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. CIW OF SAN BERNARDOo - REQU~T FOR COUNCIL Ac-.J.ON
From:
Roger DeFratis
Acting Personnel
Personnel
DirectorF:EC'D.-ADMIN.oJf1fl.bject:
1'07 ;'~"I _0 1'1 'I' '),~
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Resolution to amend agreement with
Private Medical-Care, Inc., to
extend term of agreement an adrtitional
year effective January 1, 1988.
Dept:
Date: November 9, 1987
rrftY
Synopsis of Previous Council action:
The City previously entered into an agreement with Private Medical-Care Inc., on
November I, 1981, to make available a Vision Care Plan to City employees.
Recommended motion:
Approve the resolution to extend the terms of agreement an additional year with
Private Medical-Care Inc., effective January 1, 1988, with no change in rates.
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Contact person: Rooer DeFrati s
Phone:
5008
N/A
Supporting data attached: Yes
Ward:
FUNDING REQUIREMENTS:
Amount:
NIA
Sou rce:
Existinq Budqet-nFrSn_NL7'
,
Finance: ..!t..I#'JIT"d.cro....L.-__1 'Sf:..'r<..,.,)l<' €_'S'
Council Notes:
75.0262
11-9-87
A!lenda Item No. /7
. clk OF SAN BERNARDt..Jo - REQUWT FOR COUNCIL AC~ON
STAFF REPORT
The vision care plan, made available in 1981, was originally
implemented as an additional plan for employee purchase
without City Contribution. Bargaining Units members may now
use their Cafeteria amounts toward the cost of the vision
plan.
There are no increase in rates over last year.
Employee Only
Employee + 1 dependent
Employee + 2 dependents
or more
$ 7.68 per month
$10.65 per month
$15.36 per month
11-9-87
75.0264
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28 11-9-87
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RESOLUTION NO.
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AMENDMENT TO AGREEMENT WITH PRIVATE MEDICAL-
CARE, INC., EXTENDING THE TE~~ FOR AN ADDITIONAL YEAR EFFECT-
IVE JANUARY 1, 1988.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AS FOLLOWS:
SECTION 1. The Mayor of the City of San San Bernardino
is hereby authorized and directed to execute on behalf of
said City an amendment to agreement with Private Medical
Care, Inc., extending the term for an additional year,
effective January 1, 19BB, relating to an Optical Plan for
employees and dependents, a copy of which is attached hereto,
marked Exhibit "A" and incorporated herein by reference as
fully as though set forth at length.
I HEREBY CERTIFY that the foregoing Resolution was duly
adopted by the Mayor and Common Council of the City of San
Bernardino at a
meeting thereof, held on the
day of
, 1987, by the following
vote, to wit:
AYES:
Council Members
NAYS:
ABSENT:
City Clerk
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The foregoing resolution is hereby approved this
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28 11-9-87
day of
, 1987.
----
Mayor of the City of San
Bernardino
as to form and legal content:
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DENTAL HEALTH PLAN
Affiliated with Delta Dental Pian
AMENDMENT
TO
OPTICAL HEALTH CARE AGREEMENT
(PREPAID)
THIS AGREEMENT is made by and between PRIVATE MEDICAL-CARE, INC. and CITY OF SAN
BERNARDINO, PMI GROUP #9040, for the purpose of amending the original Prepaid
Optical Health Care Agreement as follows:
'1. The term of the Agreement as noted on page 1, number 1, shall be amended to
read January 1, 1988 through December 31, 1988.
2. Group shall provide a list of eligible subscribers each month shall be
amended to read commencing January 1, 1988 as noted on page 2, number 2.
3. The following new Coordination of Benefits language is hereby added to page
3 of the Agreement:
2.4
If an eligible person is entitled under a group insurance policy or any
other group health benefits program (i ncludi ng another PMI program) to
receive or be reimbursed for the cost of optical services which are also
Benefits under this program, and if the other policy or program is "primary"
under the rules described in Paragraph 2.4 (a) below, then the cost of
opti ca 1 servi ces rendered by non-Primary Optometri sts under thi s program
shall be reimbursed only to the extent that the optical services are
Benefits and are not fully paid for or provided under the terms of the other
policy or program. If this program is "primary" under those rules, Benefits
sha 11 be provi ded as if the other pol i cy or program did not exi st and any
payment received by a Dentist from other coverage shall be applied to any
copayments due from an eligible person.
a. If the other policy or program principally covers services or expenses
other than optical care, this program shall be "primary." Otherwise,
the determination of which policy or program is "primary" shall be
governed by the following rules:
1) The policy or program covering the patient as other than a
dependent shall be primary over the policy or program covering the
patient as a dependent.
2) The policy or program covering a child as a dependent of a parent
whose birthday occurs earlier in a calendar year shall be primary
over the po 1 icy or program coveri ng a chi 1 d as a dependent of a
parent whose birthday occurs later in a calendar year (except for
a dependent child whose parents are separated or divorced as
described in (3) below).
1-88.RE.189
5122 Katella Avenue, Suite 206. Los Alamiws. CA 90720 (213) 493-6661, (714) 978.6624
So, ~ 1-8O().32H529 No,Calilornia 1-8OQ.422-4234 Nationwide 1,800,821,2058
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3) In the case of a dependent child whose parents are legally
separated or divorced:
a) If the parent with custody has not remarried, the policy or
program covering the child as a dependent of the parent with
custody shall be primary over the policy or program covering
the child as a dependent of the parent without custody.
b) If the parent with custody has remarried, the policy or
program covering the child as a dependent of the parent with
custody shall be primary over the policy or program covering
the child as a dependent of the stepparent, and the policy or
program covering the chil d as a dependent of the stepparent
shall be primary over the pol icy or program covering the
child as a dependent of the parent without custody.
c) If there is a court decree that establishes financial
responsibility for optical services which are Benefits under
this program, then notwithstanding 3 (a) and 3 (b), the
policy or program covering the child as a dependent of the
parent wi th such fi nanci a 1 res pons ibil ity sha 11 be primary
over any other policy or program covering the child.
If the primary policy or program cannot be determined by the rules
described in (1), (2) or (3), the policy or program which has
covered the eligible person for the longer period of time shall be
primary, with the following exception: A policy or program
covering the eligible person as a laid-off or retired employee or
the dependent of a laid-off or retired employee shall not be
primary under this rule (4) over a policy or program covering the
e 1 i gi b 1 e person as an employee or the dependent of an employee.
However, if the provisions of the other policy or program do not
include this exception, which results in neither program being
primary, then this exception shall not apply.
4)
b. An eligible person shall provide to PMI and PMI may release to or
obtain from any insurance company or other organization, any
information about the eligible person that is needed to administer this
Paragraph 2.4. PMI shall, in its sole discretion, determine whether
any reimbursement to an insurance company or other organization is
warranted under thi s Paragraph 2.4, and any such reimbursement pa id
shall be deemed to be Benefits under thi s Agreement. PMI shall have
the right to recover from a dentist, eligible person, insurance company
or other organization, as PMI chooses, the amount of any Benefits paid
by PMI which exceed its obligations under the terms of this
Paragraph 2.4.
All other aspects of the Prepaid Optical Health Care Agreement currently in
effect remain the same.
1-B8.RE.190
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IN WITNESS WHEREOF. the parties have executed this Agreement and have affixed
their signatures on the day of 198
CITY OF SAN BERNARDINO
PMI GROUP #9040
By:
Signature
Date
Print Name and Title
P.O. Box 1318
Address
San Bernardino CA 92402
City State Zi p
714{384-5002
Telephone Number
Approved as to form
and legal content:
1-88.RE.191
PRIVATE MEDICAL-CARE, INC.
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By: 0fyrh,O, J"",t:fr~
Slgnature ' /
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Date