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City of Renton
Effective Date 1/1/2024 to 1/1/2025
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-187899
Rates by Tier
EE $ 677.90
EE/S $ 1,710.86
EE/1C $ 1,172.94
EE/2+C $ 1,605.36
EE/S/1C $ 2,205.88
EE/S/2+C $ 2,638.26
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
CAG-23-384
Mayor Armondo Pavone
10-24-2023
Attest:
Jason A. Seth, City Clerk
Rates Confirmation
City of Renton -LEOFF 1 Retirees
Effective Date 1/1/2024 to 1/1/2025
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-188134
Rates by Tier
EE $ 1,463.56
S $ 1,663.22
1C $ 878.82
AAC $ 1,177.78
526GG07-0917
CAG-23-384
Medicare Rates by Tier MedicareAB $ 514.59
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
Mayor Armondo Pavone
10-24-2023
Attest:
Jason A. Seth, City Clerk