for the 9093 people. >> it's close to the same? >> it's very little movement in 2014. keep everything stable both blue shield and city plan stable and try to get the mou agreements fixed for 2015 to at least save blue shield. that was our intent. we were successful in that. the demographic report will come to the board at the march meeting. >> one more question for lisa? you are presenting a status quo 910 and 9310, are we expecting almost all unions to move to 9310 in 2015?

>> there is no one left on the status quo. no unions left on the hundred percent. there are about half of our membership because one of our largest union is on a plan that would be the 9010 as of july. so i would say that we have at least half of our membership in the 9010. we have done some projections if those unions don't adjust their contributions, we will see what we have models for this board previously if we have enough influence for the over all population that we have migration in families and continue migration and continue adverse selection and we are doing everything we can do to help support the understanding of the importance of coming up with the contribution model that allows competition and fair

pricing. all we can do at this point is cross our fingers and hope we have been heard. >> thank you. >> are there other questions? is there public comment on this item? hearing no public comment, we'll move to item 5. >> okay. >> item 5. action item review dental plan and approve retiree plan. committee chair scott? >> yes, this is a continuing direct response by the staff to the public comments and letters and other input about the dental plan as it currently stands. it needs to be noted here very clearly that the concerns have been heard and considered a wide range of alternatives and we are coming forthwith this

report today, our actuary. >> okay hold on. we have some late breaking updates. >> that is true. >> i'm on my game today. >> as was clearly stated this is an on going discussion about the approved retirees for dental coverage. we have a document that is fairly long, but the substance is in the first 11 pages and there is a

whole bunch of additional permutations of plan configurations because as this plan is on going, people have asked many questions. what if it was half way up? because it's a thousand dollars cap. not that we personally or hsf believe that it's financially doable. that information has been provided so that everybody is fully aware and we have what they call a well-rounded consideration decision about what we have. so that being the case i would like to walk you through what we are excited about and you go through your leisure and decide whether or not you want to bring forth some of the questions of some of these options in the opinion. with that i will turn to page two, what we would like are three designs. one of the important

aspects of these three designs is what we want to -- first i can turn you over to say this is what you currently have on page three, it's a thousand dollars cap. it's 100 percent for the p po's and has been discussed previously. ppo's are 25 percent of the dentist available. they are cheaper and cheaper discounts. in a perfect world everybody would be a ppo and would get all of this coverage for $30. that's not the case. a lot of the dentist with delta dental are premier dental. they have a 5-7 percent discount over what they charge. they have by far the largest network. so the non-participating a very small section of the entire dental provider matrix in california. this is what you have and it says the only first two

cleanings which include under that's the cleaning statement. i'm sorry. what we want to talk about are three plans and what we have in these three plans are what they call d and p, diagnostic and preventative. we can increase maximum or have it waived. when you waive it means all the benefits apply to diagnostic which is what you need to have done every year, your cleaning, etc, x-rays, you need to get this done to know what's going on in your teeth. so delta dental says we need to create programs where we wave that and the max -- applies to your dental hygiene. then if we allow

this, we can apply the full amount to the thousand dollars max. we have a grid produced by delta dental for us and gives you some understanding as to what the cost is on average for the d and p piece of this. it generally runs between $250-300. we put it out here in this grid. what the point of this table is on 5 to show you how many people hit their max minimums and 19 percent hit their maximums. of those people 85 use d and p. to give you a rough consideration. if 85 percent of those people were categorized as primary enrollees. 85 percent would have additional $200 that

could apply for more benefits because of the waiver. i think that's great because they go in and they go, you've used up a bunch of stuff and now it's manageable and now they go in and say i have my waiver and i have my basics. i'm being a good person taking care of my teeth and now i have $200 to take care of this. now i'm really good to go. the price on this is pretty good. that being said, we look at this and say, are there any questions about the beefk -- basic flow of what we are suggesting? >> i just want to get my head around this a little bit. i like to use cases as way to understand this. you went through a couple quickly, but just to understand, if you do what you are supposed to do, is that like a factor baked into this waiver, meaning you have to get your diagnostic and prevention stuff and if you do there is a bonus for

you? >> it's not applied to your maximum. yeah, you have a thousand dollars max. if you get your teeth cleaned and all listed as part of the d and p course of action, none of those are applied to the max. if you need a crown or whatever the case may be, you have a thousand dollars versus you chewed off $200 and you have $800 left. >> what if you get a crown and it cost $2,000 max, then you get your d and p also? >> yes. you are good to go on that category of benefit. depending on where you go it's 100 percent ppo and 80 percent at premier dentist. any other questions?

>> what does this cost? hopefully everybody, i want everybody to be aware there has been a change of some of these numbers. initially when we quoted one which says we get the waiver, nothing else changes. all the structure of the benefits that occurred are the same except we have the d and p aware of which generally runs you about $200-300. under this, when we initially got the pricing, it was $45. there has been a correction by delta dental. that should have been $47.72. if you don't have that; it should be in there. it's 47.72, $92, $94. what

happened was there was some confusion and they publiced a rate at 7.29 percent higher than the existing rates and when they went back and said since we have made the offer, we will honor the offer for 1 year, but we want everybody to know and this is a transparent board that the true number was 11.76 percent increase. so for everybody's clarity of knowledge that is the offer and, but delta said we'll give you that number because they are being straight forward honoring our offer commitment. so is there any questions about those two numbers because that can get confusing? >> not so much a question but if it's an effort by this board at this point to be very transparent about this. so if we decide to act on the 7.29, we need to understand that there is consequence to that.

pay me now or pay me later. so we did this and review and discussion with the acting director. i said we needed to put this number out there now so that we are making an informed decision. and it's not like we are going to get a discount and then it's never going to come back again, it will come back at some level. we can't predict the future. i just wanted everyone to be clear. >> yes, i honor this as very straight forward and very fiduciary and accountable by saying it's really 11.6. that is our initial alternative one. >> yes, sir? >> so the rates that you have includes 11 percent that it was the $47.72? >> yes, sir. that was

monthly. yeah. >> if it's monthly, you gain a premium of d and p is $250 but the inclusive rates amounts to $60 so you gain $190? >> yeah. if you get your teeth cleaned. yeah because it's the percentage of people using d and p as retiree, the point is $5. >> because of the dollar amount because some of the reimbursed might not know how much they gain. so in terms of the yearly increase in the premium is about $60 but your d and p from $250-300. you get $300 in terms of benefits? >> well-spoken. any comments

on that one? >> we have two more that we would like to run by you. on page 7, what we did is we went through this and they have the waiver, but they also and structure it like our existing active plan where we have the non-part at 50 percent. so it's a thousand, a thousand, a thousand, and this particular product, because some of the people get left -- less for about 5 percent. this number is 10.8 percent and we have a third one. where we go on the third one, this is more of an increased plan maximum and we go $1500 for the ppo, $1200 for the premier dentist and leave it at a thousand. since you raise it so much, there is no real need to wave the d

and p or that would allow more to it. this particular one in crisis rates by 12 percent. so i think these are all three very fantastic alternatives and where we are now is that what we think we want to do on a go forward basis, excuse me, because we want to clearly say that alternative one to us is by far very promising, but we need to survey the members. am i saying that correctly, lisa? and get their opinion as to whether they are willing to have a stay at -- yes, sir? >> president had a comment or question? >> on alternative 3, the d and p not exempt, so, i don't think that's a good trade off,

to not accept d and p. you are only getting $200 extra as a premier and that's where most of our people are. so you say the d and p is worth about $250-300 a year and a crown cost you $1500. since most of our people are in the premier i look at that one. you are getting $1500 for the ppo. but that's not a good alternative. i don't really think it's great. that's my assessment looking at this. >> i think it's a flat trade and where you are really beefing this particular alternative is for ppo and it has a certain amount amplified for people going to the performpo -- ppo and a flat trade on the premier, it's

equivalent maybe $50 on the premier but it's trying to push people towards the ppo. >> i understand it, but i don't like it. if you are going to a dentist that -- you are going to have problems later. steering people to the ppo is not my thing. i don't think it's a good idea. >> okay. i totally appreciate that. >> that's exactly what this is trying to do. >> yes. okay. we have clarified the intent of alternative three. with that being said, i would like to move on to recommendations. i think the recommendation is more of look at these three alternatives and from our perspective, just mine and jointly with hsf, we should explore alternative one and threaten. -- three. if i

have this correct, we need to survey the population and see what the preferences are. any comments at this point? >> are there comments? >> yes, i think what we've prepared as the last attachment to this agenda item is a sample survey and so what the board is in response to last meeting where we were -- it was recommended that we do survey the membership, it is important to make sure whatever we do is something that we'll have the most membership involved in this benefit. we don't want to have a benefit design that's a higher price and we lose 10 or 15 percent of our retirees who no longer can afford the benefit. i think the recommendation was we prepare a survey and send it out to all retirees and make sure that we are designing this benefit in a way that will work financially for them and meets their needs in terms of

the value equation that we are trying to solve for. so that is the recommendation now. thises drafted before we found out the rate was changed on the first one. but as commissioner lynn recommended we did change the percentage for what does that mean for me in terms of dollars. the last survey on question no. 1, it currently says $3.50 would you pay that, we have to up that to would you pay $5 a month in benefit. this has the three alternatives that he walked us through and we'll solicit people's input on that and then if you support all three of those being surveyed we'll get these out in the next couple weeks and we'll have that feedback and bring back to the board for your consideration in a month or

so. >> comments? >> my concern is about the survey, i think it's a good idea. many people might not even know they are on a ppo or another one. they think ppo is top of the line and think it's a good thing and not realize that they are in premier. i can see that happening. this will go to all retirees? >> yes, we were actually thinking of sending it to all retirees who have a dental benefit, and using it now and someone suggested that maybe we should send it out to all retirees because those that do not have a dental benefit they might be interested in reengaging. there is about 6,000 retirees that are not

engaging in the dental benefit now. >> i was concerned that we might lose members that can't afford an extra $5. plan three was another $70 a year for a single. >> it's a difficult choice because if we lose members, the premium is going up for all of us. >> i think commenting generally on this, we've had a sufficient level of public comment about the fact that i'm paying premiums, and not getting my basic coverage done and my dental issues are larger than that. so, we either are stuck staying with what we've got and continuing to hear that or considering something that is going to have some level of cost attached to it. there is no

free benefit here. i think that to a degree that we need to, i hope the survey will have a cover letter explaining what it is we are doing, why we are asking you to complete the survey, kind of characterizing a little bit of what the options are so people understand what we are doing here. i would strongly support that all retirees in that we are responsible for whether they are participants today or not be given an opportunity to give us in put on this. >> also in the letter to mention the difference between the three categories to make that very clear when they fill this out. >> yes. are there other questions or comments? is there public comment at this time? excuse me, protocol

demands that i should ask for a motion before i ask for public comment. >> that's true. >> please stand there because we'll get to that momentarily. do we have a motion to adopt a recommendation to retirees? >> i move we send the retiree survey. >> there is a motion and second. are there any questions by the board on the motion , if not, we now have public comment. >> thank you. i appreciate the information you gave me at the beginning of this process, warms my heart. i support the survey most assuredly and i'm glad that you are considering surveying all retirees because i they we might be able to

bring people back in the system and that's what we really want to do is enhance that, but i think we do have to define the three categories so people know which categories their dentist is in and what we find among retirees and among actives as well, people don't like changing dentist when they find a good dentist they trust and they hang onto them and dentist are more important than other doctors, sorry doctors in other categories that might have a relationship with their patients. but dentist, very intimate and they may hang onto their patients than physicians. i think we've all agreed that the preventative practices are

most assuredly signature with regard to maintaining physical health and dental oral health. at some point years ago, if you got cleaning for the year, you paid no further cleaning benefit. you just had to meet that cleaning in the first year and all that was covered 100 percent. that was many years ago. it was really wonderful and it had a good impact because everyone who worked for the unified school district made sure they got regular cleanings. it would seem to me that in alternative three that we might consider that same deal with alternative one. i don't understand why if you increase the benefit to $200 you are really not giving them anything. it's the same as no. 1 as alternative one by $1 as alternative one by

discounting the $200. seem to be we should be focused on prevention and keeping those preventative services not at all part of that total premium. we want to encourage our members to get those preventative services, but thank you. >> thank you. >> herbert weiner extractee. last year i had two molars removed. anyway, i have an e-mail from my dentist. i recently had my teeth cleaned and this is her opinion. i got it by e-mail. i hope to submit it to you hard copy. "to whom it may concern. it's important for herbert weiner to have three teeth cleanings a year due to periodontal problems.

herbert had to have three teeth removed and he has general bone loss. if the patient loses anymore teeth, it will affect his health" i'm submitting this into the record for documentation. i don't think i'm an exceptional case. i'm citing my case as an example. also you need to remember if you don't have this done, it may lead to root canal and more extractions. it's cost preventative to have this procedure. thank you.

>> other public comment? >> dennis krueger retired and inactive firefighters. i haven't had a lot of time to study this but i see the plan they are looking gives you your best bang for your buck as far as the value of what you can get out but it still doesn't account for the d and p. i would like to see that maybe factored into that particular plan. going 32 you this, the biggest bang for your buck of course is the $2500 with everything. if i cost it out right, it's paying by -- >> could you cite the reference? >> you are paying $1560 for two people for $5,000 worth

of dental coverage. you are getting the biggest bang for your buck. i know a lot of retirees cannot possibly afford this. what i would like to see is a tiered system where people have a choice of which dental plan they want to choose. i understand as people get in for 1 year and then get what they need done and then they get out. but the premium reflects what benefit they are receiving. if they pay the higher premium for 1 year they get that benefit. they go back down the next year, that's their choice and they get the premium reflecting what they are getting. i don't see it as a complete usage of the system on the users part. both people are receiving a benefit here. if you go back to the beginning where they talk about the usage and realize no you that only 19 percent of the people are using their

thousand dollars, that money is pure profit going back to somebody somewhere along the line or maybe it's used to offset the rest of the plan to other people. i don't profess to know all this. and what they figure. but i'm looking at what this usage is as compared to what people are paying for. so, again i would like to see possibly a tiered system so people have a choice and the three plans that you are looking at, no. 3 is by far the best, but the best bang for your buck is the highest plan. the last question, if you have more than employee plus two, does the rate stay the same or does it continue to go up? >> director? >> employee plus two or more is actually