estimate of more like 20 million. but the reality is it depends really on how quickly claims are paid and how many claims are deferred into future months. but 25 million is where we would have been had those actuarial rates held up at that low cost. >> thank you. >> any other comments, any other questions? seeing none, thank you very much. >> thank you. >> madam secretary, item number 5. >> item 5, action item, eliminate $75,000 lifetime cap on uhc transgender benefit for active and early retiree plans, lisa ghotbi. >> thank you, lisa ghotbi acting director. this is something we usually deal with during the rates benefits process, but this issue didn't come to light to the health service system until last week. we wanted to make sure we brought it to your attention now so we can make sure we get

it into our guides and it's clear for our members going forward. it was actually a memo issued by the department of managed health care on april 9th of 2013 which essentially says that no lifetime limits are allowed under any plan that's licensed under the department of managed health care when it comes to any kind of gender reassignment benefits. so, the two plans we have that are administered through the department of managed health care blue shield and kaiser, this is a legislative change that's mandated. for the one plan that is not covered, it was the board decision to decide to make benefits equivalent across all of our products. so, the recommendation to the board is that we do maintain consistent benefits with our united healthcare plan. and, again, this is just our

active and early retiree plan not our ppt plan [speaker not understood]. and the lifetime that will be lifted on all three products. >> commissioner scott. >> i'm in favor of the concept of doing this, but i want to talk a little bit about the process. to have this come up, you know, it happens to be something that was legally mandated and we've gone through a whole discussion with the health plans and so forth. and now this is brought to our attention after some months and now we're ready to close and getting ready to publish. so, i guess my question is do we have other regulatory issues that these plans need to be or that we need to screen for or the plans need to bring to our attention affirmatively. and if we don't have that kind of on our checklist, i would ask that we get it on there

because it may be something of a larger consequence. and i know that your staff can't spend its time screening all of the stuff that comes from the department of managed care, but it seems like we had a hole here to get this done and i'd like to know how we plan to solve it. >> that's a very good question. we did have one of our steps in preparing for the rates and benefits to have our consultants do a review of any federal or state changes that need to be brought to -- [speaker not understood] on the rates and benefits and this was missed. so, we do have a process for it, we miss it had, and i think it wasn't until kaiser let us know this was occurring, really last week and saying this is now part of the rates benefits that we were alerted to the fact. i think it's fair to say we should also be working as a double-check with our health care benefits to make sure they aren't aware of anything as well.

>> thank you. >> when did kaiser and blue shield remove it? >> the kaiser notice was it was removed essentially immediately because it's a legislative mandate. so, it has to be done immediately. >> any other comments? we have a motion. >> i move the adoption of the removal of the cap on transgender benefits. >> second it. >> this is for plan 1. >> plan 1. >> okay, it's been moved and seconded. any public comment on this item? seeing none, all those in favor. >> aye. >> opposed? it's unanimous. madam secretary, item number 6. >> item 6, discussion item, presentation of blue shield dashboard. president breslin. >> this item is not ready for this month, so, i'm assuming we want it on the september calendar. so, we will continue this

matter to our september 12th board meeting. regular board meeting. thank you. any public comment on this item? seeing none, [speaker not understood]. >> membership rules committee, item 7, action item, adopt and make editorial changes to the health service system membership rules and regulations including, but not limited to, the following. add federal eligibility requirements per patient protection and affordability care act. clarify eligibility requirements for retirees hired after january 10, 2009. clarify eligibility rule for surviving dependents of safety officers killed in the line of duty. allow hss to terminate benefits if member address and contact information are incorrect and hss has been unable to contact member for over one year.

clarify medicare enrollment requirements for dependents of active members. clarify cal-cobra eligibility. and list benefit coverage periods for 2014. president breslin. >> i move that we adopt the changes to the health membership services rules and regulations. >> seconded. >> any comments, any board comments? any public comment? it's been moved and seconded. all those in favor. >> aye. >> all those opposed? it's unanimous. item number 8. >> item 8, action item, approve revised section 125 cafeteria plan for 2014 calendar year, effective january 1, 2014. president breslin. >> i don't know that we approve the changes to section 125 of cafeteria plan. ~ i move that we >> second.

>> any discussion? any public comment? all those in favor? >> aye. >> opposed? okay, now we're onto the regular board matters. >> regular board meeting matters, item 9, action item, election of health service board officers (president and vice president) for fiscal year 2013-2014. president breslin. >> nominations are open for the president and vice president. >> i would like to make a nomination. i'd like to nominate karen breslin as the president and [speaker not understood] as the vice president. >> second. >> all right. any discussion? any public comment on this item? >> the only discussion i have is since we don't have a full quorum today, other commissioners, sometimes they defer, but i don't know the process with this commission. otherwise i move the second if there's no -- >> what do you mean we don't have a quorum?

>> we have a quorum. we don't have a full board. sorry. fair enough. >> all right. any public comment on this item? all those in -- all those in favor? >> aye. >> opposed? okay, item number 10. >> item 10, action item, appointment of chair and members of the following committees. president breslin. >> all right. the rates and benefits committee is a committee of the whole. i'm appointing commissioner scott to be chair of that committee. and the finance and budget committee, i'm appointing supervisor farrell as chair. and commissioner limb and commissioner scott to be on that committee.

and for the membership rules, commissioner [speaker not understood] as chair and commissioner breslin as members of the rules committee. and for the governance, commissioner limb as chair and dr. shlain as a member and commissioner fraser as a member. so, these have to be approved by the board, so, i'll need a motion to approve. >> i'll make a motion to approve that list. in its entirety. >> okay. >> second. >> great. is there any public comment on this item? seeing none, all those in favor? >> aye. >> opposed? unanimous.

okay, item number 11. >> item 11, discussion item, report on network and health plan issues, if any. >> anybody have anything to report today on this item? item number 11? seeing none, any public comment? oops, do we have somebody? come forward, please. thank you. my name is dianne olek and i have a question about something not covered by delta. [speaker not understood]. the academy of sleep dentistry recommends you be seen once a year to make sure the oral appliance isn't moving your jaw or teeth in any way because that can be a side effect of the oral appliance. kaiser will cover you for a three-month follow-up, but after that you're on your own.

and i don't understand since the issue is aden tal issue why if i have money left on my delta dental plan why they will not cover that. ~ and i'd like the board to discuss that or find out from delta dental why. >> [speaker not understood]. >> i'm sorry, we'll be happy to look into that. thank you. >> thank you. any other public comment? no public comment. no other public comment. item number 12. >> item 12, discussion item, opportunity to place items on future agendas. >> we always have a full agenda. commissioner scott. >> madam president, i want to go back and reinforce the opportunity now that i'm serving as chair of this rates and benefits committee. i think that we all went through the heartache of the --

this past spring. and we're on track to do the very same thing if indeed we are not proactive in terms of doing some pre-planning. so, i note the very same groups that had a defined interest and that not only means those who are represented, but also other plan members as well will come forward and share with us very explicitly, not just in comments, but in writing their views about what they think we should be trying to do from an overall health plan standpoint. we all know that no matter how those things are framed, we can't do everything and i'm not as a new chair going to promise that. but we can indeed engage in a healthy internal discussion. and doing that on the front end can help to shape the outcome. i'm happy to be very persuaded that just as we have start today engage with some of these

health plans, not only kaiser, but i think it's true for all of them, that we need to do that on a continuous and sustained basis so that we are neither surprised when they have to make the more formal recommendation about rates, everyone can then get very, very clear about what should have happened, why it didn't happen, and who wasn't there when it happened, and so on and so on. so, my great hope is we will take the time during this fall. i know we're busy with open enrollment. but during this fall to meet formally, informally, and certainly during the course of these meetings to present the ideas and come to some broad based outcomes that we would like to see. i would welcome that as chair of the rates and benefits committee, but i also think that it has to be a wide partnership to get that done. so, i hope i'm not over committing for the staff or the board, but i hope that we will

take that to heart. >> thank you. in september we will have a specific agenda item to address this, which you might have to put some input on as to how you want to do that. that would be great. >> president breslin? i also wanted to add -- i'm sorry, i missed this in the director's report. we have started negotiations with kaiser for 2015. we started on august 1st, and we just had our second meeting. so, we'll be working, working with you going forward. >> thank you. >> any public comment on this item? dennis [speaker not understood], actively [speaker not understood] retired firefighter. i'd like to congratulate the new elected officers and i look forward to watching the year. and second of all, having sat through over a year of i guess

presentations and actually negotiations that originally approved the gender -- my mind went blank there, but for the gender operations and so on. it's good now to see that that is recognized as any other procedure because at the time when they went through all that procedure, they tried to tell everybody that this is just another medical condition that has to be dealt with. so, it's nice to see even 15, 18 years later from that time this is now recognized for what it really is. so, i applaud the board on that one. >> thank you. claire [speaker not understood], retired seiu. again, i want to congratulate everyone on their positions as officers and also as chairs. and suggest that commissioner scott said a special letter go out to organizations, retiree

organizations and the unions, the public employee council and the seiu inviting them to perhaps have a meeting with one or two commissioners so you have a quorum. you know how that goes. but that you're available to meet so that you can have some discussion either with the leadership or with the rank and file to determine what their concerns and issues are and to be able to bring those back because that's i think the only way we're going to be able to keep this discussion and dialogue going, and to make sure that it's a partnership. put it on them to come forward and have that dialogue. so, again, congratulations and thank you all very much. and i want to second what dennis said about transgender. i went through that battle three times on the board and it's nice to see -- you know, we worked out some centers of excellence and we worked outweighs to keep that benefit affordable. and it's nice to see that it's now being accepted as any other condition. i wish we had made that

decision, but if it came from gmhc, i'm happy those guys did it. and i think part of the national health care also eliminates a lot of discrimination. so, we're getting there little by little. but thank you again and congratulations again. >> i just wanted to comment that we have to make sure we contact or include all members, not just unions or retirees, as i mentioned earlier. and that would mean we would have to send out a letter to every single member in the system, in my opinion, because not everybody is in unions. you can see in the past certain people show up and certain people don't. and, so, not everybody gets represented in a way. that's something i think you have to look at when you're talking about contacting people. any other discussion on this item? all right, item number 13.

>> item 13, discussion item, opportunity for the public to comment on any matters within the board's jurisdiction. my name is herbert wiener, i'm a retiree. last month they had a conference on bullying at the work site. it was part of labor fest. and the address concerns bullying at the work site and the tremendous toll it takes on employees. there were heart attacks. there have been suicides. now, unfortunately, san francisco is not blameless in this. and i would like to see the employee vip program -- vap program, excuse me, you know, work on legislation or rules and regulations regarding bullying at the work site. it really takes a tremendous

toll and, you know, [speaker not understood] occur all over the city. bosses harassing workers, peers sometimes harassing workers and this really has to stop because it slows down production. we have a limited work force. we have a heavy work load. and placing employees under stress does not help this at all. so, i would like to see this addressed in the future. thank you. >> thank you. any other public comment? seeing no public comment, we will -- i'll entertain a motion to adjourn. >> i move adjourn. >> in favor? >> before i second that -- [gavel] >> this meeting is adjourned. thanks. [adjourned]

>> hi. welcome to san francisco. stay safe and exploring how you can stay in your home safely after an earthquake. let's look at common earthquake myths. >> we are here at the urban center on mission street in san francisco. we have 3 guest today. we have david constructional engineer and bill harvey. i want to talk about urban myths. what do you

think about earthquakes, can you tell if they are coming in advance? >> he's sleeping during those earthquakes? >> have you noticed him take any special? >> no. he sleeps right through them. there is no truth that i'm aware of with harvey that dogs are aware of an impending earthquake. >> you hear the myth all the time. suppose the dog helps you get up, is it going to help you do something >> i hear they are aware of small vibrations. but yes, i read extensively that dogs cannot realize earthquakes. >> today is a spectacular day in san francisco and sometimes people would say this is earthquake weather. is this earthquake weather? >> no. not that i have heard

of. no such thing. >> there is no such thing. >> we are talking about the weather in a daily or weekly cycle. there is no relationship. i have heard it's hot or cold weather or rain. i'm not sure which is the myth. >> how about time of day? >> yes. it happens when it's least convenient. when it happens people say we were lucky and when they don't. it's terrible timing. it's never a good time for an earthquake. >> but we are going to have one. >> how about the ground swallowing people into the ground? >> like the earth that

collapsed? it's not like the tv shows. >> the earth does move and it bumps up and you get a ground fracture but it's not something that opens up and sucks you up into haddes. >> it's not going anywhere. we are going to have a lot of damage, but this myth that california is going to the ocean is not real. >> southern california is moving north. it's coming up from the south to the north. >> you would have to invest the million year cycle, not weeks or years. maybe millions of years from now, part of los angeles will be in the bay

area. >> for better or worse. >> yes. >> this is a tough question. >> those other ones weren't tough. >> this is a really easy challenge. are the smaller ones less stress? >> yes. the amount released in small earthquakes is that they are so small in you need many of those. >> i think would you probably have to have maybe hundreds of magnitude earthquakes of 4.7. >> so small earthquakes are not making our lives better in the future? >> not anyway that you can count on. >> i have heard that buildings in san francisco are on rollers and isolated?

>> it's not true. it's a conventional foundation like almost all the circumstances buildings in san francisco. >> the trans-america was built way before. it's a pretty conventional foundation design. >> i have heard about this thing called the triangle of life and up you are supposed to go to the edge of your bed to save yourself. is there anything of value to that ? >> yes, if you are in your room. you should drop, cover and hold onto something. if you are in school, same thing, kitchen same thing. if you happen to be in your bed, and you rollover your bed, it's not a bad place to be. >> the reality is when we have a major earthquake the ground shaking so pronounced that you

are not going to be able to get up and go anywhere. you are pretty much staying where you are when that earthquake hits. you are not going to be able to stand up and run with gravity. >> you want to get under the door frame but you are not moving to great distances. >> where can i buy a richter scale? >> mr. richter is selling it. we are going to put a plug in for cold hardware. they are not available. it's a rather complex. >> in fact we don't even use the richter scale anymore. we use a moment magnitude. the richter scale was early technology. >> probably a myth that i hear most often is my building is just fine in the loma prieta earthquake so everything is

fine. is that true ? >> loma prieta was different. the ground acceleration here was quite moderate and the duration was moderate. so anyone that believes they survived a big earthquake and their building has been tested is sadly mistaken. >> we are planning for the bigger earthquake closer to san francisco and a fault totally independent. >> much stronger than the loma prieta earthquake. >> so people who were here in '89 they should say 3 times as strong and twice as long and that will give them more of an occasion of the earthquake we

would have. 10 percent isn't really the threshold of damage. when you triple it you cross that line. it's much more damage in earthquake. >> i want to thank you, harvey, thanks pat for

>> august, 8, 2013, please be aware that the commission does not tolerate any disruption or out bursts of any kind and silence any mobile devices and when speaking before the commission, speak directly into the microphone and if you care to state your name for the record. >> i would like to take roll at this time. >> fong? >> wu. >> here. >> antonini. >> here. >> and moore. >> sugaya. >> here. >> the consideration of items proposed for