HomeMy WebLinkAboutContractRates Confirmation City of Renton -LEOFF 1 Retirees i,,� KAISER PERMANENTE ®
Effective Date 1/1/2026 to 1/1/2027
The below rates have been quoted for the following plan(s). Please sign below to confirm rates.
Applicant further acknowledges and agrees that payment of any premium due for the coverage shall constitute applicant's acceptance of the coverage agreement issued.
Core HMO
Group Name City of Renton -Leoff I Retirees
Group Number 0057500
RQ-207369
EE $1,731.62
s $1,967.84 Rates by Tier 1C $1,039.78
AAC $1,393.50
526GG07-0917
Medicare Rates by Tier I MedicareAB I $ 566.28 I All plans offered and underwritten by Kaiser Foundation Health Plan of Washington
This health coverage meets or exceeds the minimum essential coverage requirements and the minimum value standard for the benefits it provides.
This outpatient prescription drug coverage meets the Medicare Part D standard for creditable coverage.
Signature _______________________ Date ___________ _
526GG07-0917
10/14/2025
Attest:________________________________________
Jason Seth, City Clerk
Rates Confirmation
City of Renton
Effective Date 1/1/2026 to 1/1/2027
The below rates have been quoted for the following plan(s). Please sign below to confirm rates.
Applicant further acknowledges and agrees that payment of any premium due for the coverage shall constitute applicant's acceptance of the coverage agreement issued.
Core HMO
Group Name City of Renton
Group Number 1162600
RQ-207367
Rates by Tier
EE $ 802.08
EE/S $ 2,024.22
EE/1C $ 1,387.78
EE/2+C $ 1,899.38
EE/S/1C $ 2,609.88
EE/S/2+C $ 3,121.46
All plans offered and underwritten by Kaiser Foundation Health Plan of Washington
This health coverage meets or exceeds the minimum essential coverage requirements and the minimum value standard for the benefits it provides.
This outpatient prescription drug coverage meets the Medicare Part D standard for creditable coverage.
Signature __________________________________________________ Date __________________________
526GG07-0917
Armondo Pavone, Mayor
10/14/2025
Attest:__________________________________________
Jason Seth, City Clerk
CAG-25-312