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Proving What’s Possible in Healthcare® <br />HMA CLIENT INTENT & EXHIBIT A SCHEDULE OF FEES <br />City of Everett 020188 <br />01/01/2025 through 12/31/2025 Renewal <br />Account Information <br />Group Name: City of Everett Group: # 020188 <br />Group Size: Employees 1,071 Network: HMA Contract Period: Year 1 <br />Enrollment Type: File <br />Broker (firm): Alliant Insurance Services, Inc. – Seattle <br />Contact Info Name Phone Email <br />Broker Contact: Gene Santoy (206) 204-9186 Gene.santoy@alliant.com <br />Account Manager: Audrey Olson (425) 289-5253 Audrey.Olson@accesstpa.com <br />Client Insight Recommendations <br />HMA continuously strives for innovation and excellence in serving you. Please see your Client Insights PDF for more <br />information on our recommendations for your Plan. Check the corresponding boxes below for the recommendation you <br />want to implement. Remove/ExcludeAdd/ AcceptBenefit Recommendations <br />Medical Travel Benefits – Steerage <br />☐ ☐ <br />Add a Medical Travel Benefit for Steerage to a lower cost provider when criteria are met. <br />Benefit is covered at 100% deductible waived, in and out of network. If the plan is an HDHP, the <br />deductible will apply. <br />•Lodging limited to $200 per night <br />•Meals limited to $100 per person/per day <br />•Mileage will be reimbursed per IRS limits <br />If the Plan would like to adjust the reimbursement amount for lodging and meals, please indicate <br />below. <br />Lodging dollar limit $________ <br />Meal dollar limit $________ <br />☐ ☐ Include allowance for an additional parent/caregiver for members under the age of 18 or disabled. <br />Docusign Envelope ID: CC50B3B8-52FD-4DD0-8AA5-5843B00BE3B8