prerisk progressions and family coverage on page 3 we include more nuances of those concepts so you you know a high-level is every dollars above 11 thousand for a single you're going to have to pay x kiss taxes the thresholds are to the price index this is a proton we know that medical trend is traditionally much higher so that in and of itself is representing there's taxes over time that's important for the board to be aware of as i mentioned the increased threshold for high-risk occupations and premeditatedly retirees so the previous slides we said health care premiums and the coverage is much more broad so currently or current the law

suggests that the tax includes medical both fully insured and self-it you funded vision and dental and also contributions to medical that spending accounts be as much as medical care and flexibility e flexible spending accounts the board should note in our initial analysis we didn't clubbed that but have the information in the appendix at this time we've not included did p p 0 for dental with the summaries that the board will consider changing the funding mechanism of the dental p po at the time of implementation as written would suggest that the board change the funding most povrl at this time

regulations have not been promulgated for the implementation of taxes what was written in the actual law when was was passed we've not seen more guidance there are questions about the provisions written in the law but unfortunately, we have not had any further guidance so one important regulation that we do use in our analysis is that the law mentions you can blend similar medi-cal and medicare retirees as i mentioned above premedi-cal retirees have a larger threshold and medical retirees have a lower premiums because of the medi-cal primary we go through the blending with the in our analysis but actual details around that have not been released so we'll keep the board update.

>> on this point if an pillar has a practice of health care coverage that included prerefrment retirees and retirees as they've built their plan is there a regulation or the law talk about how this impacts going forward you're doing this analysis on an assumption that people haven't blended those populations together some you employers have done that with the pricing. >> it's also i should clarify when we say blending we mean for the purpose of the x kiss tax calculation not necessarily a - for the purpose of an "x" kiss take liability what's the stent the law will allow you to combine the retirees premiums

for the same plan. >> i'm suggesting that some employers have in their gotten maybe a blended rate for the retirees and medi-cal retirees that's what we issue year in and out we're saying we're doing something different because of the regulation i'm wondering in the tax takes that effect take into account and right now you don't know. >> not that i'm aware of. >> on page 4 h are sf requires that hewitt use the tool kit to access the essential x kiss tax for the mandated excise tax and what should be looked the again we look at without blending and with the good faith interpretation of the blending we've trending the current 2015

premiums bans the internal guidance and perpetrate the results by vendor as well as the employment status for the actual medi-cal retirees the board should note the - we've not made decisions, however we expect and then increase for the enforcement that the plan will taper off on page 5 we present our initial results without blending so in the first column we show the vendor the blue shield of california active premedi-cal's retirees enrollment as well as the estimated x kissing sister tax for 2019 and 2018 and this is

for employee plus one and two tiers the board not that it is $13.1 million and n in 87 percent it coming from preresidencies this is a result of retirees vice chair a manipulative higher premiums you'll notice that the thresholds were not increased that significantlyly. >> i'll point out this is where increasing the age of ignite is didn't even for the city and county. >> those are projected in 2018 for all 3 plans to cross the

threshold. >> the remaining 13 percent of the remaining excise tax in 2018 is a result of the city plan activities and i've mentioned we expect combrormentd to increase asterisks decrease. >> on page 6 we present our results with a good faith interpretation of the blending that we previously discussed so again, this is for the purpose of the "x" sister we're not adjusting for the contribution from here you'll notice in 2018 the excise tax assessments has been reduced from about 8 percent you'll notice the

premedi-cal retirees for the city plan and kaiser permanente plan have been eliminated and the premedi-cal retiree for please line up on the screen side of the room has been greatly reduced and created a liability for the population they have the same presumes 64 percent of the remaining excise tax from the remaining group we expect e except this to decrease but the city may reduce this because of the it low population page 7 we conclude that bans our initial estimates the 2018 it is roughly $18.3 million for the kaiser permanente plan the excise tax roughly $7 million

from retirees this can be eliminated through the blending and the blue shield california plan incur money this will will be greatly reduced by under one million dollars by blending and the uc city plan $3.1 million in 2018 with one .6 from activities we expect it to greatly reduce the enrollments on the activities as well as blending for the preretiree assessment or the premedi-cal assessment and ann hewitt will work to identify the tax reduction as well as the prelims taxes issued dobd please. i'm actually looking at i should

have looked at this i'm looking at the premedi-cal retirees and it is showing zero, zero zero across yet the statement says it is one .6 i mean one .4 for premedi-cal retirees and that's from our base assessment our initial analysis on page 5 is 4.11 and . >> blending. >> blending so we walk through the initial and blending. >> and then i think it's important to draw your attention to the sf a. >> right so in the appendix we have. >> what page and sorry appendix page 89 so essentially

telegraphs have the ability to contribute money to their sf a will be for the active population so what we the we looksd the percentage of employees that utility lists the sf a and we've created a feeling of the impact because we've given them the maximum election of $2,500 so this is not based on the actual amount it is the maximum impact if everyone contributed $5,500 to based on this information it increases the cost of actually care that results in a tax assessment of an additional 6 hundred and 70 thousands in 2018

and should the law be implemented as written the board may consider removing health care as a way to reduce costs as a step if necessary is there any questions. >> commissioner lim and i have a question on page 11. >> on the second line the seal of california for the retirees 65 single estimated premium and one hundred and 6 currently our premium is lower than the city plan and if you're looking at 2018 and the city plan is only 18 thousand how could that be 61

thousand that high if you're looking at that i think our preretirement is blend for our premium rates and then the active is only 4 hundred thousand plus how could it be almost do you believe that 21 thousand that's the highest premium so for higher than kaiser and higher than - >> what page and package 11. >> oh, i thought you said 7. >> on the second line how did you arrive at that premium. >> the single premium. >> looking at that $7 million 8 hundred and 94 that's 40 percent

and one hundred is dwifrtd by the members of the 2 thousand that 7 thousand more that's the penalty we'll be paying for that's itself basis that the plan may not be right. >> well we'll do i believe check that number for you and the concern this number is too high it's reflecting and higher than excise tax. >> but the real question commissioner lim is the methodology i assume there's signages here you need to walk us through yourself looking at what premiums might be 3 years from now you're assuming some rate of medi-cal inflation e.r. whatever to get to the starting point and the tax penalty so it

will will be helpful to explain the methodology if this is the right number that's fine. >> what person - you see a basic year to year in 2008 and with what the real rate and we actually ann provided us a trend rate we didn't publish that we didn't want to say to the vendor we're going increasing our rates they can do the rates and back out by that's the only reason the trend rate is not in our booklet. >> that's fair but how they did the california lose and we start with the 2015 premiums for the family we blend based on enrollment we have to combine

the employee pier one and two those are interpreted by the trend rates set that i myself and my colleague projected them to 2018 we did use separate rates for the different plans based on our prospective outcome as well as past experience and so simply taking the 2015 premiums and turn them 2018 and compare them to the threshold and multiple by combroorment that's the general methodology. >> thank you other questions from the board on this particular topic? >> 2018 seems to be a vastly distant time to us it's a vastly different time we sit here today

and say 2018 it will be upon us rapidly and people are saying we consider the election that will take care of it all that's a foolish position to be in i'm pleased to see we're spending time to get an advanced understanding and important popular the regulations are not complete so the degree we have through our coalition partners and other founders what understand and bring to bear some clarity about what the regulations are going to although they could be issued any day i hope we can find partnerships to try to get clarity rather than assuming well, you know the election is going to take care of it or the repeal or congress some other

wish list of disasters or probabilities thank you for your work. >> just a comment the excise tax is the final nail to get employers to drop health care under the affordable health care act why wouldn't most employers do that it appears that would be moved. >> the penalty on the other side. >> how much. >> some people have done the calculation already the thresholds is not offering health care and the city is a philosophyly it's an issue that has to be regarded moving forward. >> secretary. >> is there any other public

comment on this item secretary oh there is public comment. >> just real quick dense active retired firefighters i hope that affordable housing iron hewitt has more tools in their tool chest than reducing benefits and reducing co-pays if that's the only solutions available than a lot of peep in this country need to get together and do something to stop this from going forward that's all this happens is benefits get reduced and co-pays go up so 30's this is one more pressure point to continue to reduce health care in this country that's sad i hope there are a few more tools in

affordable housing voluntariness tool kit that can possibly come up with other solutions. >> easement defending or - its mother avon hewitt this is driving the boat but the law talking about taxing or collaborations the cadillac plan so it is what they've done at our request and thank tell me fully to conduct an analysis what might this potentially look like based on what's described in the law that's our request of them they came back as a result of the analysts and said here's areas of high cost if you understand the calculations and signages it go along with it, it's a walk up call to try to partner with others to get clarity about the law and more

importantly the regulations that are going to follow up that's my take away so they've done what we've asked them to do it's not a pretty picture understanding the law as we see it today dobd. >> i think the relevance of those numbers to the earlier blue shield presentation needs to be underscored when we trend it out the blue shield costs we were looking at our trends has been since the implement of the aco and blue shield has been unable to negotiate those rates with sutter to the blue shield numbers could be grossly expand if he were to allow whatever the market would bear so in terms of explaining to employees and retirees the importance of keeping our hospital developments down have approved

complications in 2018 in taxes and i think hence blild action now in 2015 is it would be too late if they did it in 2017 for 2018 so our actions the board of supervisors actions the whole idea of anti explosive rate setting of keeping rates down is really going to hit us if they're national successful in norwalk the same kind of rate trend we've had in the past few years. >> thank you other comments pr any public comment on this item? if not we've proceeded to the next item other public comment i should

say please. >> item 18 opportunity to place items on future agenda autopsy do i have any. >> we have the closed session we deferred from today and is there anything else. >> and there's others. >> we have item before 17 he did it before blue shield. >> we're going to cocky absolutely will come back to that. >> item 7 report on health issues if any. >> i'm sorry yes. i understand thank you very much. >> hi kate area vice president for strategic kaiser permanente i said to alert the board we have a strict notice that's been given to us from the national

union of health care workers and will be the strict notice is for this coming monday to kennedy end on the 19th we have about seven hundred of our optical workers as well that have issued notices they've be striking along with them as support. >> the optical center and not the physicians. >> i'm talking about the service center where you go get your glasses. >> yes. yes. >> i better hurry up this afternoon and get it done. >> we've put a contingency in place we're going determining whether to close some centers before you we have a plan in place we expect routine

appointments that need to be reschedule but our mental heath services is aware we'll be working with dobd to make sure she understands what's happening. >> you've gone a strike notice is there further negotiation going on. >> further negotiation all the time. >> do you know if we have scheduled meetings right now? >> all right. thank you. >> so we'll let you know if that happens on monday and any further communication. >> thank you are there any other vendor partners that they wish to bring to our attention. >> there are things that are not responded out on the

negotiations they're getting closer though. >> yes. >> vendor or partner united health care please come forward. >> i'm jackie representing united health care on behalf of jennifer couldn't be here they told me our final response to our urge care issues forbids the last couple of months we were having naturals to helping our members to quickly find urge care facilities no matter where they are we'll be mailing outpost cards to them the first graft draft of a

postcard we'll be mailing we have already went the proof went objective to kathy republican dodd they're making corrections on 8s postcard before mailing out those postcards though we'll have the approval of katherine and on the postcards just to outline what is going to see or is to the members it's going to tell you the highlight how to use customer care the vendor line instead of pressing the promotes i know that's annoying they're getting to the wrong places and not getting the correct answers when you call our customer service center just say representative instead of project one or two and the

postcards will let you know also a twenty-four hour nurse line to call those nursing should be able to tlifrm what urge care is near their home or work place and if they need to go to the urgent health care or go to the e.r. or maybe the nurse can give them advice before and also the use of m i use.org we're going to mail it that to all the members of the city of san francisco the members that are with united health care, of course and that should help out we're looking forward to working with katherine dodd that's our

segue. >> at the i'd like to do a test around the cards before i show it to everybody. >> okay any other vendor partner comment? observations considerations explanations no secretary >> item 8 discussion opportunity for the public to comment on items within the board's jurisdiction. >> any public school public comment ma'am, secretary. >> item 20. >> oh, that's it. >> by my lights we've covered the agenda in a raeblg reasonable there were notes whether we have to bring our

diner by no other business to be entertained before this board at this meeting i hereby declare us adjourned test. >> call the meeting to order. >> commissioner president katz commissioner adams commissioner brandon commissioner murphy commissioner ho item 2 approval of for the december 16th meeting all in favor, say i. opposed? minors