agenda today -- extensive agenda today. let's begin. i now call to order the regular meeting of the health service board for the city and county of san francisco. i would like to have you all please stand and join me with the pledge of allegiance. [pledge of allegiance] >> president scott: now i will ask the secretary to please call

the roll. >> clerk: thank you. [roll call]. >> clerk: we have a quorum. >> president scott: all right. i would like to go to action item one. [reading item #1] >> president scott: are there any edits, amendments, clarifications or comments on the minutes of the prior meeting? >> commissioner breslin: i move to approve. >> president scott: is there a second? >> vice president lim: second. >> president scott: we approve the minutes of the prior meeting may 14.

excuse me, may ten. is there any further discussion by members of the board? is there any public comment? hearing and seeing no public comment, we're now ready to vote. all those in favor signify by saying aye. [ayes].. >> president scott: the minutes are approved unanimously. excuse me, i had to confer with my colleague on an item. we will now begin with the rates and benefits committee. we are going to go through a variety of approvals on various plan rates and rate cards today and so forth. so, as -- just to get a sense of

what our timetable must be today, there will be another commission occupying this room at 5:30. out of courtesy, we need to be complete with our business by 5:00. we have a member appeal today that we want to consider and we want to provide adequate time for that. so, my hope and expectation is that we will have all of our rates and benefit committee and board business done by 4:00. that is our target. and then we will take time to go into closed session to have the member appeal and hopefully be completed by 5:00. that is the target so that out of courtesy, the next commission can occupy the room. we can get our stuff out of the way and so forth. just so that everyone understands the ground rules. we're not going to try to cut anybody off or truncate

presentations or information that has to be shared, but we need to be conscious of the time. and i'm asking your cooperation that we do that. all right. i'm going to claim the privilege of the chair and adjust the agenda. i would like to go to the president's report. >> clerk: item ten. discussion item president's report. president scott. >> president scott: we have with us a representative of the board of supervisors and we also know that we have a very important activity happening in the life of this board within the next two weeks. so, at this time i would like to defer to commissioner breslin to introduce our visitor and then i will pick it up after that. >> commissioner breslin: this is sharon johnson from the board of

supervisors, working with supervisor sheehy and she wants to give a little proclamation. >> well, i'm here because of you, mr. scott. you and i joined this board together when it first began as a separate city department. and i've always held you in personal regard. not only for your professionalism, but the extra bright light of kindness, thoughtfulness, thoroughness that you provided to us both as commissioners and as a friendly person in our lives here. i know this job has never been easy. you came into city government without the experience. that in itself is a challenge. and then you took it on with a graciousness of the woman you are. this board will load a lose with

your department. your husband, your family, your friend will gain a lot because you will be free from all this work. but i want to thank you from the bottom of my heart of the appreciation that i feel for you as a city employee who brought nothing but grace and dignity to this office to the city. the members of the health service system board are very lucky to have you. because supervisor sheehy, who i happen to work for now who also serves on this board and can't be here, we have a certificate of honor for you. and it is to lainey scott. i should have brought my glasses. [laughter] >> for her commitment, dedication and outstanding service as secretary to the health service system board for distinguishing herself with integrity and professionalism in

her work, the san francisco board of supervisors extends the highest commendation and well wishes for her retirement. thank you. [applause] >> thank you. >> president scott: to just continue in this vein, i would like to have the commissioners and the others on the dais sit until the appropriate moment. but lainey, i would like to have you come and stand next to us. [applause] >> president scott: it is my distinct pleasure to present this plaque to you. on behalf of the health service system board and the staff, in

honor of 12 years of exemplary service and xhcommitment to our system, the health service system board recognizing an extraordinary colleague and friend who will be missed and we wish you the very best in your retirement and in the years to come, june 2018. thank you. [applause] >> president scott: do you want to say anything? >> i do. i almost don't know what to say. but i'm overcome with emotion. and i normally don't get this way. but it's true. i started with no experience and it wasn't easy. but working on this board was such a great experience. i found that the commissioners were so wonderful and so open

and forgiving and that we all worked well together. and it was really a wonderful and worthwhile experience. and i also want to say thank you to abbie, our new director. i haven't worked with her very long but it has been wonderful working with her. and i have really enjoyed working with the board. it has been a great experience. thank you so much. [applause] >> now back to work. [laughter] >> president scott: sharon, we thank you for taking time out of what we know has been a busy schedule and busy few days for you, for coming to do this. thank you too much. >> thank you. >> president scott: we will now go back to the regular order and there will be more in the president's report in due season. we have had president's report part a at this point.

i'm sorry. commissioner breslin. >> commissioner breslin: i don't think ms. scott has missed a board meeting since i've been here. that is remarkable. >> actually when my mother died unexpectedly. so, one board meeting. but that was it. >> president scott: well, thank you again for all that you've done for each of us. >> you are welcome and thank you. >> president scott: okay. we now will go to our regular rates and benefits items. and then we will proceed accordingly. >> clerk: thank you. item three action item. [reading item #3] >> president scott: i would like to -- as we begin this particular item, commend aon for

dragging myself and commissioner breslin for the review of so much of what you are going to see this afternoon. and we have had a series of board presentations and the executive director and other members of the staff about this. and i just want to be very, very clear that this is not a solution for all time. we are basically dealing with 2019 and we understand clearly, at least i know the members of this board do, that we have some work to do to talk about longer term stability of the city plan and how we're going to address that. so, i want to put that as kind of a contextual framework around this item. and we've been trying to say that as we've gone through a series of discussion points and so on and so on. but i think it needs to be said today as well. i want to commend aon, juan and mike, for what they have done to

kind of distill what has been a very complex set of data and issues into something that is understandable. at least to this point. maybe that will get confused today. we'll find out. but it shouldn't. okay. so, please. >> matt clark, aon. thank you, president scott and lainey on behalf of ann and the rest of the vendor partners. congratulations on your retirement. >> clerk: thank you. it has been great working with you. >> so, we are going to start with the agenda to walk through what we will talk about today. a quick recap of the approved actions at the may ten board meeting, leading into the rate card discussion and two alternatives that we will present for you today. so, if we go to page three, back on may 10th, these were the five changes for the united healthcare city plan that were approved. the aim is promoting long term sustainability for the city plan. you see the items applied to

active employees and retirees. so, that brings us today to talk about the application of these decisions and the rate cards. so, on page four, we outline the aggregate financial impacts. we talked earlier about individual impacts for each item with the approvals. we now look at the aggregate impact. this should save a little over $1 million in total cost savings and you can see how that is divided between member and employer. these initiatives are looking to drive lower contributions for certain members of the population. and these do include application of 1/3 of the rate stabilization balance that was approved at the february meeting. so, on slide six, we just want

to remind that everything we are going to look at today is with a through e included. those are approved recommendations and approved actions now. we did include the status quo rate cards in the appendix just so everybody is reminded if they do want to have that information available, what the rate cards will look like. but everything we are going to talk about going forward is all with the premise that a through e have been adopted. so, on page seven, we talked at the meeting but did not take any actions on the issue of the rate stabilization funds. and again as i talked about earlier, forpolicy, 1/3 has been applied in the rating in one scenario, but we are recommending today that the board consider and we recommend

approval of utilizing the entire stabilization balance and the rating for 2019 and we will talk about why in the pages that follow. so, on page eight, it outlines the two scenarios that we are going to present to you today. now, city plan and city plan choice not available. these are the plans we're talking about. city plan choice not available created through action a from may 10th. the base is applying the 1/3 that was previously approved for the rate cards preserving the remaining 2/3, which is $1,000,007 remaining for future use. scenario two is suspend the city plan stabilization policy for 2019 and apply the entire rate

stabilization balance for 2019 rates and apply it proportion proportionally to active employees and early retirees. >> president scott: so, to be clear, your recommendation is number two in this presentation? >> that is correct. >> president scott: in other words, we would suspend the policy and apply the entire reserve to this year's activity? >> correct. >> president scott: okay. >> so, i'm going to spend a little time talking about the rationale for our recommendation and present to you the scenarios. so, the reasons as you look at page nine to apply the full stabilization reserve balance for 2019 rating are twofold. number one, we want to mitt grate the potential migration of the healthier members out of the city plan knowing there will be significant increase in the contributions. for comparison purposes, about

4.5 million in stabilization funds was used in the 2018 rating. even with full application, we still only have 1 million 661,000. that -- 1,661 million dollars. we are trying to dappen that. we want to alleviate potential for adverse selection or minimize potential for adverse selection. that could occur if we see a migration of healthy members out of the city plan. now, under two bullet points, i have a very important point to make. i know pamela will refer to this later today during her financial report. when you consider all elements of cost in the city plan for the first nine months of the fiscal year, it is running close to expectations. if those forecasts continue, which at this point we would

expect they would, it should lead to a stable environment at the end of 2018. now, certainly we know claims are claims. and there is the potential for deviation. but at least at this point based on what we know through the end of march and what pamela will discuss later today, the city plan is running at expectations so far fiscal year to date. so, it is our belief that the hsb should use any reasonable means for the hss members to mitigate contribution increases to the extent possible. and we view that's the purpose of the rate stabilization reserve. then we have some additional commentary on slide ten. >> president scott: so, if you move to slide 11, you're actually in the two scenarios at

this point? >> that is correct. we want to show everybody in the spirit of transparency how the application of the reserve monies play with the top half of the page representing the first scenario with 1/3 use. the bottom half of the page representing the full use. so, for instance, the lower left hand of each table you see the 554,000 is the 1/3 of the balance at the top. or the 661,000 at the bottom. we're applying the stabilization reserves as they have always been applied. i think we showed you an aggregate in the past. we are just simply using this form to illustrate how that would distribute between active employees and early retirees. >> president scott: all right. >> and page 12 some commentary that explains the direction of

the figures. >> president scott: so, then we go to the rate cards themselves. >> correct. >> president scott: page -- >> so, page 14 sets up the rate cards. explains scenario one and scenario two. you will see 9938 rate cards and then 19683. they incorporate the items that were approved on may 10th and then you can will also see for city plan choice not available, we are specifically targeting contributions to be equal to the blue shield access plus plan for the active employees and single tier early retier r -- retirees. >> president scott: and you brought that to us? >> correct. >> commissioner breslin: that's for active and retirees. >> active and retiree only tier. there's also relief for full families. we are applying other mechanisms

to give relief in city plan. it may be best to illustrate with numbers. slide 15 is the early retier rees as well as -- retirees as well as the contribution strategy for the active employees. so, to acclimate you to this table, i know there are a lot of numbers. we start at the very top of the page with the monthly contributions, py-2018, those are the monthly contributions being paid today by the members in city plan. the active employees, early retirees by tier. the next four numbers illustrate our projected 2019 contributions, our recommendations to you by scenario. so, the coding is where you see cp, that's city plan. where you see cp-cna, that's

city plan choice not available. participants will have city plan where they don't have choice of other plans. and then you will see ask number one, that refers to scenario one, which we talked about earlier. that's the 1/3 use and s number two is the full use. so, what i encourage you to do is hone in -- maybe let's start with the early retirees. let's hone in on what the contributions look like for city plan participants between the 1/3 use, scenario one and the full use, scenario two. in that case, the member will end up paying approximately $16 less per month under scenario two versus scenario one for the retiree only. on the retiree plus two or more, you will see reductions because

of recommendation in action e that was voted on last month. but still providing some additional relief for those city plan early retiree full families a $58 difference in the projected contribution. lowering of 58 for scenario two versus scenario one. this is where you see the benefit of applying the stabilization monies in full to the member. it's that difference between two s-1 and s-2 lines. that cascades into the active employees. s-1 and s-2 lines. that cascades into the active employees.h s-1 and s-2 lines. that cascades into the active employees.e s-1 and s-2 lines. that cascades into the active employees. >> president scott: i will ask if the board members have specific questions about the chart itself or how we have gotten to this point. because awe you said there's a lot -- as you said there's a lot of stuff running together. now we are looking at the actual

resolving numbers. so, are there questions or concerns? commissioner breslin. >> commissioner breslin: page 12. the financial benefit passes to the employees. for the early retirees, the majority of the financial benefit passes to the employer. so, i don't understand how this benefits because most employees don't pay the premium. the city picks it up already. how is this benefitting them? especially in the -- >> active employees. there's a thousand total active employees. 212 receive the full 100% employer contribution as employee only. but there are over 800 that don't and so, that is the reason you see the distribution on the active employees.

when we talk specifically about the early retirees, the actions you took last month have actually benefited more than half of ely retirees already. so, if you go back to the chart on slide 15, the fact that the families are paying a much lower increase or in fact decrease for full family retirees already is reflective of the decisions that were made last month. so, in a sense, that benefit has already been factored in for the early retiree families even before we talk about scenario two. we view scenario two as still providing additional systems to the early retiree families but also to the early retiree only that the action e doesn't address. >> president scott: so, to put

some numbers to that explanation, just bear with me. you're saying an early retiree family that's either retiree plus two. >> correct. >> president scott: currently they are paying on$1,530. if we went to scenario one, their projected increase by applying 1/3 of the fund, their premium would reduce to $1,527. >> correct. >> president scott: if we used all of the fund, it is going to reduce to $1,470. >> correct. >> president scott: so, the difference is between $1535

currently and change to $1470. am i following that correctly? >> exactly. >> commissioner breslin: but also on that page, it doesn't matter where you use s-1 or s-2 except for the early retirees plus one and early retirees plus two. all the way across the board it's the exact same if you use s-one or s-2. and there are more people in choice not available if i remember correctly. >> for the early retirees. correct. >> commissioner breslin: right. so, i mean, i don't know. to me it's not benefitting the retirees. >> my way of looking at it is actions a through e and specifically action a because that created city plan choice not available is what provided

the reduction in contribution between current and the city plan choice not available. and we specifically designed the rating so that the contributions paid by members, the active employee members and then the retiree only match the second lowest -- or second highest cost plan in access plus. and so, for instance, $100.26 is lower and for the individuals who don't have a choice of blue shield or kaiser, that $100.26 matches what the blue shield access plus individuals will pay for that coverage. now there's still some additional benefit for the families. now i'm working within the construct of the city charter

employer contribution and we have a separate discussion document. we may or may not have time to go through that in detail. so, that is the guide for me when i set the recommended contributions for the retirees. with application of the formula, i am able to produce incremental reduction in contributions for the early retiree families through scenario two. it's just that we created the reduction for the retiree onlies already through the actions taken last month. >> president scott: are there questions? commissioner sass. >> commissioner sass: i just wanted to make the observation that to the extent that part of the goal of this is to avoid migration out of the plan because rates are too high, i think it's really important for everybody to appreciate that for the active employees, no matter

whether we go with scenario one or scenario two, their rates are going up dramatically for every category. the value of this change, this million dollars change is doing very little. if you are an employer and you are seeing a reduction and you look at what's going to happen, going to be paying twice as much or one and a half times as much of what i paid last year or more as you look at this across the board. i think the migration out of that population is likely to be significant in any event. if the goal is to prevent that, this will not accomplish that goal. so -- and i just think it's important to appreciate that

this additional million dollars is having a very small effect on that group. and on the early retirees, although it lookse it is helping retiree plus two a bit more and even retiree plus one. i don't have a distribution of members here how many are in each of those three categories off the top of my head. but if we're trying to avoid outward migration, people in the retiree only are seeing their rates double. we have several groups that are not likely to -- they are only going to see one number when they get their pamphlet. they are not going to see this comparison. they are not going to see what we have done to help them but they are going to have the same reaction regardless of what scenario we choose. >> i think every observation you have made is very appropriate. what i would suggest is for this year we're taking kind of that first step. we're doing as much as we can within the framework of how the

employer contributions work and certainly with the benefit -- i talked earlier about the $1 million aggregate savings. clearly the strategic process and what we need to look at for city plan in 2020 and beyond is paramount. >> commissioner sass: let me just say i don't want to give the wrong impression. i was not in favor of using the stabilization money at the last meeting. but i have had a chance to review the utilization data you referred to earlier that pamela prepared. i spent a couple of hours with pamela and director yant. excellent analysis by pamela and i have also been on a conference call with you and pamela and director yant in the last couple of days. i can support scenario two myself. i no longer feel there's this overriding worry about not having adequate funding for 2018

that would require extra money. so, i'm not opposed to supporting scenario two, if that's the will of the rest of the group. but i do think it is important for everybody to appreciate that the benefit is -- a million dollars doesn't buy a whole lot of benefits on rates because the rates are going to go up by a significant amount for many. >> president scott: we would be happy to take any contributions by any individual commissioner to augment -- [laughter] >> if i can address commissioner sass. there are approximately 600 individuals in early retiree only. approximately 170 in retiree plus one and approximately 25 in retiree plus two or more. >> commissioner sass: retiree only is the large here's group and they are getting almost double their monthly premium.

>> president scott: are there any other questions or observations from the commissioners around this rate card? all right. mike, i'm going to ask a question at this point. we've seen the overview. is there anything else that would edify at this point us taking the recommended action? >> i would like to take you to page 18 and ask for the action. >> president scott: okay. >> so, we jointly recommend the following. that we first suspend the self-funded stabilization reserve policy on a one-time basis and spend the full balance of the december 31, 2017, stabilization rate reserve in 2019 city plan and city plan choice not available and approve the scenario number two rate cards for the 2019 plan year for city plan and city plan choice not available plan which

reflects the full use, the $1,661,000 and the rates follow. >> president scott: you have heard the recommendation. is there any further discussion by members of the board? i'm willing to entertain a motion. >> commissioner sass: well, you would move -- because scenario one is already approved. but you would move to approve scenario two. >> president scott: all right. are you moving to accept the recommendation as outlined and described on page 18 >> commissioner sass: yes. approving the scenario two rate cards for the 2019 -- >> president scott: all right. you have heard the motion. is there a second? i will second. it has been properly moved and seconded that we approve the recommendation as found on page 18 of this presentation.

is there discussion? >> commissioner breslin: i still want clarification since most of them you say retirees are single, not family. the majority of them. >> correct. the vast majority are single tier. >> commissioner breslin: so, with scenario two it's $84 they save. scenario one it is a hundred dollars. that's not a huge difference that i see. that's my point. and with choice not available, it's the same. so, i mean i -- if everyone thinks this is really important, maybe so. but i have trouble justifying this for this small amount for that group, which is the smallest group when it does state that most of the money goes to the employer. >> president scott: do you want to repeat the last portion,

commissioner breslin. >> commissioner breslin: yeah. most of this goes to the employers as you stated. that's why i have problems with this. i don't see a big difference in scenario one and scenario two for this particular group and that's the one who has the most members in it. >> so, if i may take you back to slide four. >> president scott: yes. >> just to illustrate that the benefit to many retirees has occurred through the passage of a through e. >> commissioner breslin: i know. but now we're just talking about this. not the other -- >> exactly. understood. >> commissioner breslin: that's not where i am right now. >> president scott: all right. are there any other points to be made? commissioner lim. >> vice president lim: this one that worries me most and using scenario two and applying

1,077,000 dollars like the -- the 93% goes back to the employer. it is because of the [indiscernible] >> vice president lim: that's the one that worries me the most. i understand the effect on the migration. but still the impact of the -- a applying the impact. only 77% goes back to the employee and 93 goes back to the employer. [indiscernible] >> vice president lim: that's the one that worries me the most. >> actually, the employee contribution amount remains the same between scenario one and two because it is fixed at the

imployer contribution for blue shield access plus. >> vice president lim: thank you. >> just to make a broader observation, we are kon constrained by a lack of resources. if we could apply more money, we would have a different result. but the facts we are where we are. and i don't know how -- we've kind of taken this and stretched it in several didn't ways over the discussions of this meeting knowing that ultimately there's going to be a mitigating effect. now we're talking about the magnitude of the mitigating effect and i don't know how we get beyond that without more resources. so, i understand. i profoundly understand the concerns that commissioners are expressing, but i don't know how we get out of the box here with what we have got by this limitation of $1.6 million.

>> commissioner sass: the reduction in payroll deduction is not significant for many people. they are going to see a large rate increase regardless of what we do here. and i don't know whether it's going to mitigate migration or not. i kind of suspect it won't mitigate very much. we will see what we saw last year when we saw this. many years ago we set rates quite high anticipating a large number of members and utilization. when we made that change, it was a huge out migration -- so huge in fact that it completely changed the whole actuarial gains and results. that produced the gigantic

stabilization reserves that we used. and in using those stabilization reserves, keeping those rates throw we have seen the number of city plan members grow again. now we are doing what we did several years ago and it has a predictable outcome which is there will be out migration. i don't know that will do to the analysis. i have no clue. my main reason for supporting only is that as bad as it is, if there are people in the active population who feel that -- these people do have other choices in that group, the active employees except for the choice not availables. if they choose to move to another plan, so be it. but we are doing as much as we can to help them. for those who feel they can't change, for some reason and i don't know -- i can't possibly predict what -- all the variety

of reasons might be. we have done something to help them somewhat. and it's a slightly smaller deduction than it would be otherwise. it's not significant, but it's something. that's my reason in the end for supporting it. my only worry was that this year we would have actuarial losses. >> president scott: are there any other commissioners from the commissioners? commissioners breslin. >> commissioner breslin: a lot of them are not paying the premium anyway. under the 939383. but the other ones do not. >> president scott: we know what the population is by category. any other comment beyond that? mike. >> if i could just add one more point. in the way that we're distributing rate stabilization dollars on the rate cards,

nothing has changed about the flow of who receives from the employee/retiree or the employer for what has been done in the past. i want to emphasize even though we are displaying the distribution for the first time to this board, the math has always worked that way in the past as well as for 2019. >> president scott: appreciate that clarification. any other comments? is there any public comment on this motion? hearing and seeing no public comment, we are now ready to vote. on this one i'm going to ask for a roll call vote. secretary. we are voting on the recommendation as contained on page 18 of this presentation. just so that we are clear. >> clerk: president scott. >> president scott: yes. >> clerk: vice president lim. >> vice president lim: yes. >> clerk: commissioner breslin.

>> commissioner breslin: no. >> clerk: commissioner ferrigno. >> commissioner ferrigno: yes. >> clerk: commissioner sass. >> commissioner sass: yes. >> clerk: passes 4-1. >> president scott: that is. it is a tough call and we have more to do in the upcoming days. i thank aon, abbie and your time. there is much more to be done around this. so, thank you. all right. next. >> clerk: item four. [reading item #4] >> hello. tom ricks from aon. >> president scott: hello, tom. >> today i have an update and recommendation on the retiree dental ppo. if you recall at the last meeting on may 10th, the board approved all of the active dental programs, including the

active ppo and really all of the dental hmos. the only outstanding dental plan is the retiring ppo which was proposed to the board to include the smile way benefit and we had some homework and we are back to make a final recommendation on that program. recognizing the partnership of delta dental with the population that this board serves, delta has agreed to hold the rates flat so no change for the smile way program. so, we are now recommending on page 2, the recommendation is to accept the rates as shown on slide three, which will be to add smile way with no change from 2018 to 2019 in the premiums and those premiums would be guaranteed through 2021. the following pages in this deck

have -- to remind you of the smile way program, a description of the program as well as some data on the prevalence of these chronic conditions which this program is targeted to serve. so, how many folks we are estimating would benefit from this program. with that, our recommendation is that you accept the enhancement of the smile way program and the premiums shown on slide three for 2019 and beyond. >> president scott: are there questions from members of the board to aon representative? if not, i'm willing to entertain a motion. [indiscernible] >> commissioner breslin: second. >> president scott: there is a second. it has been properly moved and seconded that we accept the recommendation as outlined on page three of this presentation. are there comments from the board?

commissioner lim. >> vice president lim: sorry. i want to acknowledge delta dental -- >> president scott: is there a delta dental representative present today? would you please come up. >> vice president lim: for keeping the rates down and for taking the increase for 2019 for the smiling program. so, acknowledge that with no premium -- increase in premium contributions in 2019. thank you for taking that initiative. >> president scott: all right. our delta dental representative is -- >> sharon with delta dental. and thank you. we really do appreciate the partnership with the san francisco health service system board board as well as recognizing the retirees. we feel strongly that this is a great benefit they are them and we wanted to come and partner with you to provide that service. >> president scott: the one question that i have, are you planning to do any type of follow on research or -- about the effectiveness of these

programs and how they are impacting this population? >> yes. >> president scott: you are? well, as that is framing itself and so on, i'm going to ask director yant to work with you so that we can be kept informed about how and what you're planning to do around researching the effectiveness of the programs and then as they may apply to our retirees in some way. so that if there's a need to have more participation in some aspect of the research by our retirees and maybe we get behind helling to promote on voluntary basis people respond to questionnaires as i think this could be a pathway to other kinds of benefit and benefit design issues. and we should be trying to promote that where we can. we would ask -- i would ask that you would keep us informed as

you go along that way. and i join commissioner lim in thanking you for the partnership and your willingness to work with us regarding the rates for these few years yet to come. so, thanks again. >> you're very welcome. >> president scott: are there any other comments from the commissioners regarding the recommendation or the motion? is there any public comment on the motion? >> public: good afternoon commissioners. claire representing rfccs. i want to thank delta and i want to thank both commissioner lim and commissioner scott in your comments. my members have been talking about this since it was first brought up last month and i have heard from a number of members who were really hoping that the smile way benefit would be included in this. and i think they are going to be very excited that it's going to

be included at no additional cost. and i'm actually very happy there would be some tracking of the use and the benefit because a lot of our members talk about the fact that dental health means good overall health and it's very significant. and i do remember that commissioner follansbee commented about the broadness of these diagnoses and how it will probably impact a lot -- or more members than we realize. but we would like to acknowledge delta in partnering with us to do that and actually all of you for supporting this. i think it's going to prove to be a very valuable benefit. and since we can't get that charter changed to have this be an employer sponsored plan, it is really important to us to see this relationship with delta and the fact that we have been able to get a few improvements over

time with regard to our dental plan. so, thank everybody from the retired employees. really appreciate. >> president scott: thank you. is there any other public comment? >> public: dennis kruger, active retired firefighters and spouses. my only question regarding think think it's a wonderful benefit, is that this under the same guidelines as the other cleaning guidelines are that if you exhaust all your medical benefit for that year, you will still be entitled to all these additional benefits if you qualify for them? >> president scott: is there someone who can respond to that? either the delta representative, aon. >> sharon with delta dental. yes. so, if you self-elect at this point in time as a chronic of those five that we've outlined

for the smile way program, then those additional cleanings as well as those additional benefits would apply. >> president scott: thank you. and i'm sure that mitch and his team and abbie will highlight in some way as we go through open enrollment here's a feature in this benefit that is broader than what we are doing today and here's how you can benefit. there will be so spotlighting i'm sure. abbie. >> yeah. i would say, a, in the spirit of prevention, dental care and oral health is key to managing manys. this is a terrific benefit in that regard. we have met with delta to look at data on what they have available to work together to do tracking around these particular conditions and how this impacts or prevents these conditions from occurring. and the one thing that i did want to point out in the

presentation that i think accentuates the urgency around delivering the message that this benefit is available is the large number of members not using any delta benefit. and that is of great concern. so, yes, it will be part of our outreach and open enrollment because oral health is key to a lot of other health problems. >> president scott: thank you. any other comments? if not, we are ready to vote on the recommendation as presented on page three of this presentation. all those in favor signify by saying aye. [ayes]. >> president scott: next item. [reading item #5]

aon. >> mike clark. juan and i will talk to you about the united healthcare medicare advantage ppo for the medicare population. i will talk commentary about the medicare advantage rates. juan will explain the design and program changes that we are recommending for action. and then i will talk about how that plays into the rate cards for twientd -- 2019. so, overall there's -- as you can see on the introduction page, page four, there's over 15,000 covered medicare eligible retirees with departments in the uhc medicare advantage ppo plan. substantial population within the family. the 2019 rate quotation on a status quo basis no changes is changing over 22%.

i will explain the tugs and pulls. that is a favorable outcome. but we also have the opportunity to add programs that we think will freely benefit members and keep the premium below where it is today. as you see on slide five, we're going to talk about two options. a status quo renewal and then a package of recommended plan design and program changes for the 2019 plan year that if you look at the bottom of the page, where you see 2019 with all proposed changes, united healthcare has quoted an insured rate in 2019 of $371.68 per member per month. a reduction from current by 0.7%. so, we will walk through those changes. we will walk through projected member impacts, positives and also some that will require

change for some members. at the end of the day we're going to propose with all proposed changes approach and so we will outline how we got there. so, on slide seven, just commentary on the renewal. there's favorable and unfavorable contributors to this overall plus 2% rate increase. favorable is the suspension of the federal health insurance tax with the affordable care act for 2019. it has been a bit of a yo-yo. it was suspended for 2017. went back into place in 2019. it's been suspended now again in 2019. it was in place for2018. >> president scott: with that suspension will it come back in 2020? >> at this point it is scheduled to return in 2020 unless congressional action happens. >> president scott: thank you. >> so, this provides about 9%

premium relief from 2018 rates. now, we also do see adjustment in claim expense. if you remember, the united healthcare ppo plan went in as an additional option in 2016. became kind of a full plan choice in 2017. and claim expenses in 2017 were higher than originally projected. when you united healthcare looks at what is changing with the revenues that go into the program, center for medicaid and medicare services, it takes it down with the tax removal. and then slide h is noting the other elements that go into the rate card. i will ask juan to walk you

through the program and design change recommendations that we will present to you. >> i thought i would share the hot seat with mike today. so, starting on page ten i'm going to go through the set of recommended design changes that we recommend the board approve. you will see on page ten it is grouped into two settings. the first group of settings will be supporting members transitioning from an inpatient setting to their homes. i have listed the four services under the heading. it is care related transportation services and it's enhanced nutrition counseling. that's actually three. so, there will be additional pages we won't go through. it provides you with strong evidence that this type of program improves the patient outcome and reduces the readmission rates.

that's one set of benefits. they are around purchasing initiatives that then provide lower co-payments for the member. there are two programs under this heading. the first one is the united healthcare preferred diabetic supply. you are asked to use a specific supply for diabetics. but also gives you zero co-pavement for the preferred diabetic supplies and some additional services like kidney dialysis and a reduced co-payments for things like urgent care, physical therapy and we will list those out on subsequent pages. >> clerk: i don't think the slides are advancing. [captioner switch] test.

>> so page 12 gives you a little bit more detail on the first set of plan designs that we talked about, the new programs to support members. you'll see the post discharge transition services, the routine transportation services and the