flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. >> now i have the secretary call the roll commissioner scott commissiioner lim

commissioner breslin supervisor farrell commissioner ferrigno commissioner follansbee commissioner sass excused we have quorum. >> thank you. >> we'll take action item one item one approval and possible modifications of the minutes. >> thank you item one action item approval with the minutes so forth the regular meeting the january 14, 2016. >> are there any edits, amendments are comments to the minutes. >> i'm trying to get open. >> i understand i'll ask those of you who are new in the audience from the last minute we have new technology something called an i pad not on ipod and all of us have gone through training and the consultant with

the city has been with us and we all have to take a manner to be patient. >> it is page 7. >> page 7. >> i think the gentleman responded a two-part question whether or not the forms i'm still not there we're available electronically you said no, i think that's my understanding include the answers towards the bottom of page 7. >> from the minutes. >> from the minutes. >> oh, i'm sorry we're on the agenda i'm out of order. >> we're to be contrary look at the draft minutes of january meeting. (laughter) so again, i call are there any edits, comments or changes to the minutes >> i saw one i can't find it.

>> so my edit the second to the last blood sugar level it was confirmed the former will be received by the employee but the form is not available electronically typed. >> okay. >> 94 c. >> anything else? >> if not i'm ready to taper a motion. >> move to approve. >> seconded that is he minutes for the january meeting at this board be approved with the idiots so noted any comments or any questions by the board any public comment? ? here we go none all in favor, signify by saying i. >> i opposed? so ordered a item. >> two general public comment on matters within the board's

jurisdiction not on today's agenda. >> my name is diane i am representing the use of force retirement we had margaret from the wellness program she did an excellent job a question she couldn't answer it was suggested i ask the question the question is members were wondering why kaiser didn't offer the silvers sneakers program as several of the other plans available and if that question would perhaps be asked of kaiser thank you. >> okay. we'll talk about what we currently do i'll call think director bohe to provide information this go issue has come up make a comment about

kaiser or an represent. >> a representative from kaiser permanente please come forward. >> hi cindy exclusive account manager currently we don't offer the snaerngz benefit but but will off of january of 2017 my understanding it is been finalized and there would be a cost with a rider. >> so your that looking it for the next planned year. >> yes. >> and more information. >> yes. >> during the renewal thank you for your comment and question questions or comments from the public on matters this board should be concerned about before we move on an extensive agenda today i tried mightily and labored

like hector. >> to narrow it but items carried over from two meetings since november and i feel that if we got to press on so i do not o i don't want to be short with any of the presenter or members of the public but we're asking our cooperation to keep our comments focused and your questions the same way we're able to get through the agenda we're trying to close the public side of the meeting at about 4 o'clock we have a closed session after that time and then there's another public body who comes in here and 5 o'clock so you know we can't inpigeon their time i'll ask for your cooperation

>> and so, now take up addition item 3. >> thank you. >> item 3 action item in violation of blackout period for the duration of the rates and benefits process commissioner scott. >> yes. we're in receipt of some guidance from the executive director regarding this you want to summarize and before you do we have a series of items today that look you fairly standard because we have extensive policies on them if you look at the website or look at the meeting materials you'll see the occupying policy on a lot of the items today is not a policy discussion because we've had these we're talking about how we're going to behalf and act during the rates and benefits renewal so just to be clear this body and its terms of governance about a year ago changed its

structure so that the rates and benefits process is done as a committee as a whole all board members participated and that allows the public to participate as well we're disliking we'll talk much over the course rates asia benefits as a whole and we will convene and hear the finance committee present items on next year's budgeting process and then go into the regular meeting and i will try to make where we or so that none of us get confused so that's what's going on and, in fact, director dodd to comment. >> we begin a blackout period for the retails and benefits that that means that no commission on the board or exclusive a staff can speak in the city attorney can conform

can speak to the vendors about rates and benefits if we're asking a question wellness of something else to the permissible but specifically so rates and benefits not to have conversations with the gender; is that correct. >> consul general. >> yes. correct obviously we can't stop the members of the public but adopting this policy the board has adopted that. >> all right. any other comments ever be observations by board members questions about the blackout notice for 2017 rates and benefits. >> move we approve the blackout period for 2017. >> it's been. moved a seconded properly through the blackout period for 2017 rates ace benefits are questions or comments by

board members? any comments from the public seeing and hearing none we're now ready to vote all in favor, signify by saying i. >> i opposed? so ordered a action item 4. >> item 4 action item to approve the administrative 2017 by ann hewitt. >> i have it up there troyer good afternoon and we have you have a presentation in your packet choops not working i guess there we go. >> so so this is a standard presentation we give every year

it is a plan you've had if you have a small body of active employees that use this plan earlier retirees and the code with the ppo you fund that plan but you set a premium quadrant have an opportunity and take the risk we step out on our risk you vote in a specific merging in april we present you the prudently for those 3 pieces to look at page 3 oh, there it is we're trying to brought to your attention in it the clarification transparency of full disclosure to the board when the fees are for the standard administrative they've increased the fees for active and medi-cal by 3 percent bye

find them to be reasonable given the services and additional amazement of money to the full fee in determining the final price before we vote on this we have 3 other piece of information on page 4 and these are the h s f sustainability fee it's $2.05 and we have a shared savings what that is as a ppo the united health care when we get a large claim they negotiate that and whatever the savings is they take the there are no percent and the rest is passed on a bill they bring it down and share the savings and have a fee for the negotiation their fee steldz and the value based on prying

they've contracted where the vend they've paid a little bit of money to do a better job so i know i'm quick we have a full agenda kwhaum when you add up the piece you took the component piece of additional cost and at the bottom of page 4 you see the rate went from 47 plus to 48 for takes. >> will you come back to the microphone so we can hear you. >> they've begun that 2 percent important early retirees and medicare and at this point i want to say last year in february we presented premium you have the p p d contract that coffers all the costs for the retirees that's been deferred from various reasons until april

not able to present at this point we have a fully discussed this with the united health care i find it appropriate and no issue that will not defer any actions take place as part of determining the final rate is we'll now looking at accepting the administration fees this is full disclosure that are being asked for by united health care and it is reasonable. >> art so we're taking one slight stem from a year ago auto yeah. >> are they're questions from the members of the board regarding the administrative fee and discussed and outlined. >> move we approve the city's administration. >> i have one question i want to make sure i understand the shared savings the cost to administrator the personnel that

go back to renegotiate out of plan bills is that it. >> this is when we take a bill say a bill comes here for 5 thousand dollars and the bill is charged with the higher fees they go into negotiate and bring it down to 13 are 12 they keep a thousand you actually, they get paid so i guess to answer the question you're paying for the service but. >> that's different. >> and figure out how that works. >> all right. any other questions from the board? we have a motion is there a second >> technical second. >> there is a motion and a second we accept the recommendation of the administrative fees for the united health care plan for the coming year any other questions from the board or any public comment? seeing and hearing none we're now

>> all in favor, say i. >> i. >> opposed? passed our next item is action or deduction item number 5. >> item 5 discussion review cy plans ann hewitt. >> you can stand there for public comment most of these items are you. >> we're at the united health care. >> is this inappropriate we need to vote on it today. >> i don't believe we can do that. >> no. you can't. >> i've looked at to my council for for the goons. >> please. need to notice it as an ax item that being said the director can make an independent decision and follow-up that way but

basically, it should be an action item and noticed to the public okay. we will do the best we can within the perimeters so if you, please. >> okay. what we're looking at the rates stabilizations calculation it should be in your packet this is a fantastic policy that you adopted before i he was allowed loudly to to be our tyler new a have deficit the coming year but collect the premium and you'll have a surplus what's the rule the rule ask say if elected $50 million and sent 45 you have $5 million of surplus the rule is we are going to rebate that over 3 years if back in 2015 we know

about it but apply to the 2017 rate every year question take a look at the deficit or service for 80 that year and how much is that and take it off the 3 by the owe or chase so at the end of the day you are fully accounting for all the money no money is kept all for the we think of the people and a excellent policy. >> i might add the original monies could from where. >> the premium in excess of the expense. >> who pays the premium. >> the city ann. >> and the members that's right. >> okay (laughter) okay. so given that what do we do? over to this page right here the expected and tuff when we price that important 2011 we had sat

we were rebeating money it was listed itemization and the contribution at this point i do presented this document you were going do pay back $7.4 million that means the premiums will be less than the expenses so what happens in 2015? well, we came in at $8 million so we spent more by $8 million so that of those priced early by the troyer let's have the based on experience spent $8 million spent more than you intended to spend you lowered the rates and at the end of the day it was an inverse what does that do creates an mop up of money you over spent you can get money instead of get money back

at the end of the day it is 4 thousand plus should be netted against the ongoing balance we go back to >> what page would you be on. >> back to page 2. >> which the actual circulation u calculation of the amount so if you go back to page 2 of our deduction items at the time of the at the end of the last year, we have $11,783,000 in the reserve we had to give back we generated extra money now only give back $11 million plus a third is $3.8 million roughly so what do you mean that means that for 2017 we finally lists the operational rates a line the rate card x amount for the

singles those will be monument for that and that we take away from the rate we reduce the rates by approximately $3.8 million so we're giving the money back we're wee rebatting the money i love the policy so wvpd this is a deduction item this is an explanation of what we're doing and giving an update of the status what we're intending to give back through 2017 for the city plan any questions. >> i do have a question. >> last year you advertised $8 million $8.51 million and you to the 26 rates and added 4 million 4 hundred thousand that

is $13 billion plus and this year you only have 3 million so how will this effect the rates when i put in more last year. >> we're not there. >> $10 million televise. >> based on the experience the thought rate i'll present the net impact i thought that was today. >> no, no we're not going to give you the rates. >> so $10 million is going to make a big difference; right? >> we spent $7 million and did a buy down of the $4 million. >> it was sort of violated the policy the policy so avoid fluctuation and two we're going to have a big fluctuation this year up because of what we did last year. >> if i can defer my answer to review the final calculations in april and let you see the netted

result i'll ask that obviously in a public forum. >> all right. >> i understand your that the continuation well-taken. >> my second question if carrying forward to 2018 the $7 million plus 586. >> and that's on the first page. >> that's correct so the following years was a lot more than that $8 million more or something is that a matter carrying forward. >> what happens this is surplus money at some point we completely eliminate we rebate it for the converse or calculated and we are at the position we're casing more or asking for money into the rate or taking money away from the rate vertical if that policy

works and rated as best it can be end up with a large surplus it's a begun i thought the idea to have this here in the case something goes wrong. >> actually, you wanted to say something. >> the stabilization piece this money we're willing to spend obviously $404,000 more modern last year in previous years if we spent $11 million more the stabilization fund we will divide that $11 million by 3 and take it out over 3 years. >> do you see what i'm saying is that accurate? may i reframe that >> please.

the purpose of the stabilization. >> may i. >> alert everyone a copy of the policy is one the appendices to this item. >> and you can read it. >> and the oifshz of the policy are very clearly stated. >> quote the objective the stabilization reserve 2 to spread gains or losses into the following years premium calculation in an evenhanded manner such the employee and the employers and membership are not subject to volatile year over year changes in premium it is a piece it not not prevent volatility we can't control the marketed but a piece to help to reduce the voluntary outlet we might experience. >> that's correct and to going to the original state e statement if i generate a

surplus not hold onto that an afghanistantion we'll resurplus and adversely a deficit we will add the deficit into the rate at the end of the day as we get it perfectly rate no stabilization either a surplus or deficit this is a house to amnestimemorializ. >> this is a matter to be introduced today i'll ask if we have public comment if we be guided by the recommendations this is in here and we will take action at a later date okay. >> all right. is there are

there other board members. >> on page 2 when your suing 3.7 applied to the 2017 is it safe to say it will be applied against the premiums for the 2017 rates we have not gotten the premiums but for the city plan that amount will be applied across the board. >> right. >> any other clarifying questions by the members of the board if i for the deduction item, i.e., want to reiterate i'll ask the executive director to be guided by the recommendation since not an objection to the recommendation actually such time we take action all right. discussion and possible action item 6. >> item 6 discussion and possible action presentation on

premium rates relate activity equalization ann hewitt. >> i know this will be distinctive by ann hewitt by the executive director will be making comments as well. >> so in looking at the excise tax tax even though it is postponed one thing the early retirees exceed the excise tax for all levels of retiree only retire plus 2 i consulted and we went back and examined it and learned it is not equal cross the h ss membership the rate calculations for early retirees differ from

all others h s f the active members 65 plus members that he differ from all city plan members in the future kaiser and blue shield exceeding the federal excise tax threshold for 2018 and subtract years looking at 2020 plus one and plus 2 so h ss relate activity is within the industry standards are the amount and with unless a member of the commission, the public, or staff so requests calpers we compare ourselves with consistently and not showing on the screen sfgovtv we have a presentation. >> okay so in terms of background we set and we set the insurance premium

for 3 tiers retiree only retiree plus one and two for all 3 plans we're saying united health care is both city plan and the n p p 0 per the charter the premium were calculated and this is dr. first pass at this the retiree calculations were 13w5u7b9 the county average and the actual difference if the premium and have up to 3 minutes - no rebuttal. to assist the board in the accurate preparation of the the prop example subscribe that multiplies that number by 50 percent the actual difference the amount between the active rate and the retiree rate so essentially a subcontracting the survey and then your 13w5ub9 e subtracting

did differ that he municipal court by 50 percent so but the charter didn't determine the rate relative activity it is a policy determination that the health service board and consultation with the troyer the cost is negotiated by h ss with the insurer and deficit into 3 tiers when we set the tiers one plus two and the relationship is called rate relative activity the insurance. >> excuse me. where did if term come from. >> it's an industry term. >> not in that industry in health services i've never heard it. >> we've never discussed this before.

>> that's right. >> the ratio of one or one to the bar. >> i know what you're saying. >> we call it ratio. >> we call it plan design. >> it is the rate they're like go ahead. >> so in the insurance industry and the 10 county with the 10 county average within calpers the data is in your packet a retiree only is one a retiree plus 2 is two and retiree plus 2 or more is 3 so the ratio 2 to 203 for example, the only premium was one thousand dollars plus one independent is 3 thousand and the retiree plus or more is $3,000 each person costs one thousand dollars so a matter

of long term practice h ss applies those ratios of relative it's and at some point the standards were changed to apply them only to active all of the city plan members and 64 plus members so they were specifically changed for the early retirees and kaiser and blue shield and they were changed rather than 1, 2, 3 therapy changed for blue shield is one to 1.4.4 to one .81 and kaiser is one to 1.4 to one point and there is others close to 2 and this is close to 3 that is highlighted on the chart on the next chart on the next page. >> if you look at the bottom

and look at it city plan it is 1 to one .96 or round up to 3 and one to one .9 to 2.84 and rounded up and 65 plus is there it is actually slightly lower than in that category and similarly the itself off are 2 to 2 point and the retirees is 65 plus 1.199 to 2.99 the only place the blue shield and kaiser early retirees and one to 1.6911 excuse me. >> so equalizing the rate ratios or relative activities

across the members effects 1/3rd the early retirees and that chart the the middle of the next slide. >> on page 7 correct thank you. this decreases the premiums for the retirees only and it will increase the presumes for the retirees plus one and two since about the early 2000s the retiree only have been subsidizing the retiree plus one and 12 and kaiser and unemployed not have an effect on city plan it is equal 1, 2, 3 approximately so as you can see that the retiree only column as additions up to 3 thousand three hundred and 4 and the r plus one

and two are there the well getting at r plus one and two is adding up to 8 plus and we want to reduce the - we want to make it equal everyone treated equal and second happens to be a product if we take those $3,000 three hundred and 4 members and reduce their premium because they've been subsidizing the r ones and two's there's a they're the largest group of people wouldn't exceed the threshold we recommend we have treat everyone fairly at the ratios but over 3 years and we want to ask that the board direct the 24-hour to

present 3 rates and the status quo equalizing them over 3 years actually is this be - equalizing them at at ones and 3 years you'll see the impact on the early retirees will be so again, we have the comparisons the appendix on page 9 slide 9 you know so 1 to two or 1.8 all within the 1, 2, 3 for the different classifications. >> if i may the trig point of the discussion the fact that this this issue as impact on the

policy. >> we've been doing that an, an consistent basis for the last year anticipating that the excise tax will be impacting us in 2018. >> 2018. >> they've move forward it out and everyone is bracketing a great say of relief but the facts it is still coming and things we do today could with a material impact on that 3, 2, 1 years from now just as we were taking the advanced look to try to lessen the impact on the membership we said in the last meeting we've not do it for every causation but at the end of the process but the process of reviewing all of that we've come across this issue might not will have been discussions by this board but now with that, open up for public comment a it

prepares us for 2020. >> comments. >> have i have a number of questions who i think gated who is behind this was interested where did they come from. >> our are we looking at how our rates are calculated and discovering the early retirement rates were not equal to the rest of the membership. >> from other departments. >> in the controller is taken an interest the idea was why are. >> the idea came from here not the controller. >> correct. >> did the troyer work with the controller. >> he will be in terms of the determining you know if you take an action he'll be in terms of - >> i want to say a few years ago we had an incident a

different controller so he minded our troyer to work on it but the director made sure a firewall you're using staff for this does want because it is conflicting interests the fiduciary with respect to our troyer trust to advise the members so we have the fiduciary dude so that was done at the time the same staff was not allowed to be used for this type of thing it is competing i mean it is not i don't think in any way considered good for the members. >> all right. >> and then i have other things i'm wondering where the historical spot is because i've been here for 15 years i've spoken to harry from the 2000

and from 76 to 2004 where was it it was consistently applied what was that time. >> it's my understanding that was appliedblast before 2002 and 2004 before prop e. >> we can go back and pull the rates. >> we'll make a presentation if this is effecting did mostly vulnerable people the early retirees with go independents are not paying will $1,100 a month and now. >> in this plan. >> that's blue shield. >> no an active pain and suffering $300 a month it looks

like the early retirees are getting a deal they're paying more than anyone there is a lot of motorbikes have to retire early can't work to 65 and have dependent it will be a hardship when you look at a the charter the intent it clear move to have the rates the charter states in a couple of sections and that means they should pay the same the same - i read this paying the same premium equalize the premiums and that's why a lot of things - that's excluding the m

o u. >> which part of charter terms of the equalizing. >> is that - the total tricks from retired persons covered under medical should be reduced to the amount by such person to medicare because of the monthly costs for retired persons maybe higher for active employees the san francisco and bla-bla have the coverage for - to defray the difference the cost to the system and provide the same coverage to spells out and partners so monthly contributions required from the sooifrz spouse and domestic partners blah,

blah, blah shall be equal to the contributions for members the system for the health coverage so the intent clearly not to have one group priced out of the plan to increase those fees much more for the early retirees that is been a concern to try - with the dependents if i verse increase it. >> we're working on the fairness that the retiree on were subsidizing excuse me. the retiree plus dependents and so everyone should be treated equally and . >> and that's not what the charter and the charter is talking about the actual difference between the actives and retirees and municipal court it by 50 percent so actually and

extensive it is a further subsidy beyond the equalization. >> look at the numbers caesar and see how much more they pay and as i understand this is precisely what guess asked we can take look at the numbers. >> we looked at the book last year to see what the retirees are paying. >> that's what we're looking at tasking the executive director and the troyer to do tooth brush this the driver here is moving around the excise tax. >> well, why do we expand other benefits if we are concerned about the excise tax why didn't we expand the benefits to people working two hours when we require thirty. >> that's the decision by the department of the human

services. >> how about increasing the surrogate plan they'll make the plan nor assessable i mean, if we're going to add more benefits and then take fwt people already on the system doesn't make sense to me we should be taking care of the people on the system. >> all right. other comments. >> so question when you had a rating for the premiums the early retirees are combined with the updates; right? so when we had a rating we have the retirees and actives and have a different one for the retirees that is meaning 65 and ether. >> the rates have been set up on the relevance the act of single person is 5 hundred by the single early retiree maybe a thousand because it is we take

all the experience the overall pool is 6 percent we take all the rates 6 percent. >> combined. >> yeah. not the same rate. >> it - not talking about the rates but the pooling. >> the pooling. >> it is early realtors are he retirees are together and separately and yeah. >> that's correct. >> and we did the premiums their pulled together with the actives. >> for the early retirees. >> depending on what the mou is when you except had you split it out you do it for plus one you use the 1, 2, 3 contributing. >> for the actives. >> uh-huh. >> so that insurance and then blue shield or kaiser didn't submit premiums separately from

that early retirees it is all pooled into one. >> for the overall increase for the cost yes, but the rates are different for the actives and retirees they're higher. >> for the subsidy for the city. >> you take the experience theoretical the actives can be subsidizing the rates far the early retirees it is rated as one pool. >> understood when you spread it out for the actives how you, you spread the premium is for the employee only they get i mean did premium is 5 hundred when you that split it out for the actives this is one one thousand and for the he was it is one thousand except the split is difference from the actives i mean from the actives and also for the city plan.

>> that's not - so it the premium is the same for the different spread. >> the different category of the permanent that's correct historically for actives and for the industry and 1, 2, 3 so the starter is 5 hundred and maximum the next is 15 hundred and at this pace if so it a thousand tor the early retiree the next rate is 15 hundred and the next is basically doubled. >> but the total amount the premium is how we spread is so for the early retirees the premium a month is the same except how to say spread it is spread for 9 employee only for and employee the retiree plus one and the family is getting less. >> yeah. >> it didn't commissioner tang the premium is this how to say

being it spread. >> other than the. >> the vulnerable people are the ones with dependents. >> i understand this is the whole issue anybody here reverting before 65 with a dependent better that about this they'll have a huge sticker shock and one more question. >> before but you do this is not a decision i don't want it to go across the airways this is a deduction with a possible action with requesting the troyer bring back to the board a detailed rate structure that shows exactly what we're talking about in terms of the the money that are involved for the industrialized member and the employed that's the step nothing

else. >> we know what the result. >> i don't know that i'm sorry commissioner you don't imagine i don't know that and nobody knows until the calculations are done it is borders on getting without the information which you've asked for us to bring back historic i expect they'll do and bring us back the factual information if we permit them to do so the calculations they'd the nature of the discussion. >> i also want to know the relative activity is a policy determination by the health services. >> we don't know that where is this stuff appear and nobody knows where it comes from. >> bans living memory none knows that's part of clarification in 2003 something changed

that's 12 years ago. >> yes. >> and how much money boo do you you think - is the property change going to reduce the city premium contribution in totally annually. >> would you have a way of knowing that troyer at this time. >> no, i can't answer that. >> so as a fiduciary are you considering yourself a fiduciary of the system. >> yes. he actually am a fiduciary it's might responsibility in cornerstones with the guiding principles and dr. >> i want to make sure what we can expect based on the discussion is that people go back and find out when the disparity began to surface and whether it was linked to a

policy decision of the board the board felt this was really hard on early retirees with dents and therefore, we should be potential charging more to early retirees without dents to make up for this that the commas the minutes. >> that's my anticipation if this go forward we're asking for clarification how this is being done why it is being done it is not consistent we seem to go reflecting to the 10 county survey so why is that we're doing something different that's a question i have looking at the initial presentation beyond that a long time it because we know that it has a cost effect on something that is 3 years down the road we can wait and i'll

guarantee whatever at change that will be more that i'm willing to say and substantially the fact the group more so we're trying to be prudent by taking an advances look we've been doing for the last year when it comes to the excise tax issue so that's how kind of we got here other comments? thanks >> i've seen this happen in many bodies we're having a conversation will happen the next time around we shouldn't be afraid of more information from my prospective commissioner breslin i understand where our coming from and certainly i don't think that is a done deal i'll say it is me have 3 little

kids but compelled by the early realtors with the dents i don't think we should be afraid to ask for more information that is completely fair and i think, however, i'm not concerned how to came back to be if if so a real issue we should be looking at these things all the time and things are brought to people attention in forms and fashioned i don't care if someone off the street this is an issue we should look at it from that my prospective i'll be supportive of looking at it and have the substantive discussion next week and any other questions if the board members. >> this is a question really in terms of numbers ass as far as employees with dependents then if everybody is treated

equally they'll spend upward of $3,000 a month out of somebody's paycheck if you use that evacuation that's the example in the presentation $3,000 that's the full rate not as an example not parts between what the city and the employee pays for a single but right but for early retirees. >> it's. >> what kind of increase worst case scenario. >> as far as what we pay okay at this point in time we need to do the examples and show you what a looks like status quo and what it looks like under this this concern and then you can say okay. >> is that. >> that's essentially what is

- >> i'd like to say probably the next meeting give us a presentation of what the numbers look like currently and what the numbers should have been if we had followed the same plan without these kind of like city plan a presentation this is what is currently the spread or how much for the retirees only pay retirees plus one or more and this is what in 2016 is the basis for 2015 rate if we followed it and the relative activity of the actives this should have been the predicament for the plus one and 2 paid we want to see the numbers for its next meeting. >> if that is what you guys want

me to do the essence of the board i don't want to confuse the numbers based on 2016 to somehow be communicated the public service some representation we have to be clear those are 2016 rates as an example. >> exactly. >> that's a noted point maybe we can do think illustration it show was it it would have been this year if we used this formula. >> all right. that's a request if we decide to proceed commissioner breslin. >> i asked a question about this for the threshold of the excise tax it said multi employer plans are entitled to use the family threshold in all for all planters your good evening do checkout that for me that will make a big difference for the

excise tax. >> and last month i asked you that we're talking about bringing down the - >> premiums or whatever not to do it on the backs of the most vulnerable but that question was not answers i don't know if you have it today. >> at this point, i don't have the answer but i'll bring that back. >> that's big deal. >> so what is the pleasure of the board at this point? >> i'll make 80 a motion to approve item 6. >> and you'll come back with the presentation of the rates that's really. >> based on the 2016. >> that's a motion at this point. >> and is - >> based on just a moment and that's based on the 2016 rate. >> and what it should have

been. >> but the recommendation from the staff is to look at 3 ways to look at what would that will if it were this today and what would that will in over 3 years. >> using the 2016 rate and using the 2016 rate a. >> is there a clarifies to the motion i'll make the motion to accept the staff recommendation. >> using 2016 rates all right. is there a second >> second. >> is there any discussion by the board members apply any public comment? or discussion on the motion on the monoxition. >> good afternoon commissioners restored employees in the city and county after discussion with some of the members yesterday what we're

looking at it pretty much what supervisor farrell we want to see more information i can't recall specifically what occurred in 2003 i actually think when i retired i dumped those files i apologize. >> what. >> i had files back when i got on the board but i've i'm not sure i think that we have had this discussion at the board and when i sat at the negotiating tables has to do with how we minimize costs across the board and sometimes employee only or what we call retiree only whatever category the single person sometimes those rates might have had to submit what had to do with the families the old days the families got the good rates we balanced that out over time we're logan to

minimize the out of pocketed expenses you're discussing the rates you're talking about the rates before the charter kicks in before actives out-of-pocket in regards to the mous if you're look at when they're paying it is misrepresented that reflect their contract mou so their out of pocket sorry is absent diversities this is an the actual rates if i understand that that correctly this discussion has to do with with the raw rates about we apply the subsidies you have to look at percentage and look at it as you say the impact whether it is you know, however, every possible somewhere so you can make a decision what way about best ethics e eric have the at least economic impact on the members and i do have a number of early

retirees in my organization and they all have young dents and their screaming at those premium coasts but prop a on this subsidies the first dent so this is a problem for any early retiree i stong suggest you get the research for a future discussion and come up and tell you don't do that. >> if we make it it that point. >> you can decide whether to do it or stay the same without the information none know. >> other public comment. >> tim o'brien secretary and reertdz forearm a preponderance of the early retirees i don't know if that is a fact i know

many of the members do retire before the age of 65 whether they want to or not they need to and i look at those rates to me getting all the information is what the president said based on around the excise tax i mean that is what the pushing this thing forward healthy people have also subsidize sicker people whether vacationed or education people without children pay for a education that people that have children the idea one subsidies the other is a way insurance works so i have no probable cause my members have no problem with that but that looks like those people when we reach the age dependents are covered there the health plans that includes a lot more

dependents than retirees then as they say the least able to suffer the circumstances i hope the information is not used to justify a method of saving something on the excise tax boosting those people premiums. >> thank you for your comment is there any additional public comment? >> hearings are we ready to vote in favor of the motion as proposed all in favor, signify by saying i. >> i opposed? >> no. >> the i's have it. >> no. >> no? >> no the i's have it. so or the i'll ask the troyer now the motion is passed how quickly is this something you'll have next month or the

following. >> bans what was passed. >> maya quick question a one time analysis what it looks like for 2016 rates at that point you may decide whether or not to continue this process for the 2017 to, be presented in april the one time. >> exactly question and director dodd. >> it was my understanding you're to do that but projected over 3 years. >> yes. i'll do outline 3 categories director dodd at this point you'll say yes you'll take the action item and vote we adopt this or not. >> no let's not leap forwards we'll look at it and instruct you further to the same thing for 2017 and or may say.

>> stop it. >> understood clearly what i'm going to do. >> and again, i want to ask the question my original ask will you be able to do this next month. >> i believe the best interests of the board to have this done next month i will do it for next month we need it before presenting the rates in april but i don't think i have a choice. >> that's when i wanted the clarification moving on to the next item which is item number help me secretary. >> 7. >> 7. >> and we're marching right along. >> destruction for the i cared reserves for the blue shield ann

hewitt. >> i'm sure this will not be as controversial. >> it is not controversial my statute our required under it the programs incurred as a matter of full public disclosure that he beginning of the rates and benefit cycle we share on the financial books of the trust the balance sheet you the item before you on page 3 this is the r d and r presently what they were were were as is june 2014 and we review the numbers an your books you have your auditors powerful $29 million for the reserve the i d and refresh my recollection reserves if you terminate the program and after the termination date this is what you have.

>> would you give me a sense consequential to how many months as those reserves are between one to two months and no exhibit 5 and our auditors have reviewed those those are independently reviewed so this is the information we present to the board. >> it's an informational item. >> i think so. >> are there me questions from the members of the board? >> any public comment? hearings we'll go to the next item and deduction for the contingency refers ann hewitt. >> in addition you have a lost coverage that was adopted brother i became our troyer in 2011, i do this for others r all the self-plans for the ppo and health and doenl and now blue

shield has a contingency reserve you're at reflex for the exposure we've resclaultd those on page 3 the reason we presented at this point that's on your ballot sheet from the audit and approved from around external force your carrying a total of 2 to $3 million 8 hundred and 44 plus so for dr. if you project the certain amount where you're taking the risk and go over you want to make sure especially, as a public segment that you have money set aside on the balance sheet you have that money on our balance sheet an sclent policy

you have an approved contingency reserve policy an i dr you have a contingency and a stabilization. >> which helps to reinforce our responsibility as fiduciaries for those members and absolutely so with no further discussion. >> share to the board we have pubically disclosed the amazes that any questions by the members of the board any public comment? hearings move on to the next item i'm very attempted to take a hygiene break we know this issue will be with discussion

substance. >> thank you we're now ready to take discussion item. >> good morning item 89 discussion and possible action educational presentation currency and possible instruction for staff to explore further. >> ann hewitt. >> asked to bring you more information and education on the xeept of the currensurrogacy hy we'll be covering both topics to begin with the surrogacy an overall it is a practice by this a com becomes pregnant

and there are two main types surrogacy it is depending on the source of generic materials if it needs tobacco donated that is available for the couple and key preference of surrogacy that is a generic linkage that is available surrogacy versus adoption in terms of the market it is not very common benefit but there is greg interest. >> what do you mean not common can you give me a clarification if from a current employers stand point. >> yes. if i were to insure a complete guests under 4 percent. >> thank you. >> there is growing interest in that area that are current medical carriers don't offer this i'll talk about that many a

minute why there is tax and legal ms. campbell's why not covered under the medical plan it is popper in a tech industry for people to have a career and as the first to offer this benefit by others we're aware of that offer this is a university. >> any governmental and expect governmental federal, state, and local that do. >> not that i'm aware of typically benefits are maximum additional ranges from $10,000 to $30,000 in terms of designs the benefit will be available to any employee and would be subject o state and federal it is not like

dental insurance not an eligible irs so something that is important to understand typical covered serves a surrogacy agency fee there are agencies with that type of programs and medical teams associated with the pregnancy and screening and legal fees excluded services include valory contributions and legal expenses not orchid with the surrogacy of the child and expenses prior to the employees dated of hiring and charges in violation of law and maternity clothing and loss of income etc. in terms of the cost of surrogacy looking around research on the internet and other resources the cost is

typically 15 to $50,000 bans a variety of factors the benefit will be administrative code in house not a vendors that administers this type of program lake the medical vendors for the medical insurance we did identify a possible insurance company policy and we're curiosity exploring that as an option to bring that to be your desire for more go information and in terms of the legal and tax this type of a benefit for surrogacy may not be combined are a maternity benefit the sewer detergent is not a dependent of the employee you may want to reevaluate our lease policy as the employers may want to do this if you implement this to allow for leave for an employee who has a child via surrogacy and this is legal in

cancel not legal in all states so i'll pause before i recommend adoption >> yes. the question might be ♪ moment why that being discuss as you recall we had a forum in november we were taking a wide look at a wide-ranging series of topics things that might directly impact the benefit design cost of the issues today and things that might be broader this was one of them so we carried there item over a a couple of times and now today in february why are we talking about this well, it was an educational item from the informative board forum that's why we're talking about is that so, now i'll ask any questions by board members open this topic on this aspect the

presentation >> are we dwg to finish. >> after she finishes. >> please. thank you. >> so in terms of boupgs to provide you an overview this is generally early reimbursement for the adoption of american people child by an employee maybe a reimbursement of a specific expense or expense associated with an adoption or a certainty amount of money for example, 5 thousand dollars that is paid after the adoption is finalized in terms of market this is fairly common i have a statistic go from a survey in 201352 percent of employers were over and over some kind of financial assistance it is common the marketplace in terms of of design per child

dollars maximum 5 thousand dollars for a common cold and 5 thousand dollars in a lifetime and available to all employees and it it has been provided information 0 on this type of program and have kwflgdz adoption fees and court covets and attorney fees and travel and other expenses related to the boupgs i adoption not to adopt a spouses children and the benefit cannot be used the expenses were used to claim a deduction on a tax filing an individual so basically, you can't double dip if an employer reimbursing you the cost varies wildly depending on the type adoption the state and attorneys and travel is required for the adoption

the typical costs via the fosters zorro 25 hundreds to private or international adoption 7 to $40,000 are more and in terms of legal and tax this can be provided florida the section it is non-taxable to the employees from the criteria is met by the irs and for your information in 2015. adoption benefits of $13,000 plus and the ability to use those deductions all right. thank you and again, this was part of that broader discussion in november the members of the board have questions on either of those comments or observations

i'm curious why since this is a very rare benefit stated here curious why we are considering it? >> and very rare benefit and expensive and i don't know if any other pueblo entities is doing director dodd we have been approached by employees are interested whether or not the surrogacy we have at largest population of gay men in our employee force if you as a percentage and gay mendicant get pregnant the benefit we restrict the benefit to gay men and restrict to be to people for men in fertility treatment but a request from the employees not

on expensive benefit when you look at the lifetime why are we are doing that we're competing with twitter and the other tech companies that are providing that we have a tough time recruiting. >> just to clarify are you saying surrogacy and board adoption. >> surrogacy in particular so because we've been asked for it when you spread out one $10,000 surrogacy over 65 thousand members it is not an expensive benefit but like the idea was we were the first local area to do the surgery and it is more responding from the requests from the membership. >> thank you. >> reading a lot in the

newspapers we read a lot about that but generally people going to countries when in their poor and have to do that to make a living is tough to me but i know and it isn't only gay men but regular couples i know that i know a couple that did this not restricted to gay men i don't believe but i find to extremely i like the adoption idea i never thought i never gave it a thought not providing anything to the staff but for the fertility benefits so that is reasonable. >> other comments. >> yeah. number one yeah. you know i've had friends that

did the servicing and that was a list or a small fraction of the actual costs so maybe helped them to make a decision but not adequate to discovery it i guess the question i have are in terms of the request how do the number the requests for the adoption benefits compare to the costs for the surrogacy. >> we actually don't say have requests for adoption benefits when we affected with other companies they said you should provide adoption it is more logical you know. >> other questions so what is the thinking of the board on this topic.

>> we can send a letter i don't know we can say we're only paying for the medical process. >> uh-huh. >> i would be inclined to support the adoption but not the services. >> so listed the agenda is possible instructions to staff to scholar further the inclusion o. >> so come back with a design approach for this benefit or either one of these benefits that is being asked. >> again basically, i'm emotional not on data i think it might be reasonable to ask for exploration the disposition

benefits need to be a baseline if we were to proceed further with surrogacy to start with adoption to see what other costs and the additions might be useful for members. >> if we do only the adoption it that will be an issue with the defendant we added on adoption so i'm happy to approach the challenge if fair okay with going forward with just adoption. >> are we can have both we're an exploration we'll do that the form of a motion. >> i'd like to make a motion for the instruction for the staff to explore that as presented. >> post surrogacy and

adoption. >> is there a second. >> i'll second. >> okay properly there is a motion and a second we provide instruction to the h ss staff is it explore the benefit around surrogacy and the adoption and bring those the results of those design efforts back to the board. >> any other questions by the board any public comment on this item? seeing and hearing none we're now ready all in favor, signify by saying i. >> i >> . >> opposed? >> so ordered. >> thank you thank you. >> all right. we're now down to discussion item number ten. >> 10 technical e 10

presentation on the coby benchmarking. >> i'm senior vice president and part of consulting team the plan benchmarking so we've got information related to the hmo and poa they do a compared analysis on an ongoing basis to make sure the programs are competitive against the market is on page one we were starting with the hmo plan design oriented to the illustration we have the actual data elements the planned designed features on the far left the current 2016 plan design for kaiser and blue shield plan and in want middle of the column

berringer's we call them the book of collection of information think plan program that represents one thousand sponsors the database they're specific differences the industry developers we want to make sure we all the government piece separately from other employees the components within the businesses and additionally, we asked our carriers to provide their general book of business information for this comparison if we - we pulled out co-pay for physicians and specialists and some of the other key components in i look at cross h ss plan the book of business for and kaiser you'll note the co-pay of 25 there's is compatible to other plans offer you'll notice for the carries

within h ss the co-pays are are the same physician and puc and specialists we see variance in our book of biz business there is a campfire destroy trends to differentiate between puc and specialists and specialists costs more as well so two key components on a hospital design up for admission co-pay or per day co-pay and as you can see you have a per admission co-pay and for the berringer's for those that over co-pay they tend to be higher so your plan is more generous than the industry and those are offer a per that a day the co-pays were $1 per day from an outpatient surgery prospective for the kaiser book of business again, i on the h ss

plans are more generous for the outpatient sewers the emergency co-pays with relatively similar and that's another area we see trends in terms of higher co-pays and as their sixth e.r. usages and the next component we're looking at the pharmacy components again their co-pay structured and under the current plan with carries have you basically two tier plan generic and brands and many of the berringer's have a 3 tier co-pay structure we're move forwarding and looking at the co-pay i think there compatible comparable or more generous and then the mail order components are similar generous plan design with the h ss compared to the

beneficiaries on the ann hewitt and out carrier prospective i'll stoop there for any questions. >> i have some questions under the mail order or the r x not form the figures are authorized only is true but when the member gets authorization the question when is the co-pay to the member if necessary get the co-pay. >> it is under beforehand yes you're right the route to that may require a physician to authorize the co-pay is still the brand. >> and is lower. >> other questions on the hmo benchmarking. >> the next page the piano and

the components are different than the hmo design and as you can see that we do have co-pays but offer the co-insurance out-of-pocket and a benchmarking the health care program is the in network component we're benchmarking and looking at also known as book of business for a government and national employers so from a co-pay prospective and some of the physicians specialists and hospitals for those that offer co-pays you see this co-pays outlined on the business information i would say from a trend prospective as well we're seeing moore plans to a co-insurance basis versus and co-pay and we see that jr. and looking at the co-pay you're at 85 percent co-insurance that is comparable with the breshgz benchmarks from

the vertical and tend to see less generous from other national large employers in terms of the emergency co-pay again, some 0 models are co-insurance balances and some co-pays the co-pay have one hundred benchmark prospective the second category of benefits dedribble we look at the independent and individual and the family dedurable they're low and more diverse there an the benchmark it is double on the government benchmark and 5 hundred and 12 hundred for families we wanted to look at the out of pocket the particular pays before the plan pays 100 percent and you're out of pocket mooms are slightly higher than what we see think is benchmarks from the government and national employer

prospective again, i'm make the comment we see that are within the subject matter jurisdiction of the commission. upwards on the out-of-pocket their increasing their deductibles from year to year and looking at the generic the mail order drugs a co-pay for a moment you see their generous from the generic prospective as well as brands and non-formula. >> yes commissioner follansbee so the 85 percent are those of builds charges or negotiated charges. >> negotiated charges within the network correct. >> other questions. >> thank you thank you. >> this is informative didn't guide us to my action.

>> that's correct. >> next item. >> >> item 11 discussion ic d discussion. >> this was an carry over item an area of discussion but i can tell you question have one person who has probability for all the plains database that is profoundly interested in this and we should be as well just genericly because this drives a core what people pay ceding my education in this area started dare not talk about how a long time when i found a person was keetsdz for go heart pacemakers therapy coded slightly

differently and the same patient had too of them at $25,000 each tatted it can create a problem and have impact on you as a member as well as an employer it is rather arrest cane bit of stuff that is a factor and it is a major change the destroy so, please. >> thank you very much for that background this informational only we'll review and why it is changing and the potential impact to not only employees but planned sponsors and others this is actually an interesting area so this is the research and the estimate of the i ic d back to 1700s a statistician that developed this now more previously lengths in the us and adopted the 19 hundreds with the hmo pushing

that forward the 1950s so we'll have not had a lot of version changes since there then that is interesting in europe they're in the 20 edition we're coming we're moving forward more quickly in terms of what it is a international class of station two components one a diagnoses code that basically identifies the disease there is the procedural code xhoenlt which identifies the services render and it is across the board with our health system and obviously you mentioned for diagnoseic purposes and we were currently and ic d-9 now the tenth version effect on 2015 so all things concurred is the if you new

format of the i cd 10 a new component of i cd 10 the modification and the second one pc coding the change we had a dramatic change in medication and new diseases and devices we needed to make modifications to reflect those changes it impacts how coverage is determined and the treatment are going forward more things on page 2 this is a clinical administrations component diagnoses code we are seeing a 4 hundred percent increase in the codes if you look at the left there is about 14 thousand code we have 69 thousand code it give more

expensive sit around the disease at component if you have a broken arm your left arm versus our right arm that specification is occurring and if we move to postage there 3 the procedure coding system if you look at the numbers advertise mostly patient but outpatient that are combakd impacted from the 4 thousand to 72 thousand codes again a lot a much increased level of specifications the procedure coding process we thought weed add humor on page 4 to demonstrate some the champion i didn't bitten by a pig those are

actual quotes but fun to look at agree few of them and moving to page 6. >> if it is peoples to be humorous let us at least laugh please procedure. >> can i ask god forbid one bitten by a pig as as opposed to the subsequent encurrent our insurance carrier will find that every single time it is very important. >> (laughter) pursue. >> so the next couple pages talk about the impact to not only carriers but provider and employers and plan sponsors that was a significant under take and say it is awesome quiet the good news from a carrier prospective and system readiness prospective all of the major carriers

understood the changes that happened and we have not yielded seen any major fall out from the change the system so i think the obscures have done a good job in anticipating and obviously complications the various keys we anticipate issues with some of the data but anticipate that to be a fairly small percentage in total the carriers did a good job in modeling for the conversion process so in terms of page 6 we anticipated a two key areas we thought their might be impact one was around obviously the crosswalk and the incorrect coding process we may see some

lag in claims issues that are holding the processing to make sure the codes are correct we've not seen the fallout a declining in claims and not seen that happen that's the good news again in terms of some anticipated impact to the data and to costs we thought their might be slight changes in trends and how we look at the reflexes we can get to a more granule level of the procedure. >> the costs associated there maybe implications in terms of data it maybe more around accuracy versus cost increases that and that some anonymous the date. >> you have a point at the bottom of this page - i've seen

upcoming e up coding and through the use of c p t codes and set forth that is not necessarily will abate that people will found out how to use the koetsdz in quick order. >> i agree that is a good comment to think about a lot of software that looks at issues and that had to be updated with the codes. >> i'm not trying to cast a spell on the physicians but saying the process does that. >> this presentation is fascinating through organized medicine with the associations

attempt to keep postponing physicians hate this and as a kaiser i mean, my bookkeeper in fee practice kept coming back and ask me what i meant by the diagnoses and all that but kaiser kept coming back and they didn't do the coding until the business group wanted to know what we were doing we had to learn and he was surprised the physicians don't 90 know how to code but the codes change and there was no commissioner tang in code the figures signing off and so even within kaiser that was a tremendous we got pages and pages of requests so some of the exclusions in terms of not seeing a lot of this i'm not sure where it is homing it not st. mary's but it is there the board is if so physician take

overflow room to the correct coding they should. >> we're talking about the fact the solution were prepared and have physicians out there their software that is out there that you can put in our code you know it today and will crosswalk to new codes with that said, there's a set of codes common within the field i'm not sure we have 79 thousands but additional elements i'm not sure you can't know all the codes. >> can i. >> yes. director dodd. >> i wanted to comment we have arch periodic meeting with kaiser last week and commissioner scott came one of the things that went down the enter keeper that was a big deal a couple years ago their attributing to that better coding the fact they're not just

having a process but actually coding kudos to kaiser and those doctors. >> ultimately you wanted to change the care pattern of more data all right. >> i think we can want to move this to bed. >> we're actually done. >> a potential industry and client impact but on page 8 i want to refocus on that people may themselves because of the higher costs of something that may or may not accurate i'm not putting out on alarm but this could happen i wanted to focus on that for the members. >> there definitely can w be miss coding that relates to a different level of co-pay but a

situation to advantageous a lower software that is something that the carriers are negotiating with the providers what the impact it would be a negative impact but little miss coding should be on alert. >> all right. thank you for your time and presentation are there any questions additional questions from the board questions or comments any any public comment? . >> seeing none, oh, i'm sorry that commissiioner lim. >> for all the industry it is 2008 or the entire industry and yes all the industry were impacted. >> all right. we have excluded the rates and benefits portion of the meeting we have concluded the rates and benefits portion of the meeting

we are now moving to the finance committee commissiioner lim will be the presiding officer >> thank you item action item for the 2016-2017 and fiscal year 2017-2018 general fund administration budget commissiioner lim. >> so on february 8th the finance and budget committee met and unanimously approved the health services general fund effects budget for fiscal year 2016-2017 and 2017-2018 t the mayor want a two-year budget so we presented we've approved a two-year budget for 2016-2017 and during that meeting we suggested through the health services because in the budgets didn't include a one-time request for equipment it is

needed for some of the economics equipment to just perspective the mayor gives budget instructions to all department to cut 2016-2017 by one and a half percentage on the general fund support portion but not for the whole budget and the impact of that 2016-2017 is a reduction of $48,000 that is on our page four of the ipad and it is a keep up the good work for 96 plus so the finances and budget committee mostly approved the two-year budget and i'd like to entertain a

motion for the board to approve the 2016-2017 and 2017-2018 budget. >> i move we approve. >> second. >> i have a question. >> yes. >> okay. >> i saw wellness issues on that budget how do you determine what wellness into the 2004 and the other. >> the wellness activities everyone has assess assess two so all people across the country go into the 2005 and specific communications items related to rings go into the 2004 and the general fund things for active employees in the former employers. >> what's the difference what is 2005 and the 2005 are things

that would benefit all of our employees and retirees because everyone pays into the 2005 the general fund is they know that are only for active employees in the 71 and community college reports. >> it is fund by the general fund. >> pardon me. >> it is the city budget. >> that's my question thank you. >> so second. >> second. >> any discussion from the board. >> any any public comment? seeing none, we're ready to vote>> all in favor, say i. >> i. >> opposed? be that motion carries. >> congratulations to pamela on well done saw i'll not only add it pamela but ear entire

team this process was very arrest cane and you talked about the mayor's guidance a tremendous amount of worry about a two-year budget my hope the reason will prevail in this process the facts are this board and this system does have requirements that are expanding they innovate contracting at any level i hope and somebody's wisdom we can finally get that message cross pam you and your team will continue to present that adirector dodd. >> pam and drooping your woeshz were heard and they're no

longer the mayor's office and finance committee no longer considering having a fixed year budget for our department or other 38 departments this year it is only for the enterprise departments that are on the fixed year budgeted your woeshz we are heard thank you. >> i'd like to thank my staff particularly elaine that come in on december 1st and looked did budget in january, i appreciate that. >> and this chair i'd like to thank you. your going through the bills item by item to see that so thank you next item. >> >> item 13 action item approval the health care fiscal year 2016-2017 and 2017-2018

budget. the health care student delegate report fund commissiioner lim >> on the same meeting we also approved the health care social security ability fund we call the 20205 and an increase to present at the next board meeting with the $2 plus per month in order to pay for items undefined by the charter and the proposing reflexes from 2005 the $3 will be presented during the next month's meeting and at the same time the formula the staff will be presenting what the dollars increase per member will be spent for .

>> is with that said, is there a motion to approve? the health care system ability funds the 205 >> i'll move. >> second. >> i'll second. >> you'll second and second is is from commissioner follansbee. >> i have questions i can't reads this but is there an accounting from year to year like a projection what was the balance forward from last year and every year the started in 2013; right? the 204. >> no before that. >> that was increased from one 04 to 2. >> i'm talking about looking at how much money was projected and spent at the end of the

year. >> i show that was carried forward for the prior years. >> if you look at. >> this hospital projection nothing about balances and what went forward from year for year and spent. >> if you look at page 3 important, important with time revenues what happens is whatever is not spent out of the ongoing revenues drops to one time because if won't be available again so if it is not spent on ongoing and not the current revenues come on are greater than the expense of the ongoing expenses it go down to one time. >> where where did it go. >> 0 the one time revenue on page 3 the one time revenue

the way that for 2015-2016 projection that 1484 that was based on the revenue that h not been spent over the period of years it takes along from one year to build up over several years we've gotten one $.5 million one million dollars 4 plus this is on page 3 of the report. >> i'm looking at 3 under 2016. >> correct. >> we're it is 2016. >> i don't see what was carried forward from the year before. >> it was roughly i'd like to is the majority of money for the 1484 came from previous years procedural. >> i think we should be able

to see that you know what was spent and carried forward year to year. >> i'll be glad to bring that. >> it would be more clear was what was projected we'll not know for 2015 yet. >> we include in our monthly report bans our request. >> but it would be nice to see what is proemg and actually spent at the end of the year clear. >> okay. you can take that request back thank you very much. >> something else i wanted to ask about the material and sentence do that he work do we know if they work we've been doing this for two years thai statistics our satisfying money that we improve the population

health or anything any of the issues are making a difference. >> i'm going to turn it over to stephanie fishing she'll be able to answer that question. >> i'll only suggest if you come up and tells us you'll be able to save us millions of of dollars you'll have a role for life (laughter). >> stephanie fisher so you'll not see bigger trends on the programs from 3 to 4 years it is too early the best data we'll have is going to be the the assessment data be able to provide you a report on those baseline the little bit of change you'll see in a year and direction for where we're going.

>> on that point have you at least identified what particular metrics you'll be looking for change is it disease, bad mass index or the paper we've taken preventive therapy. >> we're starting to think that through now we're seeing what the medical data can side for us that's a moving target and understanding that particularly from a well-being the idea of well-being assessment a score to change that score has been associated with changes in health care costs utilization and so the hope we'll see shifts in that early outcomes we'll be looking for employees prospective about

how the workplace is supporting their well-being is early indicators between 2014-2015. >> how about the survey that was what i was referring to. >> in the 2014 before i went on leave and officially back that most we'll start to look at the year one data the two year will be going on the next couple of months the good news the analysis close together that's why you've not heard. >> any offer laptop in services like phone calls to people that have mammograms kaiser does most of that areas that over laptop. >> yeah. the idea behind the well-being assessment was

characteristics of well-being that can't be quantified there medical plans we'll have a new set of data people how that they're being supported and ideas around their emotional well-being not a lot of questions what conditions you have because obviously the better data will be in our claims data so that was the concept hidden the well-being assessment a new set of information so when we combine that with the medical data and the database we'll have a better picture. >> we use to contracted with was it carrying for the vendors to do some of the things like kaiser and blue shield they do preventive stuff already i don't know about blue shield. >> could they be doing some of the things >> certain wellness services

confused they're changing part of what wear doing is getting our hands around all the ways to communicate it, it is hard to every in terms of fitness discounts our members have access it is complicated depends on you're a retiree or testify and then on top of we have additional discounts that are fantastic but a lot for the members to digest we're working on cataloging that and making percentage clear and identifying ga gaps. >> you don't m have any idea until later on to see if those incentives work. >> the idea hidden the incentives they'll get people to take the well-being assessment we got people to take it for much less dollars for employees

but they were not to change their behavior but incentives to see how their were and to give us that baseline data we're going away from the individual and towards the departments to create a workplace that is well, that has a longer impact and start to give people dollars and set up the expectation are they doing it for your well-being or the money so philosophically. >> t-shirts and stuff. >> hoping to do more burn brandon's the past year we didn't do that we're looking for how to do that moving forward but we have been able to purchase materials that help to

celebrate our champions additional getting people the shape up challenges with small tokens it didn't set that expectation to be well, you get something besides getting to, well holy those items create enthusiasm but people don't say he did did shape up challenge to get this they say i heard about the people were handing out things but i as i understand up and got incentives that's the strategy we're. >> hope that work. >> what's that. >> you hope that works. >> when i hear you sdreb the best practices in terms of how those programs do get grounded communicated and people participated and that's half the battles is trying to get people somewhat engaged and get they're attention in a t-shirt does that

to kickoff or bottled water or what have you that's part of it to try again to attract their notice and get people talking about that unfortunately today you can't send an e-mail and have everybody we're inundated with e-mails you have to communicate in different ways and go back going back to basics is one of the ways people see oh, that t-shirts are water bottle it starts the conversation so that is really how we take limited funds and maximize impact. >> yeah, since i've been on the board i've been reading way back how to get people to do this motivate i don't know they ever came up with something that does that really work so i'm anxious to know what works. >> the answer not one thing

that works we're people different things you have to hit either the most risky targets one strategy or taking a few things that hit the most people 340r7 to find the balance if provides the best results for us. >> thank you thank you. >> well, i know i'm rehesitant to vote to increase this is it 204 and up to $3 is that. >> i mean - >> that's added to the premium. >> yeah. but presents it in march our next meeting we'll be approving the 204 for 2016. >> you're not approving. >> what's in the item we're approving the 205 and recommended increase that will

be brought up the next month's meeting. >> i want it noted that includes before education money as whatever and wale be talking about that and some detail toornt. >> pamela levin i think health services center sorry we're thinking of the general fund budget includes the fiduciary education it includes the board education and evacuation moved from the 204 to the general fund. >> i missed my opportunity to comment there on the record. >> since the employee engagement. >> right the employee engagement money and the 205 budgets for 2016-2017 the increases of going

to $3 per member per month is going to be the next meeting for the increase. >> any other comments from the any public comment? seeing and hearing none >> all in favor, say i. >> i. >> opposed? that motion carries. >> question have now included the finance portion of the meeting and go to the regular board meeting and we'll start with item 14 discussion president's report commissioner scott. >> with an item maybe two but one particularly about the way in which our meeting was adjourned last week this was a matter of transparency i want to just to be clear there was also a technical metrological change

the way this room and other rooms in city hall are when these boards and commission go into closed session historically we have been there is impression all the microphone are turned off and the ones in the rooms are operating that permanent not the way the new system we had initials of trying to share we could here the appellant and also to be sure we were secure and in closed session and so if anyone happened to look at the last week's meeting the ends of it i'm sure you all did you'll find that you see me standing up and saying the meeting was adjourned several steps need to be followed prior to that we'll be in regular

order we adjourned properlyly nothing off the record we'll take that under advisement and make sure we have the secretary brands as we go into closed session this afternoon okay. that's my report and p. >> item 15 director dodd. >> i will highlight the important things many my report first, we have progressed with the employee engagement discussion we met with the founder of the it s firm they've administrative code 5 hundred thousand employee engagement to all 50 states state of california tests the questions are written the right way we

mating may want to add questions and maybe four story questions they'll help to draft them so to 4 questionnaire and wanted to do a sweat shirt to shout out to bryan rodriquez that is instrumental in implementing our customer management system it went live last friday and exist to be able to document every conversation and every answer given over the phone will be the same consistent and hopefully improve our members satisfaction i also want to do a shout out to you've are heard about the 1094 required by the ante between

marina and mitchell and also mary in communication we distributed 41 thousand plus 95 forms singles the first time the addition of work but did it close to when people got their w 2 forms we when we go to the tax person it was a major under taking in your report you have a benefit transcription that was held for the board of supervisors request and then lastly i also included a right if the 2020 dedication looking at proposals to strengthen employees health benefits a thing i went to

i'm going to call an ste we agreed the wellness report meets she's written a report for 2015 and those reports are in your packets if you want to stephanie give those highlights. >> yes or no. >> just concerned that is item 1-800- i 350i9 be out of order. >> it is included that the unanimous plan. >> yes. it is the annual report. >> that concludes my report. >> thank you. >> i do want to calling your attention to one item the calendar of rates and benefits that is also i believe included in our report katherine; is that correct. >> yeah. a single calendar that lists the variance be things we'll be doing as we come to

final approval of the rates and benefits i did not want that to be overlooked did agreed upon calendar absolutely things move around absolutely, yes but give anyone that wants to know little time table we're working on we'll now move to discussion item number 16. >> item 167 discussion h ss reporting as of december 31st, 2015, pamela levin. >> pamela chief financial officer health services i just want to quickly update you on between the reports that question issued last month for year to date he november 2015

and this report through year to date december 2015 the primary difference is that for blue shield and that is they were unfavorable claims experienced there were additional claims in december more so than expected and which was worth about $3 million and - do you want me to okay and favorable exclaims for the self-insured dental plan for experiences over what was projects in november this is again consistent with what happened in 2014. >> that concludes my remarks you i know some of the commissioners are desperately trying to find

out of out our age on the screen is 1 hundred and having you scrolled through that quickly thank you very much. >> and that is a discussion item our next item is. >> item 17 action approval the h ss annual report and wellness report director dodd. >> i was the defer to stephanie and not belabor the annual report we accomplished all of the goals and objectives and i'm proud to see be the director of that department it is a remarkable list of accomplishment how is that report communicated broadly to the membership. >> it is posted on the website required i guess it is required the charter maybe required

anyway, i sent to the mayor and is board of supervisors that's it and now we do is electronically. >> i think to say nodded a lot of initial demographic data that talks about who we are and what we do thereer wonderful pictures the commissioners listed there and noted but the initial if you pages of the report do provide a very good summary of the scope of the work and effort about what the system is a very good working reference i'll commend that what do those people do on a thursday afternoon and kind of ties itself it is well done. >> and then i'll call an stephanie. >> okay stephanie now the annual report on that program.

>> stephanie sfooish e fisher health services the most exciting thing i've learned to be more brief. >> thank you. >> the besides you have the item before you the going into detail about the health services center opened in may of 2014 and 2011 is our first full year we were open all 12 months very exciting all sorts of things sorry i have a presentation. >> sfgovtv thank you. >> i'm a little bit rusty. >> that's quite all right. welcome back. >> so we increased our visitors per month by 43 percent and increased the participant

the individual people that come by 80 percent which is very exciting and really the effort of the group experience helped itself people come to group experience if you build if people will come it's been challenging we put effort into special events that attract not our typical kumbaya dodger but we get a place not just about group exercise but comprehensive walgreens well-being and seminars so the special events are good in bringing in addition people so our goal for next year is really to decrease the number of visits for group experience we'll increase the business for people more than just exercise comping for seminars and coaching and spell events and

communities and even just individual time the wellness center. >> another priority related to that is lined the exercise classes sell themselves in some regard but putting our efforts on the group exercise classes that appeal to folks not typically active we offer a walking group we offer an chuchltd schedules and yoga they tend have lower attention if we only cared been attention we'll put kumbaya across the board but providing not not cardiac

exercise but classes think strength you'll see our goal not just to to have maximum participation that will not reach all the people we care about and time to help in a way they need it so that's within of the goals for last year, we are reaching capacity in our classes for some of the larger classes like kumbaya we can't make those bigger we maxed out there so we're adding classes at the time to try to spread it out and provide opportunities for people that don't have the ability to come at noon and attracts new people and you'll see the classes at city hall have much larger size they're much larger space but limits for city hall the classes get cancelled and

special events out of over control but that's why you'll see huge differences like city hall holds 200 people and the wellness center maybe thirty. >> does city hall how does that relate you hire the teachers that how does that work. >> we have a relationship with rec and park to provide the folks and they pay for the classes that are here. >> we pay the classes at city hall as well it's the well-being center. >> there's a lot of people the class. >> last september 2014 we tringd and not having a lot of prarpg that was not a excited

list they carried it through the year and the words spread. >> our most important and exciting special events in the wellness center this year was the flu shot chaplain we kept it away from open enrollment and have all the people we have a huge success in bringing people into open enrollment a one-stop shop for flu shots this was exciting it brought in over three hundred folks and the second fair which a great partnership with all the various vendors and that brukt in a lot of people that hadn't here on behalf of the appellant it was a year and month after we opened the wellness and people hadn't heard about it but we're

bringing in now people that's all i'll say again the lamp the wellness center do you guys have any questions about the bigger well-being prom not on thatrm not on that point. >> this is the howled of the well-being supervisor farrell has gun gone for the day for about 16 months they have made huge strides in putting a foundation for this program an we appreciate them and supervisor farrell spoke to the boards commitment to the well-being and offer some inspiration that was very exciting we increased the

champions to two hundred and 9 champions 27 percent increase since the beginning of the year that's the effort of us talking to people the mayors meeting and a encouraging people to have more champions and reduced the number of departments that don't have champions at all they're not getting wellness so we're making strides but always room to do more and come up with the most effective way to handle 200 and 9 champions with the few staff that's a lot more than we anticipated with the good return challenges we're still working on. >> we did the consecutive well-being assessment within the city we were able to increase

participation at the san francisco unified school district we doubled it there and we also increased that dramatically at the courts due to specific efforts to work with those employers thanks guess to this board there was also the ability to offer the incentives to all employers that made our messaging clear and easy and i think helps from the members prospective as i said we're looking for the results this spring those are the big highlights i'm happy to talk more but from the staff unless conveys one questions are the characteristics of the department that doesn't have champions off site or some something that sets them apart

and harder random. >> one of the trends we're seeing the largest department tends to not have enough champions not a good ratio the champions to employees in terms of the departments without you champions there's some variability but tends to be the smaller departments. >> any 0 other questions thank you very much you and your team and the work this is a great evolution of effort over the period of time since you began and the results we're showing and the data comparisons that commissioner breslin was talking about this will help to reinforce us over time thank you for all your hard work. >> thank you for your support and patience. >> that's an action item

i'm more than willing to i'd like to entertain a motion. >> i move we approve the not to my knowledge report and wellness report. >> a second, it's become properly there is a motion and a second we adopt the report and discuss questions or comments any comments from the general public comment? hearings we're now ready to vote all in favor, signify by saying i. >> i opposed? so ordered added item 18 action approval the demographic report marina colorado linkage. >> replenishing you have so dubious distinction between us and the closed session.

>> i was impressed with stephanie brevity. >> marina health services we are preventing the january 2016 annual demographics report i'd like to alm rosemary. >> existence manager that takes all the wring numbers and packages them for condition summation i'll quickly explain how to read the report and then talk about some key summary statements there's loot to take home additional enjoy for those in the the audience you can again to sfgovtv.org we start out the report we going through our lives meaning our subscribes and the employees and the dents and we tend to repeat some of

the slices of data and give them to you in subsequent pages so after you get a look at all our lives we then focus on the members so our employees and retirees and then focus what is going on no dents and retirees with their dents dents and finally is few pages a pattern to the report, if you will, the other things i want to call out this report tends to be bias to our enrolled mel enrolled mechanics the statistics are happening across enrollments although we have a few statistics related to dental or populations to keep that in mind >> so on page one of the demographics report our key

summary we're not mel enrolled with one and 15 thousand plus lives and as i mentioned that is really looking at mel enrolled but the health system and the wave coverage if people look at the population we'll be higher than that in lives the health commission's supports and this year as you may know because you approved it we mentioned the 2016 with the piano product anothers enrollment of lives if if product one thousand 200 and 33 which sheet the expectation for the united health care and health services moving to page 6. >> what. >> page 6 >> thank you.

>> again breakdown the lives by age you are our average age i want to point out i know you pay attention to the statistics the graph on the top right a dip in the afternoon a little if 47 point to 44.3. >> i think that should be not we're thinking about our carriers quotes. >> think that should be not we're thinking about our carrier quotes we have a younger population. >> yes. >> please go ahead. >> absolutely pursue we also have a small population if you're wondering why that hemispheres about 1 hundred and 29 out of the plan but more people coming in aging 36.2 and

the average dropping out was around 47 that he and moving a simmer notes to page 16 comments when we look at our employee members and their dependents again consistently are seeing the enrollment in kaiser increasing so the lives there increased by about 1 percent and looking at overall lives 3 percent for blue shield looking at the total number that number stated flat but the proportionately lost about 2 percent when we look at the employee lives keep in mind again and on page 21 here's our

summary inform dependents and page excuse me. the table and pretty graphics to go with it we continue to see the majorities of our retirees are are living in the bay area and 36 san francisco prove or disprove proper we've seen a consistent percentage of breakdown of early retirees to the medicare retirees that stated consistent and in our total lives we didn't call out on page one a an increase to the dental a driver was analyst the retiree dental plan increases by one and 21 people to page on the fly sorry i'm a hockey fan i building under

trying to support decisions with data and came to mind in terms of the conversation earlier agenda item we talked about you are early retirees and the arts ones to the r-2 so the board anybody interested in focusing on page 27 going forward which helps look at which portion have dents and have children dependent in particular board it combined the early retirees since i'll give numbers the early retirees if you look at the retirees and that's a totalities of 5 thousand plus people the ones with dependents your r one and two are 2 thousand and 94, 67 have an adult only dependent and it is really 1

percent that have children or other dependents three hundred and 13 people keep in mind. >> i'd like to be being sure that slide is combined with the material that is psycho coming back to us with the analysis we requested we have a real profile of what the population is. >> absolutely we'll do that and a not to several going forward in the annual graphic and feedback a summary on page 29 this is the page that is the summary page before you get to break down by employers but really not a lot here that will surprises you otherwise the city and county is ti percent and the unified school district is our second largest proportion of lives and the population the

ucsf all their lives have the higher retiree to employee ratio we certainly seen a significant increase in enrollment in the highest proposition of that which was run into kaiser we saw a lot of hire last year and to change the affordable health care act and the health care coverage and ben the twenty-four hour people we saw the vast majority of those people in kaiser if any questions i'll entertain them. >> figure 4 on your report i didn't understand the - it was sort stepping stone yeah. so all lives covered on h ss

medical plans so there was sort of like - >> this one. >> i understand the graphics in terms of why there were changes at some point on the excise tax is it just pretty. >> it is trying to do several things i think the manager talked about that this can be confusing as a stand alone we'll take it under advisement. >> you know i mean, i don't understand i understand retirees without medicare but homing it didn't go to the left is it just i've i mean what's the excise tax mean. >> it means both nothing. >> an 0 zone okay. >> not a typical xyz but a components and in fact, the

popoff or the dependents or not including dependents we'll work on that one. >> that line was not straight and simple is better. >> i know that (laughter) excuse me. >> 27 is early retirees where. >> page 27 xhutsdz all retirees based on the conversation that was happening. >> i thought that was one earlier. >> i recognized you needed that so i only have those numbers verbally for you. >> okay preponderance of the evidence and paying attention to this meeting i'll provide the written. >> other questions. >> this is an action item. >> i'll move approval the january 2016 demographic report. >> been properly moved and

seconded and clarified is there me other questions or discussion by the board? any public comment? hearings we're now ready to vote all in favor, signify by saying i. >> i opposed? so opposed? soopposed? so ordered . >> health plan issues report if any, any. >> kaiser do you want to talk about opening your new building. >> oh, (laughter). >> kaiser permanente so we're

excited to announce with very mission bay facility medical office building opening on march 8 we had the honor of having commissioner scott and some of the h ss director dodd and some staff over to tour the facility it is approximately 200 thousand square feet facility that will be a full range of office building and we're very excited to be able to expand you are services aha the currency of the tour and looking at the services i think that will be a great benefit to the members of the system both from a accessibility and easy to get to there is plenty of parking around that great pharmacy will be a state

of the art and i thank you for your for seethe and putting that facility at that location. >> thank you can i ask a question. >> i have been a kaiser doctor will you have data think patient satisfaction or member satisfaction and employee satisfaction comparing the specialists that split up to certify fill both sides with puc primary care and looking at care and i imagine there might be some issues that might rise this is the new venture for kaiser in san francisco. >> right well, i, come back with more research we did tests. research surveys with every

member >> i'm curious there will be organized bans site of service. >> in other words, yes, i'm aware of the member satisfaction surveys. >> i'm come back with more information. >> thank you. any others items okay. if not we'll move to 20. >> item 20 discussion opportunity to place items on future agendas. >> anyone item 21. >> item 21 deduction opportunity for the public to examine on matters within within the board's jurisdiction. >> so i feel omnipresent nothing happened item 22. >> item 22 action item vote on whether or not to hold closed session for the follow-up commissioner scott. >> i'm now ready to entertain

such a motion. >> i ask we hold the appeals follow-up. >> is there a second. >> there is it is properly moved and seconded we hold the closed session for member appeal i have to not we're almost on time comment if the board? public hearings we're now ready to vote all in favor, signify by saying i. >> i opposed? so ordered. >> okay. we're back would open session and opening the doors the members of the public wishing to rejoin usould open

session and opening the doors the members of the public wishing to rejoin uld open session and opening the doors the members of the public wishing to rejoin ld open session and opening the doors the members of the public wishing to rejoin d open session and opening the doors the members of the public wishing to rejoin open session and opening the doors the members of the public wishing to rejoin open session and opening the doors the members of the public wishing to rejoin us and we're back in session i going to entertain a motion regarding the appeal. >> item 24 action taken in closed session and i report we not reports on the action in closed session. >> is whether it a second it is properly said under the appropriate keyed provision any discussion hearing none, all in favor, signify by saying i. >> i opposed? so ordered a action item vote to dloe. >> ready to entertain a motion. >> i move we don't disclosure. >> second? >> properly moved and seconded

all in favor, signify by saying i. >> i >> opposed? so ordered a and with that, we stand