supplement you have a couple of weeks of vendors coming in and being in bone krefrn program from 8 to 5 for two weeks we can splult that with strategy open enrollment meetings for retirees to come and ask questions and later than learn about the option we'll fund the materials we'll send out information on tips for educating our decrease as well as using out of network physicians it was mentioned one of the things we do to help prevent drufks so reach out to all current providers that have submitted claims to the members and let them know they have members e members on a p po plan

so insure there's no type of when the member goes to see their decrease they're aware of the change i mentioned we're implementing an enhances service model i want to highlight is couple of things how we help retirees to enroll after the effective dates the next couple slides talk about the call centers all of the the call centers or centers a staffed with representatives that focus on medicare populations they've all been trained with cultural training to know about the benefits for the city and county of san francisco as well as your culture here and we basically provide them with all the information they need to they can best insist the future

members have a hyatt high rates of satisfaction from members members two and retiree that call into the preare enrollment center and the post enrollment center we have seasoned representatives that really kind of speak to the level of services we're able to provide the retirees are there any questions open the retiree experience for the materials or other information. >> altitude centers their opened monday to friday 8:00 a.m. to 8:00 p.m. >> correct. >> preenrollment their opened 365 days a year 78 a.m. to 8:00 p.m. >> that's in terms of 6 we see a lot of retirees calling in before effective dates we want to make sure we get the

questions answered. >> just clarification this is an option plan that will be offended we're not asking all the retirees that's an option the retirees can go during open enrollment they have the option to stay where they are. >> katherine i think the intent to present next month the traditional city plan this united health care product that is also p po as well as blue shield and kaiser i mean so it's not you could vote to replace it or vote to leave both of them if we were to replace the medicare we need the plan to deal where

our retirees there's no intent to eliminate city plan that's an important message to send to activities and retirees. >> i understand that is something you'll consider at you're next board meetings the saved opportunity and this gadsby reduction opportunity i think we've profiled it more than $25 per member per month from a savings stand up that's before taking out the administrative savings you'll chief by moving them off the city plan closer to $50 per monthly savings you'll have to evaluate that when were you have all the details in front of you i'll be happy to answer any questions but thank you for all the great questions and your

time. >> i have a few questions this is a medicare assignment plan medicare will be assigned to you. >> so we take a premium from medicare. >> right. >> and provide the comprehensive plan. >> so, now you'll set the fee for the providers not medicare. >> so for our contracted network that's always a negotiation between the planner and the provider but because we accept any will provider to see our members we never touch that rate so i think the data is 68 percent of the members are seeing contract provider in our network and 32 percent of the providers receive the medicare rate we don't touch and accept the plan. >> they'll receive it how. >> directly from us they'll send the bill we'll pay them

more written than they'll get the 0 payment from the government. >> you'll reimburse that member. >> so in less than one percent of the time the member gets the bill what we're able to do is convince the provider to send the bill directly to us the retiree is left directly. >> and you pay the providers the medicare fee. >> that's correct. >> we pay the medicare. >> that's the hang up in the other lands plans. >> that's correct in the other plans there's no out of network coverage you can only go to a left to right hmo or p po in our platoon you can go to a contract

provider or any willing provider. >> when i saw this i thought it was a sales presentation to me i was surprised but i always wondered why we're doing this because your actuary was giving us a glowing report on how great we're doing that so i couldn't see why to change the plan. >> i wouldn't speak in the place of actuallyy but the savings will be substantial for you. >> can i answer that commissioner breslin. >> when app recommended we switch to the a plus funding that was presented in a similar manner to the board here's an option here's what it will do in

fact i think we had two meetings before we decided to make the switch but maintained our coordination benefits plan for medicare advantage and the co fornix the retirement population so when this was presented to us but as an alternative funding for an actualy equality and service wise equality p po with the exception of the members that would get - it seemed appropriate to bring since it's a a product that's a p po virtually no disruption for the members that's the part i really question when we get down to the

wire. >> if you go to the provider and he says i don't want to deal with the insurance companies there's what you are when the where the rubber meets the road. >> again u h c has said their curling that there's virtually no disruption and again, that's an option for the members if we want to stick with paying the $250 deduct and 15 percent of what we didn't pay after medicare pays which is a claim process you've heard before if they want to stake with the paperwork and they stay in the plan but if they want to keep their decrease and eliminate the $250 deducted and pay the co-pay then this is an option so i felt

i believe it was my responsibility to bring it to the board as a funding option as well as an option that will save money own to the trust and to the employer given. >> the employee. >> and the employee once again how is this going to effect the non medicare. >> it will not and because the non medicare's premium is blended with the medicare people is that going to change. >> no our actuary already - i want to let he knows we reviewed this was the chair commissioner scott went through this on a conference call i reviewed it

with him before the meeting so you know we're not just springing it but bringing up as an alternative to health care. >> we went through the issue now this is another pharmacy changed again which snapshot changes. >> i will say the 900 and 5 members you'll see that same change c.m.s. wants the high-risk medications removed from the plans and want it from any local hmo or p p plan you might offer that's the big hand of government but i said before we get our medical and pharmacy teams to look at the the alternative therapies and do that well in advance we'll be

doing the outreach before they make the switch and we'll be outreaching in a december timeframe not to have an event that happened on january 1st. >> the two cards issue is not an issue because the pharmacy they only ask firing id that is not a problem that the members are used to it what are the larger employees who has this. >> calpers. >> not the mp o but one of the vendors let's see we cover the state of illinois and north carolina the state of georgia and mexican-american and hawaii metro life and involving and on the; right? so sacramento municipal utilizes so we have

here in california and other public sector bodies we have the most established track record of success and we've got a long references list if you want to visit and understand. >> just like the counties of california and there are other county in california. >> the county of sacramento. >> uh-huh. >> let me see here so what about the hearing aid coverage how will that work. >> it is a group participating group benefit they will have 3 levels of hearing aid one in the area and one behind the area and one that hangs on a hook i'm not wearing mine i've got behind the

area it is the most predictability hearing aids are expensive i'm sure you're aware of so the example i know best is that i'm able to get a hidden area state of the art 12 band blue tooth to any cell phone for $629 hearing aid if i bought on the open market would cost double the price so this is when we sat down with kaiser we've covered their thirty thousand members and kaiser said to the buy a stand alone rider. >> we would probably have to do that our hearing aid program is more generous so we'll have to buy a stand alone rider. >> we'll be happen happy to do

that. >> our current hearing aid benefit is 85 percent covered after the deduct $250 one aid per 6 months we'll have to come up with a writer that matches that. >> it's a $500 credit every 6 months towards the pretty much so it would be - >> it will be figured out. >> your reporter. >> one of the main concerns we have people in blue shield they have special problems and had to go to special decreases outside of bluldz network they went over to plan one and able to see other decreases in clinics and so on and so forth how would that work you're saying you'll have those clinics in the

network already. >> not network would be either contract or if they accept medicare there's no diego dictation of providers. >> we have a specialist care this was my concern. >> i know you're raising your hand easily. >> you can come over. >> the question was how do we rate the activities and early reporters for the city plan and bring their experience together but the retirees are rated sparingly. >> the medicare retirees. >> so to clarify nothing happens to that pool that will not create a big mess in the other pool with a bad rate problem.

>> you're basically saying katherine i can take that plan or stay in that plan. >> that's up to you. >> so i have a question to you how will this impact networks months health when you present the new rate. >> this rate versus where we are. >> as with persuasive that as an action item so you'll be rep both rates. >> a comparison it's my job you're actuallyy to bring you the cost analysis and you make your decision on all the factors. >> and the members will have an option of open enrollment which plan. >> if you choose that to be the case absolutely. >> if. >> direct your attention to replace the whole thing you have that option we only want to add

a program that eventually will be a premium situation for everything that remains to be seen. >> okay. >> we wouldn't do anything to pit no one in a bad plight. >> ? a discussion item. >> oh it was an action item. >> it's a possible option item. >> whether or not you want to direct me to have neil prepared it at the next meeting. >> okay. >> okay. thank you very much. >> thank you so shall we take that as an action item we'll direct the director to have it at the next meeting? with that said >> i second that. >> -

>> would i have a motion. >> i'll second. >> no, i'm offering it for a motion. >> i'll make the motion it come back and be presented. >> i'll second that. >> any public comment? >> dennis kruger actively and restored firefighters thank you karen for asking the question about the premedicare employees and second of all to the statement of the largest administer in the country to see they only utility right to work states for their call centers helps me to understand why this country is on a down ward cycle and it is very sad.

>> thank you. i just took my scarf of my union label on my shirt i second what dennis said about the right to work state i have a number of questions that i'm very, very concerned about when we look at slide 9 was in and out of network if so the medicare advantage network not necessarily their p po networked so i think you know the delta we've not seen with the real co-pays are like i'm concerned about that in terms of the co-pays versus what we have and the comparison of formulas i guess there's going to have to be a national education program

with physicians regarding the medications because medications people have impacting a certain angle level not all figures are gurney toflts and i'm concerned about the one hundred and 5 members that are impacted by the medication i think there are issues there you are a number of questions here i think that i'm sorry we remember we had plenty of time i felt like we were getting something slick and fast not given the opportunity to vest this at the level it has to be i think my members are going to have a lot of questions with regard to this and concerns. you have a lot of decisions to make you can completely replace plan one with this or offer is

side by side it's your choose not our choose choice and i'm on one hand what happens if people needs to talk to someone after 9 o'clock to midnight i'm concerned about the urgent care networks i'm not satisfied there's enough information with that and it looks at like we'll have to get several riders the benefits we offer are a little bit higher that seems to be offered in the plan there's not enough detail and the co-pays the people are saying mentioned it didn't tells you what the actual co-pays 2 hundred and 33 there's fees whether a hundred

and 233 there's a uc r involved as opposed to the percentages mentioning didn't pay based on the billing but on a rating process that is i think this is disingenuous i urge you to look at this plan i'm not saying dump it but the devil is in the details you need to vest it more thoroughly >> hi, i'm dave soto. >> dave speak into the mike. >> sorry i'm dave the city retiree i want to echo what san francisco chronicle and claire has said the blooded really needs to vest this in daily and there's needs to be educational forms involving large groups of medicare retirees so everybody

gets a full and clear understanding of what's involved and the up and down sides are and commissioner breslin someone is gapping from this plan it didn't appear it is the city and county of san francisco or the members so who is benefiting from the plan that is something that needs to be kept very much in the for front of your consideration thank you very much. >> to clarify the motion before us is as it purposes the medical advantage plan but the director has the authority to present to us the option during the next meeting and we're not here to change the plan we're asking the director that the folks will

present the two planned we're not replacing anything so we'll know the options for the next meeting when we consider the rates. >> i just want to make a comment that presentation be specific to our membership to our actuary and i'd like to side by side comparison that is unbiased obviously by our actuary and does anyone have a public comment hearing newspaper flavor of the motion? i >> any opposed motion carries next item, please. >> item 13 action item

approval of the with regard to contract for the ss a cobra administrator. >> katherine on behalf of the chief financial officer for your previous requests we've included the process we went through to select p m a or p - p nshlgs a and when i went through the board agenda with commissioner scott he wanted to be sure we address the issue of transition time and transition process that is currently in the contract and there're there's a specific timeline it is a bit detailed we didn't approve that last week but the service perimeter and

the letters it is all planned and there's a timeline for it so our members will not royals there's a a change for the cobra and the f f a so you have before a recommendations for you're to award the contract from wage works. >> i move we approve the contract for ss a slash cobra administrator. >> i'll second that. >> okay. >> any public comment? hearing no one those in favor >> i. >> opposed motion carries. >> next item, please. >> item 14 discussion item report on the health plan issues

if any. >> chris from blue shield so we received a recent updated on the cyber attack we recently realized the preemptor figures that approximately 59 thousand of blue shield 53 million members were effected by the breach and they may have had their information breached the first way the members are current or former blue shield people that receive the blue shield benefits over the last 10 years that the blue shield

companies serve the second way anthem is the advised blue shield that no consider or banking information was compromised and allen said there doesn't appear to be accommodated and any information was obtained and no evidence exists any of the information was misused in any way so pull seven hundred and 58 city and county members may have been impacted up to 59 thousand and based on the information from anthem it is not commodity for the members interest so blue shield next week will be sending a preletter to the 7 hundred and 58 members letting them know

they've been identified by the cyber attack on anthem they'll get a letter from anthem that provides them detailed and get 2 years of identity repair and creditor laundering so we'll keep the board apprised and was have more information but be sure to give you the update any questions. >> i have a question about someone else i received a letter from a men she had a problems are the pharmacy or her cost of her drugs went up 5 hundred percent someone said that walgreens was not a preferred pharmacy. >> i believe that drod has that so we're looking at the details