HomeMy WebLinkAboutCity Council Meeting - Council - Agenda - 01/07/2014 $2,786,999.22
Approval of checks issued for payroll for November 1 through November 15 and
paid on November 20, 2013:
Date Check Numbers Amount
11/20/13 Checks 333564-333707 $ 85,420.17
11/20/13 Advices 321578-322205 1,254,145.24
$1,339,565.41
C. GEI Consultants, Inc. Agreement for Briscoe-Desimone Levee Reach 1 -
Authorize. Mayor Cooke was authorized to sign a Consultant Services Agreement with
GEI Consultants, Inc. in an amount not to exceed $399,124 to provide engineering
services for the Briscoe-Desimone Levee Reach 1 project, subject to final terms and
conditions acceptable to the City Attorney and Public Works Director.
D. 2014 Water Treatment Chemical Supply Agreements
1. JCI Jones Chemicals Inc. Agreement for Water Treatment Chemical
Supplies — Authorize. The Mayor was authorized to sign an agreement with JCI
Jones Chemicals, Inc. for water treatment chemicals, in an amount not to exceed
$91,000.00, subject to final terms and conditions acceptable to the City Attorney and
Public Works Director.
2. Cascade Columbia Distribution, Inc. Agreement for Water Treatment
Chemical Supplies for 2014 — Authorize. The Mayor was authorized to sign an
agreement with Cascade Columbia Distribution, Inc. for water treatment chemicals in
an amount not to exceed $30,900.00 subject to final terms and conditions acceptable
to the City Attorney and Public Works Director.
E. Kent Regional Trail Connector Consultant Agreements
1. Environmental Science Associates (ESA) for Environmental
Engineering Services- Authorize. The Mayor was authorized to sign a Consultant
Services Agreement with Environmental Science Associates (ESA) in an amount not
to exceed $30,847.00, to provide environmental engineering services for the Kent
Regional Trails Connector Project, subject to final terms and conditions acceptable to
the City Attorney and Public Works Director.
2. GeoEngineers, Inc. for Geotechnical Services — Authorize. The Mayor
was authorized to sign a Consultant Services Agreement with GeoEngineers Inc. in an
amount not to exceed $12,559.00, to provide geotechnical services for the Kent
Regional Trails Connector Project, subject to final terms and conditions acceptable to
the City Attorney and Public Works Director.
3. Shearer Design for Structural Engineering Services — Authorize. The
Mayor was authorized to sign a Consultant Services Agreement with Shearer Design
in an amount not to exceed $34,847.00 to provide structural engineering services for
the Kent Regional Trails Connector Project, subject to final terms and conditions
acceptable to the City Attorney and Public Works Director.
F. Green River Natural Resources Area Pump Station Consultant Agreements.
1. Pace Engineers, Inc. for Design Services — Authorize. The Mayor was
authorized to sign a Consultant Services Agreement with Pace Engineers Inc. in an
amount not to exceed $172,855 to provide pump station design services for the Green
River Natural Resources Area Pump Station Project, subject to final terms and
conditions acceptable to the City Attorney and Public Works Director.
2. Historical Research Associates for Archeological and Historic
Preservation Services- Authorize. The Mayor was authorized to sign a Consultant
Services Agreement with Historical Research Associates in an amount not to exceed
$13,537 to provide archeological and historic preservation services for the Green River
Natural Resources Area Pump Station Project, subject to final terms and conditions
acceptable to the City Attorney and Public Works Director.
3. GeoEngineers, Inc. for Geotechnical Services- Authorize. The Mayor was
authorized to sign a Consultant Services Agreement with GeoEngineers Inc. in an
amount not to exceed $27,526 to provide geotechnical engineering services for the
Green River Natural Resources Area Pump Station Project, subject to final terms and
conditions acceptable to the City Attorney and Public Works Director.
G. County Road 8 Levee Consultant Agreements.
1. Northwest Hydraulic Consultants, Inc. for Hydraulic Analysis Services-
Authorized. The Mayor was authorized to sign a Consultant Services Agreement with
Northwest Hydraulic Consultants Inc. in an amount not to exceed $18,194 to provide a
hydraulic analysis in support of levee certification for the County Road 8 Levee Project,
subject to final terms and conditions acceptable to the City Attorney and Public Works
Director.
2. GeoEngineers, Inc. for Engineering Services and Certification Report-
Authorized. The Mayor was authorized to sign a Consultant Services Agreement with
GeoEngineers, Inc. in an amount not to exceed $37,865 to provide engineering
services and a certification report for the County Road 8 Levee Project, subject to final
terms and conditions acceptable to the City Attorney and Public Works Director.
H. GC Systems Inc. Agreement for Valve Actuator, Inspection and
Replacement — Authorize. The Mayor was authorized to sign a two year Contract
with GC Systems, Inc., in an amount not to exceed $25,757.46 for the inspection and
replacement of 31 hydraulically operated water control valves, subject to the final
terms and conditions acceptable to the City Attorney and Public Works Director.
I. Motorist Information Sign Program, Ordinance - Adopt. Adopt Ordinance No.
4095 amending Chapters 6.07 and 15.06 of the Kent City Code to implement a
Motorist Information Sign Program.
J. King County Sewer Franchise Agreement — Authorize. The Mayor was
authorized to sign a Sanitary Sewer Franchise with King County to allow the City to
operate its sanitary sewer system in rights-of-way in unincorporated King County,
subject to final franchise terms and conditions acceptable to the City Attorney and
Public Works Director.
K. Carl Warren & Company Consultant Agreement for Claims Administration-
Authorize. The Mayor was authorized to sign a Consultant Services Agreement with
Carl Warren & Company for $51,542 annually for 2014 and 2015, and $53,000 for
2016, to provide claims administration services, subject to final terms and conditions
acceptable to the Risk Manager and City Attorney.
L. Tri-Tec Communications, Inc. Goods and Services Agreement for Phone
System Upgrade — Authorize. The Mayor was authorized to sign a purchase order
in the amount of $138,769 for telecommunications equipment, services, and
maintenance, included in the Goods and Services Agreement with Tri-Tec
Communications, Inc. originally signed in May 2013, subject to final terms and
conditions acceptable to the City Attorney and Information Technology Director.
M. Copper Ridge Final Plat — Approve and Authorize. The Mayor was authorized
to sign the mylars and approve the final plat for Copper Ridge.
N. 2014 Federal Lobbyist Consultant Services Agreement — Authorize. The
Mayor was authorized to sign the 2014 Consultant Services Agreement with VanNess
Feldman, Attorneys at Law, representing the City of Kent as its federal lobbyist, is an
amount not to exceed $56,000.00, subject to final terms and conditions acceptable to
the City Attorney.
0. 2014 Kent Downtown Partnership Consultant Service Agreement —
Authorize. The Mayor was authorized to sign the 2014 Consultant Services
Agreement with Kent Downtown Partnership in an amount not to exceed $33,600.00,
subject to final terms and conditions acceptable to the Economic and Community
Development Director and the City Attorney.
P. Department of Natural Resources Tree City USA Grant for Campus Park —
Accept. The Mayor accepted Department of Natural Resources Tree City USA Planting
Grant for Campus Park in the amount of $2,104.00, approve the expenditure of funds
in the Green Kent Partnership Budget, and authorize staff to sign all necessary
documents, subject to final terms and conditions acceptable to the City Attorney and
Parks and Community Services Director.
Q. King Conservation District Grant Agreement for Green Kent Partnership —
Accept. The Mayor accepted the $54,086.00 grant from the King Conservation
District, authorize the Mayor to sign all necessary documents, and approve the
expenditure of funds in the Green Kent Partnership budget, subject to final terms and
conditions acceptable to the City Attorney and Parks and Community Services Director.
R. Kent Lions Donations — Accept. The Mayor accepted $85,000 in donations from
The Kent Lions and approves the expenditure of funds in the following budgets: $5,000
in the Senior Center Budget, $5,000 in the Recreation Scholarship Budget and $75,000
in the Parks Planning and Development Lifecycle Budget.
OTHER BUSINESS
A. 2014 State Legislative Agenda — Approve. Mayor Cooke noted that the Council
reviewed the legislative agenda at the workshop. Michelle Wilmot discussed the
legislative agenda and stated that the City has $10 million of annual state shared
revenues that the City needs to keep abreast of. She communicated all of the new
additions to 2014 which involved having the reimbursement funds from the newly
established DUI pilot treatment program go to cities instead of counties, having Police
Chief Ken Thomas work on the statewide gang intelligence database with police chiefs
across the state, and revising the RCW to allow cities to increase the bid amount of an
in-house public works project to 10 percent of the City's public works budget.
Council President Higgins moved to approve the 2014 State Legislative
Agenda, seconded by Councilmember Thomas.
Councilmember Albertson recused herself from the vote due to the fact that she may
be serving on the legislature in 2014.
A vote was taken on the motion on the table which carried 6-0-1.
Councilmember Albertson abstained.
B. Downtown Subarea Planned Action Ordinance and Infill Exemption
Ordinance — Adopt. Mayor Cooke communicated that this item has received a lot of
public input and introduced Fred Satterstrom, Planning Director who communicated
that Option 3 passed the Economic and Community Development Committee by a 3-0
vote. He presented all three options to the Council.
Councilmember Perry moved to adopt Ordinance 4096 and Ordinance 4097
adopting a Planned Action Ordinance and an Infill Exemption Allowance
Ordinance for the Downtown Subarea Action Plan study area as presented in
Option 3 of the Council agenda and as recommended by the Economic &
Community Development Committee, seconded by Councilmember Boyce.
Councilmember Perry completely agreed with the recommendation from the
Committee. She stated that it makes sense to include the DCE zoned area in the
planned action area.
Councilmember Boyce added thanked the North Park Neighborhood for being a part of
this long process.
Councilmember Thomas communicated he is opposed to this and felt more should be
done on this.
Council President Higgins thanked the North Park Neighborhood. He stated the purpose
is to streamline development on downtown and this honors the input from North Park.
He said these ordinances make downtown Kent an exciting place for developers and
encourages future development.
Councilmember Perry pointed out that the result of the City's last planned action
ordinance is Kent Station.
Councilmember Ralph thanked the North Park Neighborhood and said this sends a
clear message to developers and investors that the Council wants them to build things
to develop the downtown area to attract other businesses and residents in order to
grow the City.
Councilmember Thomas stated that he forgot about the positive incentives provided in
these ordinances and commented that he is reversing his vote and supporting them.
A vote was taken on the motion on the table which carried 7-0.
C. 2013 Tax Lew for 2013 Budget, Ordinance - Adopt. Mayor Cooke introduced
Robert Nachlinger, Finance Director. Nachlinger discussed the levy and the funds
derived from the levy. He noted that this represents a reduction in the property tax
rate of about 5 cents per $1,000.
Councilmember Thomas moved to adopt Ordinance No. 4098, levying the
property taxes for the second year of the 2013-2014 biennial budget,
seconded by Councilmember Perry. Motion carried 7-0.
D. 2013-2014 Mid-Biennium Budget Adiustment, Ordinance — Adopt. Mayor
Cooke introduced the item and Robert Nachlinger, Finance Director briefly discussed
the item. He noted that the budget ws discussed fully in the workshop.
Councilmember Thomas moved to adopt Ordinance No. 4099, authorizing
mid-biennial budget modifications to the biennial budget of the city of Kent
for the years 2013-2014, seconded by Council President Higgins.
Councilmember Albertson communicated that she doesn't support the budget
adjustment, not because she doesn't support the items within the budget, but she is
opposed to this item because there is a systemic problem with the budget that hasn't
been addressed. She noted that there isn't a clear revenue stream to support budget
increases. She said this is a cautionary tale for incoming Councilmembers to find the
money in the future and for those reasons she is voting against the item.
Council President Higgins reminded the Council and the public that this is the mid-
biennium, not the crafting of a new budget. He pointed out that the systemic
imbalance exists with or without this adjustment. He said he is interested in continuing
to fix the financial state of the City. This adjustment allows the City to restore some of
things the City has had to do without such as police additions, fixing Wilson playfields,
and being able to work on the backlog of permits, he said. This is a wise adjustment at
this time and the budget situation has been made better by the hard work of the
Council. He thanked Councilmember Perry for the financial policies that have been put
into place.
Councilmember Perry communicated that she was the "no" vote for this in the
Committee. She said nothing has been added to this budget that isn't necessary and
there is a need for police officers. She added that staffing levels aren't sustainable and
wants the City to have employees that aren't doing five jobs. She added that the letter
to employees is right on and expenditures outweigh revenues. This, she said, is a
going to be a problem for the new councilmembers to solve and it doesn't only exist in
Kent and it directly relates to the 1% cap in property taxes that every City deals with.
A vote was taken on the motion on the table which carried 5-2.
Councilmember Perry and Albertson opposed.
E. Comprehensive Plan Amendment and Update to Kent City Code Regarding
School Impact Fees, Ordinances- Adopt. Mayor Cooke introduced the item. Fred
Satterstrom discussed the items and communicated that there was a public hearing on
November 19, 2013.
Councilmember Perry moved to adopt Ordinances 4100 and Ordinance
4101, updating the Capital Facilities Element of the Kent Comprehensive
Plan and Chapter 12.13 of the Kent City Code to incorporate the 2013/14 -
2018/19 Capital Facilities Plans of the Kent, Federal Way, Auburn and
Highline School Districts, including updated School Impact Fees, as
recommended by staff, seconded by Council President Higgins. Motion
carried 7-0.
BIDS
There were no bids.
REPORTS FROM STANDING COMMITTEES, STAFF AND SPECIAL COMMITTEES
A. Council President. Council President Higgins discussed the workshop which
featured the 2014 Legislative Agenda briefed by consultant Doug Levy and Michelle
Wilmot. He also said the budget adjustment was also briefed at the workshop. He
announced that this is his final meeting as Council President and thanked the Council,
Interim Chief Administrative Officer Tom Brubaker, former Chief Administrative Officer
John Hodgson, and the Mayor for all their hard work.
B. Mayor. Mayor Cooke noted that the focus of her time is on the Green River
Corridor. She noted that there is on a team working on the Horseshoe Bend Levy and
the System Wide Infrastructure Framework (SWIF). She also noted that she is working
on getting the Transportation Package adopted in the legislature and urged the
residents and business community for help in publicly stating the needs in Kent. She
closed by discussing the swearing in of the two newly elected councilmembers.
C. Administration. Tom Brubaker, Interim Chief Administrative Officer announced
that it was Councilmember Les Thomas' birthday. He thanked Robert Nachlinger for his
assistance on the budget and said there would be a five-minute executive session
concerning Property Negotiations as authorized per RCW 42.30.110(1)(i).
D. Economic & Community Development Committee. No report.
E. Operations Committee. Councilmember Thomas stated that the report was in the
minutes.
F. Parks and Human Services Committee. Councilmember Ranniger
communicated that the next Parks and Human Services Committee meeting was in
January.
G. Public Safety Committee. Councilmember Boyce communicated that the next
Public Safety Committee meeting was in January.
H. Public Works Committee. Councilmember Albertson stated she didn't have a
report, but the last meeting of the year was on December 9.
I. Regional Fire Authority. Councilmember Thomas reported that the Regional Fire
Authority Budget was passed.
Council President Higgins thanked Councilmember Perry and Councilmember Albertson
for their work on the Kent City Council. He added that he has enjoyed working with
them and wished them the best of luck.
Councilmember Thomas communicated that he hopes Councilmember Albertson enjoys
the "process" in Olympia and presented Councilmember Perry with a framed photo.
Councilmember Boyce thanked Councilmember Albertson for her service on the Council
and wished her well in her position in Olympia. He thanked Councilmember Perry and
for her help.
Councilmember Ranniger stated she will miss both Councilmember Perry and
Councilmember Albertson..
Councilmember Ralph thanked Councilmember Perry for her leadership at the regional
level and her work on the Council. She thanked Councilmember Albertson for her work
and said there are decisions and comments she has made years ago that are still
making this City better. She said she appreciates her commitment to the residents of
the City and wished both Councilmembers well in their future. She thanked Council
President Higgins in bringing the group together over the past two years.
Councilmember Perry thanked the Councilmembers and stated that effective
leadership isn't about how people feel about you, but what you've gotten done. In the
past six years she said the Council has turned a dilapidated parking lot downtown into
a new building, adopted the Downtown Subarea Action Plan (DSAP), opened the
ShoWare Center, built the neighborhood program, and passed important financial
policies. She is impressed at how much even through the recession that the City has
done. She communicated that the citizens thank the Council all of the time, but it is
the City staff that make the Council look good and do all the hard lifting. She reminded
the residents of Kent that they have an outstanding group of employees working for
them. She thanked Ben Wolters, Kurt Hanson, Ken Thomas, and all of the staff for
what they do. She thanked her family, her mother, and her husband.
Councilmember Albertson communicated that it has been a joy and pleasure to have
Councilmember Ralph on the Council. She communicated that the ShoWare is a great
building block for the community and is proud of it. She said over the eight years there
have been many successes and one of them was to change the funding of human
services from a percentage of the general fund to per capita. She discussed LINK light
rail that will forever change the economic environment of that area of Kent. She
pointed out that everyone stepped up to get the repairs done to 256th between 116th
and Benson. She thanked her husband and said she has enjoyed working with the
Council and the staff.
EXECUTIVE SESSION
At 8:56 p.m., Mayor Cooke announced that the Council would recess into an
Executive Session for six minutes to discuss property negotiation as per RCW
42.30.110(1)(c).
At 9:01 p.m., the Executive Session concluded and Mayor Cooke reconvened
the regular meeting.
ACTION AFTER EXECUTIVE SESSION
Brubaker discussed a piece of land in a subdivision known as Top of the Hill on West
Hill that is owned by the City and an offer has come in to purchase the lot.
Councilmember Thomas moved to authorize the Mayor to sign all necessary
documents to finalize the sale of a lot owned by the city of Kent in the Top of
the Hill subdivision, known as "Tract A," in approximately the amount of
$70,000, less closing costs, subject to approval of final terms and conditions
by the City Attorney, seconded by Councilmember Perry. Motion carried 7-0.
ADJOURNMENT
The meeting adjourned at 9:01 p.m.
Ronald F. Moore, MMC
City Clerk
40.
KF14 Agenda Item: Consent — 7B
TO: City Council
DATE: January 7, 2014
SUBJECT: Appointment to Kent Arts Commission — Confirm
MOTION: Confirm the Mayor's appointment of Elena Luna to the Kent
Arts Commission.
SUMMARY: Confirm the appointment of Elena Luna to the Kent Arts Commission for
a one-year term as a Youth Commissioner — term ending October 31, 2014.
Elena Luna made application for appointment as a youth member to the Kent Arts
Commission for a one-year term. Ms. Luna is currently a student at Kentridge High
School where she performs with the chorale class and advanced concert choir. Elena
is very involved in high school activities, enjoyed dance at Allegro Dance Academy,
performed in musicals at Kentridge and competed with the varsity cross country team.
She remains very active in high school and expressed a desire to become more
involved in activities here in Kent. I am pleased to recommend Elena for a one-year
appointment to the Kent Arts Commission.
RECOMMENDED BY: Mayor Suzette Cooke
BUDGET IMPACTS: None
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Elena M. Luna
(253)-266-0415
21803 121^PC SE Kent,WA 98031
ane I emoa n0hotmail.com
Objective
To obtain an entry level position on the City of Kent's Arts Commission and become more involved in my hometown.
Training and Education
Kentridge High School 2012-Present
• Performed in Chorale class 2012-2013
• Auditioned and was selected for Advanced Concert Choir 2013-Present
• Placed in various Honors language arts,history,and science classes 2010-Present
• Participating in Advanced Placement Human Geography class 2013-Present
Work Experience and Employment
Babysitting
• Assisted numerous families with child care 2011-Present
Activities and Achievements
Allegro Dance Academy
• Enjoyed dancing in Jazz 101 class 2011
Kentridge High School
• Acquired a role in the Spring Musical,Evita 2013
• Competed on the Junior Varsity Cross Country team 2012-Present
• Earned a Junior Varsity I,etter in Cross Country 2012
Northwood Middle School
• Inducted into National Junior Honor Society 2010-2012
• Participated in Debate Chub 2010-2011
Skills and Qualifications
• Enjoys interacting with people and presents ideas and conversations well
• Eager to learn and excited to see other people's creative processes
• Thoroughly appreciates art galleries,museums,libraries,and live music or dance
• Can fluently read,write,and speak Spanish
• Displays organization,leadership,and reliability
References
• Employer,Paula Johnson 253-709-5533
• Kent City Council Member;Dana Ralph 253-332-0760
• Choir Director;Catherine Robinson 253-373-4216
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KENT
° Agenda Item: Consent - 7C
TO: City Council
DATE: January 7, 2014
SUBJECT: LifeWise Assurance Company Contract for Individual and Aggregate
Stop Loss Coverage - Authorize
MOTION: Authorize the Mayor to sign the 2014 LifeWise Assurance
Company renewal contract for individual and aggregate stop loss coverage,
subject to terms and conditions acceptable to human resources and the city
attorney.
SUMMARY: LifeWise's preliminary renewal increase came in at 14.8% over 2013's
rates. The City went out to bid late this year and received two offers below our current
rates. However, LifeWise agreed to revise its renewal increase for 2014 to 0% over
2013's rates and provide a cap on the renewal of 50% for 2015. Total cost is
$369,173 and is budgeted in the Health & Wellness Fund.
EXHIBITS: Renewal document
RECOMMENDED BY: Operations Committee
YEA: Higgins, Perry, Thomas NAY:
BUDGET IMPACTS: Health & Wellness Fund
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•
Nl- KENT Agenda Item: Consent- 7D
TO: City Council
DATE: January 7, 2014
SUBJECT: Group Health Cooperative Contract for Insured HMO Plan - Authorize
MOTION: Authorize the Mayor to sign the 2014 Group Health Cooperative
contract for the City's insured HMO plan, subject to terms and conditions
acceptable to human resources and the city attorney.
SUMMARY: This contract renews the Group Health Cooperative of Puget Sound
contract for the City's insured health maintenance organization (HMO). The 2014
contract reflects a 2.2% increase in the health care premiums charged by Group
Health Cooperative and is budgeted in the Health & Wellness Fund.
EXHIBITS: Renewal document
RECOMMENDED BY: Operations Committee
YEA: Higgins, Perry, Thomas NAY:
BUDGET IMPACTS: Health & Wellness Fund
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GROUP HEALTH COOPERATIVE
CONTRACT REVISIONS
Effective January 1, 2014
(Created 08/02/2013)
This is the most current list of revisions, but this list is subject to change at any time.
CONTRACT CHANGE EXPLANATION
General Information Information regarding primary care provider selection, access to women's
health care specialists,women's health and cancer rights, and newborns' and
mothers' health protection has been incorporated.
Accessing Care A clarification has been made on how to select or change personal physicians.
A clarification has been made on how to access Group Health-designated
Specialists.
A clarification has been made to reflect the process for medical necessity
determinations.
A clarification has been made to reflect that Group Health will not deny
coverage retroactively except in the case of an intentional misrepresentation of
a material fact,if coverage was obtained based on inaccurate, false, or
misleading information provided on the enrollment application,or for
nonpayment of premiums.
Benefit Details A benefit change has been made to reflect that all cost shares for covered
services now apply to the out-of-pocket limit(applies to all non-grandfathered
plans,but also applies to grandfathered plans that choose to purchase this
benefit).
The Acupuncture provision now reflects the clarification that there is no visit
limit for treatment for chemical dependency.
The Chemical Dependency provision has been clarified to reflect the following
exclusions: experimental or investigational therapies such as wilderness
therapy;facilities and treatment programs which are not certified by the
Department of Social Health Services or which are not listed in the Directory
of Certified Chemical Dependency Services in Washington State.
The pharmacy provisions have been clarified to reflect that drugs are
considered Preferred or Non-Preferred,rather than as being listed in the Group
Health drug formulary.
The Devices,Equipment and Supplies provision has been clarified to exclude
structural modifications to a Member's home or personal vehicle.
The Diagnostic Laboratory and Radiology provision has been clarified to state
that preventive laboratory and radiology services are covered in accordance
with the well care schedule established by Group Health and the Patient
Protection and Affordable Care Act of 2010. It also states that the well care
schedule is available in Group Health medical centers, at www. he c.org, or
upon request from Customer Service.
GHC(8/2/13) 1
A benefit clarification has been added to reflect coverage for dialysis(home
and outpatient).
The Drugs—Outpatient Prescription provision has been clarified to reflect that
routine costs for prescription medications provided in a clinical trial are
covered. This provision also now reflects that Preferred contraceptive and
over-the-counter drugs as recommended by the U.S. Preventive Services Task
Force(USPSTF) are covered as Preventive Services. Additional information
regarding Group Health's Preferred drug list and requests for coverage
determinations has been incorporated into the provision. The exclusion
provision has also been revised to reflect that over-the-counter drugs, supplies
and devices not requiring a prescription under state law or regulations is
excluded except as recommended by the U.S. Preventive Services Task Force
(USPSTF).
The Home Health Care provision has been clarified to reflect that private duty
nursing is still excluded,but continuous nursing care in the Member's home is
no longer specifically excluded.
The Hospice provision has been clarified to state that hospice care,when
provided by a licensed hospice care program, is a coordinated program of
home and inpatient care, available 24 hours a day. This program uses an
interdisciplinary team of personnel to provide comfort and supportive services
to a Member and any family members who are caring for the member,who is
experiencing a life-threatening disease with a limited prognosis. These
services include acute,respite and home care to meet the physical,
psychosocial and special needs of the Member and their family during the final
stages of illness. In order to qualify for hospice care,the Member's provider
must certify that the Member is terminally ill and is eligible for hospice
services. Respite care is covered to provide continuous care of the Member
and allow temporary relief to family members from the duties of caring for the
Member for a maximum of 5 consecutive days per occurrence. Other covered
hospice services may include inpatient and outpatient services and supplies for
injury and illness, semi-private room and board except when a private room is
determined to be necessary, and durable medical equipment when billed by a
licensed hospice care program.
The Infertility provision has been clarified to include the additional exclusion
of prognostic (predictive)genetic testing for the detection of congenital and
heritable disorders.
The Maternity and Pregnancy provision has been clarified to reflect that
maternity care and pregnancy services are covered for all female members
including dependent daughters.
The Podiatry provision has been clarified to state that routine foot care is
covered when such care is directly related to the treatment of diabetes and,
when approved by Group Health's medical director, other clinical conditions
that effect sensation and circulation to the feet.
The Preventive Services provision has been clarified to reflect various services
provided as recommended by the U.S. Preventive Task Force(USPSTF).
Rehabilitation, as well as habilitative care, are now listed as covered services.
A benefit clarification has been added to reflect the coverage for telehealth.
GHC(8/2/13) 2
The Temporomandibular Joint(TMJ)provision has been clarified to state that
braces for any condition are excluded.
General Exclusions A clarification has been made to state that services or supplies and drugs that
are not Medically Necessary for the treatment of an illness, injury or physical
disability,that are not specifically listed as covered are excluded.
A clarification has been made that follow-up services or complications related
to non-Covered Services are excluded, except as required by federal or state
law.
A clarification has been made that services provided by a family member,by
someone who resides in your home, or self-care are excluded.
A clarification has been made to the Experimental or Investigational Services
exclusion to state that the trialed agent or for delivery or measurement of the
trialed agent provided as part of a qualifying Phase I or Phase II clinical trial,
as the experimental or research arm of a Phase III clinical trial is considered
experimental or investigational.
A clarification has been made to the genetic testing exclusion to state that
prognostic(predictive)genetic testing and related services are excluded.
Enrollment and Eligibility The Special Enrollment provision has been clarified to state that eligibility for
premium assistance from Medicaid or a state Children's Health Insurance
Program (CHIP),provided such person is otherwise eligible for coverage
under this Benefits Booklet is allowed. The request for special enrollment must
be made within 60 days of eligibility for such premium assistance.
The Eligibility for Medicare provision has been clarified to state that a
Member who is enrolled in Medicare has the option of continuing coverage
under this Benefits Booklet while on Medicare coverage. Coverage between
this Benefits Booklet and Medicare will be coordinated as outlined in Section
IX.
The Continuation Coverage Under Federal Law provision has been clarified to
state that this section applies only to Groups who must offer continuation
coverage under the applicable provisions of the Consolidated Omnibus Budget
Reconciliation Act of 1985(COBRA), as amended, or the Uniformed Services
Employment and Reemployment Rights Act(USERRA)and only applies to
grant continuation of coverage rights to the extent required by federal law.
USERRA only applies in certain situations to employees who are leaving
employment to serve in the United States Armed Forces. Continuation
coverage under COBRA or USERRA will terminate when a Member becomes
covered by Medicare or obtains other group coverage, and as set forth under
Subsection E.
Grievances The Grievances provision has been clarified to state that grievance means a
written complaint submitted by or on behalf of a covered person regarding
service delivery issues other than denial of payment for medical services or
nonprovision of medical services, including dissatisfaction with medical care,
waiting time for medical services,provider or staff attitude or demeanor,or
dissatisfaction with service provided by the health carrier.
Appeals The Appeals provision has been clarified to state that the appeals process is
available for a Member to seek reconsideration of an adverse benefit
determination(action). Adverse benefit determination(action)means any of
GHC(8/2/13) 3
the following: a denial,reduction, or termination of, or a failure to provide or
make payment(in whole or in part)for, a benefit, including any such denial,
reduction,termination, or failure to provide or make payment that is based on a
determination of a Member's eligibility to participate in a plan. Group Health
will comply with any new requirements as necessary under federal laws and
regulations. The most current information about your appeals process is
available by contacting Group Health's Member Appeal Department at P.O.
Box34593, Seattle,WA98124-1593, or toll-free 1-866-458-5479.
Additional clarifications have been added to the initial appeal provisions to
state that Group Health will notify the Member of its receive of the appeal
request within 72 hours of receiving it,that for appeals involving experimental
or investigational services, Group Health will make a decision and
communicate the decision to the Member in writing within 20 working days of
receipt of the appeal,that the Member may also request an external review at
the same time as the internal appeals process if it is an urgent care situation or
the Member is in an ongoing course of treatment.
The next level of appeal has been clarified to state that If the Member is not
satisfied with the decision regarding medical necessity,medical
appropriateness,health care setting, level of care, or if the requested service is
not efficacious or otherwise unjustified under evidence-based medical criteria,
or if Group Health fails to adhere to the requirements of the appeals process,
the Member may request a second level review by an external independent
review organization not legally affiliated with or controlled by Group Health.
Group Health will notify the Member of the name of the external independent
review organization and its contact information. The external independent
review organization will accept additional written information for up to five
business days after it receives the assignment for the appeal. The external
independent review will be conducted at no cost to the Member. Once a
decision is made through an independent review organization,the decision is
final and cannot be appealed through Group Health. A request for a review by
an independent review organization must be made within 180 days after the
date of the initial appeal decision notice.
Coordination of Benefits The Coordination of Benefits provision has been clarified to state that all
health plans have timely claim filing requirements. If the Member or the
Member's provider fails to submit the Member's claim to a secondary health
plan within that plan's claim filing time limit,the plan can deny the claim. If
the Member experiences delays in the processing of the claim by the primary
health plan,the Member or the Member's provider will need to submit the
claim to the secondary health plan within its claim filing time limit to prevent a
denial of the claim. If the Member is covered by more than one health benefit
plan,the Member or the Member's provider should file all the Member's
claims with each plan at the same time. If Medicare is the Member's primary
plan,Medicare may submit the Member's claims to the Member's secondary
carrier.
The Effect of Medicare provision has been clarified to state the Group Health
will pay primary to Medicare when required by federal law.
Definitions The Convalescent Care definition has been clarified to state that convalescent
care is care furnished for the purpose of meeting non-medically necessary
personal needs which could be provided by persons without professional skills
or training, such as assistance in walking, dressing,bathing, eating,preparation
of special diets, and taking medication.
GHC(8/2/13) 4
The Emergency definition has been clarified to include any situation which
would be considered an emergency under applicable federal or state law.
The Medically Necessary definition has been clarified to state the pre-service,
concurrent or post-service reviews may be conducted. Once a service has been
reviewed, additional reviews may be conducted.Members will be notified in
writing when a determination has been made.
The Medicare definition has been clarified to state that Medicare is the federal
health insurance program for people who are age 65 or older,certain younger
people with disabilities, and people with End-Stage Renal Disease(permanent
kidney failure requiring dialysis or a transplant, sometimes called ESRD).
GHC(8/2/13) 5
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KENT
Agenda Item: Consent — 7E
TO: City Council
DATE: January 7, 2014
SUBJECT: Delta Dental of Washington Administrative Services Contract for Self-
Insured Dental Program - Authorize
MOTION: Authorize the Mayor to sign the 2014 Administrative Services
contract with Delta Dental of Washington for the City's self-insured dental
program, subject to terms and conditions acceptable to human resources
and the city attorney.
SUMMARY: The city contracts with Delta Dental of Washington (DDW) as a third-
party administrator (TPA) to process claims and provide access to DDW PPO network
of dentists. The City is self-insured for this program and will wire the monthly claims
cost to DDW for the City's dental expenses. The 2014 contract reflects no increase in
administrative fees for 2014 and is budgeted in the Health & Wellness Fund. The
overall projected cost of Kent's self-insured plan, inclusive of administration fees, is
approximately $826,601.
EXHIBITS: Administrative Services Contract
RECOMMENDED BY: Operations Committee
YEA: Higgins — Thomas - Perry NAY:
BUDGET IMPACTS: Health & Wellness Fund
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Delta Dental of Washington
City of Kent
Plan #00611
Effective January 1, 2014
Summary of Plan Changes
The information contained in this summary represents a brief overview of the substantive changes made to your
plan documents. A comprehensive listing of all changes is available upon request.
Global Changes
Name Change
• To reflect the name change of the carrier all references to"Washington Dental Service"and"WDS" have
been replaced by"Delta Dental of Washington" and"DDWX, respectively
General
• To distinguish an eligible person from an enrolled member, the terms"Enrolled Employee," "Enrolled
Dependent,"and"Enrolled Person" have been added where applicable.
Contract Changes
Article 1: Definitions
• The following definitions have been added: "DDWA", "Enrolled Dependent, Enrolled Employee, Enrolled
Person", "Licensed Professional", and "Retiree".
• The following definitions have been deleted: "Contract Term", "Nonparticipating Dentist".
• The following definitions have been updated: "Delta Dental", "Delta Dental PPO Dentist", "Delta Dental
Participating Dentist" "Dentist", "Eligibility Date".
Article IV: Benefits Provided Limitations and Exclusions
• Paragraph regarding paying the lowest fee of two or more professionally accepted plans has been
deleted.
Article VI 1: Group's Obligations
• Language regarding group-prepared benefit booklets has been added.
Article VIII: General Provisions
• Amendment language has been updated.
Appendix A: Employee Eligibility Requirements
• Language has been updated.
Appendix B Dependent Eligibility Reauirements
• Language has been updated and revised.
Appendix C Method of Payment
• Language has been updated and reorganized for clarity.
• Adding unlimited annual maximum for children and unlimited medically necessary maximum.
Appendix D Group's Financial Obligations
® Language has been updated.
2014-01-00611-RC-02 i PPOL rev20131115
Certificate of Coverage Changes
The following sections have been updated for reading clarity:
• How to Use Your Plan
• Claim Forms
• Reimbursement Levels
• Employee Eligibility, Enrollment and Termination
• Dependent Eligibility and Termination
• Special Enrollment Periods
• Extension of Benefits
Plan Deductible
• Statement added for clarity
Annual Maximum
• Language has been updated to include unlimited annual maximum for children and unlimited medically
necessary maximum
Additional Procedures
• Section removed to reflect change in internal practices
Glossary
O Terms updated
Appeals of Denied Claims
Additional language added to inform subscriber of rights
Coordination of Benefits
• State-required language changes have been incorporated to clarify the term"Allowable Expense'. This
change was effective January 1, 2012 and all claims have been paid accordingly.
Benefits Changed or Updated
Class I Diagnostic
• Limitation language has been clarified to be consistent with industry standards
Class I Preventative
Space maintainer age limitation has been added for clarification—no change in benefit
Class II Restorative
• Inlay coverage has been moved to Class III Restorative to correct a discrepancy—no change in benefit
Class II Endodontics
• Retreatment language added for clarity—no change in benefit
Class III Prosthodontics
• Post and core limitation has been added
• Language regarding amalgam allowances has been clarified
• Implant-support crown and inlays have been added to crown frequency limitations
Class III Prosthodontics
• Implant maintenance procedures language has been removed from covered benefit and exclusion section
to correct a discrepancy—no change in benefit
• Denture reline and adjustment limitation has been added for clarity—no change in benefit
2014-01-00611-RC-02 ii PPOL rev20131115
Delta Dental of Washington
Dental Care Service Contract
DDWA Plan #00611
Name of Group: City of Kent
Herein called Group, agrees to a Dental Care Service Contract with Delta Dental of Washington, herein called
DDWA.
The effective date of this Contract shall be 12:01 a.m. Pacific Time on the first day of January, 2014 at Seattle,
Washington, and shall run for a period of 12 months, through December 31, 2014.
This Contract is issued and delivered in the State of Washington and is governed by Washington State laws. It is
subject to the terms set forth on the subsequent pages, appendices and amendments, which are a part of this
Contract.
Accepted By: Accepted By:
City of Kent Delta Dental of Washington
220 4th Avenue South Post Office Box 75983
Kent, Washington 98032 Seattle,Washington 98176-0983
Signed: Signed: ry
Title: Title: Vice ricawcn�
Underwriting and Actuarial
Date: Date: November 18, 2013
2014-01-00611-RC-02 1 PPOL rev20131115
Article I—Definitions
For the purpose of this Contract,the following definitions shall apply:
1.01 "Administrative Fee' means the monthly amount payable by Group to cover claims paid by DDWA and as
designated in Appendix D.
1.02 "Benefit Period" means the period beginning January 1 and ending December 31.
1.02 "Certificate of Coverage' means the benefits booklet which describes in summary form the essential
features of the contract coverage, and to or for whom the benefits hereunder are payable. In the event
that contracts are changed or amended, new certificates or a clearly understandable benefit booklet insert
to existing certificates shall be furnished. The Certificate of Coverage is incorporated into this contract by
this reference as if the contents thereof were fully set out herein.
1.03 "Contract' means this agreement between DDWA and Group. This Contract constitutes the entire
Contract between the parties and supersedes any prior agreement, understanding or negotiation between
the parties.
1.04 "Covered Dental Benefit' means those dental services that are covered under this Contract, subject to the
Limitations set forth in the Certificate of Coverage.
1.05 "DDWA" means Delta Dental of Washington, a nonprofit corporation incorporated in Washington State.
DDWA is a member of the Delta Dental Plans Association.
1.06 "Delta Dental' means Delta Dental Plans Association, a nationwide non-profit organization of dental
benefit carriers offering a range of group dental benefit plans.
1.07 "Delta Dental PPO Dentist' means a Participating Dentist who has agreed to render services and receive
payment in accordance with the terms and conditions of a written Delta Dental PPO Participating Dentist
Agreement, which includes looking solely to Delta Dental for payment for covered services.
1.08 "Delta Dental Participating Dentist' means a licensed Dentist who has agreed to render services and
receive payment in accordance with the terms and conditions of a written Delta Dental Participating
Dentist Agreement, which includes looking solely to Delta Dental for payment for covered services.
1.09 "Dentist' means a licensed dentist legally authorized to practice dentistry at the time and in the place
services are performed. This Contract provides for covered services only if those services are performed
by or under direction of a licensed Dentist or other Licensed Professional. A Dentist does not mean a
dental mechanic or any other type of dental technician.
1.10 "Eligibility Date' means the date on which an Eligible Person becomes eligible to enroll in the Plan as
detailed in Appendix A or B.
1.11 "Eligible Dependent' means any dependent of an Eligible Employee who meets the conditions of eligibility
set forth in Appendix B.
1.12 "Eligible Employee" means any employee who meets the conditions of eligibility set forth in Appendix A.
1.13 "Eligible Person" means an Eligible Employee or an Eligible Dependent.
1.14 "Enrolled Dependent', "Enrolled Employee', or"Enrolled Person" means any Eligible Dependent, Eligible
Employee or Eligible Person, as applicable, who has completed the enrollment process and for whom
Group has submitted the monthly Administrative Fee to DDWA.
1.15 "Filed Fee' means the approved fee accepted by DDWA for a specific dental procedure performed by a
Delta Dental Participating Dentist submitting that fee and performing the dental service.
1.16 "Group" means the employer or entity that is contracting for dental benefits for its employees in this
Contract.
1.17 "Licensed Professional' means an individual legally authorized to perform services as defined in their
license. Licensed Professional includes, but is not limited to, denturists, hygienists, and radiology
technicians.
1.18 "Maximum Allowable Fee' means the maximum dollar amount that will be allowed toward the
reimbursement for any service provided for a Covered Dental Benefit.
2014-01-00611-RC-02 -2- PPOL rev20131115
1.19 "Nonparticipating Dentist" means a licensed Dentist who has not agreed to render services and receive
payment in accordance with the terms and conditions of a written Participating Dentist Agreement
between a member of the Delta Dental Plans Association and such Dentist.
1.20 "Open Enrollment Period" means the annual period in which Eligible Employees can select benefits Plans
and add or delete Eligible Dependents.
1.21 "Participating Plan" means Delta Dental of Washington and any other member of the Delta Dental Plans
Association with which Delta Dental contracts to assist in administering the Benefits described in this
Contract.
1.22 "Payment Level' means the applicable percentage of Maximum Allowable Fees for Covered Dental
Benefits that shall be paid by DDWA as set forth in Appendix C.
1.23 "Plan" means this Contract that provides dental benefits.Any other Contract that provides dental benefits
and meets the definition of a"Plan" in the "Coordination of Benefits"section of the Certificate of Coverage
is a plan for the purpose of coordination of benefits.
1.24 "Retiree', for purposes of Group 00611 — Plan 03. the term Retiree may be inferred in place of the term
Employee, where applicable.
Article II—Eligibility
2.01 Every person who meets the conditions of eligibility as set forth in Appendix A or Appendix B is eligible for
enrollment in this Plan.
2.02 Group shall submit a list of Enrolled Persons to DDWA prior to the beginning of each monthly eligibility
period.
Article III—Monthly Payment
3.01 The monthly Administrative Fee and claims payment, to be remitted fully by Group, is determined as set
forth in Appendix D.
3.02 Administrative fees are due with the Eligibility listing on or before the first day of the month. No person
shall be entitled to benefits under this Contract during any month for which Administrative Fee payment
has not been received by DDWA.
3.03 Claim Reimbursement is due as described in Appendix D. The total amount of claims payment shall be
transferred, via wire transfer, to the appropriate DDWA bank account on or about the first of the month,
within two business days of DDWA notification of amount paid.
3.04 If payment is not received within 30 days DDWA may give written notice that payment is due and may, at
its option, terminate all benefits and be released from all further obligations as set forth in Article IX
entitled "Notice and Termination."
3.05 DDWA shall accept retroactive additions to eligibility(payments)that are received by DDWA within 60
days of the requested effective date.
3.06 DDWA shall accept retroactive terminations of eligibility(credits)that are received by DDWA within 60
days of the requested termination date, or to the end of the month of the last paid claim of termed
Enrolled Person, whichever is later.
3.07 DDWA shall not be obligated to refund paid claims for treatment from providers when the treatment was
performed in good faith that eligibility was current and accurate at the time of treatment.
3.08 Legislative Surcharge Clause. If any governmental unit imposes any new tax or assessment or increases
the rate of any current tax or assessment that is measured directly by the payments made to DDWA by
Group, then DDWA is authorized to increase the monthly Administrative Fee by the amount of such new
tax, assessment or increase, or pass through the exact tax amount to the Group separately.
2014-01-00611-RC-02 -3- PPOL rev20131115
Article IV—Benefits Provided, Limitations and Exclusions
4.01 Covered Dental Benefits, Limitations, and Exclusions are as described in the Certificate of Coverage and
are subject to the Plan maximum and deductible as described in Appendix C.
4.02 The percentages of the Maximum Allowable Fee, Filed Fee, or the Dentists' actual charges payable by
DDWA for Covered Dental Benefits provided to an Enrolled Person are described in Appendix C.
4.03 Payment for services provided by a Delta Dental Participating Dentist shall be made directly to the
Dentist. Contracts between Delta Dental and its Delta Dental Participating Dentists provide that, if Delta
Dental fails to pay the dentist, the Enrolled Person shall not be liable to the dentist for any sums owed by
Delta Dental.
Article V—Conditions for Benefits—Dispute Determination Procedures
5.01 Covered Dental Benefits are available for an Enrolled Person from the enrollment date until such
enrollment terminates.
5.02 An Enrolled Person may elect the services of any licensed Dentist. DDWA is not responsible for
availability of any particular licensed Dentist.
5.03 DDWA shall be entitled to receive from any attending Dentist, or from hospitals in which a Dentist's care
is rendered, any records relating to treatment rendered to an Enrolled Person as may be required in the
administration of claims.
5.04 Provider dispute resolution process is available as outlined in individual provider contracts.
5.05 To determine Covered Dental Benefits for certain treatments, DDWA may require an Enrolled Person to
obtain an examination from a DDWA-appointed consultant Dentist. DDWA will pay 100 percent of the
charges incurred for this examination.
Article VI—DDWA's Obligations
6.01 DDWA will issue to Group an electronic version of the Certificate of Coverage for this Plan in the form of a
standard DDWA benefit booklet, which summarizes the Covered Dental Benefits and other essential
features of the Plan. If any amendment to this Contract materially affects any benefits described in such
booklets, electronic versions of corrected booklets or booklet inserts showing the change will be issued to
Group. A new booklet shall be created upon initial inception of the Contract and every other year
thereafter. An insert will be created and sent in the year in which a booklet is not produced to inform
Enrolled Person of any Plan changes.
6.02 If requested, DDWA will provide to Group one printed booklet for each employee enrolled in the Plan,
plus an additional 10 percent for a reserve supply. Group will reimburse DDWA for any additional costs
due to variation in booklet size or paper requested by Group. DDWA will have booklets delivered to
Group within 15 business days after reciept of a signed booklet approval form from Group. If a signed
booklet approval form is not returned to DDWA by Group, printed booklets will not be provided.
6.03 DDWA shall provide descriptions of predetermination, claim review, and complaint and appeal
procedures in the benefit booklets issued to Group.
6.04 If a Dentist or an Enrolled Person requests a predetermination of benefits, DDWA will provide a
predetermination of benefits for the Enrolled Person. Such predetermination of benefits will be valid for a
reasonable period of time, but no longer than such person's period of eligibility. Predetermination are not
an authorization for services but a notification of Covered Dental Benefits available and are not a
guarantee of payment.
6.05 DDWA shall not be obligated to make payment for any services rendered to a person who is not an
Enrolled Person at the time the services were performed.
6.06 DDWA may provide professional review of the adequacy and appropriateness of services rendered to
Enrolled Persons through its Quality Management and Clinical Review processes.
2014-01-00611-RC-02 -4- PPOL rev20131115
6.07 DDWA shall provide Delta Dental Participating Dentist Directories to Group. This directory is available on-
line at www.DeltaDentafWA.com, It is understood that the composition of such directory is subject to
change. DDWA reserves the right to change the directory without notice. Each Enrolled Person is free to
select a Dentist of his or her choice. DDWA shall not be held liable for any act or omission on the part of
the selected Dentist. Nothing contained in this Contract shall be construed as obligating DDWA to render
dental services; its sole obligation being to pay the agreed-upon portion of Dentist's charges for Covered
Dental Benefits in accordance with the terms of this Contract.
Article VII—Group's Obligations
7.01 Group shall provide information to all Enrolled Employees as to the existence and terms of this Contract.
Group shall make available to each Enrolled Employee, booklets summarizing the Covered Dental
Benefits and other essential features of the Plan,
7.02 If Group elects to prepare and print its own summary plan description, it does so at its awn risk and
expense. The Group-prepared summary plan description must be based on the most current Certificate
of Coverage provided by DDWA, and will be for informational purposes only, not incorporated into this
Contract. Group will provide DDWA with a copy of any summary plan description that is distributed to
Enrolled Employees in lieu of the Certificate of Coverage provided by DDWA. Group is responsible for
assuring the accuracy of any summary plan description that it elects to prepare and distribute. DDWA is
not obligated to review or approve any summary plan description prepared by Group, and will not provide
any warranty for the content of the Group-produced summary plan description.
7.03 Group shall permit DDWA, at DDWA's expense, on reasonable advance written notice, to inspect
eligibility records in order to verify the accuracy of information submitted to DDWA. An equitable
adjustment of Administrative Fee shall be made in the event of inadvertent clerical errors or delays in
reporting eligibility.
7.04 Group shall sign and return any and all Contract documents within 30 days of the effective date or the
date DDWA sends the Contract document to Group or its authorized representative or agent, whichever
is later.
7.05 If a signed Contract or any changes affecting the Contract provisions are not received by DDWA from the
Group or the Group's legal representative(s) within 30 days following the effective date or the date DDWA
mails the contract to Group or its authorized representative or agent, whichever is later, but Group remits
the first month's Administrative Fee, the group will be deemed by DDWA to have agreed to the terms of
this Contract as stated, including acceptance of rates, Contract language and provisions. In such cases,
DDWA will process claims on the effective date according to these Contract provisions.
Article Vill—General Provisions
8.01 No change in this Contract shall be valid unless evidenced by written amendment signed by an
authorized representative or agent of DDWA and an authorized representative or agent of Group.
8.02 Legal action to recover benefits provided for in this Contract may not be initiated prior to 60 days after
receipt of claim by DDWA. In addition, such legal action must commence within six years from the date
the claim was received by DDWA.
8.03 Any provision of this Contract that is in conflict with any governing law or regulation of the State of
Washington is hereby amended to comply with the minimum requirements of such law or regulation.
8.04 Indemnification
DDWA shall indemnify and hold harmless Group, its affiliates and their respective directors, officers,
employees and agents, for that portion of any liability, settlement and related expense(including
reasonable attorneys'fees) resulting solely and directly from DDWA's breach of this Agreement,
negligence, willful misconduct, criminal conduct, fraud or its breach of a fiduciary responsibility related to
or arising out of this Agreement.
Group shall indemnify and hold harmless DDWA, its affiliates and their respective directors, officers,
employees and agents, for that portion of any liability, settlement and related expense (including
reasonable attorneys' fees) resulting solely and directly from Group's breach of this Agreement,
negligence, willful misconduct, criminal conduct, fraud or its breach of a fiduciary responsibility related to
or arising out of this Agreement.
2014-01-00611-RC-02 -5- PPOL rev20131115
8.05 Force Maieure
In the event DDWA is unable to perform its obligations hereunder by reason of fire, casualty, lockout,
strike, labor condition, riot, war, act of God or by ordinance, law, order or decree of any legally constituted
authority, then this Contract may, at the option of DDWA, be suspended. During any period of
suspension, DDWA shall not be required to perform any service hereunder, nor shall DDWA be liable for
any damages arising from any event that precipitated the suspension. If this Contract is suspended
pursuant to this provision, Group's obligation to make Administrative Fee payments shall also be
suspended for the same period of time.
8,06 DDWA and Group will act in accordance with applicable state and federal privacy requirements and
disclosure requirements, such as the Gramm-Leach-Bliley Act(GLBA) and the Health Insurance
Portability and Accountability Act(HIPAA), including any applicable regulations.
8.07 For the purposes of this contract, the terms spouse, marriage, marital, husband, wife, widow, widower,
next of kin, and family shall be interpreted as applying equally to domestic partnerships or individuals in
domestic partnerships as well as to marital relationships and married persons, and references to
dissolution of marriage shall apply equally to domestic partnerships that have been terminated, dissolved,
or invalidated, to the extent that such interpretation does not conflict with federal law.Where necessary,
gender-specific terms such as husband and wife used in any part of this contract shall be construed to be
gender neutral, and applicable to individuals in domestic partnerships.
8.08 Group and DDWA both acknowledge and agree that DDWA may contract with a third-party administrator
to perform certain administrative functions under this Contract, including but not limited to collection of
Administrative Fee payments due, and collection of enrollment and termination information. Any third-
party administrator performing these functions is acting as an authorized representative of DDWA, and
DDWA does not waive or disclaim any responsibility for our obligations under this Contract.
Article IX—Notice and Termination
9.01 Any notice under this Contract shall be sufficient if given by either Group or DDWA by regular mail to the
other addressed to the office stated on the front page of this Contract or to such other address as may be
designated by written notice to the other.
9.02 This Contract may be terminated effective at the end of the term by either Group or DDWA, by either
party giving written notice to the other at least 30 days prior to the end of the Contract term, except as
otherwise provided in Article III or this Article IX.
9.03 Upon default by Group in any of its obligations hereunder. DDWA may elect to terminate this Contract,
effective at the end of the month for which Administrative Fees have been received by DDWA prior to the
time of such election, by giving written notice thereof to Group. If DDWA elects to so terminate because of
default by Group, then Group shall be indebted to and agrees to pay DDWA the sum of all claims
payments and expenses incurred for dental services rendered from the date of default until the date of
termination, including costs of recovery.
9.04 If on termination of this Contract, Group has paid Administrative Fee to DDWA applicable to a period of
time after the termination date, DDWA shall,within 30 days after termination, return such portion of
Administrative Fee to Group less any amounts due to DDWA.
9.05 Acceptance by DDWA of the proper amount of Administrative Fee, after termination of this Contract and
without requiring a new application, shall reinstate the Contract as though it had never terminated, unless
DDWA shall, within five business days of receipt of such payment, either:
1) Refund the payment so made, or
2) Issue to Group a new Contract accompanied by written notice stating clearly those respects in which
the new Contract differs from the terminated Contract in benefits, coverage or otherwise.
9.06 Upon termination of this Plan, all expenses incurred prior to the termination of the Plan, but not submitted
to DDWA within six months after the date of such treatment will be excluded from any benefit
consideration.
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Article X—List of Appendices
10.01 The attached appendices are a part of this Contract. Appendices are identified as follows:
Appendix A— Employee Eligibility Requirements
Appendix B—Dependent Eligibility Requirements
Appendix C—Method of Payment
Appendix D—Group's Financial Obligations
2014-01-00611-RC-02 -7- PPOL rev20131115
Appendix A. Employee Eligibility Requirements
Section A Definition of Eligible Employee
An employee of the City of Kent is eligible to enroll on the date the employee becomes:
• an active, full-time, non-uniformed employee who regularly works a minimum of 40 hours a week;
• an active, part-time, non-uniformed employee who regularly works a minimum of 21 hours a week but
less than 40 hours a week on a continuous service basis;
• an approved job share employee working at least 20 hours per week;
• an active uniformed employee; or
Uniformed employees are defined as follows:
o LEOFF I Employees - Full-time active law enforcement officers or fire fighters who
established membership in the LEOFF system as defined in Sections (3) and (4), CH131,
Law of 1972 1st Ex. Sess. prior to October 1, 1977.°
o LEOFF 11 Employees - Full-time active law enforcement officers or fire fighters who
established membership in the LEOFF System as defined in Sections (3) and (4), CH131,
Law of 1972 1st Ex. Sess. on or after October 1, 1977.
• an elected Council Member for the City of Kent.
o The benefit provisions of this policy are available to City of Kent Council members only as a
secondary source of insurance benefit. If the insured Council member does not have
insurance from a primary source, benefits in this policy will be primary.
Retired LEOFF I employees and retired disabled LEOFF I employees who are eligible to receive
a retirement benefit under the LEOFF I Retirement Plan may enroll in the City of Kent Retiree
Plan.
Eligible Employees are Enrolled Employees after fully completing the enrollment process, including
payment of Administrative Fee by Group to DDWA.
Section B Effective Date of Coverage
Eligible Employees are eligible to enroll in this Plan on the effective date of this Contract.
An employee hired after the effective date of this Contract shall become eligible to enroll in this Plan on
the date of hire.
Section C Continuation of Coverage
An employee shall continue to be eligible to enroll in this Plan during the time this Contract is in effect as
long as the employee remains an Eligible Employee. An Enrolled Employee shall continue to be enrolled
as long as the Group has made timely payment of the monthly Administrative Fees on behalf of the
Enrolled Employee to DDWA.
While satisfying the various requirements of the FMLA and COBRA laws rests primarily with the Group,
DDWA will fully cooperate with Group in complying with these laws.
Leave of Absence
Coverage for a subscriber and enrolled dependents may be continued for up to 180 days when the
employer grants the subscriber a leave of absence and premium charges continue to be paid. If a
medical leave is granted, the City of Kent may pay the required monthly charge for the employee and
enrolled dependents for up to 180 days. The 180-day leave of absence period counts toward the
maximum COBRA continuation period, except as prohibited by the Family and Medical Leave Act of
1993.
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Section D Termination of Coverage
An employee shall cease to be eligible to enroll or cease to be enrolled in the Plan at the end of the
calendar month in which the employee ceases to be an Eligible Employee or upon termination of this
Contract, whichever occurs first. An Enrolled Employee shall cease to be enrolled at the end of the
calendar month in which the Enrolled Employee ceases to be an Eligible Employee, or at the end of the
calendar month for which Group has made the last timely payment of the monthly Administrative Fees on
behalf of the Enrolled Employee to DDWA, or upon termination of this Contract,whichever occurs first.
Section E Enrollment Requirements
All Eligible Employees enrolled in the Group-sponsored medical plan must be enrolled in this Plan
regardless of whether or not enrolled as a dependent in another dental plan. Employees who are not
enrolled in the Group-sponsored medical plan may not enroll in this I Plan. Each Eligible Employee must
complete the enrollment process. DDWA must receive the completed enrollment information within 60
days of the employee's Eligibility Date. If the enrollment information is not received within 60 days,
enrollment will not be accepted until the next Open Enrollment Period.
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Appendix B. Dependent Eligibility Requirements
Section A Definition of Eligible Dependent
An Eligible Dependent is a dependent of an Eligible Employee that meets the requirements of this Appendix B.
An Eligible Dependent becomes an Enrolled Depended upon completion of the enrollment process and
submission of the Administrative Fee to DDWA.
To be a dependent under this plan, the family member must be:
The lawful spouse of the subscriber, unless legally separated;
® The state-registered domestic partner of the subscriber;
® An eligible child under 26 years of age, or
o Spouses and children of dependents are not eligible for coverage under this plan.
o An eligible child is one of the following:
• A natural offspring of either or both the subscriber or spouse
• A legally adopted child of either or both the subscriber or spouse
• A child placed with the subscriber for the purpose of legal adoption in accordance with
state law. "Placed" for adoption means assumption and retention by the subscriber of a
legal obligation for total or partial support of a child in anticipation of adoption of such
child
• Foster children are not eligible for coverage
A legally placed ward of the subscriber, spouse, or domestic partner living permanently in the home of the
subscriber.
Section B Effective Date of Coverage
An Eligible Dependent shall become eligible to enroll in this Plan on the date the Eligible Employee
becomes eligible to enroll in this Plan, or on the first day of the calendar month following the month in
which such person became an Eligible Dependent of the Eligible Employee.
Section C Continuation of Coverage
A dependent shall continue to be eligible to enroll in this Plan while this Contract is in effect as long as the
dependent remains an Eligible Dependent of an Eligible Employee. An Enrolled Dependent shall
continue to be enrolled as long as the Group has made timely payment of the monthly Administrative
Fees on behalf of the Enrolled Employee to DDWA.
While satisfying the various requirements of the FMLA and COBRA laws rests primarily with the Group,
DDWA will fully cooperate with Group in complying with these laws.
Section D Termination of Coverage
An Eligible Dependent shall cease to be eligible to enroll or cease to be enrolled in this Plan at the end of
the calendar month during which the employee ceases to be an Eligible Employee or the person no
longer meets the definition of an Eligible Dependent, whichever occurs first. An Enrolled Dependent shall
cease to be enrolled at the end of the calendar month in which the Enrolled Employee ceases to be
enrolled, at the end of the calendar month for which Group has made timely payment of the monthly
Administrative Fees on behalf of the Enrolled Employee to DDWA, or upon termination of this Contract,
whichever occurs first.
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An Enrolled Employee may terminate coverage of an Enrolled Dependent only coincident with a
subsequent renewal or extension of this Plan. Once an Enrolled Employee terminates such Enrolled
Dependent's coverage, the coverage cannot be reinstated, unless there is a change in family status as
defined in the Special Enrollment Period section of the Certificate of Coverage.
Section E Enrollment Requirements
Eligible Dependents enrolled in the Group-sponsored medical plan of the Enrolled Employee must also
be enrolled in this Plan provided they satisfy the requirements of an Eligible Dependent. A family member
not covered under the Group-sponsored medical plan cannot be covered under this Plan.
When an Eligible Dependent is no longer enrolled in the medical plan, they no longer satisfy the
requirements of an Eligible Dependent and must be disenrolled from this Plan.
If a new Eligible Dependent is not enrolled in this Plan pursuant to the rules set forth in this Contract, such
Eligible Dependents shall not be eligible for enrollment in this Plan during the then-current contract term.
Such person may enroll during any Open Enrollment Period or during a Special Enrollment Period as
defined in the Certificate of Coverage.
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Appendix C. Method of Payment
Section A Constant Payment Plan
Fees for Covered Dental Benefits provided to an Enrolled Person are based on the following:
• Delta Dental PPO Participating Dentist based on their state's Maximum Allowable Fee for Delta Dental
PPO Participating Dentists, or their actual fee, whichever is less
• Delta Dental Participating Dentist based on their state's Maximum Allowable Fee for Delta Dental
Participating Dentists, or their actual fee, whichever is less
• Nonparticipating Dentist based on their DDWA's Maximum Allowable Fee for Nonparticipating Dentists, or
their actual fee, whichever is less
The percentages of the above-indicated fee payable by DDWA for Covered Dental Benefits are as follows:
100% and Group Health Coop. Medical -Plan 01
and
80% and HSA Medical -Plan 02
Delta Dental PPO Dentists Delta Dental Premier Dentists
Covered Dental Benefits Dentists outside of Nonparticipating Dentists in
Washington State Washington State
Class 100 percent 100 percent
Class 11 80 percent 80 percent
Class 111 80 percent 80 percent
Orthodontic 50 percent 50 percent
Accidental Injunr 100 percent 100 percent
Retirees—Plan 03
Delta Dental PPO Dentists Delta Dental Premier Dentists
Covered Dental Benefits
Dentists outside of Nonparticipating Dentists in
Washington State Washington State
Class 1 100 percent 100 percent
Class II 80 percent 80 percent
Class III 50 percent 50 percent
Orthodontic 50 percent 50 percent
Accidental Injury 100 percent 100 percent
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Section B Plan Maximum
(i) PLAN 01 - FOR ENROLLEES IN THE 100 PERCENT 8, GROUP HEALTH MEDICAL PLAN
The maximum amount payable by DDWA for Class I, II and III Covered Dental Benefits (including
Accidental Injury Benefits) per Enrolled Person during each Benefit Period shall be$1,500. Charges for
dental procedures requiring multiple treatment dates shall be considered incurred on the date the service
is completed. Amounts for such procedures shall be applied to the Plan maximum based on such
incurred date.
The lifetime maximum amount payable by DDWA for orthodontic benefits is $1,800 per Enrolled Person.
Covered benefits for Medically Necessary Orthodontia provided to children up to the age of nineteen do
not accrue towards the maximum benefit allowed under this plan.
Covered benefits provided to children up to the age of nineteen do not accrue towards the maximum
benefit allowable under this plan.
(ii) PLAN 02-FOR ENROLLEES IN THE HSA AND 80 PERCENT MEDICAL PLAN
The maximum amount payable by DDWA for Class I, II and III Covered Dental Benefits (including
Accidental Injury Benefits) per Enrolled Person during each Benefit Period shall be$1,800. Charges for
dental procedures requiring multiple treatment dates shall be considered incurred on the date the service
is completed. Amounts for such procedures shall be applied to the Plan maximum based on such
incurred date.
The lifetime maximum amount payable by DDWA for orthodontic benefits is$1,800 per Enrolled Person.
Covered benefits for Medically Necessary Orthodontia provided to children up to the age of nineteen do
not accrue towards the maximum benefit allowed under this plan.
Covered benefits provided to children up to the age of nineteen do not accrue towards the maximum
benefit allowable under this plan.
(iii) PLAN 03-RETIREES
The maximum amount payable by DDWA for Class I, II and III Covered Dental Benefits (including
Accidental Injury Benefits) per Enrolled Person during each Benefit Period shall be$1,500. Charges for
dental procedures requiring multiple treatment dates shall be considered incurred on the date the service
is completed.Amounts for such procedures shall be applied to the Plan maximum based on such
incurred date.
The lifetime maximum amount payable by DDWA for Orthodontic Benefits provided to an Enrolled Person
shall be$1,000,
Covered benefits for Medically Necessary Orthodontia provided to children up to the age of nineteen do
not accrue towards the maximum benefit allowed under this plan.
Covered benefits provided to children up to the age of nineteen do not accrue towards the maximum
benefit allowable under this plan.
Section C Plan Deductible (ALL PLANS)
DDWA is not obligated to pay the deductible, defined as the first$50 of fees for Covered Dental Benefits received
by an Enrolled Person during each Benefit Period. The total deductible amount for a family which includes an
Enrolled Employee and one or more Enrolled Dependents will not exceed three times the individual deductible or
$150 during each Benefit Period. Once the maximum deductible per family has been satisfied, no further
deduction will apply to any Enrolled Person in that family until the next succeeding Benefit Period. The deductible
does not apply to Class I Covered Dental Benefits, Orthodontic Benefits or Accidental Injury Benefits.
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Appendix D. Group's Financial Obligations
Claim Reimbursement
DDWA shall notify Group, on the last DDWA payment day of each calendar month, the actual amount of claims
paid by DDWA for that month. Notification will be via email which will constitute an invoice. Group will then have
two business days to transfer funds electronically to the appropriate DDWA bank account an amount equal to
total claims paid for the month.
Funds are due on the date notified. If the funds are not transferred within five days of notification, a late fee of one
percent of claims will be charged. An additional late charge of one percent of claims will be charged for each
subsequent 30 day period for which payment is not received. The charges shall be submitted by DDWA with a
subsequent payment notification.
Administrative Fee
The monthly Administrative Fee payable by Group under this Contract Term during the period January 1, 2014
through December 31, 2014 shall be$6.35 per Enrolled Employee. Group's payment shall be in the form of a
check or electronic transfer and shall accompany the eligibility listing. DDWA will then update the files and send a
new billing to Group for the next month of coverage.
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OTHER BUSINESS
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BIDS
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REPORTS FROM STAFF, COUNCIL COMMITTEES, AND SPECIAL COMMITTEES
A. Council President
B. Mayor
C. Administration
D. Economic & Community Development
E. Operations
F. Parks & Human Services
G. Public Safety
H. Public Works
I. Regional Fire Authority
J. Other
K. Other
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EXECUTIVE SESSION
ACTION AFTER EXECUTIVE SESSION
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