WA ST Dept of Retirement Systems 10/18/2019

'34 3h,0 STATE OF WASHINGTON DEPARTMENT OF RETIREMENT SYSTEMS P.O.Box 48380•Olympia, WA 98504-8380•(360)664-7000•Toll Free 1-800-547-6657•w,u iw.cfrs11.cov AGREEMENT To Extend Medicare-only Coverage to Eligible Employees (Members of the Law Enforcement Officers'and Fire Fighters'Retirement System—via a divided vote referendum) This Agreement is made by and between: The State of Washington, Department of Retirement Systems State Social Security Administrator ("State") and City of Everett ("Political Subdivision") WITNESSETH WHEREAS the Political Subdivision desires to extend Medicare-only coverage to its eligible employees under the provisions of chapter 41.48 Revised Code of Washington(RCW), and WHEREAS the Political Subdivision duly adopted a resolution requesting authorization to hold a divided referendum for Medicare-only coverage pursuant to Section 218 of the Social Security Act, and WHEREAS the State has authorized, and the Political Subdivision has held, a divided referendum for employees eligible for Medicare-only coverage under Section 218(d)(6) of the Social Security Act NOW, THEREFORE, in consideration of the premises,the parties hereby agree that said coverage shall be extended to the eligible employees of the Political Subdivision who elected by written ballot to participate in Medicare-only, subject to the following terms and conditions: A. SERVICES COVERED This agreement includes all services performed by eligible employees of the Political Subdivision as defined in Section 218 of the Social Security Act. B. MANDATORY EXCLUSIONS Certain services are mandatorily excluded from coverage under a 218 Agreement. This agreement shall exclude the following services as defined in Section 218(c)(6) of the Social Security Act: RECEIVED 1 OCT 22 2019 OASI