>> 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

enhanced councseling. i do want to note that those three programs is a plan increase, a plan of $7.44 per retiree. just told that thought because we'll have some reductions. page 14, the two standardized purchasing. page 14 is the diabetic supply program. as you can see in the first bullet, there's benefits to the member so zero copayment for certain test strips that are out lined there. then some additional reduction of copayments for the services that are outlined on the bottom part of the page. so you'll see the current copays associated with those services and now the proposed reduced copayments on the column next to them. so as we move to slide 15, which

is the impact to the membership for the preferred diabetic supply, so we will note that there are 495 members using diabetic supplies today. that would be now nonpreferred starting at the end of january 31st, 2018. so members using nonpreferred diabetic supplies can receive a one time transition supply upon request for the first 90 days. additionally there's an opportunity for the member and physician to make a request to get a certain amount as an exception for the nonpreferred product. then there's another third level, an appeal for circumstances where they may need to stay on the nonpreferred supply. but that would have to go through layers of approval wifo

united healthcare. the goal is to communicate with members to make sure they are -- >> the fourth quarter of 2018 would be right in the middle of open enrollment. or starting. >> right. >> if we are going to -- if we you adopt -- if we adopt this, i think this might require some targeted communication with these folks, i recognize that we are now in a whole day of people going direct on tv, one day or once a week, all kinds of insulin injectors and i have no idea what our members are using but people do get attached to certain routines and certain devices and what have you. if we decide to do this i'm going to ask through the director that we give some thought to some prenotification around this design change targeted to this population. that -- it can be very upsetting when you're going -- all you know is that you're going to the

pharmacist and the next time the supplies are out you're getting something different. you may have told me that during open enrollment but i don't remember it ever happening. just saying that we are going to need an extra step here if we do this. >> we'll come back with the refined communication, implementation plan. >> that's just a personal thing. i'm in the mist of this in my own life. not me personally but -- >> makes a lot of sense. appreciate the comment. >> what's the difference in the preferred if they are test supplies? why are they different from nonpreferred? why different supplies? >> there's different makers of the supplies but united healthcare negotiated deeper discounts with the preferred test strips, supply to bring, you know, financial savings to the organization as well as to the member. >> and what i'm reading here, it's not only the test strips it's also batteries and it's also the devices.

there's also whole architecture that goes around testing your glucose on a daily basis. united healthcare is not just dealing with us, they are dealing with the whole nation if you will with this type of populati population. surely they are able to go to manufacturers and suppliers and say we have 5 million people, let's talk. >> volume purchasing. >> right. >> exactly. >> okay. should we move onto page 16? so 16 is related to the fo formulary change. so this is the medicare group selection formulary and this is a change from what you have to do. we believe two things with this program. one, it will provide broader coverage for prescription drugs and we'll go into some level of detail there, as well as maximize the pharmacy rebates,

again, bringing the cost savings to the membership. so there are a couple of things with this formulary. first the formulary covers all of the medicare part d eligible drugs in the brand and generic form expect for some high risk medication. it does have a 98.3% drug match for the current membership and can achieve lower copays for prescription drugs under this change. so the 98.3% represents the number of scripts that are currently utilized in 2017. so if we break down that number a little bit further we will note that 90% of those scripts will have no change with this formulary change. there are just under 9% where they will have a change but it will be a benefit to them

because they will have a lower copay. then there are about 1.7 scripts -- percent of the scripts that would be a negative impact. we want to be fully visible in terms of what the impact would be for the membership. >> and what -- approximately what number of people would that impact? >> so the next bullet addresses your questions, president scott. so based on uhc's analysis there's about 5,685 members that will be positively impacted by this change. however, there are 1,746 members that will be adversely impacted. so let me clarify the numbers seem shocking to you but let me just clarify how the number was derived so you could have -- so the criteria was one rx in 2017 so you could have members

falling in in both categories. >> okay. >> so it looks bigger than it is but there's obviously an impact from a membership perspeiv so the changes outlined on this page lowers the 2019 premium by $17.40. so the first set of programs increase your cost, the second set of design changes decrease your cost. you can also see on page 17 -- actually, we want to make a note here in particular related to the very first sentence, which is speciality medications would be covered at the same copayment of preferred brand at the tier two level in 2019 as part of this change. there's some drugs that were falling into tier 3 so this is an actual added benefit to the member to have the lower copay. we wanted to make sure that was noted on the new formulary.

>> commissioner breslin, do you have a question? >> what happens to the high risk medication? you said they're not included in this part d. >> the high risk medications not included? >> all except with the high risk medications. >> with the current medication program no medications are on the formulary. i'm sorry, they are but you have to get a prior authorization for them. there's a deeper level of review due to the risks to the member. >> but no change from current. today's program. for the high risk. >> the high risk would be included in the negatives disruption. >> as part of it -- would that be part of that 1746 population? >> yes. >> all right. and we are talking about -- when you say high risk drugs, give me some sense of what we are talking about. the types of conditions i guess is what i'm saying.

>> cms has a list of medications that are considered high risk for members over the age of 65. it's not that they can't get them but we want the pharmacists to review those prescriptions with their doctor. >> you're saying that they, quote, high risk may have an adverse impact on certain people with certain conditions, certain age groups? >> yes. >> diseases, what have you. >> correct. that review is in place today. >> all right. >> when you transferred over this plan some of the medicare people had a big problem. i think it was around that, that they had been taking medications and all the sudden they were asked to -- >> prior authorization. >> because i don't know how it ever turned out mitchell helped out i hope but there were quite a few problems with that. >> certainly from a risk management point of view it's prudent practice to be certain that you are adverse drug effects are high level of review

>> i'm wondering why there would be 1700 risk. >> those are differences. >> between what is being proposed. >> correct. >> once we were to adopt this, you would take the refinement and if there's people falling into two categories or the number of prescriptions, the types, all of that would be part of full-timely zeroing in on the ultimate number and then if i recall they were out reach efforts again when we made all over changes. >> if there's a prior authorization on the file today from the old formulary we would transfer that over. >> any other questions to the board on this particular page? please continue. >> no. >> so now we are back to the rate cards. i'm going to turn

it back to mike. >> all right. that could be found on page 20. >> correct. thank you. so we have two sets of rate cards. number one is status quo without the changes that would incorporate the over all 2.0% uhc rate increase and then the second is with all recommended changes incorporating the over all 0.7% rate decrease. each of you if you recall nonmedicare dependents can enroll in a united healthcare plan or a blue shield plan. we contingently prepared some rate card exhibits that now will not apply now that we have your action from the earlier discussion on the uhc city plan so i will take you to the specific exhibits that also

match with that earlier action today. before we talk about rate cards i just want to present a r reminder that this effect -- is the full. when we do present these rate cards they're reflective of what we call the full employer c contributions hired on or before january 9th, 2009. retired persons, retired for disability and surviving spouses or surviving domestic partners who died in the line of duty. there are alternative ways that some individuals become eligible for coverage or receive an employer contribution. so for instance on page 21 just to see a group that receives coverage but no contribution.

and then on page 22 there's a group of retirees that will receive 50% of the employer charter contribution who were hired on or after january 10th, 2009, with greater than 10 years of credited service but less than 15 years. we just wanted to remind that when we present the rate cards the information is the full subsidies for the group i've outlined on page 21. just with recognition there are additional segments of retirees who will retire with alternative retiree contributions. with that on slide 24 we have the recommendation. what i want to take you to before we ask for you consideration of that recommendation is slide 32.

so slide 32 is the exhibit on the impact on the retiree contributions between the status quo scenario and the withall changes scenario. there's a 2% increase to the rate. retiree plus two or more, the rite side of the page, the right three columns are for those members who are full family with two medicare participants in the family and/ one or more. so to me the place to focus is on the left side of the page for the members in medicare.

so contributions there are zero but for the families there's contributions between the status quo and the with all changes. i think what is most important to remember as you consider the with all changes recommendation is this a multibeneficial recommendation we are making. sometimes i stand up here like i did with the city plan and it's all about the rates. so this is about the rates. we are able to actually slightly lower contributions for retirees with the with all changes verses an increase that would occur with status quo. i encourage you to think about not only the contribution reduction that can occur here but also the benefit of those additional programs, but can

rely on healthy meals up to four weeks post discharge and while we recognize there are some members that are impacted adversely through the changes to the formulary many members will benefit from that and we are able to utilize as you said, president scott, the purchasing power to bring the ability to deliver these enhanced programs to members at a reduced cost from what they are paying this year. with that i'd like to take you back to a recommendation on slide 24. we have outlined below for reference along with the 2019 plan with all recommended changes, rate card. again, noting that it's the specific rate cards, tied to

scenario two for the non-medicare dependents of medicare retirees enrolled in city plan. we just need to clarify that. that would result in a 0.7% rate decrease for the medicare members in the uhc medicare advantage pto. >> all right. and just to orient the way this presentation is set up, the scenario two can be found beginning on page 31. so it's tied to that, just so we are clear about what data we are discussing here. >> it's page 35 is the specific rate card i'm asking you to approve.

>> all right. thank you for that clarification so that we'll know. now i only have one question. it's tied back to the observation that you made at the very beginning of the presentation. that was the fact that there was increased utilization of this program beyond what was expected. when i see that it becomes a little bit of a future red flag. any time a provider tells me we projected this type of utilization but your plan and your population is more. so if this comes back to haunt us in the following year, if we

were to project what was expected into the future, can you pull out your ball for next year 2020 and tell us what kind of rate increase we might be expecting? >> i'm happy to. excellent observation. if we are sitting at this time last year united healthcare had not yet taken on the formally blue sealed retirees, that first -- that experience first started under united healthcare in 2017. so the underwriting is as best as possible. primarily based on information it's the ppo and the plan.

so there is an element of better knowledge that united healthcare has now as they sit at this time, june 2018, forecasting the 2019 that didn't exist at the time their 2018 rates occurred, so for me i view it as an adjustment due to better knowledge, not necessarily a e precursor of continuation. >> all right. we will put a peg in that for may until we come to this time next year. any questions by any of the other commissioners? >> when we -- when all the care retirees went over to this plan, wasn't there some kind of a guaranteed rate? some kind of guarantee. >> i don't recall that.

>> so there was a rate cap for 2018. so they came over in 2016 and then you had a rate cap for this year. that ended for 2018. 12/31/18 basically. >> the second thing about the nutrition counselor, you said enhanced. what was it before? it was enhanced to? >> so in the past any nutrition counseling has been tied to a disease. what we are proposing is to provide a benefit of nutrition counseling not tied to any decide. so general like you requested in the past. >> do you need a doctor referral? >> there's never a referral with this plan. >> okay. thank you. >> any other questions? >> i'm just going to follow the

logic. why would we not be suffering the supply chain benefit to the other members without the negative elements of this, which i see as potentially negative where you can changing diabetic supplies for a population of people or you're changing a pharmaceutical formulary. i mean, we don't have any data on that. why do you have one thing that's clearly positive, like a supply chain, sort of an access that you talk about using the uhd. it is combined with a couple of negatives. why would not put that positive feature what you call status quo to get some benefit there? i look at this and think that krouf g-- you've got a couple o

thing to create savings but you got something else, some other things that you were adding in here about meals and travel and these are all positive things that, you know, obviously have some kind of a coast associated with them. you could get more savings if you just made the formulary or this is sort of a mixed bag. i'm struggling with that as a concept. i'm also i guess struggling a little bit with the very small difference in premium really that this is generating in terms of a monthly, a couple dollars a month. how much is it worth? is it worth a couple dollars a month to put people through these changes to their diabetic meds or formularys? i'm sorry, it's just a couple dollars a month under this changing plan as i see it on here. you know.

does that make sense. there's things to accomplish. >> so i think the rational for bringing this as a package of changes is for bringing enhanced programs recognizing there is a cost to that and then discussing ways to help pay for that that don't necessarily came out of the the member pocket. there is a discussion, a couple dollars a month but a reduce in contributions to the families. we talked to united healthcare during the course of this. there was the remark that you've transitioned many, many retirees to the preferred diabetic

program nationally with almost no complaints. working with the executive director and her team, just recognizing the value that a member not having to worry about how they're getting home from the hospital upon discharge if they don't have a family member or friend to pick them up or how i'm going to get to my transportation -- or how am i going to get to an appointment, the enhanced nutritional counseling, so important programs that cms through their innovation program has made plans like united healthcare available to members so our goal is not to add costs to do those but then also looking for ways to help pay for those enhancements and these preferred purchasing opportunities present through the formulary change

that will benefit many members, adversely impact some and then with the diabetic supply program that enables united healthcare to then pass along to every member, not just the 495, but all 15,000 plus if they need dialysis no copay. if you need any form of therapy, lower oco-- copay, those benefis extend to all 15,000 plus members, it's not just those on dialysis. >> thank you. any other questions? any public comment or question or need clarification before we get to a motion? i may -- >> herbert winer, diabetic type ii. excuse me tardiness, i had to

have a diabetic lunch and i just came in time to hear the presentation. this morning i got a very rude shock. for diabetic strips $52 to pay and then for strips it's -- for needles it's $19. now for clarification, i'd like to know what the present coverage is because they asked me if i had medicare type b. i believe that i have type d. i won't pay anything until i can get clarification. i hope this question isn't out of order because you know that you are making proposals for next year. i'm describing my present projectment and i would like some clarification. if i'm out of order we'll hold it for later this meeting. >> i would ask that you -- if you have a specific condition and question around your specific benefit that you would seek some clarification from our very able staff members who are

present here and we not take this up as a matter of public -- >> that's fine, just so i get clarification in the meeting. >> all right. well, there are mechanisms to do that. i'll call on the commissioner and her team to confer with you at a break. >> all right. >> all right. thank you. so are there other questions around the presentations? >> dennis, active firefighters and spouses. according to all these graphs with united healthcare here, it seems like a portion of a population isn't accounted for. that portion is a medicare retiree with a non-medicare dependent. i know it might be such a small amount of people and it just falling in the aggregate and getting worked out. in my particular case, i'm in

united healthcare, my wife is in blue shield. nowhere on any of these forms have i seen that addressed. >> we can consider adding that into the presentations. >> you're saying these folks that the questioner just raised are accounted for in the final rate cards or will be? >> absolutely. they are absolutely accounted for. we don't illustrate them here but we have produced rates for that combination. >> all right. thank you. are there other general questions about the presentation? public comment questions. all right. hearing and seeing none -- i'm sorry. there is. please come forward, ma'am.

>> it's terrific to see them here. >> retiree. again, i hope i'm not out of order but one of the concerns that i have and many of my fellow retirees is the coverage that we'll receive for the 30 day skilled nursing, usually for physical therapy or rehab. it's been very difficult. i've requested price, probably three times a list of the

facilities available and i have yet to receive it. i was told by telephone finally that there are about seven mostly the kindred care but my major concern is i know that jewish home for the ages is not included. they told me specifically this wasn't included as well as the tower which i know is a very extensive facility but they do and so does the seqoia. i just wonder if there's a lack of facilities available in san

francisco. >> i can only respond briefly in that there has been a two-year -- two or three year project that was led by the department of public health looking at the shortage of skilled nursing beds in san francisco. there's quite a bit of work going on in that regard. we can make that information available to you in what is going on in that arena. it's a huge problem for the bay area. how that impacts our member social security a reasonable question for us to consider how we can address that. >> well, i think one of the things i'd like to state at the time that we were transferred into medicare advantage we were assured that we would have the same coverage under medicare. i do know that medicare does cover jewish home for the ages and the tower. i do know that one of the

spouses of a retiree planned to go to jewish home for the ages and told at the last minute they don't accept united care healthcare. >> all right. if you want to turn the specifics of that circumstance over to, again, director yant and a member of the staff we can follow up accordingly. thank you. are there any other questions about the presentation at this point? >> claire, former employee of the county. i want to look at the rate card on page 35, from what i can tell reviewing all of scenarios i think it's been mentioned that the idea is to see if we can enhance benefits and keep costs either stable or reduced which is always a great benefit. even with the small reductions it seems to me that this is a

reasonable rate card and while i do see that there are a couple of categories for the retirees where there's some increases i think over all this represents actually a good amount of work that says that we can give these recommended addition, we can really help the transportation that i know from a number of the members. i'm impressed with the meal and nutrition benefit and that's usually not included in anything. many retirees -- as we get older it's really hard to cope with change and when we get out of the hospital people are very confused and they have a hard time settling in. these increased benefits i think are very significant. especially as we get older. i would suggest or recommend or

request that all of you give serious consideration to the rates on page 35 and see if you can support them because i think this is a phenomenal amount of work done and it's always wonderful to see reductions with improvements in benefits. thank you. >> all right. thank you. new other comments? seeing and hearing none i'm ready to entertain a motion. >> i move to approve uhc medical advantage fully ensured for 2019 plan year. >> is there a second? >> second. >> properly moved and seconded that we approve the rates as presented for usc medicare advantage fully insured retirees for plan year 2019. is there any further comment or discussion by the board? any further public comment? we are now ready to vote. >> [roll call]

>> we are voting on the optional reduced premium? >> that is correct as represented on page 35 of the presentation. >> all those in favor with that clarificati clarification? >> [roll call] >> the motion carries unanimously. all right. next item. >> item 6, action item. >> so we have a large group in

in this plan. on slide 4 we've illustrated a 13.2% reduction in the premiums from keizer from 2018 to 2019. there is a table that explains the rational why. it's a combinations of adjustments from the cms contribution to the federal government, center more medicare and medicaid services as well as favorable underwriting which apart from the adjustments from -- >> unfavorable underwriting means what? >> to increase only. if keizer were -- had been able to look at the plans we would

look at a rate well below average. there's a 13.2% decrease in premium for 2019. >> all right. >> so the keizer plans have a recogninciliation later in the year. so we'll always go through this reconciliation process. >> with that you've come to the right card on page 10. >> correct. so on page 10 you see the rate card. on page 11 you see the impact of reduction in the member contributions for the retirees across the board. -- who pay for coverage. so those independent coverage, the medicare retiree only remains at zero.

so favorable news for the keizer medicare retirees for 2019. >> what's your recommendation? >> so i take you to slide 12. we recommend to a -- accept the keizer rates. >> i'm willing to entertain a motion. >> first. >> a second? >> second. >> i hope there's no member to increase the rate. is there any public comment on the motion? yes, there is some public comment. >> my name is diane and i

represent the retire division. i don't want the rates to increase but i would like to ask that in the future years that the board ask keizer to consider adding those things that united healthcare is adding, the meal delivery after hospitalization and the transportation because seniors who are members of keizer would benefit from those programs as much as seniors at united healthcare. >> thank you for the comment. any other public comment? hearing and seeing no other public comment, we are now ready to vote. all those in favor of accepting the recommendation, the rate cards for keizer medicare advantage, fully insured for plan year 2019 please indicate. >> [roll call] >> all those opposed? the motion carries unanimously.

>> action item number 7. >> mike clark. you'll see washington, the northwest and hawaii with the -- are the rates for retirees. so 2019 will be the second year. i'll take you to slide three to show you that while membership is not particularly high in these programs it's clearly for

demographics for who enrolled in the plan to estimates by keizer last year based on the entire population. as you see on slide 4, over all when you blend everything together favorable we add the vsp healthcare sustainability, so we have the rate cards illustrated for washington on slide 7, northwest on slide 8 and hawaii on slide 9. to corresponding slides exhibit the rates year over year on 10, 11 and 12. request -- with that our recommendation slide 13 and is

ask that the health service board approve contributions for multistate regional rates for early retirees and medicare retirees for washington state, northwest, primarily oregon and hawaii as presented. >> you heard the recommendation. i just have one clarifying comment. california does not control the rate setting process in the other regions of keizer? >> that's correct. >> they are independent. >> they bring the information to us but they are working with these individual regions for the creation of the rates. >> i just want to put that on the record and having been a former keizer employee, the fact they are getting them to even quote at all is a miracle. i didn't say that. go ahead. >> do you think our northern california partners are bring these rates to us. >> yes, so thank you. are there comments or questions

by the board? any public comment on the presentation? all right. i'm ready to entertain a motion regarding this recommendation. >> i would move that i accept the keizer multistate regional plan rate cards contained in this material. >> it's been properly moved that we you prove the multistate regional rate cards as presented. is there a second? >> second. >> it's been properly moved and seconded that we accept the rate cards as presented. is there further question or comment by members of the board? is there any public comment? hearing and seeing none we are now ready to vote. all those? favor? all those opposed? it carries unanimously. thank you. all right. madame secretary. >> item 8, action item, approve life and disability renewal for

the 2019 plan year, aon. >> ann thompson with aon. in front of you is the presentation for the life and disability renewal. you will recall in 2017 that we entered into a three-year rate guarantee on these programs. so that would extend through the end of 2019, next year, the last year in that rate guarantee. so there's no changes to premiums from current. the recommendation is to approve continuation of the current programs and premiums. one note i do want to make is in late 2017, this is on page 1, the hartford company acquired the group life and disability business. so the name you will see tied to these programs will no longer be aetna, it will be hartford. hartford extended the three-year guarantee through aetna through

2019. so on page 2 you can see the current programs and premiums. >> are there questions by members of the commission or the board regarding the recommendation? is there any public regarding the presentation? hearing and seeing none i'm willing to entertain a motion. >> i move to approve the rates as displayed in this presentation. >> is there a second? >> second. >> it's been properly moved and seconded that we approve the recommendation as contained on page 2 of the presentation regarding the life and disability renewal for 2019 plan

year. is there any questions? members of the board? any public comment? hearing and seeing none we are now ready to vote. all those in favor signify. all those opposed? it carries unanimously. thank you. secretary. >> item 9, discussion item, prop b retirees, medical subsidy 2019, aon. >> mike clark. we assembled this discussion back today to remind of the carter contributions that are available through section aa.428. very specifically as i mentioned earlier during one of the retiree discussions there will be a segment of retirees retiring for the very first time

during 2019 who will retire under the 50% of full contribution subsidy i call it class. so we know -- we may just want this to be for review. i know that we are pressed for time. >> well, i think that it's pretty clear in terms of what -- how this impacts the various tears and so forth. so the question i would have of you is there's a formula that is resolving out of this and you're saying it will be applied to this rate for class of retirees, correct? >> that is correct. i'll quickly take you to slide 4 to show you an exhibit that's contained in the city charter under aa.428b. the specific classification is the third where you see 50% for

those hired on or after january 10th, 200 january 10th, 2009, and retire with 10 to 15 years of credited service. on slide 5 from an illustration standpoint i'll take you to row 6, which is the employer contribution that the full contribution would group including those hired on or before january 9th, 2009. so you can see here on row 7 how the multiplier applies to that contribution to produce what we've called on row 8 employer contribution for the 50% group tried to make them just to -- they are not tied to a specific plan. it's just for everybody to see the mathematical working of this new 50% group.

>> all right. are there questions? >> so these are not tied to any of the plans at all, it's just based on your estimate? and illustration. >> so ultimately we will apply this to each plan, each retiree plan. this is merely an illustration of numbers. i've developed in to show easy math. the 50 per -- so, for example, in rate cards where you see the employer contribution on a rate card, this particular segment of retirees will receive 50% of those figures as their employer contributi contribution when they retire. >> so for the next plan year, 2020 you'll have a separate for this group of people? >> correct. so on slide 4, in the retiree

rate exhibits that sfhs develops and shares with retirees for open enrollment, the 0% group is represented on those rate exhibits today. going forward there will be a third group represented and that is the 50% group. so just by nature of timing, these are individuals who were hired on or after january 10th, 2009, so theoretically there could be a person that retires on january 9th, 2015, who falls into this at the scedesignation. >> thank you. any other questions? >> when you think about this projected way out into the future eventually those people

hire prior to 2019 will age and pass away. those people hired after 2009 will be the definition of what the city's healthcare benefit is for this group of people and, you know, if they stay many more years, if they stay longer than, you know -- you know, if they stay long enough for the city then they'll eventually get a full benefit too. we will be looking at a very different rate structure at some point in the future. >> yes. by charter direction. >> by charter direction. >> all right. okay. >> there's another point in there. i mean, there's another part of the discussion. when prop b was passed there's also a healthcare trust fund that was set up pose -- supposed to have any contributions for that month. you might have to take another look with another commission, the health service trust fund

board. i think we might have to coordinate or maybe you start the discussion with them about what time it would start and then helping them. there's a -- within the last 10 years there's a substantial amount of money that's been contributed. initially it was just the city's contribution of 12% but now all are 2%. some of these started going it already and they are putting their numbers in contribution already. >> this will be for another day and another time. all right. using my guidance that the beginning can only comprehend what

>> we are now back from recess. an i'd like to specifically thank the providers, each and every one for their full cooperation with our this and with our staff, and particularly under initially mitchell's guidance and to our new executive director mitchell gregs and now to our new executive director abbey. it has been a very challenging year. we knew that for all of us in this transition. there were a lot of moving parts during the course of the year and it's quite remarkable that the quality and thoroughness of the work that was done as a

result with all of that transition is accommodation to the staff of the hhs but also to our partners and our health plan partners and we thank you for it and we believe that our members will benefit as a result. with that we'll now move to our regular board meeting and take up the matters beginning with item 10. >> thank you. item 10, president's report. >> i only have one item that i want to specifically reference at this time. the board had an extensive letter on the topic of wellness that came to us unsigned. we provide it very hard to provide a written aresponse to the comments, demands, the requests and the observations contained in it because we don't know to whom we are speaking.

it was cc'd to a number of other entities who have some direct interests in retiree benefits and our wellness programs and so forth. so i would encourage that in the future that if in deed an individual or group has a specific concern around any program or benefit that the only way that we can be responsive as a board is to know who you are so that we can detect the kind of response that we know is going to an entity or a person or a group rather than receiving something anonymously. while the concerns are valid or are well intended, there's no way for us to come back and say beyond what we are doing in the wellness area, this is what we are finding and this is what our members are telling us. not withstanding the news

articles that were attached to the letter. also there were some slight misrepresentations or departure of the prior executive director it was abrupt, not from where i sat. i think that i'm clear on that point. she elected to retire and gave us sufficient notice and we undertook as a board to responsibly have the chief operating officer who took on the leadership of the total staff not just during the interim period of time but continued to do the work of the chief operating officer and there were officers who stepped up and took on additional responsibilities and we've talked about that. so if a letter leaves the impression there was somehow some sort of disruption in the

process here and that's not accurate. also they elude to the fact that we -- or hhr auditor is aon. that's not correct. aon is our advice regarding our plans and our responsibilities if you will regarding this plan. so while there's a formal man you can appreciate the concerns and if the party or parties want to clarify who you are and resubmit your letter then we will spend the time to at least try to be responsive to it. so with that, that's my president's report. i would ask if there's any public comment.

>> there's no acknowledgment where it came from so i appreciate your comments and your position and i think that we as an organization feel we are going to be discussing it next tuesday. when items loo -- like that come and are unidentified we have -- it doesn't have standing and unfortunately if people really have issues they really should identify themselves because there's no repercussions, it's just an acknowledgment. i didn't hear public comment in the beginning. we would like to thank alani. we didn't have to correct the minutes anymore since she took over. they were always perfect and if there was anything it was a little typo and it was