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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.
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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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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.
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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 –
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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 –
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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.
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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New
vendor name & information PBM
Costco Health Solutions MedImpact Member Advocacy
or Concierge Service
Gallagher Benefit Service Center CDHP* COBRA Dental
SODQ 6HSDUDWH
RXW PHGLFDOO\
QHFHVVDU\FRQWDFWV
VDPH DV WKH DFWLYH SODQ DW HYHU\WZR HDUV 1'LQFUHDVH WKH HOHFWLYH FRQWDFW OHQVHV EHQHILW IURP WR HYHU\
WZR HDUV
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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.
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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.
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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: PPO
plan member copay amount of $________ per virtual visit, deductible waived 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: PPO plan member
copay amount of $________ per virtual visit, deductible waived 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: PPO plan member copay amount
of $________ per virtual visit, deductible waived PPO plan member copay amount
of $________ per virtual visit after deductible met 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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
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
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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
Docusign Envelope ID: 1A38BB30-6F54-4063-9CE3-E33BB00816D3
Aadam Hussain
October 28, 2025 | 9:04 AM PDT
President and CEO