C-86-19-025-3-02 CONTRACT AMENDMENT.PDF

CONTRACT NO:  C-86-19-025-3-02                                                     AMENDMENT NO:         2        
                                                                         
 
1
 
AMENDMENT TO CONTRACT  
Between 
MARICOPA COUNTY  
By and Through  
DEPARTMENT OF PUBLIC HEALTH 
and 
Delta Dental Plan of Arizona 
 
 
I. 
The above-named contract is hereby amended as specified below: 
 
A. The Expiration date shall be extended thru February 28, 2023.  
 
B. Update to Appendix A, Summary of Benefits to reflect the rates in effect regarding the 
Plan Year Benefits Maximum per person: 
 
i. From 10/01/2020 – 2/28/2022, the maximum rate increased from $1500.00 to 
$5,000.00 per person per benefit year. 
 
ii. From 3/01/2022 – 2/28/2023, the maximum rate shall be decreased from $5,000 
to $2,500 per person per benefit year. 
  
II. 
All other terms and conditions of the original contract and its amendments shall remain in full 
force and effect. 
 
 
IN WITNESS WHEREOF, the parties agree to the changes indicated herein: 
 
      
FOR AND ON BEHALF OF                            
MARICOPA COUNTY 
 
FOR AND ON BEHALF OF DELTA DENTAL 
PLAN OF ARIZONA 
                              
 
By:  
 
 
By: 
 
        Chairman, Board of Supervisors 
 
         Delta Dental of Arizona  
 
 
Date 
 
 
Date 
ATTEST 
 
 
 
Clerk of the Board 
 
 
 
Date 
 
 
 
 
 
 
 
APPROVED AS TO FORM 
 
 
 
 Attorney for Maricopa County 
 
 
 
Date

CONTRACT NO:  C-86-19-025-3-02                                                     AMENDMENT NO:         2        
                                                                         
 
2
 
 
EXHIBIT A -CONTRACT RENEWAL 
Delta Dental of Arizona 
Dental Renewal for Maricopa County Office of Health Promotion & Education #4715 
Effective March 1, 2022 
Administrative Services Fees 
Fee per subscriber per month 
Current Fee(s) 
March 1, 2021 through February 28, 
2022 
Renewal Fee(s) 
March 1, 2022 through February 28, 2023 
Subscriber only 
$3.91 
$3.91 
Overall Percent Change 
0.00% 
 
 
Fee per subscriber per month 
Current Equivalency Rate(s) 
March 1, 2021 through February 28, 
2022 
Recommended Equivalency Rate(s) 
March 1, 2022 through February 28, 2023 
Subscriber only 
$72.83 
$72.83 
Overall Percent Change 
0.00% 
 
In addition to the Administrative Service Fee, Delta Dental shall invoice client for the cost of claims pursuant to 
the contract. Delta Dental considers remittance of payment as acceptance of the contract and will begin 
administering benefits accordingly. 
Rating Requirements 
Minimum client contributions: 100% for subscriber. 
Participation requirements: 100% 
Rating Assumptions 
The fee is valid for the effective date noted above and is guaranteed through the period shown above. 
Fee includes broker commission, if applicable. 
A directory of participating dentists is available online at www.deltadentalaz.com/find 
Group will provide each Subscriber with copies of the Certificate, the applicable Summary(ies) of Benefits, the 
Appeals Packet (if applicable), and all privacy notices and other notices from Delta Dental as may be required by 
any applicable federal or state law, at such intervals as may be required by law. 
The plan specifications are subject to exclusions and limitations. Refer to the Summary of Benefits for more 
information. 
November 29, 2021 
4715-10009000