a month away? >> september? >> i am sorry. september,... >> so we will be ready >> september? >> we will aim for the september. >> okay. >> and did you want to convey that to him? >> president? >> i think that we have done that. >> okay. >> i think that uhc, is yeah, yep. >> you are here. >> okay, thank you. >> and so the public comment, at this point. >> sure. >> with united healthcare and i am not a part of the audit team and we do have a specific audit team that works with aon and bring me in on the findings and so we did all go over the responses and i know that they are working on the reporting and things and i guess that my own thought will be that we have not met with the hsf and we have disagreed and provided them more feedback and we removed one error and so the results that you are seeing have not been finalized and we do that and we know what the true response is and what does have to be followed up and i don't know if that could be accomplished considering that we are in the middle of august

in time for a september board meeting and we could certainly keep in touch and look at those, but to your point, if there is no october meeting it will be move before the final, final will be done and it is just a timing matter. and you know, i can certainly, connect with our audit team and find out. >> that would be good. obviously, they are guide interested. >> absolutely agree. >> agree. >> thank you. >> any other public comment? >> all right, seeing none, this is not an action item and we are not approving at this point. >> why don't we take a i am sorry, under estimated, how long this will take, and i note that we have different times as everyone noticed that? and the problem is that the public can't see that. and so using this one, let us be back at 2:40.

>> next item please. >> item 7, approval of wellness plan, director dodd. >> the wellness report? >> so you have seen this before. and i know that stephanie worked with president frasier on her concerns on it. and so we want to bring it back to you for final approval and it has been presented in final draft form and the mayor's office and the department heads but it is not, we will put it out widely once it is finally approved by the health service board, are there any other questions for stephanie? >> i just would like to say

thank you very much for incorporating the comments that i suggested and i think that it makes it a stronger document, and it was already a strong document and with that i will move approval. >> second. >> any public comment? >> we will call the question, i am sorry. >> rebecca ryan from the municipal association, and i just want to take a moment to echo my colleague bob, and we are extremely excited about the launch of the wellness program, and we are committed to working towards sustain able funding, and long term metric driven, analysis, and ultimately our goal, of course, is to link, wellness to healthcare costs. we leave that it is righteous

and morally correct to care about people's health and the people that we represent, but we also believe that healthier people, should have an impact on the cost of their healthcare. and so, we see this as completely aligned with the work that we have done and. again to speak on another topic, but a related topic and i too want to express my appreciation for the tremendous effort that it took to insure that the rates were not only were stabilized but actually reduced, and that is unprecedented in my, almost, eight years here and in my over 30 years in work in the labor movement, and the rates, simply do not go down, in my experience. so i think that people don't understand the incredible accomplishment that represents and i hope that we will continue that work, continue the work on accountability, and

transparency, which i also believe is integral to managing healthcare costs and i hope that you will know that the municipal executive association and all of the labor groups in the city are your allies in this regard. and on this initiative. and we stand ready to help in whatever way that we can. >> thank you so much. >> thank you for the comments and recognizing the staff as well and the commissioner who participated in that process. >> now, any other public comment? >> all right, we will call the question. all of those in favor? >> signify by saying aye. >> aye. >> all of those opposed? thank you. >> next item? >> item 8, action item, approval of the health service system membership rules, updates lisa ghotbi. good afternoon, chief operating officers, we just have a few

rule changes proposed for the 2015 plan year, we are anticipating a few others, but those were related to the care act that actually were delayed and so they will be seen by the board next year for 16. and the first one that we will be talking about is regarding the healthcare fsa, care are forward and you may remember in january of this year, we amended the 14 plan year, rules, to incorporate the new provision announced by the irs to allow for the carry forward of up to $500 on the healthcare, and since that time, we have had more clarification on what was allowed in terms of managing that carry forward and so these changes incorporate, some changes to the 500 and i wanted to just point to page 14 and just kind of review those, and so, what it allows us to do then is to say that carry forward balance of between, of

a minimum of $10 and a maximum of $500. and we had carry forward balances of two cents, you know, it costs more to administer monthly than it was benefiting, and so, we would like to put in place a minimum and the carry forward is for one year and so the member has one additional member to use that $500 after which it will be forfeited and we believe that this is the best marriage of the benefits to the member with the administrative issues that this represents. so, if you have any questions on that? >> you do not say if it is less than $10, because the members will be asking, that i have $9 in there and you are saying, that it is forfeited. >> and so, it is no language in

there, that says that... >> and we do have that language, and so what you are saying is that we say after a year it is forfeited but we don't talk about the fact that there is forfeit turf unused funds at the end of the year on fsa and i think that it was about the balance of the rules and not describing the plan design and so we do have that language in the cafeteria document and in the other documents about the fsa benefit, but the rules, language and what we have an appeal, we often refer to the rules, and to administer that and if we need to put that in we can, but usually we take the plan benefit information and put it in either the cafeteria plan or the other document and so the benefit guide, for example has an extensive amount of information on the part of the fsa benefit. >> so it is really up to the board if you want to add it to

the rules we can, but there is that balance, of benefit design, detail in the rules, verses elsewhere. >> so i think that the commissioner lim what you are saying is that someone or a member were to read this, they would wonder what happens to the $10? >> yeah. >> because, i mean, you might put it in some other, i mean communications, but it is back to it and it does not say that. >> on page 15, is that where you are reading? >> yeah. >> so, when it says, for one plan year after which any remaining care of funds will be forfeited. >> that is after it is carried forward. that is when after one year, and i mean, that it is over for the over funds will be forfeited. but not for the one that is... so... >> not the existing. >> not for the existing one.

but... for example, you say for the 2014, i have $9.95 in there. and it is not going to be carried forward. and the members say that okay, could you give it back to me? it does not say that it is forfeited in here. so... >> right, so, we do have a whole section in our cafeteria plan, document which is on, you know, starts on bfour, and the cafeteria plan that talks about the forfeit turf the unused balances and they use it or lose it rule, it depends, and we, you know, we don't have it in the rules, we have not traditionally talked about the forfeit tur in the rules and we could add that and bring it back to the board if we feel that it needs to be there and when we do the appeals we go to the rules and if we need a further plan, we will often pull the eoc language into the

appeal document, or the benefit guide or the other resources that we used to help to explain the benefit to members. >> and may i make a suggestion, and commissioner lim that perhaps, might meet your understandable point. what i believe that i am hearing, is that looking actually cafeteria document that we do have under tab nine. >> okay. >> on page, 4, there is a great deal of detail related to the carry over, perhaps, we could just insert a short line which i am sure that our council will write for us very quickly, maybe. and it just says, that the almost a par ren sis anything under $4 will be forfeited. >> you can make the motion now. >> i want to be sure that meets your needs s that okay if it is in this other document. >> o. that i think is what we wail plan to do, and let's move it

once we can make a quick par ren ses to insert on page, b4 on the cafeteria plan under tab nine. >> yes. so, i am just, i am comfortable making a motion without changing a document that is not before us right now. so i will go ahead and make that motion for the cafeteria plan. >> i want to be sure that for commissioner lim you are okay with that as a strategy. >> fine. >> okay, good. >> any other questions on this first item. we have four more to go. so the second one is described on page, 24, and that is an attempt to clarify the dual restriction coverage for the medicare advantage and the medicare sponsored plans and so since the product was adopted right hand the uac plan, all of our plans that we offer, for

medicare eligible retirees, now, are a medicare sponsored or a medicare mapd project. and so, dual coverage for a member is a problem. and it will result in termination if they join in aoe medicare sponsored plan. it will result in termination of their benefits at hsf and it is very difficult and often takes us a couple of months to sort that out, when it happens. so we wanted to make sure that we are being clear here in the rules and also in the benefit guide where we have added additional rules to this effect. >> any questions on this one? >> great. next one? >> the third change is on page 35, and it is just a couple of words, but it has a big meaning and it has to do with the timing of premium requirements. premium contributions are due as of plan year 2015, the proposal is by the last day of the effective coverage period.

so, we are or we will no longer be requiring payment in advance of the coverage period. any questions? >> any questions? >> no. >> all right. >> okay. >> and the last major change is on page 41. and this is to review our appeals language, and make sure that we are clear about the process for appeals when it comes to the hss determination of the credited service and qualification for the retiree health benefits and subsidy. and so, there is a new process that is put in place, that is clear that obviously you are not going to go through the health plan first and that appeal will come to the health service system and there was, also, some report helped us with just a clarification on that language and hopefully you will see that in front of you. >> i want to be sure that all commissioners got the updated >> yes. good. >> i want to mention that the updated does not have the back side and so you want to keep

your other page. >> good point. >> the other page that is in there that was about to throw. >> yes. >> my afollowgies. >> but this was just a new language on this section. >> so it is there any questions, i think that should work, further process needs to be put in place, we will bring that back to the board, but this we think should be sufficient. >> all right. >> any other questions? for lisk. a or comments? >> no. entertain a motion? >> i move to adopt. >> and okay. >> sleep... >> i move the adoption of item 8 as presented. and discussed. >> so is there a second? >> a second. >> all right. >> any public comment on this item? >> no? >> my name is diane and i have

a question about the dual coverage, i have had double coverage because many years ago when my husband was working there was a possibility that he would transferred out of california and so he put me on his medical plan too and so i have double coverage and i don't want to lose the health services system what do i have to do. >> because we want to protect your privacy that you talk to the staff and we don't want to make you discuss this in front of the public on tv. >> but thank you for raising that question. >> any other public comment? >> all right. >> seeing none, we will call a question, all of those in favor? signify by aye. >> aye. >> any opposition? >> great, thank you very much. >> next item? >> item 9, action item, approval of section 125 cafeteria plan updates, lisa ghotbi. >> so, the changes for the

cafeteria plan document are in some way consistent with the changes to the rules, the first one being on page b4, and discussing the update to the fsa healthcare and the fsa carry forward. and so i think that that one, does go because it has that entire section on the forfeit turf the unused balances and i think that it does cover that issue from the rules, and in more detail, but just wanted to see if there were any questions? >> so i would like to make a motion to amend this to make it clear that the minimum of $10 means anything under $10 is forfeited. and if you happen to have language, eric? >> if you don't that is fine. >> the language, and that actually sounds good what you are saying. >> i second the motion. >> all right. >> and we will not vote on that separately, but we will call that and add that when we look at the time item in its

entirety, any other questions on this one? >> good. >> all right. next one. >> the next one is on page d3 and this is where we have listed the flex credit values, for the different groups that have flex credit as part of their benefits and so the changes for 2015, are listed and you will see that the changes this year, for the city and county, are slightly different than we have had in the past and then that there is a different amount of flex credit depending on and for the family coverage depending on the health plan that you select. and so this is a different application, of the flex credit benefits and i wanted to make sure that you are aware of that and approving it. >> any questions on this one? >> all right. and the last one is just updating, right? >> right. >> the last change is just to update the groups on the etna plan. so with that. >> any other questions from

commissioners? >> all right, so you have moved this in its entirety. >> yes, i move the adoption of item nine, with the appropriate amendment regarding the less than the $10 amount that it be adopted. >> second. >> any public comment on this item? >> seeing none we will call the question, all of those if favor, aye. >> opposition? any abstaining? >> great, wonderful, thank you. >> and i just wanted to say lisa by the way the summary is very helpful and i appreciate that. >> all right, next item. >> item ten, discussion item, report on the vendors on after hours care. hss vendors. >> yes, so i think that the

correction, while we have been fine. >> that is okay. >> and to explain to those on television or anyone else in listening, you have a powerpoint, which we have and which i believe that people attending also have a copy of? >> yes, i can get a copy of, it is just not going to up on the screen. >> heather with united healthcare and thanks for having us today and so i have some information on urgent care resources for the united healthcare members and how they can best ease to reach and yous multiple options for people to use. and so to the second page and we are talking about the tools that are available. and so number one our website for people who are using that, the my, uhc.com and i will go through that and we have a couple of apps for the smart phone users and a lot of people like to use tho and hope for me and doc gps and the people who

want to know that they can call the customer service center, and those customer service representatives will help them and then lastly just so that the people that do have the tools and helping the people decide if it is an urgent care issue and an emergency issue and after care and then those are materials that can be placed on the member website so that they have additional tools. and first of all, the my uhc.com, and so the folks can search for the physicians or facility and this works for the urgent care as well as doctors and the important thing for the members is that they know, what network they choose, because that will drive the results that they get. so first it says, choose the network for the city and county which is our choice first network and the on the right side, it is hard to see and they will type in what the network is and search what they are looking for and there is also the quick links and of course, the urgent care center ss one of those links and they can search for that center. >> what network with you talking about? >> all united healthcare

members, have choice plus network, and so when you go to my uhc.com and you are attempting to do a search it is going to ask you what network because we have networks by different names. >> we wanted to put that there because that is an important tool as you always will look under the choice plus network. >> how would they know that? >> well, you know, that is something to think about is that the member, i mean, certainly if you call or use the apps you are going to have that, but on the my uhc dot web site, let's take a peek. >> if there is a member id card on here. >> it is not. >> it is not on the member id card. >> it is in the member guide. >> it is in your member guide? >> and so, on the member guide, they are aware of that. >> yeah. >> but the issue that came to us that triggered this report, was a gentleman, and i forget where he lives and i was been out of the city and but the retiree, and he basically did call the number and then, it

went sideways and that is why you are here today. >> so they don't know what network. >> if the threshold question is that before you call in to find out what urgent care center is, you got to know what network you are in. that is a fundamental piece of information that needs to be just as clear, as where you are putting the telephone number. >> yeah. >> otherwise people are going to say, i am signed up for, >> united healthcare. >> and keep saying that. >> and over and over >> right, if the customer service person is helping them correctly and the member has their id card and give them the card and name, they will know that they are on the choice plus network because they are going to see it that is the one way that the customer service as soon as they look them up and identify them as an employee they will know the network and be able to help them. >> that seems to be the missing element >> yeah. >> the card. >> it is on the card. thank you. >> the bottom right-hand corner. >> i have not looked at that.

>> united healthcare choice plus. >> yeah that is all that they need to say is choice plus. and so, that is the piece, but they are not going to know, you are right, it is on there. >> but i see this here, and i am going to say that is like blue advantage. >> yeah. >> it is a line there, and it does not tell me that this is the key word, to cause you to get into our system. >> yeah. so we need to at least, you know, try to highlight that somehow, in the member guide, or something, that you need to know that we here in san francisco are in this network. >> yeah. >> any time that you are facing with the customer service. >> because that looks like it is the title of what united healthcare is verses, that tells me what network that i am in. >> right. >> maybe we can put it? the, when you send the confirm nation back. >> and in the enrollment. >> and the instructions to members. >> why don't we ask you to think about a way and there are ways that it can be the city

health plan-what is it call again? >> choice plus network or something like that. we will leave it to your discretion. >> okay. >> and it is good timing because we are signing off on all of these guides and member tools and make sure that is on there and i can see how that will be the hard part. >> if you contact them and a urgent care center, you want to know if they are in the choice plan network. >> yes, basically, if you are searching by the correct network, the only things that are going to show up are in the network facility to go to and like he said that is the key piece. >> if you make that phone call. >> urgent care center. >> yeah, and so that is really how this works so if you are looking for an urgent care center you go on next and you can put in a zip code range and a that i want to know 50 or 100 miles, what are my options and actually what comes up is that a pdf directory that you can print real time and that is a nice tool once they found that and if they want to they can printout that information and the other thing that you can do once you have found that care

center and picked it is that you can map the directions so that it will work like a map quest it will give you the directions to get to that location. >> the printout, is that where you got it from the site? >> yes. >> yes. right from my uhp.com and you search you can printout the directory and in your zip code range. >> so you can call or you can go to the computer. >> absolutely. >> and we have a lot of like i said, elderly people, right. >> and plan. >> and they want to use the website, you are right. they can call the customer service and if they look up them and so we will make sure that that tool is available. >> and i noticed that i did a little checking on these places over here. and some of them opened 7:00 to 7:00. and one on, and they are, and closed on sunday, and i mean, if they are going to be urgent care it seems to me that these places should be opened differents hours than this. >> i think that you going to

find out that they will be open and that is where some of the tools of what kind of care do i need can come into play because it is after hours or on a sunday, then you have to make a determination if it can wait for a regular hours or needs to be addressed at emergency. and we try to avoid the emergency, when it is appropriate, we want folks there. but we do want people to use the urgent care centers. s and so, yeah, that is the one option, if it is, and every carrier is that way, if it is not urgent, they have to choose, whether to use the emergency, and there are other tools and things like the nurse line can help to determine, if it is necessary, to go to er. and those resources are also on my uhc.com. because they can actually talk for a nurse, 24/7 and tell them what the symptoms are. >> and then, in another one, the pediatric medical, that is not a urgent care center. >> this just a sample, this was for the urgent care. >> i want specifically urgent care on here. >> yeah.

>> i am not interested in the emergency room. >> right. >> okay. >> so these two are not, urgent cares? >> i don't know, is uc on here? >> this is just a sample that we pulled. and this is just a sample. >> well,... >> this goes, all the way as i can see to wvw, san francisco as only a few. but, and what i can tell, that it and when they call, and i personally called, the number. >> okay. >> so that i gave her and she wanted my zip code and i gave it to her and the closest that she could find was south, san francisco. and that and i gave her another zip code and the closest one to that was berkeley and i gave her another zip code and the closest was south san francisco. and so, that is not really working well at all as far as a call in. if they can't find, you know, the person on the phone does not know where to find these

places and you call in and it is not working. >> right. >> i know that south san francisco is not the closest place, can you tell me if the university of california is part of that, their emergency room? >> not without doing the search i couldn't tell you without that. >> how would i know that? >> stow, by using, if you used the... and so you called and gave them. >> and they didn't have it. >> right. >> but she did not have any. >> if we did the zip code search by urgent care, i could tell you, but i have not done the specific search to know if that is in network. >> how are people going to find this stuff? if i had all of this problem, you can sure that someone else was. i thought that we are trying to save money from the people going to the emergency rooms that is the objective here. >> right. >> and the people would rather go to a closure intelligent care place than sit in afacility. >> and the one at usc has been there for a long time but it does not show up and then, i know that there is another one, over and the golden gate urgent

care. and they are also, and the hours were better there too and they are actually opened saturday and sunday. >> but, i would like to know, and be able to find out, since the person on the phone did not know anything about this, as far as anything that was in san francisco. >> may i suggest that you provide to us a list of all urgent care facilities that you know are urgent care facilitis in san francisco? >> right. >> yeah. >> and we would like to see that. >> yeah, and i will take a look because i know that we pulled a sample here and so i don't know, and she did 100 miles from 94103 as the attachment. >> that is what i am suggesting for the future meeting. >> i think that the issue which will be and i know the answers, and i looked ahead on the test. the issue is that, we have been trying, for example, to put together our member guide, and the vendor services staff called over and over again and said wis