2012-038 Human Resources - Delta Dental Claims & Administrative fees

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Exhibit A Delta Dental PPO plus Premier This Contract is effective the lst day of January, 2012 A.D., by and between Orange County, hereinafter referred to as the Contractor and Delta Dental Plan of North Carolina, Inc., a North Carolina non-profit corporation, hereinafter refened to as Delta Dental. Section I. Declarations The benefits afforded are only with respect to such benefits as are indicated in this Contract. Delta Dental's liability is limited to the benefits stated herein; subject to all the terms of this Contract having reference thereto. This Declarations Section supersedes any contrary provision of the subsequent sections of this Contract. A. Effective Date of Contract Year: 12:01 A.M. Standard Time, January 1, 2012 A.D. B. First Renewal Date: January 1, 2014 C. Group Number: 8702-0001, 0999 D. Eligibility (Subscribers and dependents): All eligible employees who have met the eligibility requirements as established by the Contractor. Dependents and domesric partners of above mentioned Subscribers are also eligible. Children under age 19 are eligible for benefits regardless of student status and/or disability. Eligibility is extended to age 26 only for children who are full time students. Subscribers and eligible dependents must enroll for a minimum of 12 months. If coverage is terminated after 12 months, they may not re-enroll prior to the open enrollment that occurs at least 12 months from the date of termination. Dependents may only enroll if the Subscriber is enrolled (except under COBRA) and must be enrolled in the same plan as the Subscriber. Plan changes are only allowed during open enrollment periods, except that an election may be revoked or changed at any time if the change is the result of a qualifying event as defined under Intemal Revenue Code Section 125. A domestic partner is defined as follows: Domestic Partner - A person of the same or opposite gender, not related by blood to the employee, who is not legally married to the employee or anyone else, and who shares the following with the employee: i) an exclusive, committed relationship as provided in the Declaration of Domestic Partnership statement, 2) a residence, and 3) responsibility for each otherT"'s common welfare and financial obligations. Note: To qualify for pomestic Partner coverage, the employee and his or her pomestic Partner must meet all of the following criteria and must sign the North Carolina Association of County CommissionersT"' Risk Management Poo1T"'s Declaration of Domestic Partner status attesting that they are: a. At least 18 years old and mentally competent to consent to a civil contract, b. Not acting under force or duress, c. Not legally married to any other person and not engaged in another domestic partner relationship, d. Not related by blood, e. Engaged in an exclusive, committed relationship that has existed for at least 12 consecutive months, f. Currently reside together and intend to do so permanently, g. Responsible for each otherT"'s common welfare and either: - Are jointly responsible for their assets and debts as provided by applicable law, or