2023-05-05 Disability Board PacketEDMONDS LEOFF 1 DISABILITY
BOARD
MEETING NOTICE AND AGENDA
REGULAR MEETING
Friday, May 5, 2023
Fourtner Room
City Hall
11:00 am
• CALL TO ORDER
• APPROVAL OF MEETING MINUTES
a. From the 2/24/2023 Meeting
b. From the 5/31/2022 Meeting
• DISCUSS AND APPROVE CLAIMS SUMMARY REPORT
c. For the period 01/01/2023 — 03/31/2023
d. Review/Discuss LEOFF 1 member's request for LTC services
e. Review/Revise Board Policies
i. 004-06 Hearing Aids (last reviewed 2/24/23)
ii. 011-16 Medical Services & Equipment (last reviewed and revised
10/20/2016)
• OTHER
0 2023 WSLEA Benefits Comparison
o Next Board Meeting date (July 2023)
Page 1
EDMONDS' LEOFF 1 DISABILITY BOARD
Meeting Minutes
Regular Meeting
05/31 /2022
MEMBERS PRESENT:
Ken Jones, Board Chair
Gary McComas, Board Member
Susan Paine, Council Member
Laura Johnson Council Member
Jim Distelhorst, Citizen -at -Large
STAFF PRESENT:
Sharon Cates, Attorney
Emily Wagener, Sr. Human Resources Analyst
Carly Derrick, Human Resources Analyst
MEMBERS OF THE PUBLIC PRESENT:
None
CALL TO ORDER:
Chair Jones called the meeting to order at 10:30 AM
DISCUSS AND APPROVE CLAIMS SUMMARY REPORT 01/01/2022 — 03/31/2022
Chair Jones introduced the claims summary report for the period of January 2022 to March 2022. He
mentioned the budget shows a zero dollar balance so everything used is going to be a deficit. Ms.
Derrick explained that finance didn't separate out the expenses as they usually do, but an
administrative budget amendment just needs to be done by Finance. Council member Johnson
suggested moving the approval to the next regularly scheduled meeting. Chair Jones agreed. Ms.
Wagener explained that waiting doesn't hold up any reimbursements.
Summary of Current
Costs
01/01/2022 -
03/31 /2022
SERVICE
Number of Claims
Total Paid for Service
Dental Expenses
7
$ 2,465.30
Eyeglasses
2
$ 374.98
Long Term Care
7
$ 27,063.00
Medical Services
8
$ 2,731.07
Medicare Premium
17
$ 29,155.00
Prescription
18
$ 5,279.99
Grand Total
59
$ 67,069.34
Edmonds LEOFF 1 Disability Board — 05/31/2022
BUSINESS
Review/discuss LEOFF 1 member's increase in LTC services (+$271.89/month effective 9/1/2022)
Chair Jones introduced the next item for discussion, the increase in long term care services by $271.89
per month. Council Member Paine noted it looked reasonable.
Board Member McComas made a motion to approve long term care increase for LEOFF 1 member.
Citizen -at -Large Distelhorst seconded the motion. The motion carried.
Review/Revise Board Policies
001-06 Payment of Annual Deductibles (last reviewed and revised 1/29/13)
003-02 Purchase of Eye Glasses (last reviewed and revised 02/03/16)
005-06 Medicare Premium Reimbursements (last reviewed and revised 04/19/17)
Council member Paine requested some verbiage changes on the annual deductibles policy to provide
further clarification. Attorney Cates will make changes to the policies as requested.
Board member McComas proposed raising the amounts for eyeglasses from $150.00 to $250.00 per
year and from $300 to $500 every two years. Ms. Wagener mentioned there is an updated policy from
2018 that shows $225 annually. Council member Johnson said she preferred a $450 every two years
policy because $225 won't cover lenses. The board agreed and talked about raising the amount to $500
every two years. The eye exam would be covered in full, in addition to the $500 hardware maximum.
Chair Jones made a motion to increase the eyeglass reimbursement maximum to $500 every
two years effective January 1, 2022. Council member Johnson seconded that motion. Motion
carried.
The Board decided to leave the current policy for Medicare Premiums intact.
Board member Jones made a motion to keep the Medicare premium policy the same. Council
member Paine seconded the motion. Motion carried.
OTHER
OPMA Changes
The Board discussed the possibility of returning to in -person meetings. Chair Jones suggested not
having another meeting until after July when there is more clarification on the requirements of in -person
meetings due to COVID.
Board member adjourned the meeting at 11:15 AM.
Page 2 of 2
CITY OF EDMONDS DISABILITY BOARD
O EDAir)
CLAIMS SUMMARY
01 /01 /2023 to 03/31 /2023
CLAIM NO.
SERVICE
RCW/PAST PRACTICE
COST
1
Medicare Premium
005-06
$ 1,782.00
2
Prescription
010-15
$ 64.04
Medical Services
RCW
$ 195.00
Eyeglasses
003-02
$ 300.00
3
Prescription
010-15
$ 31.00
Medical Services
RCW
$ 66.25
Long Term Care
008-11
$ 3,292.89
4
Medicare Premium
005-06
$ 1,978.80
Long Term Care
008-11
$ 6,000.00
5
Prescription
010-15
$ 41.00
Medicare Premium
005-06
$ 1,978.80
Long Term Care
008-11
$ 3,292.89
6
Prescription
010-15
$ 129.29
Medical Services
RCW
$ 25.91
Medicare Premium
005-06
$ 1,978.80
7
Medicare Premium
005-06
$ 1,978.80
8
Prescription
010-15
$ 87.38
Medicare Premium
005-06
$ 1,978.80
9
Prescription
010-15
$ 2.23
Medicare Premium
005-06
$ 1,765.20
Dental Expenses
002-05
$ 197.00
10
Prescription
010-15
$ 448.36
Medical Services
RCW
$ 1,302.25
Medicare Premium
005-06
$ 1,597.20
Dental Expenses
002-05
$ 700.00
11
Prescription
010-15
$ 620.65
12
Prescription
010-15
$ 250.02
13
Prescription
010-15
$ 384.96
Medical Services
RCW
$ 203.50
Medicare Premium
005-06
$ 2,041.20
Dental Expenses
002-05
$ 700.00
14
Prescription
010-15
$ 476.45
Medicare Premium
005-06
$ 2,041.20
Dental Expenses
002-05
$ 224.20
Deductibles
001-06
$ 300.00
15
Prescription
010-15
$ 327.17
Medical Services
RCW
$ 161.88
Medicare Premium
005-06
$ 2,041.20
Dental Expenses
002-05
$ 89.00
Deductibles
001-06
$ 9.98
16
Medicare Premium
005-06
$ 62.40
17
Medicare Premium
005-06
$ 62.40
Long Term Care
008-11
$ 6,600.00
18
Medicare Premium
008-11
$ 62.40
Prescription
010-15
$ 41.00
Long Term Care
008-11
$ 3,292.00
19
Long Term Care
008-11
$ 7,101.36
26
, Total Approved Claims Total Reimbursed $ 58,306.86
Disability Board 2023 Q1 City of Edmonds - Human Resources Department Page 1
Current and Historial Claim Count & Costs
Summary of Current
Costs
01 /01 /2023 - 03/31/2023
SERVICE
Number of Claims
Total Paid for Service
Deductibles
2
$ 309.98
Dental Expenses
5
$ 1,910.20
Eyeglasses
1
$ 300.00
Long Term Care
6
$ 29,579.14
Medical Services
6
$ 1,954.79
Medicare Premium
14
$ 21,349.20
Prescription
13
$ 2,903.55
Grand Total
47
$ 58,306.86
Summary of Historical
Costs
01 /01 /2022 - 03/31/2022
SERVICE
Number of Claims
Total Paid for Service
Dental Expenses
7
$ 2,465.30
Eyeglasses
2
$ 374.98
Long Term Care
7
$ 27,063.00
Medical Services
8
$ 2,731.07
Medicare Premium
17
$ 29,155.00
Prescription
18
$ 5,279.99
Grand Total
59
$ 67,069.34
Disability Board 2023 Q1 [05/05/2023] City of Edmonds - Human Resources Department Page 1
CURRENT SUMMARY OF
COST BY BARS NUMBER 01/01/2023 - 03/31/2023
LEOFF 1 Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
009.000.39.517.20.23.00
$64,000.00
$24,422.25
$39,577.75
38.16%
Reimbursement Benefits
009.000.39.517.20.23.10
$142,650.00
$32,318.80
$110,331.20
22.66%
Premium Benefits
009.000.39.517.20.29.00
$152,990.00
$29,579.14
$123,410.86
19.33%
In Home/Assisted Living
009.000.39.517.20.41 - 49
$7,500.00
$0.00
$7,500.00
0.00%
Proff. Svcs, Travel, Misc.
Expenses
TOTAL:
$367,140.00
$86,320.19
$280,819.81
23.51 %
Fireman's Pension Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
001.000.39.517.20.23.20
$10,000.00
$1,964.43
$8,035.57
19.64%
Reimbursement Benefits
001.000.39.517.20.23.10
$14,560.00
$5,386.48
$9,173.52
37.00%
Premium Benefits
001.000.39.517.20.29.00
$165,023.00
$22,293.57
$142,729.43
13.51 %
Pension and Disability
Payments
001.000.39.517.20.41.00
$1,200.00
$0.00
$1,200.00
0.00%
Professional Svcs.
TOTAL:
$190,783.00
$29, 644.48
$161,138.52 15.54%
Disability Board 2023 Q1 [05/05/2023] City of Edmonds - Human Resources Department Page 2
HISTORICAL SUMMARY
OF COST BY BARS
NUMBER 01/01/2022 - 03/31/2022
LEOFF 1 Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
009.000.39.517.20.23.00
$64,000.00
$35,794.98
$28,205.02
55.93%
Reimbursement Benefits
009.000.39.517.20.23.10
$142,650.00
$23,928.33
$118,721.67
16.77%
Premium Benefits
009.000.39.517.20.29.00
$252,990.00
$21,363.00
$231,627.00
8.44%
In Home/Assisted Living
009.000.39.517.20.41 - 49
$7,500.00
$7,000.00
$500.00
93.33%
Proff. Svcs, Travel, Misc.
Expenses
TOTAL:
$467,140.00
$88,086.31
$379,053.69
18.86%
Fireman's Pension Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
001.39.517.20.23.20
$10,000.00
$1,599.10
$8,400.90
15.99%
Reimbursement Benefits
001.000.39.517.20.23.10
$14,560.00
$3,779.19
$10,780.81
25.96%
Premium Benefits
001.000.39.517.20.29.00
$70,944.00
$11,824.74
$59,119.26
16.67%
Pension and Disability
Payments
001.000.39.517.20.41.00
$1,200.00
$0.00
$1,200.00
0.00%
Professional Svcs.
TOTAL:
$96,704.00
$17,203.03
$79,500.97 17,79a�a
Disability Board 2023 Q1 [05/05/2023] City of Edmonds - Human Resources Department Page 3
expstat.rpt
05/04/2023 1:45PM
Periods: 0 through 3
009 LEOFF-MEDICAL INS. RESERVE
39 NON -DEPARTMENTAL EXPENSES
Account Number
009.39.517 EMPLOYEE BENEFIT PROGRAMS
009.39.517.20 "` Title Not Found —
009.000.39.517.20.23.00 REIMBURSEMENT BENEFITS
009.000.39.517.20.23.10 PREMIUM BENEFITS
009.000.39.517.20.29.00 IN -HOME LTC CLAIMS
009.000.39.517.20.41.00 PROFESSIONAL SERVICES
009.000.39.517.20.43.00 TRAVEL
009.000.39.517.20.49.00 MISCELLANEOUS
Total LEOFF-MEDICAL INS. RESERVE
Grand Total
Expenditure Status Report
City of Edmonds
1/1/2023 through 3/31/2023
Page: 1
Adjusted Year-to-date Year-to-date Prct
Appropriation Expenditures Expenditures Encumbrances Balance Used
64,000.00
24,422.25
24,422.25
0.00
39,577.75
38.16
142,650.00
32,318.80
32,318.80
0.00
110,331.20
22.66
152,990.00
29,579.14
29,579.14
0.00
123,410.86
19.33
7,000.00
0.00
0.00
0.00
7,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
500.00
0.00
0.00
0.00
500.00
0.00
367,140.00
86,320.19
86,320.19
0.00
280,819.81
23.51
367,140.00
86,320.19
86,320.19
0.00
280,819.81
23.51
Page: 1
expstat.rpt
05/04/2023 1:47PM
Periods: 0 through 3
001 GENERAL FUND
39 NON -DEPARTMENTAL EXPENSES
Account Number
001.39.517
EMPLOYEE BENEFIT PROGRAMS
001.39.517.20
*** Title Not Found ***
001.000.39.517.20.23.00
PENSION & OTHER BENEFITS
001.000.39.517.20.23.10
PREMIUM BENEFITS
001.000.39.517.20.23.20
REIMBURSEMENT BENEFITS
001.000.39.517.20.29.00
PENSION AND DISABILITY PAYMENTS
001.000.39.517.20.41.00
PROFESSIONAL SERVICES
Total *** Title Not Found ***
001.39.517.78
*** Title Not Found ***
001.000.39.517.78.11.00
SALARIES
001.000.39.517.78.23.00
BENEFITS - UNEMPLOYMENT
Total *** Title Not Found ***
001.39.517.90
*** Title Not Found ***
001.000.39.517.90.23.00
PENSION EXPENSE
001.000.39.517.90.49.00
MISCELLANEOUS -SMART COMMUTER GRANT
Total *** Title Not Found ***
Total GENERAL
FUND
Grand Total
Expenditure Status Report
City of Edmonds
1/1/2023 through 3/31/2023
Page: 1
Adjusted Year-to-date Year-to-date Prct
Appropriation Expenditures Expenditures Encumbrances Balance Used
25,000.00
0.00
0.00
0.00
25,000.00
0.00
14,560.00
5,386.48
5,386.48
0.00
9,173.52
37.00
10,000.00
1,964.43
1,964.43
0.00
8,035.57
19.64
165,023.00
22,293.57
22,293.57
0.00
142,729.43
13.51
1,200.00
0.00
0.00
0.00
1,200.00
0.00
215,783.00
29,644.48
29,644.48
0.00
186,138.52
13.74
101,750.00
0.00
0.00
0.00
101,750.00
0.00
25,000.00
0.00
0.00
0.00
25,000.00
0.00
126,750.00
0.00
0.00
0.00
126,750.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
342,533.00
29,644.48
29,644.48
0.00
312,888.52
8.65
342,533.00
29,644.48
29,644.48
0.00
312,888.52
8.65
Page: 1
From:
"Rady
To:
subja
F l£IXT1
Date:
MorKiW, Mania 27, 20D 1:4108 W
Begin forwarded message:
From:
Subject: LEOFF 1
Date: March 27, 2023 at 12:32:06 PM PDT
To: "Derrick, Carly"<carly.derrick([Dedmondswa.c�ov>
Hello Carly,
Visited yesterday during which time he asked that I send you a note with the
various c olces of residences.
He thought outline form would work.
! Cogir of Edmonds
a. Price is agreeable $150 / day or approximately $4560 / month. They have a
point system in place for additional care which may not need.
b. Studio apartment with meals is available or respite lodging
c. Preferred by family because of location
d. Staff there is ready to help
B Fairwinds-Brighton Court in Edmonds
a. Similar in price as Cogir
b. Currently in COVD lockdown
c. Strong 2nd choice
III Chateau in Lynnwood
a. Similar price but not convenient location
IV Genet Adult Family Home
a. $6000 / month
b. Heard small children in background each time she called
c. Physical Therapy? Treadmill in garage
.& I have other items in place or being worked on. Dr. Callaway agreed to
write a letter giving an order for extra day(s) for Ken's care before transfer to care
facility. Also, Swer ish/Stevens case worker Katie has been in touch to ask if she
can help in this
process.
Carly, hopefully I've supplied the required information needed for the LEOFF 1
board to consider.
Please call or email me with further questions.
Sincerel
1A li
City of Edmonds Disability Board
POLICY AND PROCEDURE
Effective: Approved by the Board at the May 3, 2006 meeting
Revised: Approved by the Board at the January 24, 2007, January 21, 2010, July
2015, March 3, 2015 and April 20, 2018, July 19, 2018, and February 24,
2023 meeting(s)
SUBJECT: HEARING AIDS, #04-06
A benefit is provided by the City of Edmonds Disability Board for both hearing tests
(once every three years) and hearing aids as follows:
• Preapproval from the Board is required for the intial purchase of any hearing aids
or the replacement of hearing aids. HR may approve hearing aid purchase
reimbursement up to the maximum allowed by this policy for any replacement
hearing aids.
• The reimbursement cost for the purchase of hearing aids will be a maximum of
$4,600 every 36 months. Reimbursement requests must be accompanied by
supporting documentation from a licensed physician or hearing specialist.
• HR staff has the authority to process Board pre -approved hearing aid purchase
requests for reimbursement with the appropriate supporting documentation from
a licensed physician and/or hearing specialist up to the approved maximum
amount of $4,600 every 36 months.
• Replacement of hearing aids will only be covered after 36 months and if the
current hearing aid cannot be reasonably repaired, presuming the hearing aid is
not covered by warrantee or insurance. The Disability Board will consider
replacement of hearing aids after 36 months if a different model or style of
hearing aid is needed due to a significant hearing change or if a new hearing aid
significantly accommodates the members hearing loss. In most cases, HR may
approve replacement hearing aid purchase reimbursement requests up to the
limits set by this policy.
• The cost of batteries is covered under this policy.
NOTE: Any special needs above and beyond the dollar amount set in this policy are
subject to appeal by the LEOFF 1 member to the City of Edmonds Disability Board with
appropriate medically necessary documentation. This policy will be reviewed by the
Disability Board on an annual basis.
City of Edmonds — Disability Board
5/2/2023
From: Sharon Cates
To: Derrick, Carlv
Subject: RE: Disability Board
Date: Wednesday, May 3, 2023 11:35:56 AM
Attachments: imaae001.ong
Hearing Aids, #04-06.pdf
RCW 41.26.150 Sickness or disabilitv benefits --Medical services.Ddf
Hi Carly,
I've looked into the question of the legality of the Disability Board requiring LEOFF I
members to obtain a hearing evaluation from a hearing specialist before the Board will cover the
cost of hearing aids, given the new FDA regulations relating to over -the-counter (OTC) hearing aids.
The short answer is that, yes, it is legal for the Board to require a medical exam before purchasing
any type of hearing aid.
The new FDA regulations were implemented to improve access to hearing aid technology for
Americans, since OTC hearing aids are significantly less expensive than traditional hearing aids. Here
is a link to the Federal Register that helps explain the intent of the regulations:
https://www.federalregister.gov/documents/2022/08/17/2022-17230/medical-devices-ear-nose-
and-throat-devices-establishing-over-the-counter-hearing-aids. The main reason for these
regulations is to help ensure the safety and effectiveness of OTC hearing aids so that individuals may
be more likely to buy them and improve their quality of life.
These regulations do not impact the Disability Board's ability to require a medical evaluation
before covering the cost of their purchase because the provisions of Chapter 41.26 RCW govern the
Board's actions. As you know, that statute requires the board to pay for medically necessary health
care, and any member who refuses to obtain a required examination from a licensed physician
forfeits all right to benefits under the statute for the period of the refusal (see highlighted copy of
RCW 41.26.150, attached). So, while the FDA regulations don't require a medical exam, they also
don't prohibit entities like Disability Boards from requiring a medical exam before covering the cost
of the purchase of medical services or equipment.
In researching this topic, I found that the use of OTC hearing aids is controversial, with some
in the medical community supporting their use since many who could benefit might go without
because of the cost of traditional hearing aids, and others concerned that, without the guidance of a
medical professional, OTC hearing aids could damage individuals' ears or not work well enough and
result in them giving up on hearing aids altogether. In addition, hearing loss can be a symptom of an
underlying health issue, so consulting with at least a primary care physician is helpful in determining
the best hearing aid route for that person.
In summary, there is no legal roadblock to the Board continuing to require a medical exam in
this situation. The current wording of the second bullet point of Policy #04-06 seems to be
appropriate for both traditional and OTC hearing aids because it requires "supporting
documentation from a licensed physician or hearing specialist," which means that a member could
consult their primary care physician only and if the physician thinks that an OTC hearing aid is
appropriate, the policy will cover the cost of that purchase. Also, because the policy covers the cost
of hearing tests, a member could also go that route and obtain the necessary supporting
documentation from a hearing specialist instead.
Please let me know if this doesn't fully answer your questions.
Best regards,
Sharon
Sharon Cates
600 Stewart Street, Suite 400
Seattle, WA 98101
Phone: 206-273-7440
E-mail: Sharon(@lighthouselawgroup.com
THIS MESSAGE IS PRIVATE AND PRIVILEGED. IF YOU ARE NOT THE PERSON MEANT TO RECEIVE
THIS MESSAGE, PLEASE DELETE IT AND PLEASE DO NOT COPY OR SEND IT TO ANYONE ELSE.
From: "Derrick, Carly" <Carly.Derrick@edmondswa.gov>
Date: Tuesday, May 2, 2023 at 2:21 PM
To: Sharon Cates <sharon@lighthouselawgroup.com>
Subject: Disability Board
Hi Sharon,
The Board decided to change the hearing aid policy to outline the following:
1. Reimbursement for hearing aids is a maximum of $4,600 every 36 months.
The Board would like to keep the second bullet point of requiring an evaluation from a hearing
specialist, but they wanted to know if that was "legal" to require that in light of the new ruling that
hearing aids can be purchased over the counter and an evaluation is not required by the FDA.
Thank you,
Carly Derrick, SHRM-CP
Human Resources Analyst
City of Edmonds
Office Hours:
Monday: 8:00 am - 4:30 pm (remot%ffsite)
Tuesdays & Fridays: 8:30 am — 5:00 pm (remote from 8:30-9:30 am, onsite 9:30 am — 5:00 pm)
(425) 672-5751 (Direct)
(425) 275-4806 {HR Fax}
11-16
City of Edmonds Disability Board
Effective:
Reviewed and approved by the Board at the October 20, 2016 meeting
SUBJECT: REIMBURSEMENT OF MEDICAL SERVICE EXPENSES AND/OR
MEDICAL EQUIPMENT COSTS*, #11-16
The City of Edmonds' Disability Board designates the medical services available to
members of the LEOFF 1 (persons who establish members in the retirement system on
or before September 30, 1977) to include the following medical services in addition to
those noted in RCW 41.26.030 (22).
GENERAL RULE. The Disability Board will authorize payment of reasonable expenses
for necessary medical services and supplies incurred by a LEOFF 1 member, as long as
the expenses were not the result of dissipation or abuse. Decisions will be made on a
case -by -case basis, although the Board will adopt general policies addressing certain
frequently recurring medical claims. Any LEOFF 1 member who is unsure whether
particular medical services or supplies are covered by the LEOFF 1 program is
encouraged to petition to the Board before the costs are incurred.
EMPLOYER'S INSURANCE PLAN. As the City provides an insurance plan to LEOFF 1
members with a coverage benefit under the group hospitalization and medical aid
insurance plan, a LEOFF 1 member seeking medical services or supplies must attempt
to do so in a manner that allows for coverage under the insurance plan. If the Board
determines that the LEOFF 1 member could have obtained reasonable equivalent
services or supplies through the insurance plan and that the LEOFF 1 member failed to
do so without good reason, reimbursement will not be authorized.
OTHER SOURCES OF COMPENSATION. The amount that the Disability Board
awards for medical services/and or medical equipment will be reduced by any amount
that the member receives, or is eligible to receive, from workers' compensation, social
security, insurance provided by other employers, or other pension plans, Medicare, or
other similar sources. "For the purpose of this policy, eligible means that a member
could be reimbursed by the employer for premiums or could submit a member paid
premium to the Disability Board for approval of payment." Therefore, a member who is
eligible for compensation from one of these other sources, but who does not apply for its
benefits, will have his/her medical benefits under LEOFF 1 reduced by the amount that
would have been paid by the other source. There will be no such reduction, however, if
the member presents a claim to the other source and that other source provides
justification for refusal of payment.
City of Edmonds - Disability Board
7/18/2017
It is the policy of the Disability Board to purchase supplies, materials, equipment and
services at the most reasonable price as soon as reasonably possible. This procedure
is designed to assure the establishment of a competitive price, selection of the lowest
qualified/responsible bidder, while meeting the LEOFF 1 Retiree's needs and
expectations
• Pre -authorization from the Board prior to the acquisition of the goods and/or services
is required for items with an expense of $500.00 or more in addition to
documentation of medical necessity from the LEOFF 1's medical provider.
• No price quotes are required for purchases under $500.00, but requests for
reimbursement in the amount of $500.00 or less must still be accompanied by
documentation of medical necessity from the LEOFF 1's medical provider if not
covered by Medicare and/or the City's medical insurance and/or any other medical
insurance the LEOFF 1 retiree may have coverage through.
• In cases where the cost of acquisition of the goods and services exceeds $500.00,
three (3) quotes are required on all purchases of $500.00 or more. The number of
vendors contacted may be reduced if the item being sought is only available from
one or two vendors. The LEOFF 1 Disability Board will reimburse the lowest
qualified bid unless there is proof of extenuating circumstances (documented by the
LEOFF 1 Retiree's medical provider) as to the medical necessity of the non -lowest
priced, qualified bid.
• Replacement costs for medical equipment will only be covered if any current medical
equipment being used cannot be reasonably repaired and must be supported by
documentation from the medical provider of medical necessity.
NOTE: Any special needs above and beyond the dollar amount set in this policy are
subject to appeal by the LEOFF 1 member to the City of Edmonds Disability Board with
appropriate medically necessary documentation. This policy will be reviewed by the
Disability Board on an annual basis.
*Includes visual aids and/or adaptive devices, but excludes hearing aids
NOTE: Any special needs above and beyond the dollar amount set in this policy are
subject to appeal by the LEOFF 1 member to the City of Edmonds Disability Board with
appropriate medically necessary documentation. This policy will be reviewed by the
Disability Board on an annual basis.
2023 WSLEA COMPARISON OF BENEFITS*
Acupuncture
Jurisdiction
Policy Summary
Aberdeen
Physician prescribed, certified acupuncturist.
Bellingham
Physician prescribed. 25 visits/yr also see Massage therapy
Bothell
Physician prescribed, certified acupuncturist. Treatment plan over 2 visits.
Submit claims w/in 6 months
Bremerton
Physician prescribed.
Clallam Co
Physician prescribed as medically necessary.
Cowlitz Co
Tx beyond insurance requires tx plan in a month w/updates every 12 mos.
Douglas Co
Physician prescribed, certified provider. Treatment plan over 2 visits.
Everett
Case by Case benefit. Submit directly to Board secretary's office.
Kennewick
Pre -approval required over 12 visits/year.
King Co
Physician prescribed, certified acupuncturist. Pre -approval over 2 visits.
Mason Co
No policy
Pacific Co
Physician prescribed, licensed acupuncturist. 12 visits/year.
Pierce Co
12 visits/year.
Puyallup
12 visits/year.
Redmond
Case by case — if medically necessary.
Renton
Covered in plan 25/yr Massage/Acupuncture; to exceed needs pre -approval
Richland Fire
Administered by physician or licensed acupuncturist under guidance of physician.
Richland Police
Administered by physician/licensed acupuncturist. 12 visits/year; pre -approval for
additional. Dr letter required.
Seattle Fire
One treatment day/$135; Rx from Doctor. State licensed.
Seattle Police
Licensed practitioner for Acupuncture and Massage Therapy. As prescribed by
medical doctor.
Skagit Co
Physician prescribed, certified acupuncturist. Pre -approval over 3 visits. 12
visits/6-mos.
Skamania Co
12 visits in 6 months.
Snohomish Co
Physician prescribed as medical necessity. Pre -approval over 4 visits.
Spokane Co
$750 per year/lifetime/one condition/$3000 for tx. Includes Naturopathy,
acupuncture, massage, chiro and other holistic or alternative.
Tacoma
12 visits/year through Regence BlueShield.
Vancouver
Administered by or under direction of a physician. Pre -approval required.
Walla Walla
Physician prescribed, provided by certified acupuncturist. Treatment plan over 2
visits.
Whatcom Co
Services provided by certified acupuncturist.
Whitman Co
Services provided by certified acupuncturist. Treatment plan 6 months or 10 visit.
Yakima Co
Services by certified acupuncturist. 12 visits/year.
Bariatric Surgery
Jurisdiction
Policy Summary
Benton Co
Have covered for medical necessity.
Bothell
Board will consider programs that are Dr prescribed.
Everett
Diet Education 100% allowable charge. Non -surgical tx only.
Grays Harbor Co
Have covered for medical necessity.
Kirkland
Would consider if medically necessary.
Pasco
Not covered
Snohomish Co
Have covered for medical necessity.
Spokane
Have covered for medical necessity.
1 WSLEA Comparison of Benefits, Revised February 5, 2023
Bariatric Surgery (Cont.)
Jurisdiction Policy Summary
Thurston Co Have covered for medical necessity.
Yakima Co Have covered for medical necessity.
Board Administration
Jurisdiction
Policy Summary
Aberdeen
HR Director
Bellevue
Sr HR Analyst
Bellingham
Finance Clerk (meetings); HR Benefits Rep (pensions/bills); HR Director (policy
changes)
Benton Co
Commissioner's Executive Secretary
Bothell
Sr HR Analyst
Bremerton
Clerk (meetings/policies), HR (bills/pension)
Chelan Co
HR
Clallam Co
HR
Edmonds
HR Director
Everett
Deputy City Clerk — Finance
Franklin Co
HR
Island Co
Commissioner's staff
Jefferson Co
Commissioner's staff
Kennewick
Police Department Administrative Assistant
Kent
Benefits Manager
Kirkland
HR Analyst
Klickitat Co
Commissioner's Office Clerk of the Board/Deputy Clerk Claims
Lewis Co
Commissioner's Office Administrative Assistant
Marysville
HR Director
Mason Co
Commissioner's Office/Human Resources
Mercer Island
Human Resources
Okanogan Co
Commissioner's staff
Olympia
Office Specialist III and Personnel Analyst1
Pacific Co
Accounts Payable - Chief Deputy Auditor
Pasco
HR Director
Pend Oreille Co
Commissioner's staff
Pierce Co
Risk Management
Richland
Accounting Specialist - Finance
SeaTac
Fire Department Administrative Assistant
Skagit Co
HR Director
Skamania Co
No LEOFF I pensioners
Snohomish Co
Human Resources Generalist
Spokane
Assistant Retirement Director (pensions/Medicare); HR Benefits Specialist
(medical)
Spokane Co
Commissioner's Office Administrative Assistant
Thurston Co
Human Resources
Vancouver
Human Resources
Walla Walla Co
Commissioner's Office Administrative Assistant
Whatcom Co
Executive's Office
Whitman Co
Commissioner's Office Clerk of the Board
Yakima Co
HR Sr Program Rep
2 WSLEA Comparison of Benefits, Revised February 5, 2023
Cataract Up -grade
Jurisdiction
Policy Summary
Bellevue
Have covered - case by case.
Chelan Co
Have covered - case by case.
Everett
Allowed up to $550 instead of payment for eyeglasses.
Island Co
Would consider case by case.
Kirkland
Would consider case by case.
Klickitat Co
Would consider medical necessity.
Marysville
Monofocal lens approved; no specialty multifocal approval
Olympia
Would consider medical necessity.
Pacific Co
Not covered
Pierce Co
Have denied as not medically necessary.
Puyallup
Consider case by case.
Redmond
$1500 lifetime limit for Toric or Multifocal lenses during cataract surgery
Richland
Have covered.
Seattle Police
Consider it medically necessary for the member's vision.
Snohomish Co
Have covered for medical necessity, case by case.
Spokane
Would consider medical necessity.
Tacoma
Denied the extra charges.
Thurston Co
Would consider medical necessity.
Vancouver
Have denied as not medically necessary.
Whatcom Co
Monofocal only.
Yakima Co
Have covered for medical necessity.
Chemical Dependence
Jurisdiction
Policy Summary
Aberdeen
Repeat patients reimbursed 1 year after completion w/evidence of continued
recovery.
Bellingham Fire
Provided through medical plan for alcohol and drug tx.
Bellingham Police
Medical plan coverage
Bothell
$2,000/year for 3 consecutive years. Written confirmation program completion.
Bremerton
Per statute
Chelan Co
Medical plan covers, non -covered costs up to $5,000 over 2-year period, conditions
apply.
Clallam Co
Pre -approval required. One-time $6,000 maximum
Cowlitz Co
If exceeding insurance coverages, Licensed psychiatrist, et all (see plan), Dr ordered
with Tx plan. State licensed facility. Notify pension w/I 10 days of admission. Repeat
tx: Pay for tx/reimbursed after one year of completion.
Everett
100% allowable charges both inpatient and outpatient.
Franklin Co
Pre -approval required. Part of regular coverage.
Grays Harbor Co
Prescribed by licensed physician.
Jefferson Co
$2,000/year for 3-consecutive years.
Kennewick
Inpatient treatment facilities, one-time only. Pre -approval required.
King Co
Maximum $6,000. Pre -approval and written confirmation of program completion.
Kirkland
Physician prescribed State -approved program. Pre -approval required.
Kittitas Co
Licensed agency: Dr ordered, written plan w/in 5 days of admission. Complete tx, if tx
discontinued member cost prorated.
Lewis Co
Not to exceed by 10% average cost for such care in Lewis Co area.
Marysville
Covered through city plan/expenses not covered can be submitted to board.
Okanogan Co
Pre -approval required.
3 WSLEA Comparison of Benefits, Revised February 5, 2023
Chemical Dependence (Cont.)
Jurisdiction
Policy Summary
Pacific Co
Not to exceed by 10% the average cost for such case in the Pacific Co area.
Pasco
State approved tx only
Pend Orielle
Licensed facility approved by board Dr. Max $5,000 during consecutive years — Dr
recommended. Written tx plan, within 5 days of admission. Remains in facility thru
final or prorated.
Pierce Co
Only if administered by state -approved treatment program.
Puyallup
$12,000 every 2 calendar years.
Redmond
Case by case.
Renton
Board discretion, pre -approval needed.
Richland Fire
Complete use disorder program by City of Richland first before an out of network plan
submission to Board for authorization.
Richland Police
Complete use disorder program by City of Richland first before an out of network plan
submission to Board for authorization.
Seattle Fire
State licensed facility. Primary Dr letter/determine Tx. In/outpatient. Reimbursement
lifetime max $18,000.
Seattle Police
100% billed charges in/outpatient. Up to lifetime max $30,000. State licensed facility
Skagit Co
$9,600 maximum. Pre -approval required. Repeat treatment considered after 1year
Skamania Co
Pre -approval required. Prescribed by physician, psychiatrist, or psychologist.
Snohomish Co
Licensed treatment facility referred by doctor, one treatment per lifetime.
Spokane Co
Outpatient/residential including diagnostics, counseling. Not exceeding $7,000/2
years or total $14,000/lifetime.
Tacoma
Provided by Regence Blue Shield.
Vancouver
Pre -approved only in case of medical necessity.
Walla Walla
$6,000 maximum. Pre -approval required. Repeat treatment considered after 1year.
Wenatchee
Pre -approval by Board physician required. Maximum $5,000/2 consecutive years.
Whatcom Co
$6,000 maximum. Pre -approval required. Repeat treatment considered after 1year.
Whitman Co
$6,000 maximum. Pre -approval required. Repeat treatment considered after 1year.
Yakima Co
Preferred & Participating Providers. 100% of Allowed amount.
Yakima
Drug/Alcohol inpatient and outpatient/100% to max $5,000 every two consecutive
yrs/lifetime max $10,000.
Yakima Fire
$5,000 maximum in a two -consecutive -calendar -years, $10,000 lifetime maximum.
Chemical Dependence
Jurisdiction
Policy Summary
Aberdeen
Evaluation/treatment plan required every 6 months.
Auburn
Same as medical benefit if performed by licensed chiropractor.
Bellingham
Medicare covers spinal manipulations. Anything not covered, send documentation to
Board for reimbursement.
Bellingham Fire
Submit itemized bill and EOB for reasonable charges to pension board.
Bothell
Covered by insurance plan. If visits exceed entitlement, can submit to Board for
consideration.
Bremerton
Covered by insurance; if +visits then board discretion.
Chelan Co
Insurance max applies. Any exceeding evaluation required to establish necessity
Clallam Co
Covered when provider licensed chiropractor.
Clark Co
More than 20 visits per year must be pre -approved.
Cowlitz Co
Tx beyond insurance requires tx plan in a month w/updates every 12 mos.
Douglas Co
20 visits per calendar year.
Everett
100% of allowable charges; x-rays: once every 12/mos. 100% allowable charges.
Franklin Co
Pre -approval required over 20 visits per calendar year.
4 WSLEA Comparison of Benefits, Revised February 5, 2023
Chemical Dependence (Cont.)
Jurisdiction
Policy Summary
Grant Co
Insurance policy criteria, 20 visits/year submit report from chiro to exceed/pr
Grays Harbor Co
Evaluation/treatment plan required for services exceeding insurance coverage.
Jefferson Co
Prior approval required after 2 treatments exceeding insurance coverage.
Kennewick
Pre -approval required for over 12 visits per calendar year. Board eval for addt'I.
King Co
Treatment plan required for more than 2 visits and every 6-continuous months.
Kirkland
Prior approval after insurance limitations exhausted.
Kitsap Co
Same as other necessary medical claims.
Kittitas Co
15 visits year, exceed 15 visits requires board medical to determine necessity.
Klickitat Co
12 visits/year Max $45 per visit. Pre -approval req'd after 12/year.
Lacey
20 visits annually. To exceed/board Dr to determine necessity.
Lewis Co
Pre -approval required after 35 visits/calendar year.
Lynnwood
Pre -approval required before exceeding defined insurance benefit
Marysville
Covered with city plan, 25 visits per year
Mason Co
No policy
Mercer Island
Pre -approval required over 20 visits per calendar year.
Olympia
Pre -approval required over 20 visits per calendar year.
Pacific Co
Pre -approval required. No more than 35 visits per calendar year.
Pierce Co
As governed by statute.
Puyallup
25 visits/calendar year.
Redmond
Covered same as active employes — 22 visits annually; Board covers remaining.
Renton
Pre -approval required over 20 visits per year.
Richland
Covered as any other medical.
Seattle Fire
Licensed Chiro. $80 per session/26 sessions per year/1 tx day. X-rays covered up to
two sets per year.
Seattle Police
Maximum $60/visit up to 24 visits/year without prior Board approval.
Skagit Co
Pre -approval required after 3 visits/six mos for same condition.
Skamania Co
12 visits/year unless prescribed by chiropractor or physician. Pre -approval before
exceeding
Snohomish Co
20 visits annually. Treatment plan required after 4 visits for same injury.
Spokane Co
$750 per year/lifetime/one condition/$3000 for tx. Includes Naturopathy, acupuncture,
massage, chiro and other holistic or alternative choice.
Tacoma
Written report required after 20 visits.
Tumwater
Reasonable expenses by licensed medical provider.
Vancouver
First call $129; subsequent calls $40; x-rays $100. Kaiser members shall access
services through Kaiser.
Walla Walla
Treatment plan required after 10 visits for same condition.
Whatcom Co
Treatment plan required after 3 visits for same condition.
Whitman Co
Treatment plan required after 3 visits for same condition. 6-month progress reports.
Yakima
No specific policy
Yakima Co
12/year. Pre -approval required before exceeding defined benefit.
Chiropractic
Jurisdiction
Policy Summary
Asotin
Rx should be monthly; Rx must be quarterly March, June, September, and
December.
Benton Co
Submit with required documentation;
Bothell
Submit within six months of billing date
Bremerton
Accept faxed, copied, or e-mailed claims
Chelan Co
Accept US Mail or email within 6 months
5 WSLEA Comparison of Benefits, Revised February 5, 2023
Chiropractic (Cont)
Jurisdiction
Policy Summary
Clark Co
Submission to one year of date of service
Clallam Co
Submission to a year of date of service
Douglas Co
Accept within 6 months of date of service
Everett
Accept faxed, copies or e-mailed claims
Franklin Co
Accept faxed, copied, or e-mailed claims
Grays Harbor
Submission to 6 months from date of service or processed by insurance.
Kennewick
Submission within six months of date of service/insurance processing.
Island Co
Accept faxed, copied, or e-mailed claims
Kirkland
Submission within 6 months of service
Kittitas Co
Submission w/I 180 days of receipt of original bill.
Klickitat Co
Submission up to one year from date of service.
Longview
Submission within six months following original billing.
Lynnwood
Submission within one year: Fire: Medicare & Sup Police: Medicare & Sup HMA and
Dental to board
Marysville
Submission within 6 months of dates of service.
Mercer Island
Accept faxed, copied, or e-mailed claims
Olympia
Active or covered thru spouse/premium reimbursement $50/month. Not active/no
other plan: $600/year. Retired: 2 cleanings/year. Provision: $2000/annually
premiums/fillings/crowns. Over 2k Tx plan preapproval required. Dentures:
Preapproval/two quotes 100%.
Pasco
Two-year term; Nominations and ballots to all members
Pend Orielle
Submission w/in 6 months
Richland Fire
Submission w/in 90 days of date of expense.
SeaTac Fire
Submission within 90 days of receipt of bill.
Skamania Co
Accept faxed, copied, or e-mailed claims
Spokane
Accept faxed, copied, or e-mailed claims
Spokane Co
Submission w/in 12 months after receipt of insurance EOB
Tacoma
Submission by one year from date of service
Tumwater
Submission by one year date of service
Whitman Co
Accept faxed, copied, or emailed claims
Yakima
One year from dates of service.
Walla Walla
Submission within a year of dates of service
Claim Filina Limits
Jurisdiction
Policy Summary
Aberdeen
6 months of receipt of original bill
Asotin Co
Rx at least quarterly, March, June, Sept, December
Bellingham
12 months of date of service
Bellevue
1 year from date of service
Bothell
6 months of billing date
Bremerton
1 year from date of service
Chelan Co
1 year from date of service
Clallam Co
1 year of date of service
Clark Co
1 year of date of service
Cowlitz Co
Within 6 months from original billing.
Douglas Co
Within 6 months from the date incurred
Edmonds
12 months from date of service
Everett
1 year of date of service
6 WSLEA Comparison of Benefits, Revised February 5, 2023
Claim Filing Limits (Cont.)
Jurisdiction
Policy Summary
Grays Harbor Co
6 months of date of service or from date of denial by insurance carrier
Jefferson Co
6 months of receipt of original billing
Kennewick
6 months of date of service or date processed by insurance carrier
King Co
6 months of receipt of original billing
Kirkland
6 months of receipt of original billing
Kittitas Co
180 days of receipt
Klickitat Co
1 year of service date
Lewis Co
Submission w/in 12 mos of date of service.
Lynnwood
No later than one year.
Marysville
6 months of receipt of original billing
Mercer Island
120 days
Okanogan Co
1 year of date of service
Olympia
1 year of date of service
Pacific Co
1 year of date member becomes aware, or should have become aware
Pierce Co
1 year of service date
Puyallup
1 year of service date or knowledge of the claim
Redmond
6 months of service date
Renton
1 year of service date
Richland Police
Submission first to any medical/dental coverages then by 6 months date of expense.
Skagit Co
6 months of receipt of original billing
Skamania Co
6 months after receipt of insurance EOB; medication 1 year from date of service
Snohomish Co
1 year of service date
Spokane Co
6 months of date of service
Tacoma
1 year of service date
Thurston Co
1 year of service date
Vancouver
1 year of service date
Walla Walla
6 months of receipt of original billing
Whatcom Co
1 year of date of service
Whitman Co
Rx submission by 12months from purchase; Other claims 90 days of treatment date.
Yakima Co
1 year of service date
Claim Funding
Jurisdiction
Policy Summary
Bellevue
Separate fund for LEOFF I expenses.
Benton Co
Claims paid from general fund and administered by Commissioner's office.
Bremerton
Claims paid from general fund and administered by Board Secretary (City Clerk).
Chelan Co
Claims paid from general fund and administered by Commissioner's office/HR.
Clallam Co
Budgets for medical claims in Human Resources budget.
Clark Co
Have separate fund for LEOFF I expenses.
Douglas Co
Employing agencies pay claims, Board has budget exams ordered by Board.
Everett
Has separate fund for LEOFF I expenses.
Jefferson Co
No separate budget, paid from general fund, administered by Auditor's Office.
Mercer Island
Submission within 120 days of dates of service
Olympia
Funded through general fund and processed by Human Resources.
Pierce Co
Budget through Sheriffs department/through Risk Management for long term care
Redmond
Set aside budget for claims.
Richland
General fund transfers into pension fund based on actuary recommendation.
Skagit Co
No separate budget, paid from general fund, administered by Human Resources.
7 WSLEA Comparison of Benefits, Revised February 5, 2023
Claim Funding (Cont.)
Jurisdiction
Policy Summary
Skamania Co
Submission in timely fashion, no 6+ month claims. Medication submission w/in a year
from date.
Snohomish Co
Claims paid from benefit fund out of the LEOFF sub -fund.
Spokane Co
Budgets fund in the Sheriff's office budget, individual districts administer fund.
Vancouver
Has separate budgeted funds for LEOFF 1 expenses.
Walla Walla Co
Budget for claims as part of Sheriff's office budget, claims paid from Sheriffs Office.
Yakima Co
Budgets in a separate fund with general fund providing revenue.
Yakima Fire
Have separate fund for LEOFF I expenses.
Yakima Police
Funded through general fund and processed by City Clerk's office.
Claim Processinq
Jurisdiction
Policy Summary
Adams Co
Submitted to board within 6 months.
Bellevue
Adams Co Auditor and Accounts Payable.
Bellingham
All claims must be approved by the Board prior to payment.
Bellingham Fire
All claims must be approved by the Board prior to payment, prescription copays
reimbursed twice yearly, medical paid monthly following Board approval.
Benton Co
Submit within rolling 12 mos. from date of service w/60-day grace period.
Bothell
Board secretary provides vouchers to Auditors Office for payment. Confidential
information retained in Board files. Claims processed monthly following Board
approval.
Bremerton
Staff has $1,000 authorization limit for processing general medical claims, Claims
paid weekly.
Chelan Co
HR
Clark Co
All claims must be approved by the Board prior to payment.
Clallam Co
Claims processed monthly following Board approval.
Douglas Co
All claims must be approved by the Board prior to payment.
Edmonds
Claims must be submitted with 6 months. Claims paid monthly.
Everett
Claims paid as received, items requiring further Board review are paid quarterly.
Franklin Co
Secretary processed per Board policies.
Grant Co
Process claims as received.
Grays Harbor Co
Claims processed monthly following Board approval.
Island Co
Accountant in Sheriffs Department.
Jefferson Co
All claims must be approved by the Board prior to payment, paid bi-monthly.
Kennewick
Auditor's Office Accountant.
King Co
Claims paid monthly.
Kirkland
Board Clerk.
Kittitas Co
HR Staff Assistant to Board, claims processed bi-monthly.
Klickitat Co
Auditor's Office for County, Local Police & Fire Department's handle their own.
Lacey
Sheriffs Department after Board approval.
Claim Processing
Jurisdiction Policy Summary
Longview Claims paid as received.
Marysville Claims processed monthly following Board approval.
Mason Co Claims paid monthly after Board approval.
Mercer Island Human Resources.
Mountlake Terrace Secretary has $450 authorization limit for processing general medical claims, checks
cut weekly.
8 WSLEA Comparison of Benefits, Revised February 5, 2023
Claim Processin_g
Jurisdiction
Policy Summary
Okanogan Co
Claims paid monthly.
Olympia
Claims processed monthly.
Pacific Co
Office Specialist III in Human Resources
Pasco
Checks cut weekly. Board Secretary may process claims up to $450.
Pierce Co
Board Clerk, claims paid monthly following Board approval.
Puyallup
Risk Mgmt sends authorization to pay to Accts Pay in Sheriffs Dept or another
agency.
Renton
HR Staff Assistant to Board.
Richland
Secretary has $500 authorization limit for processing general medical claims, claims
processed twice per month.
SeaTac
Secretary processes per Board policies.
Skagit Co
Board secretary processed bills up to $500 without Board pre -approval.
Skamania Co
Secretary follows Board guidelines, claims processed as received.
Snohomish Co
Civil Deputy, Sheriffs Office.
Spokane
All claims must be approved by the Board prior to payment, claims paid monthly.
Spokane Co
Staff process per Board guidelines; process warrants twice a month.
Tacoma
Individual cities and fire districts.
Thurston
All claims must be approved by the Board prior to payment; Claims processed
monthly.
Vancouver
Secretary processes per Board policies.
Walla Walla Co
HR Staff Assistant to Board/3rd Party Administrator processes and pays claims within
2-3 weeks of receipt.
Whitman Co
Warrants processed twice a month.
Yakima
Secretary processes per Board policies, claims paid weekly.
Yakima Co
Pension Records Clerk.
Cosmetic Surgery
Jurisdiction
Policy Summary
Bothell
Only as result of accidental injury or disease necessary to correct function.
Clallam Co
Not medically necessary except post trauma reconstructive.
Everett
No specific policy but would likely approve if medically necessary.
Jefferson Co
Not considered a medical necessity.
Kent
Not considered a medical necessity.
King Co
Not considered a medical necessity.
Kirkland
Only as result of accidental injury or disease necessary to correct function.
Lacey
Services for beautification purposes not considered.
Pacific Co
Do not provide.
Richland
Only as result of accidental injury or disease necessary to correct function.
Seattle Fire
Only if medically necessary.
Seattle Police
Reconstruction to correct as a result of injury only. Pre auth required w/Dr letter
Snohomish Co
Reconstruction to correct/repair as result of injury.
Yakima Co
Not covered unless result of duty related injury.
Dental
Jurisdiction Policy Summary
Auburn Check-up, cleaning, x-rays semi-annually. All other services require pre -approval.
Orthodontic if determined medically necessary.
Bellevue $1,200/year.
Bellingham Fire As covered by statute. No insurance.
9 WSLEA Comparison of Benefits, Revised February 5, 2023
Dental (Cont)
Jurisdiction
Policy Summary
Bellingham Police
Accidental injury see policy/submit to board. Max $3,000
preventative/cleanings/maintenance/yearly. Shall have at least one cleaning/yr.
Failure may impact other dental authorizations. No whitening. Case by case for
implants/surgery.
Benton Co
Accidental injury see policy/submit to board. Max $3,000
preventative/cleanings/maintenance/yearly. Shall have at least one cleaning/yr.
Failure may impact other dental authorizations. No whitening. Case by case for
implants/surgery.
Bothell
Allowance of $1,000 in conjunction w/vision per year
Bremerton
2 exams, cleaning & x-ray up to $500/year; treatment of periodontitis allowed first
occurrence only. Routine & periodontal $2,500/yr.
Chelan Co
Accidental injury
Clallam Co
Accidental injury to teeth only.
Clark Co
Checkup, x-rays, cleaning, fluoride treatment one per year. $1,500 every 2 years for
routine/periodontal, root canal, dentures, etc.
Columbia Co
Employer shall provide benefits similar to those for active employees.
Cowlitz Co
Employer provides dental insurance.
Douglas Co
Per RCW except "Well care" as defined by member plan. Cosmetic dental/case by
case, medically necessary. Pre -approval unless emergency.
Edmonds
Accident Win 90 days of accident
Everett
$700 per year services or premium. Use it or lose it.
Franklin Co
$2,000 per calendar year (1-year roll-over of unused balance up to $4,000).
Grant Co
Accidental injury to teeth. Dentures up to $350 per plate, once every seven years.
Grays Harbor Co $750/12-mo period; $1,200 one set dentures or bridge. No orthodontia unless for
medical necessity.
Island Co
1 exam/year; 2 cleanings/year; $1,000/year routine dental; dentures, implants,
bridgework 50% to $3,000/year; no teeth whitening; no cosmetic.
Jefferson Co
No policy. No dental insurance.
Kennewick
Up to $500 per calendar year for check-ups, cleaning or denture reline.
Kent
As governed by statute.
King Co
$1,500/year. $1000 lifetime orthodontia. City covers insurance.
Kirkland
Maximum $3,000/year. Cosmetic dental only as medically necessary.
Kitsap Co
One annual routine/cleaning x-rays. All other dental preapproval required. Dental
Injury start within 90 days of accident/completed within 2 years.
Kittitas Co
Max $1,000/year. Wellness/x-rays/cleaning prescriptions by dentist.
Klickitat Co
$500/year preventive and x-rays
Lacey
Accidental injury to teeth. Orthodontics for medical necessity, pre -approval rqd.
Lewis Co
Do not provide dental care.
Longview
Only accidental injury to teeth.
Mason Co
100% billed charges routine max $2,500. One mandatory cleaning/Yr. Can carry
funds to max $5,000.
Marysville
$2000/year includes 2 cleanings/1 set of X-rays. Further expenses require prior
approval.
Mercer Island
$1,500 maximum per year for premiums/deductibles for members on city plan. If not
on city plan/case by case basis.
Okanogan Co
Accidental injury to teeth received while on -duty.
Olympia
As governed by statute.
10 WSLEA Comparison
of Benefits, Revised February 5, 2023
Dental (Cont)
Jurisdiction Policy Summary
Pacific Co $600/year preventive/restorative. Dentures 50% lowest of 2 quotes. Prior approval.
Reimburse premium for retiree coverage through current employer up to $48/month.
Pasco
$300/year. Dentures if medical necessity and pre -approved.
Pierce Co
Procedures medically necessary to prevent physical problems, prior approval
required. No orthodontia.
Pullman
$2,000 per year. Cosmetic not approved.
Puyallup
No dental insurance.
Redmond
$2,000/year.
Renton
Accidental injury to teeth and claims documented medically necessary.
Richland Police
Covered under city plan w/ limits for Type of care. Two cleanings per yr.
Richland Fire
$1,200/year preventive/restorative. $1,500/dentures one set bridges/denture/implant,
one lifetime payment. Orthodontics if medically necessary.
SeaTac Fire
$2,000/year exam, fillings, crowns, repair dentures; $1,500 one set/bridges/full or
partial dental. Orthodontic not approved unless medical tx, no cosmetic dental.
Seattle Fire
$2,000 annual applied towards premiums/dentures/cleanings/x-rays etc. by licensed
dentist.
Seattle Police
$3,000 per year/Premera plan. Oral surgery/implants if medically necessary w/prior
authorization and limits. No premium reimbursement.
Skagit Co
$750 annually for out-of-pocket dental expenses.
Skamania Co
Accidental injury to teeth only. Orthodontics for medical necessity pre -approved.
Snohomish Co
100% routine dental care. No cosmetic procedures. Board will pay insurance excess
up to $2,000.
Spokane Police
1 exam/year, 2 cleanings/year, routine dental, and peri if medically necessary. No
cosmetic or whitening. $25 max fluoride tx/year.
Spokane City Fire
$1500/year through Washington Dental Service.
Spokane Co
Coverage through plan, claims to TPA w/I 24 months
Stevens Co
$2,000 year premiums allowed. No dental insurance/two cleanings/yr. with one of
those cleanings and one checkup being mandatory. Fluoride $25/year. No ortho,
whitening, cosmetic. Submission w/in one year.
Tacoma
$750/12 months for preventive & restorative. $1,200 for dentures.
Thurston Co
$2,000/calendar year for non -cosmetic dental care w/Regence; Willamette not to
exceed max allowance.
Tumwater
As governed by statute
Vancouver
Reasonable expenses for medically necessary dental/ortho tx directly related to
medical condition.
Wahkiakum Co
Accidental injury to teeth. May approve one-time purchase of dentures. Reline of
dentures not covered. Medically necessary claims considered.
Walla Walla
As governed by statute
Wenatchee
As governed by statute. Orthodontics for medical necessity only, pre -approved.
Whatcom Co
$300/year for preventive.
Whitman Co
$3,000 per calendar year.
Yakima Co
As governed by statute.
Yakima
As governed by statute. Group dental plan provided - members pay premiums.
Yakima Fire
$1500/year excludes cosmetic
11 WSLEA Comparison of Benefits, Revised February 5, 2023
Jurisdiction
Disclosure to Employer
Benton Co
Policy Summary
Bremerton
Insurance carriers have been willing to provide information.
Kitsap Co
Insurance carriers have been willing to provide information.
Pierce Co
Authorizations requested as needed only.
Seattle Fire
Insurance carrier considers Board additional insurance provider, no release required.
Spokane Co
Members sign authorization each year giving Board permission to discuss their PHI
with family members or providers to resolve billing and/or coverage issues.
Whitman Co
Members work directly with insurance carriers.
Yakima
Routinely send out authorization forms.
Yakima Co
Claim form includes authorization for disclosure necessary to process claim.
Elections
Jurisdiction
Policy Summary
Aberdeen
Nominations and ballots by July 1 annually.
Bellevue
Nominations and ballots sent to all members.
Benton Co
2-year term/expire Dec 31.
Bremerton
Absentee ballots sent to all members — no election if only one member nominated.
Chelan Co
Secret ballot. Two-year term. Held in November.
Clallam Co
Nominations and ballots to members. Two-year term.
Clark Co
Two-year term; Police: odd year Fire: even year; nominations & ballots to members
Cowlitz Co
Nominations and ballots to affected members. Police: odd years Fire: even years
Everett
Nominations and ballots sent to all members.
Grays Harbor Co
Nominations and ballots sent to all members. 2 yr term; by Jan 15th yearly
Kennewick
Two yr term, elections in even years/January. Nominations & Ballots to members.
Kent
Nominations and ballots sent to all members; December election.
Kitsap Co
Nominations and ballots to all members via mail by January 2; Two-year term.
Klickitat
Nominations and ballots to all members via mail by December; Two-year term.
Lacey
Two-year term, nominations, and ballots to all members
Lewis Co
Two-year term/even years in January Nominations and ballots to members.
Lynnwood
Two-year terms; Fire Rep: December/even years; Police Rep: December/odd years
via mail nominations and ballots.
Marysville
Nominations and ballots/2-year term beginning January 1.
Mercer Island
Two-year term. Police: even year. Fire: odd years. Nominations/Ballots mailed.
Pend Orielle
Secret ballots to all. 1st week/December every other year/two-year term.
Pierce Co
If only one person nominated there is no election.
Pullman
January yearly/1 yr. Nominations and ballots to members.
Renton
Two-year terms/staggered. Nominations & ballots November annually.
Richland Police
Nominations and ballots sent to all members.
SeaTac Fire
Two-year term. Nominations and Ballots to all members via US Mail.
LEOFF1/December odd years; LEOFF2/even years
Seattle Police
Nomination and ballots to all members.
Skamania Co
Nominations and ballots to members via USPS. Two-year term/alternating.
Snohomish Co
Two-year term, even years; Nomination and Ballots mailed to all members
Spokane City Fire
Nominations and ballots to members in December yearly
Spokane Co
Fire: Secret ballot/all fire members/January every other yr. Police: Secret ballot/all
police members/January opposite year of Fire election. Two-year term.
Tacoma
Nominations sent to all LEOFF I members. No balloting if only one nominee.
Tumwater
Nominations and ballots in US Mail to all members
12 WSLEA Comparison of Benefits, Revised February 5, 2023
Elections
Jurisdiction
Policy Summary
Vancouver
Nominations and ballots sent to all members. Police: 3 yr term/staggered. Fire: 2 yr
term/staggered.
Whatcom Co
Nomination and ballots to respective membership: 2 Yr Term/one LE one FF
Whitman Co
Two-year term; Police/odd years. Fire/even years; Nominations & ballots to affected
groups members.
Yakima
Three-year term: Nominations and ballots sent to all members.
Yakima Fire
Two-year term. Nominations and ballots sent to all members.
Yakima Co
Nominations and ballots sent to all members.
Walla Walla
Two-year term. Police Odd years. Fire: Even years; Nominations and ballots to
members.
Equipment
Jurisdiction
Policy Summary
Aberdeen
Pre -approval required. Must be medically necessary.
Bellingham
Coverage through Regence. Orthotics covered by Regence. No payment for ice bags,
heating pads, thermometers, vaporizers, etc.
Bellingham Fire
If not covered w/insurance, submit to board.
Bothell
No equipment or supplies which have a non -medical use or function.
Bremerton
Must be prescribed by medical doctor. Prior authorization needed for reimbursement.
Chelan Co
Must be prescribed by medical doctor, anything over $250 needs prior approval,
unless emergency. <$250 reimbursed.
Clallam Co
Durable medical equipment/orthotics prescribed by physician for patient's use only.
Board may require quotes prior to purchase.
Clark Co
Medical necessary rental of durable medical equipment, unless purchase more cost
effective.
Cowlitz Co
Dr. Prescribed, must submit through any insurance coverage first then pension.
Douglas Co
Durable medical equipment prescribed by physician as medically necessary.
Preapproval required to purchase
Edmonds
>$500 Pre -Authorization from board required. Reasonable replacement costs.
Physician prescribed as medically necessary
Everett
100% of allowable charge.
Kennewick
Pre -approval required.
King Co
Pre -approval required; physician prescribed as medically necessary.
Kirkland
Pre -approval required for non -emergency equipment costing over $100.
Kittitas Co
Prothesis case by case basis likely covered/Dr documentation.
Klickitat Co
Pre -approval required; Physician prescribed as medically necessary.
Lacey
Preauthorization prior for $500+ and 3 quotes. <$500 no quote necessary.
Lewis Co
Pre -approval. Medically necessary.
Mason Co
Pre -approval required; physician prescribed as medically necessary.
Pacific Co
Pre -approval required; Physician prescribed as medically necessary.
Pasco
Pre -approval required for non -emergency equipment costing over $100.
Pend Orielle
If cost +$500/prior approval unless emergency.
Pierce Co
Braces, splints, orthopedic appliances/orthotics, prosthesis for functional reasons.
Puyallup
Medically necessary durable medical equipment defined by medical plan. All other
considered case by case.
Richland
Physician's verification of medical necessity.
Richland Fire
Provide the board with letter from Dr outlining services needed.
Seattle Fire
Pension will reimburse after Medicare. Pre-auth on most. Primary doctor letter or Rx
required depending on dollar amount. Under $250 with Dr RX
13 WSLEA Comparison of Benefits, Revised February 5, 2023
Equipment (Cont.)
Jurisdiction
Policy Summa►y
Seattle Police
Physician's letter/prescription required for medical necessity. Utilize preferred
provider (they can also ship) is preferred.
Skagit Co
Pre -approval required; Physician prescribed as medically necessary.
Skamania Co
Prescribed by physician as medically necessary. Preauthorization required.
Snohomish Co
Per RCW 41.26.
Tacoma
Amount not covered by Medicare/Regence BlueShield must be pre -approved.
Vancouver
Pre -approval required; physician prescribed as medically necessary.
Walla Walla
Pre -approval required; physician prescribed as medically necessary.
Wenatchee
Physician prescribed medically necessary. Pre -approval required over $250.
Whatcom Co
Pre -approval required; physician prescribed as medically necessary.
Yakima Co
Prescribed by physician as medically necessary.
Federal Income Tax
Jurisdiction Policy Summary
Bellevue Prior act paid through ap, 1099 end of year, no tax withheld.
Bothell Prior act paid through ap, 1099 end of year, no tax withheld.
Everett Prior act paid through ap, 1099 end of year, tax withheld upon request.
Richland Prior act paid through payroll, fit withheld.
Spokane Co No FIT withheld.
Tacoma Prior act paid through payroll, 1099R at end of year, tax withheld upon request.
Handicap
Jurisdiction
Policy Summary
Douglas Co
Paid for motorized scooter & lift for vehicle, as well as lift installation.
Edmonds
Paid for "turnaround" apparatus for members vehicle.
Everett
Have paid for stair lift; case -by -base no formal policy. Prosthetics 100% allowable
charges.
Pierce Co
Paid wheelchair ramp, railing and other modifications to make home accessible.
Richland
Have paid for wheelchair ramps and home modifications.
Spokane
Paid for lifts and ramp.
Tacoma
Does not pay - considered convenience rather than medically necessary.
Thurston Co
Paid for wheelchair ramps walk-in shower, bathroom modifications, shower chair and
toilet seat riser.
Vancouver
Have paid for installation of grab bars, raised toilet seat, lift chair.
Yakima
Have paid shower remodeling; lift recliner.
Yakima Co
Partial Approval to reimburse a Lift Chair (2016 — minus heat/vibration features).
Denied reimbursement of wheelchair ramp as not medically necessary.
Hearing Aids
Jurisdiction Policy Summary
Adams Co Covered.
Asotin Co Pre -approval required. $3,000 max/every 3 yrs. Must provide 3 bids w/warranty.
Costco ok, City card available.
Auburn Amount determined by Board designated provider 1/five years. Necessary repairs
are covered. Batteries not covered.
Bellingham Audiogram/3 years. $2,000/aid/36 months. Repairs and batteries covered.
14 WSLEA Comparison of Benefits, Revised February 5, 2023
Bellingham Fire
Covered w/insurance every 3/yrs Max $2,000 per aid. Repairs replacement due to
normal wear is covered. Batteries including rechargeable w/station. Accessories not
medically necessary and cleaning not covered.
Bellevue
Pre -approval required. Exam by MD/DO or Audiologist. Max $6,000.
Replacement/3yr. $50 for batteries.
Benton Co
Pre -approval required. Dr or Audiologist required. Board will reimburse for one or
both h/a every 5 years, submit to board within one year of billing date.
Bothell
Exam by Dr or hearing special ist/audiogram and report. $3,000 per ear/36 months.
Replacement 1x/36 months w/documentation. Repair -documentation why. Except
regular maintenance and batteries.
Bremerton
$1,800 per ear every five years; repair reimbursement up to $600 accumulative.
Chelan Co
Aids/Exam up to $6,000 every 3 yrs.
Clallam Co
Exam covered. $1,600/aid/36-months for basic amplifier hearing aid.
$2,600/aid/5-years for digitally programmable analog; $2,800/aid/5-years for
programmable digital; batteries and necessary repair/replacement.
Clark Co
Pre -approval required. Two estimates required. Charges limited to that necessary to
achieve functional corrections. Replacement: pre -approved on case by cast, limit to
reasonably necessary costs.
Cowlitz Co
Evaluation w/otolaryngologist then audiologist to include a 2 yr warrant and
audiogram/aid recommendation. 1 pair every 5 years. Repair/Maint: exceed 2 yr
warranty at reasonable cost. Repair/Replace: claim form/information 1x every 5 yr
Douglas Co
5-year replacement. Two estimates required. - $1,200/per aid.
Maintenance/batteries/loss not covered.
Edmonds
1 hearing test/3 years. Costco current rates or pre -approval if no Costco/will cover
Annual membership if member is not. Repairs/replacement 36 months. Batteries
covered.
Everett
$4,300/ 24 mos; by licensed Audiologist. All claims to HMA.
Franklin Co
Audiogram covered. Prior approval required. Active members only, unless hearing
deficiency was reason for retirement and was duty -incurred. Battery replacement
excluded. 6-year replacement.
Grant Co
Case by case pre -approval by board, medical necessity. Two bids by two vendors.
Max $1750 ea/$3500 year on 5-year basis. Maintenance/repair case by case
Grays Harbor Co $2,500/aid/5 years. Reasonable cost of batteries and repairs covered.
Island Co Would be considered case -by -case.
Jefferson Co $3,000/aid/5 years. Pre -approval required.
Kennewick Pre -approval required. Exam by board designated provider. Every 5 years.
Necessary repairs, no routine maintenance, or batteries.
Kent $2,000/aid plus 50% of balance to $3,000/aid/3 years. Necessary repairs, routine
maintenance and batteries covered.
King Co $2,500/aid/5 years. 2-year warranty required. Regular maintenance and batteries.
Kirkland $2,500 per aid/36-months by qualified medical provider or audiologist. 2-year
warranty required. Reasonable battery cost. Replacement allowed but not more than
every 3 years.
Kitsap Co $5,000/aid/5 years, warranty and batteries not covered.
Kittitas Co $6,500/3 years. Batteries and repairs covered.
Klickitat Co Exam by Dr/hearing specialist; Audiogram, report. Max $4,400/pair/48 months.
Replacement if line duty or accident. Maintenance/batteries allowed.
Lacey Exam by Md or ENT. Dr statement. Aid's must be issued by licensed fitting dispenser
or licensed audiologist. Submit to insurance first. Case by case basis.
15 WSLEA Comparison of Benefits, Revised February 5, 2023
Hearing Aids (Cont.)
Jurisdiction
Policy Summa►y
Lewis Co
Pre -approval required. Medical necessity, two bids. Repair statement why/repair vs
replacement, Replacement on case -by -case basis
Longview
Prior approval. Audiology report, device recommendation w/cost estimate.
Replacement requires new support.
Lynnwood
$2,600/ear/5 yrs; $100 allowed towards handheld remote control. Damage due to
negligence and batteries are covered.
Marysville
Pre -approval required for first time. $1,600/aid/36-months.
Mason Co
$3,000/3 yrs, includes 2-yr warranty, maintenance, batteries, and reasonable repairs.
Exam covered if not covered by medical insurance. Effective 9-1-15, reimburse
minimum Costco membership fee when hearing aids are purchased at Costco, if not
already a member.
Mercer Island
Pre -approval required.
Okanogan Co
Pre -approval required. $1,000/aid/5-years. 2-yr warranty required. Maintenance and
batteries not covered.
Olympia
Pre -approval required. Charges necessary to achieve functional correction. 3-yr
warranty required. Necessary repair and batteries allowed.
Pacific Co
Charges necessary to achieve functional correction. $2,500/aid/ 60-months.
Pasco
$1,500/aid/36-months. Batteries not covered.
Pend Orielle
Preauthorization. Medical necessity by licensed audiologist.
Pierce Co
$1,875/aid/5 years. Batteries and reasonable repairs covered.
Pullman
Two options/without prior approval evaluation by Audiologist $6,000 pair/4 years.
Audiologist evaluates/audiogram and recommendations estimates for two
aids/fittings/adjustments and costs of aids including 2 yr warranty. Lost/broken or
damage no replacement if negligent or abuse.
Puyallup
Pre -approval required. Reasonable charges based on current rate charged by
Costco/3-yrs/2-yr warranty required. Batteries & maintenance covered only when
included in purchase price.
Redmond
Pre -approval required. $2,500/aid/4-years. 2-year warranty required. Cost of
maintenance and batteries eligible.
Renton
$2,500/aid/36-months digital analog; $2,800/aid/5 years digitally amplified; Batteries
covered; Repairs need board approval
Richland Fire
$2,500 per aid. Batteries at member's expense. Replacement considered after 5
years on case by case/information by Audiologist.
Richland Police
$1,800/aid. Every 5/yrs Licensed Audiologist. Replacement batteries not covered.
Repairs/per Audiologist.
SeaTac Fire
Pre -approval required.
Seattle Fire
Medically necessary, $3800/ear/36 months cost include warranty & batteries
Seattle Police
100% hearing tests. Digital $3,500/aid/5 years. Prescribed and dispensed through
licensed Audiologist. Repair, reprogramming, maintenance, and batteries covered.
Skagit Co
$2,600/aid/36-months. Regular maintenance and batteries covered.
Skamania Co
Costs of Wa St L&I standards aids every 5 years. Damage/Responsibility of member.
Snohomish Co
$5,000/pair. Batteries $40/year.
Spokane Police
$4,000/5 years. Batteries covered. Repair/replacement case by case.
Spokane Co
$4,000/set, claim accompanied by documentation of Licensed Otolaryngologist of
medical requirement of disorder. Batteries/$75/year. Repair/ Case by case.
Spokane City Fire
Digital aids through TPA; Cleanings/Repair paid in full/5 years; batteries covered
Spokane Co
$2,000/aid/3-years. Batteries $75/12-months. Repair considered.
Tacoma
Pre -approval required. Digital $1,295/aid/5 years. $250/aid for repairs.
Tumwater
Otorhinolaryngologist or Md. Reasonable expenses.
16 WSLEA Comparison of Benefits, Revised February 5, 2023
Hearing Aids (Cont.)
Jurisdiction
Policy Summa►y
Vancouver
Pre -approval required. Charges necessary to achieve functional correction. 3-year
warranty required. Batteries not covered.
Walla Walla
Pre -approval required. $1,500/aid/36-months analog; $2,500/aid/60-months digital.
$25 deductible for regular maintenance and batteries.
Wenatchee
Prior approval required. $2900/aid/36-months. Regular maintenance/repair and
batteries eligible for reimbursement. Replacement of lost aids not covered.
Whatcom Co
$3,000/aid/5-years. 2-year warranty required. Regular maintenance and batteries
covered.
Whitman Co
$1,600/aid/5-years. Repairs considered. Maintenance/batteries not covered.
Yakima
$1,800 ea aid. With preapproval and 30-day trial period. Repairs & batteries 100%.
Pre -approval required if cost $500 to repair.
Yakima Co
$2,000/aid/5 years. Repair/loss only in line of duty. Cleaning/service/batteries
excluded.
Yakima Fire
Pre -approval required. $1,800/aid/5 years. Batteries and repairs 100% reasonable
cost. 30-day trial period required. Reasonable costs for repairs and batteries.
HIPPA
Jurisdiction
Policy Summary
Bellevue
Members assigned random number; discussions refer only to number. 3rd-party
administrator process claims. Documents kept in Disability Board files.
Benton Co
Send a form to Auditors office for payments and keep all claims and receipts in
Pension Files for HIPAA purposes.
Bremerton
Employer provided with a form authorizing payment.
Clallam Co
Summary of medical claims (not including provider) sent to the jurisdictions for
payment. All back-up paperwork stays in Pension office.
Everett
Documentation kept in Pension Board files.
Grant Co
Employer provided with form authorizing payment. Documentation kept in pension
board files.
Island Co
Provide an authorization to pay. Original documentation is kept in Pension files.
Kent
Only Pension Office see documents. All others see only voucher numbers, payee,
and amount. Board documents redacted of members identity.
Marysville
Documents maintained in Board files. Payment requisition sent to accounting stating
that documentation is on file in the Pension office.
Mercer Island
Send a form to AP for payment and keep all claims in Pension files.
Pend Oreille Co
Have a HIPAA policy listing who in the auditor's office will be handling these
documents and where they are stored.
Pierce Co
Documentation remains in Board files. Authorization to pay provider sent to
employer for payment.
SeaTac Fire
Requisition includes statement that documentation is kept in disability board files.
Seattle Police
Documents kept in Police Pension Office. All others see only voucher numbers,
payee, and amount. Minutes show Board action only, specifics considered in
executive session.
Skamania Co
Send form to AP for payment and keep all receipts in Pension files.
Spokane
The Boards, entire Retirement Department, and Risk Management staff are HIPAA
and EPHI compliant.
Whitman Co
Employer provided with a form authorizing payment. Documentation kept in Board
files.
Yakima Co
Board Secretary sees details. All others see only voucher numbers, payee, and
amount. Records kept locked in Human Resources.
17 WSLEA Comparison of Benefits, Revised February 5, 2023
Hot Tubs
Jurisdiction
Policy Summary
Everett
Request denied.
Grays Harbor Co
Request denied as spa could be used by others.
Kent
Approved purchase in 2001 ($4,460.75).
Kirkland
No requests but have paid for physical therapy that included therapeutic hot tub.
Seattle Police
Have approved bathtub attachments that would serve as a therapeutic hot tub.
and subscriptions to health type clubs that offer hot tub/pool.
Snohomish Co
Request denied.
Tacoma
Request denied.
Yakima Co
Request denied as hot tub could be used for and by others for non -necessary
medical reasons and treatments could be provided in a clinical setting.
Immunizations
Jurisdiction
Policy Summary
Bellingham Fire
Flu, Tetanus. Pneumonia by Regence. Shingles vaccine covered by Board.
Bellevue
Covered by insurance plan.
Bellingham Police
Covered in insurance plan; overseas travel access through county health
department/submit itemized bill to pension office
Bellingham Fire
Covered in insurance plan; overseas travel access through county health
department/submit itemized bill to pension office.
Bothell
Insurance prior to any reimbursement
Bremerton
Covered if prescribed by medical doctor for specific medical condition.
Chelan Co
Covered by medical plan.
Clallam Co
Vaccinations covered.
Clark Co
Flu and pneumonia vaccinations covered.
Everett
Flu/pneumonia/shingles vaccinations covered.
Grant Co
Shingles, Pneumococcal, Prevnar 13
Grays Harbor Co
Covered if prescribed by medical doctor.
Kennewick
Flu/pneumonia vaccinations covered.
Kent
Flu/pneumonia/shingles vaccinations covered.
Kirkland
Up to the amount the city pays for flu shots.
Kitsap Co
Flu/pneumonia/shingles vaccinations covered.
Lacey
No policy.
Lewis Co
Have paid shingles vaccinations.
Longview
Flu/pneumonia/shingles vaccinations covered.
Lynnwood
Flu 1/year. All other vaccinations must be Physician prescribed.
Marysville
If Physician prescribed would likely approve.
Mason Co
None.
Mercer Island
Covered if physician verified necessity.
Okanogan Co
Flu vaccinations covered.
Olympia
Flu 1/year. All others must be physician prescribed. No travel.
Pacific Co
Covered if recommended and administered by physician.
Pierce Co
Flu/pneumonia/shingles vaccinations covered.
Puyallup
Vaccinations covered.
Redmond
Covered same as active employees.
Renton
Flu, Shingles, and pneumonia.
Richland Police
Annual flu, H1N1, HepB including boosters; One time shingles/pneumonia or by
doctor prescription.
Richland Fire
Annual flu, H1N1, HepB including boosters; One time shingles/pneumonia or by
doctor prescription.
Seattle Fire
Covered w/Premera.or submit to Premera. No travel immunizations.
18 WSLEA Comparison of Benefits, Revised February 5, 2023
Immunizations
Jurisdiction Policy Summary
Seattle Police Flu/pneumonia/shingles vaccinations covered.
Skagit Co Shingles vaccine covered.
Skamania Co As prescribed by physician.
Snohomish Co Have paid shingles vaccinations.
Spokane Vaccinations covered.
Spokane Co Pneumonia vaccine covered.
Tacoma Pneumonia/shingles vaccine covered through Regence BlueShield, travel vaccines
not covered, other vaccines such as hepatitis covered if exposed.
Thurston Co Flu/pneumonia/Hepatitis vaccinations covered.
Vancouver Flu/pneumonia vaccinations covered. Inoculations suggested/required to travel
outside US and/or other inoculations related to specific medical conditions or
exposures.
Walla Walla
Every 2 years: TB, Hepatitis B; other as needed
Whatcom Co
None
Whitman Co
Flu vaccines are covered.
Yakima
Flu/pneumonia/shingles vaccinations covered.
Yakima Fire
Shingles 100% 60 plus years of age.
Yakima Co
Flu/shingles vaccines are covered.
Insurance
Jurisdiction
Policy Summary
Bellevue
Self -insured through Premera - no spouse/dependent coverage for retirees.
Bellingham
Pay medical premiums. Do not reimburse premiums for outside employment.
Bothell
Pay medical premium.
Bremerton
City provides insurance.
Chelan Co
County provides health insurance. Spouse coverage available at member's cost.
Clallam Co
Cities provide medical insurance.
Clark Co
Health/dental insurance for spouses/dependents may be purchased.
Douglas Co
Member pays dependent portion of premium.
Edmonds
Annual deductible for medically necessary services
Everett
Self -insured. No spouse/dependent coverage available.
Franklin Co
County pay health insurance composite rate and $1,250 deductible.
Grays Harbor Co
Each entity has insurance policies - none cover spouse/dependent.
Island Co
Insured through WA Counties Insurance Fund - 1 spouse purchased coverage.
Jefferson Co
Provide health insurance. Dependent premium paid by member.
Kent
Cover premium for active members. Self -insured - spouse (to 65)/dependent (to 25)
at own expense.
Kirkland
Provide health insurance. Dependent premium paid by member.
Kitsap Co
Medical insurance for members.
Kittitas Co
Retirees covered by same carrier as active until Medicare.
Klickitat Co
Employee only portion of medical & dental for active; full medical premium for retirees.
Lewis Co Not self -insured - 4 different plans - spouse/dependent coverage at own expense.
Lynnwood Fire: Medicare & Supp, HMA with Rx & Vision included, Delta Dental supplemental
Police: Medicare & Supp, Regence w/ Rx & Vision incl, Dental handled by board.
Marysville Members covered with city plan
Mercer Island LEOFF Trust plan.
19 WSLEA Comparison of Benefits, Revised February 5, 2023
Insurance (Cont)
Jurisdiction
Policy Summary
Olympia
Fire: Contact labor first, NWFFT, Davis Vision, Epic Hearing. Police:
Med/advantage/Kaiser, VSP/vision
Pacific Co
County provides health insurance. Cities are responsible for their members.
Pasco
Do not reimburse premiums. Self -insured - no spouse/dependent coverage
available.
Pierce Co
Pay employee contribution to insurance, co -pay, deductible, or co-insurance. Self -
insured (TPA-Regence) - spouse (to 65)/dependent (to 25) at own expense.
Puyallup
Cover insurance premium until Medicare. Self -insured. Member may purchase
spouse/dependent coverage via city's plan at retirement only.
Redmond
Self -insured - no spouse/dependent coverage available.
Renton
Self -insured - no spouse/dependent coverage available.
Richland Police
Medical/Dental premiums paid by the Board.
Richland Fire
Medical/dental premiums will be paid for board approved plans.
Seattle Police
Reimbursement for premiums by employers/spouse employer for primary coverage.
Skagit Co
Self -insured - spouse/dependent at own expense.
Skamania Co
County insurance - spouse/dependent at own expense (widow may continue).
Snohomish Co
Spouse -dependent at member's expenses, deducted from retirement check.
Spokane
Pay premium for active employees; reimburse retired members for Medicare Parts A
and B. Self -insured through Premera - no spouse/dependent coverage.
Bargaining unit employees covered through LEOFF Welfare and Trust.
Tacoma
Self -insured. Coverage may be purchased for spouse (to 65)/children (to 23).
Thurston Co
Employer pays insurance premium.
Vancouver
Spouse/dependents coverage available for purchase (offered COBRA if member dies).
Walla Walla No coverage allowed for spouses.
Wenatchee AWC insurance carrier. No spouse coverage available.
Whitman Co Do not provide insurance.
Yakima 100% of medical premiums. No reimbursement for outside employer premiums. May
purchase spouse coverage (until 65) at time of retirement only.
Yakima Co May purchase spouse/dependent medical -dental insurance
July 4 1. 18 Increase
Jurisdiction Policy Summary
Bellevue Seattle CPI-W from BLS. July COLA given regardless of when retiree passed away.
Everett Seattle CPI-U from BLS. July COLO given regardless of when retiree passes away.
Kent CPI Jan 1-Dec 31 previous year with 2% Minimum
Richland Seattle CPI-U from BLS. July COLA given regardless of when retiree passed away.
Seattle Fire July COLA given as due regardless of when retiree passed away.
Spokane July COLA given as due regardless of when retiree passed away.
Spokane City Fire July COLA given as due
Tacoma Seattle CPI-U from BLS for July COLA.
Vancouver Use same as DRS April 1st COLA.
Yakima CPI from L&I
Legal Counsel
Jurisdiction Policy Summary
Bellevue City Attorney
20 WSLEA Comparison of Benefits, Revised February 5, 2023
Legal Counsel (Cont.)
Jurisdiction
Policy Summary
Bremerton
City Attorney
Everett
Pension Board Attorney
Grays Harbor Co
Deputy Prosecuting Attorney
Kennewick
City Attorney
Kent
City Attorney
Kirkland
City Attorney
Klickitat Co
Prosecuting Attorney
Marysville
City Attorney
Olympia
City Attorney
Pierce Co
Deputy Prosecuting Attorney
Puyallup
City Attorney
Richland
City Attorney
SeaTac Fire
City attorney
Skamania Co
County Prosecuting Attorney
Snohomish Co
Deputy Prosecuting Attorney
Spokane Co
Prosecuting Attorney
Tacoma
City Attorney
Thurston Co
Deputy Prosecuting Attorney
Vancouver
Assistant City Attorney
Whatcom Co
Prosecuting Attorney
Yakima Co
Appointed Attorney
Long Term Care
Jurisdiction
Policy Summary
Aberdeen
No insurance. Home health physician prescribed, licensed/state certified provider.
Caregiver residing in member's home or family member not eligible. Not to exceed
average daily cost of nursing home care. Hospice in DSHS certified/Medicare-
approved program. Adult family home, assisted living facility, boarding home or
nursing home at minimum required service. Max daily rate/Genworth determined.
Adams Co
Carry insurance for members aged 65 and over.
Auburn
Pre -approval required. Not to exceed nursing care under the City's existing LTC
insurance. Non -medical charges not covered.
Bellingham
Semi -private room and board and medical care in nursing home, assisted living or In -
home case -by -case.
Bellingham Fire
Reimburse cost for geographic region using median rate/LTC. Nursing home —
semiprivate using median rate. Assisted Living/stay at home care on case -by -case
basis; Assisted living/Facility- case by case after assessment. Studio/1 bedroom
Bellevue
Medical necessity required. Assisted living - one bedroom. Nursing home - semi-
private room. Upgrades and excess charges only if medically necessary. Max
determined w/Genworth cost or 120% for area member resides. In home
care/assisted living preferable to nursing home care. In home care capped at
Nursing Home rate. See room limitations.
Bothell
UNUM for LTC coverage. Will not include non -medical charges. Nursing Home -
average daily amount for semi -private room, Assisted Living - average for studio
room; In -Home Care average daily amount of local nursing facility for semiprivate
room (custodial or housekeeping services included).
Bremerton
Nursing home (semiprivate) or home health care based on Genworth rates. Assisted
living for medical necessity. Hospice covered with insurance, Dr review.
Chelan Co
Reimbursement for out of pocket limited to $7859.81 month semi -private room in
nursing home. In home/Asst Liv $4000 monthly. Licensed in WA State
21 WSLEA Comparison of Benefits, Revised February 5, 2023
Lonp Term Care
Jurisdiction
Policy Summary
Clallam Co
No insurance. Medical necessity. Assisted living (studio). Nursing home (semiprivate
room). Upgrades and excess charges only if medically necessary. 120% of latest
Genworth costs for area member resides. In home care/assisted living preferable to
nursing home care. Hospice care covered with Dr review.
Clark Co
Pre -approval exceeding 45 days. Not to exceed average care in Clark Co by 10%.
Semiannual evaluation by Dr.
Cowlitz Co
Skilled nursing: Dr ordered w/tx plan updates every 6 months, services w/licensed
agency, max cost not exceed avg daily of nursing home through USHHS. Hospice:
admission to licensed facility or program w written plan by Dr. Facilities: Dr ordered.
Licensed facility, submit to insurance/TPA, prior approval, case by case basis.
Douglas Co
Pre -approval required. Max $ based on average local facilities for semiprivate room.
In home and assisted living limit same max as nursing. Licensed agency.
Everett
Skilled nursing: case by case basis, board review/pre-auth; Rehab 36 visits/year
100# allowable/Board review for additional.
Franklin Co
Average rate for Franklin County. Non -medical not covered.
Grays Harbor Co
Prior approval required. Adult daycare/Nursing home care when cost not exceed 10%
average cost in Grant Co. Licensed facility. Written care plan. In home/Asst living or
liv/group home medically necessary by licensed agency, itemized billing; supplies
services medically necessary, physician re-eval/6 mos if board requests.
Island Co
Carry John Hancock for most, one is covered through UNUM.
Jefferson Co
Average cost of semi -private room in defined geographic area.
Kennewick
Pre -approval required. Reasonable expenses authorized/determined medically
necessary, prescribed by Dr not to exceed median daily or monthly rate for semi
private room based on Genworth COC. Custodial care/Asst Liv-case by case basis.
Hospice: reasonable expenses licensed certified program.
Kent
Pre -approval required, Semi -Private Room $354 • Private Room $414;
Respite/Daycare: 14 days/yr max.
King Co
Home Health Care /Hospice Care physician prescribed, licensed/state certified
provider. Not to exceed average cost of nursing home care in County where
provided. Long -Term Care in state licensed facility.
Kirkland
Capped amount based on Genworth in home care, nursing, adult family home. Costs
reviewed annually
Kitsap Co
Capped amount 120% based on MetLife/Genworth. In home care, adult daycare,
assisted living, memory care, nursing home semiprivate room and hospice.
Klickitat Co
By order of physician. Nursing Home max $220/day. Home care pre -approval
required/max $130/day. No housekeeping. Non -medical charges not covered.
Hospice admission to DSHS certified/Medicare approved program
Lacey
Provide long term care coverage.
Lewis Co
Pre -approval required. Home health, Hospice, Skilled Nursing, Rehab less costly
than inpatient confinement, plan review periodically. Tx plan by Dr;
Longview
Preauthorization required. Medical necessity. Licensed agency/facility. Max monthly
based on average of three local facilities; 24 hr. care, semi private room.
Lynnwood
Medical necessity. Board approval required. Average of three facilities in South
Snohomish/North King Counties. Semiprivate. Custodial/non-medical charges not
covered.
Marysville
Medically necessary (including assisted living facility and in -home care).
Mercer Island
No insurance. Pre -approval required. Average of 3 facilities in geographic area for
semi -private room. No payment for non -medical services.
22 WSLEA Comparison of Benefits, Revised February 5, 2023
Long Term Care (Cont)
Jurisdiction Policy Summary
Olympia Pre -Authorization required. Physicians report/medical necessity. In home preferred to
Nursing home. Board review costs periodically/costs up to amount of Panorama
Rehab/Convalescent Center in Lacey. Semiprivate room/24 hrs. No custodial care. .
Pacific Co Prior approval required. $2,000/mo assisted living/in-home; $3,883.20/mo nursing
home.
Pasco Medical necessity. Custodial/housekeeping not covered. Assisted living/skilled
nursing, average in geographic area. Provider must be bonded/licensed.
Pend Orielle Pre -Authorization by board mandatory. Physician Ordered. Max monthly per day for
24 hr care in facility or home care $170 per day. No custodial care.
Pierce Co
No insurance, some agencies under Board use UNUM. Pre -approval requested. In -
home up to allowed nursing home care. Nursing home average rate for semiprivate.
Non -medical charges excluded. Do not pay deposit.
Pullman
No custodial care. Home healthcare/Dr prescribed max daily not exceed average
daily nursing home care; Nursing Home/Hospital Extended and other facilities/Dr.
ordered, State licensed, if 6+ months updated tx plan. Case by case basis.
Hospice/Dr ordered. Care is part of written plan for continuous care.
Puyallup
Individual policies. All other insurance primary to Board. Medical necessity,
preapproval required. Approval based on latest annual MetLife Market survey of
Nursing Home, Assisted Living, Adult Day Svcs & Home Care Costs. Only services
provided by bonded & licenses providers considered. No custodial services.
Redmond
Nursing/Home care COC Genworth; Private room Nursing Home; State Licensed.
Home care/no family/RN or otherwise defined by Genworth
Renton
Pre -approval required. In-Home/Hospice/Skilled Nursing state licensed facility.
Richland Fire
Adult day-care, home healthcare, rehab, assisted living and nursing home facilities:
Use Cost of Care/authorized payment. Case by case.
Richland Police
Adult day-care, home healthcare, rehab, assisted living and nursing home facilities:
Use Cost of Care/authorized payment. Case by case.
Seattle Fire
Medically necessary. Pre Auth required. Assessment. Facilities 24/7 care. No care by
immediate family members is reimbursable.
Seattle Police
Medical necessity required. May limit to Seattle area average daily rate for nursing
home.
Skagit Co
No insurance. Physician prescribed; provider licensed. DSHS certified/Medicare
approved facility. Pre -approval required. Home Health provided by Dept of Health
licensed agency.
Skamania Co
Nursing home - average of 3 facilities in Columbia Gorge geographic area for semi-
private; Assisted Living - average of 3 facilities in Columbia Gorge geographic area
for studio apartment. Custodial/housekeeping and non -medical charges not covered.
Physician ordered. Medically necessary.
Snohomish Co
Pre -approval required.
Spokane Police
Washington State Medicaid daily rate allowed for nursing home/adult family
homes/assisted living and/or home health. Custodial/housekeeping not covered.
Have covered one deposit.
23 WSLEA Comparison of Benefits, Revised February 5, 2023
Lonp Term Care (Cont)
Jurisdiction
Policy Summary
Spokane Co
Homecare/Hospice/prescribed by physician, written plan, provided by professional
licensed agency or professional. Max cost not to exceed daily nursing home care in
county by Genworth COC/Studio or semi -private room. No Custodial care. Adult
home/nursing, Board preapproval required, placement by physician, Licensed facility,
Genworth COC /semiprivate/studio. No custodial care.
Spokane City Fire
Pre -approval. Nursing/Home care through TPA, no custodial care. Medical necessity.
Doctor ordered. Home health 150% of Genworth COC. Asst Living/Studio. Nursing
Home, Preapproval or w/in 72 hrs. of emergency; Hospice care.
Tacoma
Pre -approval required for home care, assisted living and skilled nursing care.
Not to exceed average rate for semi -private room based on Genworh Survey.
Non -medical charges excluded. Do not cover deposits/move-in fees.
Thurston Co
No policy. Have covered adult day-care, in -home care, and respite care.
Vancouver
No insurance. Pre -approval required, if possible. Medical necessity. Not to exceed
average semi -private room for nursing home in Washington State. Miscellaneous
expenses not covered. Home Health care/Assisted Living by licensed -bonded
providers only.
Wahkiakum Co
Carry Transamerica Life Insurance.
Walla Walla
Pre -approval required. Home/Health Care physician prescribed, provider registered
nurse or Board -approved nursing assistance. Not to exceed that of nursing home.
Hospice Care for DSHS-certified/Medicare-approved program.
Wenatchee
Average of 3 nursing facilities in Greater Wenatchee area for semi -private room.
$4,000/month in -home care provided by bonded/licensed provider.
Whatcom Co
Pre -authorization required. Physician prescribed, licensed professional, home
care/long term care/nursing/hospice. Review after 6 months. All case -by -case basis.
Whitman Co Reasonable expenses incurred in facility with 100 miles of member's residence.
Non -medical charges not covered. Custodial care considered case -by -case.
Home Health Care not to exceed allowed rate for Skilled nursing home.
Yakima No insurance. 100% of average basic rate for room and meals, which may include
misc. housekeeping services of nursing homes or assisted living facility, in regional
area services provided plus 100% of reasonable charges for medically necessary
services. Home health limited to amount allowed for nursing home.
Yakima Co Medically necessary. Prior approval required. Nursing Home $220/day; In -home
Skilled Nursing $130/day; Assisted Living $3,000/month.
Yakima Fire Nursing home/Assisted Living. 100% reasonable charges. Medical Report/request for
Long Term Care is required.
Jurisdiction Policy Summary
Aberdeen Physician prescribed,
Bellingham Physician prescribed.
Massage Therapy
provider licensed massage therapist.
25 visits/yr also see Acupuncture therapy
Bellingham Fire On Medicare/Limited to tx by physical therapist as part of tx plan. 12 visits/yr. Referral
required by doctor.
Bothell Insurance submission then any self -pay can be submitted.
Bremerton Must be prescribed annually by medical doctor.
Chelan Co Covered by insurance if prescribed by doctor.
24 WSLEA Comparison of Benefits, Revised February 5, 2023
Massage Therapy (Cont.)
Jurisdiction
Policy Summary
Clallam Co
Physical/massage therapy physician prescribed, performed by licensed therapist.
Treatment plan after 45 days.
Clark Co
May be covered under physical therapy benefit. Pre -approval over 45 days.
Cowlitz Co
Tx beyond insurance requires tx plan in a month w/updates every 12 mos.
Douglas Co
Physician prescribed/licensed massage therapist. 6 sessions or 1 month.
Everett
Case by case, pre -approval by board w/physician's statement required.
King Co
Physician prescribed, licensed massage therapist. Treatment plan after 2 visits.
Klickitat Co
Prior authorization required. Physician prescribed, licensed therapist.
Lacey
6 sessions or 1 month. Dr ordered. 6+ preapproval by board required.
Lewis
35 visits/year Tx prescribed.
Mason Co
None
Pacific Co
Not covered
Pend Orielle
Licensed Massage Therapist, Dr or Chiro ordered. Short tx: 6 sessions or 6
months/first. Updated Rx if exceeding limit. Long tx/chronic. 1 yr tx. Dr ordered. Board
review by board dr.
Puyallup
Physician prescribed/medically necessary.
Redmond
Case by case — if medically necessary.
Renton
Covered in plan 25/yr Massage/Acupuncture; to exceed needs preapproval
Richland Police
$25/visit, maximum 2 visits/month unless ordered by physician. Pre -approval required
for more than two per month.
Seattle Fire
State Licensed. 26/year @ $70 per tx/1x day.
Seattle Police
100% of billed charges with physician's prescription.
Skamania Co
Prescribed by physician provided by licenses massage therapist. Evaluation and
treatment plan required beyond 2 visits.
Snohomish Co
Physician prescribed as medically necessary. Pre -approval over 4 visits.
Spokane Co
$750 per year/lifetime/one condition/$3000 for tx. Includes Naturopathy, acupuncture,
massage, chiro and other holistic or alternative choice.
Tacoma
Covered by Regence BlueShield. Physician prescribed for medically necessary
rehabilitation following injury/illness.
Tumwater
Dr letter required. Licensed Massage Therapist. No more than six sessions or one
month. Limits can be exceeded with Dr Reports/board approval.
Vancouver
Not covered
Walla Walla
Physician prescribed, certified massage therapist. Treatment plan over 2 visits.
Whatcom Co
Services must be provided by licensed massage therapist. Pre -approval of treatment
plan for continuous care.
Yakima Co
Case by case basis with medical documentation.
Meal Supplements
Jurisdiction
Policy Summary
Aberdeen
Does not cover weight loss products.
Bellingham
Not covered
Benton Co
Not covered
Kent
Not covered
Pasco
Not covered
Port Angeles
Not covered
Richland
Has reimbursed Glucerna but not Medi fast
Snohomish Co
Has reimbursed Glucerna for diabetic members, but not Medi fast.
Spokane
Not covered
Vancouver
Not covered
Yakima
$1,500 lifetime maximum for weight loss programs.
25 WSLEA Comparison of Benefits, Revised February 5, 2023
Medic Alert
Jurisdiction Policy Summary
Clark Co have covered
Kent have covered
Richland Fire 50% monthly fee, must be pre -approved
Spokane have paid ($35-40/month)
Vancouver Have covered
Medicare
Jurisdiction Policy Summary
Aberdeen Part B premiums reimbursed; enrollment required. Premiums for Medicare supplicant
insurance reimbursed. Do not pay Part D premiums.
Auburn Part B premiums reimbursed. Do no pay Part D premiums.
Bellevue Base Medicare premium reimbursed. No penalty for failure to sign up is reimbursed.
Bellingham
Bellingham Fire
Benton Co
Bothell
Bremerton
Chelan Co
Clallam Co
Clark Co
Cowlitz Co
Douglas Co
Edmonds
Everett
Franklin Co
Grays Harbor Co
Island Co
Jefferson Co
Kennewick
Kent
King Co
Kirkland
Kitsap Co
Kittitas Co
Klickitat Co
Lacey
Longview
Lynnwood
Marysville
Part B & D premiums reimbursed each December.
Part B & D premiums reimbursed.
Part B premiums reimbursed. Medicare required/if fail to obtain any service will be
reduced by amount member entitled to.
Part B premiums reimbursed. Do not pay Part D premiums.
Mandatory enrollment
Part B premiums reimbursed. Enrollment required.
Part B premiums reimbursed. Enrollment required.
Part B premiums reimbursed.
Part B premiums. Enrollment required
Part B premiums reimbursed.
Part A/B premiums reimbursed. No Part D premiums.
Part B premiums reimbursed. Do not pay Part D premiums. Enrollment required.
Part B premiums reimbursed. Pay Medicare supplement.
Part B premiums reimbursed. Enrollment required.
Part B premiums reimbursed (pay full premium)
Part B premiums reimbursed.
Part B premiums and supplemental reimbursed. Enrollment required.
Premiums reimbursed; enrollment required.
Part B premiums reimbursed.
Part B premiums reimbursed; enrollment required. Do not pay Part D premiums.
Part B premiums reimbursed.
Part B premiums reimbursed.
No. Member responsible to enroll to avoid reduction in benefits.
Part B premiums reimbursed.
Part B premiums reimbursed. Part D if member required to pay premium
Part B premiums reimbursed. Mandatory enrollment.
Part B premiums reimbursed; Medicare is required.
Mason Co Part B premiums reimbursed.
Mercer Island Part B premiums reimbursed.
Okanogan Co Part B premiums reimbursed.
Olympia Part B premiums reimbursed; enrollment required. Medical plan pays prime on
providers that opt -out of Medicare.
Pacific Co Part B premiums reimbursed; enrollment required.
Pasco Do no pay Medicare Part B or Part D premiums.
Pend Oreille Co Part B premiums reimbursed; Quarterly. Enrollment required.
26 WSLEA Comparison of Benefits, Revised February 5, 2023
Medicare (Cont.)
Jurisdiction Policy Summary
Pierce Co Part B premiums reimbursed by all jurisdictions except Sheriff's Department.
Members strongly urged to enroll. If member does not enroll benefits reduced by
amount Medicare could have paid.
Pullman Part B premiums reimbursed.
Puyallup Part B premiums reimbursed.
Redmond Part B premiums reimbursed. Enrollment required. No part D.
Renton Part B premiums reimbursed. Quarterly reimbursements.
Richland Police Part B premiums reimbursed.
Richland Fire
Part B premiums reimbursed w/verification. No IRMA reimbursement.
SeaTac
Part B premiums reimbursed.
SeaTac Fire
Part B premiums reimbursed
Seattle Fire
Part B premiums reimbursed. Part A reimbursed if members do not qualify.
Seattle Police
Part A/B premiums reimbursed. Mandatory enrollment.
Skamania Co
Part B premiums reimbursed. If member chooses to utilize provider that opted out of
Medicare, member pays the portion that Medicare would have paid.
Snohomish Co
Part B premiums reimbursed. Medicare required.
Spokane
Part B premiums reimbursed (plus late enrollment penalty, but not additional based
on income); part A reimbursed if member has no SS benefits. Enrollment required.
Part D covered through medical plan. If member chooses to utilize provider opted out
of Medicare, member pays portion Medicare would have paid.
Spokane Co
Part B premiums reimbursed. Enrollment required.
Spokane City Fire
Part B premiums reimbursed
Tacoma
Part B premiums reimbursed (except penalty for late enrollment); enrollment required.
Thurston Co
Part B premiums reimbursed; enrollment required. Part A reimbursed if ineligible.
Tumwater
Medicare required. Part B reimbursed
Vancouver
Part B premiums reimbursed; enrollment required. Part A not reimbursed.
Walla Walla
Part B premiums reimbursed for actual rate paid
Walla Walla Co
Part B premiums reimbursed.
Wenatchee
Part B premiums reimbursed; enrollment required. Do not pay Part D premiums.
Whatcom Co
Part B premiums reimbursed.
Whitman Co
Part B premiums reimbursed; enrollment required.
Yakima
Part B premiums reimbursed.; Supplemental premium $250 month/members not
covered by city plan.
Yakima Co
Part B premiums reimbursed, no reimbursement for penalty for late enrollment.
Reimbursement in March
Mental Health
Jurisdiction Policy Summary
Aberdeen Services provided by licensed psychiatrist/psychologist/certified clinical social worker.
Requires treatment plan beyond insurance coverage.
Bellingham Covered through the Regence medical plan.
Bellingham Fire Covered through medical plan, counseling and psychiatric.
Bothell Prior written physician recommendation, provider licensed psychiatrist/certified clinical
social worker. Treatment plan/6-mo progress reports required.
Bremerton Must be prescribed by medical doctor.
Chelan Co Upon 6t" visit for same/similar condition possible board request for records. Medically
necessary paid.
Clallam Co Psych iatrist/psychologist licensed under the provisions of RCW 18.83 covered.
Clark Co Pre -approval required. Treatment must be required by a physician.
27 WSLEA Comparison of Benefits, Revised February 5, 2023
Mental Health (Cont.)
Jurisdiction
Policy Summary
Cowlitz Co
If exceeding insurance coverages, Licensed psychiatrist, et all (see plan), Dr ordered,
Tx plan every 10 sessions, see plan for requirements
Everett
100% allowable charges.
Franklin Co
Prior approval required.
Grant Co
Licensed psychologist/psychiatrist, 6 visits/year without board approval. 7+ physician
report, pre -approval by board.
Grays Harbor Co
Under direction of licensed psych iatrist/psychologist. 6 visits/year without Board
review. Treatments for sexual dysfunction excluded.
Jefferson Co
Treatment plan required every 6 months
Kennewick
Must see board approved physician for evaluation and treatment plan. 3-month
progress reports required.
King Co
Providers licensed/certified. Treatment plan required after 2 visits and every 610
sessions. 50-minute unit by psychiatrist - $150; psychologist/advanced registered
nurse practitioner - $125; clinical social worker or mental health counselor - $110.
Kirkland Provided by State licensed psychologist/psychiatrist, unless referred to State certified
counselor by physician or Employee Assistance counselor.
Kittitas Co 10 visits or $600 within 12 months. To exceed needs board approval.
Lacey
Case -by -case.
Lewis Co
35 visits/year. Claim must include physician's statement of necessity.
Lynnwood
Pre -approval before exceeding defined benefit through insurance.
Marysville
Utilize member insurance first; non covered expenses may be submitted for
reimbursement
Mercer Island
Pre -approval after 2 visits.
Olympia
Licensed psychologist/psychiatrist/counselor, up to 20 visits/ preapproval for
additional.
Pacific Co
35 visits/year.
Pasco
State -licensed psychologist/psychiatrist, unless referred to state -certified counselor by
physician or EPA.
Pend Orielle
5 visits for same/similar condition. Only necessary services.
Puyallup
100% for treatment rendered by a physician.
Renton
Covered insurance plan 20 visits/yr Excess needs board approval.
Richland Police
Licensed therapist/psychologist or psychiatrist.
Richland Fire
Licensed Psychologist/psychiatrist on case -by -case basis.
Seattle Fire
State licensed. Letter from Doctor. 26 visits/year; exceeding visits need pre auth.
Inpatient facility.
Seattle Police
State licensed psychologist; Limit of $3600 year/24 visits year. Excess approved by
Board Secretary. Counseling state licensed qualified professional $110 visit or $2,640
year
Skagit Co Pre -approval required over 3 visits. 50-minute unit maximum rates: Psychiatrist $110;
Psychologist $90; Clinical Social Worker $80. 52 visits/year.
Skamania Co Licensed psych iatrist/psychologist/certified clinical social worker. Written Tx plan. Pre -
authorization by Board.
Spokane Co Insurance primary, excess must be preauthorized by board. Limit $600 per year.
Tacoma Coverage provided through Regence BlueShield. Marital/family counseling not
covered.
28 WSLEA Comparison of Benefits, Revised February 5, 2023
Vancouver
Physician prescribed; Pre -approval required.
Walla Walla
$2,200 for outpatient care/12-month period. Marriage and family counseling not
covered. Treatment plan required.
Wenatchee
Upon 6t" visit, medical report required.
Whatcom Co
Treatment plan required after 2 visits. 50-minute unit rate: psychiatrist $150;
psychologist/advanced registered nurse practitioner $125; clinical social worker $110;
certified mental health counselor $100.
Whitman Co
Treatment plan required after 2 visits. 50-minute unit rate: psychiatrist $135;
psychologist/advanced registered nurse practitioner $110; clinical social worker $90;
certified mental health counselor $90.
Yakima Co
State licensed psychologist/psychiatrist, unless referred to State certified counselor by
physician or Employee Assistance counselor.
Yakima
Paid at 100% $9,000 max inpatient, $3,000 max outpatient, $12,000 max/year
in/outpatient. Lifetime Max $24,000.
Yakima Fire
Pre -approval required after 2 visits. $9,000 inpatient per year. $3,000 outpatient per
year. Up to $24,000/lifetime.
Miscellaneous Medical
Jurisdiction
Policy Summary
Aberdeen
Surgical procedures and devices for birth control are not considered medically
necessary. Fitness program at members own expense. Organ transplants need pre -
approval.
Bellingham Fire
Funeral benefit $500 paid to estate if hired prior to March 1, 1970.
Bellingham Police
Death benefit $1,000 to pre-LEOFF, w/5 years' service assume qualifying beneficiary.
Not applicable if hired after March 1, 1970,
Benton Co
Have paid dental claims from Mexico
Bothell
Experimental, research, drugs procedures/biofeedback are case by case.
Clallam Co
Have paid claims from Canada
Douglas Co
Pain Therapy covered when physician prescribed, by licensed practitioner.
Everett
Swim fees if Everett Parks/submit to board office. Genetic testing, obstetrics, blood
transfusions, ambulance, contraception 100% allowable charges.
Franklin Co
Members required to use insurance contracted provided. Prior authorization required
for experimental treatments and preventative medicine.
Grant Co
$750/year exam/filling, root canal/crown/bridge/dentures. Max $1200 full or partial
denture every 5 yrs. Ortho only if medically necessary.
Grays Harbor Co
Non -emergency air ambulance service excluded. Vitamins not prescribed by a
physician excluded.
Kennewick
Board must be advised 1 month prior to surgical procedure (except in emergency).
Physical therapy/12 visits yr through licensed RPT.
Kent
Medical necessity required.
King Co
Charges must be reasonable and considered usual and customary.
Kirkland
Routine physical exam will be covered. Subrogation recovery rights.
Kitsap Co Claims must utilize any available insurance/Medicare etc; claim submission up to 1
year. Svc's beyond primary insurance require prior authorization.
Klickitat Co Charges reasonable and considered usual and customary unless a provision in these
Rules provides for reimbursement for a lesser amount.
Lacey Pain therapy tx when given by licensed practitioner; board discretion. Podiatry
reasonable expenses, Dr prescribed, case by case. Orthotics 2 pair/one year.
Residence access ramps preapproval required, reasonable expenses, primary and
secondary ramps, future maintenance, or repair/members responsibility. Three bids.
Lynnwood Claims not covered by insurance require pre -approval.
29 WSLEA Comparison of Benefits, Revised February 5, 2023
Miscellaneous Medical (Cont.)
Jurisdiction
Policy Summary
Mercer Island
Only medical services deemed reasonable and necessary shall be paid.
Mountlake Terrace
Cover out of country claims.
Okanogan Co
Missed appointments not covered. Physical therapy over 45 days must be
preapproved.
Olympia
Medical Recommendation/Colonoscopy. Bone Density - age 70/$350 every two
years.
Pasco
Reasonable cost of necessary medical care or services.
Pend Orielle
No mileage/food or lodging except as pre -authorized by board.
Pierce Co
Insurance covers Mexico, foreign travel. Naturopathy policy allows $2,500/yr
inclusive of any amounts paid by insurance.
Renton
Have paid claims from Mexico.
Richland Police
Naturopathic not covered. Physical Therapy/city plan then Dr letter w/plan submitted
to board.
Richland Fire
Meal expenses/business travel for board business only; Physical Therapy/Insurance
benefit, if +insurance must be pre -approved by Board. Death benefit $1,000 per
RCW.
Seattle Fire
Naturopath State licensed. Letter from Primary. See lab restrictions. $150 per visit/1
x day; Organ transplants. Letter required. Reasonable expenses/reasonable donor
expenses, federal licensed facility. Orthotics $450 one time/year;
Seattle Police
Dental coverage and limitations through Delta Dental plan, all members premiums
paid through office. No cosmetic.
Skagit Co
If physician outside group plan requires referral from group plan physician.
Skamania Co
Pre -authorization for any necessary medical expense not covered by insurance.
Snohomish Co
Out of country claims must be pre -approved.
Spokane City Fire
Travel for tx must be pre -approved. Member only. If problem, can be corrected
locally/no coverage.
Spokane Co
Physical therapy: above insurance requires prior approval. $750 per
year/lifetime/one condition/$3000 for tx. Includes Naturopathy, acupuncture,
massage, chiro and other holistic or alternative choice.
Tacoma
Naturopathic visits covered by Regence BlueShield, supplies/special
diets/herbs/nutritional supplements/vitamins not covered. Emergency medical care
only out of country. Denied spinal decompression therapy.
Thurston Co
Denied administrative fees.
Tumwater
Pain therapy. Licensed facility.
Vancouver
Use of non -Kaiser facilities by Kaiser members requires pre -approval. Have paid
Administrative Fee for LTC. Have covered dental & glasses from Mexico.
Whatcom Co
Naturopathic $2,500/Year
Yakima Co Insurance covers out of country claims.
On -Line Policies
Jurisdiction Policy Summary
Bellevue www.bellevuewa.gov (Boards and Comm issions/LEOFF 1 Disability Board/Policies
and Procedures
Bothell www.ci.bothell.wa.us
Bremerton www.bremertonwa.gov
Clallam Co www.clallam.net (Co Laws & Policies/Co Administrative Policies/Section 200:
Personnel/295: Disability Board
Grays Harbor Co www.co.grays-harbor.wa.us (departments, disability board)
30 WSLEA Comparison of Benefits, Revised February 5, 2023
On -Line Policies (Cont.)
Jurisdiction Policy Summary
Kennewick www.ci.kennewick.wa.us (City Managers Web Page in Navigation Pane- Disability
Board
Olympia http://olympiawa.gov/city-government/advisory-committees/leoff-disabilityboard.aspx
Renton www.rentonwa.gov (City Departments and Services/Human Resources/LEOFF
Policies and Procedures
Tacoma POLICE (cityoftacoma.org)
Tumwater Podiatry/reasonable expenses; Orthotics not to exceed two pair in one year
Vancouver http://www.citVofvancouver.us/hr/page/leoff-1-police-and-fire-pension-boards
Whatcom Co www.whatcomcounty.us/2445/Leoff-1-Disability-Board
Jurisdiction
Bellingham Fire
Bellingham
Bothell
Bremerton
Clallam Co
Clark Co
Douglas Co
Edmonds
Everett
Franklin Co
Grays Harbor Co
Kirkland
Kitsap
Kittitas Co
Lacey
Lynnwood
Marysville
Mercer Island
Mountlake Terrace
Olympia
Pacific Co
Pasco
Pierce Co
Puyallup
Richland Police
Richland Fire
Seattle Fire
Seattle Police
Skamania Co
Snohomish Co
Spokane
Spokane Co
Tacoma
Thurston Co
Vancouver
Physicals
Policy Summary
Retired annual well physical and labs covered by Insurance.
Covered by plan.
$300/year.
Allowed annually.
Cover costs not covered by other insurance.
Once every two years for members over 40. More frequent require pre -approval.
Once annually.
$300 annually
Once annually.
Pay co -pay.
Allowed as preventative.
$350/24 months, except annual pap spear or prostate examination.
$350 per year.
Cover co -pays.
Yes
$350/year Any additional procedures prescribed by Dr shall also be paid.
Not covered.
$350/year.
Covered
$350/year.
Not covered.
Not covered.
Covered
Covered
$400/year.
$400/year. Charges exceeding to be brought before the Board for consideration
Reimbursable and encouraged
$500/year.
Annual physical exam covered.
$250/year.
Covered
$200/year. Billed to insurance plan first.
1 /year
1 /year
1 /year
31 WSLEA Comparison of Benefits, Revised February 5, 2023
Physicals (Cont.)
Jurisdiction Policy Summary
Walla Walla 2 years age 36-50 to include medical history/exam, complete blood count, urinalysis,
chemistry profile, PSA, mammography, pap smear (yearly), hemoccult, complete
cholesterol profile. Every 4 years beginning at age 36: chest x-ray, exercise treadmill
test, spirometry, audiogram. Every 5 years beginning at age 50: flexible
sigmoidoscopy.
Wenatchee Covered
Whitman Co $350/year for routine physical exams and immunizations.
Yakima Co Covered annually. Request members use preferred network when possible.
Preferred Provider
Jurisdiction
Policy Summary
Bellevue
Use of network providers not required, but benefits reduced for non -preferred
providers.
Bellingham
Should use network providers and/or pharmacies. For non -network provider, the
Board may decline all or a portion of the charges.
Benton Co
Primary care physician must be network provider, may refer to non -network
providers.
Bremerton
Do not require use of preferred providers - Medicare doctors required.
Chelan Co
Members required to use in network provider when possible. If out of network
reimbursed to member for difference of in network provider, not full amount.
Clallam Co
Do not require use of preferred providers.
Clark Co
Do not require use of preferred providers.
Everett
Do not require use of preferred providers.
Grant Co
Do not require use of preferred providers.
Grays Harbor Co
Encourage use of preferred providers, may consider by pre -approval.
Kennewick
Do not require use of preferred providers.
King Co
Do not require use of preferred providers.
Klickitat Co
Do not require use of preferred providers.
Lynnwood
Do not require use of preferred providers.
Marysville
Do not require preferred providers, reduced benefits for non -participating providers.
Pasco
Do not require use of preferred providers.
Pierce Co
Do not require, but request use of preferred providers.
Puyallup
Do not require use of preferred providers.
Redmond
Do not require use of preferred providers.
Renton
Do not require, but request use of preferred providers.
Richland Police
In network encouraged.
Richland Fire
Encouraged to utilize preferred and Medicare. If not, may not be 100% covered.
Seattle Police
Encourage member utilize participating providers.
Skamania Co
Do not require preferred providers but reduce benefit for non -participating providers.
Snohomish Co
Do not require use of preferred providers; member must obtain services through
prepaid health plan.
Spokane Co
Do not require use of preferred providers.
Tacoma
Require use of Regence BlueShield preferred providers except for long term care.
Vancouver Do not require use of preferred providers.
Wenatchee Do not require use of preferred providers.
Whitman Co Do not require, but request use of preferred providers.
Yakima Co Members encouraged to use preferred provider
32 WSLEA Comparison of Benefits, Revised February 5, 2023
Prescriptions
Jurisdiction
Policy Summary
Aberdeen
Medically necessary erectile dysfunction 4 doses/month. Pre -authorization
required.
Asotin Co
Max $100/month; should submit monthly -must submit quarterly March, June,
September, and December.
Auburn
Erectile dysfunction paid as any other prescribed medication.
Bellingham
Through medical plan. Member has Medicare -with copay process with HRA card at
pharmacy. Mail order- 90-day supply. OTC by physician Rx, Rx needs annual
renewal. E/D covered with Rx.
Bellingham Fire
Covered through insurance. Copays to pension w/proof/documentation. OTC w/rx
submit to pension for reimbursement. E/D covered w/Rx from Dr.
Bellevue
Prescriptions exceeding medical plan reviewed case -by -case.
Benton Co
Insurance first. OTC by order of note or Rx by Dr.
Bothell
OTC covered with physician's prescription.
Bremerton
Covered in medical plan. Erectile dysfunction 6/month.
Chelan Co
Co -pay covered. Erectile dysfunction paid as any other prescribed medication. OTC
available without note or prescription is not covered.
Clallam Co
E/D Rx limited 6/month.
Clark Co
Physician prescribed for medical necessity.
Douglas Co
OTC medications available without a prescription are not covered. E/D same as any
other Rx.
Edmonds
Co -pays covered by board. Any E/D cap $250/yr with physician's prescription
Everett
100% to Treatment/diagnosis illness/injury. Erectile dysfunction 6/month.
Franklin Co
OTC and vitamins covered with physician's prescription.
Grant Co
Rx by licensed Dr.
Grays Harbor Co
OTC covered with Dr. prescriptions. Sexual dysfunction 8/month or 96/yr
Kennewick
E/D 8 pills/month medical necessity documentation required
King Co
Sexual dysfunctions are determined to be reimbursable.
Kirkland
Physical prescribed for medical necessity
Kitsap
OTC and E/D (limit 6 doses/month) with physician's prescription. Any Rx to be
reduced by insurance first.
Klickitat Co
Must use Mail order as part of plan when available. OTC covered with physician's
prescription.
Lewis Co
OTC covered with physician's prescription. Generics encouraged. E/D $500 12
months/case by case showing medical necessity.
Longview
Two-year term Ballots and Nominations in February every other year
Mason Co
Erectile dysfunction 6/month; OTC covered with physician's prescription.
Mountlake Terrace
OTC covered with physician's prescription.
Olympia
OTC covered with physician's prescription.
Pacific Co
Physician prescribed for organic diagnosis, up to 6 tablets per month.
Pasco
Only when prescribed by a physician.
Pend Orielle
Unless approved by board/Rx to be purchased from local Pend Orielle County area.
Pierce Co
OTC covered with physician's prescriptions. Up to 8 doses/month for Erectile
dysfunction (other drugs for same purpose).
Puyallup
100% when physician prescribed/medically necessary.
Richland Police
If Rx requires pre auth by FDA, member required to follow City's benefit provider;
E/D as prescribed by Dr.
Richland Fire
If Rx requires pre auth by FDA, member required to follow City's benefit provider;
E/D as prescribed by Dr.
Seattle Fire
Covered with Premera at pharm/mail order. Copay's reimbursable when medically
necessary for specific conditions.
33 WSLEA Comparison of Benefits, Revised February 5, 2023
Prescriptions (Cont.)
Jurisdiction
Policy Summary
Seattle Police
E/D limit/12/month or 36/month using mail order/3-month supply
Skagit Co
Erectile dysfunction not considered medically necessary.
Skamania Co
OTC covered with physician's prescription.
Snohomish Co
E/D 6 doses/month if shown medically necessary.
Spokane Co
Only drugs and medicines that require a physician's prescriptions.
Tacoma
Members shall use Regence BlueShield participating pharmacy. OTC covered by
Regence BlueShield with RX.
Thurston Co
OTC covered with physician's prescription.
Vancouver
Erective dysfunction paid as any other prescribed medication.
Walla Walla
OTC covered with a physician's prescription. Erectile dysfunction 13/quarter.
Wenatchee
OTC covered with a physician's prescription.
Whatcom Co
Erectile dysfunction when prescribed to treat organic diagnosis. 75% of charge.
Whitman Co
Erectile dysfunction not considered medically necessary.
Yakima Co
Erectile dysfunction paid as any other prescribed medication.
Smokina Cessation
Jurisdiction
Policy Summary
Aberdeen
Covered under Regence Plan
Bellingham Fire
Covered through insurance.
Bothell
Insurance coverage, any out of pocket on case by case/1x only following successful
completion and 1/yr maintenance.
Cowlitz Co
Exceeding insurance to specified amount, 1x only following completion for one year.
Everett
part of regular coverage.
Grays Harbor Co
Hypnotherapy to stop smoking excluded.
Jefferson Co
$300 one -time -only for patches.
King Co
$250 once -only following successful completion and 1-yr maintenance of goals.
Kirkland
Covered as Physician prescribed. Pre -approval required.
Pullman
80% of remaining balance not paid by insurance. One lifetime benefit.
Puyallup
Paid 100%.
Richland Police
Smoking cessation, pre -approval required.
Seattle Fire
Letter from Primary. $1000 limit/exceeding limit must have prior authorization.
Seattle Police
Smoking cessation treated as other illness/injury.
Skagit Co
$300 once -only following completion and 1-year maintenance of program goals.
Snohomish Co
Prescriptions limited to 90-days per lifetime
Spokane Co
Pre -approved by board/lifetime max $500.
Walla Walla
$250 once -only following completion and 1-year maintenance of program goals.
Whatcom Co
$250 once -only following completion and 1-year maintenance of program goals.
Whitman Co
$250 once -only following completion and 1-year maintenance of program goals.
Yakima
$50 lifetime maximum for Nicorette
Travel
Jurisdiction Policy Summary
Bellingham Travel costs not covered.
Bellevue Travel costs not covered.
Bremerton Have allowed mileage for doctor's appointments and to pick up prescriptions.
Chelan Co No personal mileage, food, or lodging.
Clallam Co Transportation to medical facility if service not available locally. Have paid
cabulance from nursing home to doctor visit.
Clark Co Have paid medical transportation to healthcare providers.
34 WSLEA Comparison of Benefits, Revised February 5, 2023
Travel (Cont)
Jurisdiction
Policy Summary
Douglas Co
Travel for medical pre authorization required, max/per diem rates for lodging, meals
and incidentals and IRS mileage rate using private vehicle.
Everett
Have paid - case -by -case.
Franklin Co
Would consider if no other options in local area or upon physician's necessity.
Grays Harbor Co
Case -by -case; generally, not approved.
Island Co
Would have to be necessary medical expense.
Kennewick
With physician referral case -by -case.
Kitsap Co
For out -of -area treatment for member only. Prior approval would be required.
Klickitat Co
Only when member required to submit to an evaluation requested by the Board.
Lacey
Case -by -case.
Mercer Island
No
Pasco
No
Pierce Co
Must be proven medically necessary unless doctor visit requested by Board.
Puyallup
Has paid airfare for member out of country to allow treatment in the states.
Richland Police
Current city travel policy. Preauthorization required for board or medical tx.
Seattle Fire
Cabulance to treatment. Travel for out -of -area treatment not covered.
Seattle Police
No
Snohomish Co
No
Spokane
Have paid travel and meals — case -by -case.
Tacoma
No covered.
Thurston Co
Have covered personal assistance including transportation to medical appointments.
Vancouver
Have paid transportation from massage.
to nursing facility and doctor's appointments from nursing facility.
Walla Walla
Would cover travel only if Board directed a member to an out -of -area physician.
Walla Walla Co
If no other options or upon physician's recommendation.
Wenatchee
Pre -authorization required.
Yakima
Have paid cabulance/medical taxi; have paid mileage for home health care provider
to transport member to doctors; case -by -case basis if same services not available in
Yakima.
Yakima Co
Only reimbursed if Board issued for IME purposes.
Vision
Jurisdiction
Policy Summary
Aberdeen
$325/lenses and frames/24-months. $200/contact lens/24-months.
Asotin
Pre -approval required. $200 max/2 yrs. Glasses may be purchased at Costco, city
card if needed.
Auburn
$270/year for frames and lenses; exam covered by medical. $1,000 per eye for
Radial Keratotomy or laser eye surgery in lieu of glasses in 2 calendar years.
Bellevue
2 sets of lenses plus $200 for frames/24-months. $400 for laser/refractive eye
surgery instead of hardware. If vision conditions uncorrectable by any other means
and member precluded from performing duties of his/her position greater amount
may be considered case -by -case.
Bellingham Fire
Routine exam/hardware covered under city Vision Plan. Laser max amount to cost of
contact lenses. One-time payment only.
Bellingham Police
Routine exam/hardware covered under city Vision Plan. Laser max amount to cost
$190 total. One-time payment only.
Bellevue 2 sets of lenses plus $200 for frames/24-months. $400 for laser/refractive eye
surgery instead of hardware.
Benton Co Allowance of $1,000 in conjunction w/dental per year
35 WSLEA Comparison of Benefits, Revised February 5, 2023
Vision (Cont.)
Jurisdiction
Policy Summary
Bothell
Lenses $200/12-months. Frames $120/24-months. Tinting, coloring, photo sun,
other options or a spare pair not covered.
Bremerton
100% exams; $190/year for eyewear - laser surgery $760 in lieu of 4 yrs eyewear
benefit.
Chelan Co
Exams covered; corrective lenses covered to $400/24 months. No Rx sunglasses.
Laser surgery to $4,000, no other vision benefits for 5 years.
Clallam Co
Annual exam. $500/2 years lenses/contacts/glasses. Refractive/laser surgery
medically necessary. Treatment for glaucoma, cataracts, macular degeneration, tear
ducts, etc. are covered.
Clark Co
1 exam yr, 1 frame/2yr, 1/lens/yr. Frames/lenses/contacts $350 per event.
Otherwise, case by case w/review by board.
Cowlitz Co
Reasonable cost of necessary eye exam, glasses, and contacts, one pair
glasses/year of contacts, 1x/year; Single pair glasses/frames/lenses every 12 most.
Single, bifocal, trifocal. Second pair for specific applications only approved if by
Ophthalmologist or licensed optometrist. Reimb limited to one every 24 months.
Contact lens, years' worth every 12 mos. Replacement: one per year. No additional
or spare reimbursement. Lasik, laser, cataract if medically necessary.
Douglas Co
1 exam/24 months. $300/24 months for lenses -frames or contacts. Laser surgery
$500/eye.
Edmonds
Annual benefit of $150 (for a total up to $300 every two years (24/mos) glasses or
contacts or eye medical services.
Everett
1 exam plus $550/year for glasses/contacts. Yearly allowance may be applied to
laser eye surgery instead of purchase of glasses.
Franklin Co
$300 for lenses/contacts/frames/prescribed eye treatments per two years.
Grant Co
Eyeglasses/contacts prescribed by optometrist/ophthalmologist. 1 yr/12 months $500
frames/lenses/contacts/tinting/bifocal/trifocal every 2 years.
Grays Harbor Co
Pre -approval required. 1 exam/12-months. $500 for frames, lenses, contacts,
tinting, bifocals, etc. per 2 years.
Island Co
1 exam/12-months. One pair of glasses obtained for the first time. Replacement
lenses for prescriptions change.
Jefferson Co
1 exam/year; 100% lenses; $100 frames/24-months; $200/contact lenses/12months.
No reimbursement for options not determined medical necessity.
Kennewick
Exam/glasses or contact lenses once/12 months. $100/year frames. $200/year
contact lenses. Tinting, coloring, photo -gray, photo -sun, etc., excluded unless
medically necessary. Progressive lenses not covered. Replacement only if
damaged in line of duty. Laser eye surgery case -by -case.
Kent
Exam coverage by Ophthalmologist or optometrist, after all insurance has been
utilized. Contacts max $100/yr. Frames $100/24 mos; Lenses $150/12 mos;
Laser/RK $250 per eye then cease hardware for two years.
King Co
$350/single set of frames/lenses/12 months. $200/pair of contact lenses/12months.
Corneal laser surgery, laser treatment for refractive conditions, and lens implants
(multifocal lens excluded) eligible only for medical conditions.
Kirkland
Rx by Optometrist or ophthalmologist limit to $350 frames/lenses and up to $200 for
second pair frames/lenses.
Kitsap Co
Frames/2 years up to $200. Lenses/annually not including extra options. Contacts in
lieu of glasses; retinal scan $50/yr. Laser in lieu of glasses/contacts suspend
hardware benefits for 4 years.
36 WSLEA Comparison of Benefits, Revised February 5, 2023
Vision (Cont.)
Jurisdiction Policy Summary
Kittitas Co By Rx/licensed ophthalmologist/optometrist. Eyewear $500 excluding eye exam.
Klickitat Co
Annual Exam 100%; frames $120/year; Lenses 100%/year; Contacts considered as
lenses; Replacement for damage during duty limit 1/year. No over -sizing, tinting,
coloring etc. options.
Lacey
Exam 100%, Lens 100% including tint, coating), Frames 100% w/in two-year period.
Second pair 25% of total cost, can be contacts/glasses. Contacts $130/two years.
Lewis Co
1 exam/year; 1 frames/2 years. Complete cost not to exceed $550. Lenses may be
tinted if prescribed by doctor as medical necessity.
Longview
Lenses/Frames $100 limit/yr or $200/2 years or Contacts; Lasik $3500
Lynnwood
1 exam/year. Frames one/2 years. Lenses 1 pair/year. $400/year maximum
Marysville
1 exam/year. $240/year for eyeglasses/contact lenses. No tinting, coloring, photo -
sun, or other options unless medical necessity.
Mason Co
Lenses -annually; Frames -. every 2 years. Limit $500 every 2 years when
purchasing 2 pairs of glasses at tone time. Laser surgery allowed at 50%.
Mercer Island
Untreated/un-tinted lenses (either eyeglass or contact lenses) 2 pairs/24 months.
$260/2 years for contact lenses. Member pays $20% co -pay for lenses. Frames
$100/pair. 1 pair frames/24-months.
Okanogan Co
100% of examination; lenses/frames $150; contact lenses $100. 1 exam and 1 pair
of glasses or contacts/1 2-months.
Olympia
1 exam/year. $300 annually. Police coverage-VSP. Fire coverage -Humana. First to
insurance, then seek reimbursement.
Pacific Co 1 exam/12 months. $300/12 months for lenses, frames and/or contact lenses.
Replace due to breakage in the line of duty. Refractive Keratotomy Surgery for
myopia/astigmatism not considered necessary medical. Corneal Laser Surgery
require pre -approval.
Pasco Annual exams and $375/yr for corrective lenses or contact lenses.
Tinting/progressive lenses if prescribed. Sunglasses only for specific condition.
Replacement only in line of duty.
Pend Orielle Total cost for corrective lenses/excluding exam $300 max/1 every two years.
Pierce Co $250 one paid of lenses/frames or contacts per year. Replacement when damaged
in line of duty.
Pullman Annual eye exam covered. $600 glasses/frames/lenses and or contacts.
Puyallup 1 per year; exam/refraction/glaucoma testing/OptoMap $100/single $125/bifocal
$160/trifocal $210 progressive $300/polycarb $75/high index $300/protective coating
$40/transitions $120/anti-reflective $140/frames $250/corrective surgery $500 per
eye.
Redmond 1 exam/year. $400/year for lenses and frames or contact lenses. Replacement on
case by case. Toric or Multifocal cataract $1500 lifetime.
Renton $450/2 years for lenses and frames or contact lenses, including tinting and
Refractive/Laser Eye Surgery. 1 exam/year.
Richland Police Annual exam and one pair lens, include anti-scratch/glare) tint, transition max
$150/frames year. Sunglasses/1x year only Dr prescribed for medical condition.
Contact Lenses/$200/year.
37 WSLEA Comparison of Benefits, Revised February 5, 2023
Vision (Cont.)
Jurisdiction
Policy Summary
Richland Fire
Insurance first if applicable; exam and one pair lens, include anti-scratch/glare) tint,
transition max $150/frames year. Sunglasses only Dr prescribed for medical
condition. Contact Lenses/$200/year. Broken frames/lenses no replacement.
Seattle Fire
Exam and tx, Rx by Dr. Frames/lenses/sunglasses 24/mos. Lens enhancements are
allowed w/i limits. One pair single vision $550; bifocal $580; trifocal $645. Change in
Rx/12 mos single $310; bifocal $335 Trifocal $405. Lasik/Licensed Ophthalmologist.
FDA approved. Performed/USA. One time $1400/eye.
Seattle Police
Annual exam. $800/year for hardware (frames/lenses) w/prescription change. Laser
eye surgery/keratotomy and blepharoplasty (eyelid) surgery if medical necessity.
Refractive Keratotomy Surgery to #1400/eye/lifetime by licensed ophthalmologist.
Corneal Laser Surgery prescribed for medical condition.
SeaTac Fire
Glasses/frames $400 every two years or sooner if correction is required. Special Rx
due to circumstance on case -by -case basis.
Skagit Co
1 pair eyeglass or contact lenses/12 months. $250/pair lens; $100/frames; $200/pair
contact lens. No over -sizing, tinting, coloring, photosun, or other options, special
requests, unless medically necessary. Pre -approval required for laser corneal
surgery.
Skamania Co
1 exam/year; $250 for 1 set of frames/2 years; $300 for 1 pair lenses/year; laser eye
surgery required preapproval. Contacts/$300. Replacement: breakage/loss on duty.
Laser surgery preapproval $1,000/eye w/no hardware/2 years.
Snohomish Co
1 exam/year. $200/frames and $300/lenses every 2 years.
Spokane Police
1 exam/year; hardware $500/2 years, Lasik $2600 per lifetime.
Spokane City Fire
Lasik through TPA/lenses for glasses allowed w/i 6 months after Lasik.
Spokane Co
$150/2 years unless medical necessity requires change sooner. Laser: Medical
necessity are only options for adequate vision or safety of employee.
Tacoma
Active plan through City (line of duty damage covered by Board). Retired members -
$300/calendar year for eyewear (glasses or contacts) through Regence BlueShield.
Current eyewear allowance for Radial Keratotomy or laser eye surgery, in lieu of
hardware in same year.
Tumwater
One exam/2 yrs. Lens covered 100%/2yrs; Frames $100/second pair glasses or
contacts 25% total cost. Contacts $130/2 years
Vancouver
1 exam and 1 pair of glasses or contact lenses/1 2-months, except replacement if
broken in line of duty, or as needed for specific medical condition. Exam $80;
$250/year hardware (lens, frames, coatings, contacts, etc.) plus $20 for UV
protection. Charges for sunglasses, photo gray or contact lenses in excess of
allowance, only pre -approved medical necessity. 1-year hardware allowance may
offset the cost of laser surgery unless vision cannot be corrected by glasses and/or
contacts.
Wahkiakum Co
Vision premiums paid on a composite basis. Expenses not paid by insurance covered,
excluding hardware.
Walla Walla
$240/pair lenses/ 1 2-months. $100/frames/24-months. $240/pair contact lens/12-
months. Over-sizing/tinting/coloring/photosun or spare pair not allowed. Refractive
Keratotomy Surgery to correct myopia and/or astigmatism not covered. Pre -
approval required for prescribed laser corneal surgery.
Wenatchee
Annual eye exam. $500 for corrective lenses every 2-years. Refractive keratotomy
surgery or laser surgery not considered medical necessity.
Whatcom Co
$800/frames and lenses/12 months
38 WSLEA Comparison of Benefits, Revised February 5, 2023
Vision (Cont.)
Jurisdiction Policy Summary
Whitman Co $75/year exam; frames/lenses/contacts $500 per two years. No laser vision
correction
Yakima Co Annual exam. Frames $200/year. No maximum on lenses. Disposable contact
lens $200/year. Tinting, special coatings, rolled and/or polished edges, oversized
lenses or prescription sunglasses not covered.
Yakima Eye exam 100%; $500 max every two years lenses/frames/contacts; The $500 can
be applied toward cost of corrective vision surgery.
Yakima Fire Annual exam. $275/2 years for lenses and/or frames and/or contact lenses. $275
lens allowance can be applied toward cost of corrective vision surgery.
W-2 for DisabilitV
Jurisdiction Policy Summary
Bellevue 2 pay codes (non -duty disability taxable and duty disability non-taxable).
Everett duty & non -duty disability same pay code. W-2 adjusted to reflect actual taxable
amount.
Marysville no active members.
Richland 2 pay codes (non -duty disability taxable and duty disability non-taxable).
Walla Walla 2 pay codes (non -duty disability taxable and duty disability non-taxable).
Whitman Co no active members.
Weight Loss
Jurisdiction Policy Summary
Aberdeen Physical fitness no covered.
Auburn $500/one-time-only, for prescribed weight loss program for at least 60 pounds.
Bellingham Weight loss has been approved for medical necessity case -by -case. Physical fitness
not covered.
Bothell Weight loss programs, physical fitness/health spas, considered when prescribed. No
requests for surgery.
Bremerton Not covered.
Clallam Co Physical fitness not covered. Weight Loss program if prescribed. No requests for
surgery.
Cowlitz Co Case by case, Dr. Monitored.
Everett Swim Fees of Everett Parks, submit to Pension Board.
Franklin Co Considered if prescribed by physician and approved by Board Physician. Prior
approval required.
Grays Harbor Co Weight loss programs/physical fitness/health spas must be medically necessary.
Pre -approved one lap -band surgery.
Jefferson Co If medically necessary if reasonable equivalent benefits could not be obtained for less.
Kennewick Necessary medical costs. No food supplements, membership in weight loss
programs, physical fitness clubs or health spas. Will cover counseling by licenses
psychologist/psychiatrist or dietician/nutritionist.
King Co May approve weight loss program prescribed/monitored by physician one-time only,
exclusive of food supplements/replacements.
Kirkland Not covered unless medical necessity and equivalent treatment could not be obtained
for less. No gym or spa memberships.
Lewis Co Covered for medical necessity and equivalent treatment could not be obtained for less.
Lynnwood Not covered.
39 WSLEA Comparison of Benefits, Revised February 5, 2023
Weight Loss (Cont.)
Jurisdiction
Policy Summary
Marysville
Weight -loss programs/physical fitness/health spas not covered unless medical
necessity and equivalent treatment not available for less.
Olympia
Access through insurance and no reimbursement
Pacific Co
Weight loss programs/physical fitness/health spas not covered unless medically
necessary.
Pasco
Weight -loss programs/physical fitness/health spas not covered unless medical
necessity and equivalent treatment not available for less.
Richland
Weight loss program prescribed one -time -only. Board will pay 50%, exclusive of
food. If applicant demonstrates goal completion and maintenance for 2 years, Board
may provide further compensation.
Richland Fire
Complete city's health care before any plan submission to Board. Dr prescribed/1x
per person/case by case. 50% excludes food/other parts as determined prior to start.
After two years/w goals/maintenance the board may provide up to full amount.
Seattle Fire
Medical necessity/BMI <30 limited $1,000. Food/supplements not covered. Prior
authorization required. Doctor letter required.
Seattle Police
100% excluding supplements/nutritional products. Upon physician's prescription do
pay 100% for physical fitness facilities for members with chronic wasting diseases.
Skagit Co
Prescribed/monitored by physician, one -time -only (excludes food supplements).
Pre -approval required. Physical fitness programs no covered. No requests for
surgery.
Skamania Co
50% one-time only, exclusive of food and other parts of the program. After 2 years
may pay up to full amount upon maintenance of goals. Exercise/fitness programs not
covered.
Snohomish Co
Health club memberships case -by -case in lieu of physical therapy for medically
necessary rehabilitation following surgery.
Spokane Police
Case -by -case for medical necessity.
Spokane Co
$500/year for prescribed dietary counseling, up to $1,500 for one condition.
Thurston Co Would require pre -approval for any procedures. Have approved one surgery.
Walla Walla Physical fitness program not covered. Pre -approval for weight loss program
prescribed/monitored by physician, one -time -only, excludes food
supplements/replacements. No requests for surgery.
Wenatchee One-time only when medical necessity, physician prescribed/monitored, when
proven cost savings long term.
Whatcom Co One -time -only when physician prescribed/monitored, excludes food
supplements/replacements.
Yakima Physician prescribed/monitored, one -time -only, excludes food supplements.
Preapproval required. No requests for surgery.
Yakima Co Have covered surgeries deemed medically necessary.
*This is a general comparison list only and should not be used to confirm, verify or
determine any benefit(s) from your Pension Board. Please contact your Pension Board
directly for any of your needs.
Rev: January 2023
40 WSLEA Comparison of Benefits, Revised February 5, 2023