked Mr. Morrison for an explanation on certain points. ________________________________________________________________ S:\Council Committees\2015\Personnel\09_September\September 18 ASR.docx Page 4 ST:al Committee member Hanson clarified that his comments were not meant to infer that he would advocate reducing the subsidy. They were meant to convey that the rising cost of healthcare is a significant problem, and the goal is to resolve that problem. In time, and with continued discussion, he is confident that a good formula will be reached. Committee Chair Weir asked if the results from the RFI were surprising, and Mr. Morrison said they were, given the fact that Blue Shield and United Healthcare did not respond to the previous RFI. He believed that Blue Shield submitted a proposal this time because GemCare is part of their group now, giving them a vested interest in the community. The Committee voted unanimously to approve staff’s recommendation and submit the item for approval at the October 14, 2015 City Council meeting. 3. COMMITTEE COMMENTS Committee Chair Weir thanked staff and Segal Company for their efforts. He is pleased that the result is a plan that will save both the City and employees money. He looks forward to talks about changing strategy, and, hopefully, getting to a point where the issue stabilizes. 4. ADJOURNMENT The meeting was adjourned at 12:29 p.m. Documents Presented At Personnel Committee August 16, 2016 Meeting Co p y r i g h t © 2 0 1 5 b y T h e S e g a l G r o u p , I n c . A l l r i g h t s r e s e r v e d . 20 1 7 R e n e w a l a n d R e s u l t s o f D e n t a l a n d V i s i o n Re q u e s t f o r P r o p o s a l In s u r a n c e a n d P e r s o n n e l C o m m i t t e e Ci t y o f B a k e r s f i e l d Au g u s t 1 6 , 2 0 1 6 5445101 2 Ta b l e o f C o n t e n t s Se c t i o n T a b Ex e c u t i v e S u m m a r y 1 Ov e r v i e w o f 2 0 1 7 P l a n R e n e w a l s 2 De n t a l P l a n s R e q u e s t f o r P r o p o s a l 3 Vi s i o n P l a n R e q u e s t f o r P r o p o s a l 4 Ap p e n d i x 5 Me d i c a l R e n e w a l De n t a l R F P A p p e n d i x Vi s i o n R F P A p p e n d i x 3 Th e o v e r a l l C i t y 2 0 1 7 c o n t r i b u t i on f o r a c t i v e e m p l o y e e m e d i c a l b e n e f i t i s i n c r e a s i n g 3 . 7 % o r $5 5 7 , 2 0 0 Th e i n c r e a s e s a r e c o m p o s e d o f t h e f o l l o w i n g Bl u e S h i e l d F u l l H M O a t 6 . 8 % Bl u e S h i e l d N a r r o w H M O a t 3 . 9 % Bl u e S h i e l d P r e f e r r e d P r o v i d e r P l a n a t n o i n c r e a s e Ka i s e r H M O a t 9 . 5 % Ka i s e r H i g h D e d u c t i b l e H e a l t h P l a n a t 6 . 1 % A r e q u e s t f o r P r o p o s a l w a s i s s u e d f o r t h e D e n t a l P l a n s a n d t h e V i s i o n P l a n Th e r e s u l t s o f t h e R e q u e s t f o r P r o p o s a l a n d B i ds t h a t w e r e r e c e i v e d p r o v i d e s a v i n g s op p o r t u n i t i e s f o r t h e C i t y t o m a i n t a i n t h e c u r r e n t b e n e f i t s a t a l o w e r c o s t Th e f a v o r a b l e r e n e w a l i n c r e a s e w i l l h e l p l o w e r t he C i t y ’ s l i a b i l i t y f o r O t h e r P o s t - E m p l o y m e n t Be n e f i t s w h e n t h e n e x t v a l u a t i o n i s p e r f o r m e d Ex e c u t i v e S u m m a r y 4 Ov e r v i e w o f 2 0 1 7 P l a n R e n e w a l s 5 20 1 7 C i t y M e d i c a l A c t i v e C o n t r i b u t i o n Pl a n E n r o l l m e n t Cu r r e n t C i t y Co n t r i b u t i o n a t 8 0 % 20 1 7 C i t y C o n t r i b u t i o n at 8 0 % A n n u a l I n c r e a s e Percentage Change Bl u e S h i e l d Fu l l H M O 1 8 2 $ 2 , 1 5 4 , 0 0 0 $ 2 , 3 0 1 , 1 0 0 $ 1 4 7 , 1 0 0 6 . 8 % Na r r o w H M O 7 9 8 3 9 , 0 0 0 8 7 1 , 8 0 0 3 2 , 8 0 0 3 . 9 % PP O 6 4 0 7 , 9 6 0 , 2 0 0 7 , 9 6 0 , 2 0 0 0 0 . 0 % Su b T o t a l 9 0 1 $ 1 0 , 9 5 3 , 2 0 0 $ 1 1 , 1 3 3 , 1 0 0 $ 1 7 9 , 9 0 0 Ka i s e r (1 ) HM O 4 6 7 $ 3 , 9 3 9 , 4 0 0 $ 4 , 3 1 3 , 5 0 0 $ 3 7 4 , 1 0 0 9 . 5 % HD H P 1 1 5 2 , 6 0 0 5 5 , 8 0 0 3 , 2 0 0 6 . 1 % Su b T o t a l 4 7 8 $ 3 , 9 9 2 , 0 0 0 $ 4 , 3 6 9 , 3 0 0 $ 3 7 7 , 3 0 0 To t a l To t a l M e d i c a l (2 ) ( 3 ) $ 1 4 , 9 4 5 , 2 0 0 $ 1 5 , 5 0 2 , 4 0 0 $ 5 5 7 , 2 0 0 3 . 7 % (1 ) Ka i s e r r e q u i r e d a c h a n g e t o t h e s p e c i a l t y c o p a y m e n t to a l i g n w i t h t h e c u r r e n t B l u e S h i e l d c o p a y m e n t . (2 ) IN G L i f e a n d A D & D , O p t u m E A P , U n u m L T D a n d H e a l t h c o m p a r e n o t i n c l u d e d a b o v e (3 ) PU D D e n t a l , M e t L i f e D e n t a l , a n d M E S V i s i o n a r e al s o n o t i n c l u d e d a s t h e y a r e u n d e r g o i n g R F P s 6 20 1 7 B l u e S h i e l d o f C a l i f o r n i a M o n t h l y R a t e S u m m a r y Bl u e S h i e l d H M O A c c e s s + S u m m a r y ( F u l l N e t w o r k ) - M e d i c a l , M e n t a l H e a l t h , P r e s c r i p t i o n D r u g s En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ac t i v e ( M o n t h l y ) Si n g l e 3 9 $ 5 2 7 . 0 3 $ 5 6 3 . 0 3 6 . 8 3 % $ 4 5 0 . 4 2 $ 1 1 2 . 6 1 $ 2 8 . 8 0 $ 7 . 2 0 2- P a r t y 3 6 $ 1 , 0 5 9 . 2 4 $ 1 , 1 3 1 . 5 9 6 . 8 3 % $ 9 0 5 . 2 7 $ 2 2 6 . 3 2 $ 5 7 . 8 8 $ 1 4 . 4 7 Fa m i l y 1 0 7 $ 1 , 5 4 8 . 5 2 $ 1 , 6 5 4 . 2 8 6 . 8 3 % $ 1 , 3 2 3 . 4 2 $ 3 3 0 . 8 6 $ 8 4 . 6 1 $ 2 1 . 1 5 Bl u e S h i e l d H M O T r i o A C O S u m m a r y ( N a r r o w N e t w o r k ) - M e d i c a l , M e n t a l H e a l t h , P r e s c r i p t i o n D r u g s En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ac t i v e ( M o n t h l y ) Si n g l e 1 1 $ 4 4 1 . 8 3 $ 4 5 9 . 1 1 3 . 9 1 % $ 3 6 7 . 2 9 $ 9 1 . 8 2 $ 1 3 . 8 2 $ 3 . 4 6 2- P a r t y 1 4 $ 8 8 7 . 9 9 $ 9 2 2 . 7 1 3 . 9 1 % $ 7 3 8 . 1 7 $ 1 8 4 . 5 4 $ 2 7 . 7 8 $ 6 . 9 4 Fa m i l y 5 4 $ 1 , 2 9 8 . 1 7 $ 1 , 3 4 8 . 9 3 3 . 9 1 % $ 1 , 0 7 9 . 1 4 $ 2 6 9 . 7 9 $ 4 0 . 6 1 $ 1 0 . 1 5 7 20 1 7 B l u e S h i e l d o f C a l i f o r n i a M o n t h l y R a t e S u m m a r y Bl u e S h i e l d P P O S u m m a r y - M e d i c a l , M e n t a l H e a l t h , P r e s c r i p t i o n D r u g s En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ac t i v e ( M o n t h l y ) Si n g l e 1 4 9 $ 5 5 4 . 1 9 $ 5 5 4 . 1 9 0 . 0 0 % $ 4 4 3 . 3 5 $ 1 1 0 . 8 4 $ 0 . 0 0 $ 0 . 0 0 2- P a r t y 1 3 0 $ 1 , 1 1 0 . 2 8 $ 1 , 1 1 0 . 2 8 0 . 0 0 % $ 8 8 8 . 2 2 $ 2 2 2 . 0 6 $ 0 . 0 0 $ 0 . 0 0 Fa m i l y 3 6 1 $ 1 , 6 6 8 . 3 7 $ 1 , 6 6 8 . 3 7 0 . 0 0 % $ 1 , 3 3 4 . 7 0 $ 3 3 3 . 6 7 $ 0 . 0 0 $ 0 . 0 0 Re t i r e e ( M o n t h l y ) Si n g l e 2 6 5 $ 1 , 0 0 6 . 7 6 $ 1 , 0 4 8 . 3 8 4 . 1 3 % Va r i e s 2- P a r t y 1 4 1 $ 2 , 0 1 3 . 3 9 $ 2 , 0 9 6 . 6 2 4 . 1 3 % Fa m i l y 9 $ 3 , 0 2 0 . 1 1 $ 3 , 1 4 4 . 9 6 4 . 1 3 % Bl u e S h i e l d M e d i c a r e A d v a n t a g e En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ov e r 6 5 R e t i r e e ( M o n t h l y ) Va r i e s Si n g l e 1 5 $ 4 1 9 . 3 8 $ 3 2 7 . 2 9 - 2 2 . 0 % 8 20 1 7 K a i s e r M o n t h l y R a t e S u m m a r y Ka i s e r H M O S e n i o r A d v a n t a g e En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ov e r 6 5 R e t i r e e ( M o n t h l y ) Va r i e s Si n g l e $ 2 1 2 . 0 0 $ 2 1 4 . 2 2 1 . 0 % (1 ) Ka i s e r r e q u i r e d a c h a n g e t o t h e s p e c i a l t y c o p a y m e n t t o a l i g n w i t h t h e c u r r e n t B l u e S h i e l d c o p a y m e n t . Ka i s e r H M O S u m m a r y - M e d i c a l , M e nt a l H e a l t h , P r e s c r i p t i o n D r u g s (1 ) En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ac t i v e ( M o n t h l y ) Si n g l e 1 3 0 $ 4 0 6 . 6 8 $ 4 4 5 . 3 1 9 . 5 % $ 3 5 6 . 2 5 $ 8 9 . 0 6 $ 3 0 . 9 0 $ 7 . 7 3 2- P a r t y 9 0 $ 8 1 3 . 3 7 $ 8 9 0 . 6 3 9 . 5 % $ 7 1 2 . 5 0 $ 1 7 8 . 1 3 $ 6 1 . 8 1 $ 1 5 . 4 5 Fa m i l y 2 4 7 $ 1 , 1 5 0 . 9 1 $ 1 , 2 6 0 . 2 4 9 . 5 % $ 1 , 0 0 8 . 1 9 $ 2 5 2 . 0 5 $ 8 7 . 4 6 $ 2 1 . 8 7 Un d e r 6 5 R e t i r e e ( M o n t h l y ) Si n g l e 2 $ 1 , 0 8 2 . 0 1 $ 1 , 2 4 5 . 3 8 1 5 . 1 % Va r i e s 2- P a r t y 2 $ 2 , 1 6 4 . 0 2 $ 2 , 4 9 0 . 7 6 1 5 . 1 % Fa m i l y 0 $ 3 , 0 6 2 . 0 9 $ 3 , 5 2 4 . 4 2 1 5 . 1 % Ka i s e r D e d u c t i b l e S u m m a r y - M e d i c a l , M e n t a l H e a l t h , P r e s c r i p t i o n D r u g s (1 ) En r o l l m e n t 2 0 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e 20 1 7 C i t y Co n t r i b u t i o n 20 1 7 E m p l o y e e Co n t r i b u t i o n 2017 City Contribution Increase2017 Employee Contribution Increase Ac t i v e ( M o n t h l y ) Si n g l e 6 $ 3 0 9 . 7 9 $ 3 2 9 . 4 4 6 . 3 % $ 2 6 3 . 5 5 $ 6 5 . 8 9 $ 1 5 . 7 2 $ 3 . 9 3 2- P a r t y 3 $ 6 1 9 . 5 8 $ 6 5 8 . 8 8 6 . 3 % $ 5 2 7 . 1 0 $ 1 3 1 . 7 8 $ 3 1 . 4 4 $ 7 . 8 6 Fa m i l y 2 $ 8 7 6 . 7 1 $ 9 3 2 . 3 1 6 . 3 % $ 7 4 5 . 8 5 $ 1 8 6 . 4 6 $ 4 4 . 4 8 $ 1 1 . 1 2 Un d e r 6 5 R e t i r e e ( M o n t h l y ) Si n g l e 0 $ 9 3 6 . 2 0 $ 1 , 0 7 4 . 9 7 1 4 . 8 % Va r i e s 2- P a r t y 0 $ 1 , 8 7 2 . 4 2 $ 2 , 1 4 9 . 9 4 1 4 . 8 % Fa m i l y 0 $ 2 , 6 4 9 . 4 6 $ 3 , 0 4 2 . 1 6 1 4 . 8 % 9 20 1 7 F l e x i b l e B e n e f i t s , L i f e a n d L T D R a t e S u m m a r y He a l t h C o m p - S e c t i o n 1 2 5 F l e x i b l e B e n e f i ts ( R a t e p e r p a r t i c i p a n t p e r m o n t h ) 20 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e Fl e x i b l e B e n e f i t s $5 . 0 0 $ 5 . 0 0 0 . 0 % Un u m - L o n g T e r m D i s a b i l i t y ( R a t e p e r $ 1 0 0 ) 20 1 6 R a t e s 2 0 1 7 R a t e s Pe r c e n t a g e Ch a n g e Lo n g T e r m D i s a b i l i t y $0 . 5 7 $ 0 . 5 7 0 . 0 % Vo y a - L i f e I n s u r a n c e ( R a t e p e r $ 1 , 0 0 0 ) 20 1 6 R a t e s 2 0 1 7 R a t e s (1 ) Pe r c e n t a g e C h a n g e Ba s i c L i f e $0 . 1 0 $ 0 . 1 3 2 7 . 5 % AD & D $0 . 0 2 $ 0 . 0 2 0 . 0 % (1 ) Vo y a ' s r a t e a s s u m e s t h a t t he C i t y w i l l s p o n s o r a n o p e n e n r o l l m e n t t o f ue l p a r t i c i p a t i o n i n i t s s u p p l e m e n t a l p l a n s . 10 De n t a l P l a n s R e q u e s t f o r P r o p o s a l 11 Se g a l i s s u e d a r e q u e s t f o r p r o p o s a l ( R F P ) i n J u l y o f 2 0 1 6 Pr o p o s e d v e n d o r s w e r e a s k e d t o s u b m i t p r o p o s a l s t o m a t c h c u r r e n t b e n e f i t d e s i g n s Th e R F P w a s d i s t r i b u t e d t o t h e f o l l o w i n g v e n d o r s : An t h e m De l t a D e n t a l Li b e r t y D e n t a l Me t L i f e ( I n c u m b e n t f o r P P O B e n e f i t s ) Un i t e d H e a l t h C a r e ( I n c u m b e n t f o r D M O B e n e f i t s ) Un i t e d C o n c o r d i a We s t e r n D e n t a l Ba c k g r o u n d 12 Re s p o n s e s w e r e r e c e i v e d f r o m PP O – An t h e m – De l t a D e n t a l – Li b e r t y D e n t a l – Me t L i f e ( I n c u m b e n t f o r P P O B e n e f i t s ) – Un i t e d H e a l t h C a r e ( I n c u m b e n t f o r D M O B e n e f i t s ) – Un i t e d C o n c o r d i a DM O – An t h e m – De l t a D e n t a l – Li b e r t y D e n t a l – Me t L i f e ( I n c u m b e n t f o r P P O B e n e f i t s ) – Un i t e d H e a l t h C a r e ( I n c u m b e n t f o r D M O B e n e f i t s ) – Un i t e d C o n c o r d i a – We s t e r n D e n t a l Ba c k g r o u n d 13 Th e i n i t i a l r e v i e w o f t h e p r o p o s a l s d e t e r m i n e a g r o u p o f f o u r f i n a l b i d d e r s f o r D M O an d s i x f o r P P O b a s e d u p o n r e s p o n s e s t o t h e q u e s t i o n s a n d c o s t s a n d p l a n d e s i g n s Th e P P O f i n a l i s t s w e r e An t h e m De l t a D e n t a l Li b e r t y Me t L i f e Un i t e d H e a l t h C a r e Un i t e d C o n c o r d i a Th e D M O f i n a l i s t s w e r e Li b e r t y Un i t e d H e a l t h C a r e ( U H C ) Un i t e d C o n c o r d i a We s t e r n D e n t a l Ba c k g r o u n d 14 PP O F i n a n c i a l A n a l y s i s S u m m a r y – A c t i v e s O n l y Pl a n s b y T i e r Cu r r e n t P l a n P r o p o s e d P l a n s Me t L i f e ( I n c u m b e n t ) An t h e m D e l t a D e n t a l L i b e r t y D e n t a l M e t L i f e United He a l t h c a r e United Concordia En r o l l m e n t R a t e s Me t L i f e D P O Si n g l e 2 3 1 $ 4 6 . 4 2 $ 4 0 . 2 0 $ 4 2 . 5 7 $ 4 1 . 8 1 $ 4 2 . 8 5 $ 3 9 . 2 8 $ 3 5 . 9 7 Tw o - P a r t y 2 0 2 9 5 . 4 5 8 2 . 6 6 87 . 5 4 8 5 . 9 8 8 8 . 10 8 0 . 7 7 7 3 . 9 6 Fa m i l y 4 6 1 1 5 9 . 1 1 1 3 7 . 7 9 1 4 5 . 93 1 4 3 . 3 2 1 4 6 . 8 6 1 3 4 . 6 4 1 2 3 . 2 9 Pl a n T o t a l An n u a l P r e m i u m $ 1 , 2 4 0 , 2 0 0 $ 1 , 0 7 4 , 1 0 0 $ 1 , 1 3 7 , 5 0 0 $ 1 , 1 1 7 , 2 0 0 $ 1 , 1 4 4 , 8 0 0 $ 1 , 0 4 9 , 5 0 0 $ 961,000 Do l l a r C h a n g e f r o m C u r r e n t $ ( 1 6 6 , 1 0 0 ) $ ( 1 0 2 , 7 0 0 ) $ ( 1 2 3 , 0 0 0 ) $ ( 9 5 , 4 0 0 ) $ ( 1 9 0 , 7 0 0 ) $ ( 2 7 9 , 2 0 0 ) % C h a n g e f r o m Cu r r e n t -1 3 . 4 % - 8 . 3 % - 9 . 9 % - 7 . 7 % - 1 5 . 4 % - 2 2 . 5 % Le n g t h o f R a t e G u a r a n t e e 36 m o n t h s 3 6 m o n t h s 3 6 m o n t hs 3 6 m o n t h s 2 4 m o n t h s (1)36 months Ra t e C o n c e s s i o n t o D P O f o r A w a r d o f B o t h P l a n s -3 . 0 % N o n e N o n e N o n e N o n e N o n e (1 ) Un i t e d H e a l t h c a r e o f f e r s a r a t e c a p o f 7 % f o r t h e t h i r d y e a r i n s t e a d o f a t h i r d y e a r r a t e g u a r a n t e e . 15 DM O F i n a n c i a l A n a l y s i s S u m m a r y Pl a n s b y T i e r Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d H e a l t h c a r e ( P U D ) (I n c u m b e n t ) Li b e r t y D e n t a l Un i t e d He a l t h c a r e Un i t e d C o n c o r d i a W e s t e r n D e n t a l Pl a n T o t a l Ac t i v e P r e m i u m $ 3 5 4 , 8 0 0 $ 3 1 2 , 9 0 0 $ 3 5 5 , 1 0 0 $ 3 0 1 , 0 0 0 $ 2 7 2 , 4 0 0 Re t i r e e P r e m i u m 61 , 0 0 0 5 7 , 3 0 0 6 4 , 4 0 0 5 5 , 4 0 0 4 7 , 7 0 0 To t a l A n n u a l P r e m i u m $ 4 1 5 , 8 0 0 $ 3 7 0 , 2 0 0 $ 4 1 9 , 5 0 0 $ 3 5 6 , 4 0 0 $ 320,100 Do l l a r C h a n g e f r o m C u r r e n t $ ( 4 5 , 6 0 0 ) $ 3 , 7 0 0 $ ( 5 9 , 4 0 0 ) $ ( 9 5 , 7 0 0 ) % C h a n g e f r o m C u r r e n t - 1 1 . 0 % 0 . 9 % - 1 4 . 3 % - 2 3 . 0 % Le n g t h o f R a t e G u a r a n t e e 36 m o n t h s 3 6 m o n t h s 3 6 m o n t h s 3 6 m o n t h s Ra t e C o n c e s s i o n t o D M O f o r A w a r d o f B o t h P l a n s No n e - 5 . 0 % N o n e N / A 16 DM O F i n a n c i a l A n a l y s i s f o r A c t i v e s Pl a n s b y T i e r Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d H e a l t h c a r e ( P U D ) ( I n c u m b e n t ) Li b e r t y D e n t a l Un i t e d He a l t h c a r e Un i t e d C o n c o r d i a W e s t e r n D e n t a l En r o l l m e n t R a t e s Im p e r i a l 1 0 0 0 Si n g l e 1 7 3 $ 2 3 . 7 2 $ 2 0 . 9 0 $ 2 3 . 7 2 $ 2 0 . 7 5 $ 1 7 . 9 0 Tw o - P a r t y 1 3 0 4 7 . 3 1 4 1 . 7 0 4 7 . 3 1 3 8 . 0 5 3 6 . 3 9 Fa m i l y 2 7 2 7 0 . 1 4 6 1 . 8 1 7 0 . 1 4 6 0 . 0 0 5 3 . 9 5 An n u a l P r e m i u m $ 3 5 2 , 0 0 0 $ 3 1 0 , 2 0 0 $ 3 5 2 , 0 0 0 $ 2 9 8 , 3 0 0 $ 2 7 0 , 0 0 0 Na p a 8 0 0 Si n g l e 2 $ 2 1 . 2 3 $ 2 0 . 9 0 $ 2 3 . 7 2 $ 2 0 . 7 5 $ 1 7 . 9 0 Tw o - P a r t y 0 4 2 . 3 3 4 1 . 7 0 4 7 . 3 1 3 8 . 0 5 3 6 . 3 9 Fa m i l y 3 6 2 . 7 5 6 1 . 8 1 7 0 . 1 4 6 0 . 0 0 5 3 . 9 5 An n u a l P r e m i u m $ 2 , 8 0 0 $ 2 , 7 0 0 $ 3 , 1 0 0 $ 2 , 7 0 0 $ 2 , 400 Pl a n T o t a l An n u a l P r e m i u m $ 3 5 4 , 8 0 0 $ 3 1 2 , 9 0 0 $ 3 5 5 , 1 0 0 $ 3 0 1 , 0 0 0 $ 2 7 2 , 4 0 0 Do l l a r C h a n g e f r o m C u r r e n t $ ( 4 1 , 9 0 0 ) $ 3 0 0 $ ( 5 3 , 8 0 0 ) $ ( 8 2 , 4 0 0 ) % C h a n g e f r o m C u r r e n t - 1 1 . 8 % 0 . 1 % - 1 5 . 2 % - 2 3 . 2 % Le n g t h o f R a t e G u a r a n t e e 36 m o n t h s 3 6 m o n t h s 3 6 m o n t h s 3 6 m o n t h s Ra t e C o n c e s s i o n t o D M O f o r A w a r d o f B o t h P l a n s No n e - 5 . 0 % N o n e N / A 17 DM O F i n a n c i a l A n a l y s i s f o r R e t i r e e s Pl a n s b y T i e r Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d H e a l t h c a r e ( P U D ) ( I n c u m b e n t ) Li b e r t y D e n t a l Un i t e d He a l t h c a r e Un i t e d C o n c o r d i a W e s t e r n D e n t a l En r o l l m e n t R a t e s Re g e n c y Si n g l e 8 4 $ 2 0 . 0 0 $ 1 7 . 7 7 $ 2 0 . 0 0 $ 1 5 . 8 5 $ 1 4 . 8 0 Tw o - P a r t y 8 6 3 2 . 0 2 2 8 . 4 5 3 2 . 0 2 2 8 . 8 5 2 3 . 7 0 Fa m i l y 5 4 9 . 0 3 4 3 . 5 7 4 9 . 0 3 4 4 . 6 0 3 6 . 2 9 An n u a l P r e m i u m $ 5 6 , 1 0 0 $ 4 9 , 9 0 0 $ 5 6 , 1 0 0 $ 4 8 , 4 0 0 $ 4 1 , 6 0 0 Tr i n i t y Si n g l e 1 7 $ 1 1 . 8 8 $ 1 7 . 7 7 $ 2 0 . 0 0 $ 1 5 . 8 5 $ 1 4 . 8 0 Tw o - P a r t y 1 1 1 9 . 0 1 2 8 . 4 5 3 2 . 0 2 2 8 . 8 5 2 3 . 7 0 Fa m i l y 0 2 9 . 1 5 4 3 . 5 7 4 9 . 0 3 4 4 . 6 0 3 6 . 2 9 An n u a l P r e m i u m $ 4 , 9 0 0 $ 7 , 4 0 0 $ 8 , 3 0 0 $ 7 , 0 0 0 $ 6 , 1 0 0 Pl a n T o t a l An n u a l P r e m i u m $ 6 1 , 0 0 0 $ 5 7 , 3 0 0 $ 6 4 , 4 0 0 $ 5 5 , 4 0 0 $ 4 7 , 7 0 0 Do l l a r C h a n g e f r o m C u r r e n t $ ( 3 ,7 0 0 ) $ 3 , 4 0 0 $ ( 5 , 6 0 0 ) $ ( 1 3 , 3 0 0 ) % C h a n g e f r o m C u r r e n t - 6 . 1 % 5 . 6 % - 9 . 2 % - 2 1 . 8 % Le n g t h o f R a t e G u a r a n t e e 36 m o n t h s 3 6 m o n t h s 3 6 m o n t h s 3 6 m o n t h s Ra t e C o n c e s s i o n t o D M O f o r A w a r d o f B o t h P l a n s No n e - 5 . 0 % N o n e N / A 18 PP O D e s i g n C o m p a r i s o n – D e v i a t i o n s O n l y (1 ) De d u c t i b l e a p p l i e s o n a p e r c a l e n d a r y e a r b a s i s t o T y p e A , B , a n d C s e r v i c e s e x c l u d i n g o r a l e x a m s , c l e a n i n g s , a n d x - r a y s . (2 ) PD P F e e r e f e r s t o t h e f e e s t h a t p a r t i c i p a t i ng P D P d e n t i s t s h a v e a g r e e d t o a c c e p t a s p a y m e n t i n f u l l , s u b j e c t t o a n y c o - p a y m e n t s , de d u c t i b l e s , c o s t s h a r i n g a n d b e n e f i t s m a x i m u m s . (3 ) R& C f e e r e f e r s t o t h e R e a s o n a b l e a n d C u s t o m a r y ( R & C ) c h a r g e , w h i c h is b a s e d o n t h e l o w e s t o f ( 1 ) th e d e n t i s t ’ s a c t u a l c h a r g e , ( 2 ) t h e d e n t i s t ’ s u s u a l c h a r g e for the same or similar se r v i c e s , o r ( 3 ) t h e c h a r g e o f m o s t d e n t i s t s i n t h e s a m e g e o g r a p h ic a r e a f o r t h e s a m e o r s i m i l a r s e r v i c e s a s d e t e r m i n e d b y M e t L if e . Be n e f i t s Cu r r e n t P l a n P r o p o s e d P l a n s Me t L i f e ( I n c u m b e n t ) A n t h e m D e l t a D e n t a l L i b e r t y D e n t a l M e t L i f e U n i t e d H e a l t h c a r e U n i t e d C o n c o r d i a In - Ne t w o r k Ou t - o f - Ne t w o r k In - Ne t w o r k Ou t - o f - Ne t w o r k In - Ne t w o r k Ou t - o f - Ne t w o r k In - Ne t w o r k Ou t - o f - Ne t w o r k In - Ne t w o r k Ou t - o f - Ne t w o r k In - Ne t w o r k Out-of-NetworkIn-NetworkOut-of-Network An n u a l M a x i m u m $2 , 5 0 0 (p e r p e r s o n ) De d u c t i b l e (1 ) In d i v i d u a l $ 5 0 Fa m i l y $ 1 5 0 Ty p e A - P r e v e n t i v e (2 ) ( 3 ) 10 0 % P D P 10 0 % R& C Ty p e B - B a s i c 80 % P D P 8 0 % R & C Re s t o r a t i v e (2 ) ( 3 ) Ty p e C - M a j o r 80 % P D P 8 0 % R & C Re s t o r a t i v e (2 ) ( 3 ) Ty p e D - O r t h o d o n t i a (2 ) ( 3 ) 50 % P D P 5 0 % R & C Or t h o d o n t i a L i f e t i m e $1 , 5 0 0 Ma x i m u m ( p e r p e r s o n ) 19 PP O D e s i g n L i m i t a t i o n s – D e v i a t i o n s O n l y Pl a n L i m i t a t i o n s an d E x c l u s i o n s Cu r r e n t P l a n P r o p o s e d P l a n s Me t L i f e ( I n c u m b e n t ) A n t h e m D e l t a D e n t a l L i b e r t y D e n t a l M e t L i f e U n i t e d H e a l t h c a r e United Concordia De d u c t i b l e De d u c t i b l e a p p l i e s t o Di a g n o s t i c & P r e v e n t i v e , Ba s i c R e s t o r a t i v e , a n d M a j o r Re s t o r a t i v e s e r v i c e s e x c e p t or a l e x a m s , c l e a n i n g , a n d x - ra y s De d u c t i b l e w a i v e d f o r al l D i a g n o s t i c & Pr e v e n t i v e De d u c t i b l e w a i v e d f o r a l l Di a g n o s t i c & P r e v e n t i v e Wa i t i n g P e r i o d Ye s ; o n l y D i a g n o s t i c & Pr e v e n t i v e a n d B a s i c Re s t o r a t i v e s e r v i c e s c o v e r e d fo r t h e f i r s t y e a r No w a i t i n g p e r i o d s N o w a i t i n g p e r i o d s Or a l E x a m s 2 p e r c a l e n d a r y e a r Cl e a n i n g s 2 p e r c a l e n d a r y e a r Bi t e w i n g X - r a y s 1 s e t p e r 6 m o n t h s f o r C h i l d ; 1 p e r 1 2 m o n t h s f o r A d u l t 1 t i m e p e r 1 2 m o n t h s th r o u g h a g e 1 7 ; 1 t i m e pe r 2 4 m o n t h s f o r ag e s 1 8 a n d o l d e r (1 ) To p i c a l F l u o r i d e 1 p e r 1 2 m o n t h s t h r o u g h a g e 18 2 p e r 1 2 m o n t h s th r o u g h a g e 1 8 2 p e r 1 2 m o n t h s t h r o u g h ag e 1 5 Se a l a n t s 1 p e r t o o t h e v e r y 3 6 m o n t h s th r o u g h a g e 1 5 1 t i m e p e r 2 4 m o n t h s th r o u g h a g e 1 5 (1 ) 1 p e r f i r s t m o l a r s a n d se c o n d m o l a r s e v e r y 2 4 mo n t h s b a s e d o n a g e 1 p e r f i r s t a n d s e c o n d pe r m a n e n t m o l a r s e v e r y 3 6 mo n t h s t h r o u g h a g e 1 5 Cr o w n s No a g e l i m i t a t i o n ; 1 p e r 5 ye a r s f o r t h e s a m e t o o t h 1 p e r 7 y e a r s o v e r a g e 16 (1 ) 1 p e r 5 y e a r s o v e r a g e 12 1 p e r 5 y e a r s f o r t h e s a m e to o t h ; c o v e r e d o n l y w h e n a fi l l i n g c a n n o t r e s t o r e t h e to o t h Ro o t C a n a l 1 p e r 2 4 m o n t h s p e r t o o t h 1 p e r l i f e t i m e p e r t o o t h (1 ) 1 p e r l i f e t i m e p e r t o o t h 1 p e r l i f e t i m e p e r t o o t h Or t h o d o n t i c Co v e r a g e Un d e r a g e 1 9 o r 2 3 i f a f u l l - ti m e s t u d e n t Un d e r a g e 1 9 U n d e r a g e 1 9 De p e n d e n t Ch i l d r e n C o v e r a g e El i g i b i l i t y Un d e r a g e 1 9 o r 2 3 i f a f u l l - ti m e s t u d e n t Un d e r a g e 2 6 N o t P r o v i d e d U n d e r a g e 2 6 U n d e r a g e 2 6 (1 ) Su b j e c t t o p r o d u c t f i l i n g s a n d a p p r o v a l , A n t h e m c a n a d j u s t t h e s e b e n e f i t s . 20 DM O A c t i v e P l a n s C o m p a r i s o n De n t a l P r o c e d u r e s Co d e D e s c r i p t i o n % o f T o t a l Pr o c e d u r e s Pa i d Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d He a l t h c a r e Im p e r i a l 1 0 0 0 Un i t e d He a l t h c a r e Na p a 8 0 0 Li b e r t y D e n t a l Un i t e d He a l t h c a r e United ConcordiaWestern Dental D0 2 3 0 I N T R A O R L P E R I A P I C A L E A A D D F I L M 3 3 . 6 % 2 , 4 3 3 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 1 2 0 P E R I O D I C O R A L E V A L U A T I O N E S T P T 5 . 9 % 4 2 9 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 2 0 I N T R A O R A L P E R I A P I C A L F I R S T F I L M 5 . 5 % 3 9 8 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D1 1 1 0 P R O P H Y L A X I S - A D U L T 5 . 2 % 3 7 6 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 7 4 B I T E W I N G S - F O U R F I L M S 4 . 4 % 3 1 9 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D1 1 2 0 P R O P H Y L A X I S - C H I L D 4 . 2 % 3 0 7 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D4 3 4 1 P R D N T L S C A L & R O O T P L A N 4 / >T E E T H - Q U A D 3 . 0 % 2 2 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 1 5 0 C O M P O R A L E V A L U A T I O N - N E W / E S T P T 2 . 6 % 1 9 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 7 2 B I T E W I N G S - T W O F I L M S 2 . 5 % 1 8 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 1 4 0 L T D O R A L E V A L U A T I O N - P R O B L E M F O C U S 2 . 2 % 1 5 9 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 3 9 2 R E S I N C O M P O S - 2 S U R F A C E S P O S T E R I O R 2 . 1 % 1 5 4 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 1 5 0 A M A L G A M - T W O S U R F A C E S P R I M A R Y / P E R M 2. 0 % 14 4 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D1 3 5 1 S E A L A N T - P E R T O O T H 1. 7 % 12 5 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 3 9 1 R E S I N C O M P O S - 1 S U R F A C E P O S T E R I O R 1. 5 % 10 6 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 1 0 I N T R A O R A L - C O M P L E T E S E R I E S 1. 5 % 10 7 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D9 3 1 0 C N S L T D X D E N T / P H Y N O T R E Q D E N T / P H Y 1. 4 % 10 2 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 1 4 0 A M A L G A M - O N E S U R F A C E P R I M A R Y / P E R M 1. 4 % 10 2 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D7 2 1 0 S U R G R E M O V A L E R U P T E D T O O T H 1. 0 % 69 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D7 1 4 0 E X T R A C E R U P T E D T O O T H / E X P O S E D R O O T 0. 8 % 58 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D4 9 1 0 P E R I O D O N T A L M A I N T E N A N C E 0. 7 % 51 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 7 5 1 C R O W N - P O R C E L N F U S D P R E D O M B A S E M E T L 0. 6 % 47 $ 0 $ 6 6 $ 0 $ 0 $ 0 $ 0 D3 3 3 0 M O L A R 0. 6 % 42 $ 0 $ 6 0 $ 0 $ 0 $ 0 $ 0 D2 3 9 3 R E S I N C O M P O S - 3 S U R F A C E S P O S T E R I O R 0. 6 % 41 $ 0 $ 0 $ 0 $ 0 $ 1 3 3 $ 0 D2 3 3 1 R E S I N C O M P O S - 2 S U R F A C E S A N T E R I O R 0. 5 % 39 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 3 3 0 R E S I N C O M P O S - O N E S U R F A C E A N T E R I O R 0. 4 % 31 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 9 5 4 P R E F A B R P O S T & C O R E A D D I T I O N C R O W N 0. 4 % 31 $ 0 $ 1 6 $ 0 $ 0 $ 0 $ 0 D3 2 2 0 T X P U L P O T - C O R O N L D E N T N O C E M E N T L J U N C 0. 4 % 30 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 3 3 0 P A N O R A M I C F I L M 0. 4 % 29 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D1 2 0 6 T O P F L U O R I D E ; T X A P P L M O D - H I R I S K 0. 4 % 29 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D2 7 5 0 C R O W N - P O R C E L N F U S E D H I N O B L E M E T L 0. 4 % 26 $ 0 $ 7 3 $ 0 $ 0 $ 0 $ 0 Al l o t h e r P r o c e d u r e s 1 2 . 0 % 87 0 To t a l P a r t i c i p a n t C o p a y 1 0 0 . 0 % 7 , 24 4 $ 0 . 0 0 $ 1 . 1 1 $ 0 . 0 0 $0 . 0 0 $ 0 . 7 5 $ 0 . 0 0 Or t h o d o n t i c s Co d e D e s c r i p t i o n Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d He a l t h c a r e Im p e r i a l 1 0 0 0 Un i t e d He a l t h c a r e Na p a 8 0 0 Li b e r t y D e n t a l Un i t e d He a l t h c a r e United ConcordiaWestern Dental D8 0 7 0 C O M P R E H E N S I V E O R T H O D O N T I C T R E A TM E N T T R A N S I T I O N A L D E N T I T I O N $ 6 0 0 No t a C o v e r e d Be n e f i t $6 0 0 $ 7 5 0 $ 1 , 5 0 0 $ 6 0 0 D8 0 8 0 C O M P R E H E N S I V E O R T H O D O N T I C T R E A T M E N T AD O L E S C E N T D E N T I T I O N $ 1 , 2 0 0 $ 1 , 2 0 0 $ 7 5 0 $ 1 , 5 0 0 $ 1 , 2 0 0 D8 0 9 0 C O M P R E H E N S I V E O R T H O D O N T I C T R E A T M E N T AD U L T D E N T I T I O N $ 1 , 2 0 0 $ 1 , 2 0 0 $ 7 5 0 $ 2 , 0 0 0 $ 1 , 2 0 0 D8 6 8 0 OR T H O D O N T I C R E T E N T I O N ( R E M O V A L O F A P P L I A N C E S , C O N S T R U C T I O N , A N D PL A C E M E N T O F R E T A I N E R S ) $1 0 0 $ 1 0 0 $ 1 5 0 $ 2 4 0 $ 1 0 0 D8 9 9 9 ST A R T - U P F E E ( I N C L U D I N G E X A M , B E G I NN I N G R E C O R D S , X - R A Y S , T R A C I N G , PH O T O S , A N D M O D E L S $2 0 0 $ 2 0 0 $ 3 5 0 $ 2 6 5 $ 2 0 0 21 DM O R e t i r e e P l a n s C o m p a r i s o n No t e : NC B r e f e r s t o pr o c e d u r e s th a t a r e n o t c o v e r e d b e n e f i t s . De n t a l P r o c e d u r e s Co d e D e s c r i p t i o n % o f T o t a l Pr o c e d u r e s Pa i d Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d He a l t h c a r e Re g e n c y Un i t e d He a l t h c a r e Tr i n i t y Li b e r t y D e n t a l Un i t e d He a l t h c a r e United ConcordiaWestern Dental D0 2 3 0 I N T R A O R L P E R I A P I C A L E A A D D F I L M 2 2 . 5 % 1 9 6 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D1 1 1 0 P R O P H Y L A X I S - A D U L T 1 4 . 6 % 1 2 7 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 2 0 I N T R A O R A L P E R I A P I C A L F I R S T F I L M 1 1 . 9 % 1 0 4 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 7 4 B I T E W I N G S - F O U R F I L M S 7 . 8 % 6 8 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 1 2 0 P E R I O D I C O R A L E V A L U A T I O N E S T P T 7 . 5 % 6 5 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 1 4 0 L T D O R A L E V A L U A T I O N - P R O B L E M F O C U S 4 . 9 % 4 3 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D4 3 4 1 P R D N T L S C A L & R O O T P L A N 4 / >T E E T H - Q U A D 3 . 6 % 3 1 $ 2 8 $ 6 5 $ 2 8 $ 5 $ 0 $ 2 8 D2 7 5 1 C R O W N - P O R C E L N F U S D P R E D O M BA S E M E T L 3 . 1 % 2 7 $ 1 1 2 $ 2 0 0 $ 1 1 2 $ 9 0 $ 6 0 $ 1 1 2 D9 3 1 0 C N S L T D X D E N T / P H Y N O T R E Q D E N T / P H Y 2 . 5 % 2 2 $ 1 4 $ 0 $ 1 4 $ 0 $ 0 $ 1 4 D0 1 5 0 C O M P O R A L E V A L U A T I O N - N E W / E S T P T 2 . 2 % 1 9 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 1 0 I N T R A O R A L - C O M P L E T E S E R I E S 1 . 8 % 1 6 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D7 2 1 0 S U R G R E M O V A L E R U P T E D T O O T H 1 . 8 % 1 6 $ 0 $ 3 0 $ 0 $ 5 $ 0 $ 0 D2 1 4 0 A M A L G A M - O N E S U R F A C E P R I M A R Y / P E R M 1 . 5 % 1 3 $ 0 $ 0 $ 0 $ 5 $ 0 $ 0 D4 9 1 0 P E R I O D O N T A L M A I N T E N A N C E 1. 4 % 12 $ 1 6 $ 7 5 $ 1 6 $ 5 $ 0 $ 1 6 D2 3 3 0 R E S I N C O M P O S - O N E S U R F A C E A N T E R I O R 0. 8 % 7 $ 0 $ 0 $ 0 $ 5 $ 0 $ 0 D2 9 5 4 P R E F A B R P O S T & C O R E A D D I T I O N C R O W N 0. 8 % 7 $ 3 3 $ 4 3 $ 3 3 $ 1 0 $ 0 $ 3 3 D3 3 3 0 M O L A R 0. 7 % 6 $ 1 1 0 $ 2 0 5 $ 1 1 0 $ 6 0 $ 4 0 $ 1 1 0 D2 7 5 0 C R O W N - P O R C E L N F U S E D H I N O B L E M E T L 0. 7 % 6 $ 1 1 4 $ 2 0 0 $ 1 1 4 $ 1 0 0 $ 6 0 $ 1 1 4 D0 2 7 2 B I T E W I N G S - T W O F I L M S 0. 7 % 6 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D0 2 7 0 B I T E W I N G - S I N G L E F I L M 0. 9 % 8 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 D6 7 5 1 C R O W N - P O R C E L N F U S D P R E D O M B A S E M E T L 0. 5 % 4 $ 1 1 2 $ 1 8 5 $ 1 1 2 $ 9 0 $ 6 0 $ 1 1 2 D2 3 3 2 R E S I N C O M P O S - 3 S U R F A C E S A N T E R I O R 0. 5 % 4 $ 0 $ 0 $ 0 $ 1 0 $ 0 $ 0 D7 1 4 0 E X T R A C E R U P T E D T O O T H / E X P O S E D R O O T 0. 5 % 4 $ 0 $ 1 5 $ 0 $ 5 $ 0 $ 0 D4 3 4 2 P R D O N T A L S C A L & R O O T P L A N 1 - 3 T E E T H 0. 5 % 4 $ 2 8 $ 6 5 $ 2 8 $ 5 $ 0 $ 2 8 D3 3 4 7 R E T X P R E V I O U S R C T H E R A P Y - B I C U S P I D 0. 3 % 3 $ 8 9 $ 1 2 5 $ 8 9 $ 2 0 $ 0 $ 8 9 D3 3 2 0 B I C U S P I D 0. 3 % 3 $ 8 9 $ 1 2 5 $ 8 9 $ 2 0 $ 3 0 $ 8 9 D9 9 4 0 O C C L U S A L G U A R D B Y R E P O R T 0. 3 % 3 $ 2 5 N C B $ 2 5 $ 1 5 $ 1 2 0 $ 2 5 D2 7 9 1 C R O W N - F U L L C A S T P R E D O M B A S E M E T L 0. 3 % 3 $ 1 0 2 $ 2 0 0 $ 1 0 2 $ 9 0 $ 6 0 $ 1 0 2 D2 3 3 1 R E S I N C O M P O S - 2 S U R F A C E S A N T E R I O R 0. 3 % 3 $ 0 $ 0 $ 0 $ 5 $ 0 $ 0 D2 1 5 0 A M A L G A M - T W O S U R F A C E S P R I M A R Y / P E R M 0. 5 % 4 $ 0 $ 0 $ 0 $ 5 $ 0 $ 0 Al l o t h e r P r o c e d u r e s 4 . 2 % 37 To t a l P a r t i c i p a n t C o p a y 1 0 0 . 0 % 87 1 $ 8 . 5 4 $ 1 6 . 0 0 $ 8 . 5 4 $5 . 4 7 $ 3 . 5 5 $ 8 . 5 4 Or t h o d o n t i c s Co d e D e s c r i p t i o n Cu r r e n t P l a n P r o p o s e d P l a n s Un i t e d He a l t h c a r e Re g e n c y Un i t e d He a l t h c a r e Tr i n i t y Li b e r t y D e n t a l Un i t e d He a l t h c a r e United ConcordiaWestern Dental D8 0 8 0 C O M P R E H E N S I V E O R T H O D O N T I C T R E A T M E N T A D O L ES C E N T D E N T I T I O N $ 2 , 2 5 0 $2 , 2 5 0 $ 2 , 2 5 0 $ 1 , 50 0 $ 1 , 5 0 0 $ 2 , 2 5 0 D8 6 8 0 OR T H O D O N T I C R E T E N T I O N ( R E M O V A L O F A P P L I A N C E S , C O N S T R U C T I O N , A N D PL A C E M E N T O F R E T A I N E R S ) $1 5 0 $ 1 5 0 $ 1 5 0 $ 1 5 0 $ 2 4 0 $ 1 5 0 D8 9 9 9 ST A R T - U P F E E ( I N C L U D I N G E X A M , B E G I NN I N G R E C O R D S , X - R A Y S , T R A C I N G , PH O T O S , A N D M O D E L S $3 5 0 $ 3 5 0 $ 3 5 0 $ 3 5 0 $ 2 6 5 $ 3 5 0 22 Th e c u r r e n t U H C p l a n f o r a c t i v e a n d r e t i r e d e m p l o y e e s i s b e i n g d i s c o n t i n u e d a n d wo u l d h a v e t o b e r e p l a c e d Un i t e d C o n c o r d i a p r o v i d e s t h e o v e r a l l b e s t b e n e f i t , n e t w o r k a n d c o s t t o t h e C i t y Th e a c t i v e a n d r e t i r e e D M O p l a n s a s a r e s u l t c a n b e c o n s o l i d a t e d i n t o o n e p l a n f o r ea c h f r o m t h e c u r r e n t t w o p l a n s , a t a n i m p r o v e d b e n e f i t f o r r e t i r e e s a n d c o s t s a v i n g to t h e m a j o r i t y o f r e t i r e e s a n d a l l a c t i v e e m p l o y e e s a n d t h e C i t y Se g a l r e c o m m e n d s a w a r d i n g t h e c o n t r a c t f o r t h e t h r e e y e a r t e r m o f t h e r a t e gu a r a n t e e t o U n i t e d C o n c o r d i a Re c o m m e n d a t i o n 23 Vi s i o n P l a n R e q u e s t f o r P r o p o s a l 24 Se g a l i s s u e d a r e q u e s t f o r p r o p o s a l ( R F P ) i n J u l y o f 2 0 1 6 Pr o p o s e d v e n d o r s w e r e a s k e d t o s u b m i t p r o p o s a l s t o m a t c h c u r r e n t b e n e f i t d e s i g n Th e C i t y h a s t w o v i s i o n p l a n d e s i g n s Wi t h e y e e x a m b e n e f i t s f o r m e d i c a l P P O p a r t i c i p a n t s Wi t h o u t e y e e x a m b e n e f i t s f o r m e d i c a l H M O p a r t i c i p a n t s Bl u e S h i e l d a n d K a i s e r H M O b o t h c o v e r e y e e x a m b e n e f i t s u n d e r t h e i r p l a n s Th e R F P w a s d i s t r i b u t e d t o t h e f o l l o w i n g v e n d o r s : An t h e m Bl u e S h i e l d Ey e M e d ME S V i s i o n ( I n c u m b e n t ) Me t L i f e Un i t e d H e a l t h C a r e VS P Ba c k g r o u n d 25 Th e r e s p o n s e s w e r e r e c e i v e d f r o m : An t h e m Bl u e S h i e l d Ey e M e d ME S V i s i o n Me t L i f e VS P Un i t e d H e a l t h C a r e d i d n o t r e s p o n d n o r p r o v i d e a n y r e a s o n f o r n o t s u b m i t t i n g Th e R F P r e q u i r e d a t h r e e y e a r r a t e g u a r a n t e e Ba c k g r o u n d 26 Al l o f t h e v e n d o r s a r e a b l e t o p r o v i d e t h e Ci t y ’ s c u r r e n t b e n e f i t d e s i g n s e x c e p t M e t Li f e Me t L i f e c a n n o t p r o v i d e a m a t e r i a l o n l y b e n e f i t s VS P p r o p o s e d a n i n c r e a s e c o s t f o r t h e c u r r e n t b e n e f i t d e s i g n s Th e i n i t i a l r e v i e w o f t h e p r o p o s a l s d e t e rm i n e d a g r o u p o f f o u r f i n a l p r o p o s e r s b a s e d up o n r e s p o n s e s t o t h e q u e s t i o n s a n d c o s t s Th e s e f i n a l i s t s w e r e An t h e m ( s u b c o n t r a c t w i t h E y e M e d ) Bl u e S h i e l d ( s u b c o n t r a c t w i t h M E S V i s i o n ) Ey e M e d ME S V i s i o n Se g a l r e q u e s t e d a b e s t a n d f i n a l p r o p o s a l f r o m t h e s e f o u r c o m p a n i e s Ba c k g r o u n d 27 An t h e m a n d B l u e S h i e l d w e r e t h e t w o h i g h e s t c o s t b i d d e r s 3- y e a r r a t e g u a r a n t e e s c o m p a r e d t o 4 - y e a r r a t e g u a r a n t e e s f r o m E y e M e d a n d ME S Vi r t u a l l y i d e n t i c a l n e t w o r k t o E y e M e d a n d M E S v i s i o n b e c a u s e o f t h e c o n t r a c t u a l re l a t i o n s h i p Ey e M e d p r o v i d e d t h e l o w e s t c o s t p r o p o s a l f o r t h e c u r r e n t b e n e f i t . E y e M e d pr o p o s e d a n a n n u a l s a v i n g s o f $ 2 9 , 6 0 0 o r 2 0 % Ex e c u t i v e S u m m a r y 28 ME S V i s i o n p r o v i d e d t h e s e c o n d l o w e s t c o s t p r o p o s a l f o r t h e c u r r e n t b e n e f i t . F o r cu r r e n t b e n e f i t s , M E S V i s i o n p r o p o s e d a n a n n u a l s a v i n g s o f $ 1 1 , 9 0 0 o r 8 % ME S V i s i o n h a s a l a r g e r n e t w o r k i n K e r n C o u n t y w h e n c o m p a r e d t o E y e M e d . M E S Vi s i o n n e t w o r k i n c l u d e s W a l m a r t , S a m ’ s Cl u b a n d C o s t c o p l u s o t h e r i n d i v i d u a l pr a c t i t i o n e r s Se g a l r e c o m m e n d s b e c a u s e o f t h e p o s s i b l e n e t w o r k d i s r u p t i o n , t h e a w a r d b e m a d e to M E S v i s i o n f o r a s a v i n g s t o t h e C i t y a n d e m p l o y e e s o f 8 % p e r y e a r f o r a t h r e e ye a r c o n t r a c t Ex e c u t i v e S u m m a r y 29 Pr o p o s e d V i s i o n R a t e s Pl a n s b y T i e r Cu r r e n t P l a n P r o p o s e d P l a n s ME S V i s i o n ( I n c u m b e n t ) An t h e m B l u e S h i e l d E y e M e d M E S V i s i o n En r o l l m e n t R a t e s PP O P l a n Si n g l e 1 7 6 $ 5 . 2 5 $ 5 . 1 2 $ 4 . 9 9 $ 4 . 4 4 $ 4 . 8 3 Tw o - P a r t y 1 5 4 1 0 . 5 5 9 . 4 0 1 0 . 0 2 8 . 9 1 9 . 7 0 Fa m i l y 3 0 5 1 3 . 7 5 1 2 . 2 5 1 3 . 0 6 1 1 . 6 1 1 2 . 6 5 An n u a l P r e m i u m $ 8 0 , 9 0 0 $ 7 3 , 0 0 0 $ 7 6 , 9 0 0 $ 6 8 , 3 0 0 $ 7 4 , 4 0 0 Do l l a r C h a n g e f r o m C u r r e n t $ (7 , 9 0 0 ) $ ( 4 , 0 0 0 ) $ ( 1 2 , 6 0 0 ) $ ( 6 , 5 0 0 ) % C h a n g e f r o m C u r r e n t - 9 . 8 % - 4 . 9 % - 1 5 . 6 % - 8 . 0 % HM O P l a n Si n g l e 2 2 6 $ 3 . 7 5 $ 3 . 6 3 $ 3 . 5 6 $ 2 . 8 0 $ 3 . 4 5 Tw o - P a r t y 1 6 2 7 . 5 0 6 . 6 7 7 . 1 2 5 . 6 0 6 . 9 0 Fa m i l y 3 6 0 9 . 7 5 8 . 6 9 9 . 2 6 7 . 2 7 8 . 9 7 An n u a l P r e m i u m $ 6 6 , 9 0 0 $ 6 0 , 4 0 0 $ 6 3 , 5 0 0 $ 4 9 , 9 0 0 $ 6 1 , 5 0 0 Do l l a r C h a n g e f r o m C u r r e n t $ (6 , 5 0 0 ) $ ( 3 , 4 0 0 ) $ ( 1 7 , 0 0 0 ) $ ( 5 , 4 0 0 ) % C h a n g e f r o m C u r r e n t - 9 . 7 % - 5 . 1 % - 2 5 . 4 % - 8 . 1 % Pl a n T o t a l An n u a l P r e m i u m $ 1 4 7 , 8 0 0 $ 1 3 3 , 4 0 0 $ 1 4 0 , 4 0 0 $ 1 1 8 , 2 0 0 $ 1 3 5 , 9 0 0 Do l l a r C h a n g e f r o m C u r r e n t $ ( 14 , 4 0 0 ) $ ( 7 , 4 0 0 ) $ ( 2 9 , 6 0 0 ) $ ( 1 1 , 9 0 0 ) % C h a n g e f r o m C u r r e n t - 9 . 7 % - 5 . 0 % - 2 0 . 0 % - 8 . 1 % Le n g t h o f R a t e G u a r a n t e e 36 m o n t h s 3 6 m o n t h s 4 8 m o n t h s 4 8 m o n t h s 30 Vi s i o n P l a n D e s i g n C o m p a r i s o n Be n e f i t s Cu r r e n t P l a n P r o p o s e d P l a n s ME S V i s i o n ( I n c u m b e n t ) (1 ) An t h e m B l u e S h i e l d E y e M e d V i s i o n S e r v i c e M E S V i s i o n In - N e t w o r k O u t - o f - N e t w o r k I n - N e t w o r k Ou t - o f - Ne t w o r k In - N e t w o r k Ou t - o f - Ne t w o r k In - N e t w o r k Ou t - o f - Ne t w o r k In-NetworkOut-of-Network De d u c t i b l e No n e Ex a m HM O P l a n B e n e f i t Co v e r e d u n d e r Me d i c a l N/ A PP O P l a n B e n e f i t C o v e r e d i n f u l l U p t o $ 4 0 Le n s e s ( u p t o 6 1 m m ) Si n g l e C o v e r e d i n f u l l U p t o $ 3 0 Bi f o c a l C o v e r e d i n f u l l U p t o $ 5 0 Tr i f o c a l C o v e r e d i n f u l l U p t o $ 6 5 Le n t i c u l a r o r A p h a k i c C o v e r e d i n f u l l U p t o $ 1 2 5 Co n t a c t L e n s e s Me d i c a l l y N e c e s s a r y (1 ) Co v e r e d i n f u l l U p t o $ 2 5 0 Co s m e t i c o r C o n v e n i e n c e (2 ) Up t o $ 1 0 0 U p t o $ 1 0 0 Fr a m e s ( S t a n d a r d ) (3 ) Up t o $ 6 0 U p t o $ 4 0 Li m i t a t i o n s Ex a m s On e c o m p r e h e n s i v e e x a m i n a t i o n i n a n y 24 c o n s e c u t i v e m o n t h s , w i t h a f o l l o w - u p ex a m i n a t i o n a t a 1 2 - m o n t h i n t e r v a l On e c o m p r e h e n s i v e ex a m i n a t i o n i n a n y 2 4 co n s e c u t i v e m o n t h s On e c o m p r e h e n s i v e ex a m i n a t i o n i n a n y 1 2 co n s e c u t i v e m o n t h s On e c o m p r e h e n s i v e ex a m i n a t i o n i n a n y 1 2 co n s e c u t i v e m o n t h s Al l L e n s e s On e p a i r i n a n y 2 4 c o n s e c u t i v e mo n t h s , 1 2 m o n t h s i f p r e s c r i p t i o n ch a n g e s (4 ) On e p a i r i n a n y 2 4 c o n s e c u t i v e mo n t h s On e p a i r i n a n y 2 4 c o n s e c u t i v e mo n t h s Fr a m e s On e f r a m e i n a n y 2 4 c o n s e c u t i v e mo n t h s (1 ) Pr i o r a u t h o r i z a t i o n i s r e q u i r e d f o r m e d i c a l l y n e c e s s a r y l e n s e s . (2 ) Th e A l l o w a n c e i s i n l i e u o f o t h e r e y e w e a r b e n e f i t s . T h e P l a n w il l p a y u p t o t h e a m o u n t s h o w n a b o v e t o w a r d s t h e c o n t a c t l e n s e v a lu a t i o n , f i t t i n g c o s t s , a n d m a t e r i a l s . A n y d i f f e r e n c e b e t w e e n th e a l l o w a n c e a n d t h e p r o v i d e r ' s c h a r g e is t h e r e s p o n s i b i l i t y o f t h e E n r o l l e e . (3 ) Th e d i f f e r e n c e b e t w e e n t h e a l l o w e d a m o u n t a n d t h e c h a r g e s f o r m o r e e x p e n s i v e f r a m e s o r u n u s u a l l e n s es , s u c h a s o v e r s i z e , w i l l b e th e r e s p o n s i b i l i t y o f t h e E n r o l l e e . (4 ) A p r e s c r i p t i o n c h a n g e m e a n s a n y o f t h e f o l l o w i n g : a c h a n g e i n p r e s c r ip t i o n o f 0 . 5 0 d i o p t e r o r m o r e i n o n e o r b o t h e y e s ; a s h i f t in a x i s o f as t i g m a t i s m o f 1 5 d e g r e e s ; o r a d i f f e r e n c e i n ve r t i c a l p r i s m g r e a t e r t h a n 1 p r i s m d i o p t e r . 31 Vi s i o n N e t w o r k A c c e s s - N u m b e r o f L o c a t i o n s Se r v i c e L o c a t i o n by C o u n t y Nu m b e r o f S e r v i c e L o c a t i o n s (1 ) ME S V i s i o n (I n c u m b e n t ) An t h e m B l u e S h i e l d E y e M e d Ey e C a r e D i s p e n s i n g L o c a t i o n s Ca l i f o r n i a Ke r n C o u n t y 9 6 3 7 9 6 4 6 Tu l a r e C o u n t y 5 8 2 9 5 8 2 7 Sa n t a B a r b a r a C o u n t y 1 2 6 2 8 1 2 6 3 2 Al l O t h e r C A C o u n t i e s 6 , 6 1 1 3 , 8 8 1 6 , 6 1 1 2 , 8 8 8 Gr a n d T o t a l 6 , 8 9 1 3 , 9 7 5 6 , 8 9 1 2 , 9 9 3 Op t o m e t r i s t s ' E x a m L o c a t i o n s Ca l i f o r n i a Not Provided Ke r n C o u n t y 6 4 3 6 4 Tu l a r e C o u n t y 4 1 2 9 4 1 Sa n t a B a r b a r a C o u n t y 6 8 2 4 6 8 Al l O t h e r C A C o u n t ie s 4 , 7 2 2 3 , 6 2 6 4 , 7 2 2 Gr a n d T o t a l 4 , 8 9 5 3 , 6 8 2 4 , 8 9 5 N o t P r o v i d e d Op h t h a l m o l o g i s t s ' E x a m L o c a t i o n s Ca l i f o r n i a Not Provided Ke r n C o u n t y 1 1 3 1 1 Tu l a r e C o u n t y 5 3 5 Sa n t a B a r b a r a C o u n t y 4 6 5 4 6 Al l O t h e r C A C o u n t i e s 1 , 1 7 5 5 7 7 1 , 1 7 5 Gr a n d T o t a l 1 , 2 3 7 5 8 8 1 , 2 3 7 N o t P r o v i d e d (1 ) Co u n t s a r e b a s e d o n s e l f - r e p o r t e d n u m b e r s b y t h e b i d d e r . 32 Vi s i o n N e t w o r k A c c e s s - N u m b e r o f P r o v i d e r s Ne t w o r k P r o v i d e r by C o u n t y Nu m b e r o f N e t w o r k P r o v i d e r s (1 ) ME S V i s i o n (I n c u m b e n t ) An t h e m B l u e S h i e l d E y e M e d Op t i c i a n s Ca l i f o r n i a Not Provided Ke r n C o u n t y 3 7 5 8 3 7 Tu l a r e C o u n t y 2 1 1 7 2 1 Sa n t a B a r b a r a C o u n t y 2 1 3 4 2 1 Al l O t h e r C A C o u n t i e s 1 , 2 9 6 4 , 1 4 9 1 , 2 9 6 Gr a n d T o t a l 1 , 3 7 5 4 , 2 5 8 1 , 3 7 5 N o t P r o v i d e d Op t o m e t r i s t s Ca l i f o r n i a Ke r n C o u n t y 1 1 5 9 6 1 1 5 1 0 0 Tu l a r e C o u n t y 7 0 5 3 7 0 4 8 Sa n t a B a r b a r a C o u n t y 1 2 1 7 2 2 1 7 8 Al l O t h e r C A C o u n t i e s 8 , 4 3 3 8 , 6 1 6 8 , 4 3 3 8 , 3 6 4 Gr a n d T o t a l 8 , 7 3 9 8 , 8 3 7 8 , 6 3 9 8 , 5 9 0 Op h t h a l m o l o g i s t s Ca l i f o r n i a Kern C o u n t y 1 9 4 1 9 3 Tulare C o u n t y 9 6 9 1 Sa n t a B a r b a r a C o u n t y 8 1 1 3 8 1 1 2 Al l O t h e r C A C o u n t i e s 1 , 9 5 4 1 , 0 9 4 1 , 9 5 4 8 5 7 Gr a n d T o t a l 2 , 0 6 3 1 , 1 1 7 2 , 0 6 3 8 7 3 (1 ) Co u n t s a r e b a s e d o n s e l f - r e p o r t e d n u m b e r s b y t h e b i d d e r . 33 Re t a i l L o c a t i o n s An t h e m ( S u b c o n t r a c t wi t h E y e M e d P l u s An t h e m a u x i l i a r y ne t w o r k ) Bl u e S h i e l d (S u b c o n t r a c t w i t h M E S ) M E S EyeMed (Insight Network) Ba k e r s f i e l d Al a i n N g u y e n O p t o m e t r y x x x x Ba k e r s f i e l d E y e C a r e O p t o m e t r y G r o u p ( 1 1 3 2 0 M i n g A v e . # 3 6 0 ) x x x x Ba k e r s f i e l d E y e C a r e O p t o m e t r y G r o u p ( 5 5 3 5 C a l l o w a y D r . # 1 0 0 ) x x x x Ba k e r s f i e l d E y e I n s t i t u t e - D a v i d B . H a i r , M D x x Ba k e r s f i e l d O p t i c a l x x x x Bo s t o n E y e c a r e A d v a n c e d O p t o m e t r y x x Ce n t r a l V a l l e y E y e C a r e x x x x Co s t c o ( 4 9 0 0 P a n a m a L n ) xx Co s t c o ( 3 8 0 0 R o s e d a l e H w y ) xx De v l y n O p t i c a l x x Dr . C a r o l e A . C a s t e e n M D , C a l l o w a y E y e c a r e & O p t i c a l x x Dr . K a i W o n g , M D xx Dr . L o u i s A l l e n O D I n c . x x x x Dr . P e n e l o p e S . S u t e r xx Dr . S t e v e R a t t y O p t o m e t r i s t x x x x Em p i r e E y e a n d L a s e r C e n t e r xx Em p i r e E y e A n d L a s e r C e n t e r : S o u t h w e s t O f f i c e x x Ge o r g e A l e x a n d r a k i s , M . D . , E y e P h y s i c i a n & S u r g e o n x x Go l d e n S t a t e E y e M e d i c a l G r o u p x x x x Hi l l c r e s t V i s i o n C e n t e r xx ICON E y e C a r e x x x x In n o v a t i v e E y e C a r e O p t o m e t r i c x x x x JC P e n n e y O p t i c a l x x Ke n ' s O p t i c a l xx Le n s c r a f t e r ( 2 7 2 4 M i n g A v e ) x x x x Le n s c r a f t e r ( 9 3 7 0 R o s e d a l e H w y S t e 1 0 0 ) x x x x Li & L i a o O p t o m e t r y ( 9 8 2 0 B r i m h a l l R o a d ) x x x x Li & L i a o O p t o m e t r y ( 1 0 0 2 W i b l e R o a d , S u i t e 1 ) x x x x Oi l d a l e C o m m u n i t y H e a l t h C e n t e r x x x x Op t i c a l E y e w e a r I n c x x x x Pr e m i e r E y e c a r e O p t o m e t r i c C e n t e r x x x x Di s p e n s i n g L o c a t i o n s 34 Re t a i l L o c a t i o n s An t h e m ( S u b c o n t r a c t wi t h E y e M e d P l u s An t h e m a u x i l i a r y ne t w o r k ) Bl u e S h i e l d ( S u b c o n t r a c t wi t h M E S ) M E S EyeMed (Insight Network) Ba k e r s f i e l d Sa m ' s C l u b V i s i o n xx Se a r s O p t i c a l xx x x So u t h w e s t E y e C a r e a n d L a s e r ( 2 1 5 C h i n a G r a d e L o o p ) x x So u t h w e s t E y e C a r e a n d L a s e r ( 4 6 4 9 p l a n z R d ) x x St a n t o n xx x St e r l i n g V i s i o n C a r e x x x x St o c k d a l e O p t o m e t r y x x x x Ta r g e t O p t i c a l ( 9 1 0 0 R o s e d a l e ) x x x x Ta r g e t O p t i c a l ( 1 1 0 0 0 S t o c k d a l e H w y ) x x x x Th e V i s i o n C e n t e r i n W a l m a r t ( 8 4 0 0 R o s e d a l e H w y ) x x x x Th u r m a n W o o d O D x x x x Tr i a n g l e E y e I n s t i t u t e x x x x Wa l m a r t V i s i o n C e n t e r ( 6 2 2 5 C o l o n y S t ) xx Wa l m a r t V i s i o n C e n t e r ( 2 6 0 1 F a s h i o n P l ) xx De l a n o De l a n o O p t o m e t r i c C e n t e r x x x x MA R K J P A R K O D I N C x x x x Wa l m a r t V i s i o n C e n t e r ( 5 3 0 W o o l l o m e s A v e . ) x x Ed w a r d s Op t i c a l C e n t e r xx x x La k e I s a b e l l a La r r y W a g g o n e r x x x x Ri d g e c r e s t Da n i e l H M a l l o r y x x Ta f t JA M E S S I M O N S O N O D x x x x Te h a c h a p i DR J O H N E F A G A N x x x x Te h a c h a p i O p t o m e t r i c C e n t e r x x x x Wa s c o Wa l m a r t V i s i o n C e n t e r ( 4 0 1 n C e n t r a l A v e ) xx WO L F G A N G H R E N K E N O D x x x x OM N I F A M I L Y H E A L T H x x x x Di s p e n s i n g L o c a t i o n s ( c o n t i n u e d ) 35 Vi s i o n G e o A c c e s s Ge o A c c e s s S t a n d a r d s ME S V i s i o n (I n c u m b e n t ) An t h e m B l u e S h i e l d E y e M e d Ge o A c c e s s Op t o m e t r i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 7 0 4 7 0 4 7 0 4 7 0 4 Wi t h D e s i r e d A c c e s s 7 0 4 7 0 3 7 0 4 7 0 3 Ru r a l A r e a s 2 p r o v i d e r s i n 2 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 67 7 6 7 7 6 7 7 6 7 7 Wi t h D e s i r e d A c c e s s 66 3 6 6 3 6 6 3 6 6 3 To t a l To t a l M e m b e r s (1 ) 13 8 3 1 3 8 3 1 3 8 3 1 , 3 8 3 Wi t h D e s i r e d A c c e s s 1 3 6 7 1 , 3 6 6 1 3 6 7 1 , 3 6 6 % w i t h D e s i r e d A c c e s s 9 8 . 8 % 9 8 . 8 % 9 8 . 8 % 9 8 . 8 % Op h t h a l m o l o g i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 70 4 7 0 4 7 0 4 7 0 4 Wi t h D e s i r e d A c c e s s 68 2 6 9 1 6 8 2 6 9 5 Ru r a l A r e a s 2 p r o v i d e r s i n 2 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 67 7 6 7 7 6 7 7 6 7 7 Wi t h D e s i r e d A c c e s s 61 6 5 9 6 6 1 6 5 9 3 To t a l To t a l M e m b e r s (1 ) 13 8 3 1 3 8 3 1 3 8 3 1 3 8 3 Wi t h D e s i r e d A c c e s s 1 2 9 8 1 2 8 7 1 2 9 8 1 2 8 8 % w i t h D e s i r e d A c c e s s 9 3 . 9 % 9 3 . 1 % 9 3 . 9 % 9 3 . 1 % (1 ) To t a l e n r o l l m e n t i s 1 3 8 3 w i t h 2 m e m b e r s o u t o f t h e s e r v i c e a r e a . 36 Me d i c a l R e n e w a l A p p e n d i x 37 Ac t i v e P l a n R a t e H i s t o r y 4. 0 % 8. 6 % 9. 5 % 3. 6 % 9. 5 % 7.0% 3. 9 % 4. 0 % 5. 0 % 3. 6 % 6. 3 % 4.6% -6 . 4 % 19 . 8 % 5. 0 % 9. 4 % 0. 0 % 5.6% 8. 7 % 11 . 9 % 10 . 7 % 9. 9 % 6. 8 % 9.6%3.9%3.9% -1 0 . 0 % -5 . 0 % 0. 0 % 5. 0 % 10 . 0 % 15 . 0 % 20 . 0 % 25 . 0 % 20 1 3 2 0 1 4 ¹ 2 0 1 5 ² 2 0 1 6 ³ 2 0 1 7 A v e r a g e Ac t i v e Pl a n Ra t e Hi s t o r y Ka i s e r H M O Ka i s e r D H M O An t h e m / B l u e S h i e l d P P O An t h e m / B l u e S h i e l d F u l l H M O Bl u e S h i e l d N a r r o w H M O 1 An t h e m P P O b e n e f i t d e s i g n s w e r e m o d i f i e d i n 2 0 1 4 . M e n t a l h e a l t h c o m p o n e n t w a s c a r v e d b a c k i n w i t h A n t h e m i n 2 0 1 4 w h i c h w a s or i g i n a l l y c a r v e d o u t t o O p t u m f o r b o t h H M O a n d P P O p l a n s . 2 Be n e f i t d e s i g n s f o r b o t h A n t h e m a n d K a i s e r H M O a r e m o d i f i e d i n 2 0 1 5 . 3 In 2 0 1 6 , A n t h e m w a s r e p l a c e d w i t h B l u e S h i e l d o f C a l i f o r n i a . 38 Ac t i v e P l a n R a t e f o r S i n g l e E m p l o y e e – R a t e H i s t o r y 20 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 Ka i s e r HM O $3 3 0 . 1 4 $ 3 5 8 . 5 0 $ 3 9 2 . 5 5 $ 4 0 6 . 6 8 $ 4 4 5 . 3 1 Ka i s e r DH M O $2 7 3 . 8 3 $ 2 8 4 . 7 9 $ 2 9 9 . 0 3 $ 3 0 9 . 7 9 $ 3 2 9 . 4 4 An t h e m / B l u e Sh i e l d PP O $4 0 2 . 8 5 $ 4 8 2 . 6 6 $ 5 0 6 . 7 8 $ 5 5 4 . 1 9 $ 5 5 4 . 1 9 An t h e m / B l u e Sh i e l d HM O $3 8 6 . 9 2 $ 4 3 2 . 9 7 $ 4 7 9 . 3 5 $ 5 2 7 . 0 3 $ 5 6 3 . 0 3 Bl u e Sh i e l d Na r r o w HM O $4 4 1 . 8 3 $ 4 5 9 . 1 1 $‐ $1 0 0 . 0 0 $2 0 0 . 0 0 $3 0 0 . 0 0 $4 0 0 . 0 0 $5 0 0 . 0 0 $6 0 0 . 0 0 Ac t i v e Ra t e Hi s t o r y 39 No n M e d i c a r e R e t i r e e P l a n R a t e H i s t o r y 0. 3 % 16 . 2 % 9. 5 % 15 . 0 % 15 . 1 % 11.2% 18 . 8 % -8 . 6 % 23 . 0 % 7. 6 % 4. 1 % 9.0% 0. 3 % 16 . 2 % 15 . 6 % 15 . 0 % 14 . 8 % 12.4% -1 5 . 0 % -1 0 . 0 % -5 . 0 % 0. 0 % 5. 0 % 10 . 0 % 15 . 0 % 20 . 0 % 25 . 0 % 20 1 3 2 0 1 4 ¹ 2 0 1 5 ² 2 0 1 6 ³ 2 0 1 7 A v e r a g e No n Me d i c a r e Re t i r e e Pl a n Ra t e Hi s t o r y Ka i s e r H M O An t h e m P P O Ka i s e r D H M O 1 An t h e m P P O b e n e f i t d e s i g n s w e r e m o d i f i e d i n 2 0 1 4 . M e n t a l h e a l t h c o m p o n e n t w a s c a r v e d b a c k i n w i t h A n t h e m i n 2 0 1 4 w h i c h w a s or i g i n a l l y c a r v e d o u t t o O p t u m f o r b o t h H M O a n d P P O p l a n s . 2 Be n e f i t d e s i g n s f o r b o t h A n t h e m a n d K a i s e r H M O a r e m o d i f i e d i n 2 0 1 5 . 3 In 2 0 1 6 , A n t h e m w a s r e p l a c e d w i t h B l u e S h i e l d o f C a l i f o r n i a . 40 No n M e d i c a r e R e t i r e e P l a n R a t e f o r S i n g l e R e t i r e e – R a t e Hi s t o r y 20 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 Ka i s e r H M O $7 3 9 . 5 6 $ 8 5 9 . 2 5 $ 9 4 0 . 8 8 $ 1 , 0 8 2 . 0 1 $ 1 , 2 4 5 . 3 8 An t h e m P P O $8 3 2 . 8 5 $ 7 6 0 . 9 6 $ 9 3 5 . 8 6 $ 1 , 0 0 6 . 7 6 $ 1 , 0 4 8 . 3 8 Ka i s e r D H M O $6 0 5 . 9 3 $ 7 0 3 . 9 9 $ 8 1 4 . 0 9 $ 9 3 6 . 2 0 $ 1 , 0 7 4 . 9 7 $ - $ 2 0 0 . 0 0 $ 4 0 0 . 0 0 $ 6 0 0 . 0 0 $ 8 0 0 . 0 0 $ 1 , 0 0 0 . 0 0 $ 1 , 2 0 0 . 0 0 $ 1 , 4 0 0 . 0 0 Re t i r e e R a t e H i s t o r y 41 En r o l l m e n t f o r A c t i v e P l a n s An t h e m H M O , 27 6 , 2 0 % An t h e m P P O , 70 0 , 5 0 % Ka i s e r H M O , 43 1 , 3 0 % Ka i s e r D H M O , 3 , 0. 2 % 20 1 5 E n r o l l m e n t - A c t i v e s Bl u e S h i e l d F u l l HM O , 1 8 2 , 1 3 % Blue Shield Narrow HMO, 79, 6% Bl u e S h i e l d PP O , 6 4 0 , 46 % Ka i s e r H M O , 46 7 , 3 3 . 9 % Ka i s e r D H M O , 11 , 1 % 20 1 6 E n r o l l m e n t - A c t i v e s 42 No n M e d i c a r e R e t i r e e E n r o l l m e n t An t h e m P P O , 42 1 , 9 9 % Ka i s e r H M O , 6 , 1% Ka i s e r D H M O , 0 , 0. 0 % 20 1 5 E n r o l l m e n t - N o n M e d i c a r e Re t i r e e s Bl u e S h i e l d PP O , 4 1 5 , 9 9 % Ka i s e r H M O , 4 , 1. 0 % Ka i s e r D H M O , 0 , 0% 20 1 6 E n r o l l m e n t - N o n M e d i c a r e Re t i r e e s 43 Fi n a n c i a l R a t i n g s f o r 2 0 1 7 R e n e w a l s Co m p a n y Ra t i n g A g e n c y Rating Bl u e S h i e l d o f C a l i f o r n i a L i f e & H e a l t h In s u r a n c e C o m p a n y A. M . B e s t A Ka i s e r F o u n d a t i o n H e a l t h P l a n I n c . S t a n d a r d & P o o r ’ s A A - Un u m L i f e I n s u r a n c e C o m p a n y o f A m e r i c a A . M . B e s t A Vo y a ( f o r m e r l y I N G ) A . M . B e s t A He a l t h C o m p N o t R a t e d N o t R a t e d 44 Se g a l b e l i e v e s i t i s i m p o r t a n t t o c o n s i d e r t h e f i n a n c i a l s t r e n g t h o f in s u r a n c e c o m p a n i e s a n d m a n a g e d c a r e o r g a n i z a t i o n s , w h i c h a r e ca n d i d a t e s f o r i n i t i a l s e l e c t i o n o r r e n e w a l a s i n s u r e r s o r s e r v i c e pr o v i d e r s t o e m p l o y e e b e n e f i t p l a n s . T h e r e f o r e , w e a r e p r o v i d i n g th e c u r r e n t c l a i m s p a y i n g a b i l i t y r a t i n g t h a t w a s a v a i l a b l e t o u s o n th e d a t e t h i s d o c u m e n t w a s p r e p a r e d f o r t h e i n s u r a n c e c o m p a n y o r ma n a g e d c a r e o r g a n i z a t i o n u n d e r c o n s i d e r a t i o n . Wh e n a v a i l a b l e , w e s e l e c t S t a n d a r d & P o o r ’ s b e c a u s e o f i t s ex c e l l e n t o v e r a l l r e p u t a t i o n a s a r a t i n g s e r v i c e . I n a d d i t i o n , i t ev a l u a t e s m o r e i n s u r a n c e c o m p a n i e s t h a n a n y o f t h e o t h e r co m p a r a b l e r a t i n g s e r v i c e s . S e v e r a l o t h e r r a t i n g s e r v i c e s ( e . g . , D u f f & P h e l p s , M o o d y ’ s , a n d A . M . B e s t ) a l s o p r o v i d e c l a i m s p a y i n g a b i l i t y ev a l u a t i o n s o f i n s u r a n c e c o m p a n i e s a n d m a n a g e d c a r e or g a n i z a t i o n s , w h i c h w e p r o v i d e w h e n a S t a n d a r d & P o o r ’ s r a t i n g i s no t a v a i l a b l e . Y o u m a y w i s h t o c o n s u l t t h e s e o t h e r s e r v i c e s b e f o r e ma k i n g a d e c i s i o n r e g a r d i n g t h e i n i t i a l s e l e c t i o n o r r e n e w a l o f a n in s u r a n c e c o m p a n y o r m a n a g e d c a r e o r g a n i z a t i o n . In s u r a n c e c o m p a n y a n d m a n a g e d c a r e o r g a n i z a t i o n r a t i n g ca t e g o r i e s e x p l a n a t i o n s a r e a t t a c h e d . F o r e x a m p l e , S t a n d a r d & Po o r ’ s r a t i n g s r a n g e f r o m “ V u l n e r a b l e ” t o “ S e c u r e ” . I n p a r t i c u l a r , th e y r e g a r d “ v u l n e r a b l e ” c o m p a n i e s ( i . e . , r a t i n g s o f B B + a n d l o w e r ) to b e a t r e l a t i v e l y s e r i o u s r i s k i n t e r m s o f m e e t i n g b o t h c l a i m s a n d cr e d i t o r o b l i g a t i o n s . I n s u r a n c e c o m p a n i e s i n t h i s c a t e g o r y s h o u l d b e re s e a r c h e d c a r e f u l l y b e f o r e b e i n g s e l e c t e d . To t h e r i g h t i s a c h a r t , w h i c h e x p l a i n s t h e S t a n d a r d & P o o r ’ s r a t i n g ca t e g o r i e s . ( D u f f & P h e l p s u s e s t h e s a m e r a t i n g s y s t e m a s St a n d a r d & P o o r ’ s ; A . M . B e s t ’ s r a t i n g s y s t e m i s s h o w n i n pa r e n t h e s e s ) . Fi n a n c i a l R a t i n g s In v e s t m e n t G r a d e o r S e c u r e : AA A ( A + + ) Co m p a n i e s r a t e d A A A h a v e t h e h i g h e s t r a t i n g as s i g n e d . C a p a c i t y t o p a y i n t e r e s t a n d r e p a y p r i n c i p a l is e x t r e m e l y s t r o n g . AA ( A + ) Co m p a n i e s r a t e d A A h a v e a v e r y s t r o n g c a p a c i t y t o p a y in t e r e s t a n d r e p a y p r i n c i p a l a n d d i f f e r f r o m t h e h i g h e s t ra t e d i s s u e r s o n l y t o a s m a l l d e g r e e . A ( A , A - ) Co m p a n i e s r a t e d A h a v e a s t r o n g c a p a c i t y t o p a y in t e r e s t a n d r e p a y p r i n c i p a l , a l t h o u g h t h e y a r e so m e w h a t m o r e s u s c e p t i b l e t o a d v e r s e c h a n g e s i n ec o n o m i c c o n d i t i o n s t h a n t h o s e i n h i g h e r r a t e d ca t e g o r i e s . BB B ( B + + , B + ) Co m p a n i e s r a t e d B B B a r e r e g a r d e d a s h a v i n g a n ad e q u a t e c a p a c i t y t o p a y i n t e r e s t a n d r e p a y p r i n c i p a l , ho w e v e r , a d v e r s e e c o n o m i c c o n d i t i o n s o r c h a n g i n g ci r c u m s t a n c e s a r e m o r e l i k e l y to lead to a weakened ca p a c i t y t o p a y i n t e r e s t a n d r e p a y p r i n c i p a l . Be l o w I n v e s t m e n t G r a d e o r V u l n e r a b l e : BB ( B ) B ( B - ) CC C ( C + + , C + ) CC ( C , C - ) Co m p a n i e s r a t e d B B , B , C C C a n d C C a r e r e g a r d e d , o n ba l a n c e , a s s p e c u l a t i v e w i t h respect to their credit wo r t h i n e s s . W h i l e s u c h c o m p a n i e s m a y h a v e s o m e pr o t e c t i v e c h a r a c t e r i s t i c s , u n certainties and major risk ex p o s u r e o r a d v e r s e c on d i t i o n s o u t w e i g h t h e m . R; N R Th e r a t i n g R i s r e s e r v e d f o r c o m p a n i e s w h o “ h a v e ex p e r i e n c e d a R E G U L A T ORY ACTION regarding so l v e n c y . ” T h e r a t i n g N R i ndicates that the insurer’s fi n a n c i a l s o l v e n c y i s n o t r a t e d . 45 Ka i s e r H M O E x p e r i e n c e 46 Ka i s e r H M O E x p e r i e n c e 47 Ka i s e r I n p a t i e n t P e r M e m b e r P e r M o n t h C o s t s 48 Ka i s e r I n p a t i e n t T o p 1 0 D i a g n o s i s R e l a t e d G r o u p 49 Ka i s e r O u t p a t i e n t P e r M e m b e r P e r M o n t h C o s t s 50 Ka i s e r P h a r m a c y P e r M e m b e r P e r M o n t h C o s t s 51 Ka i s e r P h a r m a c y U t i l i z a t i o n b y D r u g C l a s s e s 52 Ka i s e r T o p 2 5 D r u g s b y N e t C l a i m s 53 Ka i s e r T o p 2 5 D r u g s b y N e t C l a i m s ( c o n t i n u e d ) 54 Ka i s e r T o p 2 5 D r u g s b y N e t C l a i m s ( c o n t i n u e d ) 55 De n t a l R F P A p p e n d i x 56 PP O G e o A c c e s s C o m p a r i s o n Ge o A c c e s s S t a n d a r d s Me t L i f e (I n c u m b e n t ) An t h e m GR I D + De l t a De n t a l P P O Li b e r t y D e n t a l Un i t e d He a l t h c a r e Un i t e d C o n c o r d i a Ge o A c c e s s - P P O P l a n s Ge n e r a l D e n t i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 8 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 4 5 7 4 5 7 4 5 7 4 5 7 4 5 7 4 5 7 Wi t h D e s i r e d A c c e s s 4 5 6 4 5 7 4 5 6 4 5 7 4 5 6 4 5 6 Ru r a l A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 43 7 4 3 7 4 3 7 4 3 7 4 3 7 4 3 7 Wi t h D e s i r e d A c c e s s 42 8 4 1 6 4 1 8 4 2 6 4 2 7 4 2 7 To t a l To t a l M e m b e r s 8 9 4 8 9 4 8 9 4 8 9 4 8 9 4 8 9 4 Wi t h D e s i r e d A c c e s s 8 8 4 8 7 3 8 7 4 8 8 3 8 8 3 8 8 3 % w i t h D e s i r e d A c c e s s 9 8 . 9 % 9 7 . 7 % 9 7 . 8 % 9 8 . 8 % 9 8 . 8 % 9 8 . 8 % De n t a l S p e c i a l i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 8 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 45 7 4 5 7 4 5 7 4 5 7 4 5 7 4 5 7 Wi t h D e s i r e d A c c e s s 45 6 4 5 7 4 5 6 4 5 3 4 5 6 4 5 6 Ru r a l A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 43 7 4 3 7 4 3 7 4 3 7 4 3 7 4 3 7 Wi t h D e s i r e d A c c e s s 40 1 4 0 9 3 9 0 3 7 7 4 0 5 4 0 0 To t a l To t a l M e m b e r s 8 9 4 8 9 4 8 9 4 8 9 4 8 9 4 8 9 4 Wi t h D e s i r e d A c c e s s 8 5 7 8 6 6 8 4 6 8 3 0 8 6 1 8 5 6 % w i t h D e s i r e d A c c e s s 9 5 . 9 % 9 6 . 9 % 9 4 . 6 % 9 2 . 8 % 9 6 . 3 % 9 5 . 7 % 57 DM O G e o A c c e s s C o m p a r i s o n Ge o A c c e s s S t a n d a r d s Un i t e d He a l t h c a r e (I n c u m b e n t ) Li b e r t y De n t a l Un i t e d C o n c o r d i a W e s t e r n D e n t a l Ge o A c c e s s - D M O P l a n s Ge n e r a l D e n t i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 8 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 4 2 4 4 2 4 4 2 4 4 2 4 Wi t h D e s i r e d A c c e s s 4 1 6 4 1 9 4 2 0 4 0 9 Ru r a l A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 35 9 3 5 9 3 5 9 3 5 9 Wi t h D e s i r e d A c c e s s 33 7 3 4 2 3 4 8 3 1 4 To t a l To t a l M e m b e r s (1 ) 78 3 7 8 3 7 8 3 7 8 3 Wi t h D e s i r e d A c c e s s 7 5 3 7 6 1 7 6 8 7 2 3 % w i t h D e s i r e d A c c e s s 9 6 . 2 % 9 7 . 2 % 9 8 . 1 % 9 2 . 3 % De n t a l S p e c i a l i s t s Ur b a n / S u b u r b a n A r e a s 2 p r o v i d e r s i n 8 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 42 4 4 2 4 4 2 4 4 2 4 Wi t h D e s i r e d A c c e s s 41 4 4 0 6 4 2 0 4 1 5 Ru r a l A r e a s 2 p r o v i d e r s i n 1 0 m i l e s Al l M e m b e r s i n S e r v i c e A r e a 35 9 3 5 9 3 5 9 3 5 9 Wi t h D e s i r e d A c c e s s 32 7 3 2 3 3 3 5 3 2 7 To t a l To t a l M e m b e r s (1 ) 78 3 7 8 3 7 8 3 7 8 3 Wi t h D e s i r e d A c c e s s 7 4 1 7 2 9 7 5 5 7 4 2 % w i t h D e s i r e d A c c e s s 9 4 . 6 % 9 3 . 1 % 9 6 . 4 % 9 4 . 8 % (1 ) To t a l e n r o l l m e n t i s 7 8 3 w i t h 6 m e m b e r s o u t o f t h e s e r v i c e a r e a . 58 PP O N e t w o r k A c c e s s b y C o u n t y Ne t w o r k P r o v i d e r by C o u n t y Nu m b e r o f P P O N e t w o r k P r o v i d e r s (1 ) Me t L i f e (I n c u m b e n t ) An t h e m De l t a De n t a l Li b e r t y De n t a l Un i t e d He a l t h c a r e United Concordia Ge n e r a l D e n t i s t s Ca l i f o r n i a Ke r n C o u n t y 9 0 6 3 9 9 2 5 7 3 1 0 3 7 1 2 5 0 Tu l a r e C o u n t y 4 6 3 2 4 5 1 8 1 1 7 7 1 7 1 8 9 Sa n t a B a r b a r a C o u n t y 2 9 6 2 3 8 1 7 0 1 5 8 1 8 8 1 1 6 Ve n t u r a C o u n t y 8 3 3 5 8 3 4 5 9 4 1 0 4 7 3 3 2 5 Al l O t h e r C A C o u n t i e s 3 5 , 26 3 2 0 , 2 6 6 1 1 , 5 0 1 1 3 , 9 4 7 1 7 , 2 6 7 1 1 , 6 7 5 Gr a n d T o t a l 3 7 , 7 6 1 2 1 , 7 3 1 1 2 , 5 6 8 1 5 , 0 0 2 1 8 , 4 7 0 1 2 , 4 5 5 Sp e c i a l t y D e n t i s t s Ca l i f o r n i a Ke r n C o u n t y 3 2 1 1 4 4 1 3 8 9 3 1 2 8 3 8 Tu l a r e C o u n t y 1 1 0 5 8 5 5 1 6 4 1 1 0 Sa n t a B a r b a r a C o u n t y 1 0 7 8 8 8 9 5 1 6 2 2 2 Ve n t u r a C o u n t y 4 2 6 2 0 2 1 6 4 1 5 5 1 8 3 6 6 Al l O t h e r C A C o u n t i e s 5 2 , 7 0 2 6 , 0 2 9 3 , 0 8 7 4 , 0 1 2 4 , 8 8 4 2 , 5 2 2 Gr a n d T o t a l 5 3 , 6 6 6 6 , 5 2 1 3 , 5 3 3 4 , 3 2 7 5 , 2 9 8 2 , 6 5 8 (1 ) Co u n t s a r e b a s e d o n s e l f - r e p o r t e d n u m b e r s b y t h e b i d d e r . 59 DM O N e t w o r k A c c e s s b y C o u n t y (1 ) Co u n t s a r e b a s e d o n s e l f - r e p o r t e d n u m b e r s b y t h e b i d d e r . Ne t w o r k P r o v i d e r by C o u n t y Nu m b e r o f D M O N e t w o r k P r o v i d e r s (1 ) Un i t e d He a l t h c a r e (I n c u m b e n t ) Li b e r t y De n t a l Un i t e d C o n c o r d i a W e s t e r n D e n t a l Ge n e r a l D e n t i s t s Ca l i f o r n i a Ke r n C o u n t y 1 4 3 1 5 9 2 0 1 7 Tu l a r e C o u n t y 8 6 6 3 3 1 5 Sa n t a B a r b a r a C o u n t y 4 2 3 8 3 1 2 Ve n t u r a C o u n t y 1 6 0 1 2 3 3 8 1 5 Al l O t h e r C A C o u n t i e s 6 , 5 3 0 4 , 6 7 2 1 , 5 0 5 8 8 3 Gr a n d T o t a l 6 , 9 6 1 5 , 0 5 5 1 , 5 6 9 9 4 2 Sp e c i a l t y D e n t i s t s Ca l i f o r n i a Ke r n C o u n t y 1 0 0 8 6 1 2 1 Tu l a r e C o u n t y 2 4 1 4 0 N / A Sa n t a B a r b a r a C o u n t y 3 1 3 2 1 N / A Ve n t u r a C o u n t y 8 3 7 2 2 2 N / A Al l O t h e r C A C o u n t i e s 2 , 8 4 4 2 , 1 1 3 7 6 9 1 6 Gr a n d T o t a l 3 , 0 8 2 2 , 3 1 7 8 0 4 1 7 60 Fi n a n c i a l R a t i n g s f o r 2 0 1 7 D e n t a l R F P Co m p a n y Ra t i n g A g e n c y Rating An t h e m B l u e C r o s s A . M . B e s t A De l t a D e n t a l o f C a l i f o r n i a A . M . B e s t A LI B E R T Y D e n t a l P l a n o f C a l i f o r n i a A . M . B e s t A - Me t r o p o l i t a n L i f e I n s u r a n c e C o m p a n y A . M . B e s t A + Un i t e d H e a l t h c a r e I n s u r a n c e C o m p a n y A . M . B e s t A Un i t e d C o n c o r d i a D e n t a l A . M . B e s t A- We s t e r n D e n t a l S e r v i c e s A. M . B e s t B++ 61 Vi s i o n R F P A p p e n d i x 62 Fi n a n c i a l R a t i n g s f o r 2 0 1 7 V i s i o n R F P Co m p a n y Ra t i n g A g e n c y Rating An t h e m B l u e C r o s s A . M . B e s t A Bl u e S h i e l d o f C a l i f o r n i a L i f e & H e a l t h In s u r a n c e C o m p a n y A. M . B e s t A Ey e M e d V i s i o n C a r e (1 ) A. M . B e s t A - ME S V i s i o n A . M . B e s t A + Me t r o p o l i t a n L i f e I n s u r a n c e C o m p a n y A . M . B e s t A + Vi s i o n S e r v i c e P l a n A . M . B e s t A (1 ) Fi n a n c i a l s t r e n g t h r e p o r t e d f o r A . M . B e s t i s f o r F i d e l i t y Se c u r i t y L i f e I n s u r a n c e C o m p a n y , t h e i s s u i n g c a r r i e r .