Renewal Addendum No. 1RENEWAL ADDENDUM NO. 1
FOR GROUP'S #90396
Attached to and forming a part of the Agreement To Provide Dental Care Benefits between
City of Salina (plan #90396) and Delta Dental of Kansas, Inc.'
It is agreed and understood that effective with the February 1, 2013, renewal, Section VIII,
Number 3 shall read:
Please acknowledge acceptance of this renewal by signing below and returning the renewal
confirmation by fax to (316) 462 -3329 or by email to marketing @deltadentalks.com by
January 1, 2013.
Printed e
Signafure
Date
Agent's Name
Please assist us in updating our records by providing the name & email address of your
group administrator.
Contact: Email: _ /- G /�a. �s
•4 S � r(f sz , U
WELLNESS CONNECTION — As the dental benefits experts, we're here to help educate your V
employees on the importance of good oral health. Visit the Wellness Connection on our website,
.www.deltadentalks.com, to download easy -to -use wellness materials.
OPTION I
ADMIN RATE: Current:
New:
❑
$3.60
$3.65
NOTE: I year agreement; $2.25 Per Sub/Month for 2013.
OPTION II
ADMIN RATE: Current:
New:
❑
$3.60
$3.60 — 2013-
No Increase
$3.65-2014
NOTE: New 2 year agreement.
Please acknowledge acceptance of this renewal by signing below and returning the renewal
confirmation by fax to (316) 462 -3329 or by email to marketing @deltadentalks.com by
January 1, 2013.
Printed e
Signafure
Date
Agent's Name
Please assist us in updating our records by providing the name & email address of your
group administrator.
Contact: Email: _ /- G /�a. �s
•4 S � r(f sz , U
WELLNESS CONNECTION — As the dental benefits experts, we're here to help educate your V
employees on the importance of good oral health. Visit the Wellness Connection on our website,
.www.deltadentalks.com, to download easy -to -use wellness materials.
www. de I Laden tatks.com
Di DE AL
November 14, 2012
Ms. Jennifer Perry
City of Salina
300 W Ash Room 206
Salina, KS 67402 -0736
RE: Renewal of Group Dental Contract #90396
Dear Ms. Perry:
Your contract with Delta Dental of Kansas renews on February 1, 2013. It is our pleasure to serve you and your
employees and we are committed to our continued partnership.
Effective with your February 1, 2013 renewal, the administrative rate for your dental coverage will change from
3.60 to $3.65 per subscriber per month for this next policy year. February I, 2013 through January 31, 2014.
OPTION 1 Current Admin Rate: New Admin Rate:
$3.60 $3.65
NOTE: 1 year agreement; $3.65 Per Sub/Month for 2013.
OPTION 11 Current Admin Rate: New Admin Rate:
$3.60 $3.60 — 2013 — No Increase
$3.65-2014
NOTE: New 2 year agreement.
Enclosed is a policy endorsement to indicate your acceptance of this renewal. Please sign and return the
endorsement via fax to (316) 462 -3329, or email to marketing @deltadentalks.com, This endorsement must be
returned by .lanuary 1, 2013 to ensure timely submission of your group's renewal. Please attach a signed copy
of the endorsement to your current contract.
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.
Sincerely, g//�� ��A y N talie
Account Executive
AN/kam
Enclosures
DELTA DENTAL OF KANSAS Main Telephone 316- 264 -1099 800733.5823
1619 N. Waterfront Parkway Customer Service: 316264.4511 800. 2349375
P.O. Box 789769 Marketing & Sales: 316264.8413 800264.9462
Wichita, KS 67278-9769 Eligibility & Enrollment 316.264.4911 800.234.3375
Fax: 316.462.3393
Fax: 3j6-462-3392
Fax:. 316462.3329
Fax; 316.462-3394