Loading...
HomeMy WebLinkAbout1999-12-06 City Council (11)City of Palo Alto City Manager’s Report 7 TO:HONORABLE CITY COUNCIL FROM:CITY MANAGER DEPARTMENT: HUMAN RESOURCES DATE:DECEMBER 6, 1999 CMR:429:99 SUBJECT:APPROVAL OF A RESOLUTION AMENDING THE CITY OF PALO ALTO’S NON-INSURED DENTAL PLAN CONTRACT TO PROVIDE FOR THE REIMBURSEMENT OF "ROUTINE DENTAL EXAM AND PROPHYLAXIS" TWICE IN ANY CALENDAR YEAR RECOMMENDATION This report recommends the Council approve a resolution amending the City’s non-insured dental plan to provide for reimbursement of routine dental exams and prophylaxis twice in any calendar year. BACKGROUND The current City of Palo Alto dental plan was established in 1973. Since 1973, the only change made in the benefit plan design was the addition of a limited orthodontia benefit. Any other modifications made in the dental plan have been modifications in plan language to reflect changes in Federal or State regulations and changes in plan language to clarify existing benefit plan revisions without changing the dental plan’s liability. DISCUSSION Currently, the dental plan pays for dental exams and prophylaxis (cleaning) "once every six months." The exams and cleanings must be separated by at least 180 days. The dental plan language reflected the normal practice in 1973. Over the last three years, the plan has denied payment for cleanings and!or exams where these services were separated by (slightly) less than 180 days, i.e. 179 days, 178 days, etc. Denials number approximately 15 to 20 claims per year over the past three calendar years. In a survey of the market place, the majority of the plans will pay for routine cleanings and exams twice in any calendar year. Staff recommends a minor change in benefit definition to provide for "Routine dental exam and prophylaxisis twice in any calendar year," rather than "once every six months." CMR:429:99 Page I of 2 RESOURCE IMPACT There will be a slight increase in dental claims cost, which is estimated to be less than $1,000 annually. No additional funding is necessary for the additional de minimus cost. POLICY IMPLICATIONS The Dental Plan Summary Plan Description!Contract must be amended to reflect the change in dental plan benefits. ENVIRONMENTAL REVIEW This is not a project under the California Environmental Quality Act (CEQA). ATTACHMENTS 1.Resolution amending the Dental Summary Plan Description/Contract 2.Dental Summary Plan Description PREPARED BY:Leonard Zucker, Manager of Employee Benefits DEPARTMENT HEAD: JAY C. ROUNDS ~,Director of Human Resources Assistant City Manager CMR:429:99 Page ~.of 2 RESOLUTION NO. RESOLUTION OF THE COUNCIL OF THE CITY OF PALO ALTO AMENDING CHAPTER 1 OF THE CITY OF PALO ALTO EMPLOYEES’ DENTAL PLAN The Council of the City of Palo Alto does RESOLVE as follows: SECTION i. Chapter 1 of the City of Palo Alto Employees’ Dental Plan is hereby amended to read as shown on Exhibit "A", which is attached hereto and incorporated herein by reference. SECTION 2. The Council finds that this is not a project under the California Environmental Quality Act and, therefore, no environmental impact assessment is necessary. INTRODUCED AND PASSED: AYES: NOES: ABSENT: ABSTENTIONS: ATTEST:APPROVED: City Clerk Mayor APPROVED AS TO FORM: Senior Asst. City Attorney City Manager Director of Human Resources 991129 sdl 0032289 CHAPTER 1. COVERED DENTAL EXPENSES Dental benefits are subject to benefit plan percentages, and maximums shown in the Summary of Benefits and to the limitations and exclusions described later in this section. Covered dental procedures include: Diagnostic and Preventive Dental Care Routine dental exam E Prophylaxis (cleaning) Fluoride treatment for dependent children only Bitewing X-rays Full-mouth X-rays. General Dental Services Once even/5 month~ Once even/5 months Once every 12 months Once every 6 months Once every 36 months Routine filling - amalgam, synthetic porcelain and plastic restorations Routine extractions Endodontics - pulpal therapy, root canal treatment (treatment of non-vital teeth) and similar services Periodontics - treatment of the tissues supporting the teeth Oral surgery - removal of impacted teeth, gingivectomies, alveoplasfies and other dental surgery, including pro- and postoperative care Night Guards to prevent bruxism (teeth grinding) Sealants applied only to permanent molars and premolars for children up to age 16. Gold inlays, gold onlays, gold fillings and all crowns, when teeth cannot be restored with amalgam, synthetic porcelain and plastic restoration materials. Major Dental Services ¯Full or partial dentures ¯Bridgework ¯Repair of dentures, partials, and bridges EXHIBIT "A"