City Officer: Board of Supervisors – Filed: July 29, 2014 – Contractor: Delta Dental of California (Delta Dental PPO Active Self Insured and Retiree PPO fully insured, and DeltaCare DHMO)

Nature of Contract

Dental Benefits.

Date Contract Approved

July 22, 2014


Amount of contract estimated for CY 2015:



Delta Dental PPO –

Policy 9502 – Actives: (Self-funded Claims + Admin.)

Actives: $44,420,000.00

Policy Number 1673 – Retirees


Retirees: Delta Dental PPO Total: $57,390,000.00


DeltaCare USA – DHMO

Policy #01797 – DeltaCare:

Actives: $340,000.00

Retirees: $650,000.00

Total: $990,000.00



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