CONTRACT RE DENTAL INS PROCESSING WITH DELTA DENTAL OF AZ.PDF

CON 1 RACT #: MA 1)860 190140
CONTRACT PURSUANT TO PH RFP 190140
CON fltACT #: MA D860 190140
This Contract is entered into this 1" day of March, 2019 by and between Maricopa, County ("County"), a political
subdivision of the State of Arizona, and Delta Dental of Arizona ("Contactor") for the purchase of Dental Insurance
Services.
1.0 CONTRACT TERM:
This Contract is for a term of three (3) years, beginning on the day of March, 2019 and ending
the 28th day of February, 2022.
1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this
Contract for additional terms up to a maximum of six (6) years, (or at the County's sole discretion,
extend the contract on a month-to-month basis for a maximum of six (6) months after expiration).
The County shall notify the Contractor in writing of its intent to extend the Contract term at least
thirty (30) calendar days prior to the expiration of the original contract term, or any additional
term thereafter.
1.3 CONTRACT COMPLETION:
The Contractor shall make all reasonable efforts for an orderly transition of its duties and
responsibilities to another provider and/or to the County. This may include, but is not limited to
the preparation of a transition plan and cooperation with the County or other providers in the
transition. The transition includes the transfer of all records, and other data in the possession,
custody or control of Contractor required to be provided to the County either by the terms of this
agreement or as a matter of law. The provisions of this clause shall survive the expiration or
termination of this agreement.
2.0 PRICE ADJUSTMENTS:
Any requests for reasonable price adjustments must be submitted sixty (60) calendar days prior to the
Contract annual anniversary date. Requests for adjustment in cost of labor and/or materials must be
supported by appropriate documentation. The reasonableness of the request will be determined by
comparing the request with the Consumer Price Index or by performing a market survey. If County agrees
to the adjusted price terms, County shall issue written approval of the change and provide an updated
version of the Contract. The new change shall not be in effect until the date stipulated on the Contract,
3.0 PAYMENTS:
3.1 As consideration for performance of the duties described herein, County shall pay Contactor the
sum(s) stated in Exhibit "A."
3.2 Payment shall be made upon the County's receipt of a properly completed invoice.
Page 1 of 73

CONTRACT 0: MA D860 190140
33 INVOICES:
3.3.1 The Contractor shall submit one (1) legible copy of their detailed invoice before
payment(s) can be made. At a minimum, the invoice must provide the following
information:
• Company name, address and contact
• County bill-to name and contact information
• Contract serial number
• County purchase order number
• Invoice number and date
• Payment terms
• Date of service or delivery
• Quantity
• Contract Item number(s)
• Description of service provided
• Pricing per unit of service
• Extended price
• Total Amount Due
3.3.2 Problems regarding billing or invoicing shall be directed to the County as listed on the
Purchase Order.
3.13 Payment shall be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration
Form located on the County Department of Finance Vendor Registration Web Site
(http://www.maricopa. gov/922 /Vendors)
• 3.3.4 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
3.4 APPLICABLE TAXES:
3.4.1 Payment of Taxes: The Contractor shall pay all applicable taxes. With respect to any
installation labor on items that are not attached to real property performed by Contractor
under the terms of this Contract, the installation labor cost and the gross receipts for
materials provided shall be listed separately on the Contractor's invoices.
3.4.2 State and Local Transaction Privileze Taxes: Maricopa County is subject to all
applicable state and local transaction privilege taxes. To the extent any state and local
transaction privilege taxes apply to sales made under the terms of this contract it is the
responsibility of the seller to collect and remit all applicable taxes to the proper taxing
jurisdiction of authority.
3.4.3 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, state, and
local taxes applicable to its operation and any persons employed by the Contractor.
Contractor shall, and require all subcontractors to hold Maricopa County harmless from
any responsibility for taxes, damages and interest, if applicable, contributions required
under Federal, and/or state and local - laws and regulations and any other costs including
transaction privilege taxes, unemployment compensation insurance, Social Security and
Worker's Compensation.
Page 2 of 73

CONTRACT MA D860 190140
3.5 TAX: (SERVICES)
No tax shall be levied against labor. It is the responsibility of the Contractor to determine any and
all taxes and include the same in proposal price.
3.6 STRATEGIC ALLIANCE for VOLUME EXPENDITURES (SAVE):
The County is a member of the SAVE cooperative purchasing group. $AVE includes the State of
Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified school districts.
Under the $AVE Cooperative Purchasing Agreement, and with the concurrence of the successful
Respondent under this solicitation, a member of $AVE may access a contract resulting fromt a
solicitation issued by the County.
3.7 INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPA ' s):
County currently holds ICPA's with numerous governmental entities. These agreements allow
those entities, with the approval of the Contractor, to purchase their requirements under the terms
and conditions of the County Contract. It is the responsibility of the non-County government
entity to perform its own due diligence on the acceptability of the Contract under its procurement
rules, processes and procedures
4,0 AVAILABILITY OF FUNDS:
4.1 The provisions of this Contract relating to payment for services shall become effective when funds
assigned for the purpose of compensating the Contractor as herein provided are actually available
to County for disbursement. The County shall be the sole judge and authority in determining the
availability of funds under this Contract. County shall keep the Contractor fully informed as to the
availability of funds.
4.2 If any action is taken by any state agency, Federal department or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection
with, this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in
connection with, this Contract. In the event of termination, County shall be liable for payment
only for services rendered prior to the effective date of the termination, provided that such services
are performed in accordance with the provisions of this Contract. County shall give written notice
of the effective date of any suspension, amendment, or termination under this Section, at least ten
(10) days in advance.
5.0 DUTIES:
5.1 The Contractor shall perform all duties stated in Exhibit "B", or as otherwise directed in writing
by the Procurement Officer. In addition to the documents contained in Exhibit "B", Contractor
shall adhere to all standards of care and processes as contained in their entire original response.
5.2 During the Contract tern, County shall provide Contractor's personnel with adequate workspace
for consultants and such other related facilities as may be required by Contractor to carry out its
contractual obligations.
6.0 TERMS and CONDITIONS:
6.1 INDEMNIFICATION:
To the fullest extent perir itted by law, and to the extent that claims, damages, losses or expenses
are not covered and paid by insurance purchased by the Contractor, the Contractor shall defend
indemnify and hold harmless the County (as Owner), its agents, representatives, agents, officers,
directors, officials, and employees from and against all claims, damages, losses, and expenses
(including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and
Page 3 of 73

CONTRACT #: MA D860 190140
attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from the
negligent acts, errors, omissions, or mistakes relating to the performance of this Contract.
Contractor's duty to defend, indemnify, and hold harmless the County, its agents, representatives,
agents, officers, directors, officials, and employees shall arise in connection with any claim,
damage, loss, or expense that is attributable to bodily injury, sickness, disease, death or injury to,
impairment of, or destruction of tangible property, including loss of use resulting there from,
caused by negligent acts, errors, omissions, or mistakes in the performance of this Contract, but
only to the extent caused by the negligent acts or omissions of the Contractor, a subcontractor, any
one directly or indirectly employed by them, or anyone for whose acts they may be liable,
regardless of whether or not such claim, damage, loss, or expense is caused in part by a party
indemnified hereunder.
The amount and type of insurance coverage requirements set forth herein will in no way be
construed as limiting the scope of the indemnity in this paragraph.
The scope of this indemnification does not extend to the sole negligence of County.
6.2 INSURANCE:
6.2.1 Contractor, at Contractor's own expense, shall purchase and maintain the herein
stipulated minimum insurance from a company or companies duly licensed by the State
of Arizona and possessing a current A.M. Best, Inc. rating of B--. In lieu of State of
Arizona licensing, the stipulated insurance may be purchased from a company or
companies, which are authorized to do business in the State of Arizona, provided that
said insurance companies meet the approval of County. The form of any insurance
policies and forms must be acceptable to County.
6.2.2 All insurance required herein shall be maintained in full force and effect until all work or
service required to be performed, under the terms of the Contract is satisfactorily
completed and formally accepted. Failure to do so may, at the sole discretion of County,
constitute a material breach of this Contract.
6.2.3 Contractor's insurance shall be primary insurance as respects County, and any insurance
or self-insurance maintained by County shall not Contribute to it.
6.2.4 Any failure to comply with the claim reporting provisions of the insurance policies or any
breach of an insurance policy warranty shall not affect the County's right to coverage
afforded under the insurance policies.
6.2.5 The insurance policies may provide coverage that contains deductibles or self-insured
retentions. Such deductible and/or self-insured retentions shall not be applicable with
respect to the coverage provided to County under such policies. Contractor shall be
solely responsible for the deductible and/or self-insured retention and County, at its
option, may require Contractor to secure payment of such deductibles or self-insured
retentions by a surety bond or an irrevocable and unconditional letter of credit.
6.2.6 The insurance policies required by this Contract, except Workers' Compensation and
Errors and Omissions, shall name County, its agents, representatives, officers, directors,
officials and employees as Additional Insured's,
6.2.7 The policies required hereunder, except Workers' Compensation and Errors and
Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against
County, its agents, representatives, officers, directors, officials and employees for any
claims arising out of Contractor's work or service.
6.2.8 Commercial General Liability:
Page 4 of 73

CONTRACT #: MA D860 190140
Commercial General Liability insurance and, if necessary, Commercial Umbrella
insurance with a limit of not less than $2,000,000 for each occurrence, $4,000,000
Products/Completed Operations Aggregate, and $4,000,000 General Aggregate Limit.
The policy shall include coverage for premises liability, bodily injury, broad form
property damage, personal injury, products and completed operations and blanket
contractual coverage, and shall not contain any provisions which would serve to limit
third party action over claims. There shall be no endorsement or modifications of the
CGL limiting the scope of coverage for liability arising from explosion, collapse, or
underground property damage.
6.2.9 Automobile Liability:
Commercial/Business Automobile Liability insurance and, if necessary, Commercial
Umbrella insurance with a combined single limit for bodily injury and property damage
of not less than $2,000,000 each occurrence with respect to any of the Contractor's
owned, hired, and non-owned vehicles assigned to or used in performance of the
Contractor's work or services or use or maintenance of the premises under this Contract.
6.2.10 Workers' Compensation:
Workers' Compensation insurance to cover obligations imposed by Federal and State
statutes having jurisdiction of Contractor's employees engaged in the performance of the
work or services under this Contract; and Employer's Liability insurance of not less than
$1,0013,000 for each accident, $1,000,000 disease for each employee, and $1,000,000
disease policy limit.
Contractor, its contractors and its subcontractors waive all rights against Contract and its
agents, officers, directors and employees for recovery of damages to the extent these
damages are covered by the Workers' Compensation and Employer's Liability or
commercial umbrella liability insurance obtained by Contractor, its contractors and its
subcontractors pursuant to this Contract.
6.2.11 Professional Liability:
Contractor shall maintain Professional Liability insurance which will provide coverage
for any and all acts arising out of the work or services performed by the Contractor under
the terms of this Contract, with a limit of not less than $1,000,000 for each claim, and
$3,000,000 aggregate
6.2.12 Certificates of Insurance:
6.4.23.1 Prior to Contract award, Contractor shall furnish the County with valid and
complete certificates of insurance, or formal endorsements as required by the
Contract in the form provided by the County, issued by Contractor's insurer(s),
as evidence that policies providing the required coverage, conditions and limits
required by this Contract are in full force and effect. Such certificates shall
identify this contract numbef and title.
6.4.23.2 In the event any insurance policy(ies) required by this Contract is(are) written on
a claims made basis, coverage shall extend for two years past completion and
acceptance of Contractor's work or services and as evidenced by• annual
Certificates of Insurance.
6.4.23.3 If a policy does expire during the life of the Contract, a renewal certificate must
be sent to County fifteen (15) calendar days prior to the expiration date.
Page 5 of 73

CONTRACT #: MA 11860 190140
6.2.13 Cancellation and Expiration Notice:
Applicable to all insurance policies required within the Insurance Requirements of this
Contact, Contractor's insurance shall not be permitted to expire, be suspended, be
canceled, Or be materially changed for any reason without thirty (30) days prior written
notice to Maricopa County. Contractor must provide to Maricopa County, within two (2)
business days of receipt, if they receive notice of a policy that has been or will be
suspended, canceled, materially changed for any reason, has expired, or will be expiring.
Such notice shall be sent directly to Maricopa County Office of Procurement Services
and shall be mailed or hand delivered to 320 West Lincoln Street, Phoenix, AZ 85003, or
emaiied to the Procurement Officer noted in the solicitation.
6.3 INSPECTION OF SERVICES:
6.3.1 The Contractor shall provide and maintain an inspection system acceptable to County
covering the services under this Contract. Complete records of all inspection work
performed by the Contractor shall be maintained and made available to County during
contract performance and for as long afterwards as the Contract requires.
6.3.2 County has the right to inspect and test all services called for by the Contract, to the
extent practicable at all times and places during the term of the Contact. County shall
perform inspections and tests in a manner that will not unduly delay the work.
6.3.3 If any of the services do not conform with Contract requirements, County may require the
Contractor to perform the services again in conformity with Contact requirements, at on
increase in Contract amount. When the defects in services cannot be corrected by re-
performance, County may:
6.4.3.1 Require the Contractor to take necessary action to ensure that future
performance conforms to Contract requirements; and
6.4.3.2 Reduce the Contract price to reflect the reduced value of the services performed.
6.3.4 If the Contractor fails to promptly perform the services again or to take the necessary
action to ensure future performance in conformity with Contract requirements, County
may:
6.4.4.1 By Contract or otherwise, perform the services and charge to the Contractor any
cost incurred by County that is directly related to the performance of such
service; Or
6.4.4.2 Terminate the Contract for default.
6.4 NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION:
6.4.1 This Contract does not guarantee any minimum or maximum purchases will be made.
Orders will only be placed under this Contract when the County identifies a need and
proper authorization and documentation have been approved.
6.4.2 Contractors agree to accept verbal notification of cancellation of Purchase Orders from
the County Procurement Officer with written notification to follow. Contractor
specifically acknowledges to be bound by this cancellation policy.
6.5 PURCHASE ORDERS:
County reserves the right to cancel Purchase Orders within a reasonable period of time after
issuance. Should a Purchase Order be canceled, the County agrees to reimburse the Contractor for
actual and documentable costs incurred by the Contractor in response to the Purchase Order, The
Page 6 of 73

CONTRACT #: MA D860 190140
County will not reimburse the Contractor for any costs incurred after receipt of County notice of
cancellation, or for lost profits, shipment of product prior to issumnce of Purchase Order, etc.
6.6 SUSPENSION OF WORK:
The Procurement Officer may order the Contractor, in writing, to suspend, delay, or interrupt all or
any part of the work of this contract for the period of time that the Procurement Officer determines
appropriate for the convenience of the County. No adjustment shall be made under this clause for
any suspension, delay, or interruption to the extent that performance would have been so
suspended, delayed, or interrupted by any other cause, including the fault or negligence of the
Contractor. No request for adjustment under this clause shall be granted unless the claim, in an
amount stated, is asserted in writing as soon as practicable after the termination of the suspension,
delay, or interruption, but not later than the date of final payment under the contact.
6.7 STOP WORK ORDER:
The. Procurement Officer may, at any time, by written order to the Contractor, require the
Contractor to stop all, or any part, of the work called for by this contract for a period of 90 days
after the order is delivered to the Contractor, and for any further period to which the parties may
agree. The order shall be specifically identified as a stop work order issued under this clause.
Upon receipt of the order, the Contractor shall immediately comply with its terms and take all
reasonable steps to minimize the incurrence of costs allocable to the work covered by the order
during the period of work stoppage. Within a period of 90 days after a stop-work is delivered to
the Contractor, or within any extension of that period to which the parties shall have agreed, the
Procurement Officer shall either-
6.7.1 Cancel the stop-work order; or
6.7.2 Terminate the work covered by the order as provided in the Default, or the Termination
for Convenience of the County, clause of this contract.
6.7.3 The Procurement Officer may make an equitable adjustment in the delivery schedule
and/or contract price, or otherwise, and the contract shall be modified, in writing,
accordingly, if the Contractor demonstrates that the stop work order resulted in an
increase in costs to the Contractor.
6.8 TERMINATION FOR CONVENIENCE:
Maricopa County may terminate the resultant Contract for convenience by providing sixty (60)
calendar days advance notice to the Contractor.
6.9 TERMINATION FOR DEFAULT:
The County may, by written notice of default to the Contractor, terminate this Contract in whole
or in part if the Contractor fails to:
6.9.1 Deliver the supplies or to perform the services within the time specified in this Contract
or any extension;
6.9.2 Make progress, so as to endanger performance of this Conn -act; or .
6.9.3 Perform any of the other provisions of this Contract.
The County's right to terminate this contract under these subparagraphs may be exercised if the
Contractor does not cure such failure within ten (10) business days (or more if authorized in
writing by the County) after receipt of the notice from the Procurement Officer specifying the
failure.
Page 7 of 73

CONTRACT #: MA D860 190140
6.10 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST:
Notice is given that pursuant to A.R.S. §38-511 the County may cancel this Contract without
penalty or further obligation within three years after execution of the contract, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County is at any time while the Contract or any extension of the Contract is in effect,
an employee Or agent of any other party to the Contract in any capacity or consultant to any other
party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to
A.R.S §38-511 the County may recoup any fee or commission paid or due to any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County from any other party to the contract arising as the result of the Contract.
6.11 UNIFORM ADMINISTRATIVE REQUIREMENTS:
By entering into this Contract the Contractor agrees to comply with all applicable provisions of
Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE REQUIREMENTS,
COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in
Title 2 C.F.R. § 200 et seq.
6.12 CONTRACTOR LICENSE REQUIREMENT:
6.12.1 The Contractor shall procure all permits, insurance, licenses and pay the charges and fees
necessary and incidental to the lawful conduct of his/her business, and as necessary
complete any required certification requirements, required by any and all governmental
or non-governmental entities as mandated to maintain compliance with and in good
standing for all permits and/or licenses. The Contractor shall keep fully informed of
existing 'and future trade or industry requirements, Federal, State and Local laws,
ordinances, and regulations which in any manner affect the fulfillment of a Contract and
shall comply with the same. Contractor shall immediately notify both Office of
Procurement Services and the Department of any and all changes concerning permits,
insurance or licenses.
6.13 SUBCONTRACTING:
6.13.1 The Contractor may not assign to another contractor or subcontract to another party for
performance of the temis and conditions hereof without the written consent of the
County. All correspondence authorizing subcontracting must reference the Contract
Number and identify the job project.
6.13.2 The subcontractor's rate for the job shall not exceed that of the Prime Contractor's rate,
as bid in the pricing section, unless the Prime Contractor is willing to absorb any higher
rates or the County has approved the increase. The subcontractor's invoice shall be
invoiced directly to the Prime Contractor, who in turn shall pass-through the costs to the
County, without mark-up. A copy of the subcontractor's invoice must accompany the
Prime Contractor's invoice.
6.14 AMENDMENTS:
All amendments to this Contract shall be in writing and approved/signed by both parties. Maricopa
County Office of Procurement Services or the Public Health Procurement Officer shall be
responsible for approving all amendments for Maricopa County.
6.15 ADDITIONS/DELETIONS OF REQUIREMENTS:
The County reserves the right to add and/or delete materials and services to a Contract. If a
service requirement is deleted, payment to the Contractor will be reduced proportionately, to the
Page 8 of 73

CONTRACT #: MA D860 190140
amount of service reduced in accordance with the bid price. If additional materials or services are
required from a Contract, prices for such additions will be negotiated between the Contractor and
the County.
6.16 STRICT COMPLIANCE:
Acceptance by County of a performance that is not in strict compliance with the terms of the
Contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of
the Contract.
6.17 VALIDITY:
The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of the Contract.
6.18 SEVERABILITY:
The removal, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of this Contract.
6.19 RIGHTS IN DATA:
The County shall have the use of data and reports resulting from a Contract without additional cost
or other restriction except as may be established by law or applicable regulation. Each Party shall
supply to the other Party, upon request, any available information that is relevant to a Contract and
to the performance thereunder.
6.20 NON-DISCRIMINATION:
Contractor agrees to comply with all provisions and requirements of Arizona Executive Order
2009-09 including flow down of all provisions and requirements to any subcontractors. Executive
Order 2009-09 supersedes Executive order 99-4 and amends Executive order 75-5 and may be
viewed and downloaded at the Arizona State Library Research web site
(htto://azmemory.azlibrary. govicchnisingl eiternic ollecti on/exec orders/i dJ680/ree/1) which is
hereby incorporated into this contract as if set forth in full herein. During the performance of this
Contract, Contractor shall not discriminate against any employee, client or any other individual in
any way because of that person's age, race, creed, color, religion, sex, disability or national origin.
6.21 ISRAEL BOYCOTT:
By signing this Contract, the Contractor certifies that they are in compliance with Article 9, A.R.S.
§ 35-393 et seq.
6.22 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION:
6.22.1 The undersigned (authorized official signing on behalf of the Contractor) certifies to the
best of his or her knowledge and belief that the Contractor, it's current officers and
directors;
6.22.1.1 are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from being awarded any contract or grant by
any United States Department or Agency or any state, or local jurisdiction;
6.22.1.2 have not within three (3) year period preceding this Contract;
6.22.1.2.1 been convicted of fraud or any criminal offense in connection with
obtaining, attempting to obtain, or as the result of performing a
Page 9 of 73

CONTRACT #: MA 1)860 190140
government entity (Federal. State or local) transaction or contract;
and
6.22.1.2.2 been convicted of violation of any Federal or State antitrust statues or
conviction for embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen
property regarding a government entity transaction or contract;
6.22.1.2.3 are not presently indicted or criminally charged by a government
entity (Federal, State or local) with commission of any criminal
offenses in connection with obtaining, attempting to obtain, or as the
result of performing a government entity public (Federal, State or
local) transaction or contract; arid are not presently facing any civil
charges from any governmental entity regarding• obtaining,
attempting to obtain, or from performing any governmental entity
contract or other transaction; and have not within a three (3) year
period preceding this Contract had any public transaction (Federal,
State or local) terminated for cause or default.
6.22.1.3 If any of the above circumstances described in the paragraph are applicable to
the entity submitting a bid for this requirement, include with your bid an
explanation of the matter including any final resolution.
6.22.2 The Contractor shall include, without modification, this clause in all lower tier covered
transactions (i.e. transactions with subcontractors) and in all solicitations for lower tier
covered transactions related to this Contract.
6.23 VERIFICATION REGARDING COMPLIANCE WITH A.R.S. §41-4401 AND FEDERAL
IMMIGRATION LAWS AND REGULATIONS:
6.23.1 By entering into the Contract, the Contractor warrants compliance with the Immigration
and Nationality Act ([NA using e-verify) and all other Federal immigration laws and
regulations related to the immigration status of its employees and A.R.S. §23-214(A). The
Contractor shall obtain statements from its subcontractors certifying compliance and shall
furnish the statements to the Procurement Officer upon request. These warranties shall
remain in effect through the term of the Contract. The Contractor and its subcontractors
shall also maintain Employment Eligibility Verification forms (I-9) as required by the
Immigration Reform and Control Act of 1986, as amended from time to time, for all
employees performing work under the Contract and verify employee compliance using the
E-verify system and shall keep a record of the verification for the duration of the
employee's employment or at least three (3) years, whichever is longer. 1-9 forms are
available for download at USCIS.GOV .
6.23.2 The County retains the legal right to inspect Contractor and subcontractor employee
documents performing work under this Contract to verify compliance with paragraph 6.23.1
of this Section. Contractor and subcontractor shall be given reasonable notice of the
County's intent to inspect and shall make the documents available at the time and date
specified. Should the County suspect or find that the Contractor or any of its subcontractors
are not in compliance, the County will consider this a material breach of the Contract and
may pursue any and all remedies allowed by law, including, but not limited to; suspension
of work, termination of the Contract for default, and suspension and/or debarment of the
Contractor. All costs necessary to verify compliance are the responsibility of the Contractor.
6.24 INFLUENCE:
Page 10 of 73

CONTRACT #: MA D860 190140
As prescribed in MCI-1203 of the Maricopa County Procurement Code, any effort to influence an
employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct
may be grounds for Disbarment or Suspension under MC U902.
An attempt to influence includes, but is not limited to:
6.24.1 A Person offering or providing a gratuity, gift, tip, present, donation, money,
entertainment or educational passes or tickets, or any type of valuable contribution or
subsidy,
6.24.2 That is offered or given with the intent to influence a decision, obtain a contract, gamer
favorable treatment, or gain favorable consideration of any kind.
If a Person attempts to influence any employee or agent of Maricopa County, the Chief
Procurement Officer, or his designee, reserves the right to seek any remedy provided by the
Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided
by this contract.
ABSOLUTELY NO CONTACT BETWEEN THE RESPONDENT AND ANY COUNTY
PERSONNEL, OTHER THAN THE OFFICE OF PROCUREMENT SERVICES, IS ALLOWED
DURING THE SOLICITATION PROCESS UNLESS THE COMMUNICATION IS IN
REGARDS TO PRE-EXISTING BUSINESS WITH THE COUNTY. ANY
COMMUNICATIONS REGARDING THE SOLICITATION, ITS PARTICIPANTS OR ANY
DOCUMENTATION PRIOR TO THE CONTRACT AWARD MAY BE GROUNDS FOR
DISMISSAL OF THE RESPONDENT FROM THE EVALUATION PROCESS.
6.25 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO
INFORM EMPLOYEES OF WHISTLERBLOWER RIGHTS:
6.25.1 The Parties agree that this Contract and employees working on this Contract will be
subject to the whistleblower rights and remedies in the pilot prop -am on Contractor
employee whistleblower protectfons established at 41 U.S.C. § 4712 by section 828 of the
National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112-239) and section
3.908 of the Federal Acquisition Regulation;
6.25.2 Contractor shall inform its employees in writing, in the predominant language of the
workforce, of employee whistleblower rights and protections under 41 U.S.C. § 4712, as
described in section 3.908 of the Federal Acquisition Regulation. Documentation of such
employee notification must be kept on file by Contractor and copies provided to County
upon request.
6.25.3 Contractor shall insert the substance of this clause, including this paragraph, in all
subcontracts over the simplified acquisition threshold ($150,000 as of September 2013).
6.26 UNIFORM ADMINISTRATIVE REQUIREMENTS:
By entering into this Contract the Contractor agrees to comply with all applicable provisions of
Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE REQUIREMENTS,
COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in
Title 2 C.F.R. § 200 et seq.
6.27 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW:
6.27.1 In accordance with section MCI 371 of the Maricopa County Procurement Code the
Contactor agrees to retain (physical or digital copies of) all books, records, accounts,
statements, reports, files, and other records and back-up documentation relevant to this
Page 11 of 73

CONTRACT #: MA D860 190140
Contract for six (6) years after final payment or until_ after the resolution of any audit
questions which could be more than six (6) years, whichever is latest The County,
Federal Or State auditors and any other persons duly authorized by the Department shall
have full access to, and the right to examine, copy and make use of, any and all said
materials.
6.27.2 If the Contractor's books, records, accounts, statements, reports, files, and other records
and back-up documentation relevant to this Contract are not sufficient to support and
document that requested services were provided, the Contractor shall reimburse Maricopa
County for the services not so adequately supported and documented.
6.28 AUDIT DISALLOWANCES:
If at any time it is determined by the County that a cost for which payment has been made is a
disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course
of action to address the disallowance shall be at sole discretion of the County, and may include
either an adjustment to future invoices, request for credit, request for a check or a deduction from
current invoices submitted by the Contactor equal to the amount of the disallowance, or to require
reimbursement forthwith of the disallowed amount by the Contractor by issuing a cheek payable
to Maricopa County.
6.29 OFFSET FOR DAMAGES:
In addition to all other remedies at Law or Equity, the County may offset from any money due to
the Contractor any amounts Contractor owes to the County for damages resulting from breach or
deficiencies in performance of the Contract.
6.30 CONFIDENTIAL INFORMATION:
Any information obtained in the course of performing this Contract may include information that
is proprietary or confidential to the County. This provision establishes the Contractor's obligation
regarding such information.
The Contractor shall establish and maintain procedures and controls that are adequate to assure
that no information contained in its records and/or obtained from the County or from others in
carrying out its functions (services) under the Contract shall be used by or disclosed by it, its
agents, officers, or employees, except as required to efficiently perform duties under the Contract.
The Contractor's procedures and controls at a minimum must be the same procedures and controls
it uses to protect its own proprietary or confidential information. If, at any time during the duration
of the Contract, the County determines that the procedures and controls in place are not adequate,
the Contractor shall institute any new and/or additional measures requested by the County within
fifteen (15) calendar days of the written request to do so.
Any requests to the Contractor for County proprietary or confidential information s shall be
referred to the County for review and approval, prior to any dissemination.
6.31 PUBLIC RECORDS:
Under Arizona law, all Offers submitted and opened are public records and must be retained by
the Records Manager at the Office of Procurement Services. Offers shall be open to public
inspection and copying after Contract award and execution, except for such Offers or sections
thereof determined to contain proprietary or confidential information by the Office of Procurement
Services. If an Offeror believes that information in its Offer or any resulting Contract should not
be released in response to a public record request under Arizona law, the Offeror shall indicate the
specific infomiation deemed confidential or proprietary and submit a statement with its offer
detailing the reasons that the information should not be disclosed. Such reasons shall include the
specific harm or prejudice which may arise from disclosure. The Records Manager of the Office of
Page 12 of 73

CONTRACT #: MA D860 190140
Procurement Services shall determine whether the identified information is confidential pursuant
to the Maricopa County Procurement Code.
6.32 PRICES:
Contractor warrants that prices extended to County under this Contact are no higher than those
paid by any other customer for these or similar services.
6.33 IN I EGRATION:
This Contract represents the entire and integrated agreement between the parties and supersedes
all prior negotiations, proposals, communications, understandings, representations, or agreements,
whether oral or written, express or implied_
6.34 RELATIONSHIPS:
6.34.1 In the performance of the services described . herein, the Contractor shall act solely as an
independent contractor, and nothing herein or implied herein shall at any time be
construed as to create the relationship of employer and employee, co-employee,
partnership, principal and agent, or joint venture between the County and the Contractor.
6.34,2 The County reserves the right of final approval on proposed 'staff for all Task Orders.
Also, upon request by the County, the Contractor will be required to remove any
employees working on County projects and substitute personnel based on the discretion
of the County within two (2) business days, unless previously approved by the County.
6.35 GOVERNING LAW:
This Contract shall be governed by the laws of the State of Arizona. Venue for any actions or
lawsuits involving this Contract will be in Maricopa County Superior Court, Phoenix, Arizona.
6.36 ORDER OF PRECEDENCE:
In the event of a conflict in the provisions of this Contract and Contractor's license agreement, if
applicable, the terms of this Contract shall prevail.
6.37 NOTICES:
All notices given pursuant to the terms of this Contract shall be addressed to:
For County:
Maricopa County Department of Public Health
Attn: Cheryl Rentscheler, Procurement Officer
4041 N. Central Avenue, #1400
Phoenix, AZ 85012
(602) 506-6886
Cheryl.Rentscheler@maricopa.gov
For Contractor:
Delta Dental of Arizona
Attn: Ann Coupland, Senior Account Executive
5656 W. TaIavi Blvd.
Glendale, AZ 85306
(602) 588-3633
acoupland@deltacientalaz.com
Page 13 of 73

CONTRACT #: MA 1)860 190140
6.38 INCORPORATION OF DOCUMENTS:
The following are to be attached to and made part of this Contract:
6.38.1 Exhibit A, Pricing;
6.38.2 Exhibit B, Scope of Work
IN WITNESS WHEREOF, this Contract is executed on the date set forth above.
OR1ZED SIGNXTLTRE
'914D Cuoiffirr-Lf -17`0°, fiffutt5f DeA'eLf4t#
PRINTED NAME AND TITLE
ADDRESS
DAT
IVIARICOPA COUNTY
CHAIRMAN, BOARD OF SUPERVISORS DA'1E
ATTESTED:
CLERK OF THE BOARD DA' 1 E,
APPROVED AS TO FORM:
LEGAL COUNSEL DATE
Page 14 of 73

CONTRACT #: MA 1)860 190140
EXHIBIT A
Addendum :sseed and ttpda/Ed 4..."30/18 I2:05pm. Please see. eltkieneann COriFt210113 in BizE2... -nc for specffie Enanges,
SERIAL # PH SFP 190140
ATTACHMENT A
PRICING SHEET
BIDDER NAME; Delta Denial of Adzopa
F.I.DIVENDOR 16-0274899
BIDDER ADDRESS; 565 W Tadavi Blvd GIcLdiale AZ 85306
P.O. ADDRESS: PO Box 43000 Phoenixg 85080
BIDDER PHONE #: J602)588403
BIDDER FAX #: (602'1588-3921
COMPANY WEB SITE: www.del tadentalaz.com
COMPANY CONTACT (REP): Ann Coupland, Senior Account Executive
E-MAIL ADDRESS (REP): seouplandgdeltadenialaz.corn
ALLOW OTHER GOVERNMENTAL ENTITIES TO PURCHASE FROM THIS CONTRACT NO
PAYMENT TERMS: NET -30-
1.0 PRICING:
1.1 Dental Claim Administration:
Rate per member/ per month
I Maximum Rate Increase (not to exceed
Rate Guarantee rate)
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
(3/1/2019 (3/112020 - (31112021 - 1 (3/1/2022 - (3/1/2023 - (311(2024 -
2/29/2020) 2128/202'n 2/2612022) 1 2/2812023) 2129/2024) 212812025)
PRICING
1.1.1 ASO Fee (SELF
INSURED) $3.91 $3.91 $3.91 4.5% 4,5% 4.5%
1,1.2 Network Access Fee $0.00 $0.00 $0,00 0% 0% 0%
What, if any, set-up fees are there in addition to the monthly ASO fees:
Maximum Rate Increase will be calculated against prior year rate in effect.
Page 22 of 57
Page 15 of 73

CONTRACT #: MA D860 190140
rfardendum issued and updated 8/30/18 12:05pm, Please see Addendum comments in Bic14 ,nc ,ffir 6pec(fic changes.
SERIAL #: PH RFP 190140
Maximum Rate Increase (not to exceed
Rate Guarantee refit
'(earl Year 2 Year 3 Year 4 Year 6 Year 6
(311/2919 (311/2029 - (3/1/2021 - (311/2022 - (311/2023 - (311/2024 -
2/29120201 2/28/2021) 2128/2022) 2128/2023) 2/2912024) 2/28/2025)
1,1.3 FULLY €NSURED $95,53 $95.63 $99.93 5.5% 8.0%
.1.4 Charge for
rafting benefit
ocumentlbooklet (if
ny) $0,00 $0.00 Moo 0% 0% 0%
1.5 Charge for
Hitting benefit
ocumentibookiet
issurne initial order
f 15,000 copies) if
ny $0.00 $0.00 $0.00 0% 0% 0%
Maximum Rate Increase will be calculated against prior year rate in effect.
Respondent's signature be; cotes understanding and agreement to perform the services outlined in the Request
Ibrsplosal hidi cbnv % , : ho totaii,ates they have listed above.
7/1
S GUlternbr 21.201S
Signature (REQUIRED) Date
Page 23 of 62
Page 16 of 73

CONTRACT #: MA D860 190140
EXHIBIT B
Original Scope of Work:
REQUEST FOR PROPOSAL FOR: DENTAL INSURANCE SERVICES
1.0 NI ENT:
Maricopa County Department of Public Health (MCDPH) hereby solicits proposals for both an ASO dental
claim administration and dental PPO network management (participating and non-participating providers) for
a self-insured dental program and a fully insured Dental Plan commencing March 1, 2019. The plan shall
serve the Eligible Metropolitan Area (EIVIA) comprised of Maricopa and Final Counties. This plan will be
available to People Living with HIV/AIDS (PLWHJA) throughout the E,MA. Bidders may submit proposals
for One OT both types of plans.
The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations.
Guiding principles that impact planning for dental insurance services will be directed toward serving the
underserved, reducing fragmentation of care, and demonstration of measurable outcomes through Plan
performance.
Funding for this program is provided by the federal Department of Health and Human Services, Health
Resources and Services Administration (IIRSA), the Ryan White (RW) Comprehensive HIV/AIDS Treatment
Modernization Acts of 2006, and the Maricopa County General Government Department, Ryan White Part A
Program.
Other governmental entities under agreement with the County may have access to services provided
hereunder (see also Section 4.12 and 4.13).
The County reserves the right to add additional contractors, at the County's sole discretion, in cases where
the currently listed contractors are of an insufficient number or skill-set to satisfy the County's needs or to
ensure adequate competition on any project or task order work.
Multiple contracts with successful candidates may be awarded and Maricopa County reserves the right to
award to the Contractors most advantageous to the County.
2.0 BACKGROUND:
MCDPH Office of Oral Health (MCOOH) currently administers the Ryan White Dental Insurance
Program. It has been administering this federally funded dental insurance program since 1995. PLWH/A
must meet residency and income requirements to be eligible for dental insurance through this program.
3.0 APPLICANT ELIGIBILITY:
Eligible applicants for awards under this bid include public Or non-profit organizations. Contracting with
for-profit entities can be considered under certain limited circumstances, specifically when such entities are
the only available responders. All responders will be prohibited from serving as conduits to pass on their
awards to for-profit entities.
MCOOH will consider the best plan design your organization can offer relative to the specifications included
in this proposal. MCOOH reserves the right, at its discretion, to issue multiple contracts within this service
category to ensure adequate insurance for meeting the oral health service needs of the EMA, pursuant to this
Request for Proposal.
Specific considerations or restrictions which must be reflected in plan design include:
Page 17 of 73

• CONTRACT #: MA 1)860 190140
• The dental insurance plan under this REP is a payer of last resort; therefore enrolled individuals
cannot be enrolled in another dental insurance plan and be eligible to receive benefits under this
RFP.
• Existing Ryan White (RW) Program eligibility is available to individuals up to 400% Federal
Poverty Level (FPL).
• Federal law prohibits imposing a first party charge on individuals whose income is at or below
100% of the FPL.
• Federal law requires limited first party charges on individuals whose income is at or below 300% of
the FPL.
• Dependent coverage is not permitted under this RFP.
• Orthodontics is not a covered benefit under this RFP.
• Federal law prohibits direct payment or reimbursement of funds to RW members.
4.0 SCOPE OF WORK:
4.1 Program Outline
4.1.1 Eligibility:
• The Dental Insurance Plan will be available to PLWH/A who reside in Maricopa or
Pinal Counties and satisfy Ryan White program specific income eligibility
requirements.
4.1.2 Eligibility period/Enrollment Effective Date:
• Coverage begins the first day of the month following submission of the enrollment
document as long as submission is prior to Contractor cut-off date.
• Dental Insurance Plan year begins on March 1 and ends February 28.
4.2 Mandatory Contractor Expectations
4.2.1 Contractor shall receive and input eligibility data from MCOOH at least once per month.
Documents will be forwarded to Contractor either electronically or in hard copy format.
4.2.2 Contractor shall apply received data (above) to Contractor's system within 48 hours of
receipt and will generate and fax an exception report for MCOOH within five working
days from applying the data from each file.
4.2.3 Contractor must accept subscriber identification number as defined by MCOOH. The
subscriber identification number will be a unique identifier (currently this is provided by
Contractor).
4.2.4 Contractor shall procure, maintain, and update procedures and computer software needed
to receive and process all claims and all current and future regulations.
4.2.5 Contractor shall maintain claim processing procedures and software needed to screen
claims for duplicate payments, overpayments, underpayments, and non-payments.
Contractor shall have a process in place to recoup overpayments.
4.2.6 Contractor shall provide members with online access/self-service capabilities indicating
where the participating individual can inquire about his/her account through a secured
website accessible with a personal identification number. Current provider directories
that are updated at least every 30 calendar days shall also be available on-line.
4.17 Contractor shall provide MCOOH with online access capabilities including eligibility
status checks, claims status review, enrollment, disenroll3neiat, reinstatement, and access
Page 18 of 73

CONTRACT #: MA D860 190140
to reports. This will be provided through a secured website accessible with a user 11) and
password.
4.2.8 Contractor shall provide an invoice by the 5th of each month. Invoice shall be sent via
hard copy, fax, or some other pre-approved method. At a minimum the invoice shall
contain:
a Full name of member
• ID number of each member
• Insurance effective date
• Premium cost per member
• Balance due
• Previous balance
• Premium adjustments
4.2.9 Contractor shall provide MCOOH Program Coordinator with ID cards or replacement ID
cards within 48 hours of receipt of the enrollment documents or request from MCOOH.
Indicate in your proposal if there is an additional cost for ID cards.
4.2.10 Contractor shall provide reconciliation/exception reports monthly. MCOOH will respond
to this by fax within 5 working days of report receipt. Contractor will be responsible for
all fees and claims for ineligible members after receipt of MCOOH
reconciliation/exception response.
4.2.11 Contractor may be requested to conduct an annual Ryan White Dental Insurance specific
customer service satisfaction survey, provide MCOOH with results, and an action plan to
improve any unsatisfactory results.
4.2.12 Contractor will properly adjudicate and pay claims based on the following standards:
• Payment of 90% or more of all clean claims within 10 working days of receipt.
• Financial accuracy rate of 99%.
• Procedural accuracy rate of at least 96%.
4.2.13 Contractor shall notify the member and MCOOH via an Explanation of Benefits (EOB)
within one claims cycle or two weeks, whichever is less, of approval or denial of the
claim.
4.2.14 Contractor shall notify the member in writing of claims pending a determination over 30
calendar days and the reason for the delay in processing the claim.
4.2.15 Contractor shall allow MCOOH or its designee to conduct an audit of claims activity to
determine if standards were achieved.
Page 19 of 73

CONTRACT #: MA D860 190140
4.2.16 Contractor will provide a response and action plan where the standard criteria have not
been achieved.
4.2.17 Contractor shall provide a customer service program description that includes:
--The number and availability of customer service representatives to assist members with:
• questions regarding their claims.
• business hours including weekend or after hours availability.
• number of Bilingual staff (English/Spanish).
• description of how calls received in other languages are handled (e.g., Vietnamese)
• description of the customer service training program
• telephone call documentation requirements.
• telephone metrics of less than 30 seconds average speed of answer and less than 5%
abandonment rate.
4.2.18 Customer service representatives must have the ability to view information regarding
eligibility, claims status, and must be trained to explain claims denials, pending status,
reason for pending status, and claims payment to members who contact them. Include a
sample of your customer service program in your response.
4.2.19 Contractor shall provide a provider relations program description that includes a process
for dispute resolution between the member and the provider when a quality of care or
quality of service issue arises.,
4.2.20 Contractor shall provide a toll free telephone number for customer service.
4.2.21 Contractor shall provide a quality program description that addresses how quality of care
is assured to the member. The program description should include the goals, objectives,
planned activities, and a description of quality assurance initiatives.
4.2.22 Contractor shall provide fully trained staff for MCOOH meetings as requested.
4.2.23 Contractor shall provide a full claims appeal process. A copy of your appeal process
should be included in your response.
4.2.24 Contractor shall produce and distribute all insurance plan materials in both English and
Spanish.
4.2.25 Contractor shall conduct an initial audit for the purpose of assessing system set-up within
the first 90 days of the plan and provide a report to MCOOH within 30 calendar days
following the audit.
4.2.26 Contractor shall have a SAS70 audit of Contractor's claims processing system at least
every 2 years. Results of the audit shall be provided to MCOOH within 30 calendar days
of the audit completion.
4.2.27 To ensure the confidentiality of Protected Health Insurance (P111), Contractor shall be
fully compliant, through automation and manual processes, with the Health Insurance
Portability Accountability Act (HIPAA) and will sign a Business Associate Agreement
with MCOOH.
4.2.28 Contractor shall provide run-out of claims administration should MCOOH terminate ,
services with the Contractor.
Page 20 of 73

CONTRACT #: MA D860 190140
4.2.29 Contactor shall submit an updated fee schedule at the beginning of each benefit year that
shall be approved for use by MCOOH. At a minimum the fee schedule shall contain the
following fees: in-network, out of network, specialty, and tier fees. If changes to the fee
schedule occur at times outside of the benefit renewal period Contractor shall inform and
receive approval from MCOOH prior to the new foe increases going into effect.
4.3 Implementation and Ongoing Requirements
To properly implement the plan, the successful Contractor will be required to devote staff
attention to the following implementation and ongoing activities. Include samples where
appropriate.
4.3.1 Implementation Team, as defined by the Contractor, shall have expertise in Project
Management and Issue Resolution Management.
4.3.2 Set up client account according to a comprehensive time line which will identify tasks,
dates, and responsible parties.
4.3.3 Establish banlcing and/or payment arrangements. Include a copy of your banking process
overview, funding and account monitoring options, and cash management program
reports.
4.3.4 Provide implementation and ongoing educational materials describing the Contractor and
their services such as benefit plan booklets, provider directories, etc. in English and
Spanish, initially and on an ongoing basis. Indicate' if there is an additional charge for
such material.
4.4 Reporting Requirements (minimum)
All reports listed below are due by the 5th calendar day following the reporting period. Include a
sample copy of each report.
4.4.1 Your standard reporting package
4,4.2 Monthly number of claims received and/or processed
4.4.3 Monthly exceptions to the Contractor's eligibility files
4.4.4 Monthly claims payment, enrollment, and fees paid report
4.4.5 Quarterly financial and procedural accuracy claims report
4,4.6 Quarterly claims processing turnaround time reports
4.4.7 Quarterly number of appeals, reasons, and outcomes
4.4.8 Quarterly reporting of the number of dental plan members who have met their plan year
maximum
4.4.9 Monthly average speed of answer by Customer Service Representatives
4,4.10 Monthly average abandonment rate of calls received by Customer Service
Representatives
4.5 MCOOH Rights and Obligations
4.5.1 MCOOH, upon awarding a contract, assumes responsibility for the following actions:
• Page 21 of 73

CONTRACT #: MA 1/860 190140
4.5.1.1 Distribute announcement of new Contractor, plan design, and administrative
requirements.
4.5.1.2 Review and approve all communications materials to members, including but
not limited to summary plan description, claim forms, booklets, newsletters,
letters, and any other member communication material prior to its printing and
distribution.
4.6 Underwriting requirements
Your proposal should take into account the following:
4.6.1 Not to exceed renewal rate caps will be due 360 days prior to the contract renewal dates
for years four, five, and six. Final rates will be due 180 days prior to the contract renewal
date.
4.6.2 MCOOH or designee reserves the right to audit the Contractor's claims processing,
payments, and member records with reasonable notice.
The Contractor, by submitting a proposal in response to these specifications,
acknowledges MCQOHs right to select the auditors and further agrees to cooperate fully
with such auditors and waive any and all fees associated with providing access to
MCOOH's claim records including use of the Contractor's staff time to assist in the
audit. The audits may include, but not be limited to:
• Determinations of any mathematical errors in computation.
• Determinations that only eligible insureds have had claims honored.
• Review of dental charges per service.
• Review of turnaround time in claims processing_
• Review of in-network and out-of-network claims payments.
• Review of claims denials and responses to claims appeals.
The audits may be conducted during the policy period and/or upon completion of the
policy period and/or following submission of the final policy report by the Contractor at
the discretion of MCOOH.
Additionally, the Contractor may be requested to provide periodic eligibility lists or tapes
to MCOOH at no charge in order to reconcile members' eligibility.
If, at any time, MCOOH has a reasonable belief that it is being systematically
overcharged Or double-billed under the contract, or that any other significant accounting
irregularities exist, MCOOH may conduct or hire an agent to conduct an audit of the
Contractor's books and records with respect to this contract. Such audit shall be
undertaken at Contractor's expense.
4.6.3 Claims experience will need to be tracked and reported based upon the two respective
sub-groups: Marieopa County and Pinal County.
4.6.4 MCOOH may correct legitimate administrative errors and is the final determinant of
when such errors have occurred.
Page 22 of 73

CONTRACT 4: MA D860 190140
4.6.5 In determining any person's rights to benefits under the Plan, the Contractor shall rely
upon eligibility information furnished by MCOOH.
4.6.6 The policies and/or contact's rate change date and anniversary will fall on March l e.
MCOOH reserves the right to negotiate benefit modifications at other times as well if
considered in its best interest, All changes in rates/fees/maximums are subject to mutual
good faith negotiation on the value of such changes and shall be agreed upon in writing.
4.6,7 MCOOH maintains the right to accept, reject, or cancel the contact of a Contractor at any
time following 30 days written notice, if there is a significant change, in MCOOH's
opinion, in (including but not limited to) the Contractor's operation of the plan, quality of
care or service of the plan, satisfaction by the Ryan White members, adherence to Ryan
White Policies and Procedures, and/or adequacy of the provider network.
4.6.8 The Contractor shall have the capability to accept electronic transfer of funds.
4.6.9 The Contractor shall be responsible for drafting and distribution, subject to MCOOH
review and approval, of all communication materials and administrative forms in both
English and Spanish. Such services may be subcontracted. Such documents shall be
produced in sufficient quantities to meet MCOOH' s needs for existing and future members.
Quantities may be reduced, subject to MCOOH's approval, for all documents available on-
line.
4.6.10 The successful Contractor will implement this Dental Insurance Plan in a timely fashion
and accomplish the following tasks:
4.6,10.1 Set up eligibility data (subscriber, effective dates, etc.)
4.6.10.2 Set up the account structure and corresponding subgroups
4.6.10.3 Set up the plan design in-network and out-of-network along with plan limitations
and exclusions
4.6.10.4 Set up the dental provider contracts, terms, and network relationships
4.6.10.5 Provide a network comparison of the current network with the Contractor's
network.
4.6.10.6 Identify services that need to be pre-determined
4.6.10.7 Establish the claims edits and/or business rules
4.6.10.8 Implement a transition-related coordination of care process
4.6.10.9 Pay in-netwcirk and out-of-network claims according to the Summary Plan
Document
4.6.10.10 Provide timely ID cards to members
4.6.10.11 Ensure accurate member correspondence and reporting
Page 23 of 73

CONTRACT #: MA D860 190140
Contractor's Original Response:
_ Delta Dental of Arizona
.1)1114MORW--1--- Delta DRntalAZeorn
Maricopa County Department of Public Health
Plan Name: PPO ptus Premier
Proposed Effective Date: 03/01/2019
Quote is valid for 60 days from effective data
It you have questions, please contact:
Ann Coupiand i Sales Executive
Phone: 602_588.3633 Mobil.e: 607818.8029
ar&JDIarv.-3 IT 7:0:3:1-t-T_aiia-.2_,:nm
Page 24 of 73

CONTRACT #: MA D860 190140
Dentat Bertents Proposai or Masicopa County
Department or Public Health
Proposed Effective Date: 01/01i2019
Plan Name: PPO OuS Fternier
13In OptiOn; ASO
_-c..-.4 :,--..: .....v.. .
Delta Dentil Delia Dontal out-ot-Network
oponetit coveraga PPo Dentist Premier Dentist" Dentist"
In:kik:kW Deductible/Family Deductible $0 • 0 pa
Annuet Maximum Benefit S3,500 S3$00 $3,50D
Lif' etirne Orthodontia Not Covered Not Covered Not Covered
Preventive Services 100% 100% T00%
Basic Services 100% 100% 100%
Major Services 100% 100% 100%.
Orthodontia Not Covered Not Covered Not Covered
Rate of -Reimbursement , PPO Fee Premier R&C Eln Percentile
Is Patient Responsible for Dentist's N o N o Yes- riannvi On *calla& ov-
Total 13illed Cl-lar ges? to Lhmir iti41 itakst diozRw....
Mainlwarpay wsc-jr Cedi wham sa.tre Prcen4tr or out-te-notwafir.
r-L74-41.
PF43pLiP,ed Effective Date: 03101/201P • Oral Surgery Basic
Pate Guarantee: 36 Months • Endotiontics/Perindonticstovered Under_ Basic
Assumed Employee Participation: 100% Sealants Covered orideu. Preventive
▪ Assumed BIgIbie Errtplorees:2,W ▪ Compostte Fillings On Front Teeth: Included
Assumed ErniAoyer Cootrihudnrr 100% • Implants. Included
Broker Commission,: Net • Frequency trunitations: 5 Year
p fan wlrain-lbw 5 od at
Composite Nature Claims Administration 1. PPG Dentist
Employee Sa5.30 $3.9T These In-network dentists agreed to accept lower
reimbursement for services so members save the
most money_
2- Premier Denbst
These in-network dentists also arrept discounted
40, year Max Increase: 4,5%
514 year Max Increase: 45% reimbursement for services, hut their discount is not
6th year Max Increase 45% as steep,
Out-of-tietwork De/711st -,
These denbsts have- not agreed to discount their rates
for service, so members who see an out-of-network
dentist will have the highest out-of-pocket costs_
Page 25 of 73

CONTRACT #: MA 1/860 190140
Dental Benefits Proposal or Flaricopa County
Dep,artinertt at Public Health
Proposed Effective Date: 01/01/2019
Plan Name: F^PO plus Prernier
Plan Option: Fully in5ured
Deita Dentat Delta Dental Out-of-Network
Benefit CoVerage PPO Dentist Premier .Dontisti Dentist'
tridivickl Deductible/FamilyDeeu, ctible $0 $0
Annual .Maxirnunt Benefit 53,500 S-3,500 $3,500
Lifetime Orthodontia Not Covered Not Covered Not Covered
Preventive Services 100% 100% 100%
Basic Services 10091? 100%2 100%2
'Ma)or Services I0090 100%,1 100%z
Orthodontia Not Covered Not Covered Not Covered
-Rate- of Reirribursernent PRO Fee Premier R&C Sla Percentile
Is Patient Responsible for Dentist's NQ No Yes- climb ran catiact up
Total Billed Charges? to th.sr hail I:4147d 0420322
Kotobors snort irocur hsiou• cut-d-paP.U: Eosts wtran vazus 2 lorP-okr-cr out -a04not v.nork cO:ritist
,-Dantict:trit applan to Itua.z aunt kul.
AsLiumg-.s th B€412fft High:lightF4
Proposed Effective Dater 03/01/201g Oral SlItgery: Basic
• Rate Guarantees 24 Months • sidoolo cs./Peri otionitm3 Covered Under Basic
Assumed Erripitriee Pardolpabont 300% v. Sealants Covered under Preventive
Assumed Eligible F_roployeesz2,(11X1 . Compost* Fillings On Front Teeth:: inciuded
Assumed Em ploy er Contnbutiort 100% • implankr Included
Broker Commission.: Net . Frequency DrnibtionstS Year
Hcrc- how' r:*int-b urse p id
PPO Dentist
These in-network denti&ts agreed to atet lower
reimbursement for senricesso members save the
most money.
PrernIer Dentist.
Ard year renewal Premium; These in-network cientisN also-a:cowl discounted
reimbursement for services, but their discount is not
4th yeer MaxIncrease.- S_S% as steep.
01 year Max Increase: 65%
Oil year Max increase: EtCr% G. Out-of-Network Dentist
These dentists have not agreed to discount their rates
for service, so members who see an oot-of-network
dentist will have the highest out-of-poc•et costs.
Page 26 of 73

CONTRACT #: MA D860 190140
MARICOPA OFFICE OF HEALTH: PROMOTION & EDUCATION
Effective Date: 03701/2019
Plan Name:- Dam Dental PP O plus Premier*
Group #4715
Your benefits are based on a Contract Year
'DELTA DENTAL PPO PLUS PREMIERS- _
PPO Dentist and
Covered Services Premier Dontist
contract vear Maximum Benapt (combinaton or in and out-ot-networto $3,500
Contract Year Deductible (InclIvIduall/Farnily) (C,ombina0on at In and out-of- $0
network)
Deka Dental Plays
Preventive Services
Exams _
Routine Cleanings
X-rays
k, —La 4 Basic Services Deka Derri)P.4ys
Fillkngs
ErnOrgricy Treatment . .
Endodontics: Root canal treatment
Periodontics: Treatment of ourri disease
Oral Surgery: _ Simple extractidns.
Ora' Surgery: Surgical extractions.
Delta Dental' Pays
LAI Major Services
, prosthodontics:_BrIdges partlai dectures, compIete dentures
1Bridge and Denture Repair
Implants ._ • ,• - • •
RestoratIve: Crowns arid onleys .
"Members may Incur hl4toar otic-ot-poc ' ket cost when st=.44:9 a Premier or out-or-r.etwork dintl5L See Covered De . nMi .SerVices ]-iee .
5enrioes should be ploViderl by rierrUstioted In Maricoua. or laln -4 Counties_
BENEFITS ARE SUBJECT TO ALL PROVISIONS, TERNS rk cormmoms orTHC GROUP CONTRACT
Predetermination recommended for services over $7.sa,
Cr '`,A2.14 .G4p Y,ou?
Member Canner:bon Flmitt A Deridst 602 arstoaret &51, option 1
deldenlaz.corry'rrremlev rie]taclentalao_ceutiprovidef-search aoosS2.6132, option •
Page 27 of 73

CONTRACT Pk MA D860 190140
MARICOPA OFFICE OF HEALTH PROMOTION & EDUCATION
Effective Date: 03/01/2019
Plan !game:. Delta Dental PPO plus Premier*
Group # 4715
Your benefits are based on a Contract Year
COVERED DENTAL SERVICESE
PREVENTIVE SERVICES
- Exams, evaivations or consultations: Two in a benefit year:
• RoUtine Cleanings: Limited to two In a Peewit year. One ditricust cleaning may be exchanged for one routine
cleaning However, the dimwit cleaning is limited to once in a 5-year period.
• Tull mouth/Panores or vertical bltewlegs X-rays: ODCE le a 3-year period
• Bitewind X-rays: Two in a benerst year_
Periapical X-rays: As needed_
BASIC SE VICES
• Fillings: silver amalgam anti Tor front teeth only. synthetic tooth color fillings. One per surrane every two years.
• Emergency (Palliative Treatment): Treatment (or the relief or pain_
• Endodontics: Root canal treatment (permanent teeth): Polpotorny primary (baby) teeth_
▪ Periodontics: Treatment of gum disease- Non-surgical once every two years. surgical once every three years,
• Oral -Surgery: Simple extractions_
• Drat Surgery. Surgical extractors&
MAJOR SERVICES
• Pripsthodoritcs-: Bridges, partial dentures, complete dentures - S-year waiting period for replacement last
pen'ormed_
- Bridge and Denture Repair: Repair ot such appliances to their original condition. Including relining or dentures_
• implant- Implants are only a benent to replace a single missing tooth once in a five (5) year Interval nom the
date the procedure was last performed:
• Restorative: CrOwitS and onlays 5-year waiting period for replacement last periormed:
DENTIST PAYMENTS.
The Delta Dental PPit plus Premier plan leverages the PPO arid Premier networks. This provides all the benefits
or Delta Dental FPO plan with a plus-members that visit a dentist in the Premier network still receive the benefit
of that dentist's contracted lee
= PPO Dentist — These la-network dentists agreed to accept lower reimbursement for services so members save
the most money,
• Premier Dentist -- These in-network dentists also accept discounted reimbursement for services, but their
discount is not as steep.
- out-or-Network Dentist — These dentists have not agreed to discount their rates for service. MI members who
see an out-or-network dentist will have the highest out-or-pocket costs. Members are responsible for paying
the rwil Tee charged by the dentist and can submit Tor reimbursement at the non-participated table of
allowance:
Services should be provided by dentist located in Maricopa or Pleat counties- only.
BENEFITS ARE SUBJECT TO ALL PROVISIONS, TERMS& CONDITIONS OF TEE GROW, CONTRACT
Page 28 of 73

CONTRACT #: MA D860 190140
Deka Oer*a cAri2orla
1.:lelt:aDurltalAZ.c.vm
Why GO PPO Know YOLtr COAtOrag-P
YOU may vlstt any licensed denbst:but you wle taw , the most tiony New tali* Delta Dental PPG pdan? Thisplan cPvem treatment
by visrtIng a PPC dentist Thatsbnmuse PPO dentlytNagme- to started and completed alter your plarrs effective datecitcumerage:
acoept owar reimbursements Tor Your benefit summary and berieflt booklet have specific details about
covered treatments.
Pegisler Orlkine
sign up /or the tritembor -Connection -at dettadentilazoornirnernher
to view berte1713, ellgthlitty and clalras stair/k5 or to check evetage
dental costin your area_ 'toucan elan update your delivery
tgeftedm.ce -tor ntal henems statements (-EOM and 9n papettnsl
Understand Common Dental Terms
Find A D.Rni €51 KS our goal to make yoor:henents sImple to use ano easy to
Its e._ -}r to 13-9d.a Delta paotedentIst near you with air do:wader urp*.r_ stand. Here are wow common terms delbect .
searchtnci at deJtadentalaz,com o lnthe Delta Dental Mobile App.
EaSy 81241leltS CoOrdtnVüP Annual maximum.- The roaOrnurndlilar amount Delta IX-ntal wIn
pay toward the cost cC dental mire *Ohm spe•drtc benerit period:
0' you're covered -under trio plans, ask your dentlst to Include
Inronnahlon about both plan.s vnth your claim, and well-hark:le the Dedualble - The amount you pay Par covered dental sermlon
rest. betore Delta Dental begins to pay.
NO HD Card NeCOS$2iTy
Coinsurance - The percentage of dental care e)menses you pay
Just gl-ve your -dental ofilw your nerneand member D. Don't know altar your deductible
your member ID? Pull up an electronic ID card On your smartphone
the daetlsrs otnce bylo4gglog In to the Delta OenUI t4oblle Aock
• Predetermination - A pre-treatment esfern' ate trot beips determine
Dowrnod The t1obU App the post ore recommended dental treatment
Acmss your teneM and view yow ID card on-the-go 'van the tiolta
Dental mobile Argo_ !rs Tree or Android and 10S1
l+%rtopa Ontcs c 1-lealth PromiNlon Pducation GFC4.1p, 4715
Page 29 of 73

CONTRACT #: MA D860 190140
WOU Id.Wt it be, nice ifyou
ft eeded extra care and
could nave it cmered by
your dentai pian? With
Delta Bent R[ of Arizona,
you can.
Beta Denies Evfence-Rased Integrated - Cafe Plan (EB[CP) p-rov -Fdes a third cleaning he Refit -for individuals
with certain medical all-WWI:As that have oi21 health implications: Research has shown that increased
frequency - of cleanings can greatly.invect or;ai health and sometimes even piay an important role in
rn nog' pg conditions, such as
biabetes- Pregnancy- High-risk cardiac conditions
Heact and neck radiation Renal dialysis
Suppressed i mmune systems (du chemothety pi, HIV, It,-ars trar,spint, ar atm cell/bane riarcri IrtrP..17sp+xti
Etigibte members most-enroll in the EB1CP and ram pietea tnief health histofy, Follow these steps. to regristerfor
this benefit
1, Log in lo the Member Connection at deitadentalaz.,co raber.
2. Cli,t); Enhanced Benefits at the top of the page.
3. CetrFpkte the requireid infoanatIon„
larciaxi rmar—ozn. Ilk,rximkr1 0..-vrrkam famemt4yvvo,RAIM!4- 4.2tildfliam.ser wriAate Imr-..peamas Mit iilThaert147.
Page 30 of 73

CONTRACT #: MA D860 190140
Delta Dental of Arizona
Self-Funded Performance Guarantees for Ryan White
"1.-r : i '4-rIETXR'';;#...-----lie..601-114Wa.g1113/1WIAIMBINIMMEI
Outcomes m re tosasured and repotted DR Delta Dental of Arizona's book of busintremilts,
Crutoarries are measured and reported quarterly_
Penaltit, ifariv, viilf be paid annuaghp. Each quarter IT1354- 111:Ceisoe ZS% of the amnia amount at risk_
.... 1..'4" =, • 7,,
•- .., ' -
AVerage speed to aamwer Customer Service queue caris
claims/ Aitwa ,g_. speed to A4 of-Annualized
blgOW 315 seconds &ring CiriAz scheduled huskiims
customer Service Amwer Administrative Fees
boors.
Customer .%.rvice queue calls will have an abandonment .
ttairnst Teiephorie rate of Irms than 3% during DIDAZ sdredu led buthness 2%,of Annualized
customer Service Abandonment nets hours. Uls abancioned within the first 30 seconds are Administrative Fees
exduded:
Ciaiifrd / C$ Airra Process/et - 95% of claims dollars submitted for payment will be 29ipol Anrusalbed
Onstrimer Service financial Accuracy accurately prucmsed and paid. Administrative Fees
clain:ps / 43aiirns processing 9546 of claims -WI:gritted will be processed without 256 of Annualized
Customer Service Accurave error. Administrative ' Fees
90% of claims received willl be compierelypirice%5ed
cl aims i Clai m Payment 2.%cot Annualized
(paid, denied, or fended for additional inrm foation) Fri. . F
Customer Service Turnaround Time
within 15 buNi'ne:is. &elm after they are received.
Page 31 of 73

CONTRACT #: MA 0860 190140
Delta Dental of Arizona
Fully Insured Performance Guarantees for Ryan White
- _ __ __41,10:OripardiFerfixmante 411 . --__.M.SAEL"
Outcomes are measured aud Li i ed an Delta Dental of Arizona's bunk of busiorws resulia.
011trOMES are measured and ..i. .._
Pertaltilw. ff." - wilf be ..., id annual . Each . uartff in receive 25% of the annual amount at risk_ .. ..
7,-•.=, ,+-
'Perfani 811 ,z,".V
. .
Standeta I* _ atRi
Average speed lin answer Customer Service queue rafts
Claims / Average Speed to below 30 seconds du ring DMZ scheduled business of Annualized
CUSinliler Service Answer h ours. Premium
Cus bunter Service queue cads will have an abandonment
Claims I 'fiepliorie rate of Is than 3% during onAz 5theduled business 0.4%of Annualized
customer Service, Abandonment tate hours_ Calls abandoned within the first 30 serum& are Premium
estclutied_ "
Mims / Claims Processing- 95% of dairns claims submitted for payment will be 0.4% nualbed
customer 3ervice. Financial accurately processed and paid. Premium
Claims / Claims Pionessing 05% of claims submitted will be processed without 0.4% of Annualized
Customer Service . ADM error_ Premium
Claims or Claim Payment 5.0% of claims I ived wg1 be completely processed 0.4% of AnnualLed
(paid, deniN1,_ or pearled for additional inforroafion)
Misnomer Service Turnaround -rime Premium
within 15 bu*less claws after they are receNed,
Page 32 of 73

CONTRACT #: MA D860 190140
Delta Dental does not have a pre-exisling clause; however, Delia Dental has a limitation
clause ar follows:
Lto . dons:
A Delta Denial does not prolific for lost,mi...7.1aced Cr stolen dentures and has a
five-year -waiting period for replacement last performed.
B. Benefit for replacement of misting fixed bridges, crowns, jackets, veneers, cast,
fused or rather labeaartory processed restruaticars will be made only ales five yearS
have elapsed following any paor provisionof -Neu- procedures. involving the
same teeth and only when the existing tooth Arricture is decayed or fractured
beyond repeiv with a tilling.
C Benefit fin reiolareinent of removable prosthodentic appliance will be made only
after five years have elapsed following any pi orprovision of such applianc.es.
Benefit for replacement will be made for a pros -diode/Mc appliance more than five
years old or one notprovided wader- this Delta Dental Contract only if it is
unsatisfactory- and cannot be made satisfactory. Orthodontic benefits are provided
only Vile fast active appliance was inserted vthile the patient-was covered for
this benefit under this plan or if applicable, and immediately preceding
orthodontic plan provided by applicant Delta Dental Will natmake any payment
for repair or replacement aim orthodontic appliance furnished under this contract
or aftyprevious contract provided by applicant To be eligible to receive benefits
on treatment in progessothe patient must have been receiving benefits fican the
prior carrier provided by applicant Delta lag." reduce the maxim= benefits
available by the benefits utilized under the prior rather.
Exclusions:
A. Services for injuries Or conditions which me compensahleimder WodanineS
Compensation or Employer's Uability Law, services which am provided the Covered
Person by any Federal or State Government Agency or are provided without cost to the
Covered Person by eery intrincipality, county IX - other poliiical subdisision, or community
age:acY-
B. A service or procedure that is not generally accepted by the Panthean Dental
Association and Delta Dental's processing policies_
C. A service or procedure that is not described as 3 benefit of This Employer Group
Dental Contract and included in the Summary of Benefits in the Dental Benefits Booklet
D. A method of treatment more costly than is customarily provided_ Benefits will be
based on the least expensive professionally accepted method of treatment.
E. Dental and surgical services with re,peet to cosmetic surgery or dentist -1r for purely
cosmetic reasons_
Page 33 of 73

CONTRACT #: MA D860 190140
E Specialized techniques inchadiug. bat not limited to precimis metal for =lovable
appliances, poecisi —on attathment for partials or 'midges, overdentures, overlays,
implardology as well as.poacerlines and -appliances associated with the preceding
procedures in addition to personalization and characterization.
G. Charges for any healthcare not specifically covIzoneltmder this Employer Group
Dental Contract inchrding hospital charges, prescripedon drug charges, and laboratory
diarges or fees. Charges for denial services which are started prior to the date the person
became covered under This Employer 01011/3 Dental Contract Orlkiddl ETIftperfraned
daring the Benefit Waiting Period.
H. Procedures, apjdlances or restorations that are neer...soy to alteir, restore ear maintain
occlusion, including but -not limited to altering 'radical dimension, replacing or
stabilizing tooth staid= lost by attrition, erosion; abrasion wear or brasion, maligurrient
of teeth, periodontal Tinting, splintirogr,, pathologic recording, equilibration, bite
applianc= or harmful habit appliances-andtor other damageto either hard or soft tisanes
as a result of a device:worn in a tonane or lip piercing is not a covered benefit.
1. Temporary dentarel., other illan those povided in This Employer Group Dental
Contract.
I Study /110de.15, casts and Mbar ancillary services not oeveted in This Employer-Group
Dental Contract unless orthodontics is included_ as a covered benefit intheSammary of
Benefits_
K Travel time and related expenses.
L. Orthodontic sersices except when covered by This Employer -Group Dental Contract
aria included in the Scummy of Benefits.
M. Direct diagnostic or surgical and non-surgical treatment procedure applied to body
joints or muscles, temporal nandibular joint TM]) oar temporal mandibular disturbances
(TlyfD), except When calvetedby This Employer Group Denial Contract and irtChtded in
the Summary of Ectiefits.
DDAZ will not pay for any etaint submitted more than twelve (12) montlit from the
date of service or twelve (1.2) months afier the terminati . "on of This Employer Goanp
Dental Contract wInchever comes first_
0. DDAZ will not pay for any adjustments to previously received claims, including
submissions of additional information, Admitted more than twelve (12) mouths from the
initial payment date or initial date issue date of the repested informatirm.
Esperimental_ or 'transitional procedures or any procedure other than those amazed
Services.
Q. lvlyofiractional therapy or ET each. therapy,
It Services not performed in accordance with the laws of the State of Arizona, services
performed.hy any person other than a person authorized by dental license to perform such
services, or services pet-for:mei:Ito treat any condition, other than an oral or denial disease,
malformation, abnormality err zondition as explained. .
S. Completion offoams, providiny, diagnostic information or _records, OT duplication of
rays or other words.
T. P,,eplacesneni of lost, stolen or damaged dental appliances.
U. Procedures or services perfonned in tonjenction withnneomed dental services .
V, All other seniees not specified as named dental service.
Page 34 of 73

CONTRACT #: MA 13860 190140
wwW.cialtadPntalaz.,rom
int oternentatiOn
Statnless Trarktraorr arK1 tOmptete Support
Your Dabs Dental Of Arivona implementation Tilirle5 Approach.:
Del enthtt AritOria mi,ti&•statitis that impf,ernanting. r7.0.9 beierit paCkages Oksent sOrne
challenges, That's AY* We provide yOu With a ofhoie team of expertS. to help guide you in a srnekith
transition.
You may have qiiitions in preparation of implernentalion, Tndüthn
▪ Facilitating the e)athange cif key information
• Thning of the open enna;l1rneut period
• Timing of eligbility flIes
• ri2im4 sy$tern setup-
* Cornerbuilintion
Delta Dental of Aritona wal beip-voti aficirss the quetorahd ittOra by cbthliirling afern of experh4
supported by effective prOlect Management Our pest experlence of this method has proven
surctesS for a tfrooth imple,mentation and trantilion of beottl.
Accountability and Collaboration
Or lmpletnentation approach gttesigned to work in a oullaborativeeffort through a partnembip
with you and your team. Ont team criosist.5 of information technology wterrrs, RglhI1ity , undefwritog,
• dafitisitu4OtnOt set**, proliititc roftiotrs, fitkocg t. MFOltrtunICatibt4'abri Vt)or ArtOtInt Mariagr.
Together, eath Member of the team contributes Unkluetaleats to errs-vre 5-n10-obi tran*lori,the
Atte:Juni Mr ac us the Implementation tvianaket rid has overall acoonribitity ti you aod your
team_ Through a Clearly defined Implementation Pia tegniarly schoduled meetings and tonferenoe
Calls, the hem:provides updates, status -ph projects and resolutions raisertriteing the transition.
Continued Partnership
Ohce ifopletttenthtion aaprcafuUycemptsd. Strveral members of the teem torrtinue to actively sert,
(Jo the amount and will be a part-of triotatily meetiOgS and cureereoce calls. Each team member
carefully monitors-the acconnes performance as part of Delta pentAl nAQopomrtotmant t
customer 5atiOaction,
thal 5E5SW. DswrtAi- TAimol Med, iNkrAc3z, AZ essos I p.o. aux43O4otroaaix, AZ B50130-5CO0
E*2.93F1.37;1 I: 16 7-.07-csa: 800-.3.6-a2 .1 Fax: E.0254%
Page 35 of 73

CONIRACT #: MA D860 190140
A DELTA DENTAL
IMPLEM ENTATIO N4 PLAN
DDAZ PPO Plus Premier PLAN
Maricopa County Office of Orai Health! Ryan White
REP: 190140
Effect[ve March 1, 2019
Upon award of the Employer Group dente. benefits. Irntr-ecliIate fritemal and - external otanningwud occur:
KEY ACTIVITIES TIMELINE
Meting/Po ns conferenco with the key personnel. from MC001-I to
d-"scvss impliementatIoniVerftation oft Upon•award of contract
- Plan election, benefts and rates and needs for ereLtrohic
-- F.nrolliment datalfries and Jny specrai requiremeqts
- . Financial 2T-7:Dng2ments / reports requWed
- Meetmq 5r-_-','1e.duies.
- Speclal neod5
Pr-ovId4P.rtermi communicatIon to start group set up and assemble withm 10 days after
04t_a• Dental's imolerneptation Team that will be asrAgned to MC001-1. Inrtial meeting
To b e determine
Prepare enrollment mote-I...Ws and commun icattons for MCOOH
Conduct .enrollIment meetings, Per MC:00;4s sclieduke
coiled •g agesssary impEementation pzperwork 2nd inform9tion and Preferred -90 clays
verty compreteness of en:raiment. Prior to .affectvsdats
Within 30 cfays of codection
Aign..riroup number and beoln benefit and claims testing. of .mastor AppitcaborL
R'oiVo first test fize and coor&nate adjustments if needed. Contfnue
with ftle ioad:; for sodi•ility and coordinate enrollment flies with PreterT001 90 clays :pi-1LN- to
MCOOH 1/1/2019
At group sst up Irr the Ooita Dental siiglblitly system. 30 days prior to 3/1/2019
Notify Dslt rioti oart1c1patrg providers of tie uocornAng eftsrtve 30 days prior to 3/1/2019
date, plan desi-gn and cielms processing center for MCOOH:
Within 30 days prior to
Corn_plete instairation and e.ligiblAy mixt_ 3/1/2019
withlin 15 days prior to
Mall ID cards and benefit booldets, if .neces5-9ry. 3/1/2019
Maintain contact wth Segal to ensure a smooth t7Tansttion. Weekly - or as needed
Page 36 of 73

▪
CONERACT #: MA D860 190144)
ENIAL
Delta DentaT of Arizona — im_plementafion Plan Worksheet
rlanplunrionsizikauWarg Rad
IargneU
Cuminotildn End CeildPlatio
nab
be*. ?pals cpeelPs 13pan cros1.1
er 11,1.4x1rr 1140011Ppiamweagion,In51111111 DDAt
P UKn card:rad awm-K11
imary rat anit1.101.11.1.1.
1:111.s.mardp,,1 kpireen
41(teektfiPpk,mtaiton mecr.ps was nsptcPsi by.1.30014 PIODOPZECO..2 ..1•DODH.1117114Z
tete= lawo Mr-QcrtOorknomneriuta. I )1243C1HJ1g1.44Z 4.1pon. coalnp:Ppeal
Veglust, trriter3ber end c.2=rnerolvN4mr.orrantstime, uwn coorad 4ftlard
CAzim h.ths DMZ V0 11.Y.plerla
4wpmen1111a15
V.& Cpnie let up.. L.1.1 .1111.1.crla
lypiparabctiort
1.91sy. 0.111.
Wt./. pia- ta
PpleraaPolion
91.1tersorlarta
1.101611y sszple 1,1
Isp4rrnmilp.orr
C/Pen.1.,1[21.11/000N
LEIPPI.P.3.1111.1.1111.1.5110n. d.A ut data
FP .4, a1.1 Autism/at 112.11.1.1.
Erpalts,plakon.
1311/ 11.tment IrrApull I McgOi coAz otys.plarlo
1ppit,,L11..rfi
Rer***.b.rnrarsa4 I HOOCH 1311AZ Ingientntrilork
E.ornpslmnsh,r. argl moist!, ow ma- aisc,-auit 131:112- 11,1131. 9:11.r..111:ncp1/1
I 1 a rz no, p.m.re I_"mtswx P.111.." rw,r.:12 rwIrcr .1211...,
huregi boriproode11 31/...1111.PccsAssoP31rAp.,tr-np1 )61,300. E1C11.Z .15../Usskakallssivilaa2p•
..114m1111.....".1.4.4111. weed
moPlal 14 1.1.....tlap
LEvrArd IDCIAZ fran APP.
.11:1074-1
...1:1:1IEtrroott.,& 101,
Post.Ppo..,511., au= POOCH ID130Z
1,ptprp vemap. b11111oth,ot:IY/PM limPlocAniaat MODOP Li-IDDAZ 9111 1!11.. prVer-P
1011E1 -rvamorrooce
11eposte...Pleicar=1AI 4.11PC1701.1, k11..12. 13 run.. al eportindal Pairs Ischtetort
PC01:114.6 DEPZ 11:171714 On112.-
11KAPP.P.mr/tim;
Page 37 of 73

CONTRACT #: MA D860 190140
CONTRACTOR'S QUESTIONNAIRE
Complete each item completely and in the order shown. Clear reference to readily accessible back-up material (e.g.,
plan documents, reports, charts, etc.) is acceptable. Incomplete or inaccurate answers may result in the
disqualification of the proposal. In your response, state the question, and then the answer directly below the
question. If you are proposing both plans (self-insured and fully funded) then please provide the answers for each
plan if they differ.
1.0 Ownership
1.1 Who is the owner (sponsor) of the plan (e.g., commercial carrier, dental group, etc.)?
Delta Dental of Arizona
1.2 Do you have any plans to merge, sell, or otherwise change (e.g., change management contracts or
personnel) your current organization structure?
No, Delta Dental of Arizona has no predetermined arrangements to market or modify our
organizational structure.
1.3 If you do plan to merge, sell or otherwise change your current organization structure please explain.
Not applicable.
1.4 Provide your two most recent audited financial reports that are usually given to stockholders. These
reports should include a Balance Sheet, Income Statement, and Statement of Changes in Financial
Position, along with any auditor's notes.
Delta Dental of Arizona's Consolidated Financial Statements for years ending 2016 and 2017
have been attached under the Qualifications section of our proposal response.
2.0 Account Management
2.1 Please provide a biography of the account manager who would be the primary contact for Maricopa
County's Ryan White insurance plan staff. Provide biographies of any other members who will have
routine interaction with the Marieopa County and/or the MCOOH Ryan White Insurance plan staff.
Ann works directly with account administrators and the broker community by establishing
a single point of contact that fosters and cultivates the Delta Dental relationship with our
clients.
Ann is responsible for the management and service for large groups including her current
service on the MCOOH account. Ann closely monitors plan performance reviews market
trend analysis and strateg,izes with internal partners on plan designs, network savings, cost
utilization and meets with clients on a regular basis presenting results of said analysis.
Additionally, Ann is the point of contact for escalated account issues, billing-claims-
eligibility issues, enrollment meetings, service reporting, account management meetings with
clients, updating tracking logs and ensuring the clients performance expectations and needs
are being met.
Brief biographies, staff expertise and roles has been attached under the Qualifications
section of our proposal response.
2.2 Describe an ideal mix of skills between MCOOH and your organization that will ensure a successful
implementation and ongoing account management.
For forty-six years, Delta Dental of Arizona has been dedicated to providing superior dental
benefit plans to Arizona employers. Ranked #1 for 20 consecutive years, we constantly
strive to improve and adapt our plans to the changing needs of the population and to the
demands of the marketplace. Since 1995 Delta Dental of Arizona has served MCOOH by
administering your dental plan and insuring more than 1,971 participants. In 2002 we
began benefit administration for SAAF Title 11 and their 1,566 participants.
Page 38 of 73

CONTRACT #: MA D860 190140
All claims and customer service is handled locally at our Glendale based office, we do not
outsource services to other states or countries. Delta Dental of Arizona has 3,489 licensed
dentists participating in our provider network, ensuring adequate dentist to patient ratio.
Delta Dental of Arizona is confident we have the experience, processing policies,
infrastructure capabilities and expertise in dental benefits that are absolutely critical to a
simple, smooth implementation and ultimately, successful transition for all enrollees and
administrators.
3.0 Technology
3.1 What is the name of your dental claims payor system?
Advantech
3.2 Is your system fully integrated? Provide a high level schematic of your dental claims payor system.
Yes, Delta Dental's system is fully integrated. Visio diagrams of our claims processing
module and administrations processes have been attached under the Questionnaire: Claims
& Appeals Processes section of our proposal response.
3.3 Do you plan any revisions in your claims systems or system hardware or software?
Delta Dental of Arizona will be upgrading many of our systems during 2019 including the
claims, eligibility and customer service systems. These upgrades will enable Delta Dental of
Arizona to better respond to customer inquiries through a more robust IVR system that
integrates with the claims and eligibility systems.
3.4 If you plan any revisions in your claims systems or system hardware or software, when do you plan to
make the changes and to what extent?
Delta Dental of Arizona is planning a significant technology upgrade to all our systems
during the first quarter of 2019. This upgrade will encompass all systems including: work-
management and customer oriented systems, and our financial and billing systems. The
purpose of this upgrade is for our continuous improvement in our business processes to
provide best-in-class customer service.
3.5 What initiatives have you implemented to ensure your dental claims payor system is HIPAA.
compliant?
Delta Dental of Arizona's utilizes the Advantech claims system (developed and maintained
by Delta Dental of Wisconsin). The Advantech system has been integrated to include the
270, 276, 277, 834, 835, 837 and 997 HIPAA transaction sets in production. Delta Dental has
developed business processes and guidelines that have been applied in compliance with
HIPAA privacy and security guidelines. The Advantech system works in cooperation with
these business processes by automating certain functions such as confidential
communications and personal representative procedures; which allows the system to block
certain confidential and private information from being released.
3.6 Do you have a SAS 70 audit of your claims payment system? If so, how frequently is the audit
completed? What were the results of your latest audit?
Generally, SAS70s are performed annually by Delta Dental of Arizona's claims vendor,
Advantech. Our copy of our most recent SOC1 and SOC2 audit reports have been attached
under the Questionnaire: Audit Reports section of our proposal response.
4.0 Customer Service
4.1 What is the location of the customer service center that would handle our account?
5656 W Talavi Blvd Glendale AZ 85306
4.2 What are the hours of operation of the customer service center?
Monday through Thursday: 7:30 am to 5:00 pin
Page 39 of 73

CONTRACT #: MA D860 190140
Friday 7:30 am to 4:30 pm
Saturday and Sunday: Closed
Website and IVR/VRU are available 24 hours, 7 days a week
4.3 What is your staffing ratio of customer service representative to members?
Delta Dental of Arizona's customer service representative to member staffing ratio is
1:26,690.
4.4 How many members does the customer service center currently service?
Delta Dental of Arizona's customer service center services 587,184 members.
4.5 Will additional staff be added to the customer service center to accommodate our account?
No, not at this time. Delta Dental of Arizona's customer service/ claims methodology does
not include the assignment of client-specific units. However, in the event our member
population substantially, the need for additional staffing would be determined.
4.6 Describe how telephone calls from non-English speaking members are handled in your customer
service department.
All callers to the Delta Dental of Arizona's local or toll-free line are greeted with a Spanish
language option. When this option is selected, the caller is transferred to one of Delta Dental
of Arizona's bi-lingual customer service representatives. Additionally, for the deaf
community, Delta Dental of Arizona has trained customer service representatives to respond
to TDD/TTY operators and callers.
4.7 Describe the structure of your organization (include customer services, claims processing, provider
relations, eligibility, account management, billing).
Delta Dental of Arizona consists of 6 divisions: Executive, Operations, Sales, Finance,
Marketing and Underwriting.
Executive: CEO and Delta Dental of Arizona Board of Directors
Operations: Claims, Customer Service, Data Entry, Enrollment, Information Technology,
and Communication divisions.
Sales: Sales and Retention services
Finance: Accounting and Billing divisions
Marketing: Marketing services and Delta Dental policy compliance
Underwriting: Underwriting services and Contract compliance
A detailed Visio outlining Delta Dental of Arizona's organization has been attached under
Qualifications section of our proposal response
4.8 List the specific functions of the customer service department.
Delta Dental of Arizona's Customer Service Division provides services to our members,
providers, employer administrators, brokers as well as the general community with dental
health inquiries. Representatives are available to assist any caller with any inquiry regarding
eligibility, benefits, claims, provider network, and dental health questions and any general
questions that relate to Delta Dental or the dental community. Representatives are also
available to process claims and claim adjustments.
4.9 Will you provide a dedicated customer service team to handle inquiries related to the Ryan White
plan?
No, typically Delta Dental of Arizona's customer service/claims methodology does not
include the assignment of client-specific units. More efficient and broader service is
delivered by routing customer interactions to the first available qualified representative.
This process results in .a quicker response time and more productive customer service
experience. All customer service and claims personnel are cross-trained, allowing them to
handle customer service calls and adjust claims.
4.1 0 Describe your customer service inquiry tracking system and reporting capabilities.
Page 40 of 73

CONTRACT #: MA D860 190140
Delta Dental's utilizes Customer Inquiry Tracking System (CITS). CITS is an online, real
time correspondence detail tracking system. The system tracks by issuing a unique number
for each transaction, User ID, date of inquiry, date of resolution, group, subscriber, patient,
claim, provider, reason, type of contact (email, fax, telephone, written appeal, written
inquiry or walk-in), origin of the inquiry (accounting, agent/broker/consultant, dental office,
enrollee, group, other, PR, third party) and outcome. Each of these distinct elements can be
queried and reported upon. The supervisor has access to all open CITS and is able to
monitor the progress of the inquiries and ensure resolution
4.11 Provide sample client specific reports generated from your customer service inquiry tracking system.
Delta Dental of Arizona is providing a current MS Report for the MCOOH account; The
CITS report is attached under Questionnaire: Exhibits & Reports section of our proposal
response.
4.12 Does your organization perform customer satisfaction surveys on a continuing basis?
Delta Dental of Arizona performs customer satisfaction surveys in cooperation with client
requests. Surveys can be performed based on the client's requested criteria and timelines.
4.13 If your organization does perform customer satisfaction surveys bow often are surveys conducted?
Surveys are conducted strictly based on the client's request. If MCOOH would like surveys
performed on a specified scheduled basis, Delta Dental of Arizona will accommodate this
request.
4,14 Are customer satisfaction survey results available by client?
Yes, Delta Dental of Arizona's surveys are client specific.
4.15 Provide a copy of your most recent customer satisfaction survey instrument and the results.
Due to our Member Surveys being client specific and confidential to the client, we are
providing samples of our Member Survey Tool & Member Survey Result under the
Questionnaire: Member Survey section of our proposal response.
4.16 Provide examples of three recent changes implemented as a result of customer satisfaction surveys.
Explain how the outcome has changed.
Delta Dental is always striving to provide quality customer service to our enrollees. This is
reflected in our overall enrollee satisfaction rate, which has remained consistently high. We
have not needed to implement any significant changes as a direct result of our enrollee
satisfaction survey results.
Survey results are compiled and analyzed to identify opportunities for process improvement.
If a trend of customer dissatisfaction were to be uncovered as a result of our surveys, Delta
Dental would immediately take action to retnediate or improve our internal policies and
procedures to enhance member satisfaction.
Returned surveys that include unfavorable comments are carefully reviewed to determine if
additional follow-up with the enrollee and/or dentist is required. Follow-up is initiated by Delta
Dental as needed. A forrnal grievance process goes into effect for any returned survey deemed to
be a quality of care issue
4.17 On average, how long does it take for members to move through your menu selections and speak
directly with a customer services representative?
33 seconds.
4.18 What is your most recent year-to-date call abandonment rate at the customer service center?
1.81%.
4.19 Provide your customer service center metrics for the last three months.
Metric July August September
Page 41 of 73

CONTRACT #: MA D860 190140
35 sec I 19 sec I 16 sec
Average Abandoned Percentage 1.72% 0.77% I 1.06%
4.20 Describe your service guarantees.
Delta Dental of Arizona's standard service guarantees are as follows:
Turn Around Time — 90% in 10 working or 15 calendar days - aggregate not client specific,
receipt date to day of adjudication. Day of adjudication is not included.
Financial Accuracy: 99% total dollars paid correctly/total dollars paid. Under/over
payments are NOT off-settable.
Payment Accuracy: 95% frequency of payment accuracy. Total claims paid w/o
errors/total claims paid.
Processing Accuracy: 95% overall accuracy. Total claims paid w/o errors (including non-
financial errors) / total claims paid.
Average Speed Answered: 30 seconds average speed of answer, aggregate number.
Abandonment: 5%
4.21 Do you have an online tool where MCOOH can check the status of customer service issues or
member appeals?
Delta Dental of Arizona has a Subscriber Connection site where members may view benefits,
eligibility, claims history, and cob statements. Document downloads are also available via
this connection site.
5.0 Billing Process
5.1 Describe your billing process (frequency, due dates, grace period, late payment procedures, interest
penalties, etc.) and system for premiums or fees and/or claims reimbursement.
Delta Dental of Arizona issues a premium statement monthly for the following month's
coverage. Fully Insured Premium payment is due by the first of the month and ASO Fees
are due by the tenth day of the month, for which the billing is issued. Premium is due in full
upon due date. Billing adjustments will appear on the next month's billing statement
Failure to pay can result in the group being placed on hold (claims payments) for that
month. Group coverage will be cancelled forty-five (45) days after the hold is institute unless
payment is received in full.
Retro-active changes may be submitted up to sixty (60) days from the date of the most
current billing. Any retro-active changes beyond sixty (60) days must include written
documentation and are reviewed for consideration.
Delta Dental does not charge interest penalties.
5.2 Provide a sample monthly invoice.
Sample invoices for both fully insured and administrative services only (ASO) have been
attached under the Questionnaire: Sample Billing Statements section of our proposal.
5.3 Describe your banking arrangements.
Delta Dental offers premium payment options: Direct Pay — the group issues premium
payment directly to Delta Dental of Arizona; ACH — Delta Dental would access the group's
Page 42 of 73

CONTRACT #: MA D860 190140
account monthly for funds to be transferred for premium payments; Wire Transfers from
the group's bank are also accepted.
ASO Accounts are required to be ACH.
6.0 Benefit Provisions
6.1 Can you administer the current benefit plan without modification (See Exhibit 3)?
Yes, Delta Dental Of Arizona is able to administer the current benefits without any
modification.
6.2 If you cannot administer the current benefit plan, explain the changes you would require and the
reason for them.
Delta Dental of Arizona is able to continue with current benefit administration.
6,3 Include a detailed description of any services or materials which would be excluded under your
program.
A complete detail of Delta Dental of Arizona's Limitations & Exclusions is attached under
the Proposal section of our proposal response.
6.4 Do you offer pre-determination of benefits?
Yes, although, Delta Dental of Arizona does not require pre-determination of benefits; we do
recommend pre-determination any services exceeding $250.
6.5 Is the pre-determination of benefits mandatory or optional?
Pre-determination of benefits is optional.
6.6 Describe the pre-determination of benefits process.
A claim form will be submitted by the treating dentist to Delta Dental of Arizona. A Delta
Dental of Arizona Dental Consultant will review the claim to ensure the proposed treatment
falls within the scope of the group contract and that all treatment is necessary.
The decision of the Dental Consultant is communicated back to the Claims Processor who
completes the processing of the pre-determination.
A pre-determination voucher is returned to the subscriber and the treating dentist. The
amount of the allowable fees, and amount of benefits payable by Delta Dental and the
portion the subscriber is required to pay will be shown on the voucher.
Pre-determinations are only valid for the procedure and for the treating dentist who
submitted the pre-determination requires and may not be transferred to any other dentist.
6.7 Describe in detail how you will handle dental treatment already in process.
Benefits for multistage procedures are available for completed services as determined by the
date of preparation, except for dentures, partials and relines, as those are available as of the
date of delivery.
6.8 Describe any pre-existing condition limitations in your plan.
Delta Dental of Arizona does not have a pre-existing limitation clause; however, benefit
limitations are applicable, please refer to Delta Dental of Arizona's Limitations &
Exclusions, attached under Proposal section of our proposal response.
6.9 Does your plan charge for a dentist's sterilization fee?
No, Delta Dental of Arizona does not charge for dentist sterilization fees._
6.10 Do you have an online tool where MODOH can review the benefit set up?
Page 43 of 73

CONTRACT #: MA 1)860 190140
Yes, on the Delta Dental of Arizona website an Employer Connection site link is available.
The Employer Connection site allows authorized administrators to process enrollment,
review benefits, order ID cards, benefit booklets, print transaction reports and manage
billing statements (billing functionality is not available for administrative services only
accounts). This site can be accessed by visiting www.deltadentalaz.com .
6,11 Indicate all benefit limitations and/or exclusions in your contract proposal.
A complete detail of Delta Dental of Arizona's Limitations & Exclusions is attached under the
Proposal section of our proposal response.
6.12 Explain continuity of care arrangements for procedures started but not completed at the beginning and
end of the contract.
As the incumbent carrier, continuity of care would not be interrupted, if, Delta Dental of
Arizona is the award recipient for this RFT.
Delta Dental of Arizona accepts takeover business on a non-loss/no-gain basis. Expenses
incurred in connection with any dental procedure started prior to the enrollee's eligibility
with Delta Dental of Arizona are the responsibility of the previous carrier. Benefits for
multi-stage procedures are available for completed services as determined by the date of the
preparation except for dentures, partial & relines for those are available as the date of
delivery.
Upon cancellation of contract, benefits will not be paid for services provided after coverage
ends, including pre-determined services, except for multiple appointment procedures with a
date of service before the termination of coverage which were completed within thirty (30)
days from the date your coverage ended. Such benefits will be subject to all conditions
specified in This Contract.
7.0 Implementation/Enrollments
7.1 Do you require MCOOH to sign a copy of your Service Agreement/contract?
Yes, Delta Dental of Arizona does require a signed contract to implement an active policy.
As the incumbent carrier, an effective contract is already in force; Delta Dental of Arizona
would only require a signed amendment to that contract.
7.2 If you require MCOOH to sign a copy of your Service Agreement/contract, then please provide a
copy for their review.
Sample ASO, Fully Insured and Business Associate Agreements have been attached under
the Questionnaire: Sample Contracts section of our proposal response.
7.3 Provide a detailed implementation work plan with timeline outlining tasks, dates, roles and
responsibilities assuming a March 1,2019 effective date.
As the incumbent carrier, there would be no implementation needed. However, An
Implementation Schedule & Approach has been attached under the Qualifications section of
our proposal response.
7.4 Describe the members of your team who will be involved in the implementation prior to March 1,
2019.
The following Delta Dental of Arizona employees will oversee any renewal transitions or
implementations for MC0011:
Ann Coupiand, Senior Account Executive
Geri Tompkins, Director of Group Services
Jeanette Watte, Director of Customer Service
Doug Pimental, Director of Claims
7.5 Include brief biographies on the members of your team who will be involved in the implementation,
and reflect the expertise they bring to the implementation.
Page 44 of 73

CONTRACT #: MA D860 190140
Brief biographies, staff expertise and roles of the above-named individuals have been
attached under the Qualifications section of our proposal response.
7.6 Indicate any additional implementation costs not already included in your fees.
Delta Dental of Arizona does not charge implementation fees.
7.7 Describe your preferred method of communicating the new plan to our members.
Delta Dental of Arizona's prefers utilizing online services (i.e. web or email); however, we
will work with MCOOH to accommodate your communication preferences.
7.8 Include sample communication materials.
Sample communication materials have been attached under the Questionnaire: Sample
Communications & Co'laterals section of our proposal response.
7.9 Will you do a direct mailing to members' homes?
Yes, Delta Dental of Arizona can accommodate direct mail services.
7.10 If you will not provide direct mailing to members' homes, how will communication materials be
distributed?
Delta Dental of Arizona will perform direct mailing services.
7.11 Confirm that the cost of printing and distributing communication materials is included in your quoted
rates.
Yes, printing and distribution costs are considered in Delta Dental of Arizona's proposed
fees.
7.12 To what extent can your communication materials be customized?
Delta Dental of Arizona can allow marginal customization on certain materials. Our
Marketing Division can work with the client to review the request and create customization
that fits their needs.
7.13 Confirm that the cost of customization of communication materials is included in your quoted rates.
Yes, customization costs are considered in Delta Dental of Arizona's proposed fees.
7.14 Provide a copy of enrollment materials that MCOOH would be able to include in their enrollment
packets for its new members.
Delta Dental of Arizona has attached a sample enrollment packet under the Questionnaire:
Sample Communications & Collateral section of our proposal response. The enrollment
materials are not client specific but can be made so, if MCOME requires it.
7.15 Confirm that a sufficient supply of enrollment materials will be available to Maricopa County each
year for new hires.
Yes, Delta Dental of Arizona will provide sufficient supplies of enrollment materials for
annual open enrollment periods.
7.16 Confirm that the cost of enrollment materials is included in your quoted rates.
Yes, enrollment material costs are considered in Delta Dental of Arizona's proposed fees.
7.17 What materials are sent to a member upon selection of your dental plan?
Upon completion of enrollment, a participating member can except to receive a Delta Dental
of Arizona Member ID Card and a Delta Dental of Arizona Benefits Booklet
7.18 Are the materials sent to the member's home address once the member has selected your dental plan?
Yes, traditionally, Delta Dental of Arizona member communication materials are issued to
the member's mailing address.
7.19 Confirm that the cost of printing and distributing the new enrollee materials is included in your
quoted rates.
Page 45 of 73

CONTRACT #: MA D860 190140
Yes, printing and distribution costs are considered in Delta Dental of Arizona's proposed
fees.
7.20 Will you provide a representative for the initial dental insurance implementation plan?
Yes, Delta Dental of Arizona will provide necessary representation for enrollment meetings.
We request at least 30-day notification of scheduled meetings to ensure availability of our
representative(s).
7.21 Confirm that the cost of providing a representative has been included in your quoted rates.
Delta Dental of Arizona does not charge for account representation. There will be no
additional fee for this service considered in Delta Dental of Arizona's proposed fees.
7.22 Will you provide a representative for technical assistance and ongoing service?
Yes, MCOOH will have a dedicated Account Executive who will oversee the day to day
service issues that may arise.
7.23 Confirm that the cost of providing a representative for ongoing service has been included in your
quoted rates.
Delta Dental of Arizona does not charge for account representation. There will be no
additional fee for this service considered in Delta Dental of Arizona's proposed fees.
7.24 Confirm that you will provide draft plan documents and/or evidence of coverage booklets to MCOOH
in electronic format
Yes, Delta Dental of Arizona will provide any requested documents in electronic format to
MCOOH.
7.25 If you agree to provide draft plan documents and/or evidence of coverage booklets to MCOOH, will
there be any charge to MCOOH for these documents' (describe)?
Delta Dental of Arizona's fees for draft plan documents and evidence of coverage booklets
are included in the proposed fee.
8.0 References from clients who have/bad dental coverage with your company
8.1 How many employer groups and members are enrolled with your plan in Arizona?
As of current date, Delta Dental of Arizona has 2,607 contracted employer plans, with
282,654 enrolled subscribers (does not include dependent enrollments)
8.2 How many public sector employer groups are enrolled with your plan in Arizona?
Delta Dental of Arizona currently contracts with 146 public sector employer groups.
8.3 How many private member groups are enrolled with your plan in Arizona?
Delta Dental of Arizona currently has partnerships with Desert Schools Federal Credit
Union and AAA Arizona; their members are eligible to enrol) in a policy specifically
designed for their membership_ Delta Dental of Arizona does have an Individual Policy for
Arizona residents; a total of 5,480 subscribers.
8.4 Provide a representative list of at least five current Arizona clients (Attachment C) for which you
provide dental coverage and dental claims administration/payment, the number of covered members,
length of time that they have been contracted, and a contact name and phone number. Provide three
employer groups who have terminated within the last 2 years.
Delta Dental of Arizona has completed Attachment C and has attached under the References
. tab of our proposal. Terminated account references are also attached under the References
tab of our proposal.
8.5 Indicate the romber of clients you have in the following categories which are administered in the
same geographic location as would be used by Maricopa County:
8.5.1 Less than 1,000 members
Page 46 of 73

CONTRACT # MA D860 190140
1,960 Accounts
8.5.2 1,000 — 5,000 members
45 Accounts
9.0 Performance Guarantees
9.1 Are you willing to negotiate and implement performance guarantees?
Yes, Delta Dental of Arizona is willing to negotiate and implement performance guarantees
for Ryan White.
9.2 Do you have a standard performance guarantee agreement?
Yes, Delta Dental of Arizona has standard performance guarantees that we are willing to
offer.
9.3 Provide a copy of your standard performance agreement, if any.
Delta Dental of Arizona has provided our standard performance guarantees for both our
fully insured and self-funded options. Performance Guarantees have been attached under
the Proposal section of our proposal response.
9.4 Are you willing to deviate from the standard performance agreement?
Delta Dental of Arizona is willing to negotiate our standard performance guarantees. Our
goal is to provide mutually agreeable performance standards.
9.5 Describe any areas in which you are unwilling to deviate from your standard perfoll ance agreement.
Delta Dental of Arizona is willing to negotiate our standard performance guarantees. Our
goal is to provide mutually agreeable performance standards.
10.0 Network
10.1 Provide a brief overview of your network.
The Delta Dental PPO plus Premier plan is unique because it pairs a standard PPO network
with our extensive Premier network. Having these dual networks protects and provides a
safety net for employees using dentists outside the more limited PPO network, while also
providing the largest network based dental coverage. This distinctive plan also enables most
employees who currently see a non-PPO dentist to receive savings and contain their costs
because the no-balance billing policy applies when they use a Delta Dental Premier dentist.
While members save the most when they utilize a dentist from the discounted PPO network,
they will still save money when they go outside that network and see a Delta Dental Premier
dentist. This results in overall lower expenses for the total dental plan for the account paying
the claims as well as the member paying co-insurance.
10.2 How long has the network been operational?
Delta Dental of Arizona's provider network has been in operation since 1972.
10.3 Was the network developed entirely by you?
Yes, Delta Dental of Arizona's provider network is sole owned.
10.4 Where is your network currently operational?
Delta Dental of Arizona's provider network is operational in the state of Arizona.
Delta Dental of Arizona is a member of the Delta Dental Plans Association, as part of that
Association, members can visit a Delta Dental participating dentist nationwide.
10.5 Do you have providers available in the event of an emergency, after hours and on weekends?
Delta Dental of Arizona's provider network is a 'freedom-of-choice' network, allowing
members to visit any provider anywhere and at any time. As such, we do not oversee
provider offices business hours; however most dental offices have their business hours
posted for patient convenience.
Page 47 of 73

CONTRACT #: MA D860 190140
10.6 Do you have a national network?
Yes, Delta Dental's network is nationwide.
10.7 Is your national network part of your proposal to MCOOH making the national network available
to all Ryan White members? Members should only use in State (AZ) services.
Yes, participating members have access to Delta Dental's nationwide provider network no
matter the location of the provider.
10.8 Provide a listing of dentists (by specialty) currently under contract.
A current Delta Dental of Arizona provider directory has been attached under the
Questionnaire: Provider Directory section of our proposal response.
10.9 If you are providing a listing of the current provider network, are you willing and able to compare
your network with the current network?
Yes, however, Delta Dental of Arizona is the incumbent carrier; Delta Dental of Arizona is
willing to compare our network against another carrier's network for validation of provider
availability.
10.10 Are there any restrictions on provider access (e.g., limitation on new patients for certain providers)?
Delta Dental of Arizona does not impose restrictions on provider access. All participating
members have access to all providers within our network.
10.11 If there are restrictions on provider access, note each individual provider currently under such
restrictions.
No restrictions are imposed on member access to Delta Dental participating providers.
10.12 What is your current capacity to enroll new members with the current provider base?
As one of the leading dental provider networks in the USA, Delta Dental of Arizona's
member enrollment is unlimited.
10.13 What criteria do you use for the selection/credentialing of providers, if any?
Delta Dental of Arizona's standard provider credentialing requires the following items for
documentation and review:
• License verification
• Specialty verification (if applicable)
• Malpractice insurance
▪ State and local licensing board actions
• Infection control OSHA requirements
10.14 Describe any special training dentists receive from you, if any.
Delta Dental of Arizona provides multiple ways of educating and training contracted
dentists across Arizona. These include but not limited to
Jn dental office education and training sessions
In dental office claims review
Educational forums for providers and their staff
Attendance at the Western Regional Dental Convention
Requested training upon request of a provider office
10.15 How many members do you currently service under your network program in Maricopa COunty and
in Pinal County, Arizona? What is your provider to member ratio?
In Maricopa County, there is an estimated 92.2 patients per dentist
In Final County`, there is an estimated 10.4 patients per dentist
10.16 What are your network development plans in Maricopa County and Pinal County for 2018, 2019?
Page 48 of 73

CONTRACT #: MA D860 190140
As one of the largest dental networks in the state of Arizona, Delta Dental of Arizona does
not actively pursue recruitment of dentists.
10,17 Describe the nature and length of the contract between your providers and your organization.
As a not-for-profit dental service corporation, Delta Dental's contracts do not have a stated
expiration date; however, a participating dentist may resign their membership and give 30-
day notification. Delta Dental will involuntarily terminate a dentist, if, the dentist has
committed violations that result in the termination of their dental license, billing
irregularities, contract violations and non-compliance to correct contractual violations.
10.18 If network gaps exist in areas where potential eligible members are concentrated, how would your
firm propose to extend the network?
Delta Dental of Arizona would assign our Provider Relations staff to take appropriate steps
to contact and recruit non-participating providers in the specified area; however, it is no
guarantee that providers will contract with Delta Dental
10.19 Describe your willingness to target particular non-contracting providers upon request from
MCOOH.
Upon request from MCOOH or their participating member, Delta Dental of Arizona's
Provider Relations staff, would make best efforts to contact and recruit a non-contracted
provider; however, there is no guarantee that the provider would contract with Delta Dental.
10.20 Describe how your firm would handle a case where a network provider refuses to give agreed-upon
discounts or attempts to balance bill.
If a participating member is unable to resolve a balance billing issue with a participating
Delta Dental provider, they should contact Delta Dental of Arizona's Customer Service
division. A customer service representative will review the claim(s) with the member to
ensure the claim was processed appropriately and accurately. On behalf of the member, the
customer service representative will contact the dental office, and review the claim(s) and
contractual requirements. If our customer service representative is unable to find a
resolution with the provider's office, Delta Dental of Arizona's claims processing system is
capable of withholding claim dollars from future claims. Additionally, Delta Dental will
involuntarily terminate the provider's contract for billing irregularities and contract
violations.
10.21 Do your provider contracts support audit activities, including:
10.21.1 Audits conducted by your organization
Yes, Delta Dental of Arizona performs quality audits every 3 years or earlier if warranted
due to compliance issues or complaints.
10.21.2 Audits conducted by a third party
No, Delta Dental of Arizona does not utilize a third-party for contract compliance audits.
10.22 Describe your quality assurance and utilization review procedure in terms of provider networks,
specifically:
10.22.1 Who is responsible for quality assurance?
The Delta Dental of Arizona Quality Assessment System is based on the correlation
and coordination of all departments, divisions and affiliates of the company. The
purpose of this system is to consolidate the various dental care review processes into
a single system to monitor the delivery of oral health care for Delta Dental of
Arizona members. Established systems tie together all elements of the company to
trend and track plan administration in areas such as:
• Credentialing
• Claims customer service Inquiries and Complaints
• Professional Relations Appeals, Grievances and Contract Compliance
Reviews
• Claims adjustment
Page 49 of 73

CONTRACT 4: MA 1)860190140
• Utilization review
The Quality Assessment Plan (QAP) has been designed to monitor and improve the
dental health care provided to members by addressing the components of structure
and process of care, requirements regarding internal review systems and by
maintaining quality through its network fee regulations, multiple plan designs and
quality oversight activities.
There is a corporate emphasis on quality, at all levels of Delta Dental of Arizona's
enterprise. As a not-for-profit dental service corporation, management answers to
members, contracted employer groups, participating dentists, its Board of Directors
and the Arizona Department of Insurance (1)01).
The corporate emphasis on quality is an important distinction between a service
corporation and a typical insurance company_ DDAZ does more than process
members' dental bills: management at every level works to evaluate the dental care
included in program designs for all covered members, at the same time providing
efficient contract administration.
Oversight, describes how Delta Dental. of Arizona's Boar)d of Directors delegates
oversight responsibility through the Dental Policy Committee (DPC) to
management Management reviews the QAP activities, summarizes them, and
makes recommendations to the DPC for all QAP functions.
10.22.2 How often does this staff meet?
The DPC is comprised of all eight (8) practicing Dentist Members of the Board of
Directors and shall meet at least annually and report its activities and
recommendations to the Board of Directors for its approval or disapproval.
10.23 Identify the provider appeal process that you use to respond to network disputes for both plan
members and providers of care (e.g., member disputes, pre-determinations, or lack of pre-
determinations, etc.).
There are two types of appeals: An Expedited Appeal for urgent matters and Standard
Appeal, for non-urgent matters. Each type of appeal has three levels. The appeals operate
in a similar fashion, except the expedited appeals are processed much faster because of the
patient's condition_
Expedited Appeals Standard Appeals
(For urgently needed services not yet received) (For non-urgent services or denied claims)
Level 1: Expedited Medical Review Informal Reconsideration
Level 2: Expedited Appeal Formal Appeal
Level 3: Expedited External Independent Review Formal Appeal
External Independent Medical Review
WHO CAN APPEAL:
Either the member or their treating provider can file an appeal (on the member's behalf).
The Appeal's Packet contains appeal forms; however, members are not required to use this
form and can instead use a letter with the same information. If a treating provider appeals a
decision to deny authorization, the treating provider can be notified to provide more
information.
Decisions subject to appeal:
• A service that is not approved or paid.
• A service that is deemed not medically necessary by Delta Dental of Arizona.
• A service Delta Dental of Arizona has determined as not covered under the group's
insurance policy.
• The member was not notified regarding authorization within 10 business days of
receiving the request.
• Delta Dental of Arizona did not authorize a referral to a specialist.
Decisions not subject to an appeal:
Page 50 of 73

CONTRACT #: MA D860 190140
• Decisions related to the amount of "usual and customary charges".
• Coordination of benefits among multiple insurers.
• Application of claims towards the plan deductible.
• Disagreement with the amount of co-insurance or co-payments
• Issuance of a policy.
• Premium rate disputes.
• Concerns related to adherence of the Arizona Insurance Code.
STANIIMIDAMEAL PROCESS FOR DENIED SERVTCES
• The member may obtain reconsideration of a denied request for a service if:
• The member has coverage with Delta Dental of Arizona.
• Delta Dental of Arizona denied the member's request for a covered service [or
claim].
• The member or member's treating provider asks for reconsideration within two
years of the initial denial by calling, writing, or faxing the request to: Naira Chavez,
Appeals and Grievances Coordinator, 5656 W. TaIavi Blvd., Glendale, AZ 85306,
Phone: 602-588-3925, Fax: 602-548-5089.
APPEALS_PRUCESSIIMEFRE:
All steps of the appeals process will be conducted in compliance with HIPAA guidelines.
Level 1: Informal Reconsideration:
• Delta Dental of Arizona will confirm receipt of the informal reconsideration request
to the member and treating provider within five business days after receiving the
request.
Level 2: Formal Appeal:
• Within 30 days, Delta Dental of Arizona will determine whether to modify the initial
decision and authorize the requested service.
• The decision must be provided in writing with an explanation and supporting
documentation.
Level 3: External, Independent Review:
• The member may appeal to Level 3 only after going through Level 1 and 2. Per the
Statement of Work, for external appeal of network and/or benefit determinations,
Delta Dental of Arizona will contract with an independent third party review
organization. The Delta Dental Consultant or independent third party review
organization's determinations shall be conclusive and not subject to further review.
A copy of a Delta Dental of Arizona Appeals Booklet is attached under the Questionnaire:
Claims 8e. Appeals Processes section of our proposal response_
10.24 Provide your provider turnover rates in Maricopa County and Final County for each of the last 3
.years:
2017 0.26
2018 .008
2019 = 0.15
10.25 Indicate the reason for the terminations, if any, for each of the last 3 years:
Providers terminated during this time period were all terminated for non-compliance of
contract or provider initiated terminations.
10.26 Provide your unduplicated total network size in Maricopa and Pinal counties for each of the last 3
ears:
Provider Network Premier PPO
Maricopa County 2,579 2,353
Pinal County 283 276
Page 51 of 73

CONTRACT #: MA D860 190140
10.27 Have any dentists been terminated for quality of care issues in the last 3 years: Describe the top
three quality-of-care issues in the last 3 years.
Delta Dental of Arizona did not terminate any providers due to quality of care issues.
10.28 What is the termination clause for dentists in your network?
As a not-for-profit dental service corporation, Delta Dental's contracts do not have a stated
expiration date; however, a participating dentist may resign their membership and give 30-
day notification. Delta Dental will terminate a dentist, if, the dentist has committed violations
that result in the termination of their dental license, billing irregularities, contract violations
and non-compiianee to correct contractual violations.
10.29 Address the number of days' notification a dentist is required to give prior to termination.
Delta Dental of Arizona's Provider Contract requires a 30-day notification prior to the
termination date.
10.30 Describe a terminating dentist's obligation for treatment-in-progress.
Any multi-stage/appointment procedure must be completed as treatment in progress; ie:
crown prep / delivery, multi state root canal, denture fabrication, etc.
10.31 In Maricopa County, what is the average discount for your contracted general dentists?
Delta Dental of Arizona's PPO network discount for general dentists is 33.9%.
10.32 In Maricopa County, what is the average discount for your contracted specialist dentists?
Delta Dental of Arizona's PPO network discount for specialists is 30.1%.
10.33 In Pinal County, what is the average discount for your contracted general dentists?
Delta Dental of Arizona's PPO network discount for general dentists is 33.9%.
10.34 In PinaI County, what is the average discount for you contracted specialist dentists?
Delta Dental of Arizona's PPO network discount for specialists is 30.1%.
10.35 Is your discount calculated from billed charges or R&C?
The PPO plus Premier and non-participating network reimbursement rates have evolved
independent of a targeted percentile. However, based on group request or procurement
specification, Delta Dental of Arizona can modify its R&C reimbursement for non-network
claims using our network reimbursement methodology.
10.36 If your discount is R&C, what is your data source and what percentile do you use?
To determine usual, customary and reasonable charges for network dental Delta Dental of
Arizona analyzes fees submitted by its contracted dentists throughout the state. The
submitted fees are contained in Delta Dental of Arizona's proprietary claims platform. The
data sets are separated into percentile arrays based on procedure code (ADA CDT) and
dental specialty. A statewide reimbursement rate for network providers is established. This
rate is the Maximum Reimbursable Amount (MRA).
10.37 Do you have an online tool where Maricopa County can verify the payment terms of a dental
contract, or contract status of a dental provider?
Delta Dental of Arizona's web portal houses a 'Find-a-Dentist' search function that is
accessible by MCOOH and their subscribers. Follow the link
http://www.deltadentalaz.com/provider-searchidental/ to review this site.
10.38 Give the total number of providers currently employed in Maricopa County and Pinal County in the
following categories and the rate of turnover during the last 12 months.
Delta Dental does not employee Dentist or Dental Hygienist. Delta Dental contracts only with
Arizona Licensed Dental as defined by State Statue and does not contract with Hygienist.
Nothing in the Agreement shall be construed to create (1) a partnership, joint venture or
other joint business relationship between the parties or any of their affiliates, (ii) any
Page 52 of 73

CONTRACT #: MA 1)860 190140
fiduciary duty owed by one party to another party or any of its affiliates, or (iii) a
relationship of employer and employee between the parties.
Number Annual Rate of Turnover
Dentists Maricopa County: Premier Network = .01
Premier Network = 1,997
FPO Network= 1,828 PPO Network = .01
Pinal County:
Premier Network: 202
PPO Network: 196
Specialists Maricopa County: Premier Network = .01
Premier Network = 582
PPO Network = 525 PA) Network = .012
Pinal County:
Premier Network= 81
FPO Network - 80
Dental Hygienists 0 Not Applicable
10.39 Complete the following table for R&C and PPO discounted fees. If you have individual
contracts/files fees for participating dentists, then report the medium filed fee/contract in the PPO
column. Base your fees on Maricopa County only.
Class Dental Procedure 90th Percentile 80th Percentile PPO Contracted Fee
R&C Charge R&C Charge
0120 $64.00 $59.00 $29.00
0150 $112.00 $105.00 $47.00
0210 $188.00 $169.00 $80.00
0272 557.00 $53.00 $26.00
0274 581.110 $75.00 $35.00
0330 $160.00 $59.00 $68.00
1110 5113.00 $107.00 $62.00
1120 $78.00 $74.00 $46.00
4910 $193.00 $176.00 $86.00
II 2140 $213.00 $178.00 $91.00
2150 $276.00 $231.00 $115.00
2160 $334.00 $279.00 $141.00
2330 $190.00 $176.00 $94.00
2331 5243.00 $225.00 $108.00
2335 $351.00 $325.00 $154.00
3310 $886.00 $833.00 $445.00
3320 $1,086.00 $1,021.00 $530.00
3330 $1,346.00 $1,266.00 $740.00
4260 $2,241.00 $2,014.00 $800.00
4341 $314.00 $286.00 $144.00
7110 Not on file Not on file Not on file
7210 $315.00 $299.00 $145.00
7230 $525.00 5500.00 5244.00
7240 $616.00 $586.00 $286.00
III 2750 51,383.00 $1,299.00 $750.00
2751 51,287.00 $1,209.00 $675.00
2752 $1,319.00 $1,238.00 $700.00
Page 53 of 73

CONTRACT #: MA 13860 190140
2790 51,334.00 $1,253.00 $741.00
2792 51,287.00 51,209.00 $720.00
5110 52,302.00 $1,974.00 $895.00
5214 $2,544.00 52,181.00 51,021.00
6240 51,338.00 $1,236.00 5750.00
6750 51,368.00 51,257.00 $750.00
6752 $1,307.00 $1,201.00 5700.00
Date fee January 2018
schedules were
last updated:
Planned date of Fee schedules are
next increase: reviewed on an
annual basis.
10.40 In what way and how often do you inform plan members of changes in your provider network?
Because members are not assigned to dentists, Delta Dental does not initiate communication
with its members to inform them of new dental providers or terminating providers. Instead,
Delta Dental provides its members with three choices to search for Delta Dental providers:
1. Members can call Della Dental toll-free at 866-978-2839 and use our automated
system to search providers in a member's requested zip code.
2. Members can search for providers using Delta DentaPs robust website at
d eltadentalaz.corn.
3. Members can contact Delta Dental's Customer Service department at 866-978-2839
and request a directory of providers be mailed.
10.41 If a member is having difficulty scheduling an appointment, what type of assistance does your
company provide?
Delta Dental of Arizona's provider network is a `freedom-of-choice' network, allowing
members to visit any provider anywhere and at any time. As such, we do not oversee dental
offices business practices or hours; however, a member may contact Delta Dental of
Arizona's Customer Service division to assist in locating a participating provider
10.42 What are your requirements of the contracted general dentists when requesting authorization from
your company, or anyone else, before they can refer a patient to a specialist?
Delta Dental of Arizona's provider network is a `freedom-of-choice' network, allowing
members to visit any provider anywhere and at any time. As such, a member does not
require a referral to visit a specialist.
10.43 Describe how do you monitor quality patient care with your providers, and how often is this done?
Members with quality of care concerns about the services provided by a participating dentist
are encouraged to contact Delta Dental of Arizona's Claims Customer Services Department
by telephone or submit their concern in writing.
Inquiries that pertain to specific group contract questions benefit information, Delta
Dental's claims processing policies, or requests to recalculate previously processed claims
are handled by Delta Dental's Customer Service department.
Quality of care complaints are forwarded to Delta Dental's Professional Relations team for
review and further consideration by Delta Dental's Dental Consultant.
Delta Dental will provide a written statement to enrollees regarding the disposition or status
of the complaint.
Upon receipt of complaints involving imminent and serious threat to a patient's health, Delta
Dental will immediately inform the member of the right to file a complaint with the Arizona
Board of Dental Examiners. Delta Dental will also start an investigation into the provider's
utilization and patient care history.
Page 54 of 73

CONTRACT #: MA D860 190140
Delta Dental will request all information from the dentist including; x-ray's, treatment
notes, treatment plan and any other pertinent information needed to assist the dental
consultant in making a fair and impartial decision.
After the Professional Relations team and Dental Consultant have thoroughly researched the
facts of the complaint and rendered an opinion, the member will receive a written decision
that will include any remedy afforded to the member as a result of their quality of care
complaint.
11.0 Claims Processing
11.1 At what geographic location will claims he processed?
5656 W Talavi Blvd Glendale, AZ 85306
1 1.2 What is your targeted turnaround time for processing a clean claim from the time that it is received
in your mailroom?
Fifteen (15) calendar days.
1 L3 What is your actual average turnaround time in the claims processing center that will process
MCOOH claims?
16 business days.
1 L4 Describe your claims facilities and procedures, including:
11.4.1 The percentage of dental claims undergoing review prior to payment and subsequent to
payment
An average of 20% of claims undergoes a claims auditor and/or a dental
consultant's review prior to applying a payment.
11.4.2 Measures taken to prevent fraud by your own employees related to claims processing and
claim/draft control.
Delta Dental of Arizona utilizes several processes to identify potential fraud and
abuse by its members. First, because a very high percentage of member claims are
submitted through participating dentists, Delta Dental's member fraud
identification process is intertwined with its Provider review process. For example,
during contract compliance reviews, the Professional Relations representatives can
identify suspicious member activity. Second, Delta Dental's claims system
automatically denies member claims when the dentist's professional license
information is not loaded to the system, patient's frequency limitations have been
exceeded, waiting periods have not been met, duplicate claims have been submitted,
as well as having to pass a history cross-check review (for example, a member
cannot have two root canals performed for the same tooth). Additionally, members
are restricted by benefits covered by the plan and an annual maximum benefit
amount. Delta Dental also encourages third-party reporting to identify potential
member fraud. Reporting can happen from a variety of sources: dentists, Delta
Dental employees, a non-involved party, the employer group, and the courts.
11.4.3 Measures taken to prevent fraud by providers.
Delta Dental of Arizona identifies suspicious activities through contract compliance
reviews and post payment modeling and profiling. An example is the review of
complex surgical extractions performed by oral surgeons. Delta Dental will audit
the dental office and provide additional training, if necessary. If the dentist refuses
to comply, they will be terminated from the plan.
Page 55 of 73

CONTRACT #: MA 1)860 190140
11.4.4 Your guidelines with respect to detection of and action on overcharges, unnecessary
dental procedures, multiple procedures to the same tooth and other cost control programs
you may utilize. What is the dental consultants' role in reviewing these claims?
Delta Dental of Arizona's claims platform automatically crosschecks history for
multiple procedures performed. The system also automatically checks for
coordination of benefits, eligibility, contract provisions, time limitations, and it will
automatically suspend claims that require dental consultant review. All of these
savings are summarized on the quarterly cost-containment report. Delta Dental
employs dental consultants who review claims to ensure that the treatment proposed
or provided falls within the scope of the group contract and that all re-treatment
provided was necessary. Clinical guidelines are developed by the Delta Dental Board
of Directors Dental Policy Committee (DPC). The DPC is comprised of eight
Arizona licensed dentists.
11.4.5 Your procedures for detecting duplicate payments and recovering such amounts from
providers or members.
Delta Dental's system automatically checks for duplicate payments. If recovery of
any mistakenly paid benefits occurs, Delta Dental will first ask the dental office to
return the overpayment If that payment is not received, Delta Dental's system is
capable of "taking" the monies back from future claims.
11.4.6 What procedures are in place to verify the continued eligibility of certain types of
members' eligibility?
Delta Dental will load the eligibility information provided by MCOOH and will rely
upon that information.
11.4.7 Your procedures for handling claim inquiries from members.
The customer service unit is a fully cross trained unit that is capable of explaining
all aspects of a claim payment. If the claim is found to be incorrectly processed, the
same representative is able to reprocess the claim. If the claim requires further
research, the employee can expect a call back within two business days.
114.8 Your procedure for handling claim inquiries from MCOOH?
Most issues can be addressed immediately on the phone. However, if research is
required, Delta Dental will within one working day to any inquiry from benefits
supervisor, manager, or designated staff regarding the disposition of pending
claims or eligibility issue.
11.4.9 What is the standard turnaround time for a dental pre-determination request?
90% in 10 working or 15 calendar days — aggregate not client specific, receipt date
to day of adjudication. Day of adjudication is not included.
11.4.10 How are dental pre-determinations handled in your system to ensure claims where a
predetermination was approved are paid accordingly?
Delta Dental's claims platform automatically crosschecks history for pre-
determinations. The system also automatically checks for coordination of benefits,
eligibility, contract provisions, time limitations, and it will automatically suspend
claims that require dental consultant review.
11.5 Are you willing to provide documentation of all case specific internal audit results to MCOOH?
Yes, Delta Dental of Arizona is willing provide requested documentation.
11.6 If you will provide documentation of all case specific internal audits to MCOOH, how often will this
documentation be provided?
Delta Dental of Arizona will provide documentation as often as requested.
11.7 State your definition of a claim transaction.
Page 56 of 73

CONTRACT #: MA D860 190140
A request for benefit payment, whether electronic or in paper, that contains all information
necessary to make a determination.
A request for benefit payment, whether electronic or in paper, that contains all information
necessary to make a determination.
11.8 Based on the definition given in 11.7, what is your average in-house service time, expressed in
business days, for processing a transaction during the last 3 months?
3.6 business days.
11.9 Describe your administration of maximum allowable charges and include:
11.9.1 How you define/determine the maximum allowable charge for an out-of-network
provider
Delta Dental of Arizona's non-participating dentist table of allowance is currently
defined as the 51st percentile of the fees filed by participating dentists.
11.9.2 If your reimbursement methodology differs from usual, reasonable and customary, a full
description of your methodology. Then answer all remaining questions appropriately for
the process you have described.
11.9.2.1 Describe the data used to develop reasonable and customary screens.
Delta Dental of Arizona utilizes filed fees of contracted providers.
11.92.2 At what percentile do you consider charges reasonable and customary?
Delta Dental of Arizona's Maximum Plan Allowance is set at the
90th percentile.
11.9.2.3 How many different geographic area screens do you maintain?
One/Arizona
11.9.2.4 What procedures, if any, are excluded from your reasonable and customary
screens?
Certain codes, such as cosmetics are excluded from benefit coverage.
11.9.2.5 Does your plan allow for balance billing to patients?
Delta Dental of Arizona providers are not allowed to balance bill.
Delta Dental providers are required to collect all deductibles and
co-insurances. Non-participating dentists may balance bill.
11.9.2.6 Can you pay out-of-network claims at the 90 th or Nth percentile of R&C?
Yes, Delta Dental of Arizona would be willing to comply to this
request.
11.9.2.7 If you cannot pay out-of-network claims at the 90 th Or 80th percentile of
R&C, then please explain how you pay out-of-network claims.
Delta Dental of Arizona would be willing to comply to an 80 or 90 Th
percentile option for MCOOH.
11.10 Explain your member appeal procedures.
Delta Dental of Arizona is compliant with the Department of Insurance mandated grievance
policies. Grievances must be submitted by the treating dentist. Delta Dental will review and
make a determination (claim is reprocessed for additional benefits or response letter is sent)
within 30 calendar days. Once the determination is complete the dentist is contacted by Delta
Dental. During this time the dentist cannot charge the patient for the amount in dispute.
These issues are non-appeal able issues because no procedure has been denied.
The Department of Insurance Mandated Claims Appeal Process is also in place. Either the
subscriber or the treating dentist can file an appeal. Delta Dental provides a form to be used
Page 57 of 73

CONTRACT #: MA 1)860 190140
for an appeal at the end of the Appeals Packet. This form is not required; a letter with the
same information is acceptable. If the subscriber decides to appeal a decision that denied a
pre-determination or payment of a service, the subscriber should tell the treating dentist so
that the dentist can help with the information needed to present the case. The process for an
Appeal is described in detail in the Appeals Packet, a separate document, which is provided
to the subscriber upon joining Delta Dental. Another copy of this Appeals Packet can be
obtained on the website or by calling Delta Dental's customer service department. There are
two types of appeals: an expedited appeal for urgent matters and a standard appeal, Each
type of appeal has 3 levels. The appeals operate in a similar fashion, except that expedited
appeals are processed much faster because of the patient's condition.
Expedited Appeals Standard Appeals
(Urgently needed services not yet received) (Non-urgent services or denied claims)
Level 1: Expedited Medical Review Informal Reconsideration
Level 2: Expedited Appeal Formal Appeal
Level 3: Expedited External Independent Review External Independent Medical Review
Delta Dental does not provide informal reconsideration of a denied claim; our appeals
process begins at the formal appeal level.
Delta Dental makes decisions at Level 1 and Level 2. An outside reviewer, who is completely
independent from Delta Dental, makes decisions at Level 3. The subscriber is not responsible
to pay the costs of the external review if the subscriber chooses to appeal to Level 3. All
subscribers should read the information in the Appeals Packet for details about rights and
responsibilities during the appeals ryrocess. These will include the procedures Delta Dental
and the subscriber must follow when participating in the appeals process, time period
applicable at each level of appeal, whether the request for an appeal must be in writing, and
notices that will be sent from Delta Dental regarding the appeal. Should the subscriber have
any questions regarding the appeals process and procedures, the subscriber should contact
Delta Dental at the numbers listed in the Appeals Packet. For additional assistance with
questions regarding the appeals process, the subscriber may contact the Arizona
Department of Insurance (ADOI) Consumer Assistance Office.
11.11 Do you have online access where MCOOH can check on the status of a claim?
Yes, Delta Dental of Arizona has a Subscriber Connection site housed on our website at
www.deltadentalaz.com . Members may access this site to review claim status, benefits, eob
statements, eligibility
11.12 Do you agree that MCOOH has the final jurisdiction, in case of a claim denial due to plan
limitations and/or exclusions, to have the claim processed for payment?
Yes, Delta Dental of Arizona Agrees.
12.0 Eligibility
12.1 Describe your process for handling eligibility exceptions?
Eligibility exceptions should be submitted in writing and are reviewed and determined by
Delta Dental of Arizona's Senior Management.
12.2 In the event of an emergency, state your average turnaround time for loading eligibility from paper
forms.
In the event of an urgent enrollment, Delta Dental of Arizona would process the enrollment
request immediately.
12.3 State your average turnaround time for loading eligibility file received from MCOOH.
Delta Dental of Arizona averages 24 hour turnaround time for electronic eligibility files.
12.4 Do you have online access where MCOOH can check or add eligibility for a member?
Page 58 of 73

CONTRACT ft: MA D860 190140
Yes, on the Delta Dental of Arizona website an Employer Connection site link is available. The
Employer Connection site allows authorized administrators to process enrollment, review
benefits, order BD cards, benefit booklets, print transaction reports and manage billing
statements (billing functionality is not available for administrative services only accounts).
This site can be accessed by visiting www.deltadentalaz.com .
13.0 Communications
13.1 Provide a copy of your current provider directory.
A Delta Dental of Arizona Provider Directory has been attached under the Questionnaire:
Required Attachments section of our bid response.
13.2 How often are your provider directories updated?
Provider Directories are updated monthly.
13.3 Do you have a website with up-to-date participating provider information? Is your website available
in English and Spanish?
Yes, Delta Dental of Arizona's website provides a 'Find-a-Dentist' link, the information is
available in English only. The information contained in this site is maintained as real-time
data.
13.4 If you have a web site with up-to-date participating provider information, provide the web address.
littp://www.deltadentalaz_com/provider-search/dental/
13.5 Describe how a member can obtain a directory of participating providers or participating provider
information.
Members may download a provider directory via Delta Dental of Arizona's website or
request one be mailed via our telephone automated system. Members may also speak to a
customer service representative to assist with locating a dentist in their area or to request a
provider directory be mailed to them.
13.6 Do. you issue I.D. cards?
Yes
13.7 Are the 1.D. cards personalized or generic?
ID Cards are personalized to identify the plan subscriber and group number.
13.8 Provide a sample of your 1.D. card.
A sample Delta Dental of Arizona member ID card has been provided under the
puestionnaire: Sainnie Communications & Coliaterais section of our proposal response_
13.9 Provide a sample of all your collaterals in English and Spanish?
Sample Delta Dental of Arizona collaterals have been attached under the Questionnaire:
Sample Communications & Collaterals section of our proposal response.
13.10 Are your collaterals available electronically in a PDF file format?
Yes
13.11 What is your turnaround time from the time eligibility is loaded until I.D. cards are mailed?
10 business days.
13.12 What is the frequency of your mailings of ID. cards?
Delta Dental of Arizona Member ID Cards run weekly and are mailed out every Monday
and Thursday.
13.13 Describe your Internet capabilities for this product including plan and claim documents.
Page 59 of 73

CONTRACT #: MA 0860 190140
Delta Dental of Arizona's website offers Employer and Subscriber connection sites.
The Employer site allows the group to manage online enrollment, plan information, print
member id cards , downloadable forms, provider directories, administrative guides and
much more. Additionally, some administrators have the ability to access billing and claims
data.
The Subscriber site allows members to view eligibility, benefits, claim status, cob statements,
provider directory, downloadable forms, oral health & wellness information, and much
more.
14.0 Reporting
14.1 Provide a sample of your standard reporting package? Does this include a claims paid by month
incurred matrix?
Sample reports and current MCOOH reports have been attached under the Questionnaire:
Exhibits & Reports section of our proposal response.
Yes, Delta Dental of Arizona reporting does include claims by month incurred_
14.2 State the frequency of the reports to be provided in the reporting package.
Delta Dental of Arizona can provide monthly, quarterly, or annually reports, depending
upon the needs of MCOOH.
Delta Dental of Arizona is currently issuing monthly, quarterly & annual reports to
MCOOH.
14.3 How will standard reports be distributed — electronically or in paper format?
Delta Dental of Arizona submits reports electronically, via email to account administrators
at MCOOH.
14.4 Confirm that the cost of your standard reports is included in your stated rates.
Delta Dental of Arizona does not charge a fee for reporting.
14.5 Do you have a query tool available where MCOOH can generate ad hoc reports?
No, an Employer query tool is currently not available. However, Delta Dental of Arizona
can provide ad hoc reports and requested data upon request
14.6 Are ad hoc reports available upon request and if so, how are they charged?
Yes, Delta Dental of Arizona can create ad-hoc reports upon request. There is no additional
fee related to ad-hoc reporting requests.
14.7 Are your utilization data and standard reports available in Excel-formatted files?
Delta Dental of Arizona's reports are generated and submitted in PDF format.
15.0 Rating/Financials
15.1 Describe in detail the funding arrangement you are proposing.
Delta Dental of Arizona is proposing a Fully Insured Participating (Retention) Risk
Contract as well as an Administrative Fee Only (ASO) Contract.
15.2 Indicate any minimum requirement for Ryan White members.
Delta Dental of Arizona's proposal is based on the current member participation and does
not have minimum requirements
15.3 To what degree are renewals based on the Ryan White insurance plan's own experience?
100%
Page 60 of 73

CONTRACT #: MA 1)860 190140
15.4 What has been your dental rating trend in Arizona for participating providers for the past 3 years?
4.50%.
15.5 What has been your dental rating trend in Arizona for non-participating providers for the past 3 years?
4.50%.
15.6 On what do you base your trend calculation?
Delta Dental of Arizona's trend calculation is based on current inflation rate of the weighted
average of submitted dental fees broken down by procedure code.
15.7 Describe how you pay for out-of-network claims?
Currently, Delta Dental of Arizona's out of network claims are processed by using Delta
Dental of Arizona's Non-Participating Dentist Table of Allowance. The Non-Participating
Dentist Table of Allowance is a state wide fixed fee schedule that is discounted
approximately 20% from network reimbursement rates.
15.8 Are out-of-network claims based on a percentile of R&C, MAC or some other reimbursement?
Delta Dental of Arizona Non-Participating Dentist Table of Allowance was originally
established by using the 51e percentile of usual, customary and reasonable charges. Today,
the table has evolved into a fixed fee schedule that is reviewed and updated independently of
a targeted percentile.
15.9 Fully describe your reimbursement of out-of-network claims.
Currently, Delta Dental of Arizona's out of network claims are processed by using DDAZ
Non-Participating Dentist Table of Allowance. The Non-Participating Dentist Table of
Allowance is a state wide fixed fee schedule that is discounted approximately 20% from
network reimbursement rates.
Once the provider's claim is processed, payment is issued to the plan member. However, as
the incumbent carrier, Delta Dental of Arizona's participating providers accepts assignment
of benefits & payment is made directly to the provider.
15.10 Is the out-of-network reimbursement you have built into your proposal mandatory, or are there
alternatives the client could choose?
Although less than 1% of claims (21 total claims in the last twelve months) were out of
network, Delta Dental of Arizona is willing to work with MCOOH to determine if an
alternative reimbursement option would best serve MCOOH needs.
15.11 What are the options available for out-of-network reimbursement?
The out of network reimbursement options available are PPO, Delta Dental's non-network
fee table of allowance, 80th percentile, 85th percentile, or 90th percentile.
15.12 What would the cost impact be to MCOOH to offer the other out-of-network options?
Because MCOGH's out of network utilization is so small with less than 1% of paid claims
processed through a non-network provider, any change to said reimbursement would be
negligible.
15.13 It is the intent of MCOOH to determine the method by which your renewal rates will be calculated
prior to entering into a contract. Describe your renewal calculation procedure in detail.
The formula used to calculate renewal rates is: Paid claims plus change in IBNR reserve,
divided by earned premium, multiplied by trend, divided by the projected loss ratio
required change to prior years premium rates.
15.14 Are the retention estimate, margin, and renewal procedures guaranteed with respect to the MCOOH
contract?
It is not the intent of Delta Dental of Arizona to change its methodology from initial renewal
to subsequent renewals.
Page 61 of 73

CONTRACT #: MA D860 190140
15.15 How long are your retention estimate, margin, and renewal procedures guaranteed?
Retention estimates, margin, and the renewal procedures are guaranteed for the duration of
the contract, given no substantial changes to enrollment, utilization or benefits during the
contract term.
15.16 How, if at all, will the initial renewal methodology differ from subsequent renewals?
Retention estimates, margin, and the renewal procedures are guaranteed for the duration of
the contract; given no substantial changes to enrollment, utilization or benefits during the
contract term. It is not the intent of Delta Dental of Arizona to change its methodology from
initial renewal to subsequent renewals.
15.17 Describe the financial obligations of MCOOH in the event of contract termination for incurred but
unpaid claims.
Delta Dental of Arizona's Fully Insured proposal product includes a component for incurred
but unpaid claims in the monthly premium; therefore, MCOOH would have no additional
financial obligation for run-out in the event of termination of the contract.
ASO: Upon termination of this contract, all duties and responsibilities of Delta Dental of
Arizona would cease on the effective date of termination, regardless if the Plan continues. At
Plan Sponsor's request, Delta Dental will continue to pay claims for dental benefits that were
incurred prior to the termination date for a period not to exceed three (3) months. Delta
Dental will continue to bill the Plan Sponsor for claims paid during this period for
reimbursement to Delta Dental.
15.18 Describe your claims tun-out process and limits in the event of contract termination.
Upon termination of This Contract, DDAZ (Delta Dental of Arizona) will use the pre-fund
deposit paid at the inception of This Contract to fund claims paid in the first month after
This Contract terminates, unless the ACH option was selected. The Employer Group has
thirty (30) days to release the reserve money to DDAZ upon termination of This Contract to
pay the balance of the claims incurred during the active Contract period but paid in the run
out months following the termination of This Contract. The run out period for this
Employer Group is indicated below. After the run out period has ended, any surplus of the
reserve monies released to DDAZ for the payment of ran-out claims will be returned to the
Employer Group. If claims paid exceed the reserve for these claims (IBNR), the Employer
Group will be billed for those additional paid claims and will have thirty (30) days to
reimburse DDAZ for those additional paid claims.
15.19 Indicate your current net assets and net operating income before and after taxes, and any deferred
taxation and cause.
Delta Dental of Arizona's current Net Assets as of July 2018 are $83,912,000 and Operating
Income (same before and after taxes) for the seven months ending 7/31/2018 is $1,519,000.
15.20 Include the most recent full annual report for the plan and its parent company, if any.
Delta Dental of Arizona did not produce a 2017 annual report and will be unable to attach
such documents as requested.
Page 62 of 73

CONTRACT MA D860 190140
ATTACEINIENT E
PROVIDER GEOGRAPHIC SUMMARY
Each type of provider shall appear on a separate summary. Photocopy these two pages and submit separate
summaries for each type of provider.
Dental Plan Providers
# Dentists
+ Specialists
Complete the following chart by zip code prefix and indicate type of provider:
Organization: Delta Dental of Arizona
Number of Providers by Provider Type
Type of Provider: General Deritisi
Maricona Count
Number of Zip Number of Zip Number of
Zip Providers Code Providers Code Providers
Code
85001 0 85022 54 85048 46
85002 0 85023 38 85051 45
80003 3 85024 16 85060 0
85004 56 85027 28 85061 0
85006 11 85028 28 85064 0
85007 2 85029 56 85066 0
85008 48 85031 50 85067 0
85009 29 85032 68 85068 0
85011 0 85033 53 85069 0
85012 26 85034 1 85075 0
85013 25 85035 46 85076 0
85014 37 85037 20 85078 0
85015 60 85039 1 85082 0
85016 51 85040 4 85201 28
85017 SO 85041 41 85202 35
85018 101 85043 60 85203 112
85019 11 85044 10 85204 46
85020 43 85045 0 85205 48
Page 63 of 73

CONTRACT #: MA D860 190140
85021 I 37 85046 0 II 85206 I 77
Page 64 of 73

CONTRACT #: MA 1)860 190140
; 0 za on Continued : Delta Dental of Arizona
Type of Provider (Continued): -e.tteral Dentiit
Number of Zip Number of Zip Number of
Zi p Providers Code Providers Code Providers
Code
85207 9 85255 34 85308 160
85208 12 85256 0 85310 7
85210 41 85257 8 85311 0
85211 25 85258 43 85323 26 '
85213 26 85259 28 85324 1
85215 16 85260 71 85326 19
85217 0 85261 0 85329 0
85219 0 85264 0 85331 18
85220 0 85267 0 85335 9
r
85222 0 85268 16 85338 64
85224 67 95274 0 85339 41
85225 72 85280 0 85340 21
85226 49 85281 5 85342 0
85228 0 85282 69 85345 17
85233 20 85283 46 85351 30
85234 46 85284 66 85353 29
85236 0 85285 1 85355 0
85242 0 85296 34 85361 0
85244 0 85299 0 85374 84
85248 52 85301 37 85375 30
1
85249 17 85302 53 85381 69
-
85250 10 85303 7 85382 51
85251 56 85304 8 85541 12
85252 0 85305 13 85731 5
85253 19 85306 35 85931 0
85254 51 85307 2
Final Corm
85217 0 85222 0 85232 0
85218 0 85223 0 85237
Page 65 of 73

CONTRACT 4: MA 0860 190140
85219 0 85228 0 85239 0
85220 0 85230 0 85241 0
85221 0 85231 0 85245 0
Organization (Continued): Delta Dental of Arizona
_
85247 0 85273 0 85279 0
85272 0 85278 0 85291
GRAND TOTAL NUMBER OF PROVIDERS: 3,488
Page 66 of 73

CONTRACT #: MA 1)860 190140
ATTACHMENT E
PROVIDER GEOGRAPHIC SUMMARY
Each type of provider shall appear on a separate summary Photocopy these two pages and submit separate
summaries for each type of provider.
Dental Nan Providers
+ Dentists
Specialists
Complete the following chart by zip code prefix and indicate type of provider:
Organization: Delta Dental of Arizona
Number of Providers by Provider Type
Type of Provider: Specialty Dentist
Maricopa County
Number of Zip Number of Zip Number of
Zip Providers Code Providers Code Providers
Code
85001 0 85022 46 85048 16
85002 0 85023 1 85051 12
80003 4 85024 3 85060 0
85004 13 85027 13 85061
85006 2 85028 15 85064 0 _
85007 0 85029 13 85066 0
85008 13 85031 6 85067 0
85009 3 85032 18 85068 0
85011 0 85033 17 85069 0
85012 12 85034 0 85075 0
85013 14 85035 14 85076 0
85014 18 85037 31 85078 0
85015 25 85039 0 85082 0
85016 17 85040 0 85201 3
85017 28 85041 7 85202 20
85018 57 85043 2 85203 20
85019 6 85044 34 85204 24
85020 11 85045 0 85205 16
Page 67 of 73

CONTRACT #: MA D860 190140
85021 20 85046 Q 85206 36
Page 68 of 73

CONTRACT #: MA. 1)860 190140
Organization (Continued): Delta Dental of Arizona
Type of Provider (Continued): Specialty Dentist
Number of Zip Number of Zip Number of
Zip Providers Code Providers Code Providers
Code
85207 8 85255 25 85308 84
85208 8 85256 0 85310 14
85210 85257 0 85311 0
85211 0 85258 15 85323 7
85213 10 85259 5 85324 0
85215 9 85260 55 85326
85217 0 85261 0 85329 0
85219 0 85264 0 85331 10
85220 0 85267 0 85335
85222 0 85268 0 85338 26
85224 67 95274 0 85339 27
85225 30 85280 0 85340
85226 18 85281 2 85342 0
85228 0 85282 20 85345 6
85233 9 85283 24 85351
85234 30 85284 14 85353 9
85236 0 85285 0 85355 0
85242 0 85296 23 85361 0
85244 0 85299 0 85374 43
85248 17 85301 EIIMIIIIII 85375 =EMI
85249 3 85302 011111111111 85381 11111111101
85250 0 85303 111.11111111111 85382 44
85251 44 85304 0 85541 6
85252 0 85305 4 85731 MM.
85253 12 85306 16 85931 0
85254 32 85307 0 MEM
Pinal County
85217 0 85222 0 85232 0
85218 0 85223 0 85237 0
Page 69 of 73

Contract #: MA D860 190140
85219 0 85228 0 85239 0
85220 0 85230 0 85241 0
85221 0 85231 0 85245 0
Organization (Continued): Delta Dental of Arizona
Type of Provider (Continued): Specialty Dentist
85247 0 85273 0 85279 0
85272 0 85278 0 85291 0
GRAND TOTAL NUMBER OF PROVIDERS: 1,501
Page 70 of 73

Cantract #: MA D860 190140
Contractor's Best and Final Response:
I. Yotfr prOpotal vtatet- 'siiioertrurillgorro- a dftitfronn teeth orify, synthetit both toirOr Parigx.'-' It is
MCDPWoteift tiot Nothetic tooth odFot-thotild be offered tor al teeth ot the van, benefit
rate as sihrer amalgam.
Delta Derl's sndfiFd benefit for -fillings arlovrE for on mpogte nhetic restofatipps
anterior (front) teeth, and siiver arnalzarri on post Error (back) teeth. it tom onalft material is
-used on the posterior teeth, an 3 ilielnir:e benefIr ap or icrl for The nalearn alPdihed amount . ,
with the difference, bet Wer, the ari-ieigarn and cdr.fipasIte benefit to be pe3-6 by ti7ee
it in with to a iP-aw- oar:Ida-site. if lines on pcisteflor tenth wfthout an alternate erietit
appled„ there would be nit cost Incr2af,e Lfo the proposed adrafoistrative leea, tinwer. -iir: On the
seif-itind,A1 on Ftfaci, the annual daims projections would incTease approximate ly
whicfi equatef=.to an addltIonRI S:a,0-2,0,-S`2,:;:30 in tams cost 'annually.
2. lii t-egardt to yOOr Quaky Marogemerft prograint tappeare that this program itgeared
to‘ivarrk yotriowo loterra stfutture and otoPees.. How do voo erisore the quality of the
ir4vidoal dental prodiclera torrlailloatl in your network?
Delta Dertal of Arlzooa Waws-StikE that anie ethical Arizona dentist in good standInt with
the Athrorta State 3oerrl of Dental ExaMlrItTs (BODEX) iel'[Ribile to become R Delta Dental
provider. Vo ensure this cpalifiraticiri Is Met, we have esta tlithed a cterte7tiaiit -ig- pirOcess to
r..f-een and approve dentiat5 before they can:air, our network of provders. This process
rrthb deu the review -and . .ierifiretion a the .icilidwing itern.tiL.
▪ A turner-it unrestricted I icente to practice dentistry in Aiizorre
▪ Any ppIkeble speelaity cerrifica'fions
• Sam:tic; rm- or extlfisionis frOm. 10edica re, the Otilte of frisp.e.-±or General, Med;raU or
Arty ted gra: hesItlf, care program
.t A* State 5pard 3:11017S within t h E
* Any Current iileal drug !Lin*
Any felony convicrlons
• A rnalprauti-rle insurance poitoywith rtInirnure cove e-ot SI. rnhlirtrt per claim are S9
ratlike:1i per year
• fotr.a DEA itcense to prescribe onfroiled_ sobstances
A dentist carrot be cod:el-Ai aled as a Delta Denial pi,nvIdot if he/the Is not in good standing
with q0DEX,. ppeers on the Office of Inspector Generaf's List of Excluded
Irldivi:daRt./Entitiet or tails to psoirltie proof of a-Curren h rrialarassicia imrance potty with
itinkinum. coverage of $1 rwilion per olairn and 3 million per yea r.
Delta Dental providers itijet go tivough pror_a_,4 EVery 3 years to re MR:Iri apart Of our
network_
Itt addition, Del tE Dental Of Arizaft.iientures a netWorisprCwideT'a ticeosure status remains
corn punt with bet h federal etd Mote req•A rem ents b? condEtaiME monthly checks with
aOiDEX and the Office of inspi.ittor Generars List of azi tided ineff tiEiE;„
Delta Dental of Arizona uses the :BODEX licensed dentist listing bp veefk gr that network
providers are licensed and inwmplCance with abate Mantla rdt. The LEW is used to -identify
dentists axdoded from participatinginMedicane, Medicaid and uther ledniul health care
prograrol KIDE-TX =certifies that a p,r0ii der -has rpst their lker-,e to practice dentistry or if

Contract #: MA D860 190140
the provider appears iiithe LEI:E, Delta Dental Of Arizona: immediately reMOves that provider
from the participating dentist registry and denies any future claim paymeints.
Delta Dental of Arizona Provider Relationn. also perform cinuticatt.corriplianee reviews and
dental office traoin 4slt. Dade Dental of Arizona s -taff conduct around 7S7 lrriingvinite
each year to us network dental offices._ During these visits. ciairn suibmistion best practices
and processing policy compliance are re.viewed.
3. in regards to your i-keivaritie/Appeal protses,_ do you have any mechanisrris in plate for
grievances that may come againSt yorJrseif from your individual dental prvkiiider0
Yes, Delta Dental. has proce.duresi in place to receive, research and resolve orn rcet t.htt ace
initiated by dental providers against Delia Dental,
4. larif your ironent regarthng questionable claims that may anSe.
Delta - DE.ntal of Arizona's claim system r,A5/4 KO Jr sedip on a utide-iiibiyi-tode basis for each
group denial contract. To accommodate -most treatment scenario types, this system has built-
in logic to automatically compare and then re-route to the correct treatment node when there
is other treatment information -submitted with the -ciairn or a treatment considered inclusive 15
foetid in the patient's history. Approximately 25% of all claims, including_iisociated dollars,
are 151iNed tO,V5,..qe..-71 processing methodology edits-and/or subserfUent man_ual intervention.
During the dataientry process, the system alerts the claims processor when varying logic
mismatch is tgcted is!these cases, the dairns processor is required to complete ark
altration of the information arri., in sorne CZPS., forward the claim to our Itertted dental
eOrtiSultant for review. The dental consultant will review the submitted claims information,
speak to the dentist in question, and visit the dental office if necessary to. make a
determination,. If firrithen investigation is required, a fraud form will he completed- and
forerarded to the appropriate .department.„ Our fraud: and abuse program Is used to
siarmtarize claims data to identify putenttai er4ornalies in dental practice patberns_
lovitigative methods include: a) cross-chez -king patient hiatoryOes to identify treatment(s)
that fail outside tire .sctipe of the client's contreet; hi analyzing utilization reports that
compare dentista 1-o Iheir peers and ideinit4 potentialiy variant circa:MI pra-ctiee .patterns;
monitoring. pre-negottatetl fees thiroirei the claims processing system,„thia$ pmteCting
members ti-DITI balance-hi-Hinz when unHer the careof contracted network providers,
5_ confireavcatrability.bp perform Individualized customer service surveys hy specific group plans_
Yes, Delta Dental of Arizona can conduct client specific s-ut ,teys. Delta Dental of Arizona
conducts member satisfaction sqritays using a random sampling of the p,roupfs membership.
The site of the sampling May vary depending On the number of responses. needed to athinve
the desired torifidenoe level arid/or other parameters_ A postcard Is mailed to each selected
member with a link tati the Web survey. The standard _survey has questions that cover the
rnarnbeee satisfaction with their provider 40d with Delta Dente/ of _Anton B.'s customer serVite-.
Depending on the clierit's needs, the survey can be conducted on a quarterly, semi-annual or
annual -bases and questions Cjil he designed to meat the client's request.
Page 72 of 73

Contract #: MA D860 190140
Clarify 'arty ree-btictionsori ntental
Implants are benefit once in a 5--year marwJ arkidto replete e single Missing tooth ottly.
iriplant bee etit is 1i -rm.:ed. te $1,0110 pent-due-J., pet lin-time uted is- applied to the patient's
benefit year biaxirrits7n.
7_ Verify tinet ttmoiher-a wit teteiv" klentitimtioo dards and hOw the processtiktlil work_
Yes, all erarrAling.subscrtters rEE_Ei:VE 2 rkelta Dental of - Arizona 1,0 Cards. ID Cares and hen-etit
booklets are mailed thie sultiertibers address within LC , business days of receiving the
sii beniberr int'crimattan_ C-rnently a the-incumbent narriPc Delta Dentai of
Aritboa lLasa artaogaroent wtri MCDPHvithereti. MCDP H Iceetha id cares to the
subccitbers.
.Expiaire the reasdoing hehInd dfferir4 bitewing X-r-go twine year hut verti cal bitettritigs. ouly
do-Le lila three-year rierid.d..
Vertii bTtevilogs are generaby ta'kffi io sets coi Films, due to -thteir Urn iteb hori±ental
skate/venti4.-al naturn, and are _s`reen eis a repieoarient for-end share a trequerkpe with a tall
inb.tirti series curie 0C20. Vertical initevi-ngs are as cort.-intotiN uttIl.ted as the nature or
tiklog twite. a .year standard bitewinga are fri di3gDa.- -,...-= the Interpre-xlitmal spaces in betweerk
the teeth, id antilyine potential demy or pooblvins that cannot be see o whe-o the provider ls
competing-the inter-ciral- assess, ment at the periodic visit_ It there is any trum corttrn about
bone lass cii potentia pathology to-wands the apical tip (A a given -Lae&a singie lit:tie:plc-AIX--
ray is generally taken of the iselated area. Additionally„ Delta mut racogriimesand aligns
with the As Low Its Reasonably Athieyabie (AIA -W guidelines tor minirblzing dental X-ray
radiation exposure to pattar,tset ostabsneb in 20 22 by the Ai-nen:can- Dental Azortatiori
I.L.A.D1-4 and the f-Pbd and Drug Adentn istration f FD
9. Confirm the requested AS-0 fee fng - yeam I through 3 is S11 aldgfkg with a tna.idtnurrt rate
inzrease for years 4 thrcalOo 6-of 4_5%
CdrAirmed,
O. Verify that no-deductible is rellutred On the PPO Plus Ketnter ASO Oar} you proposed.. The
charta included irk your Dentat cilltke indicated theta deductible apphes tb Ra5it &Major
Seattes, Piease clacity,
Confirmed, there is no deductible thateppries: tbmrard riodtErre, Badk, r M41137 services. $ee
attached proposal &summan'nrfbe nahtu.
Page 73 of 73