HomeMy WebLinkAboutCity Council Committees - Committee of the Whole - 09/17/2024 (2) KENT CITY COUNCIL
• COMMITTEE OF THE WHOLE
KENT Tuesday, September 17, 2024
4:00 PM
Chambers
A live broadcast is available on Kent TV21,
www.facebook.com/CitvofKent, and
www.youtube.com/user/KentTV21
To listen to this meeting, dial
253-215-8782 or 253-205-0468
Enter Meeting ID: 87459075269
Join the meeting
Mayor Dana Ralph
Council President Satwinder Kaur
Councilmember Bill Boyce Councilmember Marli Larimer
Councilmember John Boyd Councilmember Zandria Michaud
Councilmember Brenda Fincher Councilmember Toni Troutner
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Item Description Action Speaker Time
1. CALL TO ORDER
2. ROLL CALL
3. AGENDA APPROVAL
Changes from Council, Administration, or Staff.
4. DEPARTMENT PRESENTATIONS
Operations—Council President Kaur, Subject Matter Chair
A. Approval of Minutes YES
i. Committee of the Whole - Committee of the Whole - Regular Meeting -
Sep 3, 2024 4:00 PM
B. Payment of Bills YES Paula Painter 01 MIN.
C. INFO ONLY: July 2024 Financial NO Michelle Ferguson 05 MIN.
Report
D. Medical and Stop Loss Contracts YES Laura Horea 10 MIN.
- Authorize
E. Resolution Recognizing Hillshire YES Tracy Taylor 05 MIN.
Committee of the Whole Committee of the Whole - September 17, 2024
Regular Meeting
Terrace Neighborhood Council -
Adopt
F. Resolution Recognizing Garrison YES Tracy Taylor 05 MIN.
Glen Neighborhood Council -
Adopt
G. Resolution Recognizing Nature YES Tracy Taylor 05 MIN.
Trails Townhomes (Springwood)
Neighborhood Council - Adopt
Economic and Community Development-Councilmember Larimer, Subject
Matter Chair
H. Waller Purchase and Sale YES Kurt Hanson 07 MIN.
Agreement - Approve
I. Motion in Support of the YES Michelle Wilmot 10 MIN.
Establishment of the Kent Valley
Air and Space Manufacturing
Roundtable
J. INFO ONLY: 2044 NO Kristen Holdsworth 15 MIN.
Comprehensive Plan
S. ADJOURNMENT
Unless otherwise noted, Council will hold Committee of the Whole at 4 p.m. on the first and third Tuesday of
each month.
Public Comment may be submitted in writing to the City Clerk at the meeting,which will be distributed to
each councilmember and admitted into the record, but will not be read aloud at the meeting. In order to
be admitted into the record,written comments shall be submitted not less than three hours prior to the start
of the Committee of the Whole meeting to Citvclerk@kentwa.c�ov, unless a person appears in-person,in
which case,the written comments will be handed to the City Clerk and will be admitted into the record of
the Committee of the Whole meeting.
For additional information, please contact Kimberley A. Komoto, City Clerk at 253-856-5725,or
email CityClerk@kentwa.gov.
Any person requiring a disability accommodation should contact the City Clerk at 253-856-5725 in advance
of the meeting. For TDD relay service, call Washington Telecommunications Relay Services at 7-1-1.
4.A.1
Pending Approval
Kent City Council - Committee
• of the Whole
KENT Committee of the Whole -
WAS M IN G 7 0 N
Regular Meeting
Minutes
September 3, 2024
Date: September 3, 2024
Time: 4:00 p.m.
Place: Chambers
1. CALL TO ORDER
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Council President Pro Tern, Bill Boyce called the meeting to order. o
2. ROLL CALL 0
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Attendee Name Title Status Arrived a
Satwinder Kaur Council President Excused
Bill Boyce Councilmember Present a
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John Boyd Councilmember Present
Brenda Fincher Councilmember Present
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Marli Larimer Councilmember Present N
Zandria Michaud Councilmember Excused M
Toni Troutner Councilmember Present
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3. AGENDA APPROVAL
A. I move to approve the agenda as presented.
ER SULT: MOTION PASSES [UNANIMOUS]
MOVER: Toni Troutner, Councilmember Q.
SECONDER: Marli Larimer, Councilmember
AYES: Boyce, Boyd, Fincher, Larimer, Troutner a
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4. DEPARTMENT PRESENTATIONS
A. Approval of Minutes YES
i. Committee of the Whole - Committee of the Whole - Regular Meeting -
Aug 20, 2024 4:00 PM
Packet Pg. 3
4.A.1
Kent City Council - Committee of the Whole September 3, 2024
Committee of the Whole - Regular Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
RESULT: APPROVED [UNANIMOUS]
MOVER: Toni Troutner, Councilmember
SECONDER: Marli Larimer, Councilmember
AYES: Boyce, Boyd, Fincher, Larimer, Troutner
B. INFO ONLY: Second Quarter 2024 Investment Report
Cash and Investment Officer, Joe Bartlemay presented the Second Quarter
2024 Investment Report.
Bartlemay provided an overview of all investment accounts: detailed Cash
and Investments by type (quarters 2-4 of 2023 and quarters 1-2 of 2024); —
cash and Investments from 2022-2024; and quarterly interest earnings
(quarters 2-4 of 2023 and quarters 1-2 of 2024). There has been a steady 0
increase in interest earnings. a
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Bartlemay provided the total Cash and Investments by fund, detailed the a
PFM Asset Management summary and statistics, and advised the City is well Co
within compliance for each sector allocation.
C. Resolution Delegating Authority to Designate Costs for Bond o
Reimbursement - Adopt N
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Finance Director, Paula Painter provided an overview of the Resolution 4)
Delegating Authority to Designate Costs for Bond Reimbursement. 4-
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Painter indicated this Resolution does not take away Council's authority to
issue debt - issuance of this type of declaration is simply an administrative
act that does not commit the City to issuing any tax-exempt obligations, such
as bonds, which remain subject to authorization only through subsequent
action of the City Council by its adoption of an authorizing ordinance prior to a
issuance.
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This resolution appoints and designates the City's Finance Director as the
official responsible for issuing declarations of official intent to reimburse in
compliance with U.S. Department of the Treasury regulations.
MOTION: I move to adopt Resolution No. 2076, appointing the
City's Finance Director as the agent authorized to designate
certain expenditures for reimbursement from future tax-
exempt obligations, including bonds, that may be authorized
and approved by the City Council in the future for issuance.
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Page 2 of 6 Packet Pg. 4
4.A.1
Kent City Council - Committee of the Whole September 3, 2024
Committee of the Whole - Regular Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
RESULT: MOTION PASSES [UNANIMOUS] Next: 9/17/2024 7:00 PM
MOVER: Bill Boyce, Councilmember
SECONDER: John Boyd, Councilmember
AYES: Boyce, Boyd, Fincher, Larimer, Troutner
D. INFO ONLY: Comprehensive Plan Capital Facilities and Utilities
Elements
Long Range Planning Manager, Kristen Holdsworth provided an update to the
Council on the Capital Facilities and Utilities Element.
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Holdsworth reviewed the Vision Policy Framework that includes Guiding c
Principles and Elements.
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Overview of Capitals Facilities Element a
• Inventory of public capital facilities and public services
• Forecast of future needs a
• Financing plan o
• Goals and policies for providing public capital facilities to meet adopted
levels of service N
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Holdsworth detailed the current topics, goals and policies of the Capital N
Facilities Element and detailed their connection to daily operations. a
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Summary of Changes - Capital Facilities Goals and Policies 0
• Reorganized for flow and remove redundancies 2
• Relocated policies to Land Use, Climate Resiliency, etc.
• Strengthened language to support equitable distribution of services and
facilities.
• Strengthened language to support culturally sensitive service and
communications.
• Strengthened language to promote environmental protection and climate a
resiliency
• Updated language to address new PSRC multicounty Planning Policies and
King county countywide Planning Policies
Holdsworth provided an Overview of Utilities Element
• Description of utility systems and providers in Kent
• Strategies to implement growth strategy outlined in the Comprehensive
Plan
• Goals and policies for utility services
Summary of Changes - Utilities Element Goals and Policies
Reorganized for flow
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Page 3 of 6 Packet Pg. 5
4.A.1
Kent City Council - Committee of the Whole September 3, 2024
Committee of the Whole - Regular Meeting Kent, Washington
Minutes
• Reorganized for flow and remove redundancies
• Strengthened language to ensure adequate provision of services and
facilities
• Added language to balance needs of new infrastructure with ongoing
maintenance to support increased infill density
• Strengthened language to promote environmental protection and climate
resiliency
• Updated language to address new PSRC multicounty Planning Policies and
King county countywide Planning Policies
Holdsworth announced upcoming meetings.
4-
E. Agreement with Siemens for Kent Commons Fire Alarm °
Replacement - Authorize c
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Acting Facilities Superintendent and Capital Project Manager, Nate Harper a
provided an overview of the agreement with Siemens for the Kent Commons a
Fire Alarm Replacement Project. a
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This agreement will cover the installation of a new fire alarm system at the
City of Kent Commons, scheduled for completion by the end of April 2025. N
The total cost for purchase and installation is not expected to exceed N
$353,786.34. M
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MOTION: I move to authorize the Parks Department to contract cn
for fire alarm system parts and installation through a o
Cooperative Purchasing Agreement with Siemens, and
authorize the Mayor to sign all necessary documents, subject to
final terms and conditions acceptable to the Parks Director and
City Attorney.
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RESULT: MOTION PASSES [UNANIMOUS] Next: 9/17/2024 7:00 PM
MOVER: Toni Troutner, Councilmember Q
SECONDER: Marli Larimer, Councilmember
AYES: Boyce, Boyd, Fincher, Larimer, Troutner
F. King County Veterans, Seniors, and Human Services Levy for
2024-2026 - Authorize
Kent Senior Center Manager, Cindy Robinson provided the Council with an
overview of the $827,366 from the King County Veterans, Seniors and
Human Services Levy in 2024. The Levy funds will enable the Kent Senior
Activity Center to continue its work in becoming a more inclusive senior hub,
providing seniors and/or caregivers who live in the City of Kent and
surrounding areas of unincorporated King County with opportunities to
experience social engagement and connection, to engage in activities that
promote healthy aging, and to access resources that support seniors to live
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Page 4 of 6 Packet Pg. 6
4.A.1
Kent City Council - Committee of the Whole September 3, 2024
Committee of the Whole - Regular Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
in their communities of choice.
These funds will also be used for the continued funding of two limited-term
employees - a Senior Center Outreach Coordinator and Senior Center
Program Assistant. These two full time employees will be funded 100% by
VSHSL funding.
MOTION: I move to accept grant funds from King County in the
amount of $827,366 through the King County Veterans,
Seniors, and Human Services Levy, amend the budget,
authorize expenditure of the grant funds, and delegate
authority to the Mayor to approve and execute an agreement
with King County for the use of these grant funds, subject to —
final terms and conditions acceptable to the Parks Director and
City Attorney. 0
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RESULT: MOTION PASSES [UNANIMOUS] Next: 9/17/2024 7:00 PM Q
MOVER: Toni Troutner, Councilmember a
SECONDER: Marli Larimer, Councilmember o
AYES: Boyce, Boyd, Fincher, Larimer, Troutner
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G. Consultant Services Agreement with Akana for Construction N
Management Services — Authorize a
aD
Construction Manager, Eric Conner provided an overview of the Consultant 4-
Services Agreement with Akana for Construction Management of the Meeker
Street Multimodal, Kent Elementary School and Meeker Street at 64t" Avenue
Intersection Project. The Project will construct curb bulb-outs, new cement
concrete crosswalks, pedestrian scale illumination, and ADA curb ramps. The
Meeker Street promenade will be extended 750' east of the intersection,
including a cement concrete separated 2-way bicycle path, median islands, a
pedestrian lighting, landscaping, and a rapid flashing beacon with a raised
mid-block pedestrian crossing. Q
MOTION: I move to authorize the Mayor to sign a Consultant r
Services Agreement with Cooper Zietz Engineers Inc., DBA
Akana, subject to final terms and conditions acceptable to the
Public Works Director and City Attorney.
RESULT: MOTION PASSES [UNANIMOUS] Next: 9/17/2024 7:00 PM
MOVER: Brenda Fincher, Councilmember
SECONDER: Toni Troutner, Councilmember
AYES: Boyce, Boyd, Fincher, Larimer, Troutner
S. ADJOURNMENT
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 5 of 6 Packet Pg. 7
4.A.1
Kent City Council - Committee of the Whole September 3, 2024
Committee of the Whole - Regular Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
Boyce adjourned the meeting.
Meeting ended at 4:38 p.m.
1( vn�ley A. Ko-P L o-
City Clerk
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Page 6 of 6 Packet Pg. 8
4.B
FINANCE DEPARTMENT
Paula Painter, CPA
220 Fourth Avenue South
\117KENT Kent, WA 98032
WASHINGTON 253-856-5264
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Payment of Bills
MOTION: I move to approve the payment of bills.
SUMMARY:
BUDGET IMPACT:
Packet Pg. 9
4.0
FINANCE DEPARTMENT
Paula Painter, CPA
220 Fourth Avenue South
\117KENT Kent, WA 98032
WASHINGTON 253-856-5264
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: July 2024 Financial Report
SUMMARY: Financial Planning Manager, Michelle Ferguson will report out on the
July 2024 Financial Report.
ATTACHMENTS:
1. July 2024 Financial Report (PDF)
Packet Pg. 10
ReportJuly 2024 Monthly Financial
City of Kent, Washington
General Fund Overview
Adj Budget YTD Est Actual Favorable Favorable
(Unfavorable) (Unfavorable�,
Revenues 121,149,030 68,804,945 126,136,890 4,987,860 4.1%
Expenditures 123,225,080 64,351,053 120,651,410 2,573,670 2.1%
Net Revenues Less Expenditures (2,076,050) 4,453,891 5,485,480 7,561,530
Beginning Fund Balance 63,738,811 63,738,811
Ending Fund Balance 61,662,761 69,224,291 0
50.0% 57.4%
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Reauired Ending Fund Balance Calculation
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Estimated Expenditures for 2024 (from above) 120,651,410 N
18.0% 2'
18% GF Ending Fund Balance 21,717,254
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millions General Fund Ending Fund Balance 10-year History (excluding Annexation) O
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80.00 ILL
70.00 63.74 69.22 Z
60.00 47.66 51.50 0
50.00
41.97
40.00 32.98 t
30.00 0
18.92 0.
20.00
11.91
10.00 LAIV
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2015 2016 2017 2018 2019 2020 2021 2022 2023 Est.2024
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Packet Pg. 11
ReportJuly 2024 Monthly Financial 4.C.a
City of Kent, Washington
General Fund Overview - Revenues
Revenue Categories Adj Budget YTD Est Actual Favorable Favorable
(Unfavorable) .
Taxes:
Property 16,165,310 8,676,820 16,249,000 83,690 0.5%
Sales & Use 31,682,150 19,242,754 32,110,900 428,750 1.4%
Utility 26,461,510 16,176,919 26,540,500 78,990 0.3%
Business &Occupation 19,579,930 9,102,832 20,495,900 915,970 4.7%
Other 881,820 423,902 906,600 24,780 2.8%
Licenses and Permits 7,761,430 4,943,953 8,190,600 429,170 5.5% +;
L
Intergovernmental Revenue 3,109,350 2,214,522 3,299,800 190,450 6.1% 0
Charges for Services 7,050,350 4,500,130 7,543,800 493,450 7.0% 4)
Fines and Forfeitures 757,590 663,934 1,017,600 260,010 34.3%
Miscellaneous Revenue 2,932,200 2,859,181 5,014,800 2,082,600 71.0%
Transfers In 4,767,390 - 4,767,390 - R
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Total Revenues 121,149,030 68,804,945 126,136,890 4,987,860 4.1% U-
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2024 Budgeted General
Fund Revenues z
0
B&Qlaxes__ _ Other Taxes 0
0.7% Z
Licenses and Permits
6%
Intergovernmental O
Utility Taxes —3%
21%
Charges for Services O
6%
Other
18% Fines and FnrfPits 1% i v
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Misc&Transfers In ILL
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8% C
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Sales Taxes Property Taxes
25% 13% y
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Page 2 of 14
Packet Pg. 12
ReportJuly 2024 Monthly Financial
City of Kent, Washington
General Fund Revenues ($ in Thousands)
All Revenues Sources
Prior Year Budgeted Actual
$140,000 Revenues Revenues Revenues
January 6,450 6,274 7,588
$120,000 February 6,204 5,396 7,320
$100,000 - - March 9,524 7,405 7,726
$80,000 April 16,943 19,485 17,651
May 10,441 9,373 9,550
$60,000 June 7,157 6,494 7,151
$40,000 July 11,107 91097 11,819
August 9,206 6,968 0 Q.
$20,000 September 7,953 6,519 0 w
$0idl I I I ai , I . October 17,945 20,333 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 8,109 8,768 0
December 19,976 15,038 0
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24Bud f23Prelim 24Act Total 131,014 121,149 68,805 LL
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PropertyN
Prior Year Budgeted Actual
$20,000 Revenues Revenues Revenues
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January - 0 0 Z
$15,000 - February 125 102 160 0
March 648 644 519 LL
Z
April 6,254 6,098 6,652 -
$10,000 - May 1,378 1,390 1,184 Ito
June 80 311 132
July 74 56 29
$5,000 August 56 78 0 Q.
September 199 270 0
$p October 6,497 5,867 0 is
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 648 1,249 0 C
December 95 100 0
24 Bud f23 Prelim 24Act LL
Total 16,053 16,165 8,677
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Prior Year Budgeted Actual
$40I 000 Revenues Revenues Revenues
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$35,000 January 2,202 2,354 2,635
February 2,609 2,772 3,203 v
$30,000 March 2,717 2,475 2,529
$25,000 - April 2,711 2,344 2,441 Q
$20,000 - May 3,087 2,740 3,064
$15,000 _ June 2,803 2,487 2,719
July 3,074 2,368 2,650
$10,000 August 3,119 2,822 0
$5,000 September 2,833 2,622 0
$0 October 2,895 2,668 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 2,975 2,795 0
December 3,889 3,235 0
�24Bud f23Prelim -4-24Act Total 34,915 31,682 19,243
Page 3 of 14 Packet Pg. 13
ReportJuly 2024 Monthly Financial 4.C.a
City of Kent, Washington
General Fund Revenues ($ in Thousands)
Utility Tax
Zrior ear Budgeted Actual
$30,000 evenues Revenues Revenues
January 2,517 2,618 2,549
$25,000 February 2,233 2,187 2,384
$20,000 _ March 2,272 2,238 2,346
April 2,452 2,386 2,292
$15,000 - May 2,209 2,159 2,157
June 1,943 1,969 2,093
$10,000 - July 2,308 2,349 2,356 o.
$5,000 _ August 2,014 2,041 0 W
September 2,060 2,234 0
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$0 October 2,116 2,079 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 1,997 2,080 0 5
LL
December 2,032 2,121 0 V
24 Bud f23 Prelim --+--24Act Total 26,153 26,462 16,177 N
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Other Taxes
Prior Year Budgeted Actual
$22,000 J
Z
$20,000 January 2 67 2 O
$18,000 - February 2 2 20 LL
$16,000 - March 33 9 0 Z
$14,000 April 3,373 3,367 4,198 CD$12,000 May 1,772 1,329 958
$10,000 -
$8,000 _ June 100 138 160 1=
$6,000 _ July 3,339 3,543 4,189 0
$4,000 IL- August 1,704 1,348 0
$2,000 - - - - September 219 145 0
73
$0 October 3,853 3,784 0
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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 988 1,093 0
December 6,150 5,637 0 LL
-A24 Bud f23 Prelim --+--24 Act Iq
Total 21,536 20,462 9,527 N
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Other Revenues 2'
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Prior Year Budgeted Actual
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$35,000 - E
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$30,000 January 1,728 2,353 2,402 r
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February 1,236 795 1,553 Q
$25,000 - March 3,855 2,334 2,331
$20,000 _ April 2,153 1,880 2,068
May 1,996 1,672 2,187
$15,000 June 2,231 2,102 2,047
$10,000 - July 2,310 2,008 2,594
August 2,312 1,586 0
$5,000 September 2,642 1,982 0
$0 i October 2,583 2,624 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec November 1,501 1,533 0
December 7,810 5,510 0
24 Bud f23 Prelim �24Act
Total 32,357 26,378 15,182
Page 4 of 14 Packet Pg. 14
July 2024 Monthly Report
City of Kent, Washington
General Fund Overview - Expenditures
Department . .
Adj Budget YTD Est Actual
le
(Unfavorable) (Unfavorable),
City Council 448,480 243,557 422,000 26,480 5.9%
Administration 3,519,030 1,575,407 3,269,000 250,030 7.1%
Economic & Community Developme 10,633,510 5,158,350 9,750,800 882,710 8.3%
Finance 3,899,760 1,826,173 3,537,800 361,960 9.3%
Fire Contracted Services 3,749,880 2,249,141 3,463,400 286,480 7.6%
Human Resources 2,123,280 899,984 1,858,000 265,280 12.5%
Law 1,735,880 951,005 1,676,600 59,280 3.4% Q.
Municipal Court 4,437,810 2,477,217 4,392,100 45,710 1.0%
Parks, Recreation & Comm Services 24,054,500 12,974,509 23,707,900 346,600 1.4% Iv-
Police 58,439,540 34,545,902 58,390,400 49,140 0.1% c
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Non-Departmental 10,183,410 1,449,368 10,183,410
Total Expenditures 123,225,080 64,351,053 120,651,410 2,573,670 2.1% ,t
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Variance analysis for expenditures is provided for particular departments or those in which the estimated actual CN
amount differs from the budgeted amount by at least 10% or a minimum of $500,000. 2'
Variance Notes
Economic & Community Development: Estimated spend by ECD is $883k or 8.3% under budget due to savings in S&B p
($300k), Services ($529k) and Supplies ($54k) p
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HR: Estimated spend by HR is $265k or 12.5% under budget due to savings in S&B ($29k) and Services ($236k) ?
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2024 Budgeted General Fund o
Expenditures
Police
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0.35% N
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Law
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ECD
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Finance
Parks,Recreation&Comm 3%
Services Fire Contracted Services
20% Municipal Court 3%
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Page 5 of 14
Packet Pg. 15
ReportJuly 2024 Monthly Financial
City of Kent, Washington
General Fund
Actual Prelim Adj Budget YTD Est Actual
Beginning Fund Balance 47,660,526 51,504,084 63,738,811 63,738,811 63,738,811
Revenues
Taxes:
Property 32,835,026 16,052,750 16,165,310 8,676,820 16,249,000
Sales & Use 27,943,579 34,915,382 31,682,150 19,242,754 32,110,900
Utility 21,048,283 26,153,099 26,461,510 16,176,919 26,540,500 _
Business & Occupation 19,517,633 20,367,679 19,579,930 9,102,832 20,495,900
0
Other 930,044 1,168,377 881,820 423,902 906,600
Licenses and Permits 8,567,857 7,345,842 7,761,430 4,943,953 8,190,600
Intergovernmental Revenue 3,406,561 3,310,862 3,109,350 2,214,522 3,299,800
Charges for Services 8,492,824 8,281,105 7,050,350 4,500,130 7,543,800
Fines and Forfeitures 590,339 823,389 757,590 663,934 1,017,600
ii
Miscellaneous Revenue (375,462) 6,616,771 2,932,200 2,859,181 5,014,800 N
Transfers In 11,445,001 5,978,735 4,767,390 - 4,767,390 N
Total Revenues 134,401,684 131,013,991 121,149,030 68,804,945 126,136,890 21
Expenditures J
City Council 288,639 415,087 448,480 243,557 422,000 Z
O
Administration 3,031,347 2,757,492 3,519,030 1,575,407 3,269,000 O
Economic & Community Dev 7,791,962 9,259,189 10,633,510 5,158,350 9,750,800 Z
Finance 2,810,207 3,476,740 3,899,760 1,826,173 3,537,800
Fire Contracted Services 3,900,542 3,396,485 3,749,880 2,249,141 3,463,400 0
Human Resources 1,795,361 1,909,651 2,123,280 899,984 1,858,000
Law 1,383,659 1,358,854 1,735,880 951,005 1,676,600
Municipal Court 3,433,032 3,878,284 4,437,810 2,477,217 4,392,100 Q.
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Parks, Recreation & Comm Svcs 19,439,188 21,804,373 24,054,500 12,974,509 23,707,900 W
Police 50,394,511 54,011,056 58,439,540 34,545,902 58,390,400 3
Public Works - - - 440 c
Non-Departmental 36,289,679 16,512,053 10,183,410 1,449,368 10,183,410 E
Total Expenditures 130,558,126 118,779,264 123,225,080 64,351 053 120,651,410 q
N
O
N
Net Revenues less Expenditures 3,843,558 12,234,727 (2,076,050) 4,453,891 5,485,480 >,
Ending Fund Balance 51,504,084 63,738,811 61,662,761 68,192,702 69,224,291
m
E
Ending Fund Balance Detail:
U
General Fund Reserves 51,504,084 63,738,811 61,662,761 69,224,291 2
based on same year actuals/budget 39.4% 53.7% 50.0% 57.4% Q
Page 6 of 14
Packet Pg. 16
4.C.a
July 2024 Monthly Financial Report
City of Kent, Washington
General Fund
Year-to-Year Month Comparison
2022 i % 011
thru July thru July thru July Variance Budg
Revenues
Taxes:
Property 17,444,844 8,558,071 8,676,820 118,749 1.4% 53.7%
Sales & Use 15,384,495 19,203,170 19,242,754 39,583 0.2% 60.7%
Utility 12,681,973 15,933,954 16,176,919 242,964 1.5% 61.1%
Business &Occupation 8,056,645 8,251,541 9,102,832 851,291 10.3% 46.5%
Other 261,590 370,066 423,902 53,835 14.5% 48.1% p
Licenses and Permits 4,911,311 4,122,424 4,943,953 821,528 19.9% 63.7%
Intergovernmental Revenue 1,954,312 2,342,502 2,214,522 (127,980) -5.5% 71.2%
Charges for Services 4,297,310 4,123,936 4,500,130 376,194 9.1% 63.8%
Fines and Forfeitures 374,132 419,745 663,934 244,188 58.2% 87.6%
Miscellaneous Revenue 1,108,808 2,549,379 2,859,181 309,802 12.2% 97.5%
ii
Transfers In 285,000 1,950,000 - (1,950,000) -100.0% q
Total Revenues 66,760,419 67,824,788 68,804,945 980,156 1.4% 56.8% c
N
21
Expenditures
City Council 172,088 248,771 243,557 (5,214) -2.1% 54.3%
Administration 1,153,292 1,059,980 1,575,407 515,427 48.6% 44.8%
Economic &Community Dev 4,320,840 5,608,272 5,158,350 (449,922) -8.0% 48.5% p
Finance 1,546,243 1,921,649 1,826,173 (95,476) -5.0% 46.8% p
Fire Contracted Services 2,513,652 2,645,647 2,249,141 (396,506) -15.0% 60.0% Z
Human Resources 984,339 1,168,299 899,984 (268,315) -23.0% 42.4%
Law 790,570 759,317 951,005 191,688 25.2% 54.8% c
Municipal Court 1,950,588 2,188,603 2,477,217 288,614 13.2% 55.8%
Parks, Recreation & Comm Svcs 10,527,143 11,933,681 12,974,509 1,040,829 8.7% 53.9% t
Police 29,305,758 31,829,994 34,545,902 2,715,908 8.5% 59.1% a
Non-Departmental 2,441,804 2,710,508 1,449,368 (1,261,139) -46.5% 14.2%
Total Expenditures 55,706,318 62,074,938 64,351,053 2,276,115 3.7% 52.2%
U
c
c
GF Revenues thru July GF Expenditures thru July LL
N
30,000,000 40,000,000 N
35,000,000 2'
25,000,000
30,000,000
20,000,000 c
25,000,000 N
15,000,000 2022 20,000,000 2022
0 2023 0 2023
10,000,000 15,000,000 Q
u 2024 10,000,000 a 2024
5,000,000
5,000,000
0 p -
Property Sales& Utility Other Police Parks *General ECD Non-Dept
Taxes Use Taxes Taxes Revenues Govt. &Other
*General Govt. includes City Council,Administration, HR, IT,&Finance
Page 7 of 14
Packet Pg. 17
4.C.a
July 2024 Monthly • •
City of Kent, Washington
Fund Balances
2024 •
Estimated Estimated Estimated Estimated
Beginning Revenues Expenditures Ending Fund
Fund Balance Balance
Operating revenues and expenditures only; capital and non-capital projects are excluded.
0
General Fund
Q.
a�
General Fund 63,738,811 126,136,890 120,651,410 69,2241291
Special Revenue Funds
ca
Street Fund 13,386,120 22,367,580 20,227,980 15,5251720
LEOFF 1 Retiree Benefits 1,035,037 1,044,740 1,016,600 1,063,177 N
Lodging Tax 395,685 271,730 304,230 3631185 N
Youth/Teen Programs 526,053 1,154,760 1,112,240 568,573 3
Capital Resources 27,216,924 29,890,000 36,366,560 20,740,364
Criminal Justice 9,583,141 13,604,580 13,694,380 9,493,341 Z
Human Services 3,536,818 4,117,800 3,678,000 3,976,618 0
ShoWare Operating 646,975 1,187,190 1,928,620 (94,455) Z
Impact Fee Fund - 980,600 980,600 -
Other Operating 496,733 110,330 84,320 522,743 0
Debt Service Funds v
--
V_
Councilmanic Debt Service 743,503 7,219,700 7,813,060 150,143 Q.
as
Special Assessments Debt Service 301,876 231,220 191,810 341,286
Enterprise Funds U
c
Water Utility 19,296,081 33,946,530 35,106,030 18,136,581 E
ii
Sewer Utility 4,719,022 40,560,800 40,739,160 4,540,662 N
Drainage Utility 13,900,673 29,033,190 27,758,700 15,175,163 N
Solid Waste Utility 524,274 1,068,490 1,195,020 397,744 3
Golf Complex 1,190,301 3,586,330 3,315,750 1,460,881
Internal Service Funds c
m
E
z
Fleet Services 4,534,509 7,394,860 7,048,970 4,880,399 u
r
Central Services 172,100 317,530 324,480 165,150 a
Information Technology 2,147,830 12,927,850 12,807,580 2,268,100
Facilities 3,237,808 7,474,280 7,801,180 2,910,908
Unemployment 1,336,084 216,800 227,090 1,325,794
Workers Compensation 478,245 3,027,768 3,175,880 330,133
Employee Health & Wellness 11,202,304 17,441,687 16,406,600 12,237,391
Liability Insurance 4,216,546 6,099,360 6,008,120 4,307,786
Property Insurance 964,658 1,471,485 1,192,000 1,244,143
Page 8 of 14
Packet Pg. 18
ReportJuly 2024 Monthly Financial
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
Actual Prelim Adj Budget YTD Est Actual
Operating revenues and expenditures only; capital and non-capital projects are excluded.
In instances where expenditures exceed revenues, fund balance is being utilized.
Special Revenue Funds
Street Fund
Revenues 21,474,426 22,469,259 21,432,550 4,838,919 22,367,580
Expenditures 18,646,932 21,889,515 21,473,100 8,235,100 20,227,980
Net Revenues Less Expenditures 2,827,493 579,744 (40,550) (3,396,181) 2,139,600
0
LEOFF 1 Retiree Benefits
Revenues 1,119,751 1,133,198 1,324,150 493,003 1,044,740
Expenditures 1,375,512 949,548 1,612,800 591,738 1,016,600
Net Revenues Less Expenditures (255,761) 183,650 (288,650) (98,736) 28,140 c
ca
c
Lodging Tax U_
Revenues 565,735 288,355 288,810 151,390 271,730 N
Expenditures 244,710 315,544 304,230 230,774 304,230 N
Net Revenues Less Expenditures 321,025 (27,189) (15,420) (79,384) (32,500)
Youth/Teen Programs
Revenues 1,021,842 1,104,536 1,112,240 691,322 1,154,760
Expenditures 925,650 997,496 1,112,240 3,938 1,112,240 -J
Net Revenues Less Expenditures 96,192 107,041 - 687,385 42,520 p
Capital Resources 0
Revenues 27,054,816 29,704,278 27,195,870 15,363,356 29,890,000 Z
Expenditures 20,632,883 33,422,431 36,676,380 1,608,049 36,366,560
Net Revenues Less Expenditures 6,421,934 (3,718,153) (9,480,510) 13,755,308 (6,476,560) o
Criminal Justice
Revenues 10,036,211 12,884,719 12,012,420 8,513,640 13,604,580 r-
Expenditures 9,102,237 13,930,094 13,871,330 6,396,070 13,694,380 00.
Net Revenues Less Expenditures 933,974 (1,045,375) (1,858,910) 2,117,569 (89,800)
Human Services
Revenues 4,220,533 4,259,194 4,372,640 2,295,867 4,117,800 ua
c
Expenditures 2,813,399 3,030,334 4,388,440 362,668 3,678,000
Net Revenues Less Expenditures 1,407,133 1,228,861 (15,800) 1,933,199 439,800 ii
ShoWare Operating N
Revenues 1,794,223 6,728,636 1,180,000 7,185 1,187,190 N
Expenditures 4,130,620 6,822,931 1,928,620 2,054,220 1,928,620 >,
Net Revenues Less Expenditures (2,336,397) (94,295) (748,620) (2,047,035) (741,430)
Impact Fee Fund c
m
Revenues 3,152,179 861,560 4,251,960 475,658 980,600 E
Expenditures 3,152,179 861,560 4,251,960 437,741 980,600 t
Net Revenues Less Expenditures - - - 37,916 -
Other Operating Q
Revenues 136,681 124,197 110,330 - 110,330
Expenditures 130,685 52,640 110,330 38,345 84,320
Net Revenues Less Expenditures 5,996 71,557 - (38,345) 26,010
Page 9 of 14
Packet Pg. 19
ReportJuly 2024 Monthly Financial
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
Actual Prelim Adj Budget YTD Est Actual
Operating revenues and expenditures only; capital and non-capital projects are excluded.
In instances where expenditures exceed revenues, fund balance is being utilized.
Debt Service Funds
Councilmanic Debt Service
Revenues 7,907,603 7,383,860 7,401,000 1,943,778 7,219,700
Expenditures 8,563,855 8,259,185 7,813,060 1,939,778 7,813,060
Net Revenues Less Expenditures (656,252) (875,325) (412,060) 4,000 (593,360)
Special Assessment Debt Service Q.
Revenues 720,252 800,037 205,250 231,219 231,220
Expenditures 682,020 695,278 191,810 - 191,810
Net Revenues Less Expenditures 38,232 104,759 13,440 231,219 39,410
Enterprise Funds
ca
ii
Water Utility N
Revenues 27,653,347 33,855,188 34,450,560 18,421,874 33,946,530 N
Expenditures 25,713,818 32,054,033 36,223,510 13,900,076 35,106,030 >,
Net Revenues Less Expenditures 1,939,529 1,801,155 (1,772,950) 4,521,799 (1,159,500) 3
Sewer Utility
Revenues 35,612,755 38,684,259 39,180,400 24,068,807 40,560,800 J
z
Expenditures 33,041,535 39,141,008 40,739,160 21,238,655 40,739,160 O
Net Revenues Less Expenditures 2,571,220 (456,749) (1,558,760) 2,830,152 (178,360) O
z
Drainage Utility
Revenues 24,634,562 28,535,988 28,547,290 16,740,047 29,033,190
o
Expenditures 27,537,869 30,375,568 29,122,550 10,088,241 27,758,700
Net Revenues Less Expenditures (2,903,307) (1,839,580) (575,260) 6,651,806 1,274, 990
Solid Waste Utility 00.
Revenues 1,419,785 1,141,925 1,070,560 622,422 1,068,490
Expenditures 1,151,021 1,207,525 1,252,060 673,331 1,195,020
Net Revenues Less Expenditures 268,764 (65,600) (181,500) (50,908) (126,530) u
Golf Complex cc
Revenues 3,468,448 3,806,199 3,586,326 2,325,849 3,586,330 -E
Expenditures 2,963,754 3,156,474 3,315,750 1,854,810 3,315,750 v
Net Revenues Less Expenditures 504,694 649,725 270,576 471,039 270, 880 c
N
Internal Service Funds 21
3
Fleet Services
Revenues 8,180,653 10,659,550 7,181,920 4,402,396 7,394,860
Expenditures 5,176,283 9,034,285 10,126,620 3,907,977 7,048,970 t
Net Revenues Less Expenditures 3,004,370 1,625,265 (2,944,700) 494,419 345,890
r
Central Services Q
Revenues 315,714 290,829 378,820 159,690 317,530
Expenditures 286,653 305,677 383,640 164,626 324,480
Net Revenues Less Expenditures 29,061 (14,849) (4,820) (4,936) (6,950)
Page 10 of 14
Packet Pg. 20
4.C.a
July 2024 Monthly Financial Report
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
2022 2023 2024 2024 2024
Actual Prelim Adj Budget YTD Est Actual
Operating revenues and expenditures only; capital and non-capital projects are excluded.
In instances where expenditures exceed revenues, fund balance is being utilized.
Information Technology
Revenues 11,412,426 12,839,697 12,969,340 7,083,630 12,927,850
Expenditures 11,386,844 12,862,146 12,974,480 8,023,867 12,807,580
Net Revenues Less Expenditures 25,582 (22,449) (5,140) (940,236) 120,270
Facilities
Revenues 6,271,666 7,044,933 7,347,980 4,049,415 7,474,280 0
Q.
Expenditures 7,693,874 7,999,644 9,029,030 3,245,526 7,801,180
Net Revenues Less Expenditures (1,422,209) (954,711) (1,681,050) 803,889 (326,900)
Unemployment
Revenues 117,126 235,670 183,080 127,089 216,800 ca
Expenditures 119,475 186,230 227,090 164,998 227,090 c
Net Revenues Less Expenditures (2,349) 49,441 (44,010) (37,908) (10,290) '*
N
Workers Compensation c
N
Revenues 3,172,019 3,962,162 2,971,000 1,789,852 3,027,768 >,
Expenditures 2,852,220 2,453,276 3,284,970 1,382,141 3,175,880
Net Revenues Less Expenditures 319,800 1,508,885 (313,970) 407,711 (148,112)
J
Employee Health & Wellness Z
O
Revenues 15,793,817 17,039,338 16,777,950 10,090,103 17,441,687 O
Expenditures 14,796,643 15,317,318 16,784,980 9,498,005 16,406,600 u-
Net Revenues Less Expenditures 997,174 1,722,020 (7,030) 592,098 1,035,087 Z
co
Liability Insurance
Revenues 8,677,522 6,691,790 5,826,000 3,671,860 6,099,360
Expenditures 5,626,577 5,015,392 6,008,120 4,155,793 6,008,120 1r
Net Revenues Less Expenditures 3,050,944 1,676,398 (182,120) (483,933) 91,240 a
a�
Property Insurance
Revenues 1,171,973 1,456,200 1,456,420 864,644 1,471,485
Expenditures 814,057 985,342 1,334,640 1,646,630 1,192,000
Net Revenues Less Expenditures 357,915 470,858 121,780 (781,986) 279,485
ii
v
N
Other Fund Revenues Other Fund Expenditures N
21
80,000,000 o Special 80,000,000 N Special
70,000,000 Revenue 70,000,000 Revenue
60,000,000 Funds 60,000,000 y
50,000,000 a Enterprise 50,000,000 Funds E
40,000,000 Funds 40,000,000 a Enterprise v
30,000,000 30,000,000 Funds
20,000,000 o Internal 20,000,000 Q
10,000,000 Service 10,000,000
0 0 o Internal
Funds Service Funds
2022 2023 2024 2022 2023 Prelim 2024
Actuals Prelim Budget Actuals Budget
Page 11 of 14
Packet Pg. 21
ReportJuly 2024 Monthly Financial
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
Year-to-Year Month Comparison
thru July thru July thru July Variance
Operating revenues and expenditures only; capital and non-capital projects are excluded.
Special Revenue Funds
Street Fund
Revenues 9,205,047 8,696,180 4,838,919 (3,857,261) -44.40r
Expenditures 8,959,177 7,613,345 8,235,100 621,755 8.2°r -i
Net Revenues Less Expenditures 245,870 1,082,835 (3,396,181) o
Q.
a�
LEOFF 1 Retiree Benefits
Revenues 562,492 516,159 493,003 (23,156) -4.5°r
Expenditures 813,423 579,024 591,738 12,715 2.20r
Net Revenues Less Expenditures (250,931) (62,865) (98,736)
ii
Lodging Tax N
Revenues 408,887 143,021 151,390 8,369 5.90r N
Expenditures 159,334 202,622 230,774 28,152 13.90r
Net Revenues Less Expenditures 249,553 (59,601) (79,384)
Youth/Teen Programs Z
Revenues 622,117 683,100 691,322 8,222 1.20r O
Expenditures 3,663 3,862 3,938 76 2.00r O
Net Revenues Less Expenditures 618,453 679,239 687,385 z
Capital Resources
Revenues 14,593,067 15,137,529 15,363,356 225,827 1.5°r o
Expenditures 1,776,660 3,132,402 1,608,049 (1,524,354) -48.7°r
Net Revenues Less Expenditures 12,816,407 12,005,127 13,755,308 _
a
Criminal Justice
Revenues 5,799,004 6,316,113 8,513,640 2,197,526 34.80r
Expenditures 4,617,822 5,121,633 6,396,070 1,274,437 24.90r
Net Revenues Less Expenditures 1,181,182 1,194,480 2,117,569
ii
Human Services v
04
Revenues 2,286,284 2,434,119 2,295,867 (138,252) -5.70r N
Expenditures 88,067 351,487 362,668 11,181 3.20r
Net Revenues Less Expenditures 2,198,217 2,082,632 1,933,199
ShoWare Operating
Revenues - 1,395 7,185 5,790 415.10r E
Expenditures 2,078,267 2,359,008 2,054,220 (304,788) -12.90r U
Net Revenues Less Expenditures (2,078,267) (2,357,613) (2,047,035)
r
Q
Admissions Tax revenues received quarterly (April, July, September, January)
Impact Fee Fund
Revenues 1,526,324 532,908 475,658 (57,250) -10.70r
Expenditures 1,072,394 513,108 437,741 (75,367) -14.70r
Net Revenues Less Expenditures 453,930 19,800 37,916
Other Operating
Revenues - - - -
Expenditures 51,951 21,220 38,345 17,125 80.70r
Net Revenues Less Expenditures (51,951) (21,220) (38,345)
Combines several small programs, including City Art Program and Neighborhood Matching Grants
Page 12 of 14 1 Packet Pg. 22
ReportJuly 2024 Monthly Financial
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
Year-to-Year Month Comparison
thru July thru July thru July Variance
Operating revenues and expenditures only; capital and non-capital projects are excluded.
Debt Service Funds
Councilmanic Debt Service
Revenues 2,216,099 2,103,745 1,943,778 (159,967) -7.60r
Expenditures 2,239,019 2,129,419 1,939,778 (189,641) -8.90r
Net Revenues Less Expenditures (22,919) (25,674) 4,000 0
a�
Debt service payments are generally due in June and December.
15-
Special Assessments Debt Service U
Revenues 138,546 264,637 231,219 (33,418) -12.60r
Expenditures 3,809 - - -
Net Revenues Less Expenditures 134,736 264,637 231,219
N
O
Enterprise Funds N
21
3
Water Utility
Revenues 15,053,827 17,890,695 18,421,874 531,179 3.00r J
Expenditures 10,973,715 12,727,651 13,900,076 1,172,424 9.20r z
Net Revenues Less Expenditures 4,080,113 5,163,044 4,521,799 O
O
Sewer Utility u_
Revenues 20,710,642 22,575,723 24,068,807 1,493,084 6.60r Z
Expenditures 20,696,030 20,263,457 21,238,655 975,198 4.80r c
Net Revenues Less Expenditures 14,612 2,312,266 2,830,152
v
Drainage Utility V_
Revenues 14,399,934 15,779,818 16,740,047 960,228 6.10r Q.
Expenditures 9,451,075 9,979,356 10,088,241 108,885 1.10r
Net Revenues Less Expenditures 4,948,859 5,800,462 6,651,806
U
Solid Waste Utility
Revenues 516,383 612,717 622,422 9,705 1.60r c
Expenditures 703,983 686,222 673,331 (12,891) -1.90r u_
Net Revenues Less Expenditures (187,600) (73,505) (50,908) c
Golf Complex �,
Revenues 1,981,769 2,143,641 2,325,849 182,207 8.50r
Expenditures 1,775,968 1,900,456 1,854,810 (45,646) -2.40r
Net Revenues Less Expenditures 205,801 243,185 471,039
m
E
Internal Service Funds U
r
Fleet Services Q
Revenues 3,543,051 4,778,932 4,402,396 (376,536) -7.90r
Expenditures 2,854,482 4,954,431 3,907,977 (1,046,454) -21.10r
Net Revenues Less Expenditures 688,568 (175,500) 494,419
Central Services
Revenues 167,796 173,935 159,690 (14,245) -8.20r
Expenditures 134,367 122,098 164,626 42,528 34.80r
Net Revenues Less Expenditures 33,429 51,837 (4,936)
Information Technology
Revenues 5,751,743 6,642,614 7,083,630 441,016 6.60r
Expenditures 6,221,398 7,041,623 8,023,867 982,244 13.90r
Net Revenues Less Expenditures (469,655) (399,009) (940,236)
Page 13 of 14 1 Packet Pg. 23
ReportJuly 2024 Monthly Financial
City of Kent, Washington
Other Funds Overview (Revenues and Expenditures)
Year-to-Year Month Comparison
thru July thru July thru July Variance
Operating revenues and expenditures only; capital and non-capital projects are excluded.
Facilities
Revenues 3,254,404 3,574,936 4,049,415 474,479 13.30r
Expenditures 3,053,647 3,861,013 3,245,526 (615,486) -15.90r
Net Revenues Less Expenditures 200,757 (286,076) 803,889
V_
Unemployment o
0.
Revenues 94,689 116,382 127,089 10,708 9.20r
Expenditures 74,710 156,133 164,998 8,864 5.70r IX
Net Revenues Less Expenditures 19,980 (39,752) (37,908)
c
ca
Workers Compensation
Revenues 886,687 1,128,145 1,789,852 661,707 58.70r LL
Expenditures 1,298,334 1,480,040 1,382,141 (97,900) -6.60r c
Net Revenues Less Expenditures (411,646) (351,896) 407,711 N
21
Employee Health & Wellness
Revenues 9,184,780 9,640,083 10,090,103 450,020 4.70r J
Expenditures 8,331,393 8,762,717 9,498,005 735,289 8.40r z
Net Revenues Less Expenditures 853,387 877,367 592,098 O
O
u_
Liability Insurance z
Revenues 1,901,691 2,567,282 3,671,860 1,104,578 43.00r
Expenditures 2,685,161 3,586,635 4,155,793 569,158 15.90r o
Net Revenues Less Expenditures (783,470) (1,019,353) (483,933)
V_
Property Insurance a
Revenues 456,490 559,660 864,644 304,984 54.50r �
Expenditures 1,198,115 1,493,581 1,646,630 153,049 10.20r
Net Revenues Less Expenditures (741,625) (933,921) (781,986)
c
c
ii
Other Fund Revenues thru July Other Fund Expenditures thru July N
0
N
70,000,000 2'
60,000,000 50,000,000
c
50,000,000 40,000,000
t
40,000,000 30,000,000
30,000,000 ■2022 ■2022 Q
0 2023 20,000,000 0 2023
20,000,000
10,000,000 a 2024 10,000,000 642024
0 0
Special Enterprise Internal Special Enterprise Internal
Revenue Funds Service Funds Revenue Funds Service Funds
Funds Funds
Page 14 of 14 Packet Pg. 24
4.D
HUMAN RESOURCES DEPARTMENT
Kari Endicott - Interim Human Resources Director
220 Fourth Avenue South
KENT Kent, WA 98032
W A S H i N G T O N 253-856-5270
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Medical and Stop Loss Contracts - Authorize
MOTION: I move to authorize the Mayor to approve the renewal of the
following contracts:
• Medical plan with Kaiser Permanente for one year
• Premera Administrative Services for three years
• Stop Loss Insurance with LifeWise for one year
All subject to approval of final terms and conditions by the Acting Human
Resources Director and the City Attorney.
SUMMARY:
Medical
The City contracts with Kaiser Permanente for the City's fully insured health
maintenance organization plan (HMO). The renewal has a 7.2% rate increase for
2024 (approximately $38,529).
Medical Administrative Services
The City contracts with Premera Blue Cross to be the third-party administrator for
medical claims processing, and to provide access to their network of doctors and
hospitals. The City is self-insured for this program and wires funds to cover the
weekly medical claims costs. Our current contract had a 1.9% increase in 2024 and
was scheduled to expire at the end of 2024. Premera offered an early 3-year
renewal with a 1.3% rate decrease in 2024 and 2% escalators in 2025 and 2026.
Stop Loss
City of Kent contracts with LifeWise Assurance Company for our individual and
aggregate stop loss insurance coverage. The best offer received for 2024 was from
LifeWise with an increase in the policy deductible from $200,000 to $275,000, a
30.2% premium decrease (approximately $372,000 savings), and premium refund
potential if the policy has a year-end loss ratio of 70% or better. Contracting with
LifeWise provides us an additional discount from Premera on the stop loss
integration fee.
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4.D
This stop loss policy provides added coverage to the City for individual medical
claims exceeding $275,000 per employee or dependent for each calendar year.
Medical costs exceeding this amount are reimbursed to the City under this policy.
Staff recommends renewing with these vendors based on the strength of their
plans, overall costs, customer service, discounts, and overall administration and
billing accuracy.
The cost for these contracts is budgeted in the Health & Wellness fund.
BUDGET IMPACT:
Kaiser Permanente - $542,887 for a one-year contract
Premera - $1,408,356 for a three-year contract
LifeWise - $862,590 for a one-year contract
SUPPORTS STRATEGIC PLAN GOAL:
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. Kaiser(PDF)
2. Premera (PDF)
3. StopLoss (PDF)
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4.D.a
KAISER PERMANENTE®
Kaiser Foundation Health Plan of Washington
A nonprofit health maintenance organization
Group Medical Coverage Agreement
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Kaiser Foundation Health Plan of Washington("KFHPWA")is a nonprofit health maintenance organization,duly o
registered under the laws of the State of Washington,furnishing health care coverage on a prepayment basis.The
Group identified below wishes to purchase such coverage. This Group Medical Coverage Agreement("Group
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Agreement")sets forth the terms under which that coverage will be provided,including the rights and
responsibilities of the contracting parties;requirements for enrollment and eligibility;and benefits to which those
enrolled under this Group Agreement are entitled.
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The Group Medical Coverage Agreement between KFHPWA and the Group consists of the following: �j
• Standard Provisions 0
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• Evidence of Coverage a
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City of Kent,#0036900
This Group Agreement will continue in effect until terminated or renewed as herein provided for and is effective 2
January 1,2024.
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4.D.a
Standard Provisions
1. KFHPWA agrees to provide benefits as set forth in the attached Evidence of Coverage(EOC)to enrollees
of the Group.
2. Monthly Premium Payments.
For the initial term of this Group Agreement,the Group shall submit to KFHPWA for each Member the
monthly premiums set forth in the current Premium Schedule and a verification of enrollment. Payment must be
received on or before the due date and is subject to a grace period of 10 days.Premiums are subject to change
by KFHPWA upon 30 days written notice. Premium rates will be revised as a part of the annual renewal
process.
KFHPWA reserves the right to re-rate this benefit package if the demographic characteristics change by more
than 15%.
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3. Dissemination of Information. 0
Unless the Group has accepted responsibility to do so,KFHPWA will disseminate information describing 3
benefits set forth in the EOC attached to this Group Agreement. Q
4. Identification Cards.
KFHPWA will furnish cards,for identification purposes only,to all Members enrolled under this Group
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Agreement. 0
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5. Administration of Group Agreement. vyi
KFHPWA may adopt reasonable policies and procedures to help in the administration of this Group Agreement. �
This may include,but is not limited to,policies or procedures pertaining to benefit entitlement and coverage 0.
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determinations. y
6. Modification of Group Agreement. M
Except as required by federal and Washington State law,this Group Agreement may not be modified without 7V
agreement between both parties.
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No oral statement of any person shall modify or otherwise affect the benefits,limitations and exclusions of this
Group Agreement,convey or void any coverage,increase or reduce any benefits under this Group Agreement or c
be used in the prosecution or defense of a claim under this Group Agreement.
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7. Indemnification.
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KFHPWA agrees to indemnify and hold the Group harmless against all claims,damages,losses and expenses, Y
including reasonable attorney's fees,arising out of KFHPWA's failure to perform,negligent performance or
willful misconduct of its directors,officers,employees and agents of their express obligations under this Group
Agreement.
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The Group agrees to indemnify and hold KFHPWA harmless against all claims,damages,losses and expenses,
including reasonable attorney's fees,arising out of the Group's failure to perform,negligent performances or Q
willful misconduct of its directors,officers,employees and agents of their express obligations under this Group
Agreement.
The indemnifying party shall give the other party prompt notice of any claim covered by this section and
provide reasonable assistance(at its expense). The indemnifying party shall have the right and duty to assume
the control of the defense thereof with counsel reasonably acceptable to the other party.Either party may take
part in the defense at its own expense after the other party assumes the control thereof.
8. Compliance With Law.
The Group and KFHPWA shall comply with all applicable state and federal laws and regulations in
performance of this Group Agreement.
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4.D.a
This Group Agreement is entered into and governed by the laws of Washington State,except as otherwise pre-
empted by ERISA and other federal laws.
9. Governmental Approval.
If KFHPWA has not received any necessary government approval by the date when notice is required under this
Group Agreement,KFHPWA will notify the Group of any changes once governmental approval has been
received.KFHPWA may amend this Group Agreement by giving notice to the Group upon receipt of
government approved rates,benefits,limitations,exclusions or other provisions,in which case such rates,
benefits,limitations,exclusions or provisions will go into effect as required by the governmental agency.All
amendments are deemed accepted by the Group unless the Group gives KFHPWA written notice of non-
acceptance within 30 days after receipt of amendment,in which event this Group Agreement and all rights to
services and other benefits terminate the first of the month following 30 days after receipt of non-acceptance.
10. Grandfathered Health Plan.
For any coverage identified in an EOC as a"grandfathered health plan"under the Patient Protection and N
Affordable Care Act(a/k/a the ACA),Group must immediately inform KFHPWA if this coverage does not 0
meet(or no longer meets)the requirements for grandfathered status including but not limited to any change in 3
its contribution rate to the cost of any grandfathered health plan(s)during the plan year. Group represents that, Q
for any coverage identified as a"grandfathered health plan"in the applicable EOC,Group has not decreased its y
contribution rate more than five percent(5%)for any rate tier for such grandfathered health plan when U
compared to the contribution rate in effect on March 23,2010 for the same plan.Health Plan will rely on
Group's representation in issuing and/or continuing any and all grandfathered health plan coverage 0
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11. Confidentiality. U)
Each party acknowledges that performance of its obligations under this Group Agreement may involve access �
to and disclosure of data,procedures,materials,lists, systems and information,including medical records, 0.
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employee benefits information,employee addresses,social security numbers,e-mail addresses,phone numbers y
and other confidential information regarding the Group's employees(collectively the"information").The
information shall be kept strictly confidential and shall not be disclosed to any third party other than: (i) 0
representatives of the receiving party(as permitted by applicable state and federal law)who have a need to
know such information in order to perform the services required of such party pursuant to this Group
Agreement,or for the proper management and administration of the receiving party,provided that such
representatives are informed of the confidentiality provisions of this Group Agreement and agree to abide by
them,(ii)pursuant to court order or(iii)to a designated public official or agency pursuant to the requirements of c
federal,state or local law,statute,rule or regulation. The disclosing party will provide the other party with
prompt notice of any request the disclosing party receives to disclose information pursuant to applicable legal L
requirements,so that the other party may object to the request and/or seek an appropriate protective order N
against such request.Each party shall maintain the confidentiality of medical records and confidential patient Y
and employee information as required by applicable law.
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12. HIPAA. E
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Definition of Terms.Terms used,but not otherwise defined,in this section shall have the same meaning as
those terms have in the Health Insurance Portability and Accountability Act of 1996("HIPAA"). Q
Transactions Accepted.KFHPWA will accept Standard Transactions,pursuant to HIPAA,if the Group elects
to transmit such transactions.The Group shall ensure that all Standard Transactions transmitted to KFHPWA by
the Group or the Group's business associates are in compliance with HIPAA standards for electronic
transactions. The Group shall indemnify KFHPWA for any breach of this section by the Group.
13. Termination of Entire Group Agreement.
This is a guaranteed renewable Group Agreement and cannot be terminated without the mutual approval of each
of the parties,except in the circumstances set forth below.
a. Nonpayment or Non-Acceptance of Premium.Failure to make any monthly premium payment or
contribution in accordance with Subsection 2.above shall result in termination of this Group Agreement as
3
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4.D.a
of the premium due date. The Group's failure to accept the revised premiums provided as part of the annual
renewal process shall be considered nonpayment and result in non-renewal of this Group Agreement. The
Group may terminate this Group Agreement upon 15 days written notice of premium increase,as set forth
in Subsection 2. above.
b. Misrepresentation.KFHPWA may rescind or terminate this Group Agreement upon written notice in the
event that intentional misrepresentation,fraud or omission of information was used in order to obtain
Group coverage.Either party may terminate this Group Agreement in the event of intentional
misrepresentation,fraud or omission of information by the other party in performance of its responsibilities
under this Group Agreement.
c. Underwriting Guidelines.KFHPWA may terminate this Group Agreement in the event the Group no
longer meets underwriting guidelines established by KFHPWA that were in effect at the time the Group
was accepted.
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d. Federal or State Law.KFHPWA may terminate this Group Agreement in the event there is a change in 0
federal or state law that no longer permits the continued offering of the coverage described in this Group 3
Agreement. Q
14. Withdrawal or Cessation of Services.
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a. KFHPWA may determine to withdraw from a Service Area or from a segment of its Service Area after 0
KFHPWA has demonstrated to the Washington State Office of the Insurance Commissioner that v
KFHPWA's clinical,financial or administrative capacity to service the covered Members would be c
exceeded. _J
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b. KFHPWA may determine to cease to offer the Group's current plan and replace the plan with another plan y
offered to all covered Members within that line of business that includes all of the health care services
covered under the replaced plan and does not significantly limit access to the services covered under the M
replaced plan.KFHPWA may also allow unrestricted conversion to a fully comparable KFHPWA product.
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KFHPWA will provide written notice to each covered Member of the discontinuation or non-renewal of the
plan at least 90 days prior to discontinuation.
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15. Limitation on Enrollment.
The Group Agreement will be open for applications for enrollment as described in the group master application. L
Subject to prior approval by the Washington State Office of the Insurance Commissioner,KFHPWA may limit N
enrollment,establish quotas or set priorities for acceptance of new applications if it determines that KFHPWA's Y
capacity,in relation to its total enrollment,is not adequate to provide services to additional persons.
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16. Acceptance of Group Agreement
The Group agrees as having accepted the terms and conditions of this Group Agreement and any amendments
issued during the term of this Group Agreement,upon receipt by KFHPWA of any amount of premium
payment. Q
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4.D.a
Your
Kaiser Foundation Health Plan of
Washington
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Evidence of Coverage
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4.D.a
KAISER PERMAN ELATE.
Kaiser Foundation Health Plan of Washington
A nonprofit health maintenance organization
2024 Evidence of Coverage N
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CA-1888a24
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4.D.a
Important Notice Under Federal Health Care Reform
Kaiser Foundation Health Plan of Washington("KFHPWA")recommends each Member choose a Network Personal
Physician. This decision is important since the designated Network Personal Physician provides or arranges for
most of the Member's health care. The Member has the right to designate any Network Personal Physician who
participates in one of the KFHPWA networks and who is available to accept the Member or the Member's family
members. For information on how to select a Network Personal Physician, and for a list of the participating
Network Personal Physicians,please call Kaiser Permanente Member Services at(206)630-4636 in the Seattle area,
or toll-free in Washington, 1-888-901-4636.
For children,the Member may designate a pediatrician as the primary care provider.
The Member does not need Preauthorization from KFHPWA or from any other person (including a Network
Personal Physician) to access obstetrical or gynecological care from a health care professional in the KFHPWA
network who specializes in obstetrics or gynecology. The health care professional, however, may be required to N
comply with certain procedures, including obtaining Preauthorization for certain services, following a pre-approved t
treatment plan, or procedures for obtaining Preauthorization. For a list of participating health care professionals 3
who specialize in obstetrics or gynecology,please call Kaiser Permanente Member Services at(206)630-4636 in the Q
Seattle area,or toll-free in Washington, 1-888-901-4636. y
Women's health and cancer rights
If the Member is receiving benefits for a covered mastectomy and elects breast reconstruction in connection with the c
mastectomy,the Member will also receive coverage for: v
• All stages of reconstruction of the breast on which the mastectomy has been performed. c
• Surgery and reconstruction of the other breast to produce a symmetrical appearance. _J
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• Prostheses. G
• Treatment of physical complications of all stages of mastectomy,including lymphedemas. U)
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These services will be provided in consultation with the Member and the attending physician and will be subject to M
the same Cost Shares otherwise applicable under the Evidence of Coverage(EOC). 7V
Statement of Rights Under the Newborns' and Mothers' Health Protection Act
Carriers offering group health coverage generally may not,under federal law,restrict benefits for any hospital length
of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal T
delivery,or less than 96 hours following a cesarean section.However,federal law generally does not prohibit the
mother's or newborn's attending provider,after consulting with the mother,from discharging the mother or newborn
earlier than 48 hours(or 96 hours as applicable).In any case,carriers may not,under federal law,require that a N
provider obtain authorization from the carrier for prescribing a length of stay not in excess of 48 hours(or 96 hours). Y
Also,under federal law,a carrier may not set the level of benefits or out-of-pocket costs so that any later portion of
the 48-hour(or 96-hour)stay is treated in a manner less favorable to the mother or newborn than any earlier portion
of the stay. z
For More Information
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KFHPWA will provide the information regarding the types of plans offered by KFHPWA to Members on request.
Please call Kaiser Permanente Member Services at(206) 63 0-463 6 in the Seattle area,or toll-free in Washington, 1-
888-901-4636.
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4.D.a
Table of Contents
I. Introduction...................................................................................................................................................6
II. How Covered Services Work........................................................................................................................6
A. Accessing Care.........................................................................................................................................6
B. Administration of the EOC. .....................................................................................................................9
C. Assignment...............................................................................................................................................9
D. Confidentiality..........................................................................................................................................9
E. Modification of the EOC..........................................................................................................................9
F. Nondiscrimination....................................................................................................................................9
G. Preauthorization.......................................................................................................................................9
H. Recommended Treatment. .....................................................................................................................10
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I. Second Opinions....................................................................................................................................10 i
J. Unusual Circumstances..........................................................................................................................10 0
K. Utilization Management.........................................................................................................................10
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III. Financial Responsibilities...........................................................................................................................11 y
A. Premium.................................................................................................................................................11
B. Financial Responsibilities for Covered Services....................................................................................11
C. Financial Responsibilities for Non-Covered Services............................................................................11 0
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IV. Benefits Details............................................................................................................................................12 y
AnnualDeductible.........................................................................................................................................12 0
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Coinsurance...................................................................................................................................................12 0.
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LifetimeMaximum.......................................................................................................................................12 U)
Out-of-pocket Limit......................................................................................................................................12 c
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Pre-existing Condition Waiting Period.........................................................................................................12 MI
Acupuncture..................................................................................................................................................13
Advanced Care at Home................................................................................................................................13
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AllergyServices............................................................................................................................................15 ti
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Ambulance....................................................................................................................................................15
Cancer Screening and Diagnostic Services...................................................................................................15 L
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Circumcision.................................................................................................................................................16 N
ClinicalTrials................................................................................................................................................16 Y
Dental Services and Dental Anesthesia.........................................................................................................16
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Devices,Equipment and Supplies(for home use).........................................................................................17
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Diabetic Education,Equipment and Pharmacy Supplies ..............................................................................18
Dialysis(Home and Outpatient)....................................................................................................................18 Q
Drugs-Outpatient Prescription.....................................................................................................................19
EmergencyServices......................................................................................................................................22
GenderHealth Services.................................................................................................................................23
Hearing Examinations and Hearing Aids......................................................................................................23
HomeHealth Care.........................................................................................................................................24
Hospice..........................................................................................................................................................24
Hospital-Inpatient and Outpatient...............................................................................................................25
Infertility(including sterility)........................................................................................................................26
InfusionTherapy...........................................................................................................................................26
Laboratoryand Radiology.............................................................................................................................27
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4.D.a
ManipulativeTherapy...................................................................................................................................27
Maternityand Pregnancy...............................................................................................................................27
MentalHealth and Wellness..........................................................................................................................28
Naturopathy...................................................................................................................................................29
NewbornServices.........................................................................................................................................30
NutritionalCounseling..................................................................................................................................30
NutritionalTherapy.......................................................................................................................................30
ObesityRelated Services...............................................................................................................................31
On the Job Injuries or Illnesses.....................................................................................................................31
Oncology.......................................................................................................................................................31
Optical(vision)..............................................................................................................................................32
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OralSurgery..................................................................................................................................................32 N
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Outpatient Services.......................................................................................................................................33 0
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Plastic and Reconstructive Surgery...............................................................................................................33 Q
Podiatry.........................................................................................................................................................33 rn
PreventiveServices.......................................................................................................................................33
Rehabilitation and Habilitative Care(massage,occupational,physical and speech therapy,pulmonary and
cardiac rehabilitation)and Neurodevelopmental Therapy.....................................................................34 0
ReproductiveHealth......................................................................................................................................36 N
SexualDysfunction.......................................................................................................................................36 0
SkilledNursing Facility.................................................................................................................................37 0.
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Sterilization...................................................................................................................................................37 U)
SubstanceUse Disorder.................................................................................................................................37 c
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TelehealthServices.......................................................................................................................................39 i
Temporomandibular Joint(TMJ)..................................................................................................................40
Tobacco Cessation.........................................................................................................................................41
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Transplants....................................................................................................................................................41 ti
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UrgentCare...................................................................................................................................................42
V. General Exclusions......................................................................................................................................42
VI. Eligibility,Enrollment and Termination...................................................................................................44 N
A. Eligibility. ..............................................................................................................................................44 Y
B. Application for Enrollment....................................................................................................................44
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C. When Coverage Begins..........................................................................................................................46 d
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D. Eligibility for Medicare..........................................................................................................................46
E. Termination of Coverage. ......................................................................................................................47
F. Continuation of Coverage Options.........................................................................................................47 Q
VII. Grievances....................................................................................................................................................48
VIII. Appeals.........................................................................................................................................................49
IX. Claims...........................................................................................................................................................50
X. Coordination of Benefits.............................................................................................................................51
Definitions.....................................................................................................................................................51
Order of Benefit Determination Rules...........................................................................................................52
Effect on the Benefits of this Plan.................................................................................................................54
Right to Receive and Release Needed Information.......................................................................................54
Facilityof Payment. ......................................................................................................................................54
Rightof Recovery.........................................................................................................................................54
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4.D.a
Effectof Medicare.........................................................................................................................................54
XI. Subrogation and Reimbursement Rights..................................................................................................55
XII. Definitions....................................................................................................................................................56
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4.D.a
KFHPWA believes this plan is a"grandfathered health plan"under the Patient Protection and Affordable Care Act
of 2010. Questions regarding this status may be directed to Kaiser Permanente Member Services at toll-free 1-888-
901-4636.Members may also contact the Employee Benefits Security Administration,U.S.Department of Labor at
toll-free 1-866-444-3272 or www.dol.,gov/ebsa/healthreform.
I. Introduction
This EOC is a statement of benefits,exclusions and other provisions as set forth in the Group Medical Coverage
Agreement between Kaiser Foundation Health Plan of Washington("KFHPWA")and the Group. The benefits were
approved by the Group who contracts with KFHPWA for health care coverage.This EOC is not the Group medical
coverage agreement itself.In the event of a conflict between the Group Medical Coverage Agreement and the EOC,
the EOC language will govern.
The provisions of the EOC must be considered together to fully understand the benefits available under the EOC.
Words with special meaning are capitalized and are defined in Section XII. N
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Contact Kaiser Permanente Member Services at 206-630-4636 or toll-free 1-888-901-4636 for benefits questions. 3
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II. How Covered Services Work rn
A. Accessing Care.
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1. Members are entitled to Covered Services from the following: v
Your Provider Network is KFHPWA's Core Network(Network). Members are entitled to Covered c
Services only at Network Facilities and Network Providers,except for Emergency services and care _J
pursuant to a Preauthorization. 0.
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Benefits under this EOC will not be denied for any health care service performed by a registered nurse
licensed to practice under chapter 18.88 RCW,if first,the service performed was within the lawful scope of 0
such nurse's license,and second,this EOC would have provided benefit if such service had been performed M
by a Doctor of Medicine licensed to practice under chapter 18.71 RCW.
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A listing of Core Network Personal Physicians,specialists,women's health care providers and KFHPWA-
designated Specialists is available by contacting Member Services or accessing the KFHPWA website at c
www.kp.org/wa.Information available online includes each physician's location,education,credentials,
and specialties.KFHPWA also utilizes Health Care Benefit Managers for certain services.To see a list of L
Health Care Benefit Managers,go hlWs://healLhy.kaiselpermanente.org/washington/sMort/forms and y
click on the"Evidence of coverage"link. Y
Receiving Care in another Kaiser Foundation Health Plan Service Area
If you are visiting in the service area of another Kaiser Permanente region,visiting member services may E
be available from designated providers in that region if the services would have been covered under this
EOC.Visiting member services are subject to the provisions set forth in this EOC including,but not limited
to,Preauthorization and cost sharing. For more information about receiving visiting member services in Q
other Kaiser Permanente regional health plan service areas,including provider and facility locations,please
call Kaiser Permanente Member Services at(206)630-4636 in the Seattle area,or toll-free in Washington,
1-888-901-4636.Information is also available online at
www.wa.kaiselpermanente.ora/html/Tublic/services/traveling.
KFHPWA will not directly or indirectly prohibit Members from freely contracting at any time to obtain
health care services from Non-Network Providers and Non-Network Facilities outside the Plan.However,
if you choose to receive services from Non-Network Providers and Non-Network Facilities except as
otherwise specifically provided in this EOC,those services will not be covered under this EOC,and you
will be responsible for the full price of the services. Any amounts you pay for non-covered services will not
count toward your Out-of-Pocket Limit.
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2. Primary Care Provider Services.
KFHPWA recommends that Members select a Network Personal Physician when enrolling. One personal
physician may be selected for an entire family,or a different personal physician may be selected for each
family member.For information on how to select or change Network Personal Physicians,and for a list of
participating personal physicians,call Kaiser Permanente Member Services at(206)630-4636 in the Seattle
area,or toll-free in Washington at 1-888-901-4636 or by accessing the KFHPWA website at
www.kp.org/wa. The change will be made within 24 hours of the receipt of the request if the selected
physician's caseload permits. If a personal physician accepting new Members is not available in your area,
contact Kaiser Permanente Member Services,who will ensure you have access to a personal physician by
contacting a physician's office to request they accept new Members.
To find a personal physician,call Member Services or access the KFHPWA website at www.kp.org/wa to
view physician profiles.Information available online includes each physician's location,education,
credentials,and specialties.
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For your personal physician,choose from these specialties: 0
• Family medicine 3
• Adult medicine/internal medicine Q
• Pediatrics/adolescent medicine(for children up to 18) y
Be sure to check that the physician you are considering is accepting new patients.
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If your choice does not feel right after a few visits,you can change your personal physician at any time,for v
any reason.If you don't choose a physician when you first become a KFHPWA member,we will match c
you with a physician to make sure you have one assigned to you if you get sick or injured. _J
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In the case that the Member's personal physician no longer participates in KFHPWA's network,the y
Member will be provided access to the personal physician for up to 60 days following a written notice
offering the Member a selection of new personal physicians from which to choose. 0
3. Specialty Care Provider Services.
Unless otherwise indicated in Section 11.or Section IV.,Preauthorization is required for specialty care and
specialists that are not KFHPWA-designated Specialists and are not providing care at facilities owned and
operated by Kaiser Permanente. c
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KFHPWA-designated Specialist. i
Preauthorization is not required for services with KFHPWA-designated Specialists at facilities owned and N
operated by Kaiser Permanente. To access a KFHPWA-designated Specialist,consult your KFHPWA Y
personal physician.For a list of KFHPWA-designated Specialists,contact Member Services or view the
Provider Directory located at www.kp.org/wa. The following specialty care areas are available from
KFHPWA-designated Specialists: allergy,audiology,cardiology,chiropractic/manipulative therapy,
dermatology,gastroenterology,general surgery,hospice,mental health and wellness,nephrology,
neurology,obstetrics and gynecology,occupational medicine,oncology/hematology,ophthalmology,
optometry,orthopedics,otolaryngology(ear,nose and throat),physical therapy, smoking cessation, Q
speech/language and learning services,substance use disorder and urology.
4. Hospital Services.
Non-Emergency inpatient hospital services require Preauthorization.Refer to Section IV. for more
information about hospital services.
5. Emergency Services.
Emergency services at a Network Facility or non-Network Facility are covered.Members must notify
KFHPWA by way of the Hospital notification line(1-888-457-9516 as noted on your Member
identification card)within 24 hours of any admission,or as soon thereafter as medically possible. Coverage
for Emergency services at a non-Network Facility is limited to the Allowed Amount.Refer to Section IV.
for more information about Emergency services.
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4.D.a
Members are covered for Emergency care and Medically Necessary urgent care anywhere in the world.If
you think you are experiencing an emergency,go immediately to the nearest emergency care facility or call
911. Go to the closest urgent care center for an illness or injury that requires prompt medical attention but
is not an emergency.Examples include,but are not limited to minor injuries,wounds,and cuts needing
stiches;minor breathing issues;minor stomach pain. If you are unsure whether urgent care is your best
option,call the consulting nurse helpline for advice at 1-800-297-6877 or 206-630-2244.
If you need Emergency care while traveling and are admitted to a non-network hospital,you or a family
member must notify us within 24 hours after care begins,or as soon as is reasonably possible.Call the
notification line listed on the back of your KFHPWA Member ID card to help make sure your claim is
accepted.Keep receipts and other paperwork from non-network care.You'll need to submit them with any
claims for reimbursement after returning from travel.
m
Access to non-Emergency care across the Core network service area:your Plan provides access to all N
providers in the Core Network,including many physicians and services at Kaiser Permanente medical 0
facilities and Core Network facilities across the state.Find links to providers at kp.org/wa/diregM or 3
contact Member Services at 1-888-901-4636 for assistance. Q
6. Urgent Care.
Inside the KFHPWA Service Area,urgent care is covered at a Kaiser Permanente medical center,Kaiser
Permanente urgent care center or Network Provider's office.Outside the KFHPWA Service Area,urgent 0
care is covered at any medical facility.Refer to Section IV.for more information about urgent care. v
For urgent care during office hours,you can call your personal physician's office first to see if you can get �
a same-day appointment.If a physician is not available or it is after office hours,you may speak with a 0.
0
licensed care provider anytime at 1-800-297-6877 or 206-630-2244. You may also check y
kp.org/wa/directory or call Member Services to find the nearest urgent care facility in your network.
0
7. Women's Health Care Direct Access Providers. 7V
Female Members may see a general and family practitioner,physician's assistant,gynecologist,certified
nurse midwife,licensed midwife,doctor of osteopathy,pediatrician,obstetrician or advance registered
nurse practitioner who is unrestricted in your KFHPWA Network to provide women's health care services
directly,without Preauthorization,for Medically Necessary maternity care,covered reproductive health c
services,preventive services(well care)and general examinations,gynecological care and follow-up visits
for the above services.Women's health care services are covered as if the Member's Network Personal L
Physician had been consulted,subject to any applicable Cost Shares. If the Member's women's health care N
provider diagnoses a condition that requires other specialists or hospitalization,the Member or the chosen Y
provider must obtain Preauthorization in accordance with applicable KFHPWA requirements.For a list of
KFHPWA providers,contact Member Services or view the Provider Directory located at www.kp.org/wa.
E
8. Travel Advisory Service.
Our Travel Advisory Service offers recommendations tailored to your travel outside the United States.
Nurses certified in travel health will advise you on any vaccines or medications you need based on your Q
destination,activities,and medical history.The consultation is not a covered benefit and there is a fee for a
KFHPWA Member using the service for the first time.Travel-related vaccinations and medications are
usually not covered.Visit kp.org/wa/travel-service for more details.
9. Process for Medical Necessity Determination.
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.
First Level Review:
8 COE931-0036900
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4.D.a
First level reviews are performed or overseen by appropriate clinical staff using KFHPWA approved
clinical review criteria.Data sources for the review include,but are not limited to,referral forms,admission
request forms,the Member's medical record,and consultation with qualified health professionals and
multidisciplinary health care team members.The clinical information used in the review may include
treatment summaries,problem lists,specialty evaluations,laboratory and x-ray results,and rehabilitation
service documentation.The Member or legal surrogate may be contacted for information.Coordination of
care interventions are initiated as they are identified.The reviewer consults with the health care team when
more clarity is needed to make an informed medical necessity decision.The reviewer may consult with a
board-certified consultative specialist and such consultations will be documented in the review text.If the
requested service appears to be inappropriate based on application of the review criteria,the first level
reviewer requests second level review by a physician or designated health care professional.
Second Level(Practitioner)Review:
m
The practitioner reviews the treatment plan and discusses,when appropriate,case circumstances and N
management options with the attending(or referring)physician.The reviewer consults with the health care 0
team when more clarity is needed to make an informed coverage decision.The reviewer may consult with 3
board certified physicians from appropriate specialty areas to assist in making determinations of coverage Q
and/or appropriateness.All such consultations will be documented in the review text.If the reviewer y
determines that the admission,continued stay or service requested is not a covered service,a notice of non- U
coverage is issued.Only a physician,behavioral health practitioner(such as a psychiatrist,doctoral-level
clinical psychologist,certified addiction medicine specialist),dentist or pharmacist who has the clinical 0
expertise appropriate to the request under review with an unrestricted license may deny coverage based on v
Medical Necessity. c
J
B. Administration of the EOC. 0.
0
KFHPWA may adopt reasonable policies and procedures to administer the EOC.This may include,but is not y
limited to,policies or procedures pertaining to benefit entitlement and coverage determinations.
0
C. Assignment 7V
The Member may not assign this EOC or any of the rights,interests,claims for money due,benefits,or .a
obligations here under without prior written consent.
D. Confidentiality. c
KFHPWA is required by federal and state law to maintain the privacy of Member personal and health
information.KFHPWA is required to provide notice of how KFHPWA may use and disclose personal and L
health information held by KFHPWA. The Notice of Privacy Practices is distributed to Members and is N
available in Kaiser Permanente medical centers,at www.kp.org/wa,or upon request from Member Services. Y
E. Modification of the EOC.
No oral statement of any person shall modify or otherwise affect the benefits,limitations and exclusions of the
EOC,convey or void any coverage,increase or reduce any benefits under the EOC or be used in the prosecution
or defense of a claim under the EOC.
a
F. Nondiscrimination.
KFHPWA does not discriminate on the basis of physical or mental disabilities in its employment practices and
services.KFHPWA will not refuse to enroll or terminate a Member's coverage and will not deny care on the
basis of age,sex,sexual orientation,gender identity,race,color,religion,national origin,citizenship or
immigration status,veteran or military status,occupation or health status.
G. Preauthorization.
Refer to Section IV. or call Member Services for more information regarding which services,equipment and
facility types KFHPWA requires Preauthorization.Failure to obtain Preauthorization when required may result
in denial of coverage for those services;and the member may be responsible for the cost of these non-Covered
services. Members may contact Member Services to request Preauthorization.
9 COE931-0036900
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Preauthorization requests,including prescription requests,are reviewed and approved based on Medical
Necessity,eligibility and benefits. KFHPWA will generally process Preauthorization requests and provide
notification for benefits within the following timeframes:
• For electronic standard requests—within three calendar days,excluding holidays
o If insufficient information has been provided,a request for additional information will be
made within one calendar day.
• For electronic expedited prior authorization requests—within one calendar day
o If insufficient information has been provided,a request for additional information will be
made within one calendar day.
• For nonelectronic standard requests—within five calendar days
o If insufficient information has been provided,a request for additional information will be
made within five calendar days.
• For nonelectronic expedited requests—within two calendar days
o If insufficient information has been provided,a request for additional information will be
made within one calendar day. •-
0
H. Recommended Treatment.
KFHPWA's medical director will determine the necessity,nature and extent of treatment to be covered in each Q
individual case and the judgment will be made in good faith.Members have the right to appeal coverage
decisions(see Section VIII.). Members have the right to participate in decisions regarding their health care.A U
Member may refuse any recommended services to the extent permitted by law.Members who obtain care not
recommended by KFHPWA's medical director do so with the full understanding that KFHPWA has no 0
obligation for the cost,or liability for the outcome,of such care. y
0
New and emerging medical technologies are evaluated on an ongoing basis by the following committees—the J
0.
Interregional New Technologies Committee,Medical Technology Assessment Committee,Medical Policy c
Committee,and Pharmacy and Therapeutics Committee. These physician evaluators consider the new v)
technology's benefits,whether it has been proven safe and effective,and under what conditions its use would be
appropriate. The recommendations of these committees inform what is covered on KFHPWA health plans. 0
I. Second Opinions. 3
The Member may access a second opinion from a Network Provider regarding a medical diagnosis or treatment 2
plan. The Member may request Preauthorization or may visit a KFHPWA-designated Specialist for a second
opinion.When requested or indicated,second opinions are provided by Network Providers and are covered with o
Preauthorization,or when obtained from a KFHPWA-designated Specialist. Coverage is determined by the
Member's EOC;therefore,coverage for the second opinion does not imply that the services or treatments
recommended will be covered.Preauthorization for a second opinion does not imply that KFHPWA will N
authorize the Member to return to the physician providing the second opinion for any additional treatment. Y
Services,drugs and devices prescribed or recommended as a result of the consultation are not covered unless
included as covered under the EOC.
d
E
J. Unusual Circumstances.
In the event of unusual circumstances such as a major disaster,epidemic,military action,civil disorder,labor Q
disputes or similar causes,KFHPWA will not be liable for administering coverage beyond the limitations of
available personnel and facilities.
In the event of unusual circumstances such as those described above,KFHPWA will make a good faith effort to
arrange for Covered Services through available Network Facilities and personnel.KFHPWA shall have no other
liability or obligation if Covered Services are delayed or unavailable due to unusual circumstances.
K. Utilization Management.
"Case Management"means a care management plan developed for a Member whose diagnosis requires timely
coordination.All benefits,including travel and lodging,are limited to Covered Services that are Medically
Necessary and set forth in the EOC.KFHPWA may review a Member's medical records for the purpose of
verifying delivery and coverage of services and items.Based on a prospective,concurrent or retrospective
10 COE931-0036900
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4.D.a
review,KFHPWA may deny coverage if,in its determination,such services are not Medically Necessary. Such
determination shall be based on established clinical criteria and may require Preauthorization.
KFHPWA will not deny coverage retroactively for services with Preauthorization and which have already been
provided to the Member except in the case of an intentional misrepresentation of a material fact by the patient,
Member,or provider of services,or if coverage was obtained based on inaccurate,false,or misleading
information provided on the enrollment application,or for nonpayment of premiums.
III. Financial Responsibilities
A. Premium.
The Subscriber is liable for payment to the Group of their contribution toward the monthly premium,if any.
B. Financial Responsibilities for Covered Services.
The Subscriber is liable for payment of the following Cost Shares for Covered Services provided to the N
Subscriber and their Dependents.Payment of an amount billed must be received within 30 days of the billing 0
date.Charges will be for the lesser of the Cost Shares for the Covered Service or the actual charge for that 3
service. Cost Shares will not exceed the actual charge for that service. Q
1. Annual Deductible. U
Covered Services may be subject to an annual Deductible. Charges subject to the annual Deductible shall
be borne by the Subscriber during each year until the annual Deductible is met. Covered Services must be 0
received from a Network Provider at a Network Facility,unless the Member has received Preauthorization v
or has received Emergency services. c
J
There is an individual annual Deductible amount for each Member and a maximum annual Deductible 0.
0
amount for each Family Unit.Once the annual Deductible amount is reached for a Family Unit in a y
calendar year,the individual annual Deductibles are also deemed reached for each Member during that
same calendar year. 0
Individual Annual Deductible Carryover.Under this EOC,charges from the last 3 months of the prior 3
year which were applied toward the individual annual Deductible will also apply to the current year
individual annual Deductible.The individual annual Deductible carryover will apply only when expenses
incurred have been paid in full. The Family Unit Deductible does not carry over into the next year. o
T
2. Plan Coinsurance. L
After the applicable annual Deductible is satisfied,Members may be required to pay Plan Coinsurance for 0
Covered Services. M
Y
3. Copayments.
Members shall be required to pay applicable Copayments at the time of service.Payment of a Copayment z
does not exclude the possibility of an additional billing if the service is determined to be a non-Covered
Service or if other Cost Shares apply.
a
4. Out-of-pocket Limit.
Out-of-pocket Expenses which apply toward the Out-of-pocket Limit are set forth in Section IV. Total Out-
of-pocket Expenses incurred during the same calendar year shall not exceed the Out-of-pocket Limit.
C. Financial Responsibilities for Non-Covered Services.
The cost of non-Covered Services and supplies is the responsibility of the Member.The Subscriber is liable for
payment of any fees charged for non-Covered Services provided to the Subscriber and their Dependents at the
time of service.Payment of an amount billed must be received within 30 days of the billing date.
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4.D.a
IV. Benefits Details
Benefits are subject to all provisions of the EOC.Members are entitled only to receive benefits and services that are
Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by
KFHPWA's medical director and as described herein.All Covered Services are subject to case management and
utilization management.
Annual Deductible Member pays$0 per Member per calendar year or$0 per Family Unit per calendar year
Coinsurance Plan Coinsurance: Member pays nothing
m
N
L
0
Lifetime Maximum No lifetime maximum on covered Essential Health Benefits
Q
Out-of-pocket Limit Limited to a maximum of$2,000 per Member or$4,000 per Family Unit per calendar year y
Z
The following Out-of-pocket Expenses apply to the Out-of-pocket Limit: Ambulance
coinsurance/Copayment,diagnostic laboratory and radiology Copayment,Emergency c
services Copayment,hospital inpatient Copayment,hospital outpatient Copayment, V
outpatient services Copayment,oral chemotherapy Copayment N
0
J
The following expenses do not apply to the Out-of-pocket Limit: Benefit-specific 0
coinsurances,prescription drug Copayment,premiums,charges for services in excess of a -W
benefit,charges in excess of Allowed Amount,charges for non-Covered Services
c
0
Pre-existing Condition No pre-existing condition waiting period 7V
Waiting Period
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12 COE931-0036900
Packet Pg. 43
4.D.a
Acupuncture
Acupuncture needle treatment. Member pays$10 Copayment
Limited to 8 visits per medical diagnosis per calendar year
without Preauthorization.Additional visits are covered with
Preauthorization.
No visit limit for treatment for Substance Use Disorder.
Exclusions: Herbal supplements; any services not within the scope of the practitioner's licensure
m
N
Advanced Care at Home `0
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Advanced Care at Home is a personalized,patient-centered No charge,Member pays nothing Q
program that provides care for patients with certain clinical y
conditions in their homes,or at another appropriate care
location.
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Advanced Care at Home services must be associated with an v
acute episode in which the member is treated for a brief but c
severe episode of illness,for conditions that are the result of
disease such as,but not exclusive to,congestive heart failure, 0.
0
pneumonia,upper urinary tract infection or cellulitis. The y
treatment plan may include restorative care associated with
the acute episode.The duration of an episode of care(which 0
includes acute and restorative phases)is limited to a total of 7V
30 days. �a
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To receive advanced care in the home:
• The member must be referred into the advanced care o
program by the managing provider at an emergency
room,urgent care,or inpatient setting,
• Advanced Care at Home requires Preauthorization N
based on the Member's health status,treatment plan, M
and home setting or another appropriate care Y
location within the Service Area,
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• The clinical condition must meet inpatient Medical E
Necessity criteria,
• The Member must consent to receiving advanced Q
care described in the treatment plan,
• The care location,such as the member's residence,
must be within 30 minutes ground travel time of an
emergency department,and
• The care location,such as the member's residence,
must,have cell service.
Advanced Care at Home is provided through Medically
Home,our Network provider,and they will provide the
following services in the Member's home or appropriate care
location:
• Home visits by RNs,physical therapists,
13 COE931-0036900
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4.D.a
occupational therapists,speech therapists,respiratory
therapists,nutritionist,health aides,and other
healthcare professionals in accordance with the
Advanced Care at Home treatment plan and the
provider's scope of practice and licensure.
• Communication devices to allow the Member to
contact the medical command center 24 hours a day,
7 days a week.This includes needed communication
technology to support reliable connection for
communication,and a personal emergency response
system alert device to contact the medical command
center if the Member is unable to get to a phone.
Additional services covered under this benefit include:
N
• The following equipment necessary to ensure that 0
you are monitored appropriately in your home:blood
pressure cuff/monitor,pulse oximeter,scale,and Q
thermometer. '
• Mobile imaging and tests such as X-rays, U
ultrasounds,and EKGs. W
• Safety items when Medically Necessary,such as r_
0
shower stools,raised toilet seats,grabbers,long v
handled shoehorn,and sock aids. ,n
• Meals when Medically Necessary while you are
receiving advanced care at home will be provided 0.
0
through our network provider,Medically Home. -W
13
In addition,cost sharing is waived for the following covered M
services and items when the services and items are prescribed
as part of your Advanced Care at Home treatment plan: :a
• Durable Medical Equipment.
• Medical Supplies.
• Member transportation to and from Network o
facilities when Member transport is Medically
Necessary will be arranged by Medically Home
based on the most appropriate mode of 0
transportation which could be ambulance,cabulance, M
Y
or otherwise.
• Physician Assistant and Nurse Practitioner house
calls. E
• Emergency Department visits associated with this
benefit.
a
The cost share is not waived and will apply to any services
that are not part of your Advanced Care at Home treatment
plan(for example,DME not specified in your Advanced Care
at Home treatment plan).
For outpatient prescription drug cost shares, see Drugs-
Outpatient Prescription.
Exclusions: Private Duty Nursing;housekeeping or meal services not part of your Advanced Care at Home treatment
plan;any care provided by or for a family member;any other services rendered in the home which are not specified in
your Advanced Care at Home treatment plan
14 COE931-0036900
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4.D.a
Allergy Services
Allergy testing. Member pays$10 Copayment
Allergy serum and injections. Member pays$10 Copayment
Ambulance
Emergency ambulance service is covered only when: Member pays 20%ambulance coinsurance
• Transport is to the nearest facility that can treat your N
L
condition. 0
t
• Any other type of transport would put your health or 3
safety at risk. Q
• The service is from a licensed ambulance.
• The ambulance transports you to a location where
you receive covered services.
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Emergency air or sea medical transportation is covered only y
when: U)
0
• The above requirements for ambulance service are J
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met,and o
• Geographic restraints prevent ground Emergency
transportation to the nearest facility that can treat c
your condition,or ground Emergency transportation 0
would put your health or safety at risk
m
Non-Emergency ground or air interfacility transfer to or from Member pays 20%ambulance coinsurance ti
a Network Facility where you receive covered services when o
Preauthorized by KFHPWA.Contact Member Services for Hospital-to-hospital ground transfers:No charge;
Preauthorization. Member pays nothing
N
M
Y
Cancer Screening and Diagnostic Services
d
Routine cancer screening covered as Preventive Services in Member pays$10 Copayment
accordance with the well care schedule established by
KFHPWA and the Patient Protection and Affordable Care Act Q
of 2010.The well care schedule is available in Kaiser
Permanente medical centers,at www.kp.org/wa,or upon
request from Member Services. See Preventive Services for
additional information.
Diagnostic laboratory and diagnostic services for cancer. See No charge;Member pays nothing
Diagnostic Laboratory and Radiology Services for additional
information.Preventive laboratory/radiology services are
covered as Preventive Services.
15 COE931-0036900
Packet Pg. 46
Circumcision
Circumcision. Hospital-Inpatient: No charge;Member pays
nothing
Non-Emergency inpatient hospital services require
Preauthorization. Hospital-Outpatient: Member pays$10
Copayment
Outpatient Services: Member pays$10 Copayment
Within 60 days of birth:No charge;Member pays
nothing
m
N
Clinical Trials `0
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Notwithstanding any other provision of this document,the Hospital-Inpatient: Q
Plan provides benefits for Routine Patient Costs of qualified No charge;Member pays nothing rn
individuals in approved clinical trials,to the extent benefits
for these costs are required by federal and state law. Hospital-Outpatient:
Member pays$10 Copayment 0
Routine patient costs include all items and services consistent v
with the coverage provided in the plan(or coverage)that is Outpatient Services: c
typically covered for a qualified individual who is not Member pays$10 Copayment _J
enrolled in a clinical trial. 0.
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Clinical trials are a phase I,phase II,phase III,or phase IV
clinical trial that is conducted in relation to the prevention, 0
detection,or treatment of cancer or other life-threatening 7V
disease or condition."Life threatening condition"means any :a
disease or condition from which the likelihood of death is
probable unless the course of the disease or condition is
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interrupted. c
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Clinical trials require Preauthorization. i
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Exclusions: Routine patient costs do not include: (i)the investigational item,device,or service,itself;(ii)items and Y
services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical
management of the patient;or(iii)a service that is clearly inconsistent with widely accepted and established standards
d
of care for a particular diagnosis E
z
M
Dental Services and Dental Anesthesia Q
Dental services(i.e.,routine care,evaluation and treatment) Not covered;Member pays 100%of all charges
including accidental injury to natural teeth.
Dental services in preparation for treatment including but not Hospital-Inpatient: No charge;Member pays
limited to: chemotherapy,radiation therapy,and organ nothing
transplants.Dental services(evaluation and treatment)in
preparation for treatment require Preauthorization. Hospital-Outpatient: Member pays$10
Copayment
Dental problems such as infections requiring emergency
treatment outside of standard business hours are covered as Outpatient Services: Member pays$10 Copayment
16 COE931-0036900
Packet Pg. 47
Emergency Services.
General anesthesia services and related facility charges for Hospital-Inpatient: No charge;Member pays
dental procedures for Members who are under 7 years of age nothing
or are physically or developmentally disabled or have a
Medical Condition where the Member's health would be put Hospital-Outpatient: Member pays$10
at risk if the dental procedure were performed in a dentist's Copayment
office.
General anesthesia services for dental procedures require
Preauthorization.
Exclusions: Dentist's or oral surgeon's fees;dental care,surgery,services and appliances,including:treatment of
accidental injury to natural teeth,reconstructive surgery to the jaw in preparation for dental implants,dental implants, N
periodontal surgery;any other dental service not specifically listed as covered 0
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Q
Devices,Equipment and Supplies(for home use) y
Durable medical equipment:Equipment which can withstand Member pays 20%coinsurance
repeated use,is primarily and customarily used to serve a c
medical purpose,is useful only in the presence of an illness or v
injury and is used in the Member's home. N
Annual Deductible does not apply to strip-based �
• Examples of covered durable medical equipment include: blood glucose monitors,test strips,lancets or control 0.
0
hospital beds,wheelchairs,walkers,crutches,canes, solutions. y
blood glucose monitors,external insulin pumps
(including related supplies such as tubing,syringe 0
cartridges,cannulae and inserters),oxygen and the rental 7V
of equipment to administer oxygen(including tubing, �a
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connectors,and masks),and therapeutic shoes, �
modifications and shoe inserts for severe diabetic foot
disease.KFHPWA will determine if equipment is made o
available on a rental or purchase basis.
• Orthopedic appliances:Items attached to an impaired
body segment for the purpose of protecting the segment N
or assisting in restoration or improvement of its function. 0
Y
• Ostomy supplies: Supplies for the removal of bodily
secretions or waste through an artificial opening.
• Post-mastectomy bras/forms,limited to 2 every 6 E
months.Replacements within this 6-month period are
covered when Medically Necessary due to a change in Q
the Member's condition.
• Prosthetic devices: Items which replace all or part of an
external body part,or function thereof.
• Sales tax for devices,equipment and supplies.
When provided in lieu of hospitalization,benefits will be the
greater of benefits available for devices,equipment and
supplies,home health or hospitalization. See Advanced Care
at Home for durable medical equipment provided in an
Advanced Care at Home setting. See Hospice for durable
medical equipment provided in a hospice setting.
17 COE931-0036900
Packet Pg. 48
4.D.a
Devices,equipment and supplies including repair,adjustment
or replacement of appliances and equipment require
Preauthorization.
Exclusions:Arch supports,including custom shoe modifications or inserts and their fittings not related to the
treatment of diabetes;orthopedic shoes that are not attached to an appliance;wigs/hair prosthesis;take-home
dressings and supplies following hospitalization;supplies,dressings,appliances,devices or services not specifically
listed as covered above; same as or similar equipment already in the Member's possession;replacement or repair due
to loss,theft,breakage from willful damage,neglect or wrongful use,or due to personal preference;structural
modifications to a Member's home or personal vehicle
Diabetic Education,Equipment and Pharmacy Supplies
m
N
Diabetic education and training. Member pays$10 Copayment 0
Q
Diabetic equipment: Blood glucose monitors and external Member pays 20%coinsurance rn
insulin pumps(including related supplies such as tubing, U
syringe cartridges,cannulae and inserters),and therapeutic Annual Deductible does not apply to strip-based i
shoes,modifications and shoe inserts for severe diabetic foot blood glucose monitors,test strips,lancets or control 0
disease. See Devices,Equipment and Supplies for additional solutions. v
information. U)
0
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Diabetic pharmacy supplies: Insulin,lancets,lancet devices, Preferred generic drugs(Tier 1): Member pays 0
needles,insulin syringes,disposable insulin pens,pen $10 Copayment per 30-days up to a 90-day supply y
needles,glucagon emergency kits,prescriptive oral agents
and blood glucose test strips for a supply of 30 days or less Preferred brand name drugs(Tier 2): Member 0
per item.Certain brand name insulin drugs will be covered at pays$10 Copayment per 30-days up to a 90-day 7V
the generic level. See Drugs—Outpatient Prescription for supply �a
additional pharmacy information.
Non-Preferred generic and brand name drugs
(Tier 3):Not covered;Member pays 100%of all c
charges
L
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N
Annual Deductible does not apply to strip-based Y
blood glucose monitors,test strips,lancets or control
solutions.
d
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Note:A Member will not pay more than$35,not
subject to the Deductible,for a 30-day supply of
insulin to comply with state law requirements.Any Q
cost sharing paid will apply toward the annual
Deductible.
Diabetic retinal screening. No charge;Member pays nothing
Dialysis(Home and Outpatient)
Dialysis in an outpatient or home setting is covered for Outpatient Services: Member pays$10 Copayment
Members with acute kidney failure or end-stage renal disease
(ESRD).
18 COE931-0036900
Packet Pg. 49
Dialysis requires Preauthorization.
Injections administered by a Network Provider in a clinical Outpatient Services: Member pays$10 Copayment
setting during dialysis.
Self-administered injectables. See Drugs—Outpatient Preferred generic drugs(Tier 1): Member pays
Prescription for additional pharmacy information. $10 Copayment per 30-days up to a 90-day supply
Preferred brand name drugs(Tier 2): Member
pays$10 Copayment per 30-days up to a 90-day
supply
Non-Preferred generic and brand name drugs N
(Tier 3):Not covered;Member pays 100%of all o
charges
Q
Drugs-Outpatient Prescription U
L
Prescription drugs,supplies and devices for a supply of 30 Preferred generic drugs(Tier 1): Member pays c
days or less including diabetic pharmacy supplies(insulin, $10 Copayment per 30-days up to a 90-day supply v
lancets,lancet devices,needles,insulin syringes,disposable N
insulin pens,pen needles and blood glucose test strips), Preferred brand name drugs(Tier 2): Member �
mental health and wellness drugs, self-administered pays$10 Copayment per 30-days up to a 90-day c
injectables,medications for the treatment arising from sexual supply y
assault,and routine costs for prescription medications
provided in a clinical trial."Routine costs"means items and Non-Preferred generic and brand name drugs M
services delivered to the Member that are consistent with and (Tier 3):Not covered;Member pays 100%of all 7V
typically covered by the plan or coverage for a Member who charges
is not enrolled in a clinical trial.
All drugs,supplies and devices must be obtained at a Annual Deductible does not apply to strip-based c
KFHPWA-designated pharmacy except for drugs dispensed blood glucose monitors,test strips,lancets or control
for Emergency services or for Emergency services obtained solutions.
outside of the KFHPWA Service Area,including out of the N
country.Information regarding KFHPWA-designated Note:A Member will not pay more than$35,not Y
pharmacies is reflected in the KFHPWA Provider Directory subject to the Deductible,for a 30-day supply of
or can be obtained by contacting Kaiser Permanente Member insulin to comply with state law requirements.Any
d
Services. cost sharing paid will apply toward the annual
Deductible.
Prescription drug Cost Shares are payable at the time of
delivery.Certain brand name insulin drugs are covered at the Q
generic drug Cost Share.
Members may be eligible to receive an emergency fill for
certain prescription drugs filled outside of KFHPWA's
business hours or when KFHPWA cannot reach the prescriber
for consultation.For emergency fills,Members pay the
prescription drug Cost Share for each 7-day supply or less,or
the minimum packaging size available at the time the
emergency fill is dispensed.A list of prescription drugs
eligible for emergency fills is available on the pharmacy
website at www.kp.org/waJformulga.Members can request
19 COE931-0036900
Packet Pg. 50
4.D.a
an emergency fill by calling 1-855-505-8107.
Certain drugs are subject to Preauthorization as shown in the
Preferred drug list(formulary)available at
www.kp.oriz/wa/formulM.
For outpatient prescription drugs and/or items that are
covered under the Drugs—Outpatient Prescription section and
obtained at a pharmacy owned and operated by KFHPWA,a
Member may be able to use approved manufacturer coupons
as payment for the Cost Sharing that a Member owes,as
allowed under KFHPWA's coupon program.A Member will
owe any additional amount if the coupon does not cover the
entire amount of the Cost Sharing for the Member's N
prescription.When a Member uses an approved coupon for o
payment of their Cost Sharing,the coupon amount and any
additional payment that you make will accumulate to their °
Q
Deductible and Out-of-Pocket Limit.More information is
available regarding the Kaiser Permanente coupon program
rules and limitations at kp.org/rxcoEpons.
c
Injections administered by a Network Provider in a clinical Member pays$10 Copayment V
setting. y
0
J
Over-the-counter drugs not included under Reproductive Not covered;Member pays 100%of all charges 0.
Health °
13
Mail order drugs dispensed through the KFHPWA-designated Member pays the prescription drug Cost Share for r_
mail order service. each 30 day supply or less
0
13
Annual Deductible does not apply to strip-based
blood glucose monitors,test strips,lancets or control
solutions. ti
0
T
Note:A Member will not pay more than$35,not
subject to the Deductible,for a 30-day supply of N
insulin to comply with state law requirements.Any M
cost-sharing paid will apply toward the annual Y
Deductible.
d
E
The KFHPWA Preferred drug list is a list of prescription drugs,supplies,and devices considered to have acceptable
efficacy,safety and cost-effectiveness. The Preferred drug list is maintained by a committee consisting of a group of
physicians,pharmacists and a consumer representative who review the scientific evidence of these products and Q
determine the Preferred and Non-Preferred status as well as utilization management requirements.Preferred drugs
generally have better scientific evidence for safety and effectiveness and are more affordable than Non-Preferred
drugs.The preferred drug list is available at www.kp.org/wa/formul4a,or upon request from Member Services.
A Member,a Member's designee,or a prescribing physician may request a coverage exception to gain access to
clinically appropriate drugs if the drug is not otherwise covered by contacting Member Services. Coverage
determination reviews may include requests to cover non-preferred drugs,obtain Preauthorization for a specific drug,
or exceptions to other utilization management requirements, such as quantity limits.If coverage of a non-Preferred
drug is approved,the drug will be covered at the Preferred drug level.
KFHPWA will provide a determination and notification of the determination no later than 72 hours of the request
20 COE931-0036900
Packet Pg. 51
after receipt of information sufficient to make a decision.The prescribing physician must submit an oral or written
statement regarding the need for the non-Preferred drug,and a list of all of the preferred drugs which have been
ineffective for the Member.
Expedited or Urgent Reviews:A Member,a Member's designee,or a prescribing physician may request an expedited
review for coverage for non-covered drugs when a delay caused by using the standard review process will seriously
jeopardize the Member's life,health or ability to regain maximum function or will subject to the Member to severe
pain that cannot be managed adequately without the requested drug.KFHPWA or the IRO will provide a
determination and notification of the determination no later than 24 hours from the receipt of the request after receipt
of information sufficient to make a decision.
Prescription drugs are drugs which have been approved by the Food and Drug Administration(FDA)and which can,
under federal or state law,be dispensed only pursuant to a prescription order.These drugs,including off-label use of
FDA-approved drugs(provided that such use is documented to be effective in one of the standard reference N
compendia;a majority of well-designed clinical trials published in peer-reviewed medical literature document 0
improved efficacy or safety of the agent over standard therapies,or over placebo if no standard therapies exist;or by
the federal secretary of Health and Human Services)are covered. "Standard reference compendia"means the Q
American Hospital Formulary Service—Drug Information;the American Medical Association Drug Evaluation;the
United States Pharmacopoeia—Drug Information,or other authoritative compendia as identified from time to time by
the federal secretary of Health and Human Services."Peer-reviewed medical literature"means scientific studies
printed in health care journals or other publications in which original manuscripts are published only after having been o
critically reviewed for scientific accuracy,validity and reliability by unbiased independent experts.Peer-reviewed v
medical literature does not include in-house publications of pharmaceutical manufacturing companies. y
0
J
Generic drugs are dispensed whenever available. A generic drug is a drug that is the pharmaceutical equivalent to one a
or more brand name drugs. Such generic drugs have been approved by the Food and Drug Administration as meeting .°
the same standards of safety,purity,strength and effectiveness as the brand name drug. Brand name drugs are U)
dispensed if there is not a generic equivalent.In the event the Member elects to purchase a brand-name drug instead of r_
0
the generic equivalent(if available),the Member is responsible for paying the difference in cost in addition to the
brand-name prescription drug Cost Share,which does not apply to the Out-of-pocket Limit.Member will never pay 0
13
more than the actual cost of the prescription.
Drug coverage is subject to utilization management that includes Preauthorization,step therapy(when a Member tries i.
a certain medication before receiving coverage for a similar,but non-Preferred medication),limits on drug quantity or
days supply and prevention of overutilization,underutilization,therapeutic duplication,drug-drug interactions, �-
incorrect drug dosage,drug-allergy contraindications and clinical abuse/misuse of drugs.If a Member has a new
prescription for a chronic condition,the Member may request a coordination of medications so that medications for N
0
chronic conditions are refilled on the same schedule(synchronized).Cost-shares for the initial fill of the medication Y
will be adjusted if the fill is less than the standard quantity.Please contact Member Services for more information.
d
Specialty drugs are high-cost drugs prescribed by a physician that requires close supervision and monitoring for z
serious and/or complex conditions,such as rheumatoid arthritis,hepatitis or multiple sclerosis. Specialty drugs must
be obtained through KFHPWA's preferred specialty pharmacy vendor and/or network of specialty pharmacies and are Q
covered at the appropriate cost share above.For a list of specialty drugs or more information about KFHPWA's
specialty pharmacy network,please go to the KFHPWA website at www.kp.org/wa/fonnul4a or contact Member
Services at 206-630-4636 or toll-free at 1-888-901-4636.
The Member's Right to Safe and Effective Pharmacy Services: State and federal laws establish standards to assure
safe and effective pharmacy services,and to guarantee Members'right to know what drugs are covered and the
coverage limitations.Members who would like more information about the drug coverage policies,or have a question
or concern about their pharmacy benefit,may contact KFHPWA at 206-630-4636 or toll-free 1-888-901-4636 or by
accessing the KFHPWA website at www.kp.org/wa.
Members who would like to know more about their rights under the law,or think any services received while enrolled
may not conform to the terms of the EOC,may contact the Washington State Office of Insurance Commissioner at
21 COE931-0036900
Packet Pg. 52
toll-free 1-800-562-6900.Members who have a concern about the pharmacists or pharmacies serving them may call
the Washington State Department of Health at toll-free 1-800-525-0127.
Prescription Drug Coverage and Medicare: This benefit,for purposes of Creditable Coverage,is actuarially equal
to or greater than the Medicare Part D prescription drug benefit.Members who are also eligible for Medicare Part D
can remain covered and will not be subject to Medicare-imposed late enrollment penalties should they decide to enroll
in a Medicare Part D plan at a later date;however,the Member could be subject to payment of higher Part D
premiums if the Member subsequently has a break in creditable coverage of 63 continuous days or longer before
enrolling in a Part D plan.A Member who discontinues coverage must meet eligibility requirements in order to re-
enroll.
Exclusions: Over-the-counter drugs,supplies and devices not requiring a prescription under state law or regulations;
drugs and injections for anticipated illness while traveling;drugs and injections for cosmetic purposes;vitamins,
including most prescription vitamins;replacement of lost, stolen,or damaged drugs or devices;administration of N
excluded drugs and injectables;drugs used in the treatment of sexual dysfunction disorders;compounds which include o
a non-FDA approved drug;growth hormones for idiopathic short stature without growth hormone deficiency;
prescription drugs/products available over-the-counter or have an over-the-counter alternative that is determined to be Q
therapeutically interchangeable. rn
L
Emergency Services c
v
Emergency services at a Network Facility or non-Network Network Facility: Member pays$75 Copayment c
Facility. See Section XII.for a definition of Emergency. _J
Non-Network Facility: Member pays$125 c
Emergency services include professional services,treatment Copayment y
and supplies,facility costs,outpatient charges for patient
observation,medical screening exams required to stabilize a M
patient,and post stabilization treatment.
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission,or as soon
thereafter as medically possible. c
T
If a Member is admitted as an inpatient or to Advanced Care
at Home directly from an emergency department,any N
Emergency services Copayment is waived. Coverage is Y
subject to the applicable hospital services or Advanced Care
at Home Cost Shares.
d
E
If two or more Members in the same Family Unit require
Emergency services as a result of the same accident,coverage
for all Members will be subject to only one Emergency Q
services Copayment.
If a Member is hospitalized in a non-Network Facility,
KFHPWA reserves the right to require transfer of the
Member to a Network Facility upon consultation between a
Network Provider and the attending physician.If the Member
refuses to transfer to a Network Facility or does not notify
KFHPWA within 24 hours following admission,all further
costs incurred during the hospitalization are the responsibility
of the Member.
22 COE931-0036900
Packet Pg. 53
Follow-up care which is a direct result of the Emergency must
be received from a Network Provider,unless Preauthorization
is obtained for such follow-up care from a non-Network
Provider.
Gender Health Services
Medically Necessary medical and surgical services for gender Hospital-Inpatient: No charge;Member pays
affirmation. Consultation and treatment require nothing
Preauthorization.Certain procedures are subject to age limits,
please see our clinical criteria https://wa- Hospital-Outpatient: Member pays$10
provider.kaiserpermanente.or static/pdf/hosting_/ Copayment
clinical/criteria/pdf/ eg nder reassignment_sur eg ry.pdf for N
details. Outpatient Services: Member pays$10 Copayment `0
t
Prescription drugs are covered the same as for any other Q
condition(see Drugs-Outpatient Prescription for coverage).
Counseling services are covered the same as for any other W
condition(see Mental Health and Wellness for coverage). c
v
Gender Health services require Preauthorization y
0
J
Exclusions: Cosmetic services and surgery not related to gender affirming treatment(i.e.,face lift or calf implants), 0.
complications of non-Covered Services �°
c
0
Hearing Examinations and Hearing Aids
Hearing exams for hearing loss and evaluation are covered Hospital-Inpatient:
only when provided at KFHPWA-approved facilities. No charge;Member pays nothing
ti
0
Cochlear implants when in accordance with KFHPWA Hospital-Outpatient:
clinical criteria. Member pays$10 Copayment L
d
N
Covered services for initial cochlear implants include Outpatient Services: Y
diagnostic testing,pre-implant testing,implant surgery,post- Member pays$10 Copayment
implant follow-up,speech therapy,programming and
associated supplies(such as transmitter cable,and batteries). E
z
Replacement devices and associated supplies—see Devices,
Equipment and Supplies Section. Q
Hearing aids,bone conduction hearing devices,and Bone Member pays nothing,limited to an Allowance of
Anchored Hearing Systems(BAHS)for hearing loss. $3,000 maximum per ear during any consecutive 36-
month period
After Allowance:Not covered;Member pays 100%
of all charges
Initial assessment,fitting,adjustments,auditory training and Member pays$10 Copayment
ear molds as necessary to maintain optimal fit for hearing
aids.
23 COE931-0036900
Packet Pg. 54
4.D.a
Exclusions: Programs or treatments for hearing loss or hearing care associated with externally worn hearing or
surgically implanted hearing aids and the surgery and services necessary to implant them except as described above;
hearing screening tests required under Preventive Services;replacement costs of hearing aids due to loss,breakage or
theft,unless at the time of such replacement the Member is eligible under the benefit Allowance;repairs;replacement
parts;replacement batteries;maintenance costs.
Home Health Care
Home health care when the following criteria are met: No charge;Member pays nothing
• Except for patients receiving palliative care services,the
Member must be unable to leave home due to a health
problem or illness.Unwillingness to travel and/or arrange
for transportation does not constitute inability to leave the N
home. `0
t
• The Member requires intermittent skilled home health 3
care,as described below. a
• KFHPWA's medical director determines that such rn
services are Medically Necessary and are most
appropriately rendered in the Member's home.
0
Covered Services for home health care may include the v
following when rendered pursuant to a KFHPWA-approved N
0
home health care plan of treatment:nursing care;restorative _J
physical,occupational,respiratory and speech therapy; 0
durable medical equipment;medical social worker and U)
limited home health aide services.
c
0
Home health services are covered on an intermittent basis in 7V
the Member's home. "Intermittent"means care that is to be .a
rendered because of a medically predictable recurring need 2
for skilled home health care. "Skilled home health care"
means reasonable and necessary care for the treatment of an o
illness or injury which requires the skill of a nurse or
therapist,based on the complexity of the service and the
condition of the patient and which is performed directly by an N
appropriately licensed professional provider. 0
Y
Home health care requires Preauthorization.
E
Exclusions: Private Duty Nursing;housekeeping or meal services; any care provided by or for a family member; any 0
other services rendered in the home which do not meet the definition of skilled home health care above
a
Hospice
Hospice care when provided by a licensed hospice care No charge;Member pays nothing
program.A 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
24 COE931-0036900
Packet Pg. 55
4.D.a
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.
Inpatient Hospice Services.For short-term care,inpatient
hospice services are covered with Preauthorization.
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 3-month period of hospice care.
m
N
Other covered hospice services,when billed by a licensed o
hospice program,may include the following:
• Inpatient and outpatient services and supplies for injury Q
and illness.
• Semi-private room and board,except when a private �
room is determined to be necessary. W
• Durable medical equipment when billed by a licensed o
hospice care program. V
Hospice care requires Preauthorization. 0
a
Exclusions: Private Duty Nursing;financial or legal counseling services;meal services;any services provided by
family members
c
M
Hospital-Inpatient and Outpatient .a
m
The following inpatient medical and surgical services are Hospital-Inpatient: No charge;Member pays
covered: nothing o
T
• Room and board,including private room when
prescribed,and general nursing services. Hospital-Outpatient: Member pays$10
• Hospital services(including use of operating room, Copayment N
anesthesia,oxygen,x-ray,laboratory and radiotherapy Y
services).
• Drugs and medications administered during confinement. d
• Medical implants.
z
• Withdrawal management services.
M
Outpatient hospital includes ambulatory surgical centers. Q
Alternative care arrangements may be covered as a cost-
effective alternative in lieu of otherwise covered Medically
Necessary hospitalization or other Medically Necessary
institutional care with the consent of the Member and
recommendation from the attending physician or licensed
health care provider.Alternative care arrangements in lieu of
covered hospital or other institutional care must be
determined to be appropriate and Medically Necessary based
upon the Member's Medical Condition. Such care is covered
to the same extent the replaced Hospital Care is covered.
25 COE931-0036900
Packet Pg. 56
4.D.a
Alternative care arrangements require Preauthorization.
Members receiving the following nonscheduled services are
required to notify KFHPWA by way of the Hospital
notification line within 24 hours following any admission,or
as soon thereafter as medically possible: acute withdrawal
management services,Emergency psychiatric services,
Emergency services,labor and delivery and inpatient
admissions needed for treatment of Urgent Conditions that
cannot reasonably be delayed until Preauthorization can be
obtained.
Coverage for Emergency services in a non-Network Facility
and subsequent transfer to a Network Facility is set forth in N
Emergency Services. o
t
Non-Emergency hospital services require Preauthorization.
Q
Exclusions: Take home drugs,dressings and supplies following hospitalization;internally implanted insulin pumps,
artificial larynx and any other implantable device that have not been approved by KFHPWA's medical director
c
0
c�
Infertility(including sterility) c
J
General counseling and one consultation visit to diagnose Member pays$10 Copayment 0.
0
infertility conditions. y
Specific diagnostic services,treatment and prescription drugs. Not covered;Member pays 100%of all charges M
Exclusions: Diagnostic testing and medical treatment of sterility and infertility regardless of origin or cause;all .a
charges and related services for donor materials;all forms of artificial intervention for any reason including artificial
insemination and in-vitro fertilization;prognostic(predictive)genetic testing for the detection of congenital and
heritable disorders;cryopreservation services; surrogacy;any other service not specifically listed as covered c
T
L
d
Infusion Therapy N
M
Y
Administration of Medically Necessary infusion therapy in an Member pays S 10 Copayment
outpatient setting. d
E
z
Preauthorization is required.
Administration of Medically Necessary infusion therapy in No charge;Member pays nothing Q
the home setting.
To receive benefits for the administration of select infusion
medications in the home setting,the drugs must be obtained
through KFHPWA's preferred specialty pharmacy and
administered by a provider we identify. For a list of these
specialty drugs or for more information about KFHPWA's
specialty pharmacy network,please go to the KFHPWA
website at www.kp.org/wa/formulary or contact Member
Services.
26 COE931-0036900
Packet Pg. 57
4.D.a
Associated infused medications include,but are not limited No charge;Member pays nothing
to:
• Antibiotics.
• Hydration.
• Chemotherapy.
• Pain management
Preauthorization is required.
Laboratory and Radiology
Nuclear medicine,radiology,ultrasound and laboratory No charge;Member pays nothing
services,including high end radiology imaging services such
as CAT scan,MRI and PET which are subject to t
Preauthorization except when associated with Emergency Urine Drug Screening:No charge,Member pays 3
services or inpatient services.Please contact Member nothing. Limited to 2 tests per calendar year. Q
Services for any questions regarding these services. Benefits are applied in the order claims are received
and processed.
Services received as part of an emergency visit are covered as
Emergency Services. After Allowance: No charge;Member pays nothing v
Preventive laboratory and radiology services are covered in c
accordance with the well care schedule established by _J
KFHPWA and the Patient Protection and Affordable Care Act 0
0
of 2010.The well care schedule is available in Kaiser U)
Permanente medical centers,at www.kp.orp-/wa,or upon
request from Member Services. MI
M
.a
m
Manipulative Therapy
ti
Manipulative therapy of the spine and extremities when in Member pays$10 Copayment
accordance with KFHPWA clinical criteria,limited to a total
of 10 visits per calendar year.Preauthorization is not
N
required. M
Y
Rehabilitation services,such as massage or physical therapy,
provided with manipulations is covered under the
Rehabilitation and Habilitative Care(massage,occupational, z
physical and speech therapy,pulmonary and cardiac
rehabilitation)and Neurodevelopmental Therapy section. Q
Exclusions: Supportive care rendered primarily to maintain the level of correction already achieved;care rendered
primarily for the convenience of the Member;care rendered on a non-acute,asymptomatic basis;charges for any other
services that do not meet KFHPWA clinical criteria as Medically Necessary
Maternity and Pregnancy
Maternity care and pregnancy services,including care for Hospital-Inpatient: No charge;Member pays
complications of pregnancy and prenatal and postpartum care nothing
are covered for all Members including eligible Dependents.
27 COE931-0036900
Packet Pg. 58
Hospital-Outpatient: Member pays$10
Delivery and associated Hospital Care,including home births Copayment
and birthing centers.Home births are considered outpatient
services. Outpatient Services: Member pays$10 Copayment
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission,or as soon
thereafter as medically possible. The Member's provider,in
consultation with the Member,will determine the Member's
length of inpatient stay following delivery.
Prenatal testing for the detection of congenital and heritable
disorders when Medically Necessary as determined by _
KFHPWA's medical director and in accordance with Board
N
of Health standards for screening and diagnostic tests during o
pregnancy.
Q
Donor human milk will be covered during the inpatient
hospital stay when Medically Necessary,provided through a
U
milk bank and ordered by a licensed Provider or board-
certified lactation consultant. c
0
c)
Termination of pregnancy. Hospital-Inpatient:Member pays nothing N
0
J
Non-Emergency inpatient hospital services require Hospital-Outpatient: Member pays nothing 0.
Preauthorization.
Outpatient Services:Member pays nothing U)
c
0
Exclusions: Birthing tubs;genetic testing of non-Members;fetal ultrasound in the absence of medical indications 2
13
m
Mental Health and Wellness ~
0
T
Mental health and wellness services provided at the most Hospital-Inpatient: No charge;Member pays
clinically appropriate and Medically Necessary level of nothing N
mental health care intervention as determined by KFHPWA's Y
medical director.Treatment may utilize psychiatric, Hospital-Outpatient: Member pays$10
psychological and/or psychotherapy services to achieve these Copayment
d
objectives.
Outpatient Services: Member pays$10 Copayment
Mental health and wellness services including medical
management and prescriptions are covered the same as for Q
any other condition. Group Visits:No charge;Member pays nothing
Applied behavioral analysis(ABA)therapy,limited to
outpatient treatment of an autism spectrum disorder or,has a
developmental disability for which there is evidence that
ABA therapy is effective.Documented diagnostic
assessments,individualized treatment plans and progress
evaluations are required.
Services for any involuntary court-ordered treatment program
shall be covered only if determined to be Medically
28 COE931-0036900
Packet Pg. 59
4.D.a
Necessary by KFHPWA's medical director. Services
provided under involuntary commitment statutes are covered.
If a Member is admitted as an inpatient directly from an
emergency department,any Emergency services Copayment
is waived. Coverage is subject to the hospital services Cost
Share.Coverage for services incurred at non-Network
Facilities shall exclude any charges that would otherwise be
excluded for hospitalization within a Network Facility.
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission,or as soon
thereafter as medically possible.
Mental health and wellness services rendered to treat mental
N
disorders are covered.Mental Disorders means mental o
disorders covered in the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders published by the
Q
American Psychiatric Association,except as otherwise
excluded under Sections IV.or V. Mental Health and
Wellness Services means Medically Necessary outpatient
services,Residential Treatment,partial hospitalization o
program,and inpatient services provided by a licensed facility v
or licensed providers;including advanced practice psychiatric N
nurses,mental health and wellness counselors,marriage and J
family therapists and social workers,except as otherwise a
excluded under Sections IV. or V.
U)
Inpatient mental health and wellness services,Residential
M
Treatment and partial hospitalization programs must be MI
provided at a hospital or facility that KFHPWA has approved 0
13
specifically for the treatment of mental disorders.
Non-Emergency inpatient hospital services,including i.
Residential Treatment programs,require Preauthorization.
Outpatient specialty services,including partial
hospitalization,rTMS,ECT,and Esketamine require N
M
Preauthorization.Routine outpatient therapy and psychiatry `1
services with contracted network providers do not require
Preauthorization.
E
z
Exclusions: Specialty treatment programs such as"behavior modification programs"not considered Medically
Necessary;relationship counseling or phase of life problems(Z code only diagnoses);wilderness therapy;aversion Q
therapy
Naturopathy
Naturopathy. Member pays$10 Copayment
Limited to 3 visits per medical diagnosis per calendar year
without Preauthorization.Additional visits are covered with
Preauthorization.
29 COE931-0036900
Packet Pg. 60
Laboratory and radiology services are covered only when
obtained through a Network Facility.
Exclusions: Herbal supplements;nutritional supplements;any services not within the scope of the practitioner's
licensure
Newborn Services
Newborn services are covered the same as for any other Hospital-Inpatient: No charge;Member pays
condition.Any Cost Share for newborn services is separate nothing
from that of the mother.
During the baby's initial hospital stay while the birth
Preventive services for newborns are covered under mother and baby are both confined,any applicable N
Preventive Services. Deductible and Copayment for the newborn are 0
waived 3
See Section VI.A.3. for information about temporary Q
coverage for newborns. Hospital-Outpatient: Member pays$10
Copayment U
L
Outpatient Services: Member pays$10 Copayment V
0
J
0.
Nutritional Counseling 0
Nutritional counseling. Member pays$10 Copayment r_
Services related to a healthy diet to prevent obesity are 7V
covered as Preventive Services. See Preventive Services for
m
additional information. 2
ti
Exclusions:Nutritional supplements;weight control self-help programs or memberships,such as Weight Watchers,
Jenny Craig,or other such programs
L
d
N
M
Nutritional Therapy Y
c
Medical formula necessary for the treatment of No charge;Member pays nothing
E
phenylketonuria(PKU),specified inborn errors of
metabolism,or other metabolic disorders.
a
Enteral therapy is covered when Medical Necessity criteria is Member pays 20%coinsurance
met and when given through a PEG,J tube or orally,or for an
eosinophilic gastrointestinal disorder.
Necessary equipment and supplies for the administration of
enteral therapy are covered as Devices,Equipment and
Supplies.
Parenteral therapy(total parenteral nutrition). No charge;Member pays nothing
Necessary equipment and supplies for the administration of
30 COE931-0036900
Packet Pg. 61
parenteral therapy are covered as Devices,Equipment and
Supplies.
Exclusions:Any other dietary formulas,medical foods,or oral nutritional supplements that do not meet Medical
Necessity criteria or are not related to the treatment of inborn errors of metabolism; special diets;prepared
foods/meals
Obesity Related Services
Bariatric surgery and related hospitalizations when KFHPWA Hospital-Inpatient: No charge;Member pays
criteria are met. nothing
Services related to obesity screening and counseling are Hospital-Outpatient: Member pays$10 N
covered as Preventive Services. Copayment t
Obesity related services require Preauthorization. Outpatient Services: Member pays$10 Copayment Q
Exclusions:All other obesity treatment and treatment for morbid obesity including any medical services,drugs or
supplies,regardless of co-morbidities,except as described above;specialty treatment programs such as weight control c
self-help programs or memberships,such as Weight Watchers,Jenny Craig or other such programs;medications and v
related physician visits for medication monitoring c
J
O.
O
++
On the Job Injuries or Illnesses U)
13
c
On the job injuries or illnesses. Hospital-Inpatient:Not covered;Member pays M
100%of all charges 7V
.a
am
Hospital-Outpatient:Not covered;Member pays 2
100%of all charges
0
T
Outpatient Services:Not covered;Member pays
100%of all charges
N
M
Y
Exclusions: Confinement,treatment or service that results from an illness or injury arising out of or in the course of
any employment for wage or profit including injuries,illnesses or conditions incurred as a result of self-employment E
z
M
Oncology Q
Radiation therapy,chemotherapy,oral chemotherapy. Radiation Therapy and Chemotherapy:
Member pays$10 Copayment
See Infusion Therapy for infused medications.
Oral Chemotherapy Drugs:
Preferred generic drugs(Tier 1): Member pays
$10 Copayment per 30-days up to a 90-day supply
Preferred brand name drugs(Tier 2): Member
pays$10 Copayment per 30-days up to a 90-day
supply
31 COE931-0036900
Packet Pg. 62
4.D.a
Non-Preferred generic and brand name drugs
(Tier 3):Not covered;Member pays 100%of all
charges
Optical(vision)
Routine eye examinations and refractions,limited to once Routine Exams: Member pays$10 Copayment
every 12 months.
Exams for Eye Pathology: Member pays$10
Eye and contact lens examinations for eye pathology and to Copayment
monitor Medical Conditions,as often as Medically
Necessary. N
L
0
Contact lenses or framed lenses for eye pathology when Frames and Lenses: Not covered;Member pays 3
Medically Necessary. 100%of all charges Q
One contact lens per diseased eye in lieu of an intraocular Contact Lenses or Framed Lenses for Eye
lens is covered following cataract surgery provided the Pathology: No charge;Member pays nothing
Member has been continuously covered by KFHPWA since 0
such surgery.In the event a Member's age or medical v
condition prevents the Member from having an intraocular c
lens or contact lens,framed lenses are available.Replacement _J
of lenses for eye pathology,including following cataract 0.
0
surgery,is covered only once within a 12-month period and y
only when needed due to a change in the Member's
prescription. 0
Exclusions:Eyeglasses;contact lenses,contact lens evaluations,fittings and examinations not related to eye .a
pathology;fees related to the lens fitting of non-network issued frames;ortho tic therapy e e training);
p gY> g p � pY Y g)� �
evaluations and surgical procedures to correct refractions not related to eye pathology and complications related to
such procedures c
T
L
Oral Surgery N
0
Y
Reduction of a fracture or dislocation of the jaw or facial Hospital-Inpatient: No charge;Member pays
bones;excision of tumors or non-dental cysts of the jaw, nothing
cheeks,lips,tongue,gums,roof,and floor of the mouth;and E
z
incision of salivary glands and ducts. Hospital-Outpatient: Member pays$10 0
Copayment Q
KFHPWA's medical director will determine whether the care
or treatment required is within the category of Oral Surgery or Outpatient Services: Member pays$10 Copayment
Dental Services.
Oral surgery requires Preauthorization.
Exclusions: Care or repair of teeth or dental structures of any type;tooth extractions or impacted teeth; services
related to malocclusion; services to correct the misalignment or malposition of teeth; any other services to the mouth,
facial bones,or teeth which are not medical in nature
32 COE931-0036900
Packet Pg. 63
4.D.a
Outpatient Services
Covered outpatient medical and surgical services in a Member pays$10 Copayment
provider's office,including chronic disease management and
treatment arising from sexual assault. See Preventive Services
for additional information related to chronic disease
management.
See Hospital-Inpatient and Outpatient for outpatient hospital
medical and surgical services,including ambulatory surgical
centers.
Plastic and Reconstructive Surgery N
L
0
Plastic and reconstructive services: Hospital-Inpatient: No charge;Member pays
• Correction of a congenital disease or congenital anomaly. nothing Q
• Correction of a Medical Condition following an injury or
resulting from surgery which has produced a major effect Hospital-Outpatient: Member pays$10
on the Member's appearance,when in the opinion of Copayment
KFHPWA's medical director such services can 0
reasonably be expected to correct the condition. Outpatient Services: Member pays$10 Copayment v
• Reconstructive surgery and associated procedures, N
0
including internal breast prostheses,following a _J
mastectomy,regardless of when the mastectomy was 0
performed.Members are covered for all stages of U)
reconstruction on the non-diseased breast to produce a
symmetrical appearance.Complications of covered 0
mastectomy services,including lymphedemas,are 0
covered. =a
m
Plastic and reconstructive surgery requires Preauthorization.
0
Exclusions: Cosmetic services including treatment for complications resulting from cosmetic surgery;cosmetic
surgery;complications of non-Covered Services
N
M
Y
Podiatry
d
Medically Necessary foot care. Member pays$10 Copayment z
c�
Routine foot care covered when such care is directly related Q
to the treatment of diabetes and,when approved by
KFHPWA's medical director,other clinical conditions that
effect sensation and circulation to the feet.
Exclusions:All other routine foot care
Preventive Services
Preventive services in accordance with the well care schedule Member pays$10 Copayment
established by KFHPWA may require Preauthorization. The
33 COE931-0036900
Packet Pg. 64
4.D.a
well care schedule is available in Kaiser Permanente medical
centers,at www.kp.org/wa,or upon request from Member
Services.
Screening and tests with A and B recommendations by the
U.S.Preventive Services Task Force(USPSTF).
Services,tests and screening contained in the U.S.Health
Resources and Services Administration Bright Futures
guidelines as set forth by the American Academy of
Pediatricians.
Services,tests,screening and supplies recommended in the _
U.S.Health Resources and Services Administration women's
N
preventive and wellness services guidelines. o
t
Immunizations recommended by the Centers for Disease 3
Q
Control's Advisory Committee on Immunization Practices.
Flu vaccines are covered when provided by a non-Network
Provider. W
L
Preventive services include,but are not limited to,well adult �j
and well child physical examinations;immunizations and N
vaccinations;pap smears;routine mammography screening; J
routine prostate screening;and colorectal cancer screening for a
Members who are age 45 or older or who are under age 45
and at high risk. U)
13
c
M
Preventive care for chronic disease management includes 7V
treatment plans with regular monitoring,coordination of care 2
between multiple providers and settings,medication m
management,evidence-based care,quality of care 2
measurement and results,and education and tools for patient i.
self-management support.In the event preventive,wellness or
chronic care management services are not available from a �-
Network Provider,non-network providers may provide these
services without Cost Share when Preauthorized. N
M
Y
Services provided during a preventive services visit,including
laboratory services,which are not in accordance with the
KFHPWA well care schedule are subject to Cost Shares.Eye z
refractions are not included under preventive services.
a
Exclusions: Those parts of an examination and associated reports and immunizations that are not deemed Medically
Necessary by KFHPWA for early detection of disease; all other diagnostic services not otherwise stated above
Rehabilitation and Habilitative Care(massage,
occupational,physical and speech therapy,pulmonary
and cardiac rehabilitation)and Neurodevelopmental
Therapy
Rehabilitation services to restore function following illness, Hospital-Inpatient: No charge;Member pays
injury or surgery,limited to the following restorative nothing
34 COE931-0036900
Packet Pg. 65
therapies: occupational therapy,physical therapy,massage
therapy and speech therapy. Services are limited to those Outpatient Services: Member pays$10 Copayment
necessary to restore or improve functional abilities when
physical,sensori-perceptual and/or communication
impairment exists due to injury,illness or surgery. Group visits(occupational,physical,speech
therapy or learning services):
Outpatient services require a prescription or order from a Member pays one half of the office visit Copayment
physician that reflects a written plan of care to restore and applicable Plan Coinsurance
function and must be provided by a rehabilitation team that
may include a physician,nurse,physical therapist,
occupational therapist,massage therapist or speech therapist.
Preauthorization is not required.
Habilitative care includes Medically Necessary services or N
devices designed to help a Member keep,learn,or improve o
skills and functioning for daily living. Services may include:
occupational therapy,physical therapy,and speech therapy
Q
when prescribed by a physician.Examples include therapy for
a child who is not walking or talking at the expected age.
These services may include physical and occupational W
therapy,speech-language pathology and other services for o
people with disabilities in a variety of inpatient and/or v
outpatient settings. y
0
J
Neurodevelopmental therapy to restore or improve function 0.
including maintenance in cases where significant
deterioration in the Member's condition would result without
the services,is limited to the following therapies:
occupational therapy,physical therapy and speech therapy. 7V
There is no visit limit for Neurodevelopmental Therapy .2
13
services.
Limited to a combined total of 60 inpatient days and 60 0
outpatient visits per calendar year for all Rehabilitation and
Habilitative care.
d
N
Services with mental health diagnoses are covered with no M
Y
limit.
c
d
Non-Emergency inpatient hospital services require E
Preauthorization.
c�
Cardiac rehabilitation is covered up to a total of 36 visits per Member pays$10 Copayment Q
cardiac event when clinical criteria is met.
Group visits(occupational,physical,speech
Limited to a combined total of 60 inpatient days and 60 therapy or learning services):
outpatient visits per calendar year for all Rehabilitation and Member pays one half of the office visit Copayment
Habilitative care. and applicable Plan Coinsurance
Pulmonary rehabilitation is covered when clinical criteria is Member pays$10 Copayment
met.
35 COE931-0036900
Packet Pg. 66
4.D.a
Preauthorization is required after initial visit. Group visits(occupational,physical,speech
therapy or learning services):
Member pays one half of the office visit Copayment
Limited to a combined total of 60 inpatient days and 60 and applicable Plan Coinsurance
outpatient visits per calendar year for all Rehabilitation and
Habilitative care.
Exclusions: Specialty treatment programs;inpatient Residential Treatment services;specialty rehabilitation programs
including"behavior modification programs";recreational,life-enhancing,relaxation or palliative therapy;
implementation of home maintenance programs
m
Reproductive Health N
L
0
Medically Necessary medical and surgical services for Hospital-Inpatient:No charge;Member pays 3
reproductive health,including consultations,examinations, nothing Q
procedures and devices,including device insertion and
removal. Hospital-Outpatient:No charge;Member pays
nothing
See Maternity and Pregnancy for pregnancy care and 0
termination of pregnancy services. Outpatient Services:No charge;Member pays y
nothing N
0
Reproductive health is the care necessary to support the
reproductive system and the ability to reproduce. 0
Reproductive health includes contraception,cancer and v�
disease screenings,termination of pregnancy,and maternity
c
prenatal and postpartum care. 0
All methods for Medically Necessary FDA-approved No charge;Member pays nothing 3
(including over-the-counter)contraceptive drugs,devices and 2
products. Condoms are limited to 120 per 90-day supply,
additional condoms available upon request. o
T
Contraceptive drugs may be allowed up to a 12-month supply
and,when available,picked up in the provider's office. N
0
Y
Note: Over-the-counter contraceptives can be purchased at
any KFHPWA-designated pharmacy.KFHPWA designed
network pharmacies may submit an electronic claim.If self- z
payment is made a reimbursement claim may be made by
utilizing the Member Reimbursement Drug Claim Form Q
which can be obtained on www.KP.oriz/wa in the"Forms"
section or by contacting Member Services. To request an
exception for quantity limits on condoms,members may
submit a request via www.KP.org/wa/fonnulaKy or by
contacting Member Services.
Sexual Dysfunction
One consultation visit to diagnose sexual dysfunction Member pays$10 Copayment
conditions.
36 COE931-0036900
Packet Pg. 67
Specific diagnostic services,treatment and prescription drugs. Not covered;Member pays 100%of all charges
Exclusions: Diagnostic testing and medical treatment of sexual dysfunction regardless of origin or cause;devices,
equipment and supplies for the treatment of sexual dysfunction
Skilled Nursing Facility
Skilled nursing care in a skilled nursing facility when full- No charge;Member pays nothing
time skilled nursing care is necessary in the opinion of the
attending physician,limited to a total of 30 days per condition
per calendar year.
m
Care may include room and board;general nursing care; N
drugs,biologicals,supplies and equipment ordinarily t
provided or arranged by a skilled nursing facility;and short- 3
term restorative occupational therapy,physical therapy and Q
speech therapy. rn
Skilled nursing care in a skilled nursing facility requires
c
Preauthorization. c
v
Exclusions: Personal comfort items such as telephone and television;rest cures;domiciliary or Convalescent Care c
J
O.
O
Sterilization
c
FDA-approved female sterilization procedures,services and No charge;Member pays nothing M
supplies. 7V
m
Non-Emergency inpatient hospital services require
Preauthorization.
0
T
Vasectomy. No charge;Member pays nothing
L
d
Non-Emergency inpatient hospital services require N
Preauthorization. M
Y
Exclusions: Procedures and services to reverse a sterilization
E
z
M
Substance Use Disorder Q
Substance use disorder services including inpatient Hospital-Inpatient: No charge;Member pays
Residential Treatment;diagnostic evaluation and education; nothing
organized individual and group counseling;and/or
prescription drugs unless excluded under Sections IV.or V. Hospital-Outpatient: Member pays$10
Copayment
Substance use disorder means a substance-related or addictive
disorder listed in the most current version of the Diagnostic Outpatient Services: Member pays$10 Copayment
and Statistical Manual of Mental Disorders(DSM).For the
purposes of this section,the definition of Medically
Necessary shall be expanded to include those services Group Visits:No charge;Member pays nothing
necessary to treat a substance use disorder condition that is
37 COE931-0036900
Packet Pg. 68
4.D.a
having a clinically significant impact on a Member's
emotional,social,medical and/or occupational functioning.
Substance use disorder services are limited to the services
rendered by a physician(licensed under RCW 18.71 and
RCW 18.57),a psychologist(licensed under RCW 18.83),a
substance use disorder treatment program licensed for the
service being provided by the Washington State Department
of Social and Health Services(pursuant to RCW 70.96A),a
master's level therapist(licensed under RCW 18.225.090),an
advance practice psychiatric nurse(licensed under RCW
18.79)or,in the case of non-Washington State providers,
those providers meeting equivalent licensing and certification
requirements established in the state where the provider's N
practice is located. o
t
The severity of symptoms designates the appropriate level of
Q
care and should be determined through a thorough assessment
completed by a licensed provider who recommends treatment
based on medical necessity criteria.
c
Court-ordered substance use disorder treatment shall be �j
covered only if determined to be Medically Necessary. N
0
J
Preauthorization is required for outpatient,intensive a
outpatient,and partial hospitalization services. 0
Preauthorization is required for Residential Treatment and
0
non-Emergency inpatient hospital services provided at out-of- MI
state facilities.
m
Preauthorization is not required for Residential Treatment and
non-Emergency inpatient hospital services provided in-state. i.
Member is given two days of treatment and is then subject to
medical necessity review for continued care.Member or --
facility must notify KFHPWA within 24 hours of admission,
or as soon as possible.Member may request prior A
authorization for Residential Treatment and non-Emergency `1
inpatient hospital services.Members may contact Member
Services to request Preauthorization. d
E
z
c�
Withdrawal Management Services for Alcoholism and Emergency Services Network Facility: Member Q
Substance Use Disorder. pays$75 Copayment
Withdrawal management services means the management of Emergency Services Non-Network Facility:
symptoms and complications of alcohol and/or substance Member pays$125 Copayment
withdrawal. The severity of symptoms designates the
appropriate level of care and should be determined through a Hospital-Inpatient: No charge;Member pays
thorough assessment completed by a licensed provider who nothing
recommends treatment based on medical necessity criteria.
Outpatient withdrawal management services means the
symptoms resulting from abstinence are of mild/moderate
severity and withdrawal from alcohol and/or other drugs can
38 COE931-0036900
Packet Pg. 69
4.D.a
be managed with medication at an outpatient level of care by
an appropriately licensed clinician. Subacute withdrawal
management means symptoms associated with withdrawal
from alcohol and/or other drugs can be managed through
medical monitoring at a 24-hour facility or other outpatient
facility.
Preauthorization is required for outpatient withdrawal
management and subacute withdrawal management services.
"Acute withdrawal management services"means the
symptoms resulting from abstinence are so severe that
withdrawal from alcohol and/or drugs require medical
management in a hospital setting or behavioral health agency N
(licensed and certified under RCW 71.24.037),which is o
needed immediately to prevent serious impairment to the
Member's health. Q
Coverage for acute withdrawal management services is
provided without Preauthorization.If a Member is admitted
as an inpatient directly from an emergency department,any o
Emergency services Copayment is waived.Coverage is V
subject to the hospital services Cost Share.Members must N
notify KFHPWA by way of the Hospital notification line J
within 24 hours of any admission,or as soon thereafter as a
medically possible. .°
Member is given no less than two days of treatment,
M
excluding weekends and holidays,in a behavioral health MI
agency that provides inpatient or residential substance abuse 0
treatment;and no less than three days in a behavioral health
agency that provides withdrawal management services prior
to conducting a medical necessity review for continued care. i.
Member or facility must notify KFHPWA within 24 hours of
admission,or as soon as possible.Members may request
Preauthorization for Residential Treatment and non-
Emergency inpatient hospital services by contacting Member
Services. `1
c
KFHPWA reserves the right to require transfer of the
Member to a Network Facility/program upon consultation z
between a Network Provider and the attending physician.If
the Member refuses transfer to a Network Facility/program, Q
all further costs incurred during the hospitalization are the
responsibility of the Member.
Exclusions: Wilderness therapy or aversion therapy;facilities and treatment programs which are not certified by the
Department of Social Health Services
Telehealth Services
Telemedicine No charge;Member pays nothing
Services provided by the use of real-time interactive audio
39 COE931-0036900
Packet Pg. 70
4.D.a
and video communications or store and forward technology
between the patient at the originating site and a Network
Provider at another location.Audio-only communication
requires an Established Relationship. Store and forward
technology means sending a Member's medical information
from an originating site to the provider at a distant site for
later review.The provider follows up with a medical
diagnosis for the Member and helps manage their care.
Services must meet the following requirements:
• Be a Covered Service under this EOC.
• The originating site is qualified to provide the
service.
• If the service is provided through store and forward
technology,there must be an associated office visit N
between the Member and the referring provider. `0
t
• Is Medically Necessary. 3
Q
Telephone Services and Online(E-Visits) No charge;Member pays nothing rn
Scheduled telephone visits with a Network Provider are
covered. L
c
0
Online(E-Visits):A Member logs into the secure Member v
site at www.kp.ora/wa and completes a questionnaire.A ')
0
KFHPWA medical provider reviews the questionnaire and _J
0.
provides a treatment plan for select conditions,including o
prescriptions. Online visits are not available to Members U)
during in-person visits at a KFHPWA facility or pharmacy. c
More information is available at 0
htWs://wa.kaiselpermanente.or /g html/public/services/e-visit. 0
�a
m
Exclusions:Fax and e-mail;telehealth services with non-contracted providers;telehealth services in states where �.
prohibited by law;all other services not listed above
L
d
N
Temporomandibular Joint(TMJ) M
Y
Medical and surgical services and related hospital charges for Hospital-Inpatient: No charge;Member pays d
the treatment of temporomandibular joint(TMJ)disorders nothing E
including:
• Medically Necessary orthognathic procedures for the Hospital-Outpatient: Member pays$10
treatment of severe TMJ disorders which have failed Copayment Q
non-surgical intervention.
• Radiology services. Outpatient Services: Member pays$10 Copayment
• TMJ specialist services.
• Fitting/adjustment of splints.
Non-Emergency inpatient hospital services require
Preauthorization.
TMJ appliances. See Devices,Equipment and Supplies for Member pays 20%coinsurance
additional information.
40 COE931-0036900
Packet Pg. 71
4.D.a
Exclusions: Treatment for cosmetic purposes;bite blocks;dental services including orthodontic therapy and braces
for any condition;any orthognathic(jaw)surgery in the absence of a diagnosis of TMJ, or severe obstructive sleep
apnea;hospitalizations related to these exclusions
Tobacco Cessation
Individual/group counseling and educational materials. No charge;Member pays nothing
Approved pharmacy products. See Drugs—Outpatient KFHPWA-designated tobacco cessation program:
Prescription for additional pharmacy information. No charge;Member pays nothing when prescribed as
part of the KFHPWA-designated tobacco cessation
program and dispensed through the KFHPWA-
designated mail order service N
�L
O
Other approved pharmacy products: 3
Preferred generic drugs(Tier 1): Member pays Q
$10 Copayment per 30-days up to a 90-day supply y
Preferred brand name drugs(Tier 2): Member
pays$10 Copayment per 30-days up to a 90-day c
supply v
Non-Preferred generic and brand name drugs
(Tier 3):Not covered;Member pays 100%of all c
charges y
c
M
Ii
Transplants
Transplant services,including heart,heart-lung,single lung, Hospital-Inpatient: No charge;Member pays
double lung,kidney,pancreas,cornea,intestinal/multi- nothing o
visceral,liver transplants,and bone marrow and stem cell
support(obtained from allogeneic or autologous peripheral Hospital-Outpatient: Member pays$10
blood or marrow)with associated high dose chemotherapy. Copayment N
M
Y
Services are limited to the following: Outpatient Services: Member pays$10 Copayment
• Inpatient and outpatient medical expenses for evaluation d
testing to determine recipient candidacy,donor matching E
z
tests,hospital charges,procurement center fees,
M
professional fees,travel costs for a surgical team and Q
excision fees.Donor costs for a covered organ recipient
are limited to procurement center fees,travel costs for a
surgical team and excision fees.
• Follow-up services for specialty visits.
• Rehospitalization.
• Maintenance medications during an inpatient stay.
Transplant services must be provided through locally and
nationally contracted or approved transplant centers. All
transplant services require Preauthorization. Contact Member
Services for Preauthorization.
41 COE931-0036900
Packet Pg. 72
Exclusions: Donor costs to the extent that they are reimbursable by the organ donor's insurance;treatment of donor
complications;living expenses except as covered under Section II.K.Utilization Management
Urgent Care
Inside the KFHPWA Service Area,urgent care is covered at a Network Emergency Department: Member pays
Kaiser Permanente medical center,Kaiser Permanente urgent $75 Copayment
care center or Network Provider's office.
Network Urgent Care Center: Member pays$10
Outside the KFHPWA Service Area,urgent care is covered at Copayment
any medical facility.
See Section XII.for a definition of Urgent Condition. Network Provider's Office: Member pays$10 N
Copayment 0
Q
Non-Network Provider: Member pays$125 rn
Copayment
L
♦0�
V
V. General Exclusions N
0
J
In addition to exclusions listed throughout the EOC,the following are not covered: a
0
1. Benefits and related services,supplies and drugs that are not Medically Necessary for the treatment of an U)
illness,injury,or physical disability,that are not specifically listed as covered in the EOC,except as required by r_
federal or state law.
M
0
13
2. Services Related to a Non-Covered Service: When a service is not covered,all services related to the non-
covered service(except for the specific exceptions described below)are also excluded from coverage.Members
who have received a non-covered service,such as bariatric surgery,and develop an acute medical complication �.
(such as band slippage,leak or infection)as a result,shall have coverage for Medically Necessary intervention
to stabilize the acute medical complication. Coverage does not include complications that occur during or
immediately following a non-covered service.Additional surgeries or other medical services in addition to
Medically Necessary intervention to resolve acute medical complications resulting from non-covered services N
0
shall not be covered. Y
c
3. Services or supplies for which no charge is made,or for which a charge would not have been made if the d
Member had no health care coverage or for which the Member is not liable; services provided by a family z
member,or self-care.
a
4. Convalescent Care.
5. Services to the extent benefits are"available"to the Member as defined herein under the terms of any vehicle,
homeowner's,property or other insurance policy,except for individual or group health insurance,pursuant to
medical coverage,medical"no fault"coverage,personal injury protection coverage or similar medical coverage
contained in said policy.For the purpose of this exclusion,benefits shall be deemed to be"available"to the
Member if the Member receives benefits under the policy either as a named insured or as an insured individual
under the policy definition of insured.
6. Services or care needed for injuries or conditions resulting from active or reserve military service,whether such
injuries or conditions result from war or otherwise.This exclusion will not apply to conditions or injuries
resulting from previous military service unless the condition has been determined by the U.S. Secretary of
42 COE931-0036900
Packet Pg. 73
Veterans Affairs to be a condition or injury incurred during a period of active duty.Further,this exclusion will
not be interpreted to interfere with or preclude coordination of benefits under Tri-Care.
7. Services provided by government agencies, except as required by federal or state law.
8. Services covered by the national health plan of any other country.
9. Experimental or investigational services.
KFHPWA consults with KFHPWA's medical director and then uses the criteria described below to decide if a
particular service is experimental or investigational.
a. A service is considered experimental or investigational for a Member's condition if any of the following
statements apply to it at the time the service is or will be provided to the Member:
1) The service cannot be legally marketed in the United States without the approval of the Food and Drug N
Administration("FDA")and such approval has not been granted. 0
2) The service is the subject of a current new drug or new device application on file with the FDA. 3
3) The service is the trialed agent or for delivery or measurement of the trialed agent provided as part of a Q
qualifying Phase I or Phase II clinical trial,as the experimental or research arm of a Phase III clinical rn
trial.
4) The service is provided pursuant to a written protocol or other document that lists an evaluation of the
service's safety,toxicity or efficacy as among its objectives. 0
5) The service is under continued scientific testing and research concerning the safety,toxicity or efficacy v
of services.
6) The service is provided pursuant to informed consent documents that describe the service as �
experimental or investigational,or in other terms that indicate that the service is being evaluated for its 0.
0
safety,toxicity or efficacy. y
7) The prevailing opinion among experts, as expressed in the published authoritative medical or scientific c
literature,is that(1)the use of such service should be substantially confined to research settings,or(2) 0
further research is necessary to determine the safety,toxicity or efficacy of the service. 7V
b. The following sources of information will be exclusively relied upon to determine whether a service is
experimental or investigational:
1) The Member's medical records. c
2) The written protocol(s)or other document(s)pursuant to which the service has been or will be
provided. L
3) Any consent document(s)the Member or Member's representative has executed or will be asked to N
execute,to receive the service. Y
4) The files and records of the Institutional Review Board(IRB)or similar body that approves or reviews
research at the institution where the service has been or will be provided,and other information d
concerning the authority or actions of the IRB or similar body. E
5) The published authoritative medical or scientific literature regarding the service,as applied to the
Member's illness or injury.
6) Regulations,records,applications and any other documents or actions issued by,filed with or taken by, Q
the FDA or other agencies within the United States Department of Health and Human Services,or any
state agency performing similar functions.
Appeals regarding KFHPWA denial of coverage can be submitted to the Member Appeal Department,or to
KFHPWA's medical director at P.O.Box 34593, Seattle,WA 98124-1593.
10. Hypnotherapy and all services related to hypnotherapy.
11. Directed umbilical cord blood donations.
12. Prognostic(predictive)genetic testing and related services,unless specifically provided in Section IV.Testing
for non-Members.
43 COE931-0036900
Packet Pg. 74
4.D.a
13. Autopsy and associated expenses.
14. Over-the-counter items such as hearing aids unless specifically listed as covered in Section IV.
15. Academic/career counseling,counseling for overeating,work/school ordered assessments,relationship
counseling,custodial care
16. Court-ordered or forensic treatment,including reports and summaries not considered Medically Necessary.
VI. Eligibility,Enrollment and Termination
A. Eligibility.
In order to be accepted for enrollment and continuing coverage,individuals must reside or work in the Service N
Area and meet all applicable requirements set forth below,except for temporary residency outside the Service 0
Area for purposes of attending school,court-ordered coverage for Dependents or other unique family 3
arrangements,when approved in advance by KFHPWA.KFHPWA has the right to verify eligibility. Q
1. Subscribers.
Bona fide employees as established and enforced by the Group shall be eligible for enrollment.Please
contact the Group for more information. v
2. Dependents. c
The Subscriber may also enroll the following:
0.
0
a. The Subscriber's legal spouse. v�
c
b. The Subscriber's state-registered domestic partner(as required by Washington state law)or if 0
specifically included as eligible by the Group,the Subscriber's non-state registered domestic partner.
State-registered domestic partners will be extended the same rights as spouses.
c. Children who are under the age of 26. ti
0
T
"Children"means the children of the Subscriber,spouse or eligible domestic partner,including adopted
children,stepchildren,children for whom the Subscriber has a qualified court order to provide
coverage and any other children for whom the Subscriber is the legal guardian. N
0
Y
Eligibility may be extended past the Dependent's limiting age as set forth above if the Dependent is
totally incapable of self-sustaining employment because of a developmental or physical disability
incurred prior to attainment of the limiting age,and is chiefly dependent upon the Subscriber for z
support and maintenance.Enrollment for such a Dependent may be continued for the duration of the M
continuous total incapacity,provided enrollment does not terminate for any other reason.Medical Q
proof of incapacity and proof of financial dependency must be furnished to KFHPWA upon request,
but not more frequently than annually after the 2-year period following the Dependent's attainment of
the limiting age.
3. Temporary Coverage for Newborns.
When a Member gives birth,the newborn is entitled to the benefits set forth in the EOC from birth through
3 weeks of age.All provisions,limitations and exclusions will apply except Subsections F. After 3 weeks
of age,no benefits are available unless the newborn child qualifies as a Dependent and is enrolled.
B. Application for Enrollment.
Application for enrollment must be made on an application approved by KFHPWA.The Group is responsible
for submitting completed applications to KFHPWA.
44 COE931-0036900
Packet Pg. 75
KFHPWA reserves the right to refuse enrollment to any person whose coverage under any medical coverage
agreement issued by Kaiser Foundation Health Plan of Washington Options,Inc.or Kaiser Foundation Health
Plan of Washington has been terminated for cause.
1. Newly Eligible Subscribers.
Newly eligible Subscribers and their Dependents may apply for enrollment in writing to the Group within
31 days of becoming eligible.
2. New Dependents.
A written application for enrollment of a newly dependent person,other than a newborn or adopted child,
must be made to the Group within 31 days after the dependency occurs.
A written application for enrollment of a newborn child must be made to the Group within 60 days
following the date of birth when there is a change in the monthly premium payment as a result of the N
additional Dependent. 0
A written application for enrollment of an adoptive child must be made to the Group within 60 days from Q
the day the child is placed with the Subscriber for the purpose of adoption or the Subscriber assumes total rn
or partial financial support of the child if there is a change in the monthly premium payment as a result of U
the additional Dependent.
c
0
When there is no change in the monthly premium payment,it is strongly advised that the Subscriber enroll v
the newborn or newly adoptive child as a Dependent with the Group to avoid delays in the payment of c
claims.
0.
0
3. Open Enrollment. y
KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as
described above during a limited period of time specified by the Group and KFHPWA. 0
4. Special Enrollment.
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a. KFHPWA will allow special enrollment for persons:
1) Who initially declined enrollment when otherwise eligible because such persons had other health c
care coverage and have had such other coverage terminated due to one of the following events:
• Cessation of employer contributions.
• Exhaustion of COBRA continuation coverage. N
• Loss of eligibility,except for loss of eligibility for cause;or M
Y
2) Who initially declined enrollment when otherwise eligible because such persons had other health
care coverage and who have had such other coverage exhausted because such person reached a
lifetime maximum limit. E
z
KFHPWA or the Group may require confirmation that when initially offered coverage such persons Q
submitted a written statement declining because of other coverage.Application for coverage must be
made within 31 days of the termination of previous coverage.
b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their
Dependents(other than for nonpayment or fraud)in the event one of the following occurs:
1) Divorce or Legal Separation.Application for coverage must be made within 60 days of the
divorce/separation.
2) Cessation of Dependent status(reaches maximum age). Application for coverage must be made
within 30 days of the cessation of Dependent status.
3) Death of an employee under whose coverage they were a Dependent.Application for coverage
must be made within 30 days of the death of an employee.
4) Termination or reduction in the number of hours worked.Application for coverage must be made
within 30 days of the termination or reduction in number of hours worked.
45 COE931-0036900
Packet Pg. 76
4.D.a
5) Leaving the service area of a former plan.Application for coverage must be made within 30 days
of leaving the service area of a former plan.
6) Discontinuation of a former plan.Application for coverage must be made within 30 days of the
discontinuation of a former plan.
c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their
Dependents in the event one of the following occurs:
1) Marriage.Application for coverage must be made within 31 days of the date of marriage.
2) Birth.Application for coverage for the Subscriber and Dependents other than the newborn child
must be made within 60 days of the date of birth.
3) Adoption or placement for adoption.Application for coverage for the Subscriber and Dependents
other than the adopted child must be made within 60 days of the adoption or placement for
adoption.
4) 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 EOC.The request for N
special enrollment must be made within 60 days of eligibility for such premium assistance. t
5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such 3
coverage.Application for coverage must be made within 60 days of the date of termination under Q
Medicaid or CHIP. rn
6) Applicable federal or state law or regulation otherwise provides for special enrollment. U
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C. When Coverage Begins. c
v
1. Effective Date of Enrollment. U)
• Enrollment for a newly eligible Subscriber and listed Dependents is effective on the date eligibility
requirements are met,provided the Subscriber's application has been submitted to and approved by c
KFHPWA.Please contact the Group for more information. y
• Enrollment for a newly dependent person,other than a newborn or adoptive child,is effective on the I It
of the month following date eligibility requirements are met.Please contact the Group for more M
information. 7V
• Enrollment for newborns is effective from the date of birth. =a
• Enrollment for adoptive children is effective from the date that the adoptive child is placed with the
Subscriber for the purpose of adoption or the Subscriber assumes total or partial financial support of
the child. c
T
2. Commencement of Benefits for Persons Hospitalized on Effective Date.
Members who are admitted to an inpatient facility prior to their enrollment will receive covered benefits N
beginning on their effective date,as set forth in Subsection C.1. above.If a Member is hospitalized in a Y
non-Network Facility,KFHPWA reserves the right to require transfer of the Member to a Network Facility.
The Member will be transferred when a Network Provider,in consultation with the attending physician,
determines that the Member is medically stable to do so. If the Member refuses to transfer to a Network z
Facility,all further costs incurred during the hospitalization are the responsibility of the Member.
M
D. Eligibility for Medicare. Q
An individual shall be deemed eligible for Medicare when they have the option to receive Part A Medicare
benefits.Medicare secondary payer regulations and guidelines will determine primary/secondary payer status
for individuals covered by Medicare.
A Member who is enrolled in Medicare has the option of continuing coverage under this EOC while on
Medicare coverage.Coverage between this EOC and Medicare will be coordinated as outlined in Section IX.
The Group is also responsible for providing KFHPWA with a prospective timely notice of Members'
ineligibility for Medicare Advantage coverage under the Group,as well as providing a prospective notice to its
Members alerting them of the termination event.In the event the Group does not obtain Medicare Advantage
coverage,the loss of Medicare drug coverage,other coverage options that may be available to the Member,and
46 COE931-0036900
Packet Pg. 77
4.D.a
the possibility of late enrollment penalties if the Member does not apply for Medicare coverage within the
required timeframe will also need to be provided.
E. Termination of Coverage.
The Subscriber shall be liable for payment of all charges for services and items provided to the Subscriber and
all Dependents after the effective date of termination.
Termination of Specific Members.
Individual Member coverage may be terminated for any of the following reasons:
a. Loss of Eligibility.If a Member no longer meets the eligibility requirements and is not enrolled for
continuation coverage as described in Subsection F.below,coverage will terminate at the end of the
month during which the loss of eligibility occurs,unless otherwise specified by the Group.
m
b. For Cause.In the event of termination for cause,KFHPWA reserves the right to pursue all civil
remedies allowable under federal and state law for the collection of claims,losses or other damages. t
Coverage of a Member may be terminated upon 10 working days written notice for: 3
1.) Material misrepresentation,fraud or omission of information in order to obtain coverage. Q
2.) Permitting the use of a KFHPWA identification card or number by another person or using
another Member's identification card or number to obtain care to which a person is not entitled.
L
c. Premium Payments.Nonpayment of premiums or contribution for a specific Member by the Group. V
Individual Member coverage may be retroactively terminated upon 30 days written notice and only in the c
case of fraud or intentional misrepresentation of a material fact; or as otherwise allowed under applicable —J
0.
law or regulation.Notwithstanding the foregoing,KFHPWA reserves the right to retroactively terminate c
coverage for nonpayment of premiums or contributions by the Group as described above. U)
c
In no event will a Member be terminated solely on the basis of their physical or mental condition provided M
they meet all other eligibility requirements set forth in the EOC. 7V
Any Member may appeal a termination decision through KFHPWA's appeals process.
F. Continuation of Coverage Options. o
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1. Continuation Option.
A Member no longer eligible for coverage(except in the event of termination for cause,as set forth in N
Subsection E.)may continue coverage for a period of up to 3 months subject to notification to and self- M
Y
payment of premiums to the Group.This provision will not apply if the Member is eligible for the
continuation coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA). This continuation option is not available if the Group no longer has active employees or E
otherwise terminates.
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2. Leave of Absence. Q
While on a Group approved leave of absence,the Subscriber and listed Dependents can continue to be
covered provided that:
• They remain eligible for coverage,as set forth in Subsection A.,
• Such leave is in compliance with the Group's established leave of absence policy that is consistently
applied to all employees,
• The Group's leave of absence policy is in compliance with the Family and Medical Leave Act when
applicable,and
• The Group continues to remit premiums for the Subscriber and Dependents to KFHPWA.
3. Self-Payments During Labor Disputes.
47 COE931-0036900
Packet Pg. 78
In the event of suspension or termination of employee compensation due to a strike,lock-out or other labor
dispute,a Subscriber may continue uninterrupted coverage through payment of monthly premiums directly
to the Group. Coverage may be continued for the lesser of the term of the strike,lock-out or other labor
dispute,or for 6 months after the cessation of work.
If coverage under the EOC is no longer available,the Subscriber shall have the opportunity to apply for an
individual KFHPWA group conversion plan or,if applicable,continuation coverage(see Subsection 4.
below),or an individual and family plan at the duly approved rates.
The Group is responsible for immediately notifying each affected Subscriber of their rights of self-payment
under this provision.
4. Continuation Coverage Under Federal Law.
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 N
Services Employment and Reemployment Rights Act(USERRA) and only applies to grant continuation of 0
coverage rights to the extent required by federal law.USERRA only applies in certain situations to 3
employees who are leaving employment to serve in the United States Armed Forces. Q
Upon loss of eligibility,continuation of Group coverage may be available to a Member for a limited time
after the Member would otherwise lose eligibility,if required by COBRA. The Group shall inform
Members of the COBRA election process and how much the Member will be required to pay directly to the 0
Group. v
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. 0.
0
U)
5. KFHPWA Group Conversion Plan.
Members whose eligibility for coverage,including continuation coverage,is terminated for any reason M
other than cause,as set forth in Subsection E.,and who are not eligible for Medicare or covered by another
group health plan,may convert to an individual KFHPWA group conversion plan.If coverage under the �a
EOC terminates,any Member covered at termination(including spouses and Dependents of a Subscriber
who was terminated for cause)may convert to a KFHPWA group conversion plan. Coverage will be
retroactive to the date of loss of eligibility. c
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An application for conversion must be made within 31 days following termination of coverage or within 31 L
days from the date notice of the termination of coverage is received,whichever is later.A physical N
examination or statement of health is not required for enrollment in a KFHPWA group conversion plan. Y
Persons wishing to purchase KFHPWA's individual and family coverage should contact KFHPWA.
E
VII.Grievances
M
Grievance means a written or verbal complaint submitted by or on behalf of a covered person regarding service Q
delivery issues other than denial of payment for medical services or non-provision 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. The grievance process is outlined as follows:
Step 1: It is recommended that the Member contact the person involved or the manager of the medical
center/department where they are having a problem,explain their concerns and what they would like to have
done to resolve the problem.The Member should be specific and make their position clear.Most concerns can
be resolved in this way.
Step 2: If the Member is still not satisfied,they should call or write to Member Services at PO Box 34590,
Seattle,WA 98124-1590.206-630-4636 or toll-free 1-888-901-4636.Most concerns are handled by phone
within a few days.In some cases,the Member will be asked to write down their concerns and state what they
48 COE931-0036900
Packet Pg. 79
4.D.a
think would be a fair resolution to the problem.An appropriate representative will investigate the Member's
concern by consulting with involved staff and their supervisors,and reviewing pertinent records,relevant plan
policies and the Member Rights and Responsibilities statement.This process can take up to 30 days to resolve
after receipt of the Member's written or verbal statement.
If the Member is dissatisfied with the resolution of the complaint,they may contact Member Services.Assistance is
available to Members who are limited-English speakers,who have literacy problems,or who have physical or
mental disabilities that impede their ability to request review or participate in the review process.
Appeals
Members are entitled to appeal through the appeals process if/when coverage for an item or service is denied due to
an adverse determination made by the KFHPWA medical director. The appeals process is available for a Member to
seek reconsideration of an adverse benefit determination(action).Adverse benefit determination(action)means any
of the following:a denial,reduction,or termination of,or a failure to provide or make payment(in whole or in part) N
for,a benefit,including any such denial,reduction,termination,or failure to provide or make payment that is based 0
on a determination of a Member's eligibility to participate in a plan,and including,a denial,reduction,or 3
termination of,or a failure to provide or make payment,in whole or in part,for a benefit resulting from the Q
application of any utilization review,as well as a failure to cover an item or service for which benefits are otherwise rn
provided because it is determined to be experimental or investigational or not Medically Necessary or appropriate. U
KFHPWA will comply with any new requirements as necessary under federal laws and regulations.Assistance is
available to Members who are limited-English speakers,who have literacy problems,or who have physical or 0
mental disabilities that impede their ability to request review or participate in the review process.The most current v
information about your appeals process is available by contacting KFHPWA's Member Appeal Department at the c
address or telephone number below. _J
0.
0
1. Initial Appeal y
If the Member or any representative authorized in writing by the Member wishes to appeal a KFHPWA 3
decision to deny,modify,reduce or terminate coverage of or payment for health care services,they must submit 0
a request for an appeal either orally or in writing to KFHPWA's Member Appeal Department,specifying why 7V
they disagree with the decision.The appeal must be submitted within 180 days from the Member's receipt of a
determination.KFHPWA will notify the Member of its receipt of the request within 72 hours of receiving it.
Appeals should be directed to KFHPWA's Member Appeal Department,P.O.Box 34593, Seattle,WA 98124-
1593,toll-free 1-866-458-5479. c
T
A party not involved in the initial coverage determination and not a subordinate of the party making the initial L
coverage determination will review the appeal request. KFHPWA will then notify the Member of its N
determination or need for an extension of time within 14 days of receiving the request for appeal.Under no Y
circumstances will the review timeframe exceed 30 days without the Member's written permission.
c
a)
For appeals involving experimental or investigational services KFHPWA will make a decision and E
communicate the decision to the Member in writing within 20 days of receipt of the appeal.
ca
There is an expedited/urgent appeals process in place for cases which meet criteria or where delay using the Q
standard appeal review process will seriously jeopardize the Member's life,health or ability to regain maximum
function or subject the Member to severe pain that cannot be managed adequately without the requested care or
treatment.The Member can request an expedited/urgent appeal in writing to the above address,or by calling
KFHPWA's Member Appeal Department toll-free 1-866-458-5479. The nature of the patient's condition will be
evaluated by a physician and if the request is not accepted as urgent,the member will be notified in writing of
the decision not to expedite and given a description on how to grieve the decision.If the request is made by the
treating physician who believes the member's condition meets the definition of expedited,the request will be
processed as expedited.
The request for an expedited/urgent appeal will be processed and a decision issued no later than 72 hours after
receipt of the request.
49 COE931-0036900
Packet Pg. 80
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.
If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being received,
KFHPWA will continue to provide coverage for the disputed benefit pending the outcome of the appeal.If the
KFHPWA determination stands,the Member may be responsible for the cost of coverage received during the
review period.
The U.S.Department of Health and Human Services has designated the Washington State Office of the
Insurance Commissioner's Consumer Protection Division as the health insurance consumer ombudsman.The
Consumer Protection Division Office can be reached by mail at Washington State Insurance Commissioner,
Consumer Protection Division,P.O.Box 40256,Olympia,WA 98504-0256 or at toll-free 1-800-562-6900.
More information about requesting assistance from the Consumer Protection Division Office can be found at
hllp://www.insurance.wa.jzov/your-insurance/health-insurance/appeal/.
N
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2. Next Level of Appeal 0
If the Member is not satisfied with the decision regarding medical necessity,medical appropriateness,health 3
care setting,level of care,or if the requested service is not efficacious or otherwise unjustified under evidence- Q
based medical criteria,or if KFHPWA fails to adhere to the requirements of the appeals process,the Member rn
may request a second level review by an external independent review organization not legally affiliated with or
controlled by KFHPWA.KFHPWA 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 0
written information for up to five business days after it receives the assignment for the appeal.The external U
independent review will be conducted at no cost to the Member. Once a decision is made through an c
independent review organization,the decision is final and cannot be appealed through KFHPWA. _J
a
0
If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being received, y
KFHPWA will continue to provide coverage for the disputed benefit pending the outcome of the appeal.If the
KFHPWA determination stands,the Member may be responsible for the cost of coverage received during the 0
review period. 7V
.a
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.
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0
IX. Claims V
L
Claims for benefits may be made before or after services are obtained.KFHPWA recommends that the provider N
requests Preauthorization.In most instances,contracted providers submit claims directly to KFHPWA.If your Y
provider does not submit a claim to make a claim for benefits,a Member must contact Member Services,or submit a
claim for reimbursement as described below. Other inquiries,such as asking a health care provider about care or
coverage,or submitting a prescription to a pharmacy,will not be considered a claim for benefits.
z
If a Member receives a bill for services the Member believes are covered,the Member must,within 90 days of the
date of service,or as soon thereafter as reasonably possible,either(1)contact Member Services to make a claim or Q
(2)pay the bill and submit a claim for reimbursement of Covered Services,or(3)for out-of-country claims
(Emergency care only)—submit the claim and any associated medical records,including the type of service,
charges,and proof of travel to KFHPWA,P.O.Box 30766, Salt Lake City,UT 84130-0766.In no event,except in
the absence of legal capacity,shall a claim be accepted later than 1 year from the date of service.
KFHPWA will generally process claims for benefits within the following timeframes after KFHPWA receives the
claims:
• Immediate request situations—within 1 business day.
• Concurrent urgent requests—within 24 hours.
• Urgent care review requests—within 48 hours.
• Non-urgent preservice review requests—within 5 calendar days.
• Post-service review requests—within 30 calendar days.
50 COE931-0036900
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4.D.a
Timeframes for pre-service and post-service claims can be extended by KFHPWA for up to an additional 15 days.
Members will be notified in writing of such extension prior to the expiration of the initial timeframe.
IX. Coordination of Benefits
The coordination of benefits(COB)provision applies when a Member has health care coverage under more than one
plan.Plan is defined below.
The order of benefit determination rules governs the order in which each plan will pay a claim for benefits.The plan
that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without
regard to the possibility that another plan may cover some expenses.The plan that pays after the primary plan is the
secondary plan.In no event will a secondary plan be required to pay an amount in excess of its maximum benefit
plus accrued savings.
m
N
If the Member is covered by more than one health benefit plan,and the Member does not know which is the primary 0
plan,the Member or the Member's provider should contact any one of the health plans to verify which plan is 3
primary.The health plan the Member contacts is responsible for working with the other plan to determine which is Q
primary and will let the Member know within 30 calendar days. rn
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 0
the Member experiences delays in the processing of the claim by the primary health plan,the Member or the v
Member's provider will need to submit the claim to the secondary health plan within its claim filing time limit to c
prevent a denial of the claim.
0.
0
If the Member is covered by more than one health benefit plan,the Member or the Member's provider should file all y
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. 0
Definitions.
m
A. A plan is any of the following that provides benefits or services for medical or dental care or treatment.If
separate contracts are used to provide coordinated coverage for Members of a Group,the separate contracts c
are considered parts of the same plan and there is no COB among those separate contracts.However,if
COB rules do not apply to all contracts,or to all benefits in the same contract,the contract or benefit to L
which COB does not apply is treated as a separate plan. N
M
1. Plan includes: group,individual or blanket disability insurance contracts and group or individual Y
contracts issued by health care service contractors or health maintenance organizations(HMO),closed
panel plans or other forms of group coverage;medical care components of long-term care contracts,
such as skilled nursing care;and Medicare or any other federal governmental plan,as permitted by
law.
a
2. Plan does not include:hospital indemnity or fixed payment coverage or other fixed indemnity or fixed
payment coverage; accident only coverage; specified disease or specified accident coverage;limited
benefit health coverage,as defined by state law; school accident type coverage;benefits for non-
medical components of long-term care policies;automobile insurance policies required by statute to
provide medical benefits;Medicare supplement policies;Medicaid coverage;or coverage under other
federal governmental plans;unless permitted by law.
Each contract for coverage under Subsection 1. or 2. is a separate plan.If a plan has two parts and COB
rules apply only to one of the two,each of the parts is treated as a separate plan.
B. This plan means,in a COB provision,the part of the contract providing the health care benefits to which
the COB provision applies and which may be reduced because of the benefits of other plans.Any other part
51 COE931-0036900
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4.D.a
of the contract providing health care benefits is separate from this plan.A contract may apply one COB
provision to certain benefits, such as dental benefits,coordinating only with similar benefits,and may apply
another COB provision to coordinate other benefits.
C. The order of benefit determination rules determine whether this plan is a primary plan or secondary plan
when the Member has health care coverage under more than one plan.
When this plan is primary,it determines payment for its benefits first before those of any other plan without
considering any other plan's benefits.When this plan is secondary,it determines its benefits after those of
another plan and must make payment in an amount so that,when combined with the amount paid by the
primary plan,the total benefits paid or provided by all plans for the claim equal 100%of the total allowable
expense for that claim. This means that when this plan is secondary,it must pay the amount which,when
combined with what the primary plan paid,totals 100%of the allowable expense.In addition,if this plan is
secondary,it must calculate its savings(its amount paid subtracted from the amount it would have paid had
it been the primary plan)and record these savings as a benefit reserve for the covered Member. This N
reserve must be used by the secondary plan to pay any allowable expenses not otherwise paid,that are 0
incurred by the covered person during the claim determination period. 3
Q
D. Allowable Expense.Allowable expense is a health care expense,coinsurance or copayments and without y
reduction for any applicable deductible,that is covered at least in part by any plan covering the person. U
When a plan provides benefits in the form of services,the reasonable cash value of each service will be
considered an allowable expense and a benefit paid.An expense that is not covered by any plan covering 0
the Member is not an allowable expense. v
The following are examples of expenses that are not allowable expenses:
0.
0
1. The difference between the cost of a semi-private hospital room and a private hospital room is not an y
allowable expense,unless one of the plans provides coverage for private hospital room expenses.
0
2. If a Member is covered by two or more plans that compute their benefit payments on the basis of usual 7V
and customary fees or relative value schedule reimbursement method or other similar reimbursement �a
method,any amount in excess of the highest reimbursement amount for a specific benefit is not an
allowable expense.
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3. If a Member is covered by two or more plans that provide benefits or services on the basis of
negotiated fees,an amount in excess of the highest of the negotiated fees is not an allowable expense. L
d
N
4. An expense or a portion of an expense that is not covered by any of the plans covering the person is Y
not an allowable expense.
c
d
E. Closed panel plan is a plan that provides health care benefits to covered persons in the form of services
through a panel of providers who are primarily employed by the plan,and that excludes coverage for
services provided by other providers,except in cases of Emergency or referral by a panel member.
a
F. Custodial parent is the parent awarded custody by a court decree or,in the absence of a court decree,is the
parent with whom the child resides more than one half of the calendar year excluding any temporary
visitation.
Order of Benefit Determination Rules.
When a Member is covered by two or more plans,the rules for determining the order of benefit payments are as
follows:
A. The primary plan pays or provides its benefits according to its terms of coverage and without regard to the
benefits under any other plan.
52 COE931-0036900
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4.D.a
B. (1)Except as provided below(subsection 2),a plan that does not contain a coordination of benefits
provision that is consistent with this chapter is always primary unless the provisions of both plans state that
the complying plan is primary.
(2)Coverage that is obtained by virtue of membership in a Group that is designed to supplement a part of a
basic package of benefits and provides that this supplementary coverage is excess to any other parts of the
plan provided by the contract holder.Examples include major medical coverages that are superimposed
over hospital and surgical benefits,and insurance type coverages that are written in connection with a
closed panel plan to provide out-of-network benefits.
C. A plan may consider the benefits paid or provided by another plan in calculating payment of its benefits
only when it is secondary to that other plan.
D. Each plan determines its order of benefits using the first of the following rules that apply:
N
1. Non-Dependent or Dependent.The plan that covers the Member other than as a Dependent,for 0
example as an employee,member,policyholder,Subscriber or retiree is the primary plan and the plan 3
that covers the Member as a Dependent is the secondary plan.However,if the person is a Medicare Q
beneficiary and,as a result of federal law,Medicare is secondary to the plan covering the Member as a rn
Dependent,and primary to the plan covering the Member as other than a Dependent(e.g.,a retired U
employee),then the order of benefits between the two plans is reversed so that the plan covering the
Member as an employee,member,policyholder,Subscriber or retiree is the secondary plan and the 0
other plan is the primary plan. v
2. Dependent child covered under more than one plan.Unless there is a court decree stating otherwise, �
when a dependent child is covered by more than one plan the order of benefits is determined as 0.
0
follows: y
a) For a dependent child whose parents are married or are living together,whether or not they have
ever been married: 0
• The plan of the parent whose birthday falls earlier in the calendar year is the primary plan;or 7V
• If both parents have the same birthday,the plan that has covered the parent the longest is the �a
primary plan.
m
b) For a dependent child whose parents are divorced or separated or not living together,whether or
not they have ever been married: o
i. If a court decree states that one of the parents is responsible for the dependent child's health
care expenses or health care coverage and the plan of that parent has actual knowledge of
those terms,that plan is primary.This rule applies to claim determination periods N
commencing after the plan is given notice of the court decree; 0
Y
ii. If a court decree states one parent is to assume primary financial responsibility for the
dependent child but does not mention responsibility for health care expenses,the plan of the
parent assuming financial responsibility is primary; E
iii. If a court decree states that both parents are responsible for the dependent child's health care
expenses or health care coverage,the provisions of a)above determine the order of benefits;
iv. If a court decree states that the parents have joint custody without specifying that one parent Q
has responsibility for the health care expenses or health care coverage of the dependent child,
the provisions of Subsection a)above determine the order of benefits;or
v. If there is no court decree allocating responsibility for the dependent child's health care
expenses or health care coverage,the order of benefits for the child are as follows:
• The plan covering the custodial parent,first;
• The plan covering the spouse of the custodial parent,second;
• The plan covering the non-custodial parent,third;and then
• The plan covering the spouse of the non-custodial parent,last.
c) For a dependent child covered under more than one plan of individuals who are not the parents of
the child,the provisions of Subsection a)or b)above determine the order of benefits as if those
individuals were the parents of the child.
53 COE931-0036900
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4.D.a
3. Active employee or retired or laid-off employee.The plan that covers a Member as an active
employee,that is,an employee who is neither laid off nor retired,is the primary plan. The plan
covering that same Member as a retired or laid off employee is the secondary plan.The same would
hold true if a Member is a Dependent of an active employee and that same Member is a Dependent of a
retired or laid-off employee.If the other plan does not have this rule,and as a result,the plans do not
agree on the order of benefits,this rule is ignored.This rule does not apply if the rule under Section
D.1.can determine the order of benefits.
4. COBRA or State Continuation Coverage.If a Member whose coverage is provided under COBRA or
under a right of continuation provided by state or other federal law is covered under another plan,the
plan covering the Member as an employee,member, Subscriber or retiree or covering the Member as a
Dependent of an employee,member,Subscriber or retiree is the primary plan and the COBRA or state
or other federal continuation coverage is the secondary plan.If the other plan does not have this rule,
and as a result,the plans do not agree on the order of benefits,this rule is ignored.This rule does not N
apply if the rule under Section D.1 can determine the order of benefits. 0
5. Longer or shorter length of coverage.The plan that covered the Member as an employee,member, Q
Subscriber or retiree longer is the primary plan and the plan that covered the Member the shorter y
period of time is the secondary plan. U
L
6. If the preceding rules do not determine the order of benefits,the allowable expenses must be shared 0
equally between the plans meeting the definition of plan.In addition,this plan will not pay more than it v
would have paid had it been the primary plan. c
J
Effect on the Benefits of this Plan. 0.
0
When this plan is secondary,it must make payment in an amount so that,when combined with the amount paid by y
the primary plan,the total benefits paid or provided by all plans for the claim equal one hundred percent of the total
allowable expense for that claim.However,in no event shall the secondary plan be required to pay an amount in 0
excess of its maximum benefit plus accrued savings. In no event should the Member be responsible for a deductible
amount greater than the highest of the two deductibles. �a
m
Right to Receive and Release Needed Information.
Certain facts about health care coverage and services are needed to apply these COB rules and to determine benefits c
payable under this plan and other plans.KFHPWA may get the facts it needs from or give them to other
organizations or persons for the purpose of applying these rules and determining benefits payable under this plan L
and other plans covering the Member claiming benefits. KFHPWA need not tell,or get the consent of,any Member N
to do this.Each Member claiming benefits under this plan must give KFHPWA any facts it needs to apply those Y
rules and determine benefits payable.
c
d
Facility of Payment.
If payments that should have been made under this plan are made by another plan,KFHPWA has the right,at its
discretion,to remit to the other plan the amount it determines appropriate to satisfy the intent of this provision.The
amounts paid to the other plan are considered benefits paid under this plan.To the extent of such payments, Q
KFHPWA is fully discharged from liability under this plan.
Right of Recovery.
KFHPWA has the right to recover excess payment whenever it has paid allowable expenses in excess of the
maximum amount of payment necessary to satisfy the intent of this provision.KFHPWA may recover excess
payment from any person to whom or for whom payment was made or any other issuers or plans.
Questions about Coordination of Benefits?Contact the State Insurance Department.
Effect of Medicare.
Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status,and
will be adjudicated by KFHPWA as set forth in this section.KFHPWA will pay primary to Medicare when required
54 COE931-0036900
Packet Pg. 85
4.D.a
by federal law.When Medicare,Part A and Part B or Part C are primary,Medicare's allowable amount is the highest
allowable expense.
When a Network Provider renders care to a Member who is eligible for Medicare benefits,and Medicare is deemed
to be the primary bill payer under Medicare secondary payer guidelines and regulations,KFHPWA will seek
Medicare reimbursement for all Medicare covered services.
XI. Subrogation and Reimbursement Rights
The benefits under this EOC will be available to a Member for injury or illness caused by another party,subject to
the exclusions and limitations of this EOC. If KFHPWA provides benefits under this EOC for the treatment of the
injury or illness,KFHPWA will be subrogated to any rights that the Member may have to recover compensation or
damages related to the injury or illness and the Member shall reimburse KFHPWA for all benefits provided,from
any amounts the Member received or is entitled to receive from any source on account of such injury or illness,
whether by suit,settlement or otherwise,including but not limited to: N
L
• Payments made by a third party or any insurance company on behalf of the third party; t
• Any payments or awards under an uninsured or underinsured motorist coverage policy; 3
• Any Workers' Compensation or disability award or settlement; Q
• Medical payments coverage under any automobile policy,premises or homeowners' medical payments
coverage or premises or homeowners' insurance coverage;and U
• Any other payments from a source intended to compensate an Injured Person for injuries resulting from an
accident or alleged negligence. C
v
This section more fully describes KFHPWA's subrogation and reimbursement rights. c
J
0.
"Injured Person"under this section means a Member covered by the EOC who sustains an injury or illness and any o
spouse,dependent or other person or entity that may recover on behalf of such Member including the estate of the U)
Member and,if the Member is a minor,the guardian or parent of the Member.When referred to in this section, "
KFHPWA's Medical Expenses"means the expenses incurred and the value of the benefits provided by KFHPWA M
under this EOC for the care or treatment of the injury or illness sustained by the Injured Person. 7V
.a
m
If the Injured Person's injuries were caused by a third-party giving rise to a claim of legal liability against the third 2
party and/or payment by the third party to the Injured Person and/or a settlement between the third party and the
Injured Person,KFHPWA shall have the right to recover KFHPWA's Medical Expenses from any source available c
T
to the Injured Person as a result of the events causing the injury.This right is commonly referred to as
"subrogation."KFHPWA shall be subrogated to and may enforce all rights of the Injured Person to the full extent of
KFHPWA's Medical Expenses. N
M
Y
By accepting benefits under this plan,the Injured Person also specifically acknowledges KFHPWA's right of
reimbursement.This right of reimbursement attaches when this KFHPWA has provided benefits for injuries or
illnesses caused by another party and the Injured Person or the Injured Person's representative has recovered any E
z
amounts from a third party or any other source of recovery.KFHPWA's right of reimbursement is cumulative with
and not exclusive of its subrogation right and KFHPWA may choose to exercise either or both rights of recovery. Q
In order to secure KFHPWA's recovery rights,the Injured Person agrees to assign KFHPWA any benefits or claims
or rights of recovery they may have under any automobile policy or other coverage,to the full extent of the plan's
subrogation and reimbursement claims. This assignment allows KFHPWA to pursue any claim the Injured Person
may have,whether or not they choose to pursue the claim.
KFHPWA's subrogation and reimbursement rights shall be limited to the excess of the amount required to fully
compensate the Injured Person for the loss sustained,including general damages.
Subject to the above provisions,if the Injured Person is entitled to or does receive money from any source as a result
of the events causing the injury or illness,including but not limited to any liability insurance or
uninsured/underinsured motorist funds,KFHPWA's Medical Expenses are secondary,not primary.
55 COE931-0036900
Packet Pg. 86
4.D.a
The Injured Person and their agents shall cooperate fully with KFHPWA in its efforts to collect KFHPWA's Medical
Expenses.This cooperation includes,but is not limited to,supplying KFHPWA with information about the cause of
injury or illness,any potentially liable third parties,defendants and/or insurers related to the Injured Person's claim.
The Injured Person shall notify KFHPWA within 30 days of any claim that may give rise to a claim for subrogation
or reimbursement.The Injured Person shall provide periodic updates about any facts that may impact KFHPWA's
right to reimbursement or subrogation as requested by KFHPWA,and shall inform KFHPWA of any settlement or
other payments relating to the Injured Person's injury.The Injured Person and their agents shall permit KFHPWA,
at KFHPWA's option,to associate with the Injured Person or to intervene in any legal,quasi-legal,agency or any
other action or claim filed.
The Injured Person and their agents shall do nothing to prejudice KFHPWA's subrogation and reimbursement
rights.The Injured Person shall promptly notify KFHPWA of any tentative settlement with a third party and shall
not settle a claim without protecting KFHPWA's interest. The Injured Person shall provide 21 days advance notice
to KFHPWA before there is a disbursement of proceeds from any settlement with a third party that may give rise to
a claim for subrogation or reimbursement.If the Injured Person fails to cooperate fully with KFHPWA in recovery N
of KFHPWA's Medical Expenses,and such failure prejudices KFHPWA's subrogation and/or reimbursement 0
rights,the Injured Person shall be responsible for directly reimbursing KFHPWA for 100%of KFHPWA's Medical 3
Expenses. Q
To the extent that the Injured Person recovers funds from any source that in any manner relate to the injury or illness U
giving rise to KFHPWA's right of reimbursement or subrogation,the Injured Person agrees to hold such monies in
trust or in a separate identifiable account until KFHPWA's subrogation and reimbursement rights are fully 0
determined and that KFHPWA has an equitable lien over such monies to the full extent of KFHPWA's Medical v
Expenses and/or the Injured Person agrees to serve as constructive trustee over the monies to the extent of vyi
KFHPWA's Medical Expenses.In the event that such monies are not so held,the funds are recoverable even if they �
have been comingled with other assets,without the need to trace the source of the funds. Any party who distributes 0.
0
funds without regard to KFHPWA's rights of subrogation or reimbursement will be personally liable to KFHPWA y
for the amounts so distributed.
c
0
If reasonable collections costs have been incurred by an attorney for the Injured Person in connection with obtaining MI
recovery,KFHPWA will reduce the amount of reimbursement to KFHPWA by the amount of an equitable
apportionment of such collection costs between KFHPWA and the Injured Person.This reduction will be made only
if each of the following conditions has been met: (i)KFHPWA receives a list of the fees and associated costs before
settlement and(ii)the Injured Person's attorney's actions were directly related to securing recovery for the Injured c
Party.
L
To the extent the provisions of this Subrogation and Reimbursement section are deemed governed by ERISA, N
implementation of this section shall be deemed a part of claims administration and KFHPWA shall therefore have Y
discretion to interpret its terms.
c
XII.Definitions E
z
c�
Allowance The maximum amount payable by KFHPWA for certain Covered Services. Q
Allowed Amount The level of benefits which are payable by KFHPWA when expenses are incurred from a
non-Network Provider.Expenses are considered an Allowed Amount if the charges are
consistent with those normally charged to others by the provider or organization for the
same services or supplies;and the charges are within the general range of charges made
by other providers in the same geographical area for the same services or supplies.
Members shall be required to pay any difference between a non-Network Provider's
charge for services and the Allowed Amount,except for Emergency services,including
post stabilization and for ancillary services provided by a non-Network provider at a
Network Facility.For more information about balance billing protections,please visit:
hgps://healthy.kaiserpennanente.org/washin tg on/support/fonns and click on the"Billing
forms"link.
56 COE931-0036900
Packet Pg. 87
Convalescent Care 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.
Copayment The specific dollar amount a Member is required to pay at the time of service for certain
Covered Services.
Cost Share The portion of the cost of Covered Services for which the Member is liable.Cost Share
includes Copayments,coinsurances and Deductibles.
Covered Services The services for which a Member is entitled to coverage in the Evidence of Coverage.
Creditable Coverage Coverage is creditable if the actuarial value of the coverage equals or exceeds the N
actuarial value of standard Medicare prescription drug coverage,as demonstrated `0
through the use of generally accepted actuarial principles and in accordance with CMS
actuarial guidelines.In general,the actuarial determination measures whether the 3
Q
expected amount of paid claims under KFHPWA's prescription drug coverage is at least rn
as much as the expected amount of paid claims under the standard Medicare prescription U
drug benefit.
c
0
Deductible A specific amount a Member is required to pay for certain Covered Services before V
benefits are payable. N
0
J
Dependent Any member of a Subscriber's family who meets all applicable eligibility requirements, c
is enrolled hereunder and for whom the premium has been paid. -W
Emergency The emergent and acute onset of a medical,mental health or substance use disorder M
symptom or symptoms,including but not limited to severe pain or emotional distress, 7V
that would lead a prudent layperson acting reasonably to believe that a health condition :a
exists that requires immediate medical attention,if failure to provide medical attention
would result in serious impairment to bodily function or serious dysfunction of a bodily
organ or part,or would place the Member's health,or if the Member is pregnant,the c
health of the unborn child,in serious jeopardy,or any other situations which would be
considered an emergency under applicable federal or state law. i
d
N
Essential Health Benefits set forth under the Patient Protection and Affordable Care Act of 2010, Y
Benefits including the categories of ambulatory patient services,Emergency services,
hospitalization,maternity and newborn care,mental health and substance use disorder
services,including behavioral health treatment,prescription drugs,rehabilitative and
habilitative services and devices,laboratory services,preventive and wellness services
and chronic disease management and pediatric services,including oral and vision care.
a
Established Member must have had at least one in-person appointment or at least one real-time
Relationship interactive appointment using both audio and visual technology in the past year,with the
provider providing audio only telemedicine or with a provider employed at the same
medical group,at the same clinic,or by the same integrated delivery system operated by
KFHPWA. Or the Member was referred to the provider providing audio-only
telemedicine by a provider who they have had an in-person appointment within the past
year.
Evidence of Coverage The Evidence of Coverage is a statement of benefits,exclusions and other provisions as
set forth in the Group Medical Coverage Agreement between KFHPWA and the Group.
57 COE931-0036900
Packet Pg. 88
4.D.a
Family Unit A Subscriber and all their Dependents.
Group An employer,union,welfare trust or bona-fide association which has entered into a
Group Medical Coverage Agreement with KFHPWA.
Hospital Care Those Medically Necessary services generally provided by acute general hospitals for
admitted patients.
KFHPWA-designated A specialist specifically identified by KFHPWA.
Specialist
Medical Condition A disease,illness or injury.
Medically Necessary Pre-service,concurrent or post-service reviews may be conducted. Once a service has N
been reviewed,additional reviews may be conducted.Members will be notified in Lo
writing when a determination has been made.Appropriate and clinically necessary
services,as determined by KFHPWA's medical director according to generally accepted Q
principles of good medical practice,which are rendered to a Member for the diagnosis, y
care or treatment of a Medical Condition and which meet the standards set forth below.
In order to be Medically Necessary,services and supplies must meet the following
requirements: (a)are not solely for the convenience of the Member,their family member c
or the provider of the services or supplies;(b)are the most appropriate level of service or v
supply which can be safely provided to the Member; (c)are for the diagnosis or N
treatment of an actual or existing Medical Condition unless being provided under 0
KFHPWA's schedule for preventive services;(d)are not for recreational,life-enhancing, G.
relaxation or palliative therapy,except for treatment of terminal conditions;(e)are
appropriate and consistent with the diagnosis and which,in accordance with accepted
medical standards in the State of Washington,could not have been omitted without M
adversely affecting the Member's condition or the quality of health services rendered; (f) 7V
as to inpatient care,could not have been provided in a provider's office,the outpatient 2
13
department of a hospital or a non-residential facility without affecting the Member's
condition or quality of health services rendered;(g)are not primarily for research and
data accumulation;and(h)are not experimental or investigational.The length and type c
of the treatment program and the frequency and modality of visits covered shall be
determined by KFHPWA's medical director.In addition to being medically necessary,to
L
be covered,services and supplies must be otherwise included as a Covered Service and N
not excluded from coverage. Y
Medicare 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 E
kidney failure requiring dialysis or a transplant, sometimes called ESRD).
M
Member Any enrolled Subscriber or Dependent. Q
Network Facility A facility(hospital,medical center or health care center)owned or operated by Kaiser
Foundation Health Plan of Washington or otherwise designated by KFHPWA,or with
whom KFHPWA has contracted to provide health care services to Members.
Network Personal A provider who is employed by Kaiser Foundation Health Plan of Washington or
Physician Washington Permanente Medical Group,P.C.,or contracted with KFHPWA to provide
primary care services to Members and is selected by each Member to provide or arrange
for the provision of all non-emergent Covered Services,except for services set forth in
the EOC which a Member can access without Preauthorization.Network Personal
Physicians must be capable of and licensed to provide the majority of primary health
58 COE931-0036900
Packet Pg. 89
4.D.a
care services required by each Member.
Network Provider The medical staff,clinic associate staff and allied health professionals employed by
Kaiser Foundation Health Plan of Washington or Washington Permanente Medical
Group,P.C.,and any other health care professional or provider with whom KFHPWA
has contracted to provide health care services to Members,including,but not limited to
physicians,podiatrists,nurses,physician assistants, social workers,optometrists,
psychologists,physical therapists and other professionals engaged in the delivery of
healthcare services who are licensed or certified to practice in accordance with Title 18
Revised Code of Washington.
Out-of-pocket Expenses Those Cost Shares paid by the Subscriber or Member for Covered Services which are
applied to the Out-of-pocket Limit.
m
N
Out-of-pocket Limit The maximum amount of Out-of-pocket Expenses incurred and paid during the calendar `0
year for Covered Services received by the Subscriber and their Dependents within the
same calendar year.The Out-of-pocket Expenses which apply toward the Out-of-pocket Q
Limit are set forth in Section IV. '
Plan Coinsurance The percentage amount the Member is required to pay for Covered Services received. i
c
0
Preauthorization An approval by KFHPWA that entitles a Member to receive Covered Services from a v
specified health care provider. Services shall not exceed the limits of the c
Preauthorization and are subject to all terms and conditions of the EOC.Members who _J
have a complex or serious medical or psychiatric condition may receive a standing 0.
0
Preauthorization for specialty care provider services. y
Private Duty Nursing The hiring of a nurse by a family or Member to provide long term and/or continuous one M
(or 24-hour nursing on one care with or without oversight by a home health agency.The care may be skilled, 7V
care) supportive or respite in nature. .a
m
Residential Treatment A term used to define facility-based treatment,which includes 24 hours per day,7 days
per week rehabilitation.Residential Treatment services are provided in a facility o
specifically licensed in the state where it practices as a residential treatment center.
Residential treatment centers provide active treatment of patients in a controlled
environment requiring at least weekly physician visits and offering treatment by a multi- N
disciplinary team of licensed professionals. M
Y
Service Area Washington counties of Benton,Columbia,Franklin,Island,King,Kitsap,Lewis,
Mason,Pierce, Skagit, Snohomish,Spokane,Thurston,Walla Walla,Whatcom, E
Whitman and Yakima.
M
Subscriber A person employed by or belonging to the Group who meets all applicable eligibility Q
requirements,is enrolled and for whom the premium has been paid.
Urgent Condition The sudden,unexpected onset of a Medical Condition that is of sufficient severity to
require medical treatment within 24 hours of its onset.
59 COE931-0036900
Packet Pg. 90
4.D.a
Notice of Nondiscrimination
Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.
("Kaiser Permanente")comply with applicable Federal and Washington state civil rights laws and do not
discriminate,exclude people,or treat them differently on the basis of race,color,national origin,age,
disability,sex,sexual orientation,gender identity,or any other basis protected by applicable federal,
state,or local law.We also:
• Provide free aids and services to people with disabilities to communicate effectively with us,
such as:
— Qualified sign language interpreters N
N
.L
— Written information in other formats(large print,audio,accessible electronic formats,and O
t
other formats) 3
Q
— Assistive devices(magnifiers,Pocket Talkers,and other aids)
N
• Provide free language services to people whose primary language is not English,such as: j
R
— Qualified interpreters
— Information written in other languages L))
If you need these services,contact Member Services at 1-888-901-4636(TTY 711). v0J
O
If you believe that Kaiser Permanente has failed to provide these services or discriminated in another J
way on the basis of race,color,national origin,age,disability,sex,sexual orientation,or gender identity, O
you can file a grievance with our Civil Rights Coordinator by writing to P.O. Box 35191,Mail Stop: U)
RCR-A35-03,Seattle,WA 98124-5191 or calling Member Services at the number listed above.You can file C
ca
a grievance by mail,phone,or online at kp.org/wa/feedback. If you need help filing a grievance,our Civil 6
Rights Coordinator is available to help you. v
You can also file a civil rights complaint with: d
• The U.S. Department of Health and Human Services,Office for Civil Rights electronically through
the Office for Civil Rights Complaint Portal,available at o
https://ocrportal.hhs.gov/ocr/portal/lobby.isf,or by mail or phone at: U.S. Department of
Health and Human Services,200 Independence Avenue SW.,Room 509F,HHH Building, d
Washington,DC 20201, 1-800-368-1019,800-537-7697(TDD) N
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.htmi Y
• The Washington State Office of the Insurance Commissioner,electronically through the
Office of the Insurance Commissioner Complaint portal available at E
https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status,or by phone at v
800-562-6900,360-586-0241(TDD).Complaint forms are available at r
https://fortress.wa.gov/oic/onlineservices/cc/pub/complaintinformation.aspx Q
2022-XB-7_ACA_Notice_Taglines Mtn° KAISER PERMANEWE®
60 COE931-0036900
Packet Pg. 91
4.D.a
Multi-language Interpreter Services
English:ATTENTION:If you speak a language other than English,language assistance services,free of
charge,are available to you. Call 1-888-901-4636(TTY 711).
Espan"ol(Spanish):ATENCI6N:Si habla espanol,tiene disponibles servicios de ayuda con el idioma sin cargo.
Hame al 1-888-901-4636(TTY 711).
L�3t(Chinese) rTAZK 1-888-901-4636
(TTY 711)
Tieng Viet(Vietnamese):CHID N:N6u quy vi n6i tieng Viet,quy vi co the six dung dich vu ho trd ng6n ngix
mien phi c6a chung t6i.Xin goi so"1-888-901-4636(TTY 711). N
L
a> � (Korean):J�jl:a�-�t 1�1'1 RL h}-$-o}Al o-T, 111°j 7,l j M t,I Z-1 � A]0-4 _-id q q. r
1-888-901-4636(TTY 711)-Li ---,-i 91 oIA�h1 o.
Q
PYCCKHH(Russian):BHNMAHNE! ECAm Bbi roBopmTe n0-pycCKW,Bann AOCTynHbi 6ecnnaTHbie ycnyr" to
nepeBOALIMKa.3BOHHTe no Homepy 1-888-901-4636(TTY 711). v
R
L
Tagalog:PAUNAWA:Kung nagsasalita ka ng Tagalog,maaari kang gumamit ng mga serbisyo ng tulong sa
wika nang walang bayad.Tumawag sa 1-888-901-4636(TTY 711). L)
N
YKpaIHCbKa(Ukrainian):YBAfA!FIKLL�0 BN p03MOBAACTe yKpaIHCb K0M MOBOK),BaM AOCTynHI 6e3KOWTOBHi 0
nocnyrL1 nepeKnaAy.Tene4)OHyt7Te 3a HoMepoM 1-888-901-4636(TTY 711). J
a-
8'il€U 12E (Khmer)' CiSf3PSSi5Gt5OMiMM)SS€S�StfE3�iSPS51PSSFi1€U1S2S SiiS31i5tS �PSSS i5fi1€U1Sw1UJ52nnicii5 S312iiSjS1 H 1
fi l 91[i 1S5' FUO 1-888-901-4636(TTY 711)`l
76
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El (Japanese):;]'aJ*EX : *f40)H*ipz0)aap 1�— I� � 1fLNt_t�lf-d-z t,
1-888-901-4636(TTY 711) J�Z. JS 'oj i Z-C Z:: �'�<tE t L x o .2
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hOYC'r(Amharic)*07AML.Ff 4"�S74,fi 5V35�A"40�h0 4+C?-9°A711 A?A17h-**f frig AACWv PgCQA-:
WY 1-888-901-4636(TTY 711),P,9aA-rr G
Oromiffa(Oromo):XIYYEEFFANNAA:Afaan dubbattu Oroomiffa yoo We,tajaajila gargaarsa afaanii,
kanfaltiidhaan ala,ni argama. 1-888-901-4636(TTY 711)irraatti bilbilaa.
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Packet Pg. 92
4.D.b
PREMEM
AMENDMENT 1 TO ADMINISTRATIVE SERVICE CONTRACT
BETWEEN
PREMERA BLUE CROSS
AND
CITY OF KENT
The Administrative Service Contract ("Contract") between the group named above
(the "Plan Sponsor") and Premera Blue Cross (the "Claims Administrator") was
issued January 1, 2023.
This Amendment shall further revise and extend the Contract for the period from N
L
January 1, 2024 through December 31, 2024 (the "Contract Period"). The changes to 0
the Contract for the new Contract Period shown below shall take effect on January 1, a
2024.
r
The changes are:
L
0
Face Page of Contract.
0
NOW THEREFORE section is hereby amended by removing the last sentence and now reads as J
follows: 0.
NOW THEREFORE, in consideration of the mutual covenants and conditions as contained herein the
c
parties hereto agree to the provisions in this Contract, including any Attachments and endorsements
thereto. The parties below have signed as duly authorized officers and have hereby executed this 0
Contract. `a
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Section 2, Duties And Responsibilities Of The Plan Sponsor.
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1. Subsection 2.4.e, is hereby amended to add the following Member Engagement
language. It reads:
• Plan Sponsor agrees that, and grants permission for, the following personal data to be used (D
by the Claims Administrator, and shared with Claims Administrator's vendors who provide a 0-
health plan benefit service for use, for the purpose of sending directed notifications to
members regarding programs and services included in their health plan benefits: member 0
name, member address, member email and phone number. The first paragraph of
Subsection 2.8, Funding is hereby replaced. It now reads as follows:
The Plan Sponsor shall be solely liable for all benefits payable to Members under the Plan that are Q
subject to this Contract and for value-based program payments and any other payments authorized
under this Contract
Section 3, Duties And Responsibilities Of The Claims Administrator.
1. Subsection 3.1.i, is hereby amended. It now reads:
i. Pharmacy Benefit Program For pharmacy benefit claims, Claims Administrator will pay Plan
Sponsor a prescription drug rebate payment equal to a specific amount per paid brand-name
prescription drug claim. The actual refund will be the specific amount less applicable Washington
State B&O taxes. Prescription drug rebates Claims Administrator receives from its pharmacy
benefit administrator in connection with Claims Administrator's overall pharmacy benefit utilization
ASCAM (0 1-2024)
An Independent Licensee of the Blue Cross Blue Shield Association Packet Pg. 93
4.D.b
may be more or less than the Plan Sponsor's rebate payment. The Plan Sponsor's rebate payment
shall be made to the Plan Sponsor on a calendar quarterly basis unless agreed upon otherwise.
The allowable charge for prescription drugs is higher than the price paid to the pharmacy benefit
manager for those prescription drugs.
The parties hereby agree that the difference between the allowable charge for prescription drugs
and the price paid to the pharmacy benefit manager, and the prescription drug payments received
by Claims Administrator from its pharmacy benefit manager, constitutes our property, and not part
of the compensation payable to Plan Sponsor under this Contract, and that Claims Administrator is
entitled to retain and shall retain such amounts and may apply them to the cost of its operations
and the pharmacy benefit.
Medical Benefit Drug Program The medical benefit drug program is separate from the
pharmacy program. It includes claims for drugs delivered as part of medical services. For medical
benefit drug claims, the Claims Administrator may contract with subcontractors that have rebate
contracts with various manufacturers. Rebate subcontractors retain a portion of rebates collected
as a rebate administration fee. The Claims Administrator retains a portion of the rebate. The Plan
Sponsor's medical benefit drug rebate payment shall be made to the Plan Sponsor on an annual
•L
basis if the rebate is $500 or more, less applicable Washington State B&O Taxes. If less than 0
$500, the Claims Administrator will retain the medical benefit drug rebate. Q
Notwithstanding the above as set forth in 3.1.i, if government action, changes in law or regulation,
or actions by a pharmaceutical manufacturer result in adverse effects to the availability of rebates
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or to the Claims Administrator's expectation of future rebate payments, the Claims Administrator
shall have the right to update these terms.
0
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2. Subsection 3.1.k,is hereby added to the contract. It reads: N
0
Solely as a convenience, Claims Administrator will make available the provider directory of in network J
CL
healthcare providers as well as certain machine-readable files, and cost sharing information. Claims c
Administrator will file prescription drug data collection (RxDC)on the Plan Sponsor's behalf as it U)
pertains to the Plan Sponsor's compliance requirements set forth below. Claims Administrator is not c
responsible for self-funded Plan Sponsor health plan compliance. Plan Sponsor is responsible for its
self-funded health plan compliance and may choose to access and use the information provided as a
convenience solely at its discretion to address compliance requirements pursuant to the Transparency
Coverage rules set forth in 26 CFR 54.9815-2715A1 —2715A3; 29 CFR 2590.715-2715A1 —2715A3; M
45 CFR 147.210—212; 26 CFR 54.9825-4T-6T and Federal No Surprises Billing Act set forth in 29
CFR 2590.716-1 to 29 CFR 2590.725-4; 45 CFR Part 149, as applicable; 26 CFR 54.9816-1T to 26
r
CFR 54.9831-1, as applicable. Claims Administrator will make available only the applicable data
described above for the services provided to the Plan Sponsor under this contract and only the portion L
of that applicable data it currently has in its possession. m
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Section 4, Limits Of The Claims Administrator's Responsibilities. a.
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The fourth paragraph is hereby amended. It now reads: E
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The Claims Administrator reserves the right to not administer any benefit or service that is at risk of U
violating state or federal law or is illegal under state or federal law. Q
Section 7, Term of Contract.
Subsection 7.1, 3rd paragraph is hereby amended to capture changes to Premera's day to day
business practices. It reads as follows:
The Claims Administrator reserves the right to amend this Contract at any time if needed to comply
with applicable law or regulation and on an annual basis to reflect any necessary updates to Claims
Administrator's business practices applicable to this contract.
2 Packet Pg. 94
4.D.b
Section 8, Termination.
1. A new paragraph is hereby added to this section. It reads as follows:
If this contract is terminated, the Plan Sponsor shall be liable for any payments and services rendered
before the effective date of termination.
2. Subsection 8.2, Contract Period Expiration is hereby amended. It now reads:.
This Contract will terminate on the last day of the Contract Period or the last day of any extension of
the Contract Period granted by the Plan Sponsor. If there is an administration fee guarantee period set
forth in Attachment D—Fees Of the Claims Administrator and Plan Sponsor terminates pursuant to
this 8.2 for a contract period that is shorter than the aforementioned administration guarantee period,
liquidated damages as described in 8.6 below are applicable to Plan Sponsor.
3. Subsection 8.5, Termination for Nonpayment is hereby amended. It now reads: N
The Claims Administrator may, at its sole discretion, terminate this Contract effective as of a missed o
payment or payment of funds due date in the event that the Plan Sponsor fails to make a timely
payment required under this Contract. Q
4. Subsection 8.6, Plan Sponsor Liability Upon Termination, 3rd sentence is hereby
amended. It reads::
Therefore, in the event that the Contract terminates pursuant to subsections 9.1, 9.5, or 9.2 above, but v
prior to the end of the administration fee guarantee period shown in Attachment D—Fees Of The N
Claims Administrator, the Plan Sponsor shall also pay the Claims Administrator as liquidated 0
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damages, and not as a penalty, an amount equal to two (2) months administration fees. 0.
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Section 10, Other Provisions
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1. Subsection 10.5, Integration. The subtitle has been deleted in its entirety and replaced
with subtitle "Entire Agreement."
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2. Subsection 10.9, Contract Amendments is hereby added to the contract. It reads:.
0
10.9. Contract Amendments.
This contract shall be modified by Claims Administrator at any time by changes to federal or state law L
as of the implementation date of the law or regulation. If there is any inconsistency between this
contract or any state or federal law, the law shall govern. d
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Attachment D, Fees of the Claims Administrator.
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1. The first page of Attachment D of the contract is deleted in its entirety and replaced by M
the first page of Attachment D to this amendment. °
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2. Value Based Program Payments section is hereby amended. It now reads as follows:
Value-Based Program Payments
Provider groups enter into agreements with Claims Administrator or other Blue Cross and/or Blue
Shield Licensees (Host Blues)for value-based programs. These programs offer payment and care
delivery models that support more coordinated, efficient and quality-driven healthcare aimed at
encouraging coordination and optimizing services to control cost. Such programs include but are not
limited to the following: the BCBSA Total Care program, shared savings arrangements like Global
Outcomes Contracts, accountable care organizations, patient-centered medical homes, global
payment/total cost of care arrangements, outcomes-based payment arrangements, provider
enablement arrangements, and coordinated care model arrangements.
3 Packet Pg. 95
4.D.b
Claims Administrator and the Host Blues may pay value-based program providers for meeting the
programs' standards for treatment outcomes, cost efficiency and quality. Claims Administrator and the
Host Blues plans may also pay value-based program providers for provider enablement activities to
facilitate patient care coordination and clinical support activities. Arrangements with these providers
and payments related to these programs require investments in health information technology
including but not limited to workflow automation, clinical and eligibility data exchanges, referral,
medication reconciliation and care transitional support to continue to improve cost and quality
outcomes for members.
The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount
established for each value-based program provider's attributed or assigned members. The PMPM
amount will be multiplied by the number of the Plan Sponsor's Members that are attributed or assigned
to each provider group. The PMPM amounts differ between the provider groups and may change
during the Contract Period. All PMPM amounts are paid to the value-based program provider per the
arrangement between Claims Administrator and provider and the Claims Administrator receives no
compensation or mark-up associated with the PMPM payment. In the case of pay for performance
programs, the PMPM amount is tied to specific outcomes achieved by the provider. In the case of
care coordination, the PMPM amount is tied to productivity or development/maintenance activities
•L
completed in support of patient care coordination and clinical support activities. Detailed reporting z
including but not limited to program PMPM charges and available settlement or productivity reporting
will be provided to Plan Sponsor within or as a supplement to the Plan Sponsor billing statement. Q
Additional information is available upon request, and a charge may apply. r
3. The Surprise Billing Protection Program has been renamed and updated. It now reads:
WA Surprise Billing Protection Program- o
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The Plan Sponsor will reimburse the Claims Administrator the following fees and amounts expended N
by the Claims Administrator for each arbitration as defined by state law. 0
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4. The Federal No Surprise Billing section is deleted in its entirety and replaced with the
0
following to further clarify expenses involved with the FNSA OR process. It describes
how the fees associated with the IDR process will be handled.
Federal No Surprises Act Independent Dispute Resolution (IDR) Process
The Plan Sponsor will reimburse the Claims Administrator the following fees and amounts expended M
by the Claims Administrator or the Blue Cross Blue Shield Association licensee that are associated c
with each Independent Dispute Resolution as defined under federal law:
Fee Amount L
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Arbitration Fee, per arbitration $2,500 L_
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For representation of the Plan in arbitration proceedings initiated by a
provider.
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Federal IDR Process Fee, per arbitration. Variable
Administrative fee due from each party participating in the Federal OR Q
process. The fee is set by the Federal Government and subject to
adjustment.
Certified IDR Entity Fee, per arbitration Variable
The non-prevailing party in arbitration is responsible for the certified OR
entity fee. The Certified OR Entity Fee will vary within a range for single case
or batched determinations. The fee ranges will be adjusted annually by the
Federal Government.
4 Packet Pg. 96
4.D.b
5. The No Cost Rx Program is hereby added to the contract. It reads:
No Cost Rx Programs:
Right Price: Right Price is a no cost program offered through our existing pharmacy benefit manager.
Right Price embeds a discount card prick check and integrates the discount card price, if applicable,
into existing claim logic for retail generics.
Attachment F, CareCompass360.
Appendix 5, Chronic Condition Management Program has been removed in its entirety.
Attachment H, Premera Value-Based Provider Arrangements
Attachment H is amended and hereby made part of the contract. It reads as follows:
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N
Value-Based Program Payments o
Provider groups enter into agreements with Claims Administrator or other Blue Cross and/or Blue
Shield Licensees (Host Blues)for value-based programs. These programs offer payment and care Q
delivery models that support more coordinated, efficient and quality-driven healthcare aimed at r
encouraging coordination and optimizing services to control cost. Such programs include but are not
limited to the following: the BCBSA Total Care program, shared savings arrangements like Global
Outcomes Contracts, accountable care organizations, patient-centered medical homes, global v
payment/total cost of care arrangements, outcomes-based payment arrangements, provider N
enablement arrangements, and coordinated care model arrangements. o
J
Claims Administrator and the Host Blues may pay value-based program providers for meeting the a
programs' standards for treatment outcomes, cost efficiency and quality. Claims Administrator and the �°
Host Blues plans may also pay value-based program providers for provider enablement activities to
facilitate patient care coordination and clinical support activities. Arrangements with these providers
and payments related to these programs require investments in health information technology
including but not limited to workflow automation, clinical and eligibility data exchanges, referral, 2
medication reconciliation and care transitional support to continue to improve cost and quality
outcomes for members.
The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount o
established for each value-based program provider's attributed or assigned members. The PMPM
amount will be multiplied by the number of the Plan Sponsor's Members that are attributed or assigned
to each provider group. The PMPM amounts differ between the provider groups and may change `m
during the Contract Period. All PMPM amounts are paid to the value-based program provider per the d
arrangement between Claims Administrator and provider and the Claims Administrator receives no a.
compensation or mark-up associated with the PMPM payment. In the case of pay for performance
programs, the PMPM amount is tied to specific outcomes achieved by the provider. In the case of E
care coordination, the PMPM amount is tied to productivity or development/maintenance activities z
completed in support of patient care coordination and clinical support activities. Detailed reporting U
including but not limited to program PMPM charges and available settlement or productivity reporting Q
will be provided to Plan Sponsor within or as a supplement to the Plan Sponsor billing statement.
Additional information is available upon request, and a charge may apply.
Attachment J Chronic Condition Management Program
The Attachment J to the contract is replaced by the Attachment J to this amendment and is
hereby made part of the contract.
Attachment K Performance Guarantees
Attachment K to this amendment is hereby made part of the contract.
5 Packet Pg. 97
4.D.b
All other provisions of the Contract remain unchanged. This amendment forms a part of your
Contract. Please keep the amendment with your Contract.
CITY OF KENT
BY: DATE:
Title
ADDRESS:
PREMERA BLUE CROSS
N
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BY: DATE: January 1, 2024 rn
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Jeffrey Roe
President and Chief Executive Officer
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P.O. Box 327 N
Seattle, WA 98111-0327 0
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4.D.b
ATTACHMENT B - CENSUS INFORMATION
Administration Fees, effective January 1, 2024, are based on the following:
Number of Active and Retired Members: 1,884
Employee Dependents
Medical/Rx 710 1,174
Number of COBRA Members: None N
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Employee Dependents
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Medical/Rx 0 0 ,n
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Packet Pg. 99
4.D.b
ATTACHMENT D
to the Administrative Service Contract
between
PREMERA BLUE CROSS
and
City of Kent
Group Number:1018212
Effective: 1/1/2024 through 12/31/2024
Pursuant to the Administrative Service Contract,the Plan Sponsor shall pay the Claims Administrator the fees,as set forth
below,for administrative services.
Administration Fees:
$53.93 per employee per month
Administration Fee Breakdown:
Administration Fee(Medical/Rx) $50.43
Producer Fee $3.50 N
Total $53.93 O
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Administration Fee Guarantee: O
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The base administration fee,not including other charges such as producer fees,is guaranteed as shown below during the period from
1/1/2024 through 12/31/2026. This period shall be known as the"administration fee guarantee period." V
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Year Amount Contract Period Begins Contract Period Ends
O
Year 1 $50.66 1/1/2024 12/31/2024 V
Year 2 $51.67 1/1/2025 12/31/2025 N
to
Year 3 $52.70 1/1/2026 12/31/2026 O
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Claims Runout Processing Fee: O'
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The charge for processing runout claims is an amount equal to the active administration fee at the time of termination,times the
average number of subscribers for the 3-month period preceding the termination date,times two.
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BlueCard Fee Amount:
V
BlueCard Fees are tracked and billed monthly in addition to claims expense.
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Packet Pg. 100
4.D.b
Value-Based Program Payments
Provider groups enter into agreements with Claims Administrator or other Blue Cross and/or Blue Shield
Licensees (Host Blues)for value-based programs. These programs offer payment and care delivery models
that support more coordinated, efficient and quality-driven healthcare aimed at encouraging coordination and
optimizing services to control cost. Such programs include but are not limited to the following: the BCBSA Total
Care program, shared savings arrangements like Global Outcomes Contracts, accountable care organizations,
patient-centered medical homes, global payment/total cost of care arrangements, outcomes-based payment
arrangements, provider enablement arrangements, and coordinated care model arrangements.
Claims Administrator and the Host Blues may pay value-based program providers for meeting the programs'
standards for treatment outcomes, cost efficiency and quality. Claims Administrator and the Host Blues plans
may also pay value-based program providers for provider enablement activities to facilitate patient care
coordination and clinical support activities. Arrangements with these providers and payments related to these
programs require investments in health information technology including but not limited to workflow
automation, clinical and eligibility data exchanges, referral, medication reconciliation and care transitional
support to continue to improve cost and quality outcomes for members. N
The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount established z
for each value-based program provider's attributed or assigned members. The PMPM amount will be multiplied
by the number of the Plan Sponsor's Members that are attributed or assigned to each provider group. The Q
PMPM amounts differ between the provider groups and may change during the Contract Period. All PMPM
amounts are paid to the value-based program provider per the arrangement between Claims Administrator and
provider and the Claims Administrator receives no compensation or mark-up associated with the PMPM
payment. In the case of pay for performance programs, the PMPM amount is tied to specific outcomes o
achieved by the provider. In the case of care coordination, the PMPM amount is tied to productivity or v
development/maintenance activities completed in support of patient care coordination and clinical support v,
activities. Detailed reporting including but not limited to program PMPM charges and available settlement or
productivity reporting will be provided to Plan Sponsor within or as a supplement to the Plan Sponsor billing a
statement. Additional information is available upon request, and a charge may apply.
0
Fee For Class Action Recoveries
The Plan Sponsor shall pay the Claims Administrator a fee for its work in pursuing class action recoveries on
behalf of the Plan Sponsor as described in Subsection 3.5. The fee shall be a proportionate share of$50,000
based on the proportion of the amount recovered on behalf of the Plan Sponsor compared to the total amount M
recovered by the Claims Administrator for all lines of business.
WA Surprise Billing Protection Program
The Plan Sponsor will reimburse the Claims Administrator the following fees and amounts expended by the L
Claims Administrator for each arbitration as defined by state law.
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Self-Funded Group Health Plan Opt-in Form No charge a
Completion
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Arbitration Fee, per arbitration $2,500 E
For representation of the Plan in arbitration
proceedings initiated by a provider.
All other outside counsel fees will be passed through Q
to the Plan Sponsor. Should a provider submit
arbitration claims aggregating claims from more than
one client (fully insured or self-funded), the outside
counsel fees will be pro-rated based upon the
number of claims from the Plan as a percentage of
the total number.
Claim Reprocessing Fee, per claim $200
9 Packet Pg. 101
4.D.b
Federal No Surprises Act Independent Dispute Resolution (IDR) Process
The Plan Sponsor will reimburse the Claims Administrator the following fees and amounts expended by the
Claims Administrator or the Blue Cross Blue Shield Association licensee that are associated with each
Independent Dispute Resolution as defined under federal law:
Fee Amount
Arbitration Fee, per arbitration $2,500
For representation of the Plan in arbitration proceedings initiated by a provider.
Federal IDR Process Fee, per arbitration (for invoices paid prior to 8/2/2023) *$350
Administrative fee due from each party participating in the Federal IDR process.
Federal IDR Process Fee, per arbitration (for invoices paid after 8/2/2023) *$50
Administrative fee due from each party participating in the Federal IDR process.
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Certified IDR Entity Fee, per arbitration Variable 0
The non-prevailing party in arbitration is responsible for the certified IDR entity fee. '
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The Certified IDR Entity Fee will vary within a range for single case or batched
determinations. The fee ranges will be adjusted annually by the Federal Government.
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Outside Legal Counsel Fee, per arbitration Variable 0
0
All outside counsel fees will be passed through to the Plan Sponsor. Should a v
provider submit arbitration claims aggregating claims from more than one client (fully N
0
insured or self-funded), the outside counsel fees will be pro-rated based upon the _J
number of claims from the Plan as a percentage of the total number. 0
CareCompass360*
See Attachment G—CareCompass360°for an overview of services provided. Services are included in the
Claims Administrator's Administration Fee except where stated below.
Personal Health Support Not included in Administration Fee. $300 per actively
(See Appendix 2) engaged Member per month of active engagement. o
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BestBeginnings Maternity Engagement fee: $50 one-time fee per
(See Appendix 3) Member when the L
Member registers for the
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program and downloads W
the mobile application a
High Risk Maternity Case $350 additional one-time =
Management fee for Members engaged E
in high-risk case U
management f°
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Neonatal Intensive Care Risk Assessment Fee waived
&Case Management
(See Appendix 4)
No Cost Programs
Rx Programs:
Right Price: Right Price is a no cost program offered through our existing pharmacy benefit manager. Right
Price embeds a discount card prick check and integrates the discount card price, if applicable, into existing
claim logic for retail generics.
10 Packet Pg. 102
4.D.b
ATTACHMENT H - PREMERA VALUE-BASED PROVIDER
ARRANGEMENTS
Value-Based Program Payments
Provider groups enter into agreements with Claims Administrator or other Blue Cross and/or Blue Shield
Licensees (Host Blues)for value-based programs. These programs offer payment and care delivery models
that support more coordinated, efficient and quality-driven healthcare aimed at encouraging coordination and
optimizing services to control cost. Such programs include but are not limited to the following: the BCBSA Total
Care program, shared savings arrangements like Global Outcomes Contracts, accountable care organizations,
patient-centered medical homes, global payment/total cost of care arrangements, outcomes-based payment
arrangements, provider enablement arrangements, and coordinated care model arrangements.
Claims Administrator and the Host Blues may pay value-based program providers for meeting the programs'
standards for treatment outcomes, cost efficiency and quality. Claims Administrator and the Host Blues plans N
may also pay value-based program providers for provider enablement activities to facilitate patient care
coordination and clinical support activities. Arrangements with these providers and payments related to these z
programs require investments in health information technology including but not limited to workflow Q
automation, clinical and eligibility data exchanges, referral, medication reconciliation and care transitional ,
support to continue to improve cost and quality outcomes for members. N
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The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount established
for each value-based program provider's attributed or assigned members. The PMPM amount will be multiplied v
by the number of the Plan Sponsor's Members that are attributed or assigned to each provider group. The
PMPM amounts differ between the provider groups and may change during the Contract Period. All PMPM o
amounts are paid to the value-based program provider per the arrangement between Claims Administrator and J
provider and the Claims Administrator receives no compensation or mark-up associated with the PMPM o
payment. In the case of pay for performance programs, the PMPM amount is tied to specific outcomes
achieved by the provider. In the case of care coordination, the PMPM amount is tied to productivity or
development/maintenance activities completed in support of patient care coordination and clinical support
activities. Detailed reporting including but not limited to program PMPM charges and available settlement or c,
productivity reporting will be provided to Plan Sponsor within or as a supplement to the Plan Sponsor billing
statement. Additional information is available upon request, and a charge may apply. M
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11 Packet Pg. 103
4.D.b
ATTACHMENT J — CHRONIC CONDITION MANAGEMENT PROGRAM
The Chronic Condition Management program helps members with chronic conditions to manage them in order
to live healthier lives. The Claims Administrator's Chronic Condition Management Program Manager(the
Program Manager) monitors participating Members' health data and uses it to create actionable, personalized
and timely coaching and reminders. The Program Manager receives Members' health data in real time via
cellular technology.
The Program Manager is able to share the data with the Member's doctor or someone close to the Member if
the Member requests it.
Personalized support and interaction are available during normal business hours. However, coaches are
available to support acute events 24 hours a day, 365 days a year.
Covered Services
Diabetes Management: N
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For members who have Type 1 or Type 2 diabetes. 0
Members receive: '
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• A blood glucose meter from the Program Manager that uploads blood sugar readings to the Member's r
personal online account. Members must use the Program Manager's meter. A carrying case comes
with the meter.
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• Unlimited test strips for this meter. Members can reorder test strips using the meter or online. The C)
strips will be sent to the Member directly. N
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• A lancing device and lancets. J
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• Control solution °
• Real-time reminders to check blood sugar or to take medication, and tips based on the Member's
blood sugar readings that can help keep blood sugar levels within a healthy range.
• One on one live coaching and support via phone, text, e-mail, or the program manager's mobile app. `2
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Coaches are health professionals, such as dietitians or registered nurses, that are certified diabetes 0
educators.
• Health summary reports that Members can share with their doctors
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• The Program Manager's mobile application
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Access To Services
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• The Claims Administrator will work with the Program Manager to identify Members who meet the L_
qualifications for the Diabetes Management and Hypertension programs. The Claims Administrator will
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transmit eligibility files weekly to the Program Manager.
• For the Diabetes Prevention program, the Program Manager will ask Members to complete a brief
screening questionnaire to determine if the member meets eligibility criteria. c}a
Billing Q
The Program Manager will submit medical claims for the services. Members pay nothing.
The Program Manager will contact Members who stop participating in the program by phone to engage or re-
engage them. If the Member does not re-engage, the Program Manager will not bill for that Member beyond
the initial period.
Members have the option to cancel the program at any time.
12 Packet Pg. 104
ATTACHMENT K
PERFORMANCE GUARANTEE AGREEMENT
BETWEEN
Premera Blue Cross of Washington
AND
City of Kent
EFFECTIVE 1/1/2024 THROUGH 12/31/2024 (The "Agreement Period")
This Performance Guarantee Agreement is between Premera Blue Cross of Washington ("the Company"), and
City of Kent ("the Group"). The Company will provide an acceptable level of service as described herein or will
pay the penalties also described herein.
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SECTION 1. TERM L
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The term of this Agreement shall only be the Agreement Period. Q
Provided this Agreement is executed prior to or on the Effective Date, the Company's fulfillment of the
performance guarantees set forth in this Agreement shall be measured from the Effective Date.
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In the event that this Agreement is not executed prior to or on the Effective Date, the Company's performance v
shall be measured in accordance with Section 3.C. n
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The performance guarantees under this Agreement are contingent on the Company receiving timely payment of o
administrative fees or subscription charges, as applicable, from the Group. in
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SECTION 2. PERFORMANCE GUARANTEES AND PENALTY AMOUNTS
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The Company guarantees its performance as stated below. The maximum amount of accumulated penalties E
for the Agreement Period shall be $29,500.00 ti
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Performance Guarantee Metrics:
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1)Account Management: Quarterly Account Management Team Satisfaction Survey
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The Company will provide an online survey that measures the effectiveness of account management in a
providing superior service to the client. The Account Management Survey shall be distributed to appropriate
members of the Group's benefits staff, and/or third party benefit consultants as selected by the Group, at the E
end of each quarter. The Group and its selected associates shall complete the Online Account Management
Survey within thirty (30) days of receipt. The failure of the group to respond to one of the quarterly surveys shall 2
nullify the Account Management Survey metric, and the Company will not pay the penalty. Q
Following the end of each quarter and receipt of the survey response(s) from the Group, the Company will
calculate the Mean Score in each performance assessment category by using a mean score calculation. The
Account Management Commitment will be deemed as fulfilled if Question 8 "Overall Satisfaction with Account
Management Team" is equal to or greater than 3 on a 5 point satisfaction scale. Surveys with no response will
be removed from our scoring computation. Only completed survey's submitted within 30 days of distribution will
be used to score Account Management performance.
This metric is Corporate Standard and reporting will be Group Specific; Quarterly Survey; Annual Settlement
The estimated penalty for this metric will be $4,500.00
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Packet Pg. 105
4.D.b
Performance Guarantee Metrics:
2) Claims : Claims - Clean Claims Turnaround Time within 30 Days
Turnaround Time (TAT) is measured from the date a clean claim is received by the Company (either via paper
or electronic data interchanges) to the date it is processed for payment, denied, or pended for external
information. A clean claim is defined as one that has been received by The Company with the relevant and
correct information required to process the claim. This claim will have no defects or irregularities, includes any
required substantiating documentation, and can be adjudicated without interruption. The calculation for the
Claim Turnaround Time percentage will be measured on the percentage of all Clean Claims processed within
30 Days of Receipt divided by Total Clean Claims Processed (*excluding Blue Card claims), not less than 97%.
*Performance Standard will be tolled with respect to a claim during the period the claim is suspended for
information outside The Company's claims processing system or scope of responsibility or control (i.e., review
by other organizations not integrated into processing system).
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This metric is Corporate Standard and reporting will be Book of Business; Reported quarterly and settled°,
annually '
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The estimated penalty for this metric will be $4,500.00
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3) Claims : Claims Accuracy - Dollars N
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The Company guarantees that at least 99% of total benefit dollars payments shall be accurate (less than 1% to J
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be in error) in a contract year, when overpayments and underpayments are combined, not offset against one o
another. Calculated as Total Dollars Paid less Total Absolute Value of Dollar Errors, divided by Total Dollars N
Paid, based on annual randomly selected audit sample, not less than 99%.
This metric is Corporate Standard and reporting will be Book of Business; Reported quarterly and settled
annually
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The estimated penalty for this metric will be $4,500.00
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4) Claims : Claims Accuracy - Frequency M
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95% of the Groups clean claims shall be paid without error (payment and procedural) in a contract year. c
Calculated as Total Claims With No Errors divided by Total Claims Paid, and based on annual randomly E
selected audit sample, not less than 95%. M
This metric is Corporate Standard and reporting will be Book of Business; Reported quarterly and settled a
annually
The estimated penalty for this metric will be $4,500.00
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4.D.b
Performance Guarantee Metrics:
5) Contract Services: Booklets
Premera will guarantee booklet proofs within 45 business days of receipt of the group renewal confirmation.
Additional drafts or final (electronic) booklets will be provided within 10 business days of producer/client edits to
initial draft and repeat with each revision as necessary. Printing and mailing of booklets are not subject to
performance guarantee.
This metric is non-standard and reporting will be Group specific settled annually
The estimated penalty for this metric will be $2,500.00
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6) Customer Service: Customer Service - Abandonment Rate 0
The Company guarantees that no more than 5 percent of incoming calls that are made to our toll-free customer Q
service telephone line shall be dropped before speaking to a Customer Service Representative. Customer
Service Abandonment Rate calculated as Total Abandoned Calls divided by Total Accepted Calls.
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This metric is Corporate Standard and reporting will be Combined score of all PG Groups in Customer Service o
Unit. Reported quarterly, settled using 12 mo avg.
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The estimated penalty for this metric will be $4,500.00 J
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7) Customer Service: Customer Service - Service Level within 30 seconds
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The Company guarantees that 75% of all calls to their toll-free customer service telephone line will be answered
in thirty seconds or less. Answered means the time from when the caller selects the option to speak with an
agent until a Customer Service Representative answers the call. Results are calculated as Total Calls
Answered Within 30 Seconds divided by Total Calls Received.
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This metric is Corporate Standard and reporting will be Combined score of all PG Groups in Customer Service
Unit. L
Reported quarterly, settled using 12 mo avg a
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The estimated penalty for this metric will be $4,500.00 E
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SECTION 3. EVALUATION OF PERFORMANCE AND PAYMENT OF PENALTIES
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A) At the end of the Agreement, the Company shall compile the necessary documentation and perform the
necessary calculations to evaluate its fulfillment of each performance guarantee set forth in this Agreement and
make this information available to the Group.
B) If the Company fails to meet any of the performance guarantees set forth in Section 2, the Company shall
pay to the Group the financial penalty based on the percentage set forth in Section 2.
C) In the event that this Agreement is not executed by the Effective Date, the Company's performance shall be
measured from the first day of the month following the month this Agreement is executed. In such event the
applicable penalty amounts will be pro-rated for that portion of the year for which performance guarantee
metrics are in force.
D) Refer to Section 4 if the contract under which the Company provides insurance and/or administrative
services to the Group is terminated prior to the end of the term of this Agreement.
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SECTION 4. TERMINATION OF AGREEMENT 0
If this Agreement terminates prior to the last day of the Agreement Period the Group is not entitled to any Q
penalties under Section 2 of this Agreement. This Agreement shall terminate upon the earliest of the following
dates: ;a
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A) the end of the Term of this Agreement;
B) the effective date of any state's or other jurisdiction's action which prohibits activities of the parties under this �
Agreement;
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C) the date upon which the Group either fails to meet its obligation to sufficiently fund the bank account from
which claims are paid (if applicable), or fails to make timely payments of either administrative fees or
subscription charges anytime during the plan year; FU
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D) the date upon which the contract under which the Company provides services to the Group is terminated; M
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E) any other date mutually agreeable to the Company and Group.
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Packet Pg. 108
4.D.c
AMENDMENT NO. 15
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
It is hereby agreed the Policy shall be amended as follows:
Effective January 1, 2024:
The following Section has been replaced:
Section 1, Declarations. N
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The following page has been replaced: a
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Table of Contents. �
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The following Riders have been added: N
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Surplus Rider; and o
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Rate Cap Rider.
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The following Rider renews for the 2024 Policy Year: ti
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• Specific Advance Funding Rider.
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All other terms and conditions of the contract remain unchanged.
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LifeWise Assurance Company
Name and Title of Officer
Signature of Officer
Ben Helsel
President
Date of Signature LifeWise Assurance Company
1. Sign and return copy to LifeWise Assurance Company.
2. Retain copy with Your Policy.
PSL-500 WA AM (9-18) Ame Packet Pg. 109
4.D.c
TABLE OF CONTENTS
Effective January 1, 2024
Section1. Declarations........................................................................................................................1
Section2. Definitions...........................................................................................................................4
Section3. Benefits...............................................................................................................................7
Section 4. Exclusions and Limitations ..................................................................................................8
Section 5. Claim Administrator.............................................................................................................8
Section 6. Claim Provisions .................................................................................................................8
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Section7. Material Changes................................................................................................................9 L
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Section 8. Termination and Renewal....................................................................................................9
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Section9. Premiums..........................................................................................................................10 Q
Section 10. General Provisions............................................................................................................11
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Section 11. Records and Reports ........................................................................................................12
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Section 12. Liability and Indemnification...............................................................................................13 c)
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Section 13. Entire Contract, Changes..................................................................................................13 N
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Section 14. Incontestable Clause.........................................................................................................13 0-
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Section15. Legal Actions ....................................................................................................................13 U)
Section16. Insolvency.........................................................................................................................13
Section17. Assignment.......................................................................................................................13
Specific Advance Funding Rider............................................................................................................14
RateCap Rider......................................................................................................................................15
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SurplusRider.........................................................................................................................................16
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PSL-500 WA(9-18) Packet Pg. 110
4.D.c
This Declarations for Policy Number WA 518212 apply to the Policy Term January 1, 2024 through
December 31, 2024 in its entirety.
SECTION 1 - DECLARATIONS
A. POLICY INFORMATION
1. Policy Number WA 518212
2. Policyholder City of Kent
3. Policy Term January 1, 2024 through December 31, 2024
4. Covered Underlying Plan City of Kent's Health Plan N
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5. Claim Administrator Premera Blue Cross r
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B. SPECIFIC BENEFIT SCHEDULE N
For all Eligible Losses except those to which a Special Risk Limitation applies: L
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1. Covered Loss Basis °
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Covered Services Incurred from January 1, 2010 through December 31, 2024 and Paid from N
January 1, 2024 through December 31, 2024. 0
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If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is °
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subsequently reversed by an Independent Review Organization (IRO), the date such Eligible
Claim Expense was originally denied by the Covered Underlying Plan will be considered the
"Paid"date under the above referenced Policy.
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2. Covered Services include m
Medical
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Prescription Drug
3. Number of Covered Units ui
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Composite 711 0
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4. Specific Deductible per Participant $275,000
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Please note: The minimum Specific Deductible per Participant shall not exceed the lesser of 5%
of expected claims or$100,000.
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5. Specific Payable Percentage (in excess of Specific Deductible) 100% Q
6. Maximum Specific Benefit in excess of the Specific Deductible
Per Policy Term Unlimited
Per Lifetime Unlimited
PSL-500 WA(9-18) 1 Packet Pg. 111
4.D.c
C. AGGREGATE BENEFIT SCHEDULE
For all Eligible Losses except those to which a Special Risk Limitation applies:
1. Covered Loss Basis
Covered Services Incurred from January 1, 2010 through December 31, 2024 and Paid from
January 1, 2024 through December 31, 2024.
If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is
subsequently reversed by an Independent Review Organization (IRO), the date such Eligible
Claim Expense was originally denied by the Covered Underlying Plan will be considered the
"Paid"date under the above referenced Policy.
2. Covered Services include
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Medical
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Prescription Drug Q
3. Number of Covered Units
Composite 711
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4. Aggregate Payable Percentage in excess of Deductible 100% N
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5. Aggregate Corridor 200%
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(Please note: Aggregate Corridor will never be less than 120%of expected claims).
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6. Minimum Aggregate Deductible
The greater of:
A. $29,451,013.56; or
B. The sum of Aggregate Monthly Factors, multiplied by the corresponding number of
Covered Units used to calculate premium in the first month of the Policy Term, multiplied ti
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by the number of months in the Policy Term, multiplied by 95%.
7. Annual Aggregate Deductible ui
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Is equal to the greater of A or B, where: a
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A =The sum of the Monthly Aggregate Deductible Amounts applicable to each Policy Month
in the Policy Term
B =The Minimum Aggregate Deductible
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Please Note:Annual Aggregate Deductible cannot be finalized until the Monthly Aggregate
Deductible Amounts are calculated for each Policy Month of the Policy Term. w
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8. Aggregate Monthly Factor per Covered Unit
Composite $3,451.83
9. Maximum Aggregate Eligible Loss per Participant $275,000
10. Maximum Aggregate Benefit per Policy Term $1,000,000
PSL-500 WA(9-18) 2 Packet Pg. 112
4.D.c
D. PREMIUM
Specific Monthly Premium Rate
Composite $108.40
Specific Rate Guarantee Period 12 Months
Aggregate Monthly Premium Rate Per Covered Unit
Composite $0.02
Aggregate Rate Guarantee Period 12 Months
The Specific Monthly Premium Rate and the Aggregate Monthly Premium Rate apply only to this N
Policy Term. 0
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E. SPECIAL RISK LIMITATIONS
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Retirees Included Yes
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An employee of the City of Kent is eligible to enroll on the date he or she satisfies the following: v
• Becomes a retired LEOFF I employee, provided such employee: Cn
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- Has attained age 50; 0
- Has at least 5 or more years of credited service with the employer; and 0-
- Is eligible to receive a retirement benefit under the LEOFF I Retirement Plan. �°
• Becomes a retired, disabled LEOFF I employee who is eligible to receive a retirement benefit
under the LEOFF I Retirement Plan.
Other: No lasers or other limitations
apply to the 2024 contract year.
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F. AFFILIATE
Name Covered Underlying Plan
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None in
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PSL-500 WA(9-18) 3 Packet Pg. 113
4.D.c
RATE CAP RIDER
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
Effective January 1, 2024, it is hereby agreed Section 9 paragraph B, Changes in Premium Rates, is
amended by the addition of:
7. At renewal, any increase in the Specific Premium Rates will be limited to 50%for the next Policy
Term.
At renewal, We will not apply any new Special Risk Limitation, including but not limited to an Alternate
Specific Deductible or Excluded Loss, unless requested in writing by You.
We reserve the right to revise the Deductibles and other terms and conditions of this Policy at the end of N
any Policy Term by providing written notice to You. o
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All other terms and conditions of the Policy will continue to apply including but not limited to reapplication 3
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of the Specific Deductible or Aggregate Deductible in the next Policy Term.
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Ben Helsel
President o
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PSL-500 WA RC (2-20) 15 Rate C Packet Pg. 114
4.D.c
SURPLUS RIDER
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
Effective January 1, 2024, it is hereby agreed the Policy shall be amended as follows:
Policy Cover is changed to reflect a Participating contract;
Section 10 Item D is deleted; and
The following items are added:
Definitions
A. Actual Loss Ratio means the result when the Claims for the Policy Term are divided by the N
Premium. For example, if We reimbursed $85,000 in Claims during the Policy Term, and You paid o
$125,000 in Premiums during the Policy Term; then the Loss Ratio is equal to 68% (85,000/125,000 = r
.68). Q
B. Claims means the Specific Stop Loss Covered Services paid during the Policy Term.
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C. Gross Premium means the Specific Stop Loss premiums that are paid during a Policy Term. All
premiums must be paid when due throughout the Policy Term. v
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D. Maximum Loss Ratio (MLR) is the percentage calculation and is used to define the maximum loss 0
ratio for a surplus refund. It is calculated as follows: (X1% Refund Cap /X2% Risk Share =X3%); 0-
XX%TLR -X3% = MLR%). The maximum refund will be payable if the Actual Loss Ratio is MLR% or �°
lower. The Maximum Loss Ratio for your contract is 32.5%.
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E. Net Premium means the Gross Premium received less premium tax and commissions.
F. Policy Term means a period of consecutive months during which the experience for the Specific
Benefit Coverage will be used to determine if a Surplus is payable.A Surplus will be calculated at the
end of each Policy Term and will be finalized for credit or payment at the end of the Policy Term. The c
Policy Term is shown under the Surplus Rider Details.
G. Refund Cap means the maximum amount of Surplus available for a Surplus payment. This maximum y
amount will be equal to 15% of the Net Premium received during the Policy Period. 0
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H. Surplus means an amount that will be paid or credited to You if the Specific Stop Loss Actual Loss
Ratio is below the Target Loss Ratio during the Policy Term. There is no impact to You if the Surplus
calculation results in a deficit. m
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I. Risk Share means the percentage of the funds available for the Surplus. The Risk Share is shown
under the Surplus Rider Details. Q
J. Target Loss Ratio means the highest Loss Ratio where a Surplus may be payable. If the actual Loss
Ratio during the Policy Term is equal to or greater than the Target Loss Ratio, then a Surplus will not
be payable. The Target Loss Ratio is shown under the Surplus Rider Details.
PSL-500 WA SR (2-20) 16 Surpl Packet Pg. 115
4.D.c
Surplus Rider Details
1. Policy Term Consecutive months beginning with January 1, 2024
and ending December31, 2024
2. Target Loss Ratio 70%
3. Refund Cap 15% of Net premium
4. Risk Share 60%—LifeWise Assurance Company
40%—City of Kent
We will calculate the amount of Surplus payable for the Policy Term. If the Actual Loss Ratio is equal to or
less than the Target Loss Ratio, You will be eligible for a Surplus credit or payment, subject to the N
limitations below. If the Actual Loss Ratio exceeds the Targeted Loss Ratio, You will not be eligible for a o
Surplus payment. The surplus credit or payment is calculated as the Net Premium x (Target Loss Ratio—
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Actual Loss Ratio) x Risk Share%. The Surplus credit or payment may not exceed the Refund Cap. Q
A Surplus payment/credit will be calculated by Us on or about the 4th month after the end of the Policy
Term and if a Surplus is payable, it will be paid/credited to You. For a policy that includes a run-out
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period, the Surplus will be calculated on or about the 4th month after the end of the run-out period. o
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LIMITATIONS N
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The following Limitations apply to the Surplus payment or credit: 0-
1. The Stop Loss policy must remain in-force during the Surplus Policy Term. 0
2. All premiums must be paid throughout the Surplus Policy Term. U)
3. The policy must be in-force on the date the Surplus would be paid or credited.
4. No interest is earned or payable on the Surplus amount.
All other terms and conditions of the Policy will continue to apply.
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by �
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Ben Helsel Q
President
LifeWise Assurance Company
PSL-500 WA SR (2-20) 17 Surpl Packet Pg. 116
4.E
OFFICE OF THE MAYOR
Mayor Dana Ralph
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5710
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Resolution Recognizing Hillshire Terrace Neighborhood
Council — Adopt
MOTION: I move to adopt Resolution No. 2078, recognizing the Hillshire
Terrace Neighborhood Council, supporting its community building efforts,
and conferring on it all opportunities offered by the City's neighborhood
program.
SUMMARY: The Hillshire Terrace neighborhood consists of 68 households and is
located south of Kentridge High School. The neighborhood has completed the
process to be recognized as a neighborhood council.
The City's Neighborhood Program is an initiative designed to foster better
communication among residents in a geographic area and city government. The
underlying objective of the program is to provide an avenue for residents to
work together to enhance the livability of their neighborhoods.
The program encourages the organization of neighborhood councils, which serve as
independent, non-profit organizations promoting resident-based efforts for
neighborhood improvements while also establishing a partnership between city
government and the neighborhoods they serve.
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Neighborhood Council Hillshire Terrace Resolution (PDF)
Packet Pg. 117
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RESOLUTION NO. 2078 Z
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A RESOLUTION of the City Council of the
City of Kent, Washington, recognizing Hillshire
Terrace Neighborhood Council.
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RECITALS o
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A. The City of Kent has developed a Neighborhood Program to 0
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promote and sustain an environment that responds to residents by building o
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partnerships between the City and its residents. In addition, the City of
Kent encourages residents to work together to form geographically distinct r
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neighborhood councils as a means to foster communication among
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residents and to enhance their sense of community. °
B. The City of Kent recognizes and supports neighborhood Cn
councils by endorsing a process to establish neighborhood boundaries,
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approve neighborhood councils, and provide neighborhood grant matching
program opportunities to make improvements in defined neighborhoods. L
C. The Hillshire Terrace neighborhood consists of sixty-eight y
households. _
D. The Hillshire Terrace neighborhood is located south of o
Kentridge High School and is shown on Exhibit A, attached and -0
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incorporated by this reference. M
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E. On June 14, 2024, the Hillshire Terrace neighborhood
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submitted an official registration form to request that the City recognize z
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1 Hillshire Terrace
Neighborhood Council Resolution
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Packet Pg. 118
4.E.a
the Hillshire Terrace Neighborhood Council and to allow the neighborhood
to take part in the City's Neighborhood Program. o
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NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
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WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS: M
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RESOLUTION 0
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SECTION 1, - Recognition of Neighborhood Council. The City
Council for the City of Kent hereby acknowledges the effort and
commitment of the Hillshire Terrace neighborhood and all those who
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participated in forming the Hillshire Terrace Neighborhood Council. The City ,
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Council hereby recognizes Hillshire Terrace Neighborhood Council as an
official Neighborhood Council of the City of Kent, supports the Hillshire o
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Terrace community building efforts, and confers on the Hillshire Terrace o
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Neighborhood Council all opportunities offered by the City's Neighborhood
Program. r
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SECTION 2. - SeverabilitY. If any one or more section, subsection,
or sentence of this resolution is held to be unconstitutional or invalid, such Cn
decision shall not affect the validity of the remaining portion of this
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resolution and the same shall remain in full force and effect.
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SECTION 3. - Ratification. Any act consistent with the authority y
and prior to the effective date of this resolution is hereby ratified and =
affirmed.
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SECTION 4. - Effective Date. This resolution shall take effect and M
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be in force immediately upon its passage.
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Neighborhood Council Resolution
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October 1, 2024 U
DANA RALPH, MAYOR Date Approved 00
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ATTEST: T
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October 1, 2024
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
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APPROVED AS TO FORM: c
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TAMMY WHITE, CITY ATTORNEY
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Neighborhood Council Resolution
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Hillshire Terrace Ho( eowners Association
CONFIDENTIAL: for the use of homeowners and residents only
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Tract B:Native Growth Protection Easement,owned in equal un- Police non-emergency number: (206�296-3311 �o
divided interests by the owners of Lots 57,58,and 60 through 68 Power outages(incl.streetlights): 1-$88-225-5773 t
inclusive,and maintained by those lot owners. Vegetation within Road maintenance(incl.sanding) (206)296-8100 i)
$ the easement may not be cut,pruned,covered by fill,removed or Poison center: 1-800-732-6985 75
damaged without express permission from King County. Valley Medical Center 14nmital: (425)228-3450 Z
' Tract C:Access corridor maintained by the owner of lot 56.
Tract D:Access corridor maintained by the owner of lot 68.
11 11• Tract G:Landscape maintained by Homeowners Association.
Planter:Owners of lots 2,3,4,5,6,and 7 jointly responsible for
71ieaoux1vh4PafofthPiaouzhea1.tqucu ter the performance of maintenance of the landscape planter in the
ow' `i`tNard, e,5 a 9'
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Mar Packet Pg. 121
4.F
OFFICE OF THE MAYOR
Mayor Dana Ralph
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5710
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Resolution Recognizing Garrison Glen Neighborhood Council
— Adopt
MOTION: I move to adopt Resolution No. 2079, recognizing the Garrison
Glen Neighborhood Council, supporting its community building efforts,
and conferring on it all opportunities offered by the City's neighborhood
program.
SUMMARY: The Garrison Glen neighborhood consists of 32 households and is
located east of State Route 167 off South 2181" St. The neighborhood has
completed the process to be recognized as a neighborhood council.
The City's Neighborhood Program is an initiative designed to foster better
communication among residents in a geographic area and city government. The
underlying objective of the program is to provide an avenue for residents to
work together to enhance the livability of their neighborhoods.
The program encourages the organization of neighborhood councils, which serve as
independent, non-profit organizations promoting resident-based efforts for
neighborhood improvements while also establishing a partnership between city
government and the neighborhoods they serve.
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Neighborhood Council Garrison Glen Resolution (PDF)
Packet Pg. 122
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RESOLUTION NO. 2079
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A RESOLUTION of the City Council of the
City of Kent, Washington, recognizing Garrison Glen 0
Neighborhood Council.
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RECITALS N
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A. The City of Kent has developed a Neighborhood Program to
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promote and sustain an environment that responds to residents by building 3
partnerships between the City and its residents. In addition, the City of Kent
encourages residents to work together to form geographically distinct
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neighborhood councils as a means to foster communication among residents
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and to enhance their sense of community. o
B. The City of Kent recognizes and supports neighborhood councils c
by endorsing a process to establish neighborhood boundaries, approve
neighborhood councils, and provide neighborhood grant matching program
opportunities to make improvements in defined neighborhoods. o
C. The Garrison Glen neighborhood consists of thirty-two
households.
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D. The Garrison Glen neighborhood is located east of State Route o
167 off South 218th St. and is shown on Exhibit A, attached and incorporated -0
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by this reference.
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E. On May 22, 2024, the Garrison Glen neighborhood submitted
an official registration form to request that the City recognize the Garrison Z
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1 Garrison Glen E
Neighborhood Council Resolution
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Packet Pg. 123
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Glen Neighborhood Council and to allow the neighborhood to take part in the o
City's Neighborhood Program. a
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NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT, v
WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS: °o
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RESOLUTION
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SECTION 1. - Recognition of Neighborhood Council. The City Council 0
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for the City of Kent hereby acknowledges the effort and commitment of the
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Garrison Glen neighborhood and all those who participated in forming the
Garrison Glen Neighborhood Council. The City Council hereby recognizes
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Garrison Glen Neighborhood Council as an official Neighborhood Council of o
the City of Kent, supports the Garrison Glen community building efforts, and
confers on the Garrison Glen Neighborhood Council all opportunities offered o
by the City's Neighborhood Program. o
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SECTION 2. - Severability. If any one or more section, subsection,
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or sentence of this resolution is held to be unconstitutional or invalid, such
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decision shall not affect the validity of the remaining portion of this resolution
and the same shall remain in full force and effect.
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SECTION 3. - Ratification. Any act consistent with the authority and
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prior to the effective date of this resolution is hereby ratified and affirmed. L
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SECTION 4. - Effective Date. This resolution shall take effect and be c
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in force immediately upon its passage.
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October 1, 2024 °1
DANA RALPH, MAYOR Date Approved Z
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Neighborhood Council Resolution
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ATTEST:
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October 1, 2024 0
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
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APPROVED AS TO FORM:
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TAMMY WHITE, CITY ATTORNEY
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OFFICE OF THE MAYOR
Mayor Dana Ralph
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5710
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Resolution Recognizing Nature Trails Townhomes
(Springwood) Neighborhood Council — Adopt
MOTION: I move to adopt Resolution No. 2080, recognizing the Nature
Trails Townhomes (Springwood) Neighborhood Council, supporting its
community building efforts, and conferring on it all opportunities offered
by the City's neighborhood program.
SUMMARY: The Nature Trails Townhomes (Springwood) neighborhood consists
of 44 households and is located northwest of Lake Meridian. The neighborhood
has completed the process to be recognized as a neighborhood council.
The City's Neighborhood Program is an initiative designed to foster better
communication among residents in a geographic area and city government. The
underlying objective of the program is to provide an avenue for residents to
work together to enhance the livability of their neighborhoods.
The program encourages the organization of neighborhood councils, which serve
as independent, non-profit organizations promoting resident-based efforts for
neighborhood improvements while also establishing a partnership between city
government and the neighborhoods they serve.
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Neighborhood Council Nature Trails (Springwood) Resolution (PDF)
Packet Pg. 127
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RESOLUTION NO. 2080
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A RESOLUTION of the City Council of the a�
City of Kent, Washington, recognizing Nature Trails U
Townhomes (Springwood) Neighborhood Council.
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RECITALS
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A. The City of Kent has developed a Neighborhood Program to
promote and sustain an environment that responds to residents by building o
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partnerships between the City and its residents. In addition, the City of Kent o
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encourages residents to work together to form geographically distinct (D
neighborhood councils as a means to foster communication among residents c
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and to enhance their sense of community.
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B. The City of Kent recognizes and supports neighborhood councils Q
by endorsing a process to establish neighborhood boundaries, approve
neighborhood councils, and provide neighborhood grant matching program
opportunities to make improvements in defined neighborhoods.
C. The Nature Trails Townhomes (Springwood) neighborhood Z
consists of forty-four households. o
D. The Nature Trails Townhomes (Springwood) neighborhood is -0
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located northwest of Lake Meridian and is shown on Exhibit A, attached and
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incorporated by this reference.
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E. On June 27, 2024, the Nature Trails Townhomes (Springwood) z
neighborhood submitted an official registration form to request that the City a
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Neighborhood Council Resolution Q
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recognize the Nature Trails Townhomes (Springwood) Neighborhood Council
and to allow the Neighborhood to take part in the City's Neighborhood c
Program.
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NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS:
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RESOLUTION =_
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SECTION 1. - Recognition of Neighborhood Council. The City Council M
for the City of Kent hereby acknowledges the effort and commitment of the o
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Nature Trails Townhomes (Springwood) neighborhood and all those who 0
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participated in forming the Nature Trails Townhomes (Springwood)
Neighborhood Council. The City Council hereby recognizes Nature Trails
Townhomes (Springwood) Neighborhood Council as an official Neighborhood
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Council of the City of Kent, supports the Nature Trails Townhomes r
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(Springwood) Council community building efforts, and confers on the Nature a
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Trails Townhomes (Springwood) Neighborhood Council all opportunities :
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offered by the City's Neighborhood Program.
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SECTION 2. - Severability. If any one or more section, subsection,
or sentence of this resolution is held to be unconstitutional or invalid, such L
decision shall not affect the validity of the remaining portion of this resolution
and the same shall remain in full force and effect. z
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SECTION 3. - Ratification. Any act consistent with the authority and coy
prior to the effective date of this resolution is hereby ratified and affirmed. 0
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SECTION 4. - Effective Date. This resolution shall take effect and be T
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in force immediately upon its passage.
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Neighborhood Council Resolution Q
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October 1, 2024
DANA RALPH, MAYOR Date Approved 0
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ATTEST: ~
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October 1, 2024
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted N
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APPROVED AS TO FORM: o
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TAMMY WHITE, CITY ATTORNEY M
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SURVEY MAP AND PLANS FOR:
SPRINGWOOD TOWNHOMES, A CONDOMINIUM
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ECONOMIC AND COMMUNITY DEVELOPMENT DEPARTMENT
Kurt Hanson, AICP, EDFP
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5454
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Waller Purchase and Sale Agreement - Approve
MOTION: I move to approve the purchase of the Waller property, located at
115 Naden Avenue South, for $140,000, subject to the terms provided for
by the parties' September 16, 2024, purchase and sale agreement.
SUMMARY: The property located at 115 Naden Avenue South has been subject to
several fires, which have destroyed the residential structure. The remnants of the
structure and its contents are fire damaged and littered about the property, which
has created a public nuisance and resulted in the property being subject to code
enforcement proceedings. The owner of the property is elderly, lives out of state,
and has limited resources which are insufficient for her to abate the public
nuisance. The property owner has given the City her permission to enter the
property, abate the nuisance, and assess a lien against the property tax roll to
reimburse the City for its abatement costs.
In the course of the City's discussion with the owner concerning the need to abate
the public nuisance, she indicated she was interested in selling the property. Given
the City's vision for the Naden Avenue assemblage, the City advised the owner it
would be interested in purchasing the property. The owner and Kurt Hanson, the
City's Economic and Community Development Director, negotiated the purchase
price, from which the City would deduct the costs necessary to abate the existing
nuisance, but in no event would the owner receive net proceeds less than $47,000.
The City also agreed to cover closing costs.
Should the Committee of the Whole approve the City's purchase of the Waller
property subject to the terms of the previously negotiated purchase and sale
agreement, it will proceed to the City Council for final action the same night on its
Consent Calendar.
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Innovative Government - Delivering outstanding customer service, developing leaders, and
fostering innovation.
Packet Pg. 132
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Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
ATTACHMENTS:
1. Waller-REPSA with Exhibits (PDF)
Packet Pg. 133
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
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REAL ESTATE PURCHASE AND SALE AGREEMENT
This Agreement is entered between the CITY OF KENT, a Washington
municipal corporation, ("Buyer") whose mailing address is 220 4t" Avenue South,
Kent, Washington 98032-5895, and Ruth Waller ("Seller") whose mailing address
is 758 Norman Ave NE, Salem, Oregon 97301, for the sale and purchase of real
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property as follows: o
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1. PROPERTY. The Property, which Buyer agrees to buy and Seller agrees Q
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to sell, is commonly known as King County Tax Parcel Number 242204-9120-08 and
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located at 115 Naden Avenue South, Kent, WA 98032 (the "Property"). The Property
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includes land and a residential structure that has been significantly damaged by
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multiple fires, which has created a public nuisance in the City of Kent, Washington.
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Separately, Seller has given the Buyer consent to enter the Property and remove the M
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residential structure and its associated debris. The Property is legally described in
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Exhibit ""A", attached hereto and incorporated herein by this reference. a
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2. EARNEST MONEY. Within 15 business days of mutual acceptance of
this Agreement, Buyer shall deposit with Fidelity National Title Insurance Company r
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(the "Escrow Agent"), the sum of Five Thousand Dollars ($5,000) in the form of a �
Certified Check, as refundable earnest money to be applied toward the purchase price
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of the Property payable at Closing. If this agreement is terminated for any reason, w
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the Earnest Money shall be returned to Buyer in full within 5 business days of
termination. Q
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3. PURCHASE PRICE. The total purchase price for the Property is ONE
HUNDRED AND FORTY THOUSAND DOLLARS ($140,000), including Earnest Money,
payable on Closing. From this purchase price amount, the parties agree that Seller
shall net at Closing at least FORTY-SEVEN THOUSAND DOLLARS ($47,000)
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("Minimum Net Proceeds"). From the purchase price deposited by Seller, the Escrow Q
Agent shall: (a) pay-off all debt owed by Seller that is secured against the Property;
(b) reimburse the City for all abatement costs paid to demolish the remaining
structure and remove the public nuisance from the Property; and (c) reimburse the
City for all costs to decommission or remove any underground tanks that exist on the
Real Estate Purchase and Sale Agreement Page 1 of 7
Packet Pg. 134
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
Property; provided, however, that the City shall be reimbursed only up to a sum that
allows the Seller to receive at Closing the Minimum Net Proceeds. To ensure Seller
receives the Minimum Net Proceeds, the City agrees to pay all other costs necessary
at Closing and to forego receipt of any reimbursement that would otherwise result in
Seller receiving less than the Minimum Net Proceeds.
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4. CONTINGENCIES. This Agreement is contingent upon: 0
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(a) Buyer's receipt of Seller's information contained in the Real a
Property Transfer Disclosure Statement ("Disclosure Statement")
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the form of which is set forth in Exhibit "B." While Buyer agrees �
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to waive its right to receive the Disclosure Statement, RCW Q
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64.06.010(7) requires Seller to complete and submit to Buyer the
"Environmental" section of the Disclosure Statement, which Seller
shall complete within 10 business days from the date of mutual
acceptance of the Agreement. Within 10 days of Buyer's receipt
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of the Disclosure Statement from Seller, Buyer shall either
approve and accept the Disclosure Statement, or rescind the
Agreement to purchase the Property, in its sole and absolute
discretion. If Buyer does not deliver a written rescission notice to
Seller within the 10-day period, the Disclosure Statement will be
deemed approved and accepted by Buyer. w
(b) City Council Authorization as provided in Section 18 below. Q
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Should any of the contingencies not be met prior to Closing, then this Agreement
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shall terminate and neither Buyer nor Seller shall have any further rights, duties or
obligations hereunder, except that the Earnest Money in Escrow shall be immediately
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returned to Buyer.
5. CONVEYANCE AND CONDITION OF TITLE. The title to the Property Q
shall be conveyed by Seller to Buyer at Closing by Statutory Warranty Deed, in a
form substantially as that provided in Exhibit "'C", free and clear of all liens,
encumbrances or defects except those General Exceptions described in Schedule B,
paragraphs A-C and G-J of Title Report Number 611344568, of Exhibit'"D", attached
Real Estate Purchase and Sale Agreement Page 2 of 7
Packet Pg. 135
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
hereto and incorporated herein by this reference. All other special exceptions therein,
except that described in paragraphs 1, 2, 3, and 4, are to be removed on or before
Closing. General exclusions and exceptions common to the area and not materially
affecting the value of or unduly interfering with Buyer's reasonable use of the
Property shall be permitted. All monetary encumbrances and special exceptions
listed in Exhibit "D", other than those specifically noted above, are to be removed N
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on or before closing.
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6. TITLE INSURANCE. At Closing, Buyer shall cause Escrow Agent, to
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issue standard coverage owner's policy of title insurance to Buyer in an amount a
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equal to the total purchase price of the Property. For purposes of this Agreement, Q
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the following shall not be deemed encumbrances or defects: rights reserved in
federal patents or state deeds, building or use restrictions consistent with current
zoning and utility and road easements of record. If title cannot be made so insurable
prior to Closing, unless Buyer elects to waive such defects or encumbrances, this
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Agreement shall terminate and the Earnest Money shall be returned to Buyer.
7. CLOSING COSTS AND PRO-RATIONS. Excise Tax, if applicable, shall
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be paid by Buyer, except for those fees which are expressly limited by Federal
Regulation. Buyer shall pay all recording costs, title insurance premium, the costs of
any survey, and the fees and expenses of its consultants. Taxes for the current year, x
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rents, interest, water, sewer and other utility charges, if any, shall be paid by Seller,
and prorated as of the day of Closing. Escrow fees shall be paid by Buyer. Q
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8. CLOSING OF THE SALE. WITH THE UNDERSTANDING THAT TIME IS
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OF THE ESSENCE FOR THIS AGREEMENT, this sale shall be closed within 90 days of
the date of mutual acceptance of this Agreement, which shall also be the termination
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date of this Agreement, unless said Closing date is extended in writing by mutual E
agreement of the parties. When notified, the Buyer and Seller will deposit, without .2
Q
delay, in escrow with the Escrow Agent, all instruments and monies required to
complete the transaction in accordance with this Agreement. Closing, for the purpose
of this Agreement, is defined as the date that all documents are executed and the
sale proceeds are available for disbursement to the Seller.
Real Estate Purchase and Sale Agreement Page 3 of 7
Packet Pg. 136
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
9. CASUALTY LOSS. If, prior to Closing, the Property shall be destroyed
or materially damaged by flood, earthquake, or other casualty, this Agreement, at
option of the Buyer, shall become null and void.
10. POSSESSION. Buyer shall be entitled to possession on Closing.
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11. SELLER'S REPRESENTATIONS. Seller represents: 3
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(a) that Seller will maintain the Property in present or better condition until
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time of agreed possession; E
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(b) that Seller has no knowledge of notice from any governmental agency Q
of any violation of laws relating to the Property except:
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12. SELLER'S ENVIRONMENTAL REPRESENTATIONS. Seller represents
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that, to the best of Seller's knowledge, Seller is not aware of the existence of, or has a
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caused or allowed to be caused, any environmental condition (including, without
limitation, a spill, discharge or contamination) that existed as of and/or prior to
Closing or any act of omission occurring prior to Closing, the result of which may
require remedial action pursuant to any federal, state or local law or may be the basis
for the assertion of any third party claims, including claims of governmental entities.
x
This provision shall survive Closing and be in addition to Seller's obligation for breach
of a representation or warranty as may be set forth herein. 3
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13. SELLER'S INDEMNITIES: Seller agrees to indemnify and hold W
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harmless the Buyer, against and in respect of, any and all damages, claims, losses,
liabilities, judgments, demands, fees, obligations, assessments, and expenses and
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costs, including, without limitation, reasonable legal, accounting, consulting,
engineering and other expenses which may be imposed upon or incurred by Buyer,
or asserted against Buyer, by any other party or parties (including, without limitation, Q
a governmental entity), arising out of or in connection with any environmental
condition existing as of and/or prior to Closing, including the exposure of any person
to any such environmental condition, regardless of whether such environmental
Real Estate Purchase and Sale Agreement Page 4 of 7
Packet Pg. 137
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
condition or exposure resulted from activities of Seller or Seller's predecessors in
interest. This indemnity shall survive Closing and be in addition to Seller's obligation
for breach of a representation or warranty as may be set forth herein.
14. DEFAULT AND ATTORNEY'S FEES.
(a) Buyer's Default. If Buyer defaults hereunder, Seller's sole remedy shall N
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be limited to damages against Buyer in the liquidated amount of the 0
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Earnest Money previously paid by the Buyer. Buyer and Seller intend Q
that said amount constitutes liquidated damages and so as to avoid
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other costs and expenses to either party in connection with potential a
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litigation on account of Buyer's default. Buyer and Seller believe said Q
amount to be a fair estimate of actual damages.
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(b) Seller's Default. If Seller defaults hereunder, Buyer shall have all the y
rights and remedies available at law or in equity.
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(c) Attorney's Fees and Costs. In the event of litigation to enforce any of
the terms or provisions herein, each party shall pay all its own costs and
attorney's fees. r
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15. NOTICE TO SELLER. This form contains provisions for an agreement
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for the purchase and sale of real estate. Buyer makes no warranty or representation w
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of any kind that this form, or any of its provisions, is intended to meet the factual
and legal requirements of a particular transaction, or that it accurately reflects the
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laws of the State of Washington at the time Seller enters into the Agreement. THIS
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AGREEMENT HAS SIGNIFICANT LEGAL AND FINANCIAL CONSEQUENCES. SELLER IS
ADVISED TO SEEK INDEPENDENT LEGAL AND FINANCIAL COUNSEL REGARDING
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THESE CONSEQUENCES.
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16. NON-MERGER. The terms, conditions, and provisions of this Q
Agreement shall not be deemed merged into the deed, and shall survive the Closing
and continue in full force and effect.
Real Estate Purchase and Sale Agreement Page 5 of 7
Packet Pg. 138
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
17. NOTICES. All notices required or permitted to be given hereunder shall
be in writing and shall be sent U.S. certified mail, return receipt requested, or by
facsimile transmission addressed as set forth below:
(a) All notices to be given to Buyer shall be addressed as follows:
Kurt Hanson
Director of Economic and Community Development N
City of Kent 0
220 Fourth Avenue South a
Kent, WA 98032
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(b) All notices to be given to Seller shall be addressed as follows: E
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Ruth Waller Q
758 Norman Ave NE
Salem, OR 97301
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(c) All notices to be given to Escrow Agent shall be addressed as follows:
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Deneen Person
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Fidelity National Title
5006 Center Street, Suite J
Tacoma, WA 98409
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Either party hereto may, by written notice to the other, designate such other address
for the giving of notices as necessary. All notices shall be deemed given on the day
such notice is personally served, or on the date of the facsimile transmission, or on x
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the third day following the day such notice is mailed in accordance with this section.
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18. CITY COUNCIL ACTION REQUIRED. Seller acknowledges that the a.
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closing of the transaction contemplated by this Agreement (the "Closing") is �
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expressly conditioned on the City of Kent City Council's (the "City Council's") prior
authorization to buy the Property under this Agreement ("Council Authorization"),
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which may or may not be granted in the City Council's sole discretion. The City of E
Kent shall not be liable or obligated for any burden or loss, financial or otherwise, 2
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incurred by Seller as a result of the City Council's modification of the final terms and
conditions of this Agreement, or the City Council's failure to grant the Council
Authorization.
Real Estate Purchase and Sale Agreement Page 6 of 7
Packet Pg. 139
Docusign Envelope ID:7DF6075F-4F99-4B81-BB52-D8D29D4C1878
4.H.a
18.1 Seller's Waiver. Seller expressly waives any claim against the
City of Kent and its elected officials, officers, employees, representative and agents
for any burden, expense or loss which Seller incurs as a result of the City Council's
failure to grant the Council Authorization.
19. ENTIRE AGREEMENT. This Agreement, including all incorporated N
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exhibits, constitutes the full understanding between Seller and Buyer. There have 0
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been no verbal or other agreements that modify this Agreement. Q
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20. BINDING EFFECT AND SURVIVAL. This Agreement shall be binding E
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upon parties hereto and their respective heirs, successors and assigns; and the Q
terms, conditions and provisions of this Agreement shall survive the Closing of this
transaction.
21. DATE OF MUTUAL ACCEPTANCE. For the purposes of this Agreement,
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the date of mutual acceptance of this Agreement shall be the last date on which the a
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parties to this Agreement have executed this Agreement as indicated below.
22. EXPIRATION OF OFFER. Seller shall have only until 5:00 pm on r
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September 25, 2024, to accept the Agreement as written, by delivering a
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signed copy thereof to the Buyer or Buyer's agent. If Seller does not so deliver
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a signed copy within said period, this Agreement shall lapse and all right of the parties w
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hereunder shall terminate.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on w
the date set forth below.
BUYER: CITY OF KENT SELLER: RUTH WALLER
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Signed by:
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By: BIL"'` `" Q
aDana Ralph, Mayor IXUL11i"'u111�A , droperty Owner
Dated: Dated: 9/13/2024
Real Estate Purchase and Sale Agreement Page 7 of 7
Packet Pg. 140
4.H.a
EXHIBIT "A"
Legal Description
For APNJPareel II]ts M: 242 2 04-91 20-08
Parcel A:
That portion of Govem meat Lot 4 and the Southeast quarter of the h arhwest quarter of Section 24,7ownship 22 North, N
Range 4 East of the Willamette Meridian,in King County,Washington,described as follows: L.
Beginning ing at a point on the West line of Naden Avenue in the City of Kert, 121)feet South f the intersection f the South G
line of West Meeker Street with the said West line of Naden Avenue;
Thence continuing South,along the West line of said Naden Avenue,100 feet; M
Thence West,85 feet;
Thence Northerly,on a line parallel with the L4est line f Naden Avenue,BD feet;
Thence East to the Point of Beginning_ y
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Parcel 8
An easement for a sewer as established in that certain Warrant}deed and Easement recorded under Recording No_ 0)
U191548 go upon the following described land: Q
A strip of land 5 feet in width 2 1/feet each side of the centerline of which begins at a poi nt 120 feet South and 82 Y4 feet 4)
West of th e i ntersedion of th a South line of West Meeker Street and the VY est lin e f Naden Avenue;
Thence Northerly,parallel with the West line of Naden Aven ue, 121)feet, more or less,to the South I ine of W est M eeker
Street 't3
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Situate in the County of icing,State of Washington_
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Real Estate Purchase and Sale Agreement Page 1 of 1
Packet Pg. 141
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EXHIBIT B
SELLER'S DISCLOSURE STATEMENT
INSTRUCTIONS TO THE SELLER
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Please complete the following form. Do not leave any spaces blank. If the question clearly
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does not apply to the property write "NA." If the answer is "yes" to any * items, please explain 0
on attached sheets. Please refer to the line number(s) of the question(s) when you provide Q
your explanation(s). Delivery of the disclosure statement must occur not later than five ,
business days, unless otherwise agreed, after mutual acceptance of a written contract to c
purchase between a buyer and a seller. E
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NOTICE TO THE BUYER Q
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THE FOLLOWING DISCLOSURES ARE MADE BY SELLER ABOUT THE CONDITION OF THE
PROPERTY LOCATED AT 115 NADEN AVENUE SOUTH, KENT, WASHINGTON, ("THE
PROPERTY"), OR AS LEGALLY DESCRIBED ON ATTACHED EXHIBIT A. y
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SELLER MAKES THE FOLLOWING DISCLOSURES OF EXISTING MATERIAL FACTS OR L
MATERIAL DEFECTS TO BUYER BASED ON SELLER'S ACTUAL KNOWLEDGE OF THE a
PROPERTY AT THE TIME SELLER COMPLETES THIS DISCLOSURE STATEMENT. UNLESS YOU
AND SELLER OTHERWISE AGREE IN WRITING, YOU HAVE THREE BUSINESS DAYS FROM
THE DAY SELLER OR SELLER'S AGENT DELIVERS THIS DISCLOSURE STATEMENT TO YOU
TO RESCIND THE AGREEMENT BY DELIVERING A SEPARATELY SIGNED WRITTEN ti
STATEMENT OF RESCISSION TO SELLER OR SELLER'S AGENT. IF THE SELLER DOES NOT r
GIVE YOU A COMPLETED DISCLOSURE STATEMENT, THEN YOU MAY WAIVE THE RIGHT TO
RESCIND PRIOR TO OR AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT. Cn
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THE FOLLOWING ARE DISCLOSURES MADE BY SELLER AND ARE NOT THE w
REPRESENTATIONS OF ANY REAL ESTATE LICENSEE OR OTHER PARTY. THIS INFORMATION t
IS FOR DISCLOSURE ONLY AND IS NOT INTENDED TO BE A PART OF ANY WRITTEN
AGREEMENT BETWEEN BUYER AND SELLER. Q
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FOR A MORE COMPREHENSIVE EXAMINATION OF THE SPECIFIC CONDITION OF THIS w
PROPERTY YOU ARE ADVISED TO OBTAIN AND PAY FOR THE SERVICES OF QUALIFIED
EXPERTS TO INSPECT THE PROPERTY, WHICH MAY INCLUDE, WITHOUT LIMITATION,
ARCHITECTS, ENGINEERS, LAND SURVEYORS, PLUMBERS, ELECTRICIANS, ROOFERS,
BUILDING INSPECTORS, ON-SITE WASTEWATER TREATMENT INSPECTORS, OR
STRUCTURAL PEST INSPECTORS. THE PROSPECTIVE BUYER AND SELLER MAY WISH TO
OBTAIN PROFESSIONAL ADVICE OR INSPECTIONS OF THE PROPERTY OR TO PROVIDE
APPROPRIATE PROVISIONS IN A CONTRACT BETWEEN THEM WITH RESPECT TO ANY
ADVICE, INSPECTION, DEFECTS, OR WARRANTIES. Q
Seller is/ is not occupying the property.
Seller's Disclosure Statement - Page 1 of 5 Packet Pg. 142
4.H.a
I. SELLER'S DISCLOSURES:
*If you answer "Yes" to a question with an asterisk (*), please explain your answer and
attach documents, if available and not otherwise publicly recorded. If necessary, use an
attached sheet.
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Don't d
A. Do you have legal autherity te sell thepFepeFty? if N
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Don'tknow B. is title te the prepeFty subject te any ofthe fellewing?
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—9ptien(4) Life estate?
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Seller's Disclosure Statement - Page 2 of 5 Packet Pg. 143
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3. SEWERjGN SITE SEWAGE SYSTEM
yeuF FegulaFly billed seweF OF On site sewage
4. STRUCTURAL d
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yea'-?
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leaked within the last five years?
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systerns? if yes, please explain.
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Seller's Disclosure Statement - Page 3 of 5 Packet Pg. 144
4.H.a
6. ENVIRONMENTAL
[ ] Yes [ ] No [ ] Don't know *A. Have there been any flooding, standing
water or drainage problems on the property that
affect the property or access to the property?
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[ ] Yes [ ] No [ ] Don't know B. Is there any material damage to the o
property from fire, wind, floods, beach
movements, earthquake, expansive soils, or a
landslides? i
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[ ] Yes [ ] No [ ] Don't know *C. Are there any shorelines, wetlands,
floodplains, or critical areas on the property? ;v
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[ ] Yes [ ] No [ ] Don't know D. Are there any substances, materials, or
products on the property that may be cn
environmental concerns, such as asbestos,
formaldehyde, radon gas, lead-based paint, fuel
or chemical storage tanks, or contaminated soil
or water?
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[ ] Yes [ ] No [ ] Don't know E. Is there any soil or groundwater a
contamination?
[ ] Yes [ ] No [ ] Don't know F. Has the property been used as a legal or
illegal dumping site?
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[ ] Yes [ ] No [ ] Don't know *G. Has the property been used as an illegal
drug manufacturing site?
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DISCLOSURE
RE BY
SELLERS
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Yes E I Ne E 1 Don't know *Are theFe any etheF existing mateFial defects (n
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B. VeFffleatoen
(if any) are eengplete and eeFreet te the best ef
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' if any, te deliver a eepy ef thuslicensees and aim pr-espective buyeFS of the
Seller's Disclosure Statement - Page 4 of 5 Packet Pg. 145
4.H.a
NOTICE TO THE BUYER
INFORMATION REGARDING REGISTERED SEX OFFENDERS MAY BE OBTAINED FROM LOCAL
LAW ENFORCEMENT AGENCIES. THIS NOTICE IS INTENDED ONLY TO INFORM YOU OF
WHERE TO OBTAIN THIS INFORMATION AND IS NOT AN INDICATION OF THE PRESENCE OF
REGISTERED SEX OFFENDERS.
II. BUYER'S ACKNOWLEDGMENT
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A. Buyer hereby acknowledges that: Buyer has a duty to pay diligent attention to any o
material defects that are known to Buyer or can be known to Buyer by utilizing diligent
attention and observation. a
B. The disclosures set forth in this statement and in any amendments to this statement
are made only by the Seller and not by any real estate licensee or other party. a)
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C. Buyer acknowledges that, pursuant to RCW 64.06.050(2), real estate licensees are Q
not liable for inaccurate information provided by Seller, except to the extent that real estate
licensees know of such inaccurate information. cn
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D. This information is for disclosure only and is not intended to be a part of the written f°
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agreement between the Buyer and Seller.
E. Buyer (which term includes all persons signing the "Buyer's acceptance" portion of this
disclosure statement below) has received a copy of this Disclosure Statement (including a
attachments, if any) bearing Seller's signature. 2
DISCLOSURES CONTAINED IN THIS DISCLOSURE STATEMENT ARE PROVIDED BY SELLER
BASED ON SELLER'S ACTUAL KNOWLEDGE OF THE PROPERTY AT THE TIME SELLER r
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COMPLETES THIS DISCLOSURE STATEMENT. UNLESS BUYER AND SELLER OTHERWISE
AGREE IN WRITING, BUYER SHALL HAVE THREE BUSINESS DAYS FROM THE DAY SELLER Cn
OR SELLER'S AGENT DELIVERS THIS DISCLOSURE STATEMENT TO RESCIND THE
AGREEMENT BY DELIVERING A SEPARATELY SIGNED WRITTEN STATEMENT OF RESCISSION x
TO SELLER OR SELLER'S AGENT. YOU MAY WAIVE THE RIGHT TO RESCIND PRIOR TO OR w
AFTER THE TIME YOU ENTER INTO A SALE AGREEMENT.
3
BUYER HEREBY ACKNOWLEDGES RECEIPT OF A COPY OF THIS DISCLOSURE STATEMENT AND can
ACKNOWLEDGES THAT THE DISCLOSURES MADE HEREIN ARE THOSE OF THE SELLER ONLY, w
AND NOT OF ANY REAL ESTATE LICENSEE OR OTHER PARTY.
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DATE: BUYER:
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BUYER'S WAIVER OF RIGHT TO RECEIVE COMPLETED SELLER DISCLOSURE STATEMENT
Buyer has been advised of Buyer's right to receive a completed Seller Disclosure Statement. Q
Buyer waives that right. However, if the answer to any of the questions in the section entitled
"Environmental" would be "yes," Buyer may not waive the receipt of the "Environmental"
section of the Seller Disclosure Statement.
DATE: BUYER
Seller's Disclosure Statement - Page 5 of 5 Packet Pg. 146
4.H.a
EXHIBIT C
WHEN RECORDED RETURN TO:
City Clerk
City of Kent N
220 Fourth Avenue South o
Kent, Washington 98032 E
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Grantor: Ruth Waller
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Grantee: City of Kent cn
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Abbreviated Legal Description: Portion of Government Lot 4 and the Southeast
Quarter of the Northwest Quarter of Section 24, Township 22 North, Range 4 East of
the Willamette Meridian, in King County, Washington L
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Additional Legal Description on: Exhibit "A" a�
Assessor's Tax Parcel ID No.: 242204-9120-08
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WARRANTY DEED Cn
Ruth Waller, an individual ("Grantor"), for and in consideration of Ten Dollars w
and No/100 ($10.00) and/or other valuable consideration in hand paid, conveys and
warrants to the City of Kent, a Washington municipal corporation ("Grantee"), �
all her interest, including any after acquired title, in the real property described in
the attached and incorporated Exhibit A, situated in King County, Washington, a
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subject to easements, restrictions, reservations, right-of-way, covenants, and
conditions shown on Exhibit B, Fidelity National Title Order Number 611344568,
attached and incorporated.
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(Signatures on following page)
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WARRANTY DEED - Page 1 of 2
Packet Pg. 147
4.H.a
GRANTOR:
Name: Ruth Waller
Title: Owner N
Date:
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STATE OF WASHINGTON ) E
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COUNTY OF KING ) �,
I certify that I know or have satisfactory evidence that Ruth Waller is the
person who appeared before me, and said person acknowledged that she signed this 0
instrument, on oath stated that she was authorized to execute the instrument and
acknowledged it as the Owner to be the free and voluntary act of such party for the 2
uses and purposes mentioned in the instrument. a
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Dated:
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-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the
day and year first above written. x
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(Signature) 3
NOTARY PUBLIC, in and for the State a
of , residing at
My appointment expires
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WARRANTY DEED - Page 2 of 2
Packet Pg. 148
EXHIBIT D
FIDELITY NATIONAL TITLE COMPANY OF WASHINGTON,
INC. COMMITMENT NO. 611344568
SCHEDULE B, PART II - Exceptions
Some historical land records contain Discriminatory Covenants that are illegal and unenforceable by law. This
Commitment and the Policy treat any Discriminatory Covenant in a document referenced in Schedule B as if each
Discriminatory Covenant is redacted, repudiated, removed, and not republished or recirculated. Only the
remaining provisions of the document will be excepted from coverage.
The Policy will not insure against loss or damage resulting from the terms and conditions of any lease or easement N
identified in Schedule A, and will include the following Exceptions unless cleared to the satisfaction of the Company: `o
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GENERAL EXCEPTIONS Q
A. Rights or claims of parties in possession, or claiming possession, not shown by the Public Records.
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B. Any encroachment, encumbrance, violation, variation, or adverse circumstance affecting the Title that would be
disclosed by an accurate and complete land survey of the Land. Q
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C. Easements, prescriptive rights, rights-of-way, liens or encumbrances, or claims thereof, not shown by the V)
Public Records. c
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D. Any lien, or right to a lien, for contributions to employee benefit funds, or for state workers' compensation, or z
for services, labor, or material heretofore or hereafter furnished, all as imposed by law, and not shown by the i
Public Records.
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E. Taxes or special assessments which are not yet payable or which are not shown as existing liens by the Public Fa
Records.
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F. Any lien for service, installation, connection, maintenance, tap, capacity, or construction or similar charges for
sewer, water, electricity, natural gas or other utilities, or for garbage collection and disposal not shown by the �-
Public Records.
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G. Unpatented mining claims, and all rights relating thereto. x
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H. Reservations and exceptions in United States Patents or in Acts authorizing the issuance thereof. 3
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I. Indian tribal codes or regulations, Indian treaty or aboriginal rights, including easements or equitable servitudes. w
J. Water rights, claims or title to water. a�
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K. Any defect, lien, encumbrance, adverse claim, or other matter that appears for the first time in the Public
Records or is created, attaches, or is disclosed between the Commitment Date and the date on which all of the
Schedule B, Part I—Requirements are met. E
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This page is only apart of a 2021 ALTA@ Commitment for Title Insurance issued by Fidelity National Title Insurance Company. This Commitment is not valid without
the Notice; the Commitment to Issue Policy; the Commitment Conditions; Schedule A; Schedule 8, Part I-Requirements; Schedule 8, Part If-Exceptions; and a
counter-signature by the Company or its issuing agent that may be in electronic form.
AMECopyright American Land Title Association. All rights reserved. [AND CAN
TIT[F
I-(IATION
The use of this Form (or any derivative thereof)is restricted to ALTA licensees and ALTA members in good standing as
of the date of use. All other uses are prohibited. Reprinted under license from the American Land Title Association.
ALTA Commitment for Title Insurance w-WA Mod(07/01/2021) Printed: 09.12.24 @ 10:24 PM
Page 7 WA-FT-FTMA-01530.610051-SPS-1-24-611344568
Packet Pg. 149
4.H.a
FIDELITY NATIONAL TITLE COMPANY OF WASHINGTON,
INC. COMMITMENT NO. 611344568
SCHEDULE B, PART II - Exceptions
(continued)
SPECIAL EXCEPTIONS
1. Terms, conditions, and obligations arising from the easement described as Parcel B in Schedule A.
2. Covenants, conditions, restrictions, obligations and easements as set forth in the Warranty Deed and Easement, m
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Recording Date: June 24, 1949 t
Recording No.: 3913648 a
3. Easements for the purposes shown below and rights incidental thereto as set forth in a document:
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In favor of: City of Kent
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Purposes: Temporary construction for sewer line a)
Recording Date: September 30, 1974 Q
Recording No.: 7409300528
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Affects: The Easterly 10 feet
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4. Ordinance No. 4431 and terms and conditions set forth therein, a,
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Executed by: City of Kent 2
Recording Date: September 21, 2022 a
Recording No.: 20220921000270
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Which among other things provides: Vacating a portion of Naden Street, also known as Naden Avenue, and
reserving an easement.
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5. Taxpayer of the Land has qualified for a senior citizen exemption. Contact the County Treasurer to determine if
said exemption has been or will be cancelled and to determine the amount of any tax payment due.
6. A deed of trust to secure an indebtedness in the amount shown below, z
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Amount: $80,000.00
Dated: June 24, 2020 3
Trustor/Grantor: James Edward Waller and Ruth Lynn Waller, husband and wife
Trustee: UPF Washington Incorporated a.
Beneficiary: Cascade Federal Credit Union
Recording Date: July 2, 2020
Recording No.: 20200702001610
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END OF SCHEDULE B, PART II
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This page is only a part of a 2021 ALTA@ Commitment for Title Insurance issued by Fidelity National Title Insurance Company. This Commitment is not valid without
the Notice; the Commitment to Issue Policy; the Commitment Conditions; Schedule A; Schedule B, Part I-Requirements; Schedule B, Part II-Exceptions; and a
counter-signature by the Company or its issuing agent that may be in electronic form.
AMECopyright American Land Title Association. All rights reserved. [AND CAN
TIT[F
I-(IATION
The use of this Form (or any derivative thereof)is restricted to ALTA licensees and ALTA members in good standing as
of the date of use. All other uses are prohibited. Reprinted under license from the American Land Title Association.
ALTA Commitment for Title Insurance w-WA Mod(07/01/2021) Printed: 09.12.24 @ 10:24 PM
Page 8 WA-FT-FTMA-01530.610051-SPS-1-24-611344568
Packet Pg. 150
4.H.a
FIDELITY NATIONAL TITLE COMPANY OF WASHINGTON,
INC. COMMITMENT NO. 611344568
COMMITMENT CONDITIONS
1. DEFINITIONS
a. "Discriminatory Covenant": Any covenant, condition, restriction, or limitation that is unenforceable under applicable law because it illegally
discriminates against a class of individuals based on personal characteristics such as race, color, religion, sex, sexual orientation, gender
identity,familial status,disability, national origin,or other legally protected class.
b. "Knowledge"or"Known": Actual knowledge or actual notice, but not constructive notice imparted by the Public Records.
C. "Land": The land described in Item 5 of Schedule A and improvements located on that land that by State law constitute real property. The
term "Land" does not include any property beyond that described in Schedule A, nor any right, title, interest, estate, or easement in any
abutting street, road, avenue, alley, lane, right-of-way, body of water, or waterway, but does not modify or limit the extent that a right of N
access to and from the Land is to be insured by the Policy. O
d. "Mortgage": A mortgage, deed of trust, trust deed, security deed, or other real property security instrument, including one evidenced by r
electronic means authorized by law.
Q
e. "Policy": Each contract of title insurance, in a form adopted by the American Land Title Association, issued or to be issued by the Company
pursuant to this Commitment.
f. "Proposed Amount of Insurance": Each dollar amount specified in Schedule A as the Proposed Amount of Insurance of each Policy to be
issued pursuant to this Commitment. y
g. "Proposed Insured": Each person identified in Schedule A as the Proposed Insured of each Policy to be issued pursuant to this Commitment.
d
h. "Public Records": The recording or filing system established under State statutes in effect at the Commitment Date under which a document Q
must be recorded or filed to impart constructive notice of matters relating to the Title to a purchaser for value without Knowledge. The term d
"Public Records" does not include any other recording or filing system, including any pertaining to environmental remediation or protection,
planning, permitting,zoning,licensing, building, health, public safety,or national security matters.
i. "State": The state or commonwealth of the United States within whose exterior boundaries the Land is located. The term "State" also
includes the District of Columbia,the Commonwealth of Puerto Rico,the U.S.Virgin Islands,and Guam.
fn
j. "Title": The estate or interest in the Land identified in Item 3 of Schedule A.
2. If all of the Schedule B, Part I-Requirements have not been met within the time period specified in the Commitment to Issue Policy, this 2
Commitment terminates and the Company's liability and obligation end.
IL
3. The Company's liability and obligation is limited by and this Commitment is not valid without: y
a. the Notice; —
b. the Commitment to Issue Policy;
c. the Commitment Conditions;
ti
d. Schedule A;
e. Schedule B, Part I-Requirements;and
f. Schedule B, Part II-Exceptions;and
g. a counter-signature by the Company or its issuing agent that may be in electronic form.
t
4. COMPANY'S RIGHT TO AMEND x
The Company may amend this Commitment at any time. If the Company amends this Commitment to add a defect, lien, encumbrance, adverse W
claim, or other matter recorded in the Public Records prior to the Commitment Date, any liability of the Company is limited by Commitment _
Condition 5. The Company is not liable for any other amendment to this Commitment. 3
5. LIMITATIONS OF LIABILITY Q
a. The Company's liability under Commitment Condition 4 is limited to the Proposed Insured's actual expense incurred in the interval between d
the Company's delivery to the Proposed Insured of the Commitment and the delivery of the amended Commitment, resulting from the W
IX
Proposed Insured's good faith reliance to:
i. comply with the Schedule B, Part I-Requirements;
ii. eliminate,with the Company's written consent,any Schedule B, Part II-Exceptions;or
iii. acquire the Title or create the Mortgage covered by this Commitment.
b. The Company is not liable under Commitment Condition 5.a. if the Proposed Insured requested the amendment or had Knowledge of the aa)
matter and did not notify the Company about it in writing. E
c. The Company is only liable under Commitment Condition 4 if the Proposed Insured would not have incurred the expense had the v
Commitment included the added matter when the Commitment was first delivered to the Proposed Insured.
d. The Company's liability does not exceed the lesser of the Proposed Insured's actual expense incurred in good faith and described in Q
Commitment Condition 5.a.or the Proposed Amount of Insurance.
This page is only a part of a 2021 ALTA@ Commitment for Title Insurance issued by Fidelity National Title Insurance Company. This Commitment is not valid without
the Notice; the Commitment to Issue Policy; the Commitment Conditions; Schedule A; Schedule B, Part I-Requirements; Schedule B, Part II-Exceptions; and a
counter-signature by the Company or its issuing agent that may be in electronic form.
AMECopyright American Land Title Association. All rights reserved. [AND CAN
TIT[F
I-(IATION
The use of this Form (or any derivative thereof)is restricted to ALTA licensees and ALTA members in good standing as
of the date of use. All other uses are prohibited. Reprinted under license from the American Land Title Association.
ALTA Commitment for Title Insurance w-WA Mod(07/01/2021) Printed: 09.12.24 @ 10:24 PM
Page 9 WA-FT-FTMA-01530.610051-SPS-1-24-611344568
Packet Pg. 151
4.H.a
FIDELITY NATIONAL TITLE COMPANY OF WASHINGTON,
INC. COMMITMENT NO. 611344568
(continued)
e. The Company is not liable for the content of the Transaction Identification Data, if any.
f. The Company is not obligated to issue the Policy referred to in this Commitment unless all of the Schedule B, Part I-Requirements have been
met to the satisfaction of the Company.
g. The Company's liability is further limited by the terms and provisions of the Policy to be issued to the Proposed Insured.
6. LIABILITY OF THE COMPANY MUST BE BASED ON THIS COMMITMENT; CHOICE OF LAW AND CHOICE OF FORUM
a. Only a Proposed Insured identified in Schedule A,and no other person, may make a claim under this Commitment.
d
b. Any claim must be based in contract under the State law of the State where the Land is located and is restricted to the terms and provisions N
of this Commitment. Any litigation or other proceeding brought by the Proposed Insured against the Company must be filed only in a State or `p
federal court having jurisdiction. r
c. This Commitment, as last revised, is the exclusive and entire agreement between the parties with respect to the subject matter of this Q
Commitment and supersedes all prior commitment negotiations, representations, and proposals of any kind,whether written or oral, express
or implied, relating to the subject matter of this Commitment.
d. The deletion or modification of any Schedule B, Part II-Exception does not constitute an agreement or obligation to provide coverage beyond
the terms and provisions of this Commitment or the Policy. y
e. Any amendment or endorsement to this Commitment must be in writing and authenticated by a person authorized by the Company.
f. When the Policy is issued,all liability and obligation under this Commitment will end and the Company's only liability will be under the Policy. Q
7. IF THIS COMMITMENT IS ISSUED BY AN ISSUING AGENT
c�
The issuing agent is the Company's agent only for the limited purpose of issuing title insurance commitments and policies. The issuing agent is fn
not the Company's agent for closing,settlement,escrow,or any other purpose.
8. PRO-FORMA POLICY
The Company may provide, at the request of a Proposed Insured, a pro-forma policy illustrating the coverage that the Company may provide. A N
pro-forma policy neither reflects the status of Title at the time that the pro-forma policy is delivered to a Proposed Insured, nor is it a commitment
to insure. v
L
9. CLAIMS PROCEDURES
This Commitment incorporates by reference all Conditions for making a claim in the Policy to be issued to the Proposed Insured. Commitment d
Condition 9 does not modify the limitations of liability in Commitment Conditions 5 and 6. m
10. CLASS ACTION
ALL CLAIMS AND DISPUTES ARISING OUT OF OR RELATING TO THIS COMMITMENT, INCLUDING ANY SERVICE OR OTHER MATTER IN ?�
CONNECTION WITH ISSUING THIS COMMITMENT, ANY BREACH OF A COMMITMENT PROVISION, OR ANY OTHER CLAIM OR DISPUTE ti
ARISING OUT OF OR RELATING TO THE TRANSACTION GIVING RISE TO THIS COMMITMENT, MUST BE BROUGHT IN AN INDIVIDUAL
CAPACITY. NO PARTY MAY SERVE AS PLAINTIFF, CLASS MEMBER, OR PARTICIPANT IN ANY CLASS OR REPRESENTATIVE
PROCEEDING. ANY POLICY ISSUED PURSUANT TO THIS COMMITMENT WILL CONTAIN A CLASS ACTION CONDITION. rn
11. ARBITRATION -INTENTIONALLY DELETED
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END OF CONDITIONS ul
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This page is only a part of a 2021 ALTA@ Commitment for Title Insurance issued by Fidelity National Title Insurance Company. This Commitment is not valid without
the Notice; the Commitment to Issue Policy; the Commitment Conditions; Schedule A; Schedule B, Part I-Requirements; Schedule B, Part II-Exceptions; and a
counter-signature by the Company or its issuing agent that may be in electronic form.
AMECopyright American Land Title Association. All rights reserved. [AND CAN
TIT[F
I—(IATION
The use of this Form (or any derivative thereof)is restricted to ALTA licensees and ALTA members in good standing as
of the date of use. All other uses are prohibited. Reprinted under license from the American Land Title Association.
ALTA Commitment for Title Insurance w-WA Mod(07/01/2021) Printed: 09.12.24 @ 10:24 PM
Page 10 WA-FT-FTMA-01530.610051-SPS-1-24-611344568
Packet Pg. 152
4.1
ECONOMIC AND COMMUNITY DEVELOPMENT DEPARTMENT
Kurt Hanson, AICP, EDFP
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5454
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: Motion in Support of the Establishment of the Kent Valley Air
and Space Manufacturing Roundtable
MOTION: I move to express the City Council's support for the
establishment of the Kent Valley Air and Space Manufacturing Roundtable
and invite the participation of local aerospace industry representatives.
SUMMARY: Neighboring agencies, including other cities, school districts, and
educational institutions are working together to support the establishment of the
Kent Valley Air and Space Manufacturing Roundtable, aiming to foster collaboration
among industry leaders, educators, and public sector representatives to address
workforce development, drive legislative agendas, and promote economic
sustainability within the aerospace industry. The support of Kent and other agencies
emphasizes the importance of partnerships between K-12 education, higher
education institutions, and the aerospace sector to align training programs with
industry needs. C-suite executives from aerospace employers are invited to
participate in the Roundtable's initiatives and commit to ongoing collaboration
between educational institutions, city leaders, and industry partners to ensure the
success of this strategic initiative.
The Economic and Community Development Department is in communication with
other agencies regarding a memorandum of understanding that will be signed by
the Mayor expressing these sentiments.
This motion in support of the establishment of the Kent Valley Air and Space
Manufacturing Roundtable will both be presented to the Committee of the Whole
and placed on the City Council consent agenda on September 17, 2024.
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Innovative Government - Delivering outstanding customer service, developing leaders, and
fostering innovation.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Packet Pg. 153
4.1
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Kent Valley Air Space Roundtable MOU (PDF)
Packet Pg. 154
4.I.a
Kent Valley Air and Space Manufacturing Roundtable
Memorandum of Understanding
a
in
Subject: Establishment of the Kent Valley Air and Space Manufacturing Roundtable
=
a
Whereas, Green River College and Renton Technical College, as mission driven
institutions of higher education and talent development, recognize the value of �.
strong collaboration between aerospace leaders and the alignment of training and Y
programs with industry growth;
4-
Whereas, The Auburn, Kent, and Renton School Districts are the starting point for
student career exploration and contribute to the development of workforce a)
education programs by fostering career connections between K-12 education, post- y
secondary pathways, and the aerospace industry;
Whereas, The public sector leaders representing the cities of Auburn, Kent,
Tukwila, and Renton, along with Kent Valley education leaders, recognize the need
for a strategic initiative aimed at addressing challenges and opportunities within 0
Kent Valley's aerospace industry; V_
0
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Whereas, The Next Generation Sector Partnerships model has demonstrated N
success in facilitating collaboration between business leaders, educators, and
government entities to address industry challenges and promote economic vitality o
and sustainability; 0
Whereas, The creation of the Kent Valley Air and Space Manufacturing Roundtable o
provides an efficient platform for industry leaders to collectively address workforce
and talent development, drive legislative agendas, and promote economic vitality
and sustainability within the aerospace industry; 0
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Whereas, Participation from industry leaders is essential for success of the Kent
Valley Air and Space Manufacturing Roundtable as Kent Valley employers are
creating the jobs of the future and their guidance is critical to shaping the 0
aerospace industry's talent pipeline.
Now, therefore, be it resolved, that Green River and Renton Technical Colleges, cn
and the Auburn, Kent and Renton School Districts hereby invite establishment of A=
the Kent Valley Air and Space Manufacturing Roundtable to build stronger ;,
partnerships, foster collaboration, and expand equitable access to our region's best
jobs; >
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Be it further resolved that Kent Valley employers represented by C-suite Y
executives, are invited to join the Kent Valley Air and Space Manufacturing
Roundtable, and participate in the inaugural launch meeting scheduled for late E
October 2024, as well as subsequent biannual meetings and Action Teams;
a
Packet Pg. 155
4.I.a
Be it further resolved that the cities of Auburn, Kent, Renton, and Tukwila
express their support for the establishment of the Kent Valley Air and Space
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Manufacturing Roundtable and commit to working collaboratively with the Auburn, cn
Kent and Renton School Districts, as well as Green River and Renton Technical
Colleges, and industry partners to ensure its success;
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Be it further resolved that the Auburn, Kent and Renton School Districts, Green
River, and Renton Technical Colleges, along with the city mayors, extend their
sincere appreciation to Kent Valley Air and Space Industry employers for
considering this opportunity to collaborate and shape the future of the air and space Y
manufacturing industry and region.
4-
Signed: °
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Dr. Suzanne Johnson, President Nancy Backus, Mayor a
Green River College City of Auburn w
Date: Date: 0
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Dr. Yoshiko Harden, President Dana Ralph, Mayor
Renton Technical College City of Kent o
Date: Date: 0
0
Dr. Alan Spicciati, Superintendent Armondo Pavone, Mayor :3
Auburn School District City of Renton 0
Date: Date: a�
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0
Israel Vela, Superintendent Thomas McLeod, Mayor W
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Kent School District City of Tukwila
Date: Date: cn
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Dr. Damien Pattenaude, Superintendent >
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Renton School District
Date: Y
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Packet Pg. 156
4.J
ECONOMIC AND COMMUNITY DEVELOPMENT DEPARTMENT
Kurt Hanson, AICP, EDFP
220 Fourth Avenue South
KENT Kent, WA 98032
WASHINGTON 253-856-5454
DATE: September 17, 2024
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: 2044 Comprehensive Plan
SUMMARY: At the upcoming meeting staff will provide updates on the 2044
Comprehensive Plan, including a summary of goal and policy updates for the
following elements:
Transportation; and
Parks and Open Space.
The Transportation Master Plan was substantially updated in 2021 after community
outreach, technical analysis, project development, and City Council input. The Parks
and Open Space Plan (2022) and Recreation Program Plan (2020) were also
substantially updated since the last Comprehensive Plan periodic update. The
proposed changes to these goals and policies are minimal and limited to addressing
the preferred alternative and regulatory requirements in order to reflect and respect
the previous extensive and more specific community engagement efforts.
Staff will also share updates on how the current Human Services goals and policies
are being integrated into the 2044 Comprehensive Plan to support a healthy,
inclusive, and supportive community.
The existing elements from the 2015 Comprehensive Plan can be found online at
www.Engage.KentWA.gov/FutureKent
<http://www.Enciage.KentWA.gov/FutureKent>.
SUPPORTS STRATEGIC PLAN GOAL:
Innovative Government - Delivering outstanding customer service, developing leaders, and
fostering innovation.
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
Packet Pg. 157
4.J
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Kent Comprehenesive Plan Transportation Element G&P (PDF)
2. Kent Comprehenesive Plan Parks and Rec Element G&P (PDF)
3. Human Services crosswalk table (PDF)
Packet Pg. 158
`\, Comprehensive Plan 2044
"'KEN
Building Our Future Together'
2044 Comprehensive Plan
Draft Updated Transportation Element Goals and
Policies
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Underline text = new additions 0
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Strikethr, ugh teAl = removed
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Goal T-1 Connectivity and Options: Expand and strengthen the multimodal O
network, specifically walking, biking, and transit, to increase options Z
for those who have fewest opportunities. c
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T-1.1 Provide a balanced transportation system that delivers reasonable aa.
06
circulation for all users throughout the city, including pedestrians, 0
bicyclists, persons who use a wheelchair or other ambulation devices,
seniors, youth, people with low incomes, transit riders, freight haulers, E
motorists, emergency responders, and residents of all ages and abilities as r_
detailed in Ordinance 4247 (Complete Streets).
0
T-1.2 Coordinate land use and transportation decision making to reduce sprawl
and promote dense development patterns that support cost-effective
transit and build stronger connections between housing and employment
a.
opportunities.
T-1.3 Promote transit-oriented development around high-capacity transit M
through land use patterns, support fewincreased transit service, and
ems-emphasize e-R-non-motorized facilities to shorten trip lengths or E
replace vehicle trips #wand reduce vehicle miles traveled. U
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T-1.4 Prioritize the creation of strong east-west connections for all modes.
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T-1.5 Ensure that changes to the city's transportation system promote walking,
biking, and public transportation. Where possible, strongly discourage the a
development of dead-end cul-de-sacs, facilitate the inclusion of
connecting pathways for pedestrian and bicycle access in cases where
En age.KentVVA.gcv Futu reKent �E .
Packet Pg. 159
4.J.a
DRAFT 2
dead-end cul-de-sacs are permitted, and construct pedestrian and bicycle
facilities that connect to and through parks to shorten and encourage
non-motorized trips.
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T-1.6 Facilitate the construction of pedestrian and bicycle facilities along the
city's adopted pedestrian and bicycle network, filling gaps required to
improve safety and connectivity and comfort.
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T-1.7 Use short-term, low-cost improvements, such as pedestrian and bicycle L)
signage and markings, to identify routes when high-cost capital o
N
improvements are not funded.
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T-1.8 Develop programs and construct infrastructure for walking, biking, and o
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access to transit that make it possible for Kent residents and employees, z_
especially underserved populations as defin d OR
the T 12, to access o
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essential services and support local businesses while reducing auto-
dependent travel. a.
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T-1.9 Protect the mobility and reliability of T-1 and T-2 Freight and Goods C
Transportation System (FGTS) routes; design all other streets to E
accommodate only first/last mile freight movements through utilizing W
engineering standards that are based on smaller design vehicles.
0
T-1.10 Ensure that efforts to improve access to transit and other mobility services
consider the needs of those who rely on transit services the most and
those with special transportation needs.
a
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T-1.11 Implement transportation programs and projects that provide access to
opportunities while preventing or mitigating displacement and other C
negative impacts to underserved populations as defined in the
transportation equity defintionTM-P. E
0
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T-1.12 Advocate for new transit and mobility options for Kent residents and
employees. Y
C
E
T-1.13 Work with transit providers to start planned transit service as early and
effectively as possible and continue to support existing and new bus a
service that connects to light rail stations, high-capacity transit corridors,
EngageXentWA.gov/Putu reKent
Packet Pg. 160
'�' k FT 4.J.a
3
Seattle-Tacoma International Airport, and park and ride lots throughout
the city.
T-1.14 Support transit planning efforts based on criteria guided by the city's preferred a-
land use, population and employment distribution, and opportunities for
redevelopment. Maintain right-of-way for future high-capacity transit service.
as
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T-1.15 Update corridor plans proactively before high-capacity transit occurs to E
leverage investments, improve access, and integrate multimodal options. U
0
T-1.16 Implement transportation improvements and strategies needed to implement the CN
city's Layered Network, comply with Regional Growth Strategy, and meet level- Z
of-service standards and guidelines for transportation detailed in the TMP. O
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T-1.17 Meet capacity needs by investing in transportation system operations and Z
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management, pricing programs, transportation demand management,
public transportation, and system management activities that improve the
efficiency of the current transportation system, prior to implementing 06
major roadway capacity expansion projects.
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T-1.18 Provide active transportation facilities connecting urban residents to trails, w
parks, and open spaces. c
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Goal T-2 Safety & Health: Promote community health by improving safety and Q
by making walking, biking, and getting to transit viable and
comfortable alternatives to driving.
a.
T-2.1 Target Zero: Kent's goal is to eliminate traffic deaths and serious injuries.
Kent will continue to invest in safety plans, projects, and programs to make
progress towards this goal, with a reevaluation of progress in 2030.
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T-2.2 Through a Layered Network approach, and comprehensive concurrency
program, implement strategies to meet multimodal level of service Y
standards and enhance connectivity and integration between modes for
ease of multimodal transfers and movement of goods. E
T-2.3 Work with residents and local businesses to encourage appropriate reduEe a
speeds and cut-through traffic on non-arterial streets, especially *n
residential neighb„- Fhee s with techniques that include education,
EngageXentWA.gov/Fultu re ent E
Packet Pg. 161
4.J.a
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enforcement, and traffic calming that also supports connectivity and
physical activity.
T-2.4 Construct projects, focus investments, and implement programs that a
improve safety for all users of the transportation network especially
underserved populations as defined in TAnD
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T-2.5 Minimize the number of driveways and access points per parcel on E
arterials to improve the bicycle and pedestrian environment. U
0
N
T-2.6 Emphasize comfort and user experience in the design of bicycle facilities
following the city's bicycle level of traffic stress (LTS) guidelines. z
0
0
T-2.7 Coordinate with the Kent Police Department and school districts within the z_
City of Kent to increase safety through education and enforcement o
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programs.
a.
06
T-2.8 Plan street networks with a high degree of connectivity to encourage
walking, bicycling, transit use, and Safe Routes to Schools programming.
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T-2.9 Coordinate with regional transit providers to plan resilient transit routes W
that are iRteg tee with the e)(*St;Rg ro+ construct comfortable transit
stops that meet the City of Kent's transit stop amenity standards, and o
address potential safety and security concerns.
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T-2.10 Provide equitable opportunities for an active, healthy lifestyle by
integrating the needs of non-motorized users into the multimodal
transportation system. N
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T-2.11 Strive to reduce fatalities and serious injuries crashes by implementing city
safety projects and programs considering state best practices. E
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Goal T-3 Stewardship Policies: Maintain and improve what we have and focus
new investments on projects that have long term community and Y
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economic benefits.
E
T-3.1 Ensure that maintenance and operation of the existing and proposed a
transportation network is included in transportation planning.
- En gag eXentWA.gov/Futu re ent
Packet Pg. 162
4.J.a
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T-3.1 Protect the investment in the existing system, lower overall life-cycle costs,
and ensure resiliency of the transportation network by implementing cost-
effective maintenance and operations programs. E
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T-3.2 Coordinate new development and redevelopment with transportation
projects as mandated by the Growth Management Act (GMA)
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T-3.3 Coordinate with state and regional agencies to ensure continued mobility o
on state routes (including 1-5, SR 167, SR 509, SR 515, SR 516, SR 99 and L)
SR 181), including improvements needed to achieve the adopted level of o
N
service standards for these facilities. (Footnote: Highways of statewide
significance HSS are exempt from the concurrency ordinance) o
0
T-3.4 Consider the economic development and community benefit implications z_
in the planning and design of transportation projects. o
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T-3.5 Foster transit-oriented development opportunities and leverage public a.
and private funds to achieve city objectives related to economic 0
development and growth.
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2
T-3.6 Implement and maintain a transportation impact fee program that W
supports future the City's growth strategy and e-advances Rg the
overall goals of the Comprehensive Plan. o
T-3.7 Maintain a comprehensive asset management program that monitors the
condition of Kent's multimodal transportation network and that facilitates
data driven decision-making.
T-3.8 Develop transportation projects, programs, and investment strategies that
comply with state and federal guidelines and are consistent with best
practices for air quality, water quality and other environmental impacts. E
0
U
T-3.9 Optimize land use patterns and transportation systems to minimize air pollution
Y
and greenhouse gas emissions, consistent with the priorities of the King County
Cities Climate Collaboration. E
T-3.10 Pursue mode split goals for designated Regional Growth Centers within a
Kent to increase the share of trips made by modes other than driving
alone. Prioritize investments that make traveling by modes other than driving ��
EngageXentWA.gov/Futu reKent '
Packet Pg. 163
4.J.a
6
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alone easier and more accessible to all travelers in Kent, with special attention
paid to Kent's regional onal growth centers. Collect data and set targets to measure
progress in shifting away from drive alone travel in Downtown.
a
T-3.11 Reduce the impact of the city's transportation system on the environment ;
using technology, expanded transit use within the Urban Growth Area, and
non-motorized transportation options.
Q.
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T-3.12 Encourage the use of technologies that minimize reliance on fossil fuels L)
and reduce greenhouse gas emissions, such as electric and high fuel o
efficiency automobiles. N
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Z
T-3.13 Develop a resilient transportation system (e.g. roadway, rail, transit, and 0
0
nonmotorized) that protects against major disruptions and climate change Z
by developing recovery strategies and by coordinating disaster response
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plans.
a.
Goal T-4 Placemaking: Make investments that emphasize Kent as a welcoming 06
0
place and enhance the character of the community.
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T-4.1 Using the Complete Streets process, incorporate street trees and plantings W
in transportation facility planning and design to enhance community 0
vitality, placemaking, traffic calming, and economic development.
0
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T-4.2 Plan and implement the transportation system utilizing urban street L
design principles in recognition of the link between urban design, safety,
economic development, community health, and transportation system a.
design in the planning and implementation of transportation projects.
T-4.3 Consider the effects transportation projects have on the public realm,
particularly the impacts on public perception, placemaking and use.
0
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T-4.4 Promote and support public transit, and bicycle and pedestrian circulation
within compact urban settings. Y
W
T-4.5 Prioritize inclusion of pedestrian amenities, street trees, art and integration
into public spaces when implementing transportation projects within the
Urban Center and designated Activity Centers, key gateways, and high- a
capacity transit corridors.
EngageXentWA.gov/Putu reKent
Packet Pg. 164
4.J.a
nRAFT 7
T-4.6 Establish residential streetscape patterns that foster more opportunities
for healthy living and community interaction.
T-4.7 Construct comfortable, safe, and supportive public streetscapes for transit a
riders, pedestrians and bicyclists where appropriate based on land use
context and user feedback.
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T-4.8 During project development, use data-informed decision-making to 0
develop innovative solutions for equitable outcomes.
0
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Goal T-5 Strategy: Pursue grants, partnerships, and technologies to maximize
resource and find new efficiencies. z
0
0
T-5.1 Secure reliable funding to ensure continuous maintenance and z_
improvement of the transportation system, and explore alternative funding o
methods including user fees, tolls, and other progressive
pricing mechanisms that reduce the volatility of transit funding. a.
06
0
T-5.2 Support efforts at the state and federal level to increase funding for local
transportation. E
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T-5.2 Leverage public and private investments in the transportation network to
build a healthy, opportunity-rich city. o
T-5.3 Consistent with the regional transportation plan, coordinate Ceerdinate
land use, transportation, and development decisions with transit providers
and adjacent jurisdictions, including in subarea and corridor planning a
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efforts. '-
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T-5.4 Take an active approach to managing on- and off-street parking in
commercial and high-density residential areas to minimize land dedicated E
to parking and ensure right-of-way balances parking with other U
community needs.
Y
T-5.5 Coordinate the allocation of curb space for delivery purposes with
development.
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T-5.6 Ensure CTR employers affected employers are "''""'lerneRtin " by the state
Commute Trip Reduction (CTR) law implement a commute trip reduction
EngageXentWA.gov/Putu reKent
Packet Pg. 165
4.J.a
F) RAFT 8
program for employees, as mandated by the state Commute Trip
Reduct4 law, and evaluate program effectiveness every other year.
T-5.7 Encourage all employers to implement a commute trip reduction program a
for employees and to help reduce peak hour commute trips by facilitating
employees' use of telework, flexible work hours, compressed work week
schedules, and other scheduling options.
Q.
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T-5.8 Emphasize transportation investments that provide and encourage L)
alternatives to single occupancy vehicle travel and increase travel options, o
N
especially to and within centers and along corridors connecting centers.
J
Z
T-5.9 Utilize Transportation Demand Management strategies to increase the o
proportion of trips made by transportation modes that are alternatives to z_
driving alone, especially to and within centers and along corridors o
connecting centers, by ensuring availability of reliable and competitive
transit options. a.
06
0
T-5.10 Suppert Adopt guidelines to foster green building, commute trip
reduction goals, and multimodal forms of transportation via flexible
development standards pertaining to building setbacks, location of
parking, parking requirements, and amenities for pedestrians and
bicyclists. o
T-5.11 Facilitate the construction of curbside spaces for electric vehicle charging
stations where on-street parking is allowed.
FL
T-5.12 Implement intelligent transportation system technology and infrastructure N
to support the efficient movement of people and goods.
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T-5.13 Coordinate with the County and neighboring jurisdictions to implement E
concurrency strategies and provide for mitigation of shared traffic impacts U
through street improvements, signal improvements, intelligent
transportation systems improvements, transit system improvements or Y
transportation demand management strategies.
T-5.14 Coordinate with BNSF Railroad, UP Railroad, and the Washington Utilities a
and Transportation Commission (WUTC) to enable the safe, reliable, and
efficient movement of goods.
En gageXentWA.gov/Futu reKent
Packet Pg. 166
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T-5.15 Coordinate transportation operations, planning and improvements with
the State, Region, County, neighboring jurisdictions and other E
transportation planning agencies to ensure the city's interests are well a
represented in state and regional planning strategies, policies and projects
and to identify strategies to maximize benefits with limited financial
resources.
Q.
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T-5.165 Actively engage residents, a-r4 especially historically underserved
populations, during the planning and design of transportation facilities o
N
proposed by the city and other agencies to identify and reduce community
impacts, and provide updates and continue engagement throughout z
project construction. o
U_
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T-5.17 During project development, consider methods for reducing stormwater o
pollution and improving fish passage.
a
T-5.18 Facilitate a freight network that serves regional connectivity, especially to 0
transportation hubs such as ports and designated freight routes, in
support of regional economic vitality. Develop and implement freight
mobility strategies that strengthen, preserve, and protects the City's and
Kin_ Cq ounty's role as a major regional freight distribution hub, an
international trade gateway, and a manufacturing area while minimizing o
negative impacts on the community.
L
T-5.19 Adapt to long-term changes in mobility needs and technology through
community engagement and partner agency coordination. a
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T-5.20 Ensure transportation investments and improvements are providing
equitable benefits and impacts to all city residents. 0
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T-5.21 Coordinate land use and transportation decision making to promote U
connectivity to the Seattle-Tacoma International Airport and minimize
health, air quality, and noise impacts to communities, including historically Y
marginalized communities.
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EngageXentWA.gov/Futu reKent
Packet Pg. 167
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-, Comprehensive Plan 2044
2"'KEN
Building Our Future Together
2044 Comprehensive Plan
Draft Updated Parks and Recreation Facilities
Element Goals and Policies y
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Underline text = new additions E
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ctrikethro gh text = removed
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Park and Recreation Facilities O
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Goal P-1 Promote the provision of and access to quality parks, recreational
opportunities, and open spaces throughout the City.
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P-1.1 VVerl( with ether departmeRts te eREE)i irage new cinrvle_family girl �
multifamily residential and
commercial developments, to nrs��i Ei rde E
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recreation elements L.I
Encourage creation of publicly accessible recreational amenities within
9 P y �
public and private developments, especially centers and neighborhoods
close to high-capacity transit stops. y
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P-1.2 When acquiring, planning, de
veloping eveloping or rerdeyeleping earl/ properties
recr,ry n,ze that the different areas of the City have different recreational d
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needy(e.g., the parks needs for the downtown area are different f�T >
these on, a Et Hill) and establish g
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conciderat*en of these different needs into the various decicien_maliinry t
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Recognize and develop distinctive facilities and programming that
respond to and reflect the unique needs of the surrounding community
they serve. Y
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P-1.3 Where appropriate, initiate with other private and public interests joint
development ventures that meet recreational needs and achieve City of .2
Kent strategic goals. Q
-. ii� En age. entWA.9ov Future) ent IC ?
Packet Pg. 168
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DRAFT 2
P-1.4 Provide opportunities to improve physical and mental health through
parks and recreation facilities and programs.
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Goal P-2 Develop, maintain and operate a high-quality system of indoor a
facilities designed to appeal to a diverse range of abilities, ages,. and
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interests. _
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P-2.1 Manage existing multiple-use indoor community centers that provide E
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indoor recreational and gathering opportunities for a wide range of ages,
abilities and interests on a year-round basis. Assess opportunities for new o
indoor facilities outside of Downtown to increase access and address level cm
of service gaps. z
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P-2.2 Continue to seek strategic partnerships with other public and private z
agencies to provide indoor recreational opportunities, particularly in o
underserved areas of the City.
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Goal P-3 Where appropriate, possibly in conjunction with other public or 0
private organizations, develop and operate specialized park and
recreational enterprises that meet the interest of populations who are E
able and willing to finance, maintain or operate them. U
P-3.1 Where appropriate and economically feasible (i.e., self-supporting),
develop and operate specialized and special interest recreational facilities Y
like golf, ice skating, disc golf, mountain biking and off-leash parks. a
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P-3.2 Encourage private facilities to structure membership and use fees to
provide affordable access for-low-income households. '-
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Open Space Q
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Goal P-4 Thoughtfully and strategically acquire and manage public open space
to improve wildlife habitat and other environmental and climate Y
benefits as well as non-motorized connectivity and other
complementary recreational benefits. E
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: P-4.1 Seek to improve greenway corridors within the Kent area. Q
Engage.KentWA.gov/Futu reKent ! ,
Packet Pg. 169
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F) RAFT 3
P-4.2 Increase linkages of trails and other existing or planned connections with
greenways and open space, particularly along the Green River, Mill Creek,
Garrison Creek and Soos Creek corridors; around Lake Fenwick, Clark Lake,
Lake Meridian, Panther Lake and Lake Youngs; and around significant a
wetland and floodways such as the Green River Natural Resource Area.
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P-4.3 Seek opportunities to integrate natural drainage practices, stormwater (D
infrastructure, and climate adaptation strategies into park design and E
management to provide community amenities and climate benefits. U
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Goal P-5 N
necr�ii�e ���iiiNn multiple water ���iiec r� its jurisdiction, +fie ri��i ��c
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limited public w ater access. Work with other public and private J
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entities to preserve and increase public waterfront access and o
facilities. z
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P-5.1 Work with other public and private partners to acquire, develop, and
preserve public access to add*tiE)Ral shorelines and local access a
waterfront fishing wading, swornmincv crop. "ien . and other related 06
recreational activities and pursuits, especially on the Green River, Lake
Fenwick, Clark Lake, Lake Meridian and Panther Lake. E
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P-5.2 For any public or private waterfront projects, work with the property owner �
nr project representative to find ways to include public access iincluding �
access to scenoc views of the water. N
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Continue partnerships to increase access to water safety education and li
drowning prevention resources, especially for multilingual and income CU
eligible households. L
Goal P-6 Continue to develop an urban forestry management program that
balances environmental benefits with recreation and public safety L
priorities. E
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P-6.1 Connect people to nature and improve the quality of life in Kent by
restoring and enhancing the urban ecosystem. Y
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P-6.2 Galvanize the community around urban ecosystem restoration and
stewardship through a volunteer restoration program. Q
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Engage.KentWA.gov/Futu reKent ! ,
Packet Pg. 170
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4
r) RAFT
P-6.3 Identify opportunities and funding to protect and restore native
vegetation and tree canopy.
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Trail and Corridor Svstem
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Goal P-7 Continue to work with other departments and agencies to develop
and improve a comprehensive system of multipurpose off-road and E
on-road trails that link park and recreational resources with 0
residential areas, public facilities, commercial and employment
centers both within Kent and within the region. N
J
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P-7.1 Seek opportunities to develop trail "missing links" along existing routes, o
including the Puget Power rights-of-way, Soos Creek Trail, Mill Creek Trail, Z
Lake Fenwick Trail, Green River Trail, Frager Road and the Interurban Trail.
0
P-7.2 Work with other city departments to create a comprehensive system of
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on-road trails to improve connectivity for the bicycle commuter, 06
recreational and touring enthusiasts using scenic, collector and local road
rights-of-way and alignments. Special emphasis should be placed on E
increasing east-west connectivity. w
P-7.3 Work with neighboring cities, King County and other appropriate
jurisdictions to connect Kent trails to other community and regional trail y
facilities like the Green River, Interurban, Frager Road and Soos Creek CU
Trails. a
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P-7.4 Extend trails through natural area corridors like the Green River, Mill Creek,
Garrison Creek and Soos Creek, and around natural features like Lake
Fenwick, Clark Lake, Lake Meridian and Panther Lake in order to provide a
high-quality, diverse public access to Kent's environmental resources.
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P-7.5 Increase non-motorized connectivity and access between housing and
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parks, trails, open space, and recreational facilities. Y
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P-8 Furnish trail corridors, trailheads and other supporting sites with
amenities to improve comfort, safety and overall user experience. w
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P-8.1 Improve accessibility to trails by siting trailheads and appropriate
improvements in high visibility locations.
1117
Engage. entV A.gOV/Futurel ent IL "
Packet Pg. 171
4.J.b
r) RAFT 5
P-8.2 Design and develop trail improvements that are easy to maintain and easy
to access by maintenance, security and other appropriate personnel,
equipment and vehicles. a
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Historic and Cultural Resources
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Goal P-9 Preserve, enhance and incorporate historic and cultural resources and o
multi-cultural interests into the park and recreational system.
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P-9.1 Identify and incorporate significant historic and cultural resource lands,
J
sites, artifacts and facilities into the park system when feasible. o
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P-9.2 Work with the Kent Historical Society and other cultural resource groups z
to incorporate community activities and interpretation of historic homes
and sites into the park and recreation system.
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P-9.3 Reflect and celebrate the city's unique communities through park design, 0
signage, programming, and cultural landscape design. Preserve historic,
visual, and cultural resources and consider potential impacts to culturally
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significant sites and tribal treat, fishing,shing, hunting, and gathering grounds.
Cultural Arts Programs and Resources
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Goal P-10 Work with the arts community to utilize local resources and talents to
increase public access to artwork and programs. a
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P-10.1 Support successful collaborations among the Arts Commission, business
community, service groups, cultural organizations, schools, arts patrons
and artists to utilize artistic resources and talents to the optimum degree
possible. 0
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P-10.2 Develop strategies that will support and assist local artists and art Y
organizations. Where appropriate, develop and support policies and
programs that encourage or provide incentives to attract and retain artists
and artwork within the Kent community.
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Goal P-11 Acquire and display public artwork to furnish public facilities and
other areas and thereby increase public access and appreciation.
En gageXentWA.gov/Futu reKent !
Packet Pg. 172
4.J.b
r) RAFT 6
P-11.1 Acquire public artwork including paintings, sculptures, exhibits and other
media for indoor and outdoor display in order to expand access by
residents and to furnish public places in an appropriate manner. a
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P-11.2 Develop strategies that will support capital and operations funding for
public artwork within parks and facilities. L
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Design and Management U
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Goal P-12 Design Park and recreational indoor and outdoor facilities to J
be accessible to a wide range of physical capabilities, skill levels, age z
groups, income levels, cultural interests, and activity interests. U-
P-1 z
2.1 Look for opportunities to incorporate the principles of inclusive design in
any new construction.
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When desigRiRg ne e, reEreatiE)nal facilities e E a it t the
e p e o earn (7
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their nr.eritiec needs Rd desires fer the imnreyementc and use public CD
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inp it to inform the decigR d
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P-12.2 Promote accessible and resilient parks, trails, and community centers that
meet current and future community needs.
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P-12.3 USiRg tke Continue to utilize Crime Prevention through Environmental a
Design (CPTED) and other design and development standards and
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practices, seed ^nn^rt„nities to improve park safety and security features
for users, department personnel, and the public at large.
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P-12.4 Design parks and facilities to maximize available space and benefits for a
users, including offering parks with multiple functions and implementation E
of shared use facilities. r
P-12.5 Provide opportunities for individuals to strengthen connections within
their community through hrouah services, programs, events, and volunteer E
activities, including opportunities that encourage cultural and inter-
generational interaction. a
EngageXentWA.gov/Futu re ent
Packet Pg. 173
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nRAFT 7
Goal P-13 Design and develop park and recreational facilities to be of low-
maintenance materials.
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P-13.1 Design and develop facilities that are of low-maintenance and high-quality a
materials to reduce overall facility maintenance and operation
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requirements and costs.
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P-13.2 Incorporate maintenance considerations early in the process in all designs E
for parks and recreational facilities.
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Goal P-14 Investigate proven and practical methods of financing park and CM
recreational requirements, including joint ventures with other public z
agencies and private organizations and private donations. o
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P-14.1 Investigate various public financing options that may contribute to a long- o
term, sustainable approach to finance a vibrant, relevant, safe and
attractive park and recreation system. a
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P-14.2 Where feasible and desirable, considerjoint ventures with King County,
Kent, Highline and Federal Way School Districts, regional, state, federal E
and other public agencies and private organizations to acquire, develop
and manage regional facilities (i.e., swimming pool, off-leash park, etc.).
P-14.3 Ma Collaborate with and work with support funding for foundations Y
L
and non-profits to investigate grants and selicit donations to that provide a
secondary support for facility development, acquisition, maintenance,
operations, and the provision of programs and,-services a)
Reeds that meet the needs of the entire Kent community, particularly low- •N
income community members.
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P-14.4 Proactively manage and maintain park assets in a way that results in E
replacement or renovation in advance of need. U
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Goal P-15 Further deveh " Continue to implement and refine the performance- Y
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based level of service approach to stewarding park and recreation
facilities that is introduced identified in the 2016 Park & Open Space �
Plan. Q
Engage.Kent A. orr/Future) ent ! ,
Packet Pg. 174
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8
DRAFT
P-15.1 Prior to acquiring, surplusing, and/or developing a potential park or
recreational facility, carefully evaluate its potential contribution to the
system and significance to creating equity between the Kent subre-iq on's
levels of service, and ^nly proceed if the potential action is considered to d
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performance C
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P-15.2 Prior to renovating a park asset or redeveloping a park, carefully evaluate E
its current and potential contribution to the system and significance to L)
creating equity between the Kent subregion's levels of service.,, an o
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tp system and can ntrib ite systems eyerall performance J
"h-l��SC TI�G-QTrG�TfCf-I-17CfC�CV the systems Z
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P-15.3 Periodically evaluate the entire system in terms of each park and facility z
performance. Consider recommending the repurposing of any asset or o
property whose current and potential recreational value is not expected to
contribute to the system's overall performance. a
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Goal P-16 Continue to create easily accessible information, build constituent
trust, and be transparent in decision-making processes to share how E
projects are identified. U
P-16.1 Continue authentic community engagement processes to inform and
guide decisions for plans, development, programming, and system Y
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changes. li
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P-16.2 Provide accessible signage and wayfindinq tools to direct individuals to
park facilities from nearby streets and trails in order to promote and �'-,
facilitate public use of parks
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P-16.3 Continue using data-based mapping and indices analysis to identify E
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projects.
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2044 Kent Comprehensive Plan Update: Human Services Element
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Goals and Policy Updates
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DRAFT: September 2024
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Introduction E
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The Human Services Element (Chapter 7) of the 2035 Comprehensive Plan is intended to provide a framework for the delivery of human services programs that
support the community's growth,vitality, and health.The element also includes a narrative on the demographic and socio-economic trends that existing in the N
community and describes the Housing and Human Services Division and Kent's role in encouraging a healthy community.
z
During the initiation of the project in 2022,the Project Team met with several members of the staff to understand how the City's different divisions use the 0
Comprehensive Plan.A key finding of that conversation was that while the comprehensive plan is intended to be an overarching policy guiding document that the U_
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City collectively uses, many divisions and departments will only turn to the elements that are directly related or obvious to their role and day-to-day
responsibilities. Understanding a goal of the state, region, and city is to facilitate equitable outcomes for all,the Project Team discussed integrating the Human
Services Element into the 2044 Comprehensive Plan's Land Use Element.The Comprehensive Plan is the foundation that guides growth and development in the
city and establishes the plan for implementation through its elements. Embedding the Human Services goals and policies into the land use element and other 2
elements, as relevant, centers the Comprehensive Plan in equity and encourages a healthy, inclusive, and supportive community.
The Land Use Element is organized in to four broad categories: f°
3
• Growth and Development establishes the foundation for how land use decisions will be evaluated, based on growth targets, desired design elements for o
future development, and alignment with decision-making for land use decisions.
• Community-Centered Design focuses on how urban spaces, such as streets, public spaces, and future development contribute to the well-being and
prosperity of Kent.This category organizes goals and policies that address how the built environment interacts with the people who live and work in s'
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Kent. N
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• Essential Public Facilities identifies specific goals and policies necessary to achieve the desired community vision.This includes community services,
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parks, utilities, and other elements necessary to foster community-focused growth.
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• Innovation&Shared Prosperity addresses the need to be equitable, inclusive, and accessible for all existing and future members of Kent in support of a
complete community.This category includes goals and policies that highlight economic development related to future development and land use. m
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Engage.KentWA.gov/FutureKent
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"KE T
HUMAN SERVICES AND LAND USE CROSSWALK
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Goal HS- Build safe and healthy communities Promote safe and healthy communities to Moved to Land Use: Community-Centered Design.
1 through mutually supportive reduce health disparities and improve
Responds to:
connections, building on the strengths health outcomes for all-_Rudd- safe an L
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and assets of all residents. healthy rGn;M nities;through Mutually • CPP-H-23:Adopt and implement programs and E
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sup Arthop ,,,.•a„RS building on the policies that ensure healthy and safe homes. C)
+.engths and assets of all re-Si, P-RUS. . CPP-PF-18: Provide human and community services to c
meet the needs of current and future residents in King
County communities through coordinated, equitable Z
planning,funding, and delivery of services by the O
county, cities, and other agencies. U_
• MPP-DP-18:Address existing health disparities and Z
improve health outcomes in all communities
HS-1.1 Provide children,youth and families with Bea resource fore-children,youth, Moved to Land Use: Community-Centered Design.This
community resources needed to support and families that need to be connected with responds to the role that the city can play as a connector
their positive development, including community resources needed-to support and resource for community members, especially, if those
early intervention and prevention their positive development, including early in need do not know where to start or who to go to.
3
services. intervention and prevention services.
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HS-1.3 Support efforts to strengthen Moved to Land Use: Community-Centered Design with no L)i
neighborhoods and ensure individuals changes because this implies the need for accessible a)
and families feel connected to their services, physical connections, gathering spaces, and i-I
community and build support systems fostering a sense of connection and belonging within Kent in
within neighborhoods. communities. E
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HS-1.4 Increase community participation from Increase community participation from Moved to Land Use: Innovation &Shared Prosperity and c
traditionally under-represented traditionally under-represented populations, reorganized under HS-3 goal to "Build community a
populations, including youth, persons of including youth,ems-communities of collaborations and seek strategic approaches to meet the >
color, immigrants and non-native English color, immigrants,and needs of Kent residents." By reorganizing, the policy is c
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speakers. Englis4limited English speaking more widely applied for all citywide decisions. Without
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populationse�s. the voices and participation of those that are not
historically involved in public processes,those v
collaborations and approaches may not be realized.
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Goal HS- Support residents in attaining their Moved to Land Use: Innovation &Shared Prosperity N
2 maximum level of self-reliance. because self-reliance is a path for economic mobility and J
component of an equitable, inclusive, and accessible p
community. 0
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Respondsto:
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• CPP-PF-18: Provide human and community services to
meet the needs of current and future residents in King
County communities through coordinated, equitable
planning,funding, and delivery of services by the �c
county, cities, and other agencies. 3
HS-2.1 Ensure that people facing hardship have access to resources to help meet immediate or basic needs. o
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HS-2.2 Improve access to services that allow individuals to improve their mental and physical health, overall well-being and ability to live independently.
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S—2.3 Promote access to jobs and services, Consider removing or using language to strengthen
especially for lower income individuals, economic development goals around programming and E
when planning local and regional supporting historically underserved communities and =
transportation systems and economic transportation goals and policies around access and
development activities. connections. E
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Goal HS-3 Build community collaborations and Moved to Land Use: Innovation &Shared Prosperity. c
seek strategic approaches to meet the Without the voices and participation of those that are not
needs of Kent residents. historically involved in public processes,those >
collaborations and approaches may not be realized. c
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Consider reorganizing Policy HS—1.4 here.
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Respondsto: E
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• CPP-PF-18: Provide human and community services to
meet the needs of current and future residents in King N
County communities through coordinated, equitable
planning,funding, and delivery of services by the Z
county, cities, and other agencies. O
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HS-3.1 Lead efforts to improve the ability of human services systems to meet demands and expectations by increasing capacity, utilizing technology, ?
coordinating efforts and leveraging resources. o
HS-3.2 Collaborate with churches, employers, businesses, schools and nonprofit agencies in the community.
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HS-3.3 Encourage collaborative partnerships between the City and the school districts to align resources to accomplish mutual goals that meet the needs of
children and families. cc
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Goal HS-4 Support equal access to services, Support equal equitable access to services, Moved to Land Use: Community-Centered Design. Moving c
through a service network that meets through a service network that meets this goal and supporting policies would emphasize the
needs across age,ability,culture and needs across age,ability,culture and importance of a well-connected and responsive
language. language. community that meets the needs of all residents.
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meet the needs of current and future residents in King =
County communities through coordinated, equitable
planning,funding, and delivery of services by the E
county, cities, and other agencies.
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HS-4.1 Promote services that respect the diversity and dignity of individuals and families and are accessible to all members of the community. Q
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HS-4.2 Encourage service enhancements that build capacity to better meet the needs of the community, reduce barriers through service design and are c
responsive to changing needs. a
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HS-4.3 Ensure that services are equally Ensure that services are equally accessible
accessible and responsive to a wide and responsive to a wide range of
range of individuals, cultures and family individuals, cultures and family structures ;v
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structures and are free of discrimination and are free of discrimination and prejudice.- E
and prejudice. c0
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(New Policy)Target investments that allow N
for affordable,fair, and equitable delivery of
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services that provide a safe, resilient, Z
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efficient, and functional system. O
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Goal HS-5 Oversee city resources with consistent Oversee city resources with consistent Moved to Land Use: Essential Public Facilities.This goal
ethical stewardship,fairness in ethical stewardship, fairness in allocating and supporting policies would emphasize the importance
allocating funds and strong funds and strong accountability for ensuring of equitable outcomes necessary to foster community-
accountability for ensuring services are services and programs are effective at focused growth.
effective. meeting diverse community needs. Responds to:
ca• CPP-PF-18: Provide human and community services to N
meet the needs of current and future residents in King o
County communities through coordinated, equitable
planning,funding, and delivery of services by the
county, cities, and other agencies.
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EC` gage. entW .gov/F ttureKent Packet Pg. 180
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HS-5.1 Provide funds to nonprofit human Seek opportunities and ways, including but Consider revising to be more inclusive of other ways to c
services providers to improve the quality not limited to funding, the city can support support nonprofit organizations. a
of life for low-and moderate- income PrPvO '^f -prk+^ nonprofit human services >
Strengthen P&OS 16.3 to: y
residents. providers to improve the quality of life for c
low and moderate income residents. Collaborate with and support funding for foundations and
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non-profits that provide secondary support for facility a
development, acquisition, maintenance, operations, and 0
the provision of programs and services that meet the v
needs of the entire Kent community, particularly low- N
income community members.
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HS-5.2 Continue the City's active participation in subregional and regional planning efforts related to human services. 0
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HS-5.3 Support new and existing human c„nn^r+ ^ Rd ^ ;S+;^., hI I. .aA
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services programs, and coordinate pFegFams, and Continue to coordinate
policies, legislation and funding at the policies, legislation and funding at the local,
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local, regional, state and federal levels. regional, state and federal levels to support
new and existing human service programs to
meet community needs and ensure f°
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equitable access to parks and human v,
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En e.Kent1� A. o Future Ken re w'°"' IT
""'°' Packet Pg. 181