HomeMy WebLinkAboutCity Council Meeting - City Council Meeting - 10/01/2024 KENT CITY COUNCIL AGENDA
40!00�9 Tuesday, October 1, 2024
KENT 7:00 PM
VV A 5 H I N G T O N
Chambers
A live broadcast is available on Kent TV21,
www.facebook.com/CityofKent, and
www.youtube.com/user/KentTV21
To listen to this meeting, dial
253-215-8782 or 253-205-0468
Enter Meeting ID: 82979108067
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
**************************************************************
COUNCIL MEETING AGENDA - 7 P.M.
1. CALL TO ORDER/FLAG SALUTE
2. ROLL CALL
3. AGENDA APPROVAL
Changes from Council, Administration, or Staff.
4. PUBLIC COMMUNICATIONS
A. Public Recognition
i. Employee of the Month
ii. Proclamation for Hispanic Heritage Month
iii. Proclamation for Breast Cancer Awareness Month
iv. Appointments to the Kent Human Services Commission
V. Appointmens to the Kent Parks and Recreation Commission
vi. Recognition of Three Neighborhood Councils
B. Community Events
S. REPORTS FROM COUNCIL AND STAFF
A. Mayor Ralph's Report
B. Chief Administrative Officer's Report
City Council Meeting City Council Regular Meeting October 1, 2024
C. Councilmembers' Reports
6. PUBLIC HEARING
A. First Public Hearing on the 2025-2026 Biennial Budget, including the
Identified Priorities for the Use of Opioid Settlement Funds
B. First Public Hearing on the 2025-2030 Capital Improvement Program
7. PUBLIC COMMENT
The Public Comment period is your opportunity to speak to the Council and Mayor on issues
that relate to the city of Kent or to agenda items Council will consider. This is not an open
public forum and comments that do not relate to the business of the city of Kent are not
permitted. Additionally, the state of Washington strictly prohibits people from using this public
comment opportunity for political campaign purposes, including to support or oppose a ballot
measure or any candidate for public office. Speakers may not give political campaign speeches
but must instead speak concerning a matter on the City Council's agenda or matters
concerning the general business of the City of Kent. Further, in providing public comment,
speakers must address the Mayor and Council as a whole; remarks intended to target an
individual on the dais are not permitted. Finally, please note that this public comment
opportunity is for you to provide information to the Mayor and City Council that you would like
us to consider, but we will not be able to answer questions during the meeting itself.
The City Clerk will announce each speaker. When called to speak, please step up to the
podium, state your name and city of residence for the record, and then state your comments.
You will have up to three minutes to provide comment.
Public Comment may be provided orally at the meeting, or submitted in writing, either by
emailing the City Clerk by 4 p.m. on the day of the meeting at CityClerkCdkentwa.gov or
delivering the writing to the City Clerk at the meeting. If you will have difficulty attending the
meeting by reason of disability, limited mobility, or any other reason that makes physical
attendance difficult, and need accommodation in order to provide oral comment remotely,
please contact the City Clerk by 4 p.m. on the day of the meeting at 253-856-5725 or
CityClerk0kentwa.gov.
Alternatively, you may email the Mayor and Council at MayorpKentWA._gov and
CityCounci10KentWA..ocovv. Emails are not read into the record.
S. CONSENT CALENDAR
A. Approval of Minutes
i. Council Workshop - Workshop Regular Meeting - Sep 17, 2024 5:15
PM
ii. City Council Meeting - City Council Regular Meeting - Sep 17, 2024
7:00 PM
iii. City Council Meeting - City Council Special Meeting - Sep 23, 2024
5:00 PM
iv. Council Workshop - Workshop Special Meeting - Sep 23, 2024 5:30 PM
B. Payment of Bills
C. Appointments to the Kent Human Services Commission - Confirm
City Council Meeting City Council Regular Meeting October 1, 2024
D. Appointments to the Kent Parks and Recreation Commission - Confirm
E. Accept the 2024 Asphalt Grinding Project as Complete - Authorize
F. Medical and Stop Loss Contracts - Authorize
G. Resolution Recognizing Hillshire Terrace Neighborhood Council - Adopt
H. Resolution Recognizing Garrison Glen Neighborhood Council - Adopt
I. Resolution Recognizing Nature Trails Townhomes (Springwood)
Neighborhood Council - Adopt
9. OTHER BUSINESS
A. Presentation Re: Purchase of Building for Municipal Services Center
and Plan for Renovating Centennial Center for City Hall and Police
Services
10. BIDS
11. EXECUTIVE SESSION AND ACTION AFTER EXECUTIVE SESSION
12. ADJOURNMENT
For additional information, please contact Kimberley A. Komoto, City Clerk at 253-856-5725, or
email CityClerk@kentwa.aov.
NOTE:A copy of the full agenda is available in the City Clerk's Office and at 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.
5.B
DO
C re P� o
of department highlights
October1
c�
• The REDI team participated in the Neighbor
ADMINISTRATION 2 Neighbor grantee convening. The
Administration convening is an opportunity to learn and —
celebrate the various projects that were
• The Environmental Protection Agency grant funded by the Seattle Foundation's
application to address flooding at the Mill Neighbor 2 Neighbor program. Multiple non- E
Creek Middle School has been submitted. profit organizations from Kent were °
This is the culmination of many months of recognized for their efforts in the Kent
meeting, planning, and preparing. The Kent community. a
School District worked in partnership with The REDI team has been invited to
the City, as well as community based participate in an upcoming regional
organizations including Centro Rendu V_
conversation about private-public a
Mother Africa, World Relief and ANEW. If partnerships in support of non-profits. The
the grant is awarded, we can anticipate a event is being led by a partnership between N
significant improvement to the Mill Creek Magic Cabinet, Seattle Foundation, King
Middle School that will improve the playfield County, and Communities of Opportunity. o
and reduce flooding to pathways to the
school.
• The 2025-2026 budget was presented to
the Council on September 24. Finance staff T)
will continue the budget discussions with Economic & Community Development .9
Council at meetings over the course of the Kent School District, in close partnership a
next months as the Council forms its final with the City of Kent, applied to an
budget for adoption. Environmental Protection Agency
Communications Community Change grant with community U
Thank you all for attending the Mayor's based organizations Mother Africa, Centro ii
• Annual BBQ! It was great to see everyone Rendu, and World Relief plus workforce M
from all our departments and to honor all training agent ANEW. The project, titled c
"Mill Creek Middle School: Healthy Creek, E
the hard work you do. Healthy Field" requests funding to make the E
Equity area less prone to flooding. This will ensure L)
• The REDI team continues to work on the safer, easier to maintain athletic fields for
Welcoming City certification. The certification is awarded by Welcoming students and enable KSD to provide athletic
America, a national non-profit working and recreational opportunities to
towards the inclusion of our immigrant neighborhood residents. It will also create
neighbors. The City will be audited this needed stormwater infrastructure in Kent's
upcoming February. The audit will look at dense urban core near transit. Deadline for
how the City and its partners collaborate to application is rolling through November,
make Kent more inclusive for all. with no firm date when the EPA may notify
applicants on grant success.
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Long Range Planning Team federal clearinghouse on-time during the
• Community Based Behavioral Health week of September 23, 2024.
Facilities Code Update: Over 140 survey • The 2023 Accountability Audit is nearly
responses informed final code amendment complete with only the Cash Receipting and
language. LUPB held a public hearing on Self-Insurance sections still in progress.
proposed code updates on September 23 • The General Ledger Unit is beginning some
and recommended council approve. pre-work for the 2024 reporting period. If
• 2044 Comprehensive Plan Update: The your department manages capital work in
project team is working to finalize drafts of progress or capital assets, they will be
each element. This includes extensive reaching out to review all year-to-date
coordination and technical expertise from activities.
Public Works, Parks, Police, Finance, and Budget:
ECD, as well as external agencies such as • The mayor presented her 2025-2026 a
Puget Sound Fire, school districts, and other Proposed Biennial Budget at 5pm on
utility providers. The draft Comprehensive Monday, September 23 at a Special Council =
Plan will be released in mid-October and Meeting. A Budget Workshop immediately
hearings will be in mid-November. Staff are followed where the Finance Director ;
also working to notify property owners of presented the economic outlook, a high- L)
proposed land use and zoning changes. level overview of the 2025-2026 citywide E
• The 2025 legislative session is gearing up! proposed budget, and then provided °
Staff have already received requests to detailed information on the changes to the
review and provide feedback on preliminary General Fund budget. Additional Budget a
concepts regarding subdivision processes Workshops will be held in October on the
and other efforts to streamline development 1st, 8th, and 15th. V_
reviews. 0
a
Current PlanningHUMAN RESOURCES
• Despite summer being the traditional end of )
construction season, recently initial
applications for some significant projects Interviews
were submitted. These include the new o Facilities Supervisor
Sound Transit Parking Garage at James and o Administrative Assistant 2
Railroad and the Mercy Housing mixed use o Combination Building Inspector N
development "Multicultural Village" located Workday T)
on the North TOD site at KDM Station. Final review of 2024 - 2027 CVS contract E
• Current Planning staff have also undertaken renewal. a
w
process improvement efforts to improve Negotiating contract with Workday Learning
efficiency generally and the transition to the content providers and preparing for
Amanda permitting system specifically. implementation stages. c
Submittal checklists for all land use . Continue reviewing Workday Major Release
application types have been revised to be 2024R2 - Go live 9/23/2024.
more customer friendly; and timelines for • Continue setup of Hive to track Workday
registered (aka stock plans) residential requests/projects. E
building plan permits have been shortened • Workday August 2024 Statistics U
through improved coordination across o 8847 - Total number of business
divisions. process events initiated during the
selected month.
o 220 - Total number of business process
events that were initiated by a manager
Accounting
during the selected month
o 46 - Total number of business processes
• The 2023 Federal Single Audit Report has completed including new hires,
been completed and submitted to the terminations, and job changes.
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o 63 - Total number of employee benefits • Sprint 3 of 4 underway for Business License
business processes completed in the System (Admin/Back Office module)
selected month. This includes Enhancements. Release to Production now
retirement savings changes, addition of expected in mid-Q4 for internal use.
dependents to an enrollment, new • Sprint 4 of 4 underway on IT Timesheet
enrollments, and changes to eligibility. Application for Project Management Office
Risk (PMO) and Applications Development
• Reserve Evaluation and Loss Forecast divisions to use in capturing time allocated
(Actuarial Report) has been finalized and to either Projects or Ops, but with a focus
sent to Finance for review. on whether the task is capitalizable or not.
Benefits Release to Production expected at the end
• Working with Alliant on Benefits renewals of Q3 for internal use.
for 2025 • Preparing to begin Sprint 1 of 3 for City Tax a
• Review/testing/implementation of Workday System Enhancements. Sprint starts
R2 updates October with a Release to Production
• Upcoming DRS Rate Changes effective expected end of Q4 for both external and
9/20/2024 internal use. ;
• Gathering information for FY23 Ongoing Technical Leadership support for L)
Accountability Audit Axon RMS and Black Creek JMS projects E
• Laserfiche discovery and planning phase alongside Police, Corrections, and the IT ,°
• Working with Employees and Managers on Project Management Office (PMO).
Protected Leave cases and ADA Ongoing operational support for GIS a
Accommodations system/servers, GoAnywhere integration for
Process Improvement jobs/servers, DevOps, and Data
• Providing ELT support for new building. Warehousing. a
• Providing summary of Emp & Mgr feedback Ongoing operational support for all custom
to CAO & Mayor. developed solutions that are in Production )
L
• Supporting ECD current planning team with (data and bug fixes as needed).
strengths finder & employee development Business Systems o
work. Infrastructure: Deployed monthly Microsoft >
• Ongoing support of new building patches to Servers and Workstation to W
conversations, internal communications. maintain security. N
• Government Performance Consortium • Amanda: Finalized Dev Portal Upgrade, .9
planning for remainder of 2024 and Q1 continued progress on Property Record E
2025. Management, and implemented additional a
w
Department Updates dynamic info pages in Portal for application
• Working through Kentsgiving Campaign requirements.
planning—pursuing donations, planning a PD: Finalizing operating system for new c
special event to celebrate the charity Akin, MDC deployment. M
and all of you! Communication went out Infrastructure and Security Operations Center •E
with instructions on the Department In conjunction with Quenten, quickly triaged =E
Games—let us know who will make up your and addressed Pinpad issue in Customer E
team by 9/6! Service that was preventing payment via U
Credit Card. Jeff was out of office, but
jumped in and was able to determine the
cause of the issue and resolve. Happy to
report all Pinpads are currently working
Administration normally.
• Ongoing coordination of IT's Completed installation of fiber cross connect
contract/procurement/accounting process. to imaging bench to provide 10 gig
Application Development connectivity. Worked with Facilities to get
fiber patch cable from closet to bench,
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connected to fiber loop running to City Hall the three cases confirmed for trial, one
for connectivity to imaging server and defendant pleaded guilty, one case was
bench switch. Advised Leslie of completion, dismissed for evidentiary reasons, and the
awaiting feedback regarding performance at third case was continued due to
imaging at bench. unavailability of the officer during the
• Work with Facilities to research / finalize scheduled trial date.
path for fiber connection between FS74 and Chief Prosecutor Sara Watson, together
KEHOC. Meet with Kris on site at 74 to with the King County Prosecuting Attorney's
research existing / best possible path, and Office, trained Kent Police Department
review and sign off on blueprints for route officers on the value of new supplemental
and needs for conduit. forms to be used during domestic violence
Project Management Office investigations. These forms support risk
• Replacing the Police Department's end of assessment and victim protection by a
life criminal record management system, ensuring comprehensive documentation,
Tiburon, with a scalable solution that will enhancing legal decision-making, and
integrate with other department systems serving as a central resource across the
for centralized management and legal system. ;
secure/encrypted data share. The solution Assisted and advised Parks Operations staff 0
will streamline the current PD system on the procurement of a tree removal E
landscape resulting in more efficient, contractor to complete work in North ,°
accurate tracking of records and Meridian Park.
maintenance contract savings in addition to Assisted and advised Police Department a
aligning with citywide initiatives. staff regarding the City's continued
• Connecting all the workspaces within each partnership with Public Health - Seattle & V_
of the City of Kent's Municipal courtrooms King County to promote pedestrian safety a
using purpose-built audio visual (A/V) through the Washington Traffic Safety
technology to enhance communication, Commission Walker/Roller Safety Grant. )
collaboration and digital information sharing Worked with staff to draft resolutions °;
capabilities. The technology enhancements recognizing new Neighborhood Councils o
will fully integrate with a parallel project to throughout the city. >
significantly modernize the accessibility and Assisted and advised Public Works and W
ergonomics of each courtroom sponsored by Economic and Community Development on N
the Parks-Facilities department. ARPA-related procurement and contracting •c
matters. E
• Assisted the Clerk's Office with processing w
and responding to large public records 2
requests. U
• Covered one Community Court calendar in Assisted the HR Department with a number c
September which included 124 cases spread of sensitive employment and labor-related
across 81 defendants, 46 of whom failed to matters.
appear. Just one of the defendants who Advised City departments on several '
appeared was out of compliance to such a procurement and contract matters related E
degree that a sanction was imposed; all to various ongoing projects.
others were demonstrating progress. . Assisted outside counsel on a number of
• Covered one Expired Bench Warrant cases currently in litigation.
Calendar in September which included 107 . Worked with staff to acquire the property
cases spread across 87 defendants, just two rights necessary to complete various
of whom appeared. projects throughout the city.
• The September jury term saw 105 cases set . Assisted the Neighborhood Response Team
for trial, three of which were confirmed for and code enforcement staff to address a
trial. 128 civilian witnesses were issued number of code enforcement issues
subpoenas for the September jury term. Of throughout the city.
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Significant crime
PARKS, RECREATION, AND activities/arrests/investigations
COMMUNITY SERVICES On September 6, officers were dispatched
to a suspicious vehicle at 23100 block of
Recreation and Cultural Services 128th PI. The car was stopped in the
• A showing of family film, IF, wrapped up bushes at the corner with a male passed
our series of three outdoor movies at out inside. When they arrived, the officers
Kherson Park on Friday, September 6. noted a scoped rifle in the car wedged
Approximately 60 people enjoyed the between the seat and console. The male
movie, as well as free ice cream treats and started moving around and one officer
Kent Parks swag. retrieved his 40. As the male stepped out
• The 2024-2025 Spotlight Series is set to of the car and started walking away, he was
kick off on Friday, September 20 with Ann ignoring all commands to stop. The officer a
Hampton Callaway's Sings The '70s. The winged him with a 40 round and the highly 0
Tony nominated Broadway star and intoxicated man finally stopped and was
platinum selling singer/songwriter covers taken into custody without further incident.
hits from the great songwriters of the time, On September 11, officers were dispatched o
including Carole King, James Taylor, Joni to a female stating she had been sex L)
Mitchell, Billy Joel, John Lennon and more. trafficked and trapped in a vehicle with a E
male claiming to shoot the female. WSP °
• New Traffic Signal Control Box Art Wraps g
are currently being installed in nine assisted and located the vehicle as it exited
locations throughout Kent. Look for the onto Willis. The female was interviewed and a
new artworks at 4th Ave. and Gowe St., SR provided resources. As she was not from
167 Northbound and SR 516 (Willis), 104th the area, Officers Peterson and Hans used
Ave. SE and SE 256th St., 102nd Ave. SE Project Be Free and Blue Bridge to find her a
and SE 240th St., 111th Ave. SE and Kent- housing for the night so detectives could
Kangley Rd., 108th Ave. SE and SE 208th follow up with her tomorrow. The male was L
St., 108th Ave. SE and SE 217th St., booked into King County Jail following
Pacific Hwy. S. (SR99) and 260th St., and medical clearance that was declined, and o
Kherson Park and 2nd Ave. the vehicle was impounded for a search
• Artwork by Rene Dickey and Johanna warrant. A lengthy and in-depth interview
Porter is on display in the Centennial revealed multiple other crimes in multiple N
Center Gallery through October 24. other jurisdictions both in state and across c
state lines. E
On September 11, an officer was dispatched w
to a recent theft from vehicle at the Dwell 2
Events and awards received at Kent Station parking lot. Upon arrival, he U
• Events: located a male standing near a vehicle c
o Ranger Master Sprague's Retirement which had been broken into and the male cc
Party - 9/15 took off on foot. The officer took off on foot .2
o Barbells & Badges Event at Imperial after him and quickly caught up. The male E
Crossfit - 9/19 was detained in front of the RJC. Upon his E
• Staff Changes/Off-Boarding/On- arrest, a firearm was located in addition to U
Boarding/Div Change/Promotions: other burglary tools. The owner of the
o CO Ofc. Ortiz, Brian - 9/12, Resignation vehicle had his firearm stored in the center
o CO Ofc. Johnson, Riheendd - 9/12, console and it had been taken by the
Resignation suspect. The suspect, a 15-year-old Kent
o Ofc. Stevenson, Kyle - 9/15, Resignation resident, was booked for Theft of a Firearm,
o Court Security Ofc. Fadler, Ed - 9/18, UPFA, Malicious Mischief, and Obstruction
End of Probation into King County Juvy.
• On September 12, an ex-BF of the victim
arrived at their apartment and threatened
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them with a gun. The suspect and two was conducted and 24 casings were located
others fled in a vehicle. KPD started a in the parking lot of Meeker Market located
pursuit. The pursuit was terminated by the at 1513 W Meeker Street. Surveillance
officers. Guardian-1 was over head and video showed that a fight occurred across
followed the suspect vehicle which collided the street at the 7-11 and an unknown
with another vehicle at 164/SE 272. A male subject was chased across the street by 1
and female fled on foot but were captured suspect on foot and the other suspects were
by PD. A second female who was trapped in in a gray SUV. Once at the Meeker Market,
the suspect's vehicle was removed. The the suspects opened fire at the unknown
male suspect driver was booked on several subject. Trailer 66 was struck by the gunfire
felony charges, and the vehicle was with one of the rounds going through the
impounded for search warrant. couch and into the sound system. All of the
• On September 13, 2024, an officer had a suspects got back into the gray SUV and
walkup at the K2 substation. The reporting fled the area westbound on Meeker Street.
party advised he was given a possible pipe Case referred to detectives.
bomb from a homeless man outside of the On September 17, an officer was dispatched -
Walgreens at 25605 104th. The reporting to a female hiding in the bathroom of the
party advised the male told him he found Banyan Tree located at Kent Station. It was 0
the device by the building near the drive- reported she had visible injuries to her face E
through pharmacy. The device was and did not speak English. The officer °
4-
retrieved from the reporting party and arrived to find the victim had confronted
placed in a secure area. The Port of Seattle her husband for cheating on her. As she Q
Police Bomb Squad was contacted and was investigating the content of his phone,
responded the scene. Video showed the he began assaulting her, to include L
suspect approach the front door from 104th strangling her until she lost consciousness. a
and linger near the planters on the N side of She stated she was out for an unknown
the main E entrance driveway before amount of time, then fled the apartment )
L
entering Walgreens. The explosive detection when he left for work. The officer quickly
K9 gave a positive alert to the presence of developed the probable cause for the o
explosives in the concrete divided area husband. Officers arrived at the apartment
where the suspect was seen on camera to find he was not there. He later pulled up
before entering the store. Nothing was in his vehicle as units were on scene. He N
located in a check there by the POSBS. was booked for Assault 1. c
• On September 14, at approximately 2:40 On September 17, an officer was dispatched E
am, Kent Police Officers responded to the 7- to a toned-out stabbing at the Public a
11 located at 18012 68 Ave S for a hold-up Storage at 25700 Pacific Highway South. An 2
alarm. The investigation revealed that two employee had called in and the victim and U
unknown males dressed in dark clothing suspects had both fled in separate vehicles. o
entered the store. The two males went The responding officer interviewed
behind the counter and one of the males witnesses and viewed video to determine •2
pulled a gun and demanded the cash from what occurred and following up with the
the safe. The employee was unable to open nearby Hospital which had called in with a E
the safe but gave the suspects the cash stabbing patient. Case was forwarded to U
from the two registers. The suspects fled detectives.
before the police arrived. Video surveillance On September 18, an officer conducted a
of the incident was obtained, and the case shoplift call at Old Navy. The reporting
was referred to detectives. party stated the same suspect had hit them
• On September 16, at approximately 3:24 for high dollar losses multiple times. An
am, Kent Police Officers were dispatched to additional officer not only identified the
the area of RENEW on James for an illegal suspect but located and arrested him on
discharge. Several residents called in DOC warrants the next day. Stolen items
stating they heard gun fire. An area search
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from Home Depot were found on him at the PUBLIC WORKS
time of arrest.
• On September 20, officers contacted an Survey
individual known to Police for violent crime Survey Field staff are staking construction
at the in-session Kent Valley Learning improvements on the Reith Road, 218th
Center. During this they saw a handgun Ave. and the boundary for McSorley
magazine in the vehicle. Due to the wetlands. Staff are also providing
individual being a convicted felon and on topographic mapping for the Meet Me on
DOC for Assault 2, the vehicle/bag were Meeker project, West Hill Transmission
seized for a warrant. Detectives were mains and HSIP projects on Canyon Drive
contacted and requested the case. and on 104th Ave SE. Survey Office staff
• On September 20, officers responded to a are preparing CIP project boundary records,
suspect who had attempted to shoplift at writing legal descriptions for the Meet Me on
Grocery Outlet. When confronted by the Meeker project and providing professional co
manager, the suspect assaulted the review of private and CIP projects.
manager and poked him in the eye amongst GIS staff are testing processes for Data
many other strikes. The manager held the Warehousing/Public Data Sharing, the New ;
suspect down until PD arrived. No force was GIS Request Portal and the Radio-read L)
used to take the suspect into custody. He water meter tracking. Planning continues on c
was booked for Robbery 2. the GIS Re-architecture project. GIS staff
• On September 21, an officer had a FLOCK continue support for the Lead Service Line
hit for a stolen vehicle at 101s' and 256t". public-facing web map and the Amanda/GIS a
He located the vehicle at 104t" and 256t" integration. Final reporting and process W
but lost it in traffic. It was relocated empty documentation for the Aerial Imagery V_
at Saar's Super Saver. While awaiting AFIS, Impervious Surfaces audit is being a
the suspect returned to the vehicle. A foot completed.
pursuit began with KPD officers arresting Environmental )
him. While searching the vehicle, officers Integrated Aquatic Vegetation Management 4'
located the ID of the female, who was Plan (Lake Meridian) Grant: Department of o
wanted by Skagit County for Robbery 1, Ecology grant awarded the city $30,000 for
Assault 2, Strangulation, and Kidnapping 1. the Lake Meridian Integrated Aquatic
She was located nearby after a failed Vegetation Management Plan Update. Draft N
attempt to change her appearance by agreement routed to Legal for review.
turning a black t-shirt inside out and was Consultant selection will be done once grant E
then arrested. agreement is fully executed. w
• On September 23, Officers were dispatched Lower Russell Habitat Area A: Grant
to the Washington Park Apartments for a acceptance is scheduled for COW
USPS worker who was delivering mail and presentation on October 1. c
was robbed at gunpoint. The reporting Boeing Rock Recreation/Habitat cc
party/Victim had the community mailboxes Enhancement: Grant acceptance is c
open and was placing parcels and mail into scheduled for COW presentation on October E
the boxes when a male, approximately 35 1. o
y.o., pointed a Block style firearm with a King County Flood Control District: McCoy U
weapon-mounted flashlight at him. Not Levee repair (downstream end of the
wanting to die over the mail, he backed off Horseshoe Bend) began construction by the
and allowed the suspect to take what he Corps of Engineers on the week of
wanted. The suspect then fled on foot. The September 16, 2024, and will go for about
victim was able to snap two photos of the six weeks.
suspect as he fled. A K9 track for the Green River Natural Resources Area
suspect was negative. Case forwarded to (GRNRA): Major theft occurred recently at
detectives for investigation. the GRNRA where controller boxes had been
opened and wirings stolen. Continue
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working with Ops staff to discuss the extent o Ecology's Ramp Grant: Next cleanup in
of damage, identify the remedy and November. Requesting the Department of
associated costs, and strategies for future Ecology for an additional $5,000 to
prevention. The most important first steps perform one additional cleanup of ramps
to recovery are to restore power and get during the 2"d quarter of 2025. Waiting
the pump operational again. Coordinating on the final decision.
with PW Operations (Wetlands group) on o Waste Reduction and Recycling (WRR):
purple loosestrife (an invasive nonnative The consultant (Cascadia) is preparing a
weed regulated by King County) control. scope of work to provide additional
Contractor's work completed for this year. technical assistance in Kent for business
Discussing management arrangements for outreach through the end of December
the site between Public Works and Parks. which will utilize WRR money. The two
• Vegetation Monitoring: All monitoring Kent McDonalds locations have shown a a
activities completed. Data processing and high interest in the program and have co
report writing started. requested additional site visits to
c
• Lake Fenwick Aerator Diffuser: Discussing evaluate their waste stream.
the proposal from Tetra Tech. Compiling • Cross Connection Control: Working with ;
data related to the aerator and diffuser other groups and departments about L)
redesign. Also contacting another revisions to the Kent Design and E
consultant to review the feasibility of Tetra Construction Standards (KDCS). Final °
Tech proposed modifications to the diffuser meeting scheduled on Tuesday, Sept 24 to
system. discuss proposed changes to CCCP-plans a
• S 124th Beaver issue -HPA application and associated KDCS language.
submitted. • Prism Data Base Replacement: Staff have
• Lakes Water Quality Monitoring - reviewed the database options and a
WaterWorks quarterly grant report narrowed it down to one favored database
submitted; working with King County Lakes that we are working with for replacing )
L
Stewardship on quarterly billing to match Prism.
the grant reporting schedule; coordinating Design o
with Parks and King County Lakes Sanitary Sewer Comp Plan: Received list of
Stewardship regarding algal blooms DRAFT recommended system improvements
monitoring and data sharing. King County with total project costs from consultant. N
Lakes Stewardship agreement will expire on Met with financial consultant on 9/4 to c
Dec 31, 2024. A new agreement will be share information necessary for financial E
executed for another three years. analysis, relooking at scope of work to w
• Site Clean-up (Mayor's Homeless Task confirm if other work is desired/necessary. 2
force/On-Call Garbage Contract/State Ramp 74th and Willis Intersection Improvements: U
Litter Clean-Up): ROW clean-up continues. Signed WSDOT Construction Agreement c
The 2"d round of September clean-up runs returned to WSDOT (with stipulation, W
this week. Next Task Force meeting on Sept contingent on TCP approval prior to start of •2
25. Coordinating with other agencies such construction).
as the Department of Ecology for Kent-Des 81st Stormwater Pump Station: 60% review c
Moines highway clean-up and Metro for bus sent out Aug. 21st with meetings completed US
stops throughout the city. with PW Sections. Working on 90% design
• TeamUp2CleanUp: The fall event is and will share with PW Sections by the end
happening on Sept 28. Registration is open of September 2024 for review.
and volunteers can sign up at KEHOC Design Support (Fiber and PSE
www.kentwa.gov/talkingtrash. Website is Electric): Contract for 2" conduit executed
updated. Distributed posters around town, for inside building and adding outside
partners, and schools. conduit to building from power pole area as
• Solid Waste Grants: a part of fiber project.
Page 8 of 13
Packet Pg. 11
5.B
• Woodford Ave South Storm Connection to
James St Pumpstation: Team is preparing,
contact documents for advertisement.
Advertisement date is to be determined.
• Mill Creek ReEstablishment - Little Property
Floodplain Channel: Coordinating with �, .
construction team to discuss -
constructability and contracting
preferences. Submitted response to
Muckleshoot Indian Tribe in efforts to
secure concurrence with channel cross-
_ .�
section.
• 2025 Pavement Preservation: Complete
Streets memo submitted to finalize process _ -- - CO
Sept 23. Team is outlining activities needed
c
to get design to 60%. —
U
• S 212th St Preservation - 59th PL S to ;
72nd Ave: 90% review distributed Aug 29. 0
Comments due Sept 25. E
• MMoM - Washington/Thompson Ave to Reith Road Roundabouts: Construction
Interurban Trail: Paperwork for obligation of detour is ongoing. Reith Road is closed from r
design funds is currently being routing for 253rd to Lake Fenwick Rd. Forming and
signatures. Preparing documents to obligate pouring of curb & gutter on the corners of
funds for Right-of-Way phase. 30% plans both roundabouts is ongoing. More curb and
distributed for review Sept 12. Comments gutter placement scheduled for this week. 0.
due Sept 26. Work on the block wall at the corner of
• S 224th St - Phase 3 East/Stage 2: Reith Road and 46th Ave is expected to be L
Reviewing roadway geometrics in complete this week. Electrical subcontractor 4
coordination with driveways and existing continues with underground work, setting o
infrastructure. Connected with utilities for light pole base rebar cages. >
participation in Joint Utility Trench. R/W W
exhibits prepared and in review by N
engineer. c
• S 196th St Preservation (WVH to EVH): . E
Preliminary design schedule prepared. w
• S. 224th St - Phase 3 West/Stage 1:
Meeting with Parks Sept 24 to discuss Soos
Creek discharge option at Garrison Park. - c
Construction
• Mill Creek / 761h Avenue S Culvert 4 U
Improvements: Backfill for SEW walls is x
ti
expected to be complete this week. Bridge °X ' o
subcontractor is preparing for north :',
All
driveway bridge deck pour; concrete pour
scheduled for 9/27. Setting rebar for south
driveway bridge deck this week. Currently
forming retaining wall 5 as well. Lightweight 2024 Pavement Preservation:
fill on 76th Ave has been completed. o 132"d Ave SE - Asphalt roadway paving
Contractor placing crushed surfacing over complete from 2401h to 22811 PI.
fill for roadway subgrade preparation. Contractor scheduling side street and
Lightweight fill on 76th Ave is taking place driveway apron paving.
this week.
Page 9 of 13
Packet Pg. 12
5.B
o Meeker Street - Work in downtown Kent
is scheduled to proceed the week of
October 7.
o SE 264t" St - four of the five new curb
ramps are complete. Work on the SW
corner of 264t"/104t" proceeded on
Monday (9/23). Gravity block wall and
storm culvert installation details being - --
ironed out, work required varies from 0.
plans. Contractor scheduling.
o SE 216t" - Speed cushion construction to Green River Bridge Repainting and Deck
started on Wednesday, 9/18. Milling of Repair: Closure of Meeker St implemented
pavement complete at (3) locations. on Monday, August 5. The contractor has
o SE 222 PI/223 St - milling of asphalt 'a submitted a request to extend the closure a
for (4) new speed cushions between for beyond September 29. Blasting and
108 Ave SE and 116 Ave SE complete. priming is complete. Painting is underway
o Striping for all locations is scheduled to and will continue for the following 2 weeks, c
take place beginning in the first week of followed by scaffolding removal. The bridge lu
October as weather permits. E
• Green River Bridge Repainting and Deck deck joint repairs and polyester concrete G
Repair: Closure of Meeker St implemented overlay will follow scaffolding removal.
on Monday, August 5 and will be in place Q.
until September 29. Scaffolding installation
on the bridge and under the bridge is
complete. Containment installation is a
complete and sealed. Blasting
approximately 90% complete on topside, _ L
hopefully complete this week. Scheduled toism
start below bridge next week. Painting o
prime coat has begun.
q
d
TO ' V
TH AVE,
ESOUTHBOUND • 18.2024 •
• S 218t" Street/98t" Avenue S from 94t"
_ Place S to S 216t" Street: The closure of S
218t" St / 98t" Ave S from 94t" PI S to S E
216t" St is being implemented on Tuesday, 0
September 12. This closure and its detour
routs will be in place until October 2025.
Large tree removal and utility potholing are
proceeding with the implementation of the
closure. Tree removal anticipated to be
complete this week. Storm drainage
installation to proceed on the week of
September 23. Reviewing Contractor RFP on
Page 10 of 13
Packet Pg. 13
5.6
PSE material supply. Material submittals are Street Vegetation staff pulled weeds,
being delivered and under review. pruned and raked beds at the PSE planted
Streets islands and at S 256t" St and W Meeker St,
• Street Maintenance crews prepared, poured maintained the planted beds and removed
new sidewalk, stripped forms, and backfilled the broken Ginkgo tree on W Meeker St,
sidewalks at 74t" Ave S, north of S 2591" St, mowed along 641" Ave S and operated the
at 401 4t" Ave N and at 1721 W Meeker St, spray truck, weather permitting, at various
cleaned the sidewalk on SE 256t" St locations citywide.
between 120t" Ave SE and 1271" Ave SE and The Sidearm mower crews mowed along SE
on SR 516, west of 156t" PI SE, cored for Kent Kangley Rd from 132nd Ave SE to 108t"
Engineering at S 196t" St and 81St Ave S, Ave SE, 132nd Ave SE from SE Kent Kangley
ground sidewalks on SR 515 between SE Rd to S 287t" St, W Valley Hwy from Willis
208t" St and SE 192nd St, swept sidewalks St to S 277t" St, S 223rd St from 108t" Ave
on 116t" Ave SE between SE Kent Kangley SE to SE 216t" St, 116t" Ave SE from S co
Rd and 108t" Ave SE, repaired shoulders 240t" St to SE Kent Kangley Rd, 152nd Ave =
with crushed rock at W Cloudy St and 2nd SE from SE Kent Kangley Rd to S 280t" St
Ave N, sawcut for removal and performed a and along 124t" Ave SE from SE 216t" St to ;
hot patch asphalt repair on 74t" Ave S, SE 192nd St. 0
north of S 2591" St, repaired the soundwall Wetland Mitigation crews line trimmed at E
at S 228t" St and 54t" Ave S and performed the Downey site and planted at the Hytek ,°
shoulder repairs at 409 3rd Ave S, 26110 site.
108t" Ave SE and on S 228t" St between Water/Sewer a
85t" PI S and 88t" PI S. Distribution crews have installed a vault lid
• Signs and Markings crews installed bases, and worked on asphalt and site clean-up at
replaced signs and updated the inventory the Meeker St Bridge project, potholed for a
for the retro-reflectivity program at SE Engineering at Woodford Ave N, installed a
224t" PI and 110t" Ave SE, installed bases log fence at Clark Springs, prepared for )
L.
and signs on S 228t" St, east of 88t" Ave SE, valve replacements on S 196t" St, 70t" Ave U
at W Titus St and 2nd Ave SE and at 93rd Ct S, 102nd Ave SE and SE 237t" St and o
S and S 243rd PI, core at SE 277t" St and repaired an Air Vac leak at Lake Fenwick Dr
108t" Ave SE, maintain signs on S 212t" and 515t PI S. Hydrant crews installed a new
Way from SR 167 to S 98t" PI, turn flags in hydrant at 8455 S 212t" St, poured a N
school zones and perform sign maintenance hydrant pad at 1721 W Meeker St, installed 'c
at various locations citywide. radio read meters on Railroad Ave S, drilled E
• Solid Waste staff cleaned up debris along S lids for Smart Point computers, prepared for w
228t" St from 84t" Ave S to 68t" Ave S and an air liquid meter swap, raised a valve can 2
along S 212t" Way from SR 167 to S 98t" PI, and installed a valve marker at 27232 72nd
removed graffiti at the Joe Jackson Bridge Ave S, installed new meters at Clark Lake c
and performed hot spot inspections, graffiti and performed hydrant operations at 104t" M
removal, and response to service requests Ave SE and SE 240t" St.
at various locations citywide. Sewer staff cleaned sewer lines at S 239t"
• Water Vegetation crews line trimmed and St and W Morton St, SE 222nd St and 100t" c
mowed at the Clark Springs water Ave SE and at Lakeside Blvd and 58t" Ave U
easements, Kent Springs Lower fence line, S, installed ecology blocks at the Vactor
the 208t" Ave SE Well, Blue Boy Tank, site, completed storm inspections for the
Garrison Creek Well, Woodland Way PRV, 2025 overlays at SE 111t" St and SE 225t"
Pump Station #2, O'Brien Well, Pine Tree St, performed a vacuum test at 124t" Ave
Water main Easement, Kent Springs Water SE and SE 256t" St for the Bernasconi
Main Easement, Pump Station #5 and at project, assisted the Pumpstation crews
Guiberson Reservoir and repaired the fence with asphalt work at Victoria Ridge and
at Armstrong Springs. performed weekly checks and asphalt
repairs at various locations citywide.
Page 11 of 13
Packet Pg. 14
5.B
Source, Supply and Pumpstations St, 101St Ave SE and SE 2081" St, SE 2161"
• Source and Supply staff replaced exhaust St and 112t" Ave SE and at SE 224t" St and
fan belts and removed a fan for the Benson Rd SE and NPDES pumping and
generator room at Pumpstation #5, repairs at various locations Citywide.
removed the hoist at Kent Springs, replaced Wetland Maintenance crews mowed and line
the heater in the control room at the East trimmed at Ramada Inn at 22318 84t" Ave
Hill well, ran the offline well, assisted with S, the GRNRA at 22306 Russell Rd, Pacific
the generator wiring at the Victoria Ridge Northwest Equipment at 7820 S 200t" St,
Sewer Lift Station, performed shoulder and Birdsong Meadows at 11623 SE 2315t PI,
fence work with the Storm section at Clark Linda Crest A at 12704 SE 202nd PI, Linda
Springs and inspected Pressure Reducing Crest B at 12524 SE 201s' PI, Signal Electric
Valves (PRV) at various locations citywide. at 3rd Ave S and S 2591" St, Redondo at
• Water Quality staff have operated, 23020 251" Ave S, the 64t" Ave P2 Channels
shutdown and prepared for a filter #2 at 22615 64t" Ave S and at the 72nd CO
media and valve actuator replacement at Diversion Channel at 21807 681" Ave S. r-
the 212t" Treatment Plant, worked on Holding Pond crews mowed and line —
U
September work orders and performed T- trimmed at the Ramada Inn (pond) at ;
run, disinfection byproducts and wellhead 22318 84t" Ave S, Top of the Hill at 24319 0
sampling at various locations citywide. 102nd Ave SE, Misty Meadows at 13003 SE E
• SCADA staff have replaced the 232nd PI, 277t" Corridor #3 at 27412 Green ,°
Uninterruptible Power Supply (UPS) and River Rd S, Bolger Rd at 23076 Bolger Rd,
installed a Verkada security camera at the Muth at 4611 S 215t" St, LID 336 at 8400 S a
Upper Mill Creek Dam, worked on 192nd St, Cambridge SP at 27023
troubleshooting errors with the Intouch Cambridge PI, Riverview at 4441 S 216t" St
logon and Win-911 and ran the generator and at Kentwood Glen 3 at 4425 S 257t" St a
alarms, decommissioned the old SCADA and line trimmed and cleaned up the
servers and tested the 74 PLC switchover frontage areas along Taylor's Glen at 15117 N
L
and installed a new Automatic Transfer SE 276t" PI, Nancy's Grove Division 1 at U
Switch (ATS) and worked on the generator 14871 SE 279t" PI and along Tahoma Vista o
wiring at the Victoria Ridge Sewer Lift at 25231 133rd PI SE. >
Station. Fleet/Warehouse
• Pumpstation crews continued the wiring The Warehouse crews have continued with N
work at Victoria Ridge, worked with staff training on Cityworks, warehouse
Bainbridge Electric to replace the Murphey purchase orders and other various E
controllers at Horseshoe Ridge, performed warehouse processes, worked on forklift w
sewer wet well cleaning, attended a power certification and recertification classes,
and telemetry meeting for GRNRA, and continued to assist with CDL training,
performed Sewer and Storm pumpstation maintained the shops yard, keeping it clean c
checks at various locations citywide. and free of litter and debris, cleaned and
Storm Drainage/Vegetation: maintained the wash rack, washed, and
• Storm crews performed pond repairs at vacuumed motor pool vehicles, issued
11202 SE 225t" St, 13227 SE 236t" PI, Personal Protection Equipment (PPE) and c
12807 SE 232nd PI and at SE 248t" St and motor pool vehicles to staff and hydrant U
1215t PI SE, cleaned lines for an overlay at meters and public notice boards to
103rd PI SE and SE 213t" PI, performed a contractors, repaired small equipment as
manhole and catch basin changeout at E needed, received parts and inventory
Willis St and Central Ave S, removed orders, picked up and delivered the inner-
material at the Johnson Creek Beaver Dam, office mail and hauled spoils as time and
and cleaned the shoulder area at Clark equipment were available.
Springs. Crews also performed National Fleet staff swapped an engine in a Ford
Pollutant Discharge Elimination System Escape for Engineering, received new
(NPDES) inspections at 98t" PI S and S 2081" vehicle builds, upfitted new vehicles,
Page 12 of 13
Packet Pg. 15
5.B
prepared vehicles for auction, sent multiple
vehicles to the body shop, sent bucket truck
#8850 to the dealer, worked on sidearm
mower repairs for Parks, performed air
brake inspections and worked on scheduled
and non-scheduled maintenance repairs.
CO
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Page 13 of 13
Packet Pg. 16
8.A.1
Pending Approval
City Council Workshop
• Workshop Regular Meeting
KENT Minutes
WAS HiNaTor+ September 17, 2024
Date: September 17, 2024
Time: 5:15 p.m.
Place: Chambers
I. CALL TO ORDER
Council President Kaur called the meeting to order.
Attendee Name Title Status Arrived
Satwinder Kaur Council President Present o
Bill Boyce Councilmember Present
John Boyd Councilmember Present °
a
Brenda Fincher Councilmember Present �-
a
Marli Larimer Councilmember Present
Zandria Michaud Councilmember PresentLn
a
Toni Troutner Councilmember Present r
Ln
14
II. PRESENTATIONS o
1 2044 Comprehensive Plan Update: Kristen 75 MIN. ti
Housing Element Holdsworth a
a)
CIO
Long Range Planning Manager, Kristen Holdsworth presented the Council
with the Housing Element Update for the 2044 Comprehensive Plan.
c
Background for Housing Element Updates:
Growth Management Act requirements
Changes required by state law, and to King County's Countywide Planning
Policies and the Puget Sound Regional Council's Regional Growth Strategy
Changes recommended by planning documents and assessments that focus a
on specific topic or policy area in the plan.
Kent Housing Options Plan ;
Kent Existing Conditions and Baseline Assessment
Changes driven by community input and staff recommendations.
A recap of recent State Housing Legislation was provided and Holdsworth
advised the City has already addressed Accessory Dwelling Units.
Holdsworth talked about HB1220's Housing Needs Allocation for Kent (10,200
new housing units) and also provided details on Eastside and South King
County Cities allocations.
The new state requirement to also plan on housing for levels of affordability.
Packet Pg. 17
8.A.1
City Council Workshop Workshop Regular September 17, 2024
Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
Holdsworth detailed the percent on new housing units needed by level of
affordability. Kent needs 28% of its new housing to be affordable to
extremely low income households. Kent also needs almost half of its new
units to be affordable for workforce and market rate.
Land Capacity Analysis describes the amount and types of land available for
residential uses in the City of Kent. It is conducted in several steps, as
follows:
1. Update 2021 King County Urban Growth Report to account for recent
development.
2. Remove acreage in critical areas and land needed for future right-of-way and
other infrastructure to identify net residential capacity. 4-
03. Apply assumptions for density, housing types, and income categories
M
consistent with the City's zoning designations. o
4. Report results by capacity for various housing types, density levels, and a
income categories. g
Range of assumptions to adjust for Kent's market (middle housing truly is
80%+ in South King County, not in Eastside). a
Holdsworth talked about historic federal practices that created barriers to �
housing that have disproportionately impacted communities of color, cm
restricting access to homeownership, neighborhoods of opportunity, and
financing. a
Holdsworth provided a recap of the Community Conversations. o
Increase opportunities for homeownership.
r
Provide opportunities for residents to live near employment and other
services by incorporating mixed-use development into areas that are
supported by transit, bicycling and pedestrian connections.
Naturally Occurring Affordable Housing:
Low-cost market rentals or unsubsidized rental housing, generally older
housing stock in established neighborhoods. a
Kent has the most naturally occurring affordable housing units of an city in
the subregion. c
There is a risk that these will no longer be affordable because they are
unrestricted/unregulated and there is an imbalance of supply and demand.
Summary of Major Changes to Goals and Policies:
Address new GMA, PSRC, and County requirements.
Increase housing variety and choice for all income levels.
Preserve affordable housing while minimizing and mitigating displacement.
Maintain naturally occurring affordable housing.
Leverage and expand partnerships.
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 2 of 3 Packet Pg. 18
8.A.1
City Council Workshop Workshop Regular September 17, 2024
Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
Continue to evaluate existing efforts to encourage housing:
• Multifamily Tax Exemption Program
SEPA Infill development
Upzones of parcels into proximity to high-capacity transit
Streamlined permit review.
Design guidelines updates.
STEP housing.
ADU code update
Middle Housing
a�
r
Holdsworth talked about the SKHHP Housing Capital Fund:
Awarded $7.1 Million over 2 years. 4-
5 new builds (600 units)
�a
Preservation of 20 units
0
2024 funding $4 million a
Kent has contributed about $7 million; two of the five funded proposals are in g
Kent.
a
Middle Housing Policy Implementation:
Middle housing is permitted outright in residential zones per State �
requirements. N
Kent has some flexibility in the type of middle housing permitted.
Must allow six of nine middle housing types. a
Middle housing creates additional home ownership opportunities. N
4-
0
Holdsworth highlighted updates with the Comprehensive Plan for zoning and a
r
Land Use Consolidation.
Update to Neighborhood Services Land Use includes:
1. Comp Plan Change:
Remove Townhome zones from implementing zoning options (only 1 lot)
Keep neighborhood commercial.
2. Zoning Code Change a
Remove gas stations as allowed use (only 1 gas station)
c
Holdsworth walked the Council through the next steps and future meetings.
Meeting ended at 6:00 p.m.
Ki,mb-eAey A. Ko-wwto-
City Clerk
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 3 of 3 Packet Pg. 19
8.A.2
Pending Approval
Kent City Council
• City Council Regular Meeting
KENT Minutes
WAS HiNaTor+ September 17, 2024
Date: September 17, 2024
Time: 7:00 p.m.
Place: Chambers
1. CALL TO ORDER/FLAG SALUTE
Mayor Ralph called the meeting to order.
c
2. ROLL CALL
Attendee Name T Status Arrived °
Dana Ralph mayor Present c
Satwinder Kaur Council President Present a
Bill Boyce Councilmember Present a
John Boyd Councilmember Present
Brenda Fincher Councilmember Present a
0
Marli Larimer Councilmember Present ti
Toni Troutner Councilmember Present
N
Zandria Michaud Councilmember Present N
ti
3. AGENDA APPROVAL 0
CIO
A. I move to approve the agenda as presented c
Chief Administrative Officer, Pat Fitzpatrick advised there will be an Executive
Session as per RCW 42.30.110(1)(b) - Selection of a Site or Property
Acqusition and an Executive Session as per RCW 42.30.110(1)(i) - Discuss
Anticipated Litigation with Legal Counsel. Executive Sessions are estimated
to last 45 minutes with no action following.
a
as
RESULT: MOTION PASSES [UNANIMOUS] a
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Troutner, Michaud
4. PUBLIC COMMUNICATIONS
A. Public Recognition
i. Proclamation Honoring Jaleen Roberts - 2024 Paralympics Medalist
Mayor Ralph presented the Proclamation Declaring Jaleen Roberts Day in the
City of Kent to Paralympics Medalist, Jaleen Roberts. Parks Director, Julie
Parasondola expressed words of appreciation of Roberts. Roberts and her
mom expressed words of appreciation of the Proclamation.
Packet Pg. 20
8.A.2
Kent City Council City Council Regular Meeting September 17, 2024
Minutes Kent, Washington
ii. Proclamation for Constitution Week
Mayor Ralph presented the Proclamation for Constitution Week to Anita
Speir, Recording Secretary of the Lakota Chapter, National Society Daughters
of the American Revolution and Speir expressed words of appreciation of the
Proclamation.
iii. Proclamation for National Diaper Need Awareness Week
Mayor Ralph presented the Proclamation for Diaper Need Awareness Week to
Jack Edgerton, Executive Director at KidVantage and Edgerton expressed
words of appreciation of the Proclamation. r
iv. Proclamation for Week Without Driving
Mayor Ralph presented the Proclamation for Week Without Driving to Kent o
Bicycle Advisory Board members Julie Dunn, Maria Castro and Prem Subedi
and Dunn expressed words of appreciation of the Proclamation. Q
a
v. Appointment to the Kent Special Events Public Facilities District Board g
Mayor Ralph recognized Randall Smith as an appointee to the Kent Special a
Events Public Facilities District Board.
ti
v
vi. Torklift Central's Annual Turkey Challenge o
N
Jasmyne Faborito, Marketing Director from Torklift Center and Sandra
Durbrow, Kent Foodbank Board Member and Kent United Methodist Church
Member invited the public to participate in the Annual Torklift Central Turkey N
Challenge that runs September 291" - November 3ra o
a�
B. Community Events
_
Council President Kaur announced upcoming events at the accesso ShoWare
Center.
Councilmember Fincher announced upcoming Spotlight Series events.
C. Public Safety Report a
Deputy Police Chief Matt Stansfield presented the Public Safety Report.
_
Deputy Chief Stansfield presented Officer Pat Baughman with the Chief's
Award for Professional Excellence.
Deputy Chief Stansfield presented the Chief's Award: Citizen Commendation
to Bentley Hendrickson, Esme Munguia, and Kylie Love for their actions on
July 16, 2024, in thwarting an attempted kidnapping.
Deputy Chief Stansfield announced the upcoming Community Event: Badges
and Barbells that will be held on September 19th from 6-8 p.m. at Imperial
Crossfit.
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 2 of 6 Packet Pg. 21
8.A.2
Kent City Council City Council Regular Meeting September 17, 2024
Minutes Kent, Washington
S. REPORTS FROM COUNCIL AND STAFF
A. Mayor Ralph's Report
Mayor Ralph announced she is working with directors, finance, and staff on
the budget and will present her budget during the special City Council
meeting on September 23, 2024.
B. Chief Administrative Officer's Report
Chief Administrative Officer, Pat Fitzpatrick advised his report is included in
today's agenda packet.
r
C. Councilmembers' Reports
Council President Kaur advised today's workshop can be viewed online. -
�a
Kaur serves as the Chair of the Puget Sound Clean Air Agency that recently 0
discussed the agency partnering with nonprofits in overburden communities. a
Kent is considered an overburden community with air pollution. g
Kaur serves on the King County Domestic Violence Initiative Taks Force that a
0
recently met in Council chambers and heard presentations from community
partners, including a presentation from Sergeant Landon Meyer on the N
Project Be Free program. N
ti
Councilmember Larimer provided an overview of the Economic and a
Community Development items on today's Committee of the Whole agenda.
4-
0
Councilmember Boyce serves on the Sound Cities Association Public Issues
r
Committee that is working on Operational Policies.
Councilmember Fincher advised of the new traffic control box art and also a�
invited the public to attend upcoming Spotlight Series Events.
CU
a
6. PUBLIC HEARING
Q
None.
7. PUBLIC COMMENT
None.
8. CONSENT CALENDAR
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 3 of 6 Packet Pg. 22
8.A.2
Kent City Council City Council Regular Meeting September 17, 2024
Minutes Kent, Washington
RESULT: APPROVED [UNANIMOUS]
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Troutner, Michaud
A. Approval of Minutes
i. Council Workshop - Workshop Regular Meeting - Sep 3, 2024 5:15 PM
ii. City Council Meeting - City Council Regular Meeting - Sep 3, 2024 7:00
PM
c
B. Appointment to the Kent Special Events Public Facilities District
4-
Board - Appoint
�a
MOTION: I move to appoint Randall Smith to fill the recently o
vacated Position 3 on the Public Facilities District Board to �-
a
complete the term ending August 31, 2026. g
C. Resolution Delegating Authority to Designate Costs for Bond a
Reimbursement - Adopt g
ti
MOTION: I move to adopt Resolution No. 2076, appointing the N
City's Finance Director as the agent authorized to designate N
certain expenditures for reimbursement from future tax- ti
exempt obligations, including bonds, that may be authorized a
and approved by the City Council in the future for issuance. cn
4-
D. Agreement with Siemens for Kent Commons Fire Alarm
Replacement - Authorize
c
MOTION: I move to authorize the Parks Department to contract
for fire alarm system parts and installation through a
Cooperative Purchasing Agreement with Siemens, and
CU
authorize the Mayor to sign all necessary documents, subject to
final terms and conditions acceptable to the Parks Director and
City Attorney. Q
a�
E. King County Veterans, Seniors, and Human Services Levy for
2024-2026 - Authorize
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.
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 4 of 6 Packet Pg. 23
8.A.2
Kent City Council City Council Regular Meeting September 17, 2024
Minutes Kent, Washington
F. Consultant Services Agreement with Akana for Construction
Management Services - Authorize
MOTION: I move to authorize the Mayor to sign a Consultant
Services Agreement with Cooper Zietz Engineers Inc., DBA
Akana, subject to final terms and conditions acceptable to the
Public Works Director and City Attorney.
G. 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 r
establishment of the Kent Valley Air and Space Manufacturing
Roundtable and invite the participation of local aerospace
4-
industry representatives. 0
�a
H. Accept the Morrill Meadows Park Renovation as Complete - o
Authorize a
a
Q
MOTION: I move to authorize the Mayor to accept the Morrill
Meadows Park Renovation project as complete and release a
retainage to Harkness Construction upon receipt of standard g
releases from the State and the release of any liens.
I. Waller Purchase and Sale Agreement - Approve N
MOTION: I move to approve the purchase of the Waller
property, located at 115 Naden Avenue South, for $140,000,
should the City and the property's owner agree on final terms
of the purchase and sale.
a�
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9. OTHER BUSINESS
A. Resolution to Support Proposition No. 1, Kent School District
415, Capital Projects and Technology Levy - Adopt
MOTION: I move to adopt Resolution No. 2077, that expresses
the Council's support for Kent School District Proposition No. 1, a
which will appear on the November 5, 2024, ballot, wherein
voters will be asked to approve an excess property tax levy to
support the renovation, expansion and improvement of school
facilities, and for safety and technology improvements to meet
the current and future needs of Kent School District students.
RESULT: MOTION PASSES [UNANIMOUS]
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Troutner, Michaud
10. BIDS
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 5 of 6 Packet Pg. 24
8.A.2
Kent City Council City Council Regular Meeting September 17, 2024
Minutes Kent, Washington
None.
11. EXECUTIVE SESSION AND ACTION AFTER EXECUTIVE SESSION
The Council went into Executive Session at 7:54 p.m. for 45 minutes.
At 8:39 p.m., Executive Session was extended for an additional 20
minutes.
A. As per RCW 42.30.110(1)(b) - Selection of a Site or Property Acquisition
B. As per RCW 42.30.110(1)(i) - Discuss Anticipated Litigation with Legal
Counsel
12. ADJOURNMENT
At 8:59 p.m., Mayor Ralph reconvened into regular session and at 9 p.m., c
adjourned the meeting. c
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Meeting ended at 9:00 p.m. a
K6mbv,r1ey A. Kota- o
City Clerk
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Page 6 of 6 Packet Pg. 25
8.A.3
Pending Approval
Kent City Council
• City Council Special Meeting
KENT Minutes
WAS HiNaTor+ September 23, 2024
Date: September 23, 2024
Time: 5:00 p.m.
Place: Chambers
1. CALL TO ORDER / FLAG SALUTE
Mayor Ralph called the meeting to order.
c
2. ROLL CALL
Attendee Name T Status Arrived °
Dana Ralph Mayor Present c
Satwinder Kaur Council President Present a
Bill Boyce Councilmember Present a
John Boyd Councilmember Present
Brenda Fincher Councilmember Present a
0
Marli Larimer Councilmember Present LO
R
Toni Troutner Councilmember Present le
N
Zandria Michaud Councilmember Present N
M
N
3. MAYOR RALPH'S 2025-2026 BIENNIAL BUDGET MESSAGE 0
CIO
Mayor Ralph presented her 2025-2026 Budget Message as follows: c
I am proud to present to you my proposed 2025-2026 biennial budget. This
proposed budget was prepared in collaboration with City Council, City
departments, and community members. As a result of that collaboration, I firmly
believe this budget is a road map that reflects the values of our organization and its
commitment to our community. It is why I am grateful that as City leaders, we have
shared values centered around benefiting our residents, businesses, and
visitors. I thank the City Council for its teamwork and commitment to
improvement so we can continue to make Kent a place we are all proud to call y
home.
c
Over the last several years, inflation has played a major role in our decision-
making process. With the Consumer Price Index for Urban Wage Earners and
Clerical Workers (CPI-W) for the Seattle-Tacoma- Bellevue area coming in at 40-
year record high numbers, we recognized a growth in expenditures would be
imminent. Over the last several years, we have certainly seen expenditures grow
rapidly. Inflation has exacerbated the City's structural imbalance as labor
contracts are tied, at least in part, to CPI-W. Outside of salaries and benefits,
operation and projects costs are on the rise as well.
Earlier this year, knowing inflation was going to impact the 2025-2026 biennial
Packet Pg. 26
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
budget, Council and staff agreed to maintain a status quo budget for this biennium.
You will see this budget does exactly that as well as provides several options for
restoration and stabilization. It was agreed that any budget request would be
accompanied by a revenue stream or expenditure reduction to support it. We also
collectively agreed to no new initiatives.
Within the $884 million total 2025-2026 biennial budget, $259 million is allocated
to the General Fund. The proposed General Fund budget has been established
with the intent to use some of the City's reserves in the General Fund to balance
the budget in both 2025 and 2026. Our reserves are above the required r
minimums, and this is the kind of use they were intended for.
4-
We have continued our commitment to equity in City projects, programs, and °
service delivery. The Race and Equity Division worked closely with community o
stakeholders and staff to develop the Council's Race and Equity Strategic Plan and a
have been working through actionable steps of that plan. This budget includes g
the use of ARPA funding to extend the Race & Equity Coordinator temporary
limited-term position through 2026. This position will continue to support the o
mandatory Title VI reporting on behalf of the City and serve as a consultant to IR
departments to assist with equity related matters while assisting in the N
implementation of the Race and Equity Strategic Plan. N
M
N
The City will continue to be on the forefront of transparency and accountability in
law enforcement. Recent laws on police reform changed how the Department N
4-
recruits police officers, interacts with the community, and provides service. The
Police Department expanded its recruiting efforts and as a result has been able to
attract qualified and diverse recruits. Over the last year, the Police Department
has become nearly fully staffed to available budget for the first time in many
a�
years. However, it is well established that Washington has the lowest rate of officers =
on a per capita basis as compared to any other state in the nation, and that the 2
number of officers in Kent is among the lowest in the State. Therefore, even at fully
budgeted staffing, Kent has a significant need for additional officers. To remedy this, a
earlier this year, the City's only legislative priority was to empower the City
Council to increase the sales tax councilmanically to fund public safety. If this had c
passed, it would have given us the opportunity to fund our police force bringing
our officer per thousand in alignment with just the average of other
departments across the State. Although this did not make it to the floor of the
legislature for a vote, the need is still there. This budget includes a modest
increase in our business and occupation tax (B&O Tax) to help mitigate some of
the immediate needs within our Police Department.
Over 50 of our 167 commissioned officers have a tenure of three years or less.
This has increased the responsibility of our Police Sergeants who have the duty to
provide direct supervision, mentoring, and development of these officers. That,
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 2 of 10 Packet Pg. 27
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
coupled with the changes in policing, has impacted the workload for our Sergeants.
The current nine officers per sergeant ratio is unrealistic and unsustainable. This
budget includes the addition of two Patrol Sergeants along with one Police
Officer, which will reduce the sergeant-to-officer ratio to one sergeant per five
officers. The three new positions will support the Patrol Division giving the Police
Department the ability to have a slightly increased presence on the street to
handle 911 calls and to patrol the City. Funding has also been added to the budget
to add a Correctional Sergeant allowing them the ability to supervise, mentor
and develop their Correctional Officers instead of being pulled to work a post.
With this additional position, two Correction Sergeants will be available to work
each shift. These additions will not get our staffing levels to where they need to be =
but will help to mitigate some immediate needs. We will continue our efforts with 4-
the legislature for additional funding options to fund our Police Department to °
necessary levels. o
L
Q
State-level police reform bills have made apprehending criminal suspects Q
significantly more challenging. In our continued response to regionally increasing 2
crime, this budget includes funding for advanced technology to fight and a.
investigate crime. We use drones daily for in-progress calls and crime scene
LO
photography. The drones we currently have are past their operational life and have N
operational security issues. This budget includes funding to replace three drones N
per year. In addition, this budget includes the purchase of the FUSUS platform. N
FUSUS is a real-time crime center platform that provides for the ability of
businesses and residents to allow the Police Department access to their cameras to 4-
help with investigations. FUSUS is designed in a way in which a private entity can
join by paying a small fee and in turn receive a box that plugs into their private
cameras. The Police Department will not have unrestricted access to the
cameras; they will only be able to see the cameras that are a part of the
FUSUS crime center. If an incident occurs within view of those cameras, the
Police Department can request access. If the private entity allows access, we can a
then pull video from their cameras right into FUSUS without having to go to their
location, attempt to pull the video, save it to a jump drive and then head back to a
the station to upload the video into Evidence.com. This technology will save our
detectives hundreds of hours of time each year.
In 2022, the City budgeted a portion of HB 1590 sales tax funding to support a
co-responder program. With those funds, the City partnered with the Puget Sound
Regional Fire Authority to participate in their FD CARES program. This program is
ongoing and is included in the 2025-2026 biennial budget. With the use of grant
funding, we were also able to partner with Project Be Free, an organization that
has been serving all of King County since 2022. Their focus is on serving the
entire family affected by Domestic Violence and has had a dramatic positive effect
on all those contacted, including our own officers. With the grant dollars coming to
an end, this budget includes $185,000 per year to continue the use of this
........ ......... ......... ......... ......... ......... ......... .........
Page 3 of 10 Packet Pg. 28
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
service. This funding will provide dedicated staffing from Project Be Free to respond
to Kent incidents. This is just another step in our commitment to our co-responder
programs. In the short time it has been instituted, we have seen a dramatic effect
within the department our officers with new tools to handle domestic violence calls,
as well as increased cooperation by victims and victim families in investigations.
While it is still too early in the program to grade effectiveness on recidivism, we fully
believe we will be able to show hard data that corresponds to recidivism going down
for domestic violence defendants.
The Police Department has recently created a Professional Standards Unit. This
unit is responsible for handling complaints that come into the department. c
Currently, it is largely a manual process to review complaints, comply with public 4-
records request requirements and track trends or common issues. To make °
efficiencies and to ensure transparency in how complaints are resolved, this o
budget includes funding to implement the Professional Standards Suite available a
in the Power DMS software. The Police Department currently uses Power DMS for Q
their policies and standard operating procedures. The Professional Standards 2
Suite securely manages internal affairs cases, has an early intervention program, a.
and has forms that allows for the easy tracking of use of force and pursuits as
LO
well as the ability to provide resolution to complainants. N
0
N
Serving in the police force often comes with high stress and intense demands, so it N
is important for our law enforcement personnel to continue to protect and serve to
the best of their ability by being mentally and physically fit. We support our N
officers mental and physical wellbeing through access to holistic wellness
services. This budget includes $30,000 to expand the opportunities available to
officers for wellness visits with a licensed mental health provider. The police
officer's role is stressful, emotionally draining, and physically taxing. Research has
a�
shown police wellness programs reduce on-the-job injuries, improve retention, and
help in recruiting new officers. Additionally, maximizing wellness in police staff a
protects our significant investments in training, equipment, and other personnel
costs. a
The workload for our probation officers has increased significantly as we have seen a
rise in mental health and drug cases which require more intensive supervision. This
budget includes the addition of a probation officer to help with the increase demands
of the job including providing support for general probation services, mental health
caseloads, and our growing DUI and Community Court programs. The Municipal
Court was awarded a $75,000 grant from Washington Traffic Safety Commission to
cover half of the costs of a probation officer position in 2025. The Municipal Court
will apply for the grant again; however, there is no guarantee that it will be
awarded. The remainder of the position in 2025 would be paid for by shifting a
portion of the Resource Coordinator's salary to be paid for out of the opioid
settlement dollars.
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Page 4 of 10 Packet Pg. 29
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
This budget includes the addition of an Assistant City Attorney for the Civil
Division beginning in 2026. Our civil attorneys have been managing an increased
workload, in both volume and complexity, while having a deficit in attorney work
capacity overall. This is due to priority being given to several large and
simultaneous projects, along with code enforcement issues relating to problem
properties that are difficult and time consuming to address. Other issues such as
the increase in encampment-related issues, major projects going on in the City, and
state legislative action contrary to City policies and governance have also added to
the workload. The volume and complexity of this work has necessitated this new r
position.
4-
The City's Permit Center continues to realize demands for service beyond their 0
capacity with current staffing levels. Beginning in 2025, Washington cities will be o
required to comply with unfunded State mandates that include shortened permit a
issuance timelines. Reporting requirements will increase and penalties will apply if g
timeliness requirements are not met. Offset by the revenues generated by the
Permit Center, this budget converts an expiring temporary limited-term Permit o
Technician position to a permanent position. This budget also converts two IR
additional temporary limited-term positions to permanent positions. One will be N
a Long-Range Planner and the other a Current Planner. Finally, the budget N
includes a new position within the Economic and Community Development N
Department to administer the City's flood plain certification program. A portion of
this position will be paid for out of the Drainage Fund. 4-
0
Kent Parks' newly developed Asset Management System opens unprecedented
opportunities to analyze and optimize Parks' operational workflows, assess the
condition of assets, and evaluate parks performance. This innovative system is a
a�
direct result of the dedicated efforts of our GIS Analyst position. The GIS Analyst is =
essential in managing our assets and providing technical support for all geospatial 2
data created within the system. This role ensures the accurate collection,
maintenance, and analysis of spatial data, which is crucial for informed decision- a
making. This budget converts the expiring temporary limited- term position to a
permanent position allowing the Parks Department to optimize operational c
efficiency by streamlining maintenance schedules, prioritizing repairs, and allocating
resources more effectively. It will enhance asset condition monitoring through
regular assessments and document the condition of park assets helping us to
identify potential issues before they become costly problems. We will be able to track
park performance by tracking and analyzing park usage and visitor satisfaction.
Finally, it will foster community engagement through the use of interactive maps
and data visualizations to engage with the community, soliciting feedback and
promoting park programs and events.
This budget extends the temporary limited-term Parks Program Coordinator position
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Page 5 of 10 Packet Pg. 30
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
at the Senior Center through 2026 allowing the Parks Department to review its
business model for the Senior Center and create a long-term viable solution for
the Center that would be addressed with the mid-biennial budget adjustment or
next biennial budget. This budget also extends the temporary limited-term
Facilities Capital Projects Manager which is currently slated to expire in May 2025
for an additional three years. With large projects such as the Kent East Hill
Operations Center, there is no doubt that additional support will be needed to keep
all projects moving forward.
The Kent Commons Community Center currently has a part-time Program Assistant
position who supports community education programming, handling essential c
tasks such as contracts, billing, payments, onboarding, and general program 4-
support. This role also assists with registration, office coverage, special events, and °
recitals when available. The demands on this position have grown significantly o
and the workload has exceeded what this part-time position can manage a
effectively. To address this issue this budget increases this position to full-time. Q
This adjustment will create a sustainable workload, allow for consistent office 2
coverage, as well as the ability to manage duties effectively during times of a.
lunch breaks, illness, and vacation. To cover the increased cost of this position, the
LO
Parks Department has reduced its part-time line items within the Recreation N
Division. The result will be to ensure that our Commons staff can meet the N
growing demands efficiently and continue to provide high-quality service to our N
community.
In 2023, dedicated staff hours were allocated for encampment management as
part of the Natural Resources team, with the expectation that additional staff time
would provide the necessary resources.
a�
However, the demand for encampment response remains high, currently
consuming 65% of available staff time. These same staff resources are also a
responsible for trail maintenance and community stewardship events via the
Green Kent program. Annually, 10 to 15 locations require contracted services, with a
typical costs ranging from $3,000 to $5,000 per day for one to two days of work,
not including the variable disposal costs. To effectively manage this ongoing issue,
this budget includes an additional $75,000 each year to support contracted
encampment cleanup services.
Kent Parks, through its Recreation and Cultural Services Division, proudly delivers
the Spotlight Series to Kent and surrounding communities. This series showcases a
diverse range of performers across multiple genres and styles, enriching our
community's cultural landscape. These performances serve an estimated 2,500 to
3,000 people annually. The associated costs for these events have risen sharply.
To sustain the quality and reach of the Spotlight Series, this budget includes an
increase of $55,000 for the Spotlight Series to ensure we can continue to deliver a
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Page 6 of 10 Packet Pg. 31
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
robust cultural program that benefits the entire community. The increased cost is
offset by a reduction of under-utilized budgeted line items.
The use of our Parks has been increasing and changing rapidly over the last
several years. This requires our delivery of services to evolve. In 2024, our Parks
Department explored a one-time pilot program in which it used a contracted
security firm to provide support to manage high-use park locations such as Lake
Meridian, Van Doren's, Hogan, and West Fenwick parks. The pilot program was
successful. The current use of contract security services to supplement park staff
securing of both park buildings and parking lots has already shown a reduction
in illicit use specifically in parking lots within our park system. While this has not c
eliminated all issues, it has been a positive step in responding to these trends 4-
that have created a demand on police responses. This program currently includes °
the lock up of park restroom buildings and parking lots at 28 locations to 0
discourage use outside of normal park operating hours. This budget includes a
$50,000 per year to continue this program. Q
Security and safety of our city employees and facilities have been in the o
forefront of our minds as we have seen continued growth in theft, vandalism and R
LO
acts of violence. We are seeing vandalism occur regularly at several parks' N
locations. The repair and replacement of doors, restroom dividers, lighting and N
other elements of park facilities are straining existing budgets. Because of this, we N
are dedicating $50,000 per year to cover the increased costs in this area.
4-
Over the last couple of years, we have worked to increase employee safety
through upgraded security measures at our facilities, having field staff double-up
when working in high-risk areas, distributing staff safety training videos, and
implementing a pepper spray policy. The meter reading staff have been
p 9 P pp p Y p Y• 9
experiencing safety issues in the field while reading meters and shutting off
delinquent accounts. At its current staffing levels, the Meter Reader group is unable a
to double-up in some areas due to the growing number of new meters and the
increased number of delinquent accounts requiring shutoffs. This budget includes a
the addition of one Meter Reader to allow for better workflow, a more manageable
workload for city meter staff, and the ability to double-up on routes where c
needed, increasing the safety of our employees.
The Drainage Fund has close to 400 sites to mow and trim during the growing
season. In the past, we have tried to use a temporary position to help with this
work. Unfortunately, it is difficult to retain temporary help as they tend to seek
out permanent positions which leaves our crew short-staffed and unable to
maintain all of the sites that the Drainage Vegetation team is responsible for.
Using funding from the temporary positions budget, this budget includes the
addition of a permanent, full-time Drainage Vegetation Maintenance position.
Page 7 of 10 Packet Pg. 32
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
This budget also extends a temporary limited-term Design Engineer which is set to
expire in June 2025. This position will continue to support current and upcoming
work. The City has been successful with grant applications and have been
awarded grants from regional funding partners such the Transportation
Improvement Board and Puget Sound Regional Council. This position will
ensure we can deliver on current commitments without the costly expense of a
consultant.
With the use of some of our Fleet fund balance, this budget includes the
replacement of 13 pieces of major equipment for Parks and Public Works for
assets that are past their useful life and are in need of replacement. The c
equipment includes a variety of mowers, tractors, woodchippers, flatbed trailers, 4-
vehicle/cart and portable light towers. 0
0
Finally, this budget includes investment in the City's capital program. a
a
East Hill North Community Park - Roadway Improvements. The Parks
Department was awarded approximately $2.5 million from the State Department of a.
0
Commerce to develop the East Hill North Community Park. This budget includes an R
LO
additional $1.5 million to support near-term improvements along 132nd which will N
improve pedestrian connectivity from the neighborhood to the park, opening the N
way for a more modest set of improvements at the park including limited parking, N
a restroom building and trails. The roadway improvements along 132nd would a
likely include an extruded curb separated walkway along the eastern edge of the N
4-
road with rectangular rapid flashing beacons at 218th and 214th with a short 0
segment of elevated boardwalk between 214th and 216th. These improvements
would tie-in with trail improvements in the park, creating safe bike and pedestrian
access to the park and facilitate future expansion.
a�
c
Roundabout Project Design Funding. A single lane roundabout at the a
intersection of the of 116th Ave SE and SE 248th Street is a project identified in the
City of Kent Transportation Master Plan. This intersection has high congestion a
during the morning and afternoon commutes and is within proximity to Kent East
Hill Operations Center, Puget Sound Regional Fire Authority Station 74, the YMCA,
Clark Lake Park, Morrill Meadows Park, Martin Sortun Elementary and George
Daniel Elementary. Relief of this congestion would be beneficial to the
commuters on the East Hill, emergency responders as well as employees
working at KEHOC. Multi-modal enhancements would be improved at this
location. In order to be ready to take advantage of granting opportunities, this
budget includes $300,000 for the design of the project. We will be at a greater
advantage for grant funding with the design complete.
Technology. During this biennium, the City will continue to invest in technology
by funding hardware and software lifecycles with approximately $1.7 million
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Page 8 of 10 Packet Pg. 33
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
each year in addition to $3.4 million in additional capital projects over the
biennium. Many of these improvements are intended to support our IT security
zero trust architecture approach and align with the recent IT reorganization
that helped us further focus on bolstering our security and contract
accountability.
Some of technology projects include:
• Replacement of the City's Council & Committee meeting minute, agenda,
and video management software ($135,000).
• Updates to iNovah, the City's point-of-sale system to ensure PCI
compliance which is designed to protect cardholder data ($36,000).
• Improvements to the City taxes and business licensing systems
($499,000).
• Modernization and security of our Active Directory services by establishing o
a new hybrid on premise and cloud-based environment ($200,000).
• Migration of the Telestaff solution from the Kronos Private Cloud to Google o
Cloud as required by the vendor ($110,000). a
• Integration with Valley Comm's new CAD (computer aided dispatch)
vendor, Versaterm, with Axon Records and to ensure this new system
a
works smoothly with Kent Police Department's mobile devices ($70,000). o
• Replace and create the integrations from the legacy Corrections jail LO
management system, Tiburon, to the new BlackCreek system ($133,000). N
• Replace the current database used to manage Stormwater Program N
workflows, including NPDES (National Pollutant Discharge Elimination N
System) and FOG (Fats, Oils, and Grease) and Erosion Control workflow
with updated software that can support enterprise systems integrations N
and collaboration to streamline the manual current state processes within
Public Works Environmental Engineering ($300,000).
Tonight, I respectfully transmit the 2025-2026 budget to the City Council for
consideration. There is a tremendous amount of demand for City services. Our job
as City leaders is to remain fiscally responsible, anticipate future challenges, and 2
a
move this City forward. I believe this proposed budget accomplishes all of these
obligations. a
This document is a representation of the collaborative efforts of City leadership, City
Council, City staff and the Kent community. I would like to extend my gratitude to
Chief Administrative Officer Pat Fitzpatrick, department directors and their staff for
the dedication and hard work that was put into this budget process. Thank you to the
Finance Department, particularly Finance Director Paula Painter, Financial Planning
Manager Michelle Ferguson, and her team, Kathleen McConnell and Shane
Sorenson, who masterfully navigated this budget process.
Thank you all for your hard work, collaboration, and your willingness to continue to
move Kent forward. Our residents, businesses and visitors are counting on it and
deserve nothing less.
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Page 9 of 10 Packet Pg. 34
8.A.3
Kent City Council City Council Special Meeting September 23, 2024
Minutes Kent, Washington
4. ADJOURNMENT
Mayor Ralph adjourned the meeting.
Meeting ended at 5:31 p.m.
Ki4 Ley A. Kamoto-
City Clerk
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Page 10 of 10 Packet Pg. 35
8.A.4
Pending Approval
City Council Workshop
• Workshop Special Meeting
KENT Minutes
WAS HiNaTor+ September 23, 2024
Date: September 23, 2024
Time: 5:35 p.m.
Place: Chambers
I. CALL TO ORDER
Council President Kaur called the meeting to order.
Attendee Name Title Status Arrived
Satwinder Kaur Council President Present o
Bill Boyce Councilmember Present
John Boyd Councilmember Present °
a
Brenda Fincher Councilmember Present �-
a
Marli Larimer Councilmember Present
Zandria Michaud Councilmember Present a
Toni Troutner Councilmember Present M
Dana Ralph Mayor Present
N
O
II. PRESENTATIONS M
1 2025-2026 Biennial Budget Paula Painter 75 MIN. a
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Finance Director, Paula Painter presented the Council with details on the °
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2025-2026 Biennial Budget. °J
Painter provided an overview of the Economic Outlook, including the fiscal
cliff, streamlined sales and use tax, inflation, and discussed whether their
might be a recession. ICU
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Painter provided an overview of the 2025-2026 revenue and expenditure a
summaries for all funds.
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The position summary by departments were reviewed from 2024 through
2026.
Painter detailed the General Fund Revenue Summary for 2024 through 2026
and talked about the revenue sources and major revenue changes.
Painter walked the Council through the B&O Tax Increases and compared
rates with surrounding jurisdictions.
Painter detailed the major revenue changes to the general fund.
Packet Pg. 36
8.A.4
City Council Workshop Workshop Special September 23, 2024
Meeting Kent, Washington
Minutes
......................................................................................................................................................................................................................................................................................................._...............................................................................................................................................................................................................
Expenditure assumptions included salary increases, self-insured health plans,
retirement plans, supplies, services, and insurance allocations.
Painter reviewed general fund expenditures by department and major
expenditure changes relating to full time employees.
Painter closed by providing the upcoming meetings, workshops and advised
the plan is to adopt the budget during the December 10, 2024, regular
meeting.
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Meeting ended at 6:20 p.m.
O
Kerley A. Kavnata- >
City Clerk a
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Page 2 of 2 Packet Pg. 37
8.B
KENT
WASH IN G T O N
DATE: October 1, 2024
TO: Kent City Council
SUBJECT: Payment of Bills
MOTION: I move to approve the payment of bills received through 8/31/24
and paid on 8/31/24 and approve the checks issued for payroll 8/16/24 -
8/31/24 and paid on 9/5/24, all audited by the Committee of the Whole
on 9/17/24.
SUMMARY:
Approval of payment of the bills received through: 08/31/24
and paid 08/31/24
Approval of checks issued for Vouchers:
Date Document Numbers Amount
08/31/24 Wire Transfers 10317 10327 $ 2,424,397.44
08/31/24 Regular Checks 781304 781703 $ 7,334,527.61
08/31/24 Payment Plus 106209 106243 $ 131,569.02
Void Checks $ -
Void Payment Plus $ -
08/31/24 Use Tax Payable $ 1,780.34
Total Accounts Payable: $ 9,892,274.41
Approval of checks issued for Payroll: 08/16/24-08/31/24
and paid 09/05/24
Date Document Numbers Amount
09/05/24 Checks $2,501,698.85
Voids and Reissues $0.00
09/05/24 Advices FR&P 463779 463785 $4,541.59
Total Payroll: $2,506,240.44
BUDGET IMPACT:
09/17/24 Committee of the Whole MOTION PASSES
RESULT: MOTION PASSES [UNANIMOUS]Next: 10/1/2024
7:00 PM
MOVER: Bill Boyce, Councilmember
SECONDER: John Boyd, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Michaud, Troutner
Packet Pg. 38
8.0
KENT
WASH IN G T O N
DATE: October 1, 2024
TO: Kent City Council
SUBJECT: Appointments to the Kent Human Services Commission -
Confirm
MOTION: I move to confirm the Mayor's appointment to the Human
Services Commission: Korlette Bird, filling the remainder of a term that will
expire on January 3, 2026, and Devan Mitchell, filling the remainder of a
term that will expire on February 15, 2026.
SUMMARY:
Korlette Bird - Position 9
Four-year term ending 1/3/2026
Korlette and her husband have lived in Kent for 32 years as they raised their 6
children. They have owned 2 small businesses, and both currently work in Kent for
larger companies. Korlette is interested in the safety, economics and pleasure of
living and working in the city of Kent.
Devan Mitchell - Position 5
Four-year term ending 2/15/2026
Devan was born and raised in the Seattle area and graduated from Sammamish
High School in Bellevue. Devan has worked in the banking industry for 14 years and
is married with two little girls, Emmaline and Naomi. He and his family have lived in
Kent for the last three years.
SUPPORTS STRATEGIC PLAN GOAL:
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
Packet Pg. 39
8.D
KENT
WASH IN G T O N
DATE: October 1, 2024
TO: Kent City Council
SUBJECT: Appointments to the Kent Parks and Recreation
Commission - Confirm
MOTION: I move to confirm the Mayor's appointments of Vicki Pettigrew,
Ahmed Abukhater and Crystal Goodwin to initial terms on the Kent Parks
and Recreation Commission for a three-year term starting October 1, 2024.
SUMMARY: The Kent Parks and Recreation Committee was created to foster local
input on the strategic planning efforts that influence Kent's parks and recreation
system and provide guidance on the following:
• Ways to advocate public support, involvement, and funding of Kent parks,
facilities, and programs;
• Opportunities to engage the public in decisions affecting Kent parks, facilities,
and programs;
• Budget recommendations for the acquisition, development, and operation of
parks, facilities, and programs;
• Policy recommendations;
• Comprehensive parks and trails planning;
• Priorities for the acquisition of land and/or facilities;
• Development, design, and operation of parks, facilities, and programs;
• Capital improvements planning;
• Rules, regulations, or other restrictions applicable to parks, facilities, and
programs;
• Concessions at park facilities;
• Contracts, interlocal agreements, and lease agreements regarding parks and
recreation activities.
• Other matters that the mayor or city council or parks director may refer to
the Parks and Recreation Commission for its consideration and recommendation.
After an extensive recruitment process that included social media posts, Mayor's
newsletter and emails to community-based organizations, in September of 2024,
Vicki Pettigrew, Ahmed Abukhater and Crystal Goodwin were interviewed by the
Director of Parks, Julie Parascondola, and the current Parks Commission Chair
Sarah Veele and were selected to advance for final review by myself and were
appointed October 1, 2024.
Packet Pg. 40
8.D
Vicki Pettigrew is a retired Boeing employee with 43 years of service. She resides
next to one of Kent Parks and wants to be a better ally to help make better
decisions regarding park usage. She was a former member of the Parent Education
program and has also served as a leader for Boy Scouts and Girl Scouts.
Ahmed Abukhater An award-winning author and TED speaker, Dr. Ahmed
Abukhater (GISP, AICP) is an architect, environmental scientist, and urban and
regional planner by trade. He is recognized globally as one of the top thought
leaders, strategic consultants, and innovators in intelligent cities, smart growth,
geospatial and navigation solutions, sustainable community development,
transboundary water resources management, and conflict resolution. Government
organizations, corporations, and universities on every continent have implemented
his ground-breaking work in these fields.
Throughout his career spanning well over 20 years and across over 100 countries,
he served in various senior and executive positions in governmental and non-
governmental organizations, including Boeing, NASA, Trimble, Pitney Bowes, and
Esri. Dr. Abukhater has held faculty appointments at the University of Washington,
the State University of New York, the University of Texas at Austin, and Seattle
University. As a practitioner, he strives to promote a holistic approach to addressing
modern community and organizational needs through proactive community
engagement, participatory planning and collaborative decision-making, and the
creation of innovative human-centric technology solutions. He is a big advocate for
connecting people, places, and activities by creating livable, vibrant, and resilient
communities that offer opportunities for people to work, live, and play while
fostering our community's physical and mental health.
Crystal Goodwin During her professional career, Crystal has worked in the K-12
education system as a Spanish Dual Language teacher, Academic Intervention
Specialist, and building administrator. She has taught locally in Washington and
internationally in Colombia. She has her Master of Education in Instructional Design
and Master of Science in Curriculum and Instruction. She has served on the finance
committee, board development committee, equity committee and board
governance committee. In her most recent role, she has partnered with the
Washington Office of Superintendent of Public Instruction concerning their
Statewide Proficiency Initiative for Languages and Leadership as a means of
informing technical assistance for the World Language standards review and
revision.
I am pleased to appoint Vicki Pettigrew, Ahmed Abukhater, and Crystal Goodwin to
the Kent Parks and Recreation Commission for a three-year term expiring
September 31, 2027.
SUPPORTS STRATEGIC PLAN GOAL:
Packet Pg. 41
8.D
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.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
Packet Pg. 42
8.E
140
KENT
DATE: October 1, 2024
TO: Kent City Council
SUBJECT: Accept the 2024 Asphalt Grinding Project as Complete -
Authorize
MOTION: I move to authorize the Mayor to accept the 2024 Asphalt
Grinding Project as complete and release retainage to Statewide Parking
Lot Service, Inc. upon receipt of standard releases from the State and the
release of any liens.
SUMMARY: The project included planing asphalt pavement to prepare the surface
for overlay. Asphalt overlay work was performed by the City's Streets crew.
The final contract total paid was $73,625.00, which is $33,625.00 under the original
contract amount of $107,250.00
BUDGET IMPACT: Work is budgeted out of the Street Fund.
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Packet Pg. 43
8.F
140
KENT
DATE: October 1, 2024
TO: Kent City Council
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.
Packet Pg. 44
8.F
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)
09/17/24 Committee of the Whole MOTION PASSES
RESULT: MOTION PASSES [UNANIMOUS]Next: 10/1/2024
7:00 PM
MOVER: Satwinder Kaur, Council President
SECONDER: John Boyd, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Michaud, Troutner
Packet Pg. 45
8.F.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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City of Kent,#0036900
This Group Agreement will continue in effect until terminated or renewed as herein provided for and is effective 2
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8.F.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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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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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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8.F.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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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
Packet Pg. 48
8.F.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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8.F.a
Your
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8.F.a
KAISER PERMAN ELATE.
Kaiser Foundation Health Plan of Washington
A nonprofit health maintenance organization
2024 Evidence of Coverage N
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8.F.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.
2 COE931-0036900
Packet Pg. 52
8.F.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
z
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
3 COE931-0036900
Packet Pg. 53
8.F.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.
0
Sterilization...................................................................................................................................................37 U)
SubstanceUse Disorder.................................................................................................................................37 c
0
TelehealthServices.......................................................................................................................................39 i
Temporomandibular Joint(TMJ)..................................................................................................................40
Tobacco Cessation.........................................................................................................................................41
m
Transplants....................................................................................................................................................41 ti
0
UrgentCare...................................................................................................................................................42
V. General Exclusions......................................................................................................................................42
VI. Eligibility,Enrollment and Termination...................................................................................................44 N
A. Eligibility. ..............................................................................................................................................44 Y
B. Application for Enrollment....................................................................................................................44
c
C. When Coverage Begins..........................................................................................................................46 d
E
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
4 COE931-0036900
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8.F.a
Effectof Medicare.........................................................................................................................................54
XI. Subrogation and Reimbursement Rights..................................................................................................55
XII. Definitions....................................................................................................................................................56
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5 COE931-0036900
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8.F.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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0
Contact Kaiser Permanente Member Services at 206-630-4636 or toll-free 1-888-901-4636 for benefits questions. 3
Q
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.
0
U)
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.
m
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.
6 COE931-0036900
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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.
N
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.
c
0
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
0.
0
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.
7 COE931-0036900
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8.F.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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8.F.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
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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.
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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.
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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
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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.
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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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8.F.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
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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
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2. Plan Coinsurance. L
After the applicable annual Deductible is satisfied,Members may be required to pay Plan Coinsurance for 0
Covered Services. M
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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.
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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.
11 COE931-0036900
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8.F.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
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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
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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
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Pre-existing Condition No pre-existing condition waiting period 7V
Waiting Period
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12 COE931-0036900
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8.F.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
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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.
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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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8.F.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_
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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.
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through our network provider,Medically Home. -W
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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: .2
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• 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.
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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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8.F.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
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condition. 0
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• 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)
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• 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. 65
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
t
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.
0
U)
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
ti
interrupted. c
T
Clinical trials require Preauthorization. i
d
N
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. 66
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
t
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
m
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. 67
8.F.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
J
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
d
N
Annual Deductible does not apply to strip-based Y
blood glucose monitors,test strips,lancets or control
solutions.
d
E
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. 68
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. 69
8.F.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. 70
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. 71
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. 72
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. 73
8.F.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. 74
8.F.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. 75
8.F.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. 76
8.F.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. 77
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. 78
8.F.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. 79
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. 80
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. 81
8.F.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. 82
8.F.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. 83
8.F.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. 84
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. 85
8.F.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. 86
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. 87
8.F.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. 88
8.F.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. 89
8.F.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. 90
8.F.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. 91
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. 92
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. 93
8.F.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. 94
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.
m
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. 95
8.F.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
L
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. 96
8.F.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
T
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.
M
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. 97
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
T
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. 98
8.F.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. 99
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
•L
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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8.F.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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8.F.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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0
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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8.F.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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8.F.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
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8.F.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
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8.F.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
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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
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8.F.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 L0
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, 0.
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 m
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. 108
8.F.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
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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
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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. 109
8.F.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
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— Written information in other formats(large print,audio,accessible electronic formats,and O
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other formats) 3
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— Assistive devices(magnifiers,Pocket Talkers,and other aids)
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• Provide free language services to people whose primary language is not English,such as: j
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— Qualified interpreters
— Information written in other languages L))
If you need these services,contact Member Services at 1-888-901-4636(TTY 711). v0J
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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
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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. 110
8.F.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
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1-888-901-4636(TTY 711)-Li ---,-i 91 oIA�h1 o.
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PYCCKHH(Russian):BHNMAHNE! ECAm Bbi roBopmTe n0-pycCKW,Bann AOCTynHbi 6ecnnaTHbie ycnyr" to
nepeBOALIMKa.3BOHHTe no Homepy 1-888-901-4636(TTY 711). v
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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)
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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
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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
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1-888-901-4636(TTY 711) J�Z. JS 'oj i Z-C Z:: �'�<tE t L x o .2
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kanfaltiidhaan ala,ni argama. 1-888-901-4636(TTY 711)irraatti bilbilaa.
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Hilfsdienstleistungen zur VerfOgung. Rufnummer: 1-888-901-4636(TTY 711). Q
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XB0001444-58-22
61 COE931-0036900
Packet Pg. 111
8.F.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.
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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.
0
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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. 112
8.F.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.
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2. Subsection 3.1.k,is hereby added to the contract. It reads: N
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Solely as a convenience, Claims Administrator will make available the provider directory of in network J
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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
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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. 113
8.F.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
L
a.
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. 114
8.F.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. 115
8.F.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:
a�
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. 116
8.F.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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8.F.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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8.F.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
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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. 119
8.F.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. 120
8.F.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
E
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. 121
8.F.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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8.F.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.
0
• 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
:0
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
a
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. 123
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
1 of 4
Packet Pg. 124
8.F.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
0.
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
0
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
2of4
Packet Pg. 125
8.F.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.
L
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.
0
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
7i
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
3 of 4
Packet Pg. 126
8.F.b
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;
0
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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8.F.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. 128
8.F.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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8.F.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. 130
8.F.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. 131
8.F.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. 132
8.F.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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LifeWise Assurance Company L)
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by J
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Ben Helsel
President o
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8.F.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. 134
8.F.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
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140
KENT
DATE: October 1, 2024
TO: Kent City Council
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)
09/17/24 Committee of the Whole MOTION PASSES
Packet Pg. 136
8.G
RESULT: MOTION PASSES [UNANIMOUS]Next: 10/1/2024
7:00 PM
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Michaud, Troutner
Packet Pg. 137
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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 D)
Terrace Neighborhood Council. 'E
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RECITALS o
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A. The City of Kent has developed a Neighborhood Program to 0
promote and sustain an environment that responds to residents by building o
partnerships between the City and its residents. In addition, the City of
Kent encourages residents to work together to form geographically distinct r
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
councils by endorsing a process to establish neighborhood boundaries,
approve neighborhood councils, and provide neighborhood grant matching a
program opportunities to make improvements in defined neighborhoods. i
C. The Hillshire Terrace neighborhood consists of sixty-eight y
households. _
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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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the Hillshire Terrace Neighborhood Council and to allow the neighborhood
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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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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
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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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October 1, 2024 U
DANA RALPH, MAYOR Date Approved 00
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Hillshire Terrace Ho( eowners Association
CONFIDENTIAL: for the use of homeowners and residents only
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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
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8.H
KENT
WASH IN G T O N
DATE: October 1, 2024
TO: Kent City Council
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 218t" 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)
09/17/24 Committee of the Whole MOTION PASSES
Packet Pg. 142
8.H
RESULT: MOTION PASSES [UNANIMOUS]Next: 10/1/2024
7:00 PM
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Michaud, Troutner
Packet Pg. 143
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RESOLUTION NO. 2079
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A RESOLUTION of the City Council of the
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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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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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ATTEST:
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October 1, 2024 0
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
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140
KENT
DATE: October 1, 2024
TO: Kent City Council
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)
09/17/24 Committee of the Whole MOTION PASSES
Packet Pg. 148
8.1
RESULT: MOTION PASSES [UNANIMOUS]Next: 10/1/2024
7:00 PM
MOVER: Satwinder Kaur, Council President
SECONDER: Bill Boyce, Councilmember
AYES: Kaur, Boyce, Boyd, Fincher, Larimer, Michaud, Troutner
Packet Pg. 149
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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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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
Packet Pg. 150
8.I.a
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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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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October 1, 2024
DANA RALPH, MAYOR Date Approved 0
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ATTEST: ~
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KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted N
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_-ESURVEY MAP AND PLANS FOR; 8.I.a
SPRINGWOOD TOWNHOMES, A CONDOMINIUM
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9.A
140
KENT
DATE: October 1, 2024
TO: Kent City Council
SUBJECT: Presentation Re: Purchase of Building for Municipal
Services Center and Plan for Renovating Centennial Center
for City Hall and Police Services
SUMMARY: Staff is presenting a proposal that asks the Council to consider
investing in a new municipal services building at 20610 68t" Ave. S. in the
CenterPoint Office Park development and moving its Police headquarters and
Council Chambers into a new City Hall in the existing Centennial Center at 400
West Gowe Street. These initiatives aim to address current facility deficiencies and
space needs and position the city to better serve its growing population for decades
to come.
Kent has seen significant growth in the past decades with general population
growth and annexations. As the City has grown from 17,000 to approximately
140,000 over the past 50 years, the availability of space has not kept pace with
growth. There is a significant need for space for the Kent Police Department which
is currently housed in a retrofitted building that was built in 1974 and originally
served as a library. At the same time, the Kent City Hall building is in need of
significant and costly repairs, including a seismic retrofit, plumbing, electrical, and
elevator improvements. The costs of these needed improvements is significant, and
when completed, will not provide for any additional space.
These issues are not unique to Kent. Other jurisdictions are facing similar
challenges as the region grows. For example, Tukwila recently constructed a new
public safety building at a cost of $69 million, Lacey just started construction on a
$61.5 million public safety building, Marysville constructed a new municipal building
at a cost of $53.8 million, and the cities of Puyallup and Federal Way are grappling
with space shortages. Mercer Island is also facing a significant challenge as its City
Hall has been deemed uninhabitable.
If the City Council approves the purchase, the City will co-locate multiple city
departments, which are currently split between City Hall and the Centennial Center,
into the new municipal services building located at 20610 68th Ave S. Built in 1983
and renovated in 2003, it offers over 81,000 square feet of office space on a 5.54-
acre site, with nearly 350 parking spaces. With capacity for more employees, the
building should accommodate Kent's anticipated growth over the next 20 years.
The new municipal services building offers significant opportunities to explore future
green technologies, such as solar panels and energy-efficient HVAC systems, which
will reduce operational costs and the city's environmental footprint. The city is
Packet Pg. 154
9.A
exploring grants and other funding to support these sustainability initiatives.
As part of this facilities plan, the Centennial Center will serve as the new home to
City Hall and Police headquarters. Council Chambers will be moved from the current
City Hall building to the first floor of the Centennial Center. In addition to housing
the Council Chambers, the first floor of Centennial/City Hall will have office space
for the Council and meeting spaces for the Council and community.
The remainder of the new City Hall building at the Centennial Center will house the
Police Department headquarters. This move will consolidate Police Department
operations which are currently spread across three buildings, and will allow for
sufficient space to house officers, detectives, and specialty units, as well as provide
space for investigative interview rooms, evidence storage, and training.
This proposal underscores the City's commitment to maintaining a transparent and
accessible local government. By keeping the Council Chambers downtown,
residents can easily participate in city governance, attend meetings, and connect
with elected officials. Maintaining City Hall downtown also ensures that the most
visible elements of Kent's government remain at the heart of the community.
The combined investment in the municipal services building and the renovation of
the Centennial Center into a new City Hall and Police headquarters is projected to
cost significantly less than constructing a new building or retrofitting the existing
City buildings. It is anticipated that the cost to purchase and renovate the municipal
building at CenterPoint and to renovate the Centennial Center (new City Hall) to
house Council Chambers and Police headquarters will cost between $43 and $63
million. Accounting for the scale of the building needed for Kent, the sixth largest
city in Washington, this is much less that the cost other cities in the region have
faced when constructing new buildings.
The City intends to fund the purchase of the municipal building and the conversion
of the Centennial Center into the new City Hall and Police headquarters through
existing capital funds and the issuance of bonds. The bond issue will be repaid over
30 years from existing funding resources within the City's Capital Resource Fund,
which is a funding source different than that used for funding police and other staff.
If approved, the City will retain a consultant to assist the City in planning for the
space at the new municipal services building. This will be a months-long process
that will ensure that the layout of the building is such that the City can realize
efficiencies in strategically locating various departments. An expected move-in date
would be estimated to occur in 2026 with completion of the renovation of the
Centennial Center estimated to occur in 2027.
The City Council will hear a presentation regarding the proposed plan at its October
1, 2024, City Council Meeting. If Council choses to move forward, it will consider
the approval of the purchase of the CenterPoint building at a special Council
meeting on October 8, 2024.
SUPPORTS STRATEGIC PLAN GOAL:
Packet Pg. 155
9.A
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.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Draft PSA (PDF)
Packet Pg. 156
9.A.a
PURCHASE AND SALE AGREEMENT
This PURCHASE AND SALE AGREEMENT ("Agreement") is by and between BOEING
EMPLOYEES' CREDIT UNION, a Washington state credit union(`BECU"or"Seller"),and the City of Kent,a
Washington municipal corporation("City"or"Purchaser"). BECU and the City are each individually referred to as
a"Party"and collectively as"the Parties." _
RECITALS >
0
A. Seller owns approximately 5.54 acres or 241,167 square feet of real property in King County,
Washington,legally described on Exhibit A and generally depicted on Exhibit A-1,each attached hereto and made a
part hereof. The Property (as defined in Section 1) is located at 20610 681 Avenue South, Kent, WA 98032 and ,o
consists of tax parcel number 012204-9021.
a
B. The Property that is the subject of this Agreement includes the real property,any improvements and -0
fixtures located on the real property, any rights, privileges, and easements appurtenant to the Real Property, any
furniture, fixtures and equipment("FFE")located within the structure on the real property, Seller's rights(if any)in
all intangible property related to the Property (including names and permits) and, at Purchaser's option, certain
contracts in connection with the ownership and maintenance of the Property, which shall be transferred, conveyed, c�
and assigned by a Bill of Sale and Assignment of Contracts substantially in the form attached hereto as Exhibit
the original of which Seller agrees to execute at Closing.
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C. Under the terms and conditions set forth herein,Purchaser desires to acquire the Property. N
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0.
NOW, THEREFORE, in consideration of the terms and conditions of this Agreement, and the mutual •�
covenants contained herein,the Parties agree as follows:
1. Property. O
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1.1. Agreement to Sell and Purchase Property. Seller agrees to sell and shall convey to
Purchaser,and Purchaser agrees to buy and shall acquire from Seller,upon and subject to the terms and conditions set 3
forth in this Agreement,the property described on Exhibit A,together with:any structures,improvements and fixtures o0
located on the real property;any furniture,fixtures and equipment("FFE")and other personal property located within p
the structure on the real property; any easements, appurtenances, rights, privileges, including without limitation all d
minerals,oil,gas and other hydrocarbon substances on and under the real property subject to any prior restrictions of z
record;any and all development rights,air rights,water,water rights and water stock relating to the real property;all 2-
trees, timber rights, shrubbery and plants, now in or on the real property; improvements thereunto belonging or a
appurtenant to the real property;all right,title and interest of Seller in and to all alleys,strips,or gores of land,if any,
lying adjacent to the real property;all utilities serving the real property;all right,title and interest of Seller in and to
all rights-of-way,rights of ingress or egress,or other interests in,on,or to,any land,highway,street,road,or avenue, c
open or proposed,in,on,or across,in front of,abutting or adjoining the real property(collectively,the"Property"). W
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2. Purchase Price. The total purchase price for the Property payable to Seller by Purchaser,inclusive d
of the Earnest Money Deposit(as defined in Section 3),is Eleven Million Two Hundred Fifty Thousand and 00/100 a
Dollars($11,250,000.00)(the"Purchase Price"). The Purchase Price,less the Earnest Money Deposit,shall be paid
in cash at Closing(as defined in Section 11.4),and is based on the understanding that if Purchaser were to condemn M
the Property, Seller would be entitled to receive just compensation for the Property. Purchaser and Seller agree that
no portion of the Purchase Price shall be allocated to tangible personal property for sales/use tax purposes. Q
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3. Earnest Money. Within three(3)business days of the Effective Date,Purchaser shall deposit into a
escrow(the "Escrow")with Fidelity National Title, Attn: Megan Packwood, megan.packwood@fnf.com("Escrow
Agent")the amount of One Hundred Fifty Thousand and 00/100 Dollars($150,000)(the"Earnest Money Deposit"). C
All cash deposited into escrow by Purchaser,if the deposit is in cash,shall be deposited by Escrow Agent at a federally
insured institution in an account and on terms selected by Purchaser and approved by Seller. All interest earned will
become part of the Earnest Money Deposit, and all references herein to the Earnest Money Deposit shall include all
accrued interest thereon. Unless Purchaser terminates this Agreement in accordance with this Agreement,or if Seller coo
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9.A.a
fails to timely cure a default or fails to meet Purchaser's closing conditions,the Earnest Money Deposit shall become
non-refundable(except as otherwise provided herein),but shall be applicable to and credited from the Purchase Price
at Closing. If Purchaser fails to deposit the Earnest Money Deposit within five(5)days from the time period required ar
pursuant to this Section 3,then this Agreement shall automatically terminate,and neither party shall have any further
right against the other except as expressly set forth herein.The Earnest Money Deposit is sometimes referred to herein U
as the"Deposit." _
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4. Title Review;Title Condition.
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4.1. Title Commitment. Within seven (7) days from the Effective Date, Seller shall cause
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Fidelity National Title, Attn: Megan Packwood, megan.packwood@fnfcom ("Title Company") to deliver a ,o
preliminary commitment for an owner's standard coverage policy of title insurance covering the Property, naming
Purchaser as the insured and in the amount of the Purchase Price,together with full and complete legible copies of all a
recorded items or exceptions disclosed therein(the"Commitment"). Seller covenants and agrees to convey a good
and marketable title in fee simple absolute,and remove on or before Closing any(i)exceptions for real estate contracts,
mortgages,deeds of trust,assignments of rents and leases,financing statements and any other liens or encumbrances
for monetary liabilities or obligations to other persons or entities,(ii)exceptions for the payment of real estate excise,
sales, conveyance or stamp taxes and any delinquent real estate taxes, and (iii)exceptions relating to Seller's due U
authorization, execution and/or delivery of the deed to Purchaser (the "Seller Encumbrances"). Purchaser shall,
within ten(10)days of receipt of the Commitment or with five(5) days of receipt of any supplement thereto,notify n
Seller in writing if Purchaser objects to any of the encumbrances shown on the Commitment or supplement,other than
the Seller Encumbrances; provided, however, that regardless of whether Purchaser delivers a Notification, Seller U
agrees that all monetary encumbrances or liens recorded against the Property (other than installments of local Q70
.
improvement districts not yet due and payable,and other than taxes and utilities to be prorated as of Closing)shall be 0
paid or discharged by Seller on or before Closing. If Purchaser objects to an encumbrance(s),Seller shall,within five 3
(5) days of such Purchaser's notice, notify Purchaser in writing whether Seller will remove the objected-to 2
encumbrance(s). If Seller fails to respond within five(5)days, Seller shall be deemed to have elected not to remove o
the objected-to encumbrance(s). If Seller elects not to remove an objected-to encumbrance(s),then Purchaser's sole a�
option shall be,by written notice to Seller within ten(10)days from Seller's declaration(or deemed declaration) of
non-removal,to(i)accept the objected-to encumbrance(s)as a Permitted Exception,or(ii)terminate this Agreement,
in which case the entire Earnest Money Deposit, whether identified as "refundable" or"non-refundable") shall be m
refunded to Purchaser, and neither party shall have any further right against the other except as expressly set forth o
herein. If Purchaser fails to respond within said ten(10)day time period,then Purchaser is deemed to have terminated d
this Agreement, in which case the entire Earnest Money Deposit shall be refunded to Purchaser, and neither party M
shall have any further right against the other except as expressly set forth herein. Other than the Seller Encumbrances i
or any Seller monetary encumbrances or liens recorded against the Property, all other encumbrances not objected to a
by Purchaser, or objected to but then subsequently waived by Purchaser, shall be deemed permitted exceptions
("Permitted Exceptions"). The Closing Date shall be extended as necessary to allow for the time periods set forth
herein for objections and responses thereto. c
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4.2. Condition of Title. Seller covenants to convey the Property in condition to be insured by c
the Title Company as hereinafter provided. Closing shall be conditioned upon Title Company issuing or committing y
to issue to Purchaser an extended coverage ALTA,within Purchaser's reasonable discretion,(2006 or such other form a
of policy requested by Purchaser) owner's policy of title insurance in the amount not less than the Purchase Price,
insuring a fee simple absolute interest in the Property vested in Purchaser free and clear of all matters except the M
Permitted Exceptions, and the lien of current real property taxes not yet due and payable (the "Title Policy"). In
addition,Purchaser shall have the right to obtain a mortgagee policy and such endorsements as Purchaser may request
in its sole discretion. If title is not insurable at Closing subject only to the Permitted Exceptions determined in
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accordance with this Agreement,Purchaser may(a)elect to proceed to Closing despite such non-insurability,thereby a
accepting any such matters as Permitted Exceptions,or(b)terminate this Agreement and receive a refund of the entire
Deposit. p`
5. Possession;Prohibited Transactions.
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5.1. Possession. Purchaser shall be entitled to possession at Closing.Seller shall not be entitled U
to remove any furniture, fixtures, equipment or other personal property from the Property prior to Closing,but shall Q
PAGE
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Packet Pg. 158
9.A.a
remove any such items identified by Purchaser for Seller's removal. The parties agree to cooperate with one another
in the removal of any furniture,fixtures,or equipment identified by Purchaser for Seller's removal. Should the parties E
agree,the removal need not be completed prior to Closing,but shall be completed prior to December 31,2024,unless ar
the parties mutually agree otherwise. Seller agrees that it will coordinate in advance its removal of any furniture,
fixtures,or equipment the Purchaser identified for removal so that Purchaser's representative can remove and secure U
any cable,coil,fiber,or other wiring to protect against damage and preserve its future use. _
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5.2. Prohibited Transactions. Until the Closing or earlier termination of this Agreement: c
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5.2.1. Encumbrances. Seller may not allow or create any lien, encumbrance or charge
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on the Property without promptly discharging the same on or prior to the Closing. ,o
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5.2.2. Compliance with Agreement. Seller shall not knowingly and intentionally take a
any action, or omit to take any action, which action or omission would have the effect of violation of any of its -0
representations,warranties,covenants and agreements contained herein.
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5.2.3. Existing Debt. Seller shall not amend,modify or increase any notes secured by
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any existing deeds of trust or mortgages, if any, or any other documents encumbering the Property nor request an V
extension, postponement, forgiveness, or indulgence of the holder of such deeds of trust or mortgages without the
consent of Purchaser.
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5.2.4. Maintenance of Property. Seller shall (i) not commit any waste, damage, or N
nuisance; and (ii) promptly advise Purchaser of any litigation, arbitration, or administrative hearing before any E
governmental agency concerning or affecting the Property. 23
.2
3
6. Representations and Warranties. 2
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6.1. Seller's Representations and Warranties. Seller represents and warrants to Purchaser that
the following facts are true as of the date of Seller's execution hereof and as of Closing, or as of such other date as
may be set forth herein:
3
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6.1.1. Organization, Standing, Authority. Seller is in good standing under the laws of p
the State of Washington and is qualified to transact business in Washington State. Seller has full right, power, and N
authority to execute and deliver this Agreement and to consummate the purchase and sale transactions provided for z
herein without obtaining any further consents or approvals from, or the taking of any other actions with respect to, 2
any third parties. This Agreement,when executed and delivered by Seller and Purchaser,will constitute the valid and a
binding agreement of Seller,enforceable against Seller in accordance with its terms.
6.1.2. Liti ag tion. There is no action,suit,investigation or proceeding(administrative or o
otherwise)pending or threatened against or affecting the Property or any portion of it.
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6.1.3. Title. Seller has good,marketable and indefeasible title to all of the Property free
and clear of all liens,claims and encumbrances except for the Exceptions accepted by Buyer pursuant to Section 4.1 a
above.
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6.1.4. Hazardous Substances. To Seller's knowledge: (i)no hazardous or toxic material
or substance, as such terms are defined under applicable local, state and federal laws and regulations, have been a
deposited either intentionally or unintentionally by Seller, and the Property does not contain any such materials or CO
substances (ii)the Property does not contain underground tanks of any kind; (iii)the Property does not contain and $
does not produce polychlorinated biphenyls, urea formaldehyde, asbestos or radon gas; (iv) the Property does not
contain toxic mold;and(v)there are no surface or subsurface conditions which constitute or with the passage of time
may constitute a public or private nuisance. Seller has not undertaken any of the foregoing activities and has not
caused or allowed any of the foregoing conditions to exist on the Property. The parties acknowledge that Seller has
made no investigation with regard to hazardous materials or substances on the Property in order to make this
representation,and that no such investigation is required by the terms of this Agreement. M
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Packet Pg. 159
9.A.a
6.1.5. Leases. There are no other leases, tenancies, licenses or other agreements
affecting the occupancy of the Property other than those delivered to Purchaser pursuant to this Agreement.
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6.1.6. Documents. Seller represents and warrants that the Documents provided in
Exhibit B are complete copies of all of the documents known to be in Seller's possession or control. V
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6.1.7. Non-Foreign Person. Seller is not a"foreign person"as such term is defined in
Section 1445(f)of the Internal Revenue Code of 1986,as amended. c
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6.1.8. Mechanics'Liens. To the extent any improvements,repairs or maintenance have
L
been made or will be made to the Property prior to Closing which might form the basis of mechanics' and ,o
materialmen's liens,Seller agrees to keep the Property free from liens which might result or cause the Title Company
to remove or insure over, at or prior to Closing,any such lien as an exception to coverage in the Title Policy,and to a-
indemnify,defend,protect and hold Buyer harmless from any and all such liens and all attorneys'fees and other costs -0
incurred by reason thereof.
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6.2. Purchaser's Representations and Warranties. Purchaser represents and warrants as =
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follows: (�
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6.2.1. Organization, Standing, Authority. Purchaser is a municipal corporation duly n
organized,validly existing and in good standing under the laws of the State of Washington. Seller acknowledges that
Closing is expressly conditioned on the Kent City Council's prior authorization to buy the Property under this N
Agreement, which may or may not be granted in the City Council's sole discretion. Purchaser shall not be liable or M
obligated for any burden,loss or damages,financial or otherwise,incurred by Seller as a result of the City Council's .0
modification of the final terms and conditions of this Agreement,or the City Council's failure to grant the authorization E
required to proceed to Closing.As-Is. Purchaser agrees to accept the Property subject only to the specific 2
representations and warranties set forth in this Agreement. Except as expressly set forth in this Agreement, the `-
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Property is being sold in an"AS IS"condition and"WITH ALL FAULTS"as of the Closing Date. Except as expressly
set forth in this Agreement, including without limitation in Section 6.1, no representations or warranties have been
made or are made and no responsibility has been or is assumed by Seller or Seller's affiliates as to any matters
concerning the Property,including,without limitation,the condition or repair of the Property or the value,expense of pap
operation,or income potential thereof or as to any other fact or condition which has or might affect the Property. The p
parties agree that all understandings and agreements heretofore made between them or their respective agents or N
representatives are merged into this Agreement and any exhibit hereto which alone fully and completely express their z
agreement,and that this Agreement has been entered into after a reasonable investigation,or with the parties satisfied 2-
with the opportunity afforded for a reasonable investigation. Purchaser is not relying upon any statement or
a
representation by Seller unless such statement or representation is specifically embodied in this Agreement or any
exhibit annexed hereto. To the extent that Seller has provided or will provide to Purchaser information from any
inspection,engineering or environmental reports prepared by third parties concerning any asbestos or harmful or toxic =
0
substances, Seller makes no representations or warranties with respect to the accuracy or completeness,methodology
of preparation or otherwise concerning the contents of such reports other than the representation that these are the
complete reports in Seller's possession or control. In furtherance of the foregoing, except as expressly provided in y
this Agreement, Seller makes no representations or warranties as to the truth, accuracy or completeness of any a
materials,data or other information prepared by third parties. It is the parties' express understanding and agreement
that such materials prepared by third parties are provided only for Purchaser's convenience in making its own M
examination and determination as to whether it wishes to purchase the Property. The above disclaimers shall constitute
a directive to Purchaser to conduct its own reasonable investigation. This provision shall survive Closing. Q
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6.3. Survival. The foregoing representations in Section 6.1 and Section 6.2 shall be true and a
correct as of the date hereof and as of the Closing Date. The representations,warranties and covenants contained in
this section shall survive the Closing Date for a period of one (1) year, except for the Seller's representations in C
Section 6.1.4 which shall survive the Closing Date for a period of five (5)years, and shall not be deemed to merge
upon delivery and acceptance of a statutory warranty deed by which Seller shall transfer title to Purchaser at Closing d
subject only to the Permitted Exceptions. Notwithstanding the foregoing, neither parry's liability for a breach of a z
representation or warranty shall exceed One Million Dollars($1,000,000),except that Seller shall defend,indemnify M
and hold Purchaser harmless for any costs(including without limitation attorneys',consultants and expert witness fees Q
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Packet Pg. 160
9.A.a
and costs) incurred in any investigative or remedial action conducted under applicable local, state and federal laws
and regulations related to hazardous or toxic substances or materials.
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7. Seller's Covenants. From and after the date of this Agreement and continuing through Closing,
Seller agrees with Purchaser as follows: V
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7.1. Access to Records, Network, and Systems. Upon at least forty-eight (48) hours prior
notice, Seller shall grant Purchaser, its employees, engineers, attorneys, accountants and other representatives, full c
and complete access during normal business hours to the Property and to all of Seller's records, files and operating
statements(including working papers)concerning the Property in Seller's possession or control, except to the extent
L
such records relate solely to Seller's banking operations at the Property. Purchaser shall be entitled to duplicate or ,o
make abstracts of such records, files or financial statements, subject to Section 14.10 below. Further, for all
technological systems and equipment included within the purchase under Section 5.1 of this Agreement,Seller agrees a
to use its best efforts to provide Purchaser with all information needed to access and use those technological systems
and their associated networks.
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7.2. Operation of Property. Seller shall use commercially reasonable efforts to maintain and
operate the Property in substantially the same manner as prior hereto pursuant to its normal course of business(such V
maintenance obligations not including capital expenditures or expenditures not incurred in such normal course of
business), subject to reasonable wear and tear and further subject to destruction by casualty, condemnation or other
events beyond the reasonable control of Seller. Without limitation of the foregoing, Seller shall use commercially
reasonable efforts to maintain its current insurance. N
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Q.
7.3. Service Contracts. Seller shall not, without the prior consent of Purchaser, enter into, 23
materially modify or terminate any Service Contracts or materially modify or terminate any Service Contracts without =
3
Purchaser's written consent (which consent may not be unreasonably withheld, conditioned or delayed prior to the 2
expiration of the Feasibility Contingency Period and delivery of the Additional Earnest Money Deposit, but which `p
consent may be withheld in Purchaser's sole discretion after expiration of the Feasibility Contingency Period).
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7.4. Leases. Seller shall not enter into leases of space in the Property,which is currently vacant,
extend or renew any existing leases of space in the Property,or grant existing tenants any right or option to expand
m
contract, renew, extend or terminate any existing leases of space in the Property or otherwise modify any existing p
lease of space in the Property except as specifically set forth in this Agreement. N
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8. Casual . If a fire,flood,earthquake,windstorm or other casualty(a"Casualty")occurs and affects 2-
the Property,or a portion thereof,prior to the Closing Date so that the Property is no longer suitable for Purchaser's a
intended use, then Purchaser shall have the right, by written notice given to Seller within twenty (20) days of
Purchaser's receipt of the notice of Casualty,to terminate this Agreement, in which event the entire Earnest Money
Deposit (whether deemed refundable or non-refundable) shall be immediately returned to Purchaser, and this c
Agreement shall be of no further force and effect,and thereafter,no party shall have any further rights or obligations
under this Agreement,except those provisions that expressly survive termination. Seller shall fully inform Purchaser c
as to the occurrence of any such event and the expected insurance proceeds payable. Seller shall also take such prompt y
action to restore damage and to prevent further damage as a reasonably prudent owner would undertake to the extent a
insurance proceeds are available therefor. If Purchaser does not timely terminate this Agreement, then Seller shall
assign to Purchaser its claims to all insurance proceeds,including the sole right to settle or approve the settlement of M
any insurance claim, and the Purchase Price shall be reduced by the amount of any deductible and by the amount of
any proceeds paid to Seller that are not used for repair and restoration of the Property in a manner approved by
Purchaser. At the request of Purchaser, Seller shall make a notice of claim to Seller's insurer prior to Closing. CO
Purchaser shall have twenty(20)days after notice of the event to notify Seller as to whether Purchaser elects to proceed a
with Closing. During such twenty(20)day period,Seller shall cooperate and use its best efforts to provide Purchaser
with all information reasonably necessary to evaluate the loss. C
9. Condemnation. In the event of any commenced,to be commenced or consummated proceedings
_
in eminent domain or condemnation(collectively"Condemnation")by a governmental entity other than Purchaser z
and respecting the Property or any portion thereof on or after the Effective Date and prior to the Closing Date,then, M
within twenty(20)days from receipt of a notice from Seller,Purchaser may elect,in its sole discretion,to terminate Q
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Packet Pg. 161
9.A.a
this Agreement by written notice to Seller. If Purchaser elects to terminate this Agreement,the entire Earnest Money
Deposit (whether deemed refundable or non-refundable) shall be immediately returned to Purchaser, and this
Agreement shall be of no further force and effect,and thereafter,no party shall have any further rights or obligations ar
under this Agreement,except those provisions that expressly survive termination. If Purchaser elects not to terminate
this Agreement or fails to respond within said twenty (20)-day time period, then this Agreement shall continue in U
effect. There shall be no reduction in the Purchase Price,and Seller shall,prior to the Closing Date,assign to Purchaser =
its entire right,title and interest in and to any condemnation award or settlement made or to be made in connection
with such Condemnation proceeding. Purchaser shall have the right at all times to participate in all negotiations and c
dealings with the condemning authority and approve or disapprove any proposed settlement in respect to the
Condemnation.
L
10. Conditions to Purchaser's Obligation to Close. The obligation of Purchaser to close hereunder r-
shall be subject to the satisfaction of the following conditions(all or any of which may be waived,in whole or in part a
by Purchaser in writing):
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10.1. Representations and Warranties True at Closing. The representations and warranties made
by Seller in this Agreement shall be true in all material respects as of Closing with the same force and effect as though
such representations and warranties had been made or given on and as of the date of Closing. c�
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10.2. Compliance with Agreement. Seller shall have performed and complied with all of its
obligations under this Agreement which are to be performed or complied with by it prior to or at Closing.
11. Closing. Q.
.2
11.1. Closing Date. Closing of the transaction under this Agreement shall occur thirty(30)days
from and after the date the Kent City Council approves purchase of the Property and the terms of this Agreement(the 2
"Closing Date"). The parties may select an alternative Closing Date upon written agreement. Jp
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11.2. Delivery at Closing by Seller. On or prior to the Closing Date, Seller shall deposit in c
Escrow with the Escrow Agent all instruments and monies necessary to complete the sale in accordance with this
Agreement,including,but not limited to: m
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11.2.1. a Statutory Warranty Deed to Purchaser, signed by Seller, in recordable form N
containing the legal description of the Property in such form as will convey the title to the Property to Purchaser,free z
and clear of all liens, encumbrances, conditions, easements, assignments, and restrictions, except for the Permitted 2
Exceptions(the"Deed"); a
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11.2.2. an affidavit stating that as of the Closing Date, there are no outstanding,
unsatisfied judgments,tax liens, or bankruptcies against or involving Seller or the Property,that there have been no c
labor or materials furnished to the Property for which mechanic's or other liens could be filed, and that there are no
unrecorded leases,contracts,easements,or other unrecorded interests of any kind related to the Property which Seller m
has not fully disclosed to Purchaser in writing;and d
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11.2.3. a certificate signed by Seller certifying that it is not a foreign person for purposes
of the Foreign Investment in Real Property Tax Act("FIRPTA"), as revised by the Deficit Reduction Act of 1984, M
which certificate shall include Seller's taxpayer identification number and address, or (ii)a withholding certificate
from the Internal Revenue Service to the effect that Seller is exempt from withholding tax on the Purchase Price under a
FIRPTA. a
11.2.4. Such other affidavits, documents and certificates as may be customarily and
reasonably required by the Escrow Agent in order to effectuate the transaction contemplated. C
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11.3. Delivery at Closing by Purchaser. On or prior to the Closing Date,Purchaser shall deposit
in Escrow with the Escrow Agent all instruments and monies necessary to complete the sale in accordance with this
Agreement.
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9.A.a
11.4. Closing. When used herein, "Closing" shall mean the date the Deed from Seller to
Purchaser is recorded,the Purchase Price(adjusted for credits and debits to Seller's account made in accordance with
this Agreement)has been released by the Escrow Agent to Seller and all actions have been completed as necessary ar
for the Title Company to deliver the Title Policy to the Buyer in the normal course of the Title Company's business.
U
11.5. Proration of Taxes and Utilities. Taxes for the current year,and water gas,sewer,electric =
and other utilities serving the Property(collectively, "Utilities"), and amounts payable under any service contracts,
annual permits and/or inspection fees shall be prorated as of the Closing Date on the basis of the actual days of the c
month in which the Closing Date occurs. All final special assessments, deferred taxes or penalties that are levied at
or prior to Closing shall be paid in full by Seller.
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11.6. Escrow Instructions. Each of the Parties may provide Escrow Agent with additional
closing instructions, provided that such instructions do not contradict the terms of this Agreement. In absence of d
and/or in addition to any such instructions, the provisions of this Agreement are intended by Seller and Buyer to
constitute their joint closing instructions to Escrow Agent.
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11.7. Closing Costs.
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11.7.1. Seller Costs. Seller shall pay the premium for the Title Policy, all State of
Washington real estate transfer or excise taxes on the conveyanceand one-half of the Escrow Agent's fees. •0
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11.7.2. Purchaser Costs. Purchaser shall pay the cost of recording the Deed,any premium U
associated with an extended policy or additional endorsements to the Title Policy,and one-half of the Escrow Agent's 70
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fees. 0
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11.7.3. Miscellaneous Costs. Any other costs or expenses incident to this transaction and 2
the closing thereof not expressly provided for above shall be allocated between and paid by the parties in accordance Jo
with custom and practice in the county in which the Property is located.
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12. Default and Remedies.
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12.1. Seller Default. If Seller shall be in default of any of its obligations hereunder and such p
default shall not have been cured within ten (10) days after written notice thereof to Seller,then Purchaser shall be
entitled, as its sole and exclusive remedy, to one of the following: (i) terminate this Agreement and the Escrow, in z
which case Purchaser shall be entitled to the immediate return of the entire Earnest Money Deposit;(ii)to seek specific 2
performance of this Agreement, provided that the action for specific performance must be initiated in a court of a
competent jurisdiction within forty-five(45)days of Seller's failure to timely cure the default, and provided that the
foregoing shall not limit any rights of Buyer to be indemnified by Seller or to receive attorneys' fees and costs as
provided in this Agreement with respect to the breach by Seller of any express obligation to indemnify Buyer c
expressed in this Agreement,regardless of whether occurring before or after Closing; or(iii) close Escrow,thereby W
waiving any default. m
12.2. Purchaser Default. In the event Purchaser is in default of this Agreement which may occur
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only after such default shall not have been cured within ten (10) days after notice thereof to Purchaser), the entire
Earnest Money Deposit shall be forfeited to the Seller as the sole and exclusive remedy available to the Seller for such chi
default by Purchaser. Seller expressly waives its right to recover damages or to seek specific performance.
Initials: CO
Purchaser Seller a
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12.3. Attorneys' Fees. In the event Seller or Purchaser shall bring any suit or action to enforce
this Agreement or any term or provision hereof,the substantially prevailing party shall be entitled to a reasonable sum E
as attorneys'fees and all costs and expenses incurred in connection with such suit or action including those on appeal.
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9.A.a
12.4. No Consequential Damages. UNDER NO CIRCUMSTANCES WILL ANY PARTY OR _
ITS AFFILIATES BE LIABLE TO ANY OTHER PARTY OR ITS AFFILIATES UNDER OR PURSUANT TO c
THIS AGREEMENT FOR INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, PUNITIVE OR
CONSEQUENTIAL DAMAGES, INCLUDING, BUT NOT LIMITED TO, DAMAGES FOR LOST PROFITS,
LOSS OF BUSINESS OR USE OF PROPERTY, OR COST OF CAPITAL, WHETHER IN AN ACTION FOR V
CONTRACT OR TORT, EVEN IF SUCH PARTY HAS BEEN ADVISED OF THE POSSIBILITY OR a)
EXISTENCE OF SUCH DAMAGES.
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13. Reconciliation. _
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13.1. Reconciliation. Seller shall prepare and deliver to Purchaser,not later than forty-five(45) `o
days following Closing,a reconciliation statement(the"Reconciliation"),which shall(i)show the calculation of the
actual common area maintenance expenses, operating expenses and all other expenses of the Property (including 0
insurance premiums and property taxes and assessments and excluding non-property related administration and a
management expenses) (collectively, the"Expenses")that are due and payable as of Closing, if any. The Expenses
shall be prorated between the Parties with Purchaser being responsible for all Expenses accruing on or after Closing,
including Expenses paid by Seller in advance prior to Closing,if any.Purchaser shall be entitled to all reimbursements
of Expenses accruing on or after Closing. d
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13.2. Payment. To the extent one party receives an amount due the other party pursuant to the 0
Reconciliation,the receiving party shall promptly remit such amount received to the other parry.
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13.3. Survival. The obligations hereunder shall survive Closing. 70
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14. Miscellaneous.
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14.1. Governing Law, Jurisdiction, and Venue. This Agreement shall be construed and o
interpreted in accordance with and shall be governed and enforced in all respects according to the laws of the State of `q
Washington. Any dispute arising under,in connection with, or incident to this Agreement or about its interpretation c_
will be resolved exclusively in the state or federal courts in the county where the Property is located. Each of the
parties irrevocably submits to those courts'venue and jurisdiction for such disputes. 0
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14.2. Oral Agreements and Representations. There are no oral or other agreements, including
but not limited to any representations or warranties,which modify or affect this Agreement. Seller shall not be bound
by,nor liable for,any warranties or other representations made by any other person,partnership,corporation or other
entity unless such representations are set forth in a written instrument duly executed by Seller. Purchaser
acknowledges to Seller that in entering into this Agreement,Purchaser is not relying on any warranties except those a
expressly set forth herein.
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14.3. Survival;Nonmerger. The representations,warranties, covenants and indemnities of this
Agreement shall survive Closing or earlier termination of this Agreement,and shall not merge into the Deed. cW
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14.4. No Brokers. Seller and Purchaser each represent to the other that neither party has(i)dealt
with any other real estate broker or(ii)is represented by a real estate broker in connection with the negotiations leading a
to this Agreement, except for Will Frame, Andy Miller and Drew Frame of Kidder Mathews, representing Seller. M
Seller agrees to indemnify and hold Purchaser harmless from and against the claims of all other brokers or
intermediaries claiming to have had any dealing, negotiations or consultations with Seller in connection with this
Agreement or the sale or lease of the Property. Q
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14.5. Notices. All notices required or permitted to be given hereunder shall be in writing and
shall be deemed given: (a)when personally delivered; (b)when delivered by private courier service(such as Federal p`
Express);or(c)three(3)days after being deposited in the United States mail in registered or certified form,postage
prepaid,return receipt requested,addressed as follows:
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If to Seller: Boeing Employees' Credit Union
Attn:Facilities Q
PAGE
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9.A.a
12770 Gateway Dr.
Tukwila,WA 98168
Telephone:206-812-5118 ar
Email: andy.reiswig@becu.org
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with copy to: Summit Law Group,PLLC =
315 Fifth Ave. S, Suite 1000
Seattle,WA 98104 c
Attention:Kyle Branum,Ada Danelo
Email:kyleb@summitlaw.com;adad@summitlaw.com
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If to Purchaser: City of Kent c
Attn:Arthur"Pat"Fitzpatrick,Chief Administrative Officer a
220 Fourth Avenue South
Kent,WA 98032
Telephone:253-856-5781
Email:PFitzpatrick@kentwa.gov c
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14.6. Enforcement. The failure of either party to insist upon or enforce strict performance by the
other party of any provision of this Agreement or to exercise any right under this Agreement shall not be construed as
a waiver or relinquishment to any extent of such party's right to assert or rely upon any such provision in any other
instance;rather,the same shall remain in full force and effect. U
70
Q.
14.7. No Waiver. No waiver of any right under this Agreement shall be effective unless 0
contained in a writing signed by a duly authorized officer or representative of the party sought to be charged with the 3
waiver and no waiver of any right arising from any breach or failure to perform shall be deemed to be a waiver of any 2
future right or of any other right arising under this Agreement. o
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14.8. BindingN ature. All rights and obligations arising out of this Agreement shall inure to the 5
benefit of and be binding upon the respective successors,heirs,assigns,tenants,administrators,executors,and marital
communities, if any, of the parties hereto. This document shall not bind either party unless it has been properly m
authorized,executed and delivered by Purchaser and Seller. o
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14.9. Execution. This Agreement shall not be binding or effective until fully executed and z
delivered by Seller and Purchaser. i
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14.10. Confidentiality. Purchaser agrees to maintain the terms of this Agreement, including,
without limitation, any information relating to Seller's finances or operations, in confidence except to the limited W
extent such disclosures are(a)required by law,(b)made in confidence to Purchaser's attorneys,(c)made in connection r-
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with any legal proceeding brought to interpret or enforce this Agreement, (d) already a matter of public record, or W
(e)requested or agreed to in writing by Seller.
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14.11. Time. Time is of the essence of this Agreement. Unless otherwise specified in this a)
Agreement, any period of time measured in days in this Agreement shall start on the day following the event
commencing the period and shall expire at 9:00 p.m.PST of the last calendar day of the specified time period. If the M
last day is a Saturday, Sunday or legal holiday,as defined in RCW 1.16.050,the specified period of time shall expire
on the next day that is not a Saturday, Sunday or legal holiday. Any specified period of five(5)days or less shall not
include Saturdays, Sundays or legal holidays. "Business day"means any day that is not a Saturday, Sunday,or legal co
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holiday. $
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14.12. Entire Agreement; Amendment. This Agreement sets forth the entire agreement of the C
parties as to the subject matter hereof and supersedes all prior discussions and understandings between them. This
Agreement may not be amended or rescinded in any manner except by instrument in writing signed by a duly
authorized officer or representative of each parry hereto. z
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9.A.a
14.13. Severability. Should any of the provisions of this Agreement be found to be invalid,illegal
or unenforceable by any court of competent jurisdiction, such provision shall be stricken and the remainder of this E
Agreement shall nonetheless remain in full force and effect unless striking such provision shall materially alter the ar
intention of the parties. m
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14.14. Holidays. Should the last day for giving any notice, or taking any action, required or =
permitted under this Agreement,fall on a Saturday, Sunday or legal holiday,the last day shall be postponed until the
next day when Escrow Agent is open for regular business. c
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14.15. Captions. The captions and section headings hereof are inserted for convenience purposes
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only and shall not be deemed to limit or expand the meaning of any section. ,o
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14.16. Invalidity. If any provisions of this Agreement shall be invalid,void,or illegal,it shall in a
no way effect,impair,or invalidate any of the other provisions hereof. -0
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14.17. Recording. Purchaser may not record a memorandum of this Agreement.
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14.18. Counterparts. This Agreement may be executed in counterparts,which shall be treated as U
originals for all intents and purposes,and all so executed shall constitute on agreement,binding on all of the parties
hereto, notwithstanding that all the parties are not signatory to the original or the same counterpart. Any such n
counterpart shall be admissible into evidence as an original hereof against the person who executed it.
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14.19. Effective Date. The effective date of this Agreement shall be the last date written below. E
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14.20. Knowledge. As used in this Agreement, or in any other agreement, document, certificate M
or instrument delivered by Seller to Purchaser, the phrase "to Seller's actual knowledge", "to the best of Seller's
knowledge"or any similar phrase shall mean the actual,not constructive or imputed,knowledge of Gregg Kats, SVP Jo
Administration&Servicing,without investigation.
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14.21. Exhibits. The Exhibits hereto are incorporated into and made an express part of this
Agreement. 00
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14.22. Further Acts. The Parties shall execute and deliver such further instruments and
documents,and take such other further actions,as may be reasonably necessary to carry out the intent and provisions z
of this Agreement. 2
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9.A.a
SELLER:
BOEING EMPLOYEES' CREDIT UNION,
a Washington state credit union
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PURCHASER: 0
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CITY OF KENT,
a Washington municipal corporation U)
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By. 3
Name: Dana Ralph
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Title: Mayor a�
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9.A.a
EXHIBIT A
LEGAL DESCRIPTION
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9.A.a
EXHIBIT A-1
PROPERTY DEPICTION
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9.A.a
EXHIBIT B
DUE DILIGENCE DOCUMENTS
1. Copies of the Service Contracts,easements,contracts,agreements and recorded documents affecting the Property U
to Seller's actual knowledge;
2. Copies of available geotechnical engineering reports; M
3. Copies of available Phase I and/or Phase II or other environmental reports; d
4. Operating information of the Property, and any documents in Seller's possession relating to the environmental
condition of the property, all recorded documents and agreements affecting the Property, and the prior title
policies and reports on the Property which are in the possession of Seller;and
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5. Copies of all surveys, building plans and specifications, engineering reports, warranties and similar reports
including,without limitation,construction,roof, equipment, and other warranties, and similar documents in the M
possession of Seller.
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