system and may also happen through provider to provider discussion for next steps. looking at pages four and five for united healthcare on page 4, the nonmedicare population, because it does differ. on the nonmedicare plan, members have the option to contact a doctor at any time to make an appointment for a second opinion they do not need to notify the current provider that they are seeking a second opinion. the services must be otherwise covered under the plan and the cautionary is applied on the network status. if they are in network or out-of-network out of network. the sharing of the results from the second opinion is really up to the member to share with the initial divider. united healthcare does not sit facilitate that process. -- does not facilitate that process.

on page 5, members can have the option for a second or third opinion to determine advisability of undergoing surgery or a major nonsurgical diagnostic or therapeutic procedure. there is more specific language outlining the third option or the third opinion. the member would contact another doctor to seek the second opinion. to the initial second opinion differ than they have the option for the third opinion. the same rules apply that the physician, the services must otherwise be covered under the plan and that the medicare provider is willing -- the willing provider -- the provider must be willing to bill healthcare. the member has a choice to share that second or third opinion with the initial provider and united healthcare does not facilitate that process. on pages six, seven, eight and

nine, this was just another view doing the side-by-side of some of the key questions about preauthorization and can they go out of the network? i will not go through that. on page 10, is a high-level summary of the reminder of best doctors on the services that they provide. members can contact best doctors directly to obtain services and then they have the choice to share that second opinion information with their initial provider. on the last page and on page 11 capped not asking -- providing a recommendation for action, it is next steps that we are thinking about and we are open to any other ideas that you may have. it is to continue to review the reporting that we received from best doctors and engage with medical carriers on activity around second opinion. if we can get into some reporting of how many people are seeking those, it is a challenge

because it is a coding system. appeals, again, are not necessarily called out as to which one are related to second opinion and which ones art. -- aren't. but looking at how we can capture that information going forward and recommending that we explore the market as it relates to the expert second opinion, which to be specific and direct, is a services provided by best doctors. >> president breslin: any comments? >> yes. the thrust of this request was whether, indeed, best doctors was duplicating services that we are being provided in plans. if we are already -- if a member is already covered in getting this service through the plan, is it an overlay? best doctors do that. quiet -- while i appreciate the analysis, is very informative

and very thorough. this is kind of where we need to ultimately try to get to as to whether best doctors, because -- whatever it is per member per month cost, layered on top of whatever else we are doing. so somehow, we need to get to that point of analysis now that the side-by-side chart -- it was profoundly informative for me. that is really the answer we are seeking. whether we need to have the best overlay or are we already getting that through the health plans we additionally, why can't some of these things be the same at a threshold level? in one case, you seem to be able to go out on your own and initiate this process. the other, you must go through the pcc. people may have a problem with that. the doctor had said this is what i think now you are challenging

what i think, or what i am recommending for you. it is pushing the member or the patient, in this case and a bit of a fix. by best doctors being a third party, you are relieved of that pressure and that patient-doctor interaction. i'm just saying that this is not the end of the discussion. we have to, kind of, get to the original question. this will be helpful to get there. >> vice president follansbee: thank you very much for this overview. as someone who is a retired physician, and worked for all these health plans at one point or another, my contract was there but then i was a kaiser physician in the last half of my career. the system is much more complex than this. i think that it's hard to codify that. the thing that i am impressed by in this presentation is the best doctors claims to really get the

case initially reviewed, and then forwarded to a physician and it really was an expert in the issue that the members are asking review of. none of these plans seem to do that. none of these actually seem to, on the surface, you know, some of them are member initiated. i want to see dr so-and-so because my neighbour like her or him or whatever. otherwise, you can pick someone and we will go to mother. so there is still not a lot of patient member engagement in feeling trust that this opinion is actually reflective of another level of review. i will tell you that i know that in some health plans, certain surgical procedures are -- or oncology care is reviewed by a whole team of doctors and

pathologists and nurses. so they are getting multiple opinions to come up with a treatment plan that made it look like one doctor decided that i just needed surgery for my breast cancer, but in fact it was a team. it is hard to codify this. i think as we look at our own strategic plan, i will keep coming back to it. and then the complexity of medicine and the need to demand best care, that this does not suffice at all on the surface. for what we want for our members , frankly. >> it's an informative good start. it certainly answers the initial question. >> president breslin: to me it is informative. united healthcare came out the very best here. they were able to go outside the plan. if you can't go outside your plan, i don't see what good that is. because sometimes the doctors will agree with other doctors. there is some sort of buddy system sometimes.

i thought that what united healthcare did was really good here. you could even get a third opinion sometimes. i thought kaiser and blue shield were short and blue shield seem to be really restrictive and kaiser seemed quite restrictive too. so maybe we can do some work on this. may be they can do better than they are doing and be more open about this. >> i agree with all of your comments. this is for a start. it does have to be part of the strategic plan. as we talked about engaging and supporting members and thinking about how do we do that as one, it may be through existing programs and in enhancing or changing and modifying or through partnerships with outside parties and making sure that those are all lined and providing the support we need for our members under that plan. >> president breslin: interesting, as i recall a

report from best doctors, they didn't have any referrals on kaiser. >> they did have quite a few. we are pending, we were hoping we could have updated data for today but hasn't come in from best doctors yet. i think the way that we pose the question to best doctors on the other side of the coin is how are they integrating with the health plans we their relationship due to their business model, with patients so they don't go back to a physician. i think there's opportunity to try to enhance this service that may be needed by some of our members. >> vice president follansbee: i remember the discussion. i think the discussion was that there were a number of members who have kaiser who have used best doctors. what was the concern from the staff was that kaiser member

services was not recommending best doctors to members you may have come to them with concerns about another opinion or the advice they were getting on the didn't seem to understand that best doctors was an option for our health service system members. that was a concern. not that the kaiser members couldn't do it on their own, i think they were. >> thank you. >> president breslin: any other comments? thank you, very much. any public comment? >> good afternoon commissioners. i am a retired employee. one of the things that i hear from our members who want second and sometimes third opinions is that they really don't want to stay within the network and get the opinions they want to go outside because there is some perception that sometimes within the same medical group or within

the same network that there will be more collaboration with the original diagnosis, which may or may not be valid. but i think one of the questions i recall was best doctors was only serving members and not dependence. and when we are looking at -- i actually know dependence that benefited from best doctors but i thought that was mentioned at one of our previous meetings. i know that were the other systems, whether it is kaiser, blue shield or united health care, it is everyone in the system. but i saw the director nodding your head. best doctors is not restricted to just members. it includes dependence as well. >> correct. >> thank you for that clarification. >> president breslin: any other public comment? seeing none, item number 9, please see eight item nine is action item. cafeteria plan, 2018 annual

update. >> chief operating officer. this is the plan year 2019, cafeteria plan document to review. this is an annual thing that i present to the board. it is an action item because of the fact that this is one of our plans documents and any material changes to this document has to be reviewed and approved by the board. this is from section 125 of the internal revenue code. we required to have a complaint document. back in november last year, we had an education session on section 125 of cafeteria plans and why it's important for us to follow these rules consistently. throughout the membership. included in your pocket is a summary of the changes. there are not that many this year. the first change i would like to draw your attention to is on

page 30. it is updating the name of the executive director. the second change is updating on section. >> commissioner ferrigno: , updating on the annual election amount maximum under i.r.s. guidelines. currently the health care fsa is maxed out at 2500 per year. the i.r.s. has increased that so we are increasing that as well to 2,650 per year. in section b. 5.1 and c5 .1 are the same changes. i realize after a thorough review of the plan document that there was one situation that the plan could terminate that was not included in our rules but we are following operationally. that is a healthcare f.s.a. or dependent care f.s.a. that can terminate situation if the participant does not make the required f.s.a. contribution. and the last change is in

section d5 and this is annual changes every year. we update the amount of flex credit amounts for employees who have the flex credit benefit right now. they get extra flex credit earnings for benefits. again, that's updated -- this is updated every year based on the rates you approve in may and june. that concludes the changes for 2019. do you have any questions? >> president breslin: any questions from the board? >> i adopt remove the changes as presented. >> second spew on any public comment? all those in favor? aye. >> president breslin: all those opposed? it is an economist is unanimous -- it is unanimous to be eight item tennis action item. vote whether to cancel november 9th, 2018 health service board meeting and hold an educational forum.

>> i understand that this is tradition at this point and we will have a packed agenda for the november forum. >> i move that we council the regular november board meeting and hold an educational forum. >> second. >> second. >> president breslin: any public comment on this item? all those in favor? >> aye. >> president breslin: anyone opposed? it is unanimous. >> vice president follansbee: may i raise a question to the chair? i heard references to the october meeting. are we meeting in october? >> yes. >> vice president follansbee: all right. [laughter] >> president breslin: we will discuss the strategic plan and have an action item. all right. item number 11, please. >> clerk: item 11, discussion

item. report on network and health plan issues, if any,. >> good afternoon. i am with the sp spe. wanted to provide an update on the progressive coverage that we discussed during the last meeting. the reason that we rolled out this coverage, effective midyear , was because we felt that overall it was a positive or an add-on to existing plants. we wanted to get that out as soon as possible. i did go back to my management team and we did approve to reimburse those members. there were 16 claims in total from january 1st through the end of june. surge of reimburse those 16 members who received standard progressive lenses. we are in the process of doing that and they will be receiving a reimbursement, in the mail -- check in the mail along with an explanation letter as to why

they are receiving this. >> president breslin: thank you. >> vice president follansbee: thank you very much for your prompt response. [laughter] >> thank you. >> president breslin: very good. anybody else? >> i'm from united healthcare. after the august meeting, with the concerns raised about jewish home, we took that back to our organization and did some research on their license. there was some confusion there. i am happy to report that we have been negotiating with them. they have accepted our terms and we are in the contracting face of that. we are bringing in that work for future. >> vice president follansbee: excellent. >> also, towers, i was advised by my network team that they are also in the work as of june first, 2018. they are a contracted provider now. >> president breslin: excellent.

very good. good work. >> vice president follansbee: thank you. >> president breslin: any public comment on this item? so was towers and before? or was it just something new? june 1st. ok. >> good afternoon. i am a retiree and representative of protect our benefits. i want to thank united healthcare for utilizing jewish home for the aging at the tower tower. and not to appear at terribly greedy, i am wondering about the progress on that sequoia and the heritage. >> i am with united healthcare. i don't have any information or

any update on those two at this point but i will take it back and try to report back at the october meeting. >> thank you. >> you're welcome. >> president breslin: thank you. >> president breslin: that was good news. [laughter] >> president breslin: any other public comment on this item? we will move on to the next item >> clerk: item 12. discussion item. opportunity to place items on future agendas, public comments on matters within the board's jurisdiction. >> president breslin: any ideas on future agendas? ok. nothing from the public on this. any public comment on this pretty all right. item number 13. >> clerk: item 13, discussion item. opportunity for the public to comment on any other matters within the board's jurisdiction. >> president breslin: you can comment on anything you want here. would anybody like to comment?

last chance. i don't see anyone out there. ok. any board comments? all right. moving on cap next item. >> clerk: item 14, action item vote on whether to have a closed session of member appeal. president breslin. >> president breslin: i will need a motion to go into closed session. >> vice president follansbee: i am rules we go into closed session to consider an item. >> second. >> president breslin: ok. any public comment? all those in favor? >> aye. >> president breslin: any opposed? no. we will now go into closed session. >> we have to vote on number 15 as well. >> president breslin: excuse me, there is one more. >> clerk: we have one more. >> president breslin: ok. >> clerk: item 15, action item vote on whether we have closed

session with legal council. one case. president breslin? >> president breslin: i need a motion. >> vice president follansbee: i move we go into closed session for a conference with the legal council on anticipated litigation as the defendant. >> president breslin: ok. >> second. >> president breslin: goods. all those in favor? >> aye. >> president breslin: any opposed? no. we will go into closed session, everyone.