Policy Endorsement #5
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November 28, 2007
Ms. Krystal Norris
City of Salina
300 W Ash, Room 2006
Salina, KS 67402-0736
RE: Renewal of Group Dental Cantract #90396
Dear Ms. Norris:
Your contract with Delta Dental of Kansas will renew on February 1, 2008. We are pleased to be able to serve you
and yoUr employees again and are committed to aur continued partnership with you.
Because Delta Dental makes every effort to hold increasing dental costs to a minimum, your administrative rate for
February 1, 2008 experienced only a slight increase. Effective with your February 1, 2008 renewal, the
administrative rate for your dental coverage will change to. $3.25* per subscriber per month for tills next policy year,
February 1, 2008 to. January 31, 2009.
* 3 yr agreement: $3.00 for 2006 and 2007 and $3.25 for 2008.
,
Enclosed is a policy endorsement which reflects the revised rates. Please sign and return one of the endorsements in
the enclosed self-addressed envelape, or fax to 913/381-8312. This endarsement must be returned by Tanuaty 1.
2008 to. ensure timely submissian af yaur graup's renewal.
We look forward to the continued opportunity to be of service to you and your employees. If you have any questions
regarding your renewal, please feel free to contact your agent or me at anytime.
Sin1ef'
f' A / A ~?')I[.
M/N':::n:1
Account Executive
AN /kam
Enclosures
DELTA DENTAL OF KANSAS
1619 N. Waterfront Parbvay
P.O. Box 789769
Wichita. KS 67278'9769
Main Telephone:
Customer Service;
Marketing & Sales:
Eligibility & Enr?llment:
),6.264.,099
3I6.z64-45II
),6'264.84')
3'6'264'45"
800'7))'5823
800'2)4')375
800'264'9462
800,234'3375
Fax: )16'462'))9)
Fax: )16-462'339)
Fax:)16'462-)329
. Fax: 3'6'462'3394
POLICY ENDORSEMENT NO.5
FOR GROUP #90396
Attached to and forming a part of the Agreement To Provide Dental Care Benefits between
City of Salina (plan #90396) and the Delta Dental of Kansas, Ine.
It is agreed and understood that effective with the Februaty 1, 2008, renewal, Section I, Number 6 shall
read:
RATE: Administrative Fee: $3.25
(per subscriber per month)
* 3 yr agreement: $3.00 for 2006 and 2007 and $3.25 for 2008.
Please acknowledge acceptance of renewal by signing below and returning one copy of the policy
endorsement in the enclosed, self addressed envelope or fax to 316/462-3329 by January 1. 2008.
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S. ture
I~- 18-U1-
Date
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Delta Dental of Kansas, Ine.
POLICY ENDORSEMENT NO.5
FOR GROUP #90396
Attached to and forming a part of the Agreement To Provide Dental Care Benefits between
City of Salina (plan #90396) and the Delta Dental of Kansas, Inc.
It is agreed and understood that effective with the February 1, 2008, renewal, Section I, Number 6 shall
read:
RATE: Administrative Fee: $3.25
(per subscriber per month)
* 3 yr agreement: $3.00 for 2006 and 2007 and $3.25 for 2008.
Please acknowledge acceptance of renewal by signing below and rerurning one copy of the policy
endorsement in the enclosed, self addressed envelope or fax to 316/462-3329 by TanuaJy 1. 2008.
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Delta Dental of Kansas, Inc.
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