Contract - United Concordia Dental - 11/7/2024 United Concordia
dental
October 3,2024 "Revised2"
City of Round Rock
Craig Morgan
221 East Main Street
Round Rock, TX 78664
Re: City of Round Rock: Dental Insurance Renewal for 2025
Group Numbers: 923517-000/001/099; Account Number:0228442
Dear Mr. Morgan:
Thank you for allowing United Concordia to continue to serve as the dental plan administrator for
City of Round Rock.We appreciate the opportunity to provide the employees and their
dependents with access to quality,affordable dental care. Please allow this letter to serve as formal
notification of the renewal of the Administrative Services Only(ASO)dental contract with United
Concordia for the policy period of January 1, 2025 through December 31,2027 (3-years). Effective
January 1, 2025,the group's Administrative Fee/Network Access Fee(NAF)for the United
Concordia dental program are as follows:
Current ASO Fee:$1.20 Renewal ASO Fee:$1.20
Current ASO NAF: 12% Renewal ASO NAF: 13%
*Included in renewal is increase of CIAI to$2,000
Enclosed is a copy of the Renewal Acceptance Form. Please have an authorized representative sign
and scan a copy to my e-mail, felicia.knox@ucci.com. If a copy of the Renewal Acceptance Form is
not received by United Concordia, payment of the above renewal ASO fees will constitute
acceptance of the United Concordia dental program.
Should you have any questions with regards to the above fees/rates, please contact me at
(713)787-0562. United Concordia Companies, Inc. looks forward to continuing as the dental
benefits administrator of choice.
Sincerely
Felicia Knox
Sr. Client Manager, United Concordia
Attachment: Acceptance Form
9801 Westheimer Road I Suite 310 I Houston,TX 77042 1713.787.0562
United Concordia
dental
City of Round Rock
United Concordia Renewal Acceptance Form
Funding: Administrative Services Only(ASO)
Fee Policy Period: January 1,2025 through December 31,2027(3-years)
*Included in renewal is increase of OM to$2,000
Group Numbers: 923517-000/001/099
RENEWAL ASO FEE: $1.20* RENEWAL NAF FEE: 13%**
1, a l ,as a duly authorized representative of the above
named, b the monthly ASO fees as noted above.
< <el (21
Si ture Da e
Please return Acc tance to: felicia.knox@ucci.com
Or
Felicia Knox
9801 Westheimer Road
#310
Houston,TX 77042
(713)787-0562
*The ASO Fee is per contract per month.
"The Network Access Fee(NAF)is the percentage of the difference between the amount billed by a
participating provider for a covered service and the allowed amount negotiated by the Claims Administrator
with the participating provider for the covered service.
Notice: United Concordia requires at least 31 days written notice prior to termination of group
policy.
9801 Westheimer Road I Suite 310 I Houston, TX 77042 1713.787.0562
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