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Home My WebLink AboutContractProving What’s Possible in Healthcare® HMA CLIENT INTENT & EXHIBIT A SCHEDULE OF FEES City of Renton 4034/5034 01/01/2026 through 12/31/2026 Renewal Account Information Group Name:City of Renton Group: # 4034/5034 Group Size:Employees 656 Network:HMA Contract Period: 1 Year Enrollment Type:Web Enroll OE Dates: 11/1 -11/30/2025 Broker (firm):Gallagher Benefit Services – Bellevue Contact Info Name Phone Email Broker Contact:Amanda Aykan (425) 974-3286 Amanda_Aykan@ajg.com Account Manager:Lisa Littlejohn (425) 285-3685 Lisa.Littlejohn@accesstpa.com Client Insight Recommendations HMA continuously strives for innovation and excellence in serving you. Please see your Client Insights PDF for more information on our recommendations for your Plan. Check the corresponding boxes below for the recommendation you want to implement. Re m o v e / Ex c l u d e Ad d / Ac c e p t Benefit Recommendations Medically Necessary Vision Hardware ܆ Confirm whether you wish to separate medically necessary contact lenses from elective contact lenses. Benefits will be paid at the same level as elective contact lenses and limited to one pair per calendar year. 1-&"4&4&&#&-08'03$07&3"(&%&5"*-4 Doula Services ܆ ܈ Confirm whether you wish to continue coverage for Doula Services. Benefit will require Pre- Authorization and will be neutralized based on the plan’s standard INN co-insurance amount. Declining both options results in Doula coverage being excluded. ܈ ܆ Confirm whether you wish to continue coverage for Doula Services. Benefit will require Pre- Authorization and will apply the plan’s standard INN and OON co-insurance amount. Deductible is waived for PPO plans. For HDHP plans deductibles will apply. Declining both options results in Doula coverage being excluded. ܆ p 1-&"4&4&&#&-08'03$07&3"(&%&5"*-4 CAG-25-313 HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 2 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Subrogation Reduction Authority HMA continuously strives for innovation and excellence in serving you. Please see your Client Insights PDF for more information on what Subrogation Reduction Authority is, and the threshold options listed below. Check the corresponding boxes below for the threshold you want to implement. Re m o v e / Ex c l u d e Ad d / Ac c e p t Benefit Recommendations No Threshold ܆ ܈ Plan Sponsor approves all subrogation reductions. This is how your plan currently operates. $10,000 Threshold ܈ ܆ Plan Sponsor approves any subrogation settlements over $10,000 and less than 100% recovery. $25,000 Threshold ܈ ܆ Plan Sponsor approves any subrogation settlements over $25,000 and less than 100% recovery. Summary of Communicated Benefit Changes (Medical, Dental, Vision, Rx, Buy- Up Products) *NOTICE* Below are the 2026 Federal Requirements for plans. HMA cannot update your plan without your written approval. Please use the tables below to outline any necessary changes. PPO 2026: Maximum allowed OOPM $10,150 Individual/$20,300 Family. If your plan’s OOPM is already less than or equal to these values no change is required. QHDHP 2026: Minimum Deductible $1,700 Self-Only/$3,400 Family/$3,400 Individual w/in Family, Maximum OOPM $8,500 Self-Only/$17,000 Family/$10,150 Individual w/in Family. PPO Plan – 4034 - Active Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 3 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 PPO Plan – 4034 - Active Accumulator In Network Out of Network ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 4034 – Dental Only Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 4034 – Dental/Vision Only Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 4034 - Leoff Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 4 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 PPO Plan – 4034 - Leoff Accumulator In Network Out of Network ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 4034 Vision Only Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 5034 Dental Only Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. PPO Plan – 5034 Dental/Vision Only Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 5 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 PPO Plan – 5034 Retiree Accumulator In Network Out of Network Deductible Individual – Family – Individual – Family – Out of Pocket Maximum Individual – Family – Individual – Family – ܈ The group’s health plan does not require updates to meet the 2026 Federal Requirements outlined above. All other changes: For Doula coverage, the Plan would like to neutralize the benefit and waive the deductible. Vendors To support members better, we include information in our systems for HMA’s Customer Care Team to leverage and educate members about available services. Vendor type Current vendor name Ch a n g e ? New vendor name & information PBM Costco Health Solutions ܈܈ MedImpact Member Advocacy or Concierge Service Gallagher Benefit Service Center ܆܆ CDHP* ܆܆ COBRA ܆܆ Dental ܆܆ SODQ6HSDUDWHRXWPHGLFDOO\QHFHVVDU\FRQWDFWVVDPHDVWKHDFWLYHSODQDWHYHU\WZR\HDUV$1'LQFUHDVHWKHHOHFWLYH FRQWDFWOHQVHVEHQHILWIURPWRHYHU\WZR\HDUV HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 6 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Vendor type Current vendor name Ch a n g e ? New vendor name & information Kidney Dialysis ܆܆ Maternity ܆܆ Telehealth ܆܆ Vision ܆܆ Fiduciary ܆܆ Nurseline ܆܆ ACA Reporting ܆܆ Disease Management ܆܆ Data Analytics ܆܆ Other Vendor ܆܆ * Consumer-driven Health Plan (CDHP), e.g. HRA, FSA, HSA, LPFSA, DCRA. * Please note that if you choose to work with a non-preferred vendor, we may not be able to integrate eligibility, claims reporting, or accumulators and additional fees may apply. Fees Claim Administrative Fees Rates for the contracted time period apply to services administered by HMA. Fees for outside vendors are subject to change at any time. HMA fees and commissions may remain in effect beyond the above-stated term until changed by mutual written agreement of the parties. HMA reserves the right to pass through any and all regulatory assessments, fees, or similar financial obligations that are attributable to a client health plan whether known or not during the renewal process or that may become applicable during the term of HMA's services to a client and its health plan. HMA shall use reasonable efforts to identify and communicate to clients about assessments that it will be liable for but shall bear no liability for such obligations. Fee Product Description $28.31 Medical Plan Administration PEPM In light of the Administration's PEPM Rate Hold for 2026, PEPM discounts will not be available. $5.50 HMA PPO Network Access PEPM HMA Preferred provides access to Regence BlueShield in Western Washington, Asuris NW Health in Eastern Washington, Regence BlueCross BlueShield of Oregon, Regence BlueShield of Idaho, and Regence BlueCross BlueShield of Utah. PHCS provides network access in all other states for members residing in the PHCS service area. HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 7 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Fee Product Description $3.75 Care Management PEPM HMA’s Care Management suite of services is an in-house program that encompasses pre-authorization, utilization management, case management, behavioral health, and steerage. HMA’s care management team serves members based upon their diagnosis offering full support of the member’s healthcare journey, as well as oversight of plan spend. x Utilization Review (Prior Authorization) including Population Health, Specialty Health, Intake x Case Management including Member Support (Clinical), Transition of Care, Continuity of Care, and Discharge Planning staffed by our in-house, highly skilled, certified Case Managers and Register Nurse (RN) Case Managers. Waived HCBB Comply Tool HMA’s shoppable services tool which is provided to you to satisfy federal transparency requirements. Additional cost-saving, utilization-driving features are available through the Healthcare Bluebook premium buy-up options. $0.45 Federal Transparency Technology Enablement PEPM Self-funded health plans are subject to seven new and ongoing transparency-related federal regulatory requirements. These requirements represent a massive technology lift and investment. We are passing through only a portion of the real costs of delivering these requirements. 30% of savings Medical bill audit, claim re-pricing services, claims negotiation and medication and site of care steerage programs. This fee includes network access fees charged per claim for accessing and utilizing PPO discounts when participants receive care outside their primary state of residence. 30% of savings Electronic review of claims for code edits prior to payment. 27% of recovered funds Subrogation services The plan will receive 73% of recovered funds. Of the remaining, 22% is retained by The Phia Group, and 5% is retained by HMA.* * In the event of litigation to enforce the Plan’s right of recovery, The Phia Group fee will increase to 33.3% and HMA shall not retain any compensation. 15%-30% of recovered funds Data Mining and overpayment recovery 15%-17% recovery fee retained by Cotivitii o 15% current claims o 17% aged claims On post-payment COB and Code Edit recoveries identified by Cotiviti, additional 13- 15% retained by HMA. 9.5% of recovered funds Credit balance premier health services partner on site with providers across the country. 30% of savings Fraud, waste, and abuse o 12% of savings retained by Optum o 18% administrative allowance retained by HMA Care Management and payment integrity programs will be applied as appropriate except when prohibited by provider contractual limitations within their Provider Agreement with the network(s) accessed by the Plan. Current Products and Services What you currently have: These are the products and services you are currently providing to members. Please check the box in the Continue or Remove columns to indicate your selected action for the upcoming plan year. Products and services offered through partners on our contract may experience price/fee changes or terminate during the Plan Year. Plan Sponsor acknowledges and agrees that the fees quoted below for such services are not guaranteed. In the event of a pricing change during the term, HMA will make every effort to notify you at least 30 days in advance of such changes. Individual products and services may be subject to minimum termination notice requirements. HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 8 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Co n t i n u e Re m o v e Current Fee Renewal Fee Product ܈܆$3.00 $3.15 Dental Plan Administration PEPM ܈܆$1.50 $1.50 HMA National Dental Network Access PEPM ܈܆$0.65 $0.70 Vision Hardware Administration PEPM ܈܆$1.35 $1.40 COBRA Services PEPM ܈܆$1.35 $1.45 MDLIVE Medical (Urgent Care), Mental Health, and Psychiatry PEPM Please detail the group’s required cost share for any plans that apply: ܈܈ PPO plan member copay amount of $0 per virtual visit, deductible waived Additional Products and Services Additional Buy Up Options: Please review the additional buy-up product options below. Check the box in the Add column if you would like to include these services in the upcoming plan year. Products and services offered through partners on our contract may experience price/fee changes or terminate during the Plan Year. Plan Sponsor acknowledges and agrees that the fees quoted below for such services are not guaranteed. In the event of a pricing change during the term, HMA will make every effort to notify you at least 30 days in advance of such changes. Individual products and services may be subject to minimum termination notice requirements. Ad d Renewal Fee Product ܆$3.95 Flexible Spending Account (FSA) PAPM Only available with a PPO or non-Qualified Plan. ܆$3.95 Dependent Care FSA (DC FSA / DCRA) PAPM ܆$3.95 Health Reimbursement Account (HRA) PAPM ܆$2.70 Health Savings Account (HSA) PAPM ܆$1.95 Limited Purpose FSA (LPFSA) PAPM Only available with a qualified HDHP. ܆ $2.00 Consolidated Billing PEPM - Option 1 Premium Remittance only ܆ $3.00 Consolidated Billing PEPM - Option 2 Premium Remittance AND Eligibility Administration ܆$2.20 PACE Fiduciary PEPM HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 9 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Ad d Renewal Fee Product ܆$2.95 Care Navigator PEPM ܆$4.95 Care Navigator Plus PEPM Clients choose between an Employer Managed Incentive or digital gift cards as an incentive for those members who complete their health questionnaire within the specified timeframe determined by the Plan. Please select one of the options below: ܆܆Employer Managed Incentive: We will provide reporting of members qualifying for the incentive via BenefitFocus, employer assumes all liability for the incentive design and execution. ܆܆$25 digital gift card automatically sent to member-provided email from Tango Platform upon employer funding of Tango account. ܆܆$50 digital gift card automatically sent to member-provided email from Tango Platform upon employer funding of Tango account. ܆$2.35 Healthcare Bluebook Quality + Engagement Rewards PEPM Rewards range from $25-$1500 when a member selects a fair price provider. ܆$1.95 Vitality Wellbeing and Engagement Platform PEPM ܆$3.75 Vitality + Integrated Coaching w/ USPM PEPM ܆$200 initial consultation $550 case rate for Recovery Phase (covers 12 months per injury/issue) Omada for Musculoskeletal Billed as medical claims. No cost for Prevention program. Member cost share applies. Standard Plan Design is as follows: covered services shall be covered at 100% DW for PPO Plan(s) and 100% after deductible for QHDHPs plan(s). If Plan sponsor wants to have Omada services covered differently than indicated here, please use the Summary of Communicated Changes box at the top of this document to indicate your alternate plan design intent. ܆ Per Active Participant Per Month Prevention $75 (year 1), $50 (year 2) Hypertiension $75 Diabetes $110 Multi-Condition $125 Omada Cardiometabolic Billed as medical claims. Cost share waived as all services deemed preventive. ܆$4.15 Disease Management PEPM ܆$350 Maternity per case HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 10 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Ad d Renewal Fee Product ܆$0.70 24 Hour Nurse Line PEPM ܆$2.00 MDLIVE Medical (Urgent Care), Virtual Primary Care, Mental Health, Psychiatry, and Virtual Dermatology) PEPM Please detail the group’s required cost share for any plans that apply: տտ PPO plan member copay amount of $________ per virtual visit, deductible waived տտ PPO plan member copay amount of $________ per virtual visit after deductible met ܆܆ HDHP plan member coinsurance amount of _________% ܆$1.70 MDLIVE Medical (Urgent Care), Mental Health, Psychiatry, and Virtual Dermatology PEPM Please detail the group’s required cost share for any plans that apply: տտ PPO plan member copay amount of $________ per virtual visit, deductible waived տտ PPO plan member copay amount of $________ per virtual visit after deductible met ܆܆ HDHP plan member coinsurance amount of _________% ܆$1.05 MDLIVE Medical (Urgent Care) Only PEPM Please detail the group’s required cost share for any plans that apply: տտ PPO plan member copay amount of $________ per virtual visit, deductible waived տտ PPO plan member copay amount of $________ per virtual visit after deductible met տտ HDHP plan member coinsurance amount of _________% ܆$3.45 Virtual Behavioral Health Product Option A PEPM (6 counseling + 6 coaching per enrolled employee/family unit, per incident, per year) (By election Virtual Health Option, A or B, any exclusions within the SPD will be updated to align with Virtual Behavioral Health product offerings) ܆$4.45 Virtual Behavioral Health Product Option B PEPM (12 counseling + 12 coaching per enrolled employee/family unit, per incident, per year) (By election Virtual Health Option, A or B, any exclusions within the SPD will be updated to align with Virtual Behavioral Health product offerings) Compliance & Actuarial Services Full descriptions of the services below can be found in the Renewal Product Terms and Disclosures document. El e c t i n g Fee Product ܆ $468 Part D Creditable Coverage ܆Custom upon request NQTL Mental Health Comparative Analysis HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 11 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 El e c t i n g Fee Product ܆ $2,250 NQTL Mental Health Comparative Analysis Data Only ܆ $1,375 Section 105(h) Non-Discrimination Testing ܆$4,000 Per Client + $500 For Each Additional Employer Identification Number (EIN) ACA Support Services Buy Up Option 1 -- 1094 & 1095 Filing Service Fee varies based on employer size. Statement Fee Per Employee Form including Printing and Mailing. ܆Annual Tracking - $10.00 PEPY Monthly Tracking - $500 per Month ACA Support Services Buy Up Option 2 - Full Time Employee Tracking & Calculation Annual tracking has a Minimum of $2,000 and a Maximum of $7,500. ܆Waived MA-1099 Filing Subject to annual opt-in deadlines. *A $2.00 per card ID Card Fee applies when changes are made to the template, for example, deductible and out-of- pocket or Pharmacy Benefit Manager changes. Incidental individual card replacement or reissue available upon member request through our portal at no cost. **HMA reserves the right to invoice costs plus 20% of printing and mailing charges for member materials. Printing and mailing member materials and other collateral, including but not limited to SBCs, Member Guides, product flyers, etc. ***HRIS vendor change requests within-3 years of initial set-up incur a charge of $5,000. ****Additional data integration requests are subject to additional agreements and/or integration fees. Broker Fees These are fees for services provided by the broker or the broker’s contracted partners. HMA will remit fees to the broker only. The broker is responsible for payment of any fees to its own vendor partners. Current Fee New Fee Vendor Description Direct Pay Gallagher - Bellevue Broker Medical commission HMA Client Intent & TPA Exhibit A – City of Renton 4034/5034 Page 12 of 12 2026_HMA RENEWAL_ClientIntent_EXHIBITA_Cuty of Renton 4034/5034 5.01.25 Pharmacy Benefit Administration ܆܆ ,KDYHUHDGDQGDFFHSWWKHDWWDFKHGWHUPVDQGFRQGLWLRQVUHJDUGLQJ3%0)HHV 6HUYLFHV Stop Loss Services ܆ ,KDYHUHDGDQGDFFHSWWKHDWWDFKHGWHUPVDQGFRQGLWLRQVUHJDUGLQJ([FHVV/RVV6HUYLFHV Renewal Products and Disclosures Acknowledgement ܆ ,KDYHUHDGWKHDWWDFKHG5HQHZDO3URGXFW7HUPVDQG'LVFORVXUHVDQG,DFFHSWWKHWHUPVDQG FRQGLWLRQVFRQWDLQHGZLWKLQ This Agreement incorporates by reference the terms and conditions set forth in the Renewal Product Terms & Disclosures document, as if fully set forth herein. Acceptance IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives on the respective dates set forth below, effective as of the day and year first above written. By: City of Renton X By: Healthcare Management Administrators X Name: Name: Title: Title: Date: Date: Armondo Pavone Mayor 10/14/2025 Attest: Jason Seth, City Clerk