two items attended to that would be helpful >> are these in the open enrollment material? >> yeah the open enrollment material on the website is what i requested. and neill our great act -- >> as a matter of record for aon hewitt as your acutary this is just for public recard when we gained the $5.4 million the actives it's all the employees benefits the employ yes and employers benefit you correctly spoke to and asked the question to me it's $5.4 million for the people who are early retirees the employer does gain money of your number it's $1.2 million in the public document. thank for allowing us to go on

public record to do that i don't want to belabor that. thank you very much. >> thank you. all right. anything catherine? >> no thank you. >> is there public comment on the president or the director's report? >> thank you for recognizing i was ready for public comment claire vanski representing rccf a number of members were concerned they could not attend today's meeting at the correct center. to my delivery to the groups in the may meeting i want to incorporate i want to thank a couple of you i take that information and i share it with retirees so i referred them to a website and also said that they will probably hear more about this during open enrollment.

but people are interested. members are interested and they want to know what is going on so some of us are trying to help spread the word on that. i wanted to acknowledge yesterday margaret sulivan is part of the program again from your wellness center she brought rubber band things i kept wanting to use as a slingshot but i guess they're for exercise after the speaker and before swearing in we had a session we got up and moved around she was fantastic and gave out prizes now she's part of our program for 3-4 months it has been a very specific activity that our members have enjoyed they have commented and looked forward to it has really added a level of -- i don't know -- excitement to our group but it has encouraged

more retirees to get up and be active understand even if you sit in your chair, there say lot of things you can do har gret was outstanding on that i wanted to complement margaret on that. this meeting conflicted but it's a meeting a lot of our members would like to attend if you wanted to do another one we would probably get more members to that that. thank you >> thank you >> i should point out yesterday's meeting was video taped and will be on the website. >> dennis cruger active retired firefighters i heard you said vsp and kaiser don't mix together is that correct >> no all members have vsp but kaiser offers optometry services

was there a question whether members would like to get optometry at kaiser members ask why can't we go downstairs and get it because we provide vsp i queried the 106 people there after that the kaiser members if they prefer getting their vision in one place rather than going to vs p. is that clear? >> okay just a follow up to that. if you are iniser's -- >> no if you are in kaiser you use vsp >> you use vsp >> yes >> being a beneficiary of both blue shield and kaiser. kaiser says you can can submit your kaiser bills to the vsp for reimbursement >> but they don't pay 100% >> but there is some way to get reimbursement back from them correct?

>> yes >> thank you. >> other public comment on the president or director's report hearing none we're now going to go back to the committee of the whole on rates and benefits. the reasons why i'm doing this is because it's critical that we get this portion of our business done today because we have a deadline to go before the board of supervisors with a complete package of rates for actives and retirees in jewel at this point i'm -- july at this point i'm going to go back to the approval of minutes which is item number one >> item one action item approval with possible modification of the minutes set below remember meeting of may 142015.

>> i would call for a motion to adopt the minutes >> i have a correction on page six under a on hewitt's report. this says approximately 6500 retirees in the city plan have nonmedicare dependents there are only 6,221 retiree members in the city plan. so i think that figure is wrong maybe it was heard wrong or something. any way it's not right. i'm not sure what was said but that is not. it would be more like a follow up. 1,540 dependents out of the whole. so it's more like 20% i'm not sure what figure ou put out that day but that is not right. >> secretary? >> i will follow up and listen to see exactly what was said

>> we have the numbers before us we can add them up. that is in the document >> yeah okay. just doesn't make any sense when there is only 6500 retirees then there is one about -- let's see. supervisor farrell's appoint for five years that is the only one that isn't for five years. i guess that is at the discretion but that's the only board member not for five years >> according to the letter given by president reid she did put the date in there a five year term >> that is something new and not in our policies either. >> all right. i can't find the specific

section where that falls. >> that's under regular meeting matters page 21. >> page 21. it's at the top of the page a letter from board of supervisors president lan dan braed supervisor farrell has been reappointed to the supervisorer board expiring may 152020. >> that is correct. with those corrections i move to approve. >> already it's been moved is there a second. it's been moved and seconded. is there any further discussion or edits >> i wanted to request that you edit page 7 and 8 with the numbers that are in the

beginning of the director's report in terms of majority of the contribution coming from the employer not from the retiree members. are theretiree >> but this is what was said at the meeting are you talking about the minutes? >> yeah >> this is what was said at the meeting >> p it's an error it needs to be appended that it was said in error the corrected information is -- and we can take the paragraph from the director's report to put it in a bracket if you will with the section of the minutes >> thank you. >> it's been properly moved and seconded. that the minutes be adopted as edited. is there any further comment from the board? is there any public comment?

seeing no public comment we're now ready to vote. all those in favor, say, "aye." >> (multiple voices): aye. >> all opposed? so ordered. all right. we're now ready to move to item three >> aye team three action item. approve resolution to board of supervisors the tin county survey results for the 2016 plan year president scott. >> yes as we begin this item i would like the ak wear -- actuary to approach for the presentation here. i just want to make a broad comment. we have approved the active rates in a prior meeting the last meeting we're going to be addressing retiree rates in this meeting. and nowhere do we have a summary

of that information and that is of concern to me. i have shared it with director dodd in a prior leadership we made a change we didn't bring all of the rate cords together in one document at this meeting the mrooeding that it would save trees there by enlighten the planet or whatever but it leaves a gap in the information i asked director dodd to the board of supervisors as the rate cards are completed that some time during the month of july that all of that information get posted on the website as a common reference until such time as it is published in the open enrollment materials so if members are tries to figure out what their rates are going to be in advance and they have been

approved they can go to one common source source an official source and find the information for active and retirees we would come back to this meeting and there would be a bundle of act rate cards we don't see that i think the point is taken if we can can post this stuff our final decision and people have access to it. we accomplish the same thing without slaying a forest we will continue to follow the same principle i'm suggesting in the inter imperiod of time we make these decisions and open enrollment that these card will be posted on the website that will be the protocal moving forward >> aon hurt actuary correct me

if i'm wrong i have presented the 10-county results in a prior meeting >> yes you have >> as a matter would you like me to repeat the results >> no. you will not repeat the results he turn to director dodd standby >> the resolution before you we present annually to the board of supervisors so they can approve the 10-county rate which is to base many of our rates on and to base the retiree rates on if people have questions >> there any questions from the board members about the survey it's results how it's been utilized as we have done the calculations today? hearing no questions we will proceed to adopt this resolution is there a motion? >> i move to adopt.

>> second >> it's been properly moved and seconded that we adopt this item is there discussion from the board? is there any public comment? hearing no public comment we're now ready to vote all those in favor, say, "aye." >> (multiple voices): aye. >> all those opposed? passed so ordered. thank you. item four. >> discussion item committee of the whole presentation of blue shield medicare national ppo discussion options of funding blue shield retiree plans and side by side rate cards blue shield of california and aon hewitt. >> all right. i know that there are representatives from blue shield here in the audience i would like to have all of the members of the blue shield team that are here today to please stand. there are enough of them i don't think anybody could be at their offices at work. [laughter] but we're delighted you all came

out ready to respond to our questions we appreciate your you effort in providing an alternative proposal to your submission to this board again it reinforces the point that competition is a powerful weapon in the market please thank you for coming introduce yourself >> i'm paul brown area vice president for account management at blue shield and you all have the presentation material. i don't know if it's going to be shared with the audience but i will go through the presentation and note the page i'm on i will start with the introduction page as you noticed i brought a small army i won't introduce everybody else they are my back today we want to peak sure we bring all of the resources to answer whatever questions you may have about the alternative plan we put on the table there are pokes

from our senior markets our medicare markets seam from pharmacy operation team as well as our claim operations. should you have questions in any of those areas we will be prepared to have those folks address you directly. i'm going to back in time a bit earlier this year as we presented what i'm going to call our status quo renewal the renewal of your existing plans we put a proposal on the table and we were asked to consider another more cost effective option and we had discussions with aon hewitt in that regard what i'm going to present is that alternative option. note that it's apples and oranges with is what you have today it's completely different than several perspectives not only the way we administrator

claims the way we get revenue but also what the member experience is with this alternative plan. and moving to the next page i want to state for the record what the existing -- >> just a moment here screen has gone black we are trying to get the presentation up for the public to see we're asking those joining us by television or seeing this not to panic all of the information will be disclosed before we make this decision i can other sure you please if you continue >> i'm now on page three which say brief description of the status quo plans which are two plans one is shield 65 plus it's a group medicare advantage plan with a prescription drug plan those are available to those in

the shield 65 service area then we also have for those living outside of the medicare advantage service area our access hmo which is administrator plan not a medicare advantage plan that is for those that reside outside of the shield 65 + service area i would like to point out a few advantages and disadvantages on slide four to compare and contrast to the alternative plan on the table there are advantages sh and disadvantages to the existing plan number one should you stick with the existing set of plans there is no disruption stating the obvious retirees would maintain their existing coverages their

pcp primary care physician and medical group selection an important thing here is they're medicare is delegated within the medicare advantage plan and well as the medicare cob plan we provide a competitive rate for the plan combination the one disadvantage is we're not anticipating as an organization any of the plan 65 medicare advantage network so the zip codes in which that program is available will not change in 2016. so our alternative plan is one program instead of two. it's one program. it is a supplement to medicare pp o. or prepared provider organization with the

prescription drug plan. just to be clear this is our full national net, work this is not limited to california and it's a coordination plan with medicare so medicare will pay primary and the supplement to medicare ppo plan will pay the portion that medicare does not pay up to the benefit level we provided >> will you stop there for a moment and when you say full national network what does that mean? >> blue shield has a statewide ppo network with 70,000 physicians from san diego county to the far reaches of northern california and central valley that full network would be available to all members enrolled in this plan should you choose it. in addition it would be available nationally blue shield

is part of the blue shield cross and blue shield association we have access to all of the blue shield blue cross network so it's a truly a pochlt network >> that is not the case with the current plan we have? >> it is not. >> thank you. >> how large is the national network? >> i don't have the number of providers but it is in excess of 95-94% of all providers in the united states. it is the largest network by far of all of our competitors. the pharmacy piece of this alternative option is the existing plan. so nothing would change respect to the egg wip prescription drug plan should you elect this alternative. there are supporting programs

moving onto slide six members will continue to have access to the nurse help line and life referral plan for personal financial and legal advise. there are other programs that they have today that would not be a part of this program programs like disease management and case management are not part of the supplement to medicare plan. similar to the status quo i would like to point out advantages and disadvantages to the supplement to medicare ppo first i will go through the advantages as i mentioned retirees would have access to not only our full california network but access to our national ppo through the blue shield and blue cross association. this may be an advantage or disadvantage but there is no medical group. it is not a delegated model nor would members be required to

select a primary care physician. as a result of that they will be allowed to self refer to specialists it is truly a fee for service program again medicare pays first we're paying the claim supplement to medicare so they have free access to any specialist within our network. we were asked to craft a plan that was similar in design to the existing medicare advantage plan. so we have flexibility when we design this type of coordination plan. and we have in your packet prepared a full plan design the first two columns are the existing plans the status quo plans the third and 4th column respect the in and out of network components of the medicare cob plan.

it's worth mentioning most of the providers in the shield 65 + plan are also in the ppo. in a moment i will also talk about those exact numbers. on slide nine there are disadvantages that i want to call to your attention. there is no clinical management by blue shield or the medical groups as i mentioned in the existing plan we do disease and case management. the medical groups have their own intervention it's a delegated model so they're responsible for care delivery within their capitated contract arrangements all of that will go away should you move to a medicare cob clan. and that lack of clinical management could in the future impact utilization we want to be really clear about this. i mentioned at the beginning this is a little bit of apples

and oranges medicare advantage is different from medicare cov plan should the utilization increase that could impact future rates we want to make that very clear. other components such as gym discount silver sneakers is not available. under the supplement to medicare ppo in the process of actually presenting your id cards at the point of care is different. so today you got medicare advantage card with blue shield and you have a pharmacy card with us. with the cob plan very similar to the access plus plan that is in existence today the member would present both their medicare card and blue shield supplement to medicare ppo card. at that point the provider would

submit the claim to medicare first and blue shield would pay supplementary to that. much in a way i believe as the city plan works for retirees. moving to the next slide we got a slide on which you don't appear to have in the deck it's in the hard copy which is network overlap. we wanted to take a look at the exist existing primary care physicians that are used by retirees so we took the existing inventory of all the primary care physicians that each of your retirees are assigned to today and matched that against our ppo network it's in the hard copy the summary is 1.9% of the retirees

would be impacted by a change to the supplement to medicare ppo program because their primary care physician is not in our ppo. so 98.1 are in one are out. it's important to note when we do this type of disruption that you not only look at the disruption but you also look at the benefit to those today who may not have access to provider they want to see that they now will have access to. we do hear noise throughout the year for some providers who are not in our medicare advantage hmo or medicare advantage cob plan that members might like to have access to too so this is actually somewhat of an advantage and disadvantage. >> i understand that.

if there a request by this board you would try to contract with those providers do you have a process in place to do that. providers come in and out of networks all the time that is the nature of the business i understand that. when we know we're going to have to type of impact will you have a plan in place or could you have a plan in place to narrow? >> yes. so we do have the ability to attempt to recruit physicians not in the network. and we have a process for that. there is obviously no guarantee we can get a provider to join it's also worth noting with this plan the member is going to 88y % coverage with medicare with and out of network provider and there is an out of network

benefit that does exist today but yes to your direct question we can in fact recruit providers >> all right so you will have a reimbursement option for outof network care if that physician is not part of this network ultimately after approached or if they are you would have access to that physician under this umbrella? >> yes. so in the design if you look at the attachment the outof network benefit has a $500 deductible for most care then 90% coverage following that. after retiree has reached $500 out of pocket maximum virtually everything at that point is covered at 90%. again medicare is paying primary this is a very large network it's rather difficult actually to find providers who are not in

the ppo network should somebody have a direct need to see a provider we will try to recruit them number two as a fall back, they will have coverageage they don't have today. >> questions? >> there are a lot of things not covered under network. specifically preventive care there say whole list of them >> yes that say a good point >> what do you do all of that out of network none of those would be covered >> correct to the degree they will could covered by medicare they would have coverage there we as a blue shield policy ppo plans do not cover preventive care with nonparticipating providers >> that is no different than today is that correct? >> well today we don't cover