County of Orange Dental Plan ASO Base Fees. Fee Charges Per Employee Per Month (PEPM) Description Year 1 2025 Year 2 2026 Year 3 2027 *Year 4 if renewed 2028 *Year 5 if renewed 2029 ASO Fees $4.28 $4.39 $4.50 $4.50 $4.50 Fiduciary Included Included Included Included Included PPO Network Access Included Included Included Included Included Claims and Litigation Support Services as defined in Scope of Services for two years following termination of contract. Total $4.28 $4.39 $4.50 $4.50 $4.50 2. PPO Network Savings Guarantees Contractor guarantees to County of Orange Dental PPO Network Savings during the contract period as set forth in this Attachment B. Adjustment to the administrative fee shall be as follows and subject to the Definitions and Calculations as stated below: Definitions and Calculations: DPPO In-Network Discount Guarantee ......................................................................................... 35% Dental – Administrative Fees at risk .............................................................................................. 20% Period Covered January 1, 2025 to December 31, 2025 Assumed number of active members in Blue Shield PPO plan 2162 Assumed number of active employees in Blue Shield PPO plan 5395 DPPO Assumptions Allowed = Allowed Amount Based on Fee Schedule assigned to Zip and Procedure Code Mean = 50% UCR Discount = 1 - Allowed/Mean • 35% average discount off of the 50th percentile for all paid services. • Total paid amount divided by total calculated charges using established percentile for paid procedures. • Orthodontics are not included in the calculation. • Savings are based on contracted providers within the network. • The established percentile for the average discount will be based on Fair Health schedules. • Client specific – tracked quarterly, reported annually.
