help me, we had some conversation about how we could use our data to target the promotion of this smile way program to people with chronic conditions, so that we are getting the right people, but it's -- it's really great. sometimes your dentist will pick up on you developing the disease early on and refer you to a medical provider, may be a sign of a chronic condition you are not aware you are developing. >> i understand. but the people that already have it, and didn't have access to this prior, and so let things go, it would seem to me, if they have this type of a gum problem now, existing, they should all be included in this, too. >> it seems to me like -- >> commissioner -- >> kind of a narrow set of conditions. i mean, there are going to be people that fall through the cracks. >> could you speak a little louder. >> other conditions where people

need extra periodontal care, and 5 or 6 conditions. maybe they will broaden that. >> i think this is where the evidence is today, and we would certainly happy to look into where there may be additional evidence for preventive dental care associated with certain conditions. >> these are people that already have it. >> people that have dental disease, are you asking the dental benefit, how does that cover dental disease, and i have to look to my team. >> like -- >> to be eligible to three. >> people with issues that have to get that. >> would you please speak in the microphone. >> people with things that require more dental care and other conditions, i think it would be better if it was more broad so more members could use it. >> i can't see how it would be abused --

>> i don't know if it's an offering of delta dental or something that we can look into. >> i can't imagine anybody wanting to have their teeth -- >> we can investigate more. dental practice is enhanced as we speak, there may be things on the horizon we can investigate. >> sense of broadening the program if indeed possible. all right. commissioner lim. >> could you go back to slide nine? accident benefit rider, additional coverage. does that change the maximum annual allowance? additional coverage but will not change the maximum additional allowance? >> for folks who qualify, you have an injury, by definition, a certain accident, then it would add additional allowance. >> it would increase the additional allowance. because we have annual allowance

of 2,500. >> right. the rider would increase it up to additional 10,000. >> additional 10,000, ok. >> for a period of time following an accident. recognizing that there could be significant dental work, $2,500 does not always cover it. if you get hit in the face with a baseball or something, and so this is a benefit enhancement that would help folks in those situations. >> thank you. the other one, adult orthodontic, i like that one, because orthodontics is so expensive, so increasing the maximum, lifetime maximum of 1,000 is great. complaining, it's too expensive and i think 1,000 to the lifetime maximum is pretty good. thank you. >> president scott: all right. any other comments on these recommendations or design changes. commissioner breslin.

>> commissioner breslin: the cost estimator tool, why do you need that? you ask your dentist what is this going to cost, and they tell you. why do you need the cost estimate? add another $0.10 on. >> yes, that would add another $0.10, something rolled out broadly and delta is fully insured book of business. >> it's not really needed -- >> the tool would allow you to check costs before going to the dentist. so, some folks with like to shop perhaps or have an understanding about how much this will cost before i book an appointment, show up, one dentist to another, especially as we continue to encourage them to use the enhanced networks of delta dental. it's a way to empower members and their families to be a little more informed before having the services. >> the way i'm reading this increase cost, this is included as part of the smile away increase. >> so, i think we --

the way it's described here. it's listed separately and then you say it's included as part of the fee for the smile away. >> at staff we had the same questions and concerns you just expressed and so they weighed the additional cost for the cost estimator tool and it was, they waived it. >> they waived it. >> so it's going to be 0. >> it's not another $0.10. >> that's the way i'm reading it. >> not another $0.10, not another $0.10. >> not another $0.10 app to figure out on the phone. >> please continue. >> so, we talked about the benefit rider, the adult ortho was highlighted, orthodontics and coverage, to be in line with benchmarks, so slide ten, we have the estimated claims impact

for each of these benefits. and 1% claims and 2019 about $450,000. >> again, i just have -- >> please, commissioner breslin. >> the orthodontics, how many adults need orthodontic treatment? that's more -- >> invisalign, i have about five friends. >> adults? >> adults, yes. it's heavily promoted among adults now. >> really? >> it has become a bit of a fashion statement, particularly among millennials. >> you know, if it's heavily used i have no problem with it. but only a few problem -- >> no, i would dare say that's not true. the manufacturers and providers in this area have done a great job in marketing these types of either self-or prescribed treatments, and -- >> but are they needed?

>> you could say it's cosmetic, you could say whatever. it's happening. so -- >> yeah, and i think there are situations where it is. >> it is needed. my own mother recently got braces. as she aged, her jaw line changed so when she would close her mouth her top teeth started to rub on the bottom teeth which would wear down the tooth, so they had to do that so they would last another three decades. >> seems like implants are heavily used, i don't see that mentioned at all. that's something very common today and it's necessary a lot. >> that was not part of the recommendations here. all right. so, on ten we have hit that one. tell us about the administrative fees on 11. >> 11, delta dental service fee was up for renewal, so in 2019,

well, let me -- 4.38 per employee per month, 2016-2018, the fee actually went down $0.03, and then for the time period of 2019 to 2021, the proposed fee with the status quo services 452, and then with the smile way benefit up $0.10 to 462. so, our recommendation is to accept the 462 for the time period of 2019 to 2021. recognizing the partnership with delta dental. >> all right. moving on to the projected 2019 rates, illustrated on page 12. >> on page 12, with the enhancements, we have recommended and the fees from delta dental, as shown in the prior slide, we are recommending an overall 4.1% rate decrease from the 18 to 19 budget rates.

>> and that would lead to the summary recommendation shown on page 13. so, cover that and then entertain questions. >> our recommendation for the active delta dental p.p.o., would be to adopt the changes in the rating methodology, reducing the annual trend to 2%, eliminating margin, and adopting the benefit design changes, such as smile way program, adult ortho, maximum increase and removing the waiting period for the orthodontic coverage. in addition on 14, our recommendation continues to accept the 462 administrative fee from delta dental through 2021. and to accept the 4.1% budget rate decrease for 2019 versus 2020. >> let me ask you a question.

if we said we wanted to keep the rate the same, which is $4.54 currentl currently, do all the stuff you are talking about and the actual rate flat. >> instead of decreasing 4%. >> how much would that cost us? >> it would mean you would generate excess cash. so, it would cost you nothing, but it would create an estimated, additional 4% surplus. >> i'm saying if we used the stablization, more of the stablization reserve this year to keep the rate flat, the same. >> so you would actually use less. so, a decrease in the rate, including the stablization balance. if you want the rate to be flat,

we need to take stablization money out. >> don't want to do that. >> decrease the rate 4%, talking about 5% plus rate. >> i wanted to put that out there. commissioner lim. >> vice president lim: if he put the rate flat, using $5.56 of the stablization reserve, put the rate flat, we are using less of the reserve and changing our policy, because the current policy is one-third stablization reserve. >> president scott: i understand. i'm only asking a hypothetical, given the fact that we had a nearly doubling in this area of stablization increase, made, recommended some improvements and i'm just raising a broad question, what if we used more stablization money, is there another way to -- flat or decreased it further is what i'm asking.

>> if we used additional stablization money, we would decrease the rates even further. >> all right. i just raise that as a question. commissioner sass. >> commissioner sass: and i just -- the first bulletin on the recommended changes. page 13, is, what is the dollar, expected dollar impact on rates of reducing from, you know, of the 3% to 2% change and elimination of the claim margin. i don't see any dollars associated with this. so, when we are building up stablization reserves at the rate, what extent does this change, to what extent will this bring, change our rate calculation to affect that? >> yeah, i don't have the exact number on hand, if i recall correctly from our calculation,

it was around 4 or 5%. >> of what? >> decreasing. if it was 0, aggressive would take you from 0 to decreasing -4. i don't have the exact numbers, we can get them to you. but the magnitude -- probably about 4 to 5%. >> reducing premiums, that would also reduce the differential between total premium cost and utilization, it would create less of a surplus in effect. >> yeah, yeah. >> by how much? >> dollar-wise -- >> that's what i'm asking. seems like that would have been a number that would have been useful in this discussion. if you are making changes to change this balance of stablization money, it would be nice to know what the changes are likely to produce in dollars, you know, to effect that differential.

>> mike clark with aon, so, if you think about the change and assumptions and how that impacts the total cost rates, first of all, removing 2% margin, 2% right there, and we also take 24 months of experience and projects it forward, so we are reducing our trend assumption by 1% per year and so based on the time frame of the claims that we look at, it's approximately 2.5% impact there. so, in total about 4.5% impact, the 4 to 5% range that tom stated, earlier we talked about how every 1% of cost equates to about $450,000, and so approximately 4.5% is going to be 2.1 or so, impact and the change and assumption and the rate making will have on kind of naturally drawing down what's in the stablization reserve as we

go to the 19-20. >> the amount coming out is about 2 million less typically each year than the amount going into the stablization reserve. so, approximately $2 million impact on growth in the stablization. >> correct, for the 2019 plan year. it's not going to impact how 2018 plays out, but 2019 that's correct. >> commissioner lim. >> what if you could take the slide for the total monthly premium for 2017, use that as the base for 4% of that, is around 2 million or 1.6 million. >> thank you for that exercise, and those responses. are there other recommendations? >> so -- >> in summary? >> yes. so, that is all we have for the active p.p.o. there are other dental programs to cover, which we can cover quickly before you vote, so that you don't lose your thoughts there. and if you like, i can dive into

those on the following section quickly. as you are aware, the active employees are also offered delta care and united health. >> we are now on page 16 of the presentation. >> yes. >> yes. >> mr. president, you have different recommendations for delta dental, p.p.o., other plans, and you have recommendations that would take them differently or should we just take them, because it's just one agenda item, but you are doing a presentation currently on delta dental p.p.o., and you have recommendations on the other plans, too. so do we take this independently? >> the way the action item is written, it's a matter of approving the delta dental rates. >> as a whole? >> as a whole, that's the way it's listed here, unless it's the will of the board to

subdivide it. >> i would -- only because i'm simple minded, i would prefer dividing it, and actually voting, and these recommendations for this plan. >> ok. >> commissioner sass. >> i think while that is certainly easier to do it that way, the approval of the smileway benefit for the actives produces a rate increase for the retirees on the schedules that follow for the retiree plan. retirees pay themselves, and it's not subsidized by the city and is a, as i understand it, is a plan that has a relatively limited benefit generally speaking at a fairly high cost already. so, that one particular benefit for smileway has implications for the next two. >> if i can, i can clarify they are separate plans. we are proposing that as well on

the retirees to mirror. but they could be, they are not connected in that way. >> all right. so, is it the will of the board to separate or do i hear a motion to separate and act on the recommendations presented up through, and this presentation, page 14. >> i'm not sure, can we do that, if it's not on the agenda that way? >> yes, if you want to separate it, you can separate it. >> i thought we had -- as long as we are not dealing with something new we can vote as frequently as, we can vote on each recommendation if we choose. >> all consistent with the overall agenda item. >> okay. all right. is it the will of the group subdivide, and if so, a motion to that effect. >> i move we subdivide. >> moved and seconded we subdivide the recommendations in this presentation. discussion by members of the board? hearing and seeing none, we are

now ready to vote. all those in favor signify by saying aye, all those opposed, motion carries unanimously. now that we have subdivided, i'm ready to entertain a motion upon the recommendations. >> so. >> commissioner lim. >> delta dental p.p.o., adopt the changes, rating methodology, adopt design changes and program enhancements, and delta dental space from 4.35 to the proposed 4.62 per employee per month, and delta dental p.p.o. total rate decrease of 4.1% for 2019 plan year. >> you have heard the recommendation and the motion. is there a second? >> second. >> properly moved and seconded we accept the recommendations and outline and motion

foregoing, is there any comment? >> i would like clarification on the smileway program. can it be broadened after the fact? voted on this way, is there any way of broadening this group to people who already have peridontal problems and don't have the other? >> we can discuss it, i don't know that we can do that. but -- >> unilaterally. >> does not seem fair to me that people already have this are not going to be included in it. >> the way i understand it, and maybe you can confirm this, it's not people who are newly diagnosed that have diabetes or the other conditions that are outlined. if i'm a plan member and i have these conditions, the ones that are described here, then i could qualify for an expanded benefit intervention, correct? >> that's correct. >> all right. >> that's right.

>> now the question that i think you are raising, at least i want to be sure i understand it, there may be other conditions that might or could qualify or should qualify under this benefit. that was not part of the plan negotiations today, correct? >> correct. >> other conditions being beyond the ones described. >> yes. the current proposal, we can take it into consideration for future proposals. the program as outlined is limited to the conditions. >> all right. >> i don't know how we can vote for that, when people already have the severe gum disease and may not have any other, might not have hiv or arthritis or stroke, just happen to have years of smoking or something, maybe, whatever. but why you wouldn't include them in the 3 or 4, i don't understand that. i should ask the delta dental person that.

>> that a question, commissioner breslin? >> yes. >> would the delta dental -- why don't you have the other conditions included in the programming is what i heard being asked. >> national account manager. when this program was developed, we really focussed on the chronic diseases. we are in beta testing for a risk-based benefit approach, which would include other diseases or just needs in your dental care. so, that, we will be bringing back more information in probably the near future. it's not something that we have today. specific to your questions, we do have, i have a client that has done a risk-based benefit approach for their cleanings, so that's again something that we

can speak with anne as well as the, you know, team here, h.r. team here to really see if that's something that based on claim experience and based on your population, if that would be an approach that we would entertain in the future. but for today, this program is specific to these chronic diseases, so that you truly can identify that patient and then associate the dental need with that patient. >> all right. thank you. so, this is the program that you currently have, you are taking a broader look but not ready to offer that as a benefit design at this point in time, is that correct? >> that is correct. >> commissioner follansbee. >> from my -- from what i've heard this afternoon, i mean, i think we as a board should encourage programs that are

preventive, and this program is in fact an attempt at preventive service now with some cost that would help, hopefully prevent more serious problems that i think are probably already exist in our, in population, they don't need that kind of prevention anymore, because they have the disease and if we look at how we subsidize those services we should do that as a separate issue. but, this is a prevention and i think we should be encouraging prevention. >> all right. >> and get some experience in this regard. >> any other comments or questions? >> one more, just that you mentioned you had a client that had the risk-based dental cleaning. >> cleaning but don't do the root, the other thing included in the smileway. >> that's correct. >> and so that's the only thing offered is the cleaning. >> yeah, it's a separate approach instead of just giving every12 cleanings, it was a

risk-based approach where they set their cleanings at one, and then for anyone that needs a second cleaning, then that cleaning is provided. so, similar kind of to the smileway concept of prevention, and it's providing additional cleanings, 3 or 4, additional care for your teeth, you know, just different approaches. >> all right. so, we could have a very expanded design conversation but that's not before us today, thank you. >> exactly. >> the question is spending, is there any public comment on the motion? hearing and seeing no public comment, ready to vote. those in favor signify by aye, motion carries unanimous. ready to move to the fully insured dental plans which began

on page 15, the actual text on page 16. and you are? >> rick with aon. >> you have not changed. >> have not changed. so, offers five fully insured dental plans, two to actives, and then you offer the same dental h.m.o.s to the retirees injury to the fully insured delta dental p.p.o. for each of the fully insured delta plans, rates will remain at 2018 levels to 2019. based on the rate and renewals prepared by delta dental and united health care. we also have the option of looking at adding the smileway to the retiree population as well, since we have elected to add it to the actives. the following pages we present the renewals with the rates, so

on the next slide is a delta dental retiree p.p.o., so here you can see that with the status quo plan, the 2018, really 2021 renewal would be no change. so, they are proposing keeping costs flat through 2021 for the retirees. with the smileway benefit that, is the table below, then this would increase the rate by 1.9%. on the following page we look at the delta care h.m.o. plan, and here for both actives and retirees, no change from 18 to 19, and the rates are through 20-21. >> president scott: these rates below are guaranteed through 20-21? >> although we approve them

annually. >> i understand. the first sentence 2021. >> united health care dental h.m.o., rates are only through december 2019, 1 year, and no change in both, in either the active nor the retiree rates for this dental h.m.o. plan. >> all right. >> i will call out that initially there was a 4% increase, but the partnership, they were willing to reduce that to flat. >> all right. >> so on page 20 are your recommendations, would you -- >> correct. >> give those to us? >> we recommend for the retiree p.p.o., the delta dental p.p.o., that you accept the 1.9% rate increase to 2019, adopt the smileway benefit, so 1.9

increase to 2019, and held flat for 2020 and 2021, and dental h.m.o. plans that you accept the rate as presented. >> president scott: you have heard the recommendations. is there a motion? >> i have -- we can discuss it after. >> president scott: i'm waiting for a motion. >> i would move to approve item two and item three on this page, but i'm not comfortable with increasing dental rates for the active, for the retirees, given the expected significant increases they are going to see on access plus and trio coming up. my motion, i'm willing to move approval for item number two, delta care u.s.a. -- 2 and 3, exactly. >> what was that?

my motion, delta care u.s.a., h.m.o. plans to accept the rate renewals, no change in rates and move to approve u.h.c. insured plans, accept the rate renewals, no change. >> is there a second? >> second. >> are you -- are you saying no change, not include the smileway program? >> in those instances, they don't affect the rates. it does not affect the rates. >> they are saying add 1.9% to add that. for the retirees. >> let me put the motion properly on the floor as presented. we are dealing with page 19. the motion covers the second bullet point on that page and the third bullet point on that page. that's what the recommendation is, and that's what the motion on the floor is at this point in time. >> no change in rates. >> that's what -- that's what

they said. >> that would not be with the - the the - the the -- >> president scott: the motion as presented on page 20 is that we accept the rate renewals as presented in the document with no change in rates from 2018 to 2019, with a three-year rate lock through the end of 2021. that's one recommendation. the third recommendation is that we accept the rate renewals as presented in this document with no rate changes from 2018 to 2019 for u.c. insured delta h.m.o. plans. that is the motion. is there discussion on that motion? >> just to point this out, adding smileway benefit

enhancement, $0.87 for retiree only. retiree plus one, and plus two -- increase -- if we don't put the smileway, that means there's a rate lock through 2021. but if we add smileway increases as i said, again, $0.87 for retiree only, and 1.71 cents, so, putting this out, the benefitting to be able to smileway is more beneficial, especially -- i meant -- i know there is a motion in there, i would like to change to have

smileway added. >> president scott: all right. is there other -- >> if we vote with the smileway, then is it across the board increase to all retirees, the rate? >> president scott: yes, my understanding. >> for those who offer the delta dental p.p.o. >> for those -- >> the majority of retirees. >> if they choose it there's no -- >> proposal for the new year and we are not on the motion. i want to make that known at this point, clarifying something that isn't in the motion. so, if you could hold that question, i recognize it's germane to your understanding what is in the motion, so as privilege of the chair, i'm going to turn to the actuary and have him answer the commissioner's question. >> yes. so, the proposal for smileway would be across the board change in the delta dental p.p.o.

benefit design. so, all retirees in that plan would have the increase as pointed out by commissioner lim. there's not -- it's not a bifurcated plan to opt in and opt out, just one plan. >> president scott: all right. are we ready to vote -- >> make sure i'm clear. so we are not discussing the delta dental retiree p.p.o. yet, this is the -- we have to come back to that. >> president scott: that is correct, that is correct. >> no smileway discussion at this point. >> president scott: that's what the motion states. all right. and i'll ask the secretary to confirm that i have stated that correctly. >> yes. >> president scott: all right. so, the motion is, bullet points 2 and 3 on page 20 of the presentation, are you ready --

is there public comment on that? on this motion? >> yes, commissioners, claire swanski. what i understand about this is why delta is only offering this benefit to the active under the delta p.p.o. it would seem to me that delta would offer it for the h.m.o. as well, across the board for all actives and if you wanted to include it for retirees in the h.m.o. plan, fine. but it's usually like what delta gives to one they give to all of their plans, and when we negotiated this, because i'm going back to when we sat at the table and negotiated this and how the rates are supposed to work and what the city pays and now the contract rates that say what the employees pay, which is fixed, it's in their contract for a few years. if you make these increases in

the plans and change in the plans that delta ought to offer that smileway benefit across all delta plans, including the h.m.o.s. it's not going to be in the u.h.c. plan because it's only a delta offered. so, this is what has me confused about how you are bifurcating this, because i understand the delta retiree p.p.o., but it should be across the board and all delta or, i mean, just does not seem right. looks like you are looking to take people out of the h.m.o. plans and put them in the p.p.o. plans, and a lot of people are in the h.m.o. plans because of what they can afford. so, i guess that's my basic question i think is a problem with the motion on the floor. thank you. >> president scott: all right. thank you for your comment. any other public comment? hearing and seeing no public comment, we are now ready to vote. all -- would you -- we will have a roll call vote on this motion, please.

[roll call vote taken] motion passes 5-1. >> president scott: thank you. so ordered. all right. we are now left with the dangling part, what is your pleasure? >> i move that we accept the recommendation to adopt the smileway benefit enhancement, 1.9% rate increase in the delta dental retiree p.p.o. >> second. >> president scott: properly moved and seconded. adopt as outlined on page 20 of this presentation. the smileway benefit, and

accepting 1.9% increase. properly moved and seconded. any questions by members of the board? >> i have a problem with any increase in the retirees dental care. it's way too expensive now, they can't afford it. and adding 1.9% for a limited number of people, i don't approve. if it -- if it applied to all these people, who, retirees probably already have peridontal problems, and don't have the other conditions -- dental plan is unaffordable for a lot of retirees, actually. that's my -- >> president scott: commissioner follansbee. >> commissioner follansbee, m.d.: the diagnoses know no age. if we think the active employees would possibly benefit and experiencing how it performance over the next planned year, then, just because someone retires and is now aging, if

anything, the diagnosis become more likely and we may see more and more people need this. you know, people, an option to go into an h.m.o. plan, and my suspicion is the h.m.o. plan, if the h.m.o. provider and told i need to provide additional services, i would want to contract with delta dental as a dentist saying what are you going to pay me to see these people more often and all that, and they probably are not prepared to do that. and so our enrollees have an option to take less expensive and the risk associated with that, unfortunately, that's the reality. >> president scott: thank you for the comment. commissioner sass. >> commissioner sass: the difference in rates is not terribly significant in and of itself. the point that i was trying to make before is that looking ahead at what we are going to see for retirees for under trio,

and retirees, the dependence that can opt for trio or access plus, they are going to see a significant increase in premiums and certainly for any of those that have the city plan, they are going to see a very significant increase in premiums almost certainly, and given the larger picture of a fixed retirement income and significantly increasing medical insurance costs, i'm not interested in increasing the dental premium cost even by a small amount right now. it just adds up, it -- it's the total amount taken out of the retireme retireme retirement checks, and wherever we can minimize that, we need to do it as much as we can. and i don't believe the h.m.o. is an option for many. you are looking at the network of providers and where you can get the care and the rest, it is not -- access is not anywhere near as good. >> president scott: any other comments from the board?

commissioner lim. >> vice president lim: i fully support the motion and i think we offer this, and i understand that when we go to the big increase on the retirees. but the retirees are the ones that benefit most on the smileway program, especially retirees with these diseases, or stroke, and these are the most -- members that need the most of this benefit, so i would fully support the motion. >> president scott: all right. any public comment on the motion? >> my name is diane erlich. i would urge you to support the

motion. many are paying it on their own so this is a great benefit to them. and the conditions listed, many retirees have some form of heart disease, diabetes is rampant in this population. so, this benefit would save them money because they are already paying for these, i know i and a lot of my friends, we pay because we have conditions for four cleanings a year. we are already paying for them and it's such a small amount extra to pay for this. and i think people, even with regular medical plans, if it really is so horrible for them, they have other good options. so i urge you to support this motion. >> president scott: thank you for your public comment. hearing and seeing none, a roll call vote on this item. [roll call vote taken]

three yes, three no. >> president scott: we can't act on the motion. all right. we will move to, is that correct, counsel? >> that's correct, unless you want to revote, someone wants to change their mind. obviously we are going to need to get seven board members here before june 30th. >> president scott: if you wish to have a motion to reconsider, i'm willing to entertain that. >> i move we reconsider. >> president scott: you can't do that, because you offered the original motion. >> i did, ok, i'm wrong. then i don't. >> president scott: i think i'm correct in that. >> we can make another motion. >> this is an informal board, as

long as everybody -- >> president scott: you could not offer it, but since our counsel is saying we are not that formal here, i'll be willing to entertain your motion. >> i move we reconsider. >> president scott: is there a second to reconsider? a motion to reconsider the prior vote. discussion. >> so, i mean -- the benefits as i said, only adds $0.87 for the retiree only, plus 1, and 2.81 for the retiree plus two. the benefits -- this are the retirees that need most of the benefits more than the delta dental p.p.o. the reason why there was a reduction in the delta dental p.p.o. -- otherwise without the stablization reserve, it would have increased 1.9%, too.

but stablization reserve that brought the rate down. for $0.87, and if the retiree needs 3 or 4 cleanings, especially, and additional -- additional procedures, then it's worth, i myself as a retiree, i would need that benefit. >> president scott: thank you, commissioner lim. any other comments? >> commissioner follansbee, m.d.: i would just like to acknowledge the last testimony from the floor which i think is quite compelling to me, that many of our members are actually already attempting to follow the recommendations of their own dental providers, and this just actually puts the benefit in line with good dental practice is the way i see it, and so it might be an incremental increase

for many people, this will actually be an added benefit that will save them money on an annualized basis. >> commissioner breslin: my problem is it does not cover everyone, and every retiree who probably already has the problems. my main issue with it. and other options and the h.m.o.s, i don't consider those options because i've had bad experiences with the h.m.o. dental plans. >> president scott: thank you for your comment. >> commissioner sass: i would like to point out a couple of things. first of all, commissioner follansbee suggested this is an experiment, we are able to do for the actives, and we'll see what the results are, what the utilization is utilizing these benefits and so on, and we can do this. the we have an opportunity to do this, because there is a

stablization offset that makes this a cost neutral situation, actually 4% reduction in premiums for that group, so we have opportunity to have that experiment. i think it would be just as, make just as much logic for that experiment to continue for a year, and if we want to bring back the item a year from now, and an item that has never been in the policy before, that has never been available to retirees before and avoid a premium increase in so doing, we could certainly look at this 12 months from now and reconsider adding it at that time. but right now what we are going to see with the total cost of health insurance and dental insurance for our retirees, it is going to be quite expensive. while there may be some retirees who are paying extra for extra cleanings and the rest, there are just as many retirees on a very fixed income with a very

small pension. and are taking a large portion of that is taken out for health and welfare, and i don't believe they are getting several cleanings a year in all cases. so i think we need to think about the least fortunate with the more. >> if i look at the increases and see $0.87 a month, that's, you know, like 12 bucks a year, and if i have to get a third and fourth cleaning, all of those are over $100 each. i'm not real great in math, i only taught elementary math. but i'm looking at a couple hundred bucks a year, over 100 a year versus $12 increase on my premium, i'm thinking this is a good deal. if i have, if i've got a

dependent, it's like 24 bucks a year, versus again, the extra cleanings at the high rates of cost. i think this is a very good deal. what i heard from some retirees prior to our meeting was do you think we could get the smileway for retirees. and we think it's a good deal. not everybody utilizes the health benefits they have. that's the nature of insurance. not everybody may need it, not everybody will utilize it but we have it so it's there. not everybody may have these conditions, but they are more likely that some of these conditions occur as we age. i think that this is a rather remarkable benefit and our retirees will be thrilled to know that they'll have it because it actually will save them a lot of money or as commissioner sass points out, for those retirees who are unable to afford the extra cleanings that they are recommended to have because of their conditions, they'll be able to get them at, and have

them included in their p.p.o. and i think that's a huge, huge benefit for retirees. so thank you very much. i would urge you only one of you needs to change your vote. you don't even have to do the whole roll call again. if just one of you says you'll change, one of you who voted no, if you decide to change your vote, it changes what happens today and that would help retirees a great deal. thank you. [please stand by]

>> thank you for your comments. >> i am diane. i would ask a question. i really hope that you vote, someone votes to change the vote. if not, is there any possibility you could do what you did with the vsp plan and give those with the premier plan to buy the upgraded dental plan if we don't mind buying it and those that don't want to buy it don't have

to if you don't want to change the votes the other way? >> thank you for your public comment. any other public comment? hearing and seeing up he we are ready to vote. >> president scott. >> yes. >> vice president. yes. >> commissioner breslin. no. >> commissioner. no. >> yes. >> commissioner staff. no. sorry. >> the motion fails. it does not carry. we have no action on that item. i would ask that the staff take a look at a suggestion that was made during public comment about having this as an option in the plan if it is possible. that would be something to be considered. >> we will also pull the current

evidence on both prevention and treatment of chronic disease. i was trying to get the numbers. we are running the reports to see the prevalence of the disease. we know the adult population is 20% of population. i don't know what it is for our members that have chronic disease. rigorous dental care helps prevent it. i would imagine in the retire repopulation at least 60% or greater. we will validate that and come back and work with delta dental if there are variations. we will look into the question for existing pairry dontal -- peri dental disease. >> we have also for the dental

dental ppo not approved a rate guarantee for three years. that would be part of the unfinished business. that would need to be part of this review. i hope we can bring back something to act on in june. >> we have been at this for merely two plus hours. we have not -- excuse me. >> we have rate guarantee for dell tan dental. there is no change we approve ththe deltan dental care. all you have to do is renew it with no change. it fails to include it. >> just a moment. before you make that assertion you are in the right place. is what he is saying accurate?

>> as i understand it, you have a decision on the active and now the delta hmo and uhchno plan for retirees. the ppo for retirees is open. we need to bring it back in june if there is no action today. >> that is my understanding what we have done. i want to highlight the fact that we have not only not approved the smile away benefit but not accepted the three year rate guarantee as outlined here, is that correct? >> yes. >> thank you. now, i am going to get back to a standing point that i have that the mind can only comprehend what the end can endure. i would like to declare a 10 minute recess. into session.

we are now ready to take on item 7. >> item 6, i believe. that is the discussion item. secretary, if you would hold. given the fact we engaged in extensive discussion beyond which i apparently have no control. i would like to claim the privilege of the chair and move up the two action items that are listed on page of the agenda, then have the discussion on trio. >> that is action 7 and 8? >> yes. >> thank you. item 7. review and approve the blue shield non-medicare flex funding rates for the 2019 plan year.

>> we are dealing with item 70 the agenda. blue shield to 19 active and retiree rates. >> mike clark from am. we are going to review the rating and renewal for the two blue shield california plans that are offered to active employees and early retirees. on page 2 i am reviewing the hmo plans offered. we work with blue shield to assess bell the information and calculated increases 10.5% on

the total cost rate across the access plus rates and 5.6% increase for the trio plan across all elements of the rate cards. for both plans this represents increase of 8.8% including all components including medical and pharmacy costs with pharmacy rebates. the captiontation charges for certain services under a fixed cost in the blue shield plans, fees at attributable to the programs and large plan pooling cost. manage care organization tax in 2019 that will not apply after 2019. that is built in, and then per discussion that we had in the march health service board meeting, up for rate stabilization and amortization of $3,162,000.

the healthcare sustainabilities fee and best doctor fee we reviewed earlier today. >> any recommendation? >> the recommendation the renewal approved. we provided comments on page 4. if you look at the experience. keep in mind the 2017 access plus was the only plan offered. trio was implemented in 2018. the persons we review is actuaries is 2017 the access plus plan only. the experience was 1.4% higher than predicted if we recall from the march 2018 presentation on the claim experience for the blue shield plans. that is a factor that enters into the rating forecast. think about the 8.8% increase.

1.4% is attributable to the experience in 2017 in what was expected. we saw the health risk score scores increasing for the active and employee presentation. in the prior period to the existing data for the present period. then we relied on the blue shield inputs for how the individuals in the two plans distributed when trio was introduced. 40% migrated to trio in 2018, leaving 60% of the prior access plus population staying in access plus.

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