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.

July 22, 2014

Amount of contract estimated for CY 2015:

$58,380,000.00

Delta Dental PPO –

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

Actives: $44,420,000.00

Policy Number 1673 – Retirees

$12,970,000.00

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