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Home My WebLink AboutContract526GG07-0917 Rates Confirmation City of Renton Effective Date 1/1/2022 to 1/1/2023 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-162106 Rates by Tier EE $ 598.64 EE/S $ 1,510.84 EE/1C $ 1,035.80 EE/2+C $ 1,417.68 EE/S/1C $ 1,948.00 EE/S/2+C $ 2,329.84 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 __________________________ CAG-21-269 Armondo Pavone, Mayor Attest:__________________________________ Jason A. Seth, City Clerk 11/29/2021 526GG07-0917 Rates Confirmation City of Renton -LEOFF 1 Retirees Effective Date 1/1/2022 to 1/1/2023 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-162335 Rates by Tier EE $ 1,292.46 S $ 1,468.78 1C $ 776.08 AAC $ 1,040.10 Medicare Rates by Tier MedicareAB $ 588.22 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 __________________________ Armondo Pavone, Mayor Attest:_____________________________________ Jason A. Seth, City Clerk CAG-21-269 11/29/2021