port. they have supported literacy program, and so justice is a staple in district 10. and they help us a lot with the work scope and understanding of some of the wetlands' features. a.p.r. has been a big supporter in helping to recruit youth, and we'll be working a lot with them in developing new programs at the eco-center. the student conservation association has been a supporter and why we have interns serving in our youth stewardship program. the parks alliance has been big supporters for both of our programs, and parks in general. and that's our green usage program. thank you for your time. and that concludes my presentation. >> thank you very much. >> chairwoman: do we have any public comment on this item? come on up. >> good morning, commissioners. my name is carol bock, i'm

the environmental affairs manager for the port of san francisco. and i am here to urge you to support execution of this memorandum of understanding with the port. i made an informational presentation in march and they voted on april 9th in favor of staff executing the memorandum of understanding. we have worked with rec and park staff for almost 10 years at herring's head park, and we are just 100% confident, and also what we've heard from our contingents, since this agreement was proposed, has supported that confidence that rec and park is really the best entity to make the -- to get the best public benefit that the eco-center facility has to offer. i'm really excited about working with them, and the opportunities that are presented by having them be able to bring all of the work that they've done

outside into the park and expand it into this unique facilitymenfacility. thank you. >> thank you. >> chairwoman: next speaker. >> good morning, commissioners, general manager ginsburg, good morning. >> chairman: can i get you to speak into the mic. >> does my clock start over? >> chairwoman: yes, but you need to speak into the mic. >> can you hear me now? >> yes. >> good morning. my name is kirk rhymes, and i'm with the program in san francisco. i'm also a district 10 resident. and for the past six years, i've been very much involved in the eco-center. for the interest of time, i want to be short and brief and to the point because the eco-center has a lot of history with my

community. there are thousand linear feet away t-a community, a commm trying to engage in in this space. i'm in support because i hope that the opportunities and histories and relationships that have been promised will be fulfilled. i'm very much looking forward to working with our p.d. in doing this as a resident and as the a.p.r. i. program manager. thank you. >> thank you very much. >> chairwoman: next speaker. >> good morning commissioners. my name is jackie flynn, i'm the executive director at the a.philip randolph institute in san francisco. the eco-center is a hub for innovation and education for all. it was a commitment to the bay view hunter's point community that has suffered enormously from ahs of neglect and planned racism.

the eco-center was a programs and commitment to environmental and social justice, through education, retaining our history, engaging the community, creating local and green jobs, and a space for life-inspiring students. for the last six years, my team at apri, has worked hundreds of hours, poured in sweat, equity and love into the eco-center. our hope is we get to see the vision of our supervisor sofia maxwell, green actions' marie harrison, and tessy ester from hunter's view, who fought tirelessly to provide social justice to our community. so we are in support of the transition and m.o. u., and we're committed to continuing to be a community partner. i want to take a moment to think folks, like kim kiefer, who is not year, alongside brenda, one of

the biggest green users' fans. phil, you're so genuine when you provide opportunities for our community, and i recenter appreciate. and also thank carol bott from the port because we have worked on this for years. i'm very much happy to see the efforts of leadership. so in closing, we're hopeful with the right leadership, our community can fulfill this commitment together. i thank you guys very much. >> thank you very much. >> chairwoman: is there anyone else who would like to make public comment on this item? being none, complic public commt is closed. >> mr. ginsburg, did you want to weigh in on that? >> very briefly. it is mostly gratitude, beginning with carol and elaine forbes and the port for your long-standing partnership along the southern waterfront, and your confidence and faith

in us. we really appreciate that. it is very meaningful. to brenda, for your initiative and drive and really taking green agers, and our stewardship of the eco-center to the next level. this has been a real passion project for you, and that's very obvious, and that's why we have the right person at the helm. and, just lastly, to jackie and curt, but to the community more broadly, thank you for your trust in us as well. and we are very humble and aware of the important history of this site and both the actual and symbolic promise of environmental justice that this building holds. and we will do our best, in partnership with you, to make good on our commitments. >> thank you. the chair would entertain a motion? >> moved.

>> seconded. >> all those in favor? >> yea. >> so moved. >> chairwoman: we're now on item 8, the synthetic turf replacement project. >> good morning, commissioners, an i'm general manager dan morrow with the capital improvement division. i'd like to read the agenda for the record and then i'll go into a little more detail on why i'm here. what i'm requesting today is discussion and possible action to authorize the rec and park department to negotiate a construction contract with the silver sympathetic turf replacement project, as required under the san francisco administration code 6.23c, subparagraph two. i have a clerical error, it is actually 6.23, not

02. about a week and a half ago, i came to the capital committee and gave a brief discussion only on this item, to replace some worn-out, sympathetic turf at these facilities, with new synthetic turf, and do some upgrades, replacing fencing, fixing the bleechers, adding a drinking fountain, and making some a.d.a. im movementimprovements that are necessary. we didn't have bids in at that pointer. we weratthe point. we were waiting for the bid period to close, which was the following day. unfortunately, we only received one bid as a part of that process, and it was substantially higher than our budget for the construction work. with that we scratched our heads a little and tried to figure out what our next steps were. we went to the city public works office, and we saw when you receive one bid

over the estimate or no bids, it affords the department to move forward with a negotiation process with a qualified contractor. as part of that process, it also requires that we get the general manager's approval to move forward before we ask for your permission. so in your packages, jewel you'll see a letter that commissioner ginsburg signed. my goal is to move forward, find a competent contractor, and negotiate a bid price that is lower than the bid we received. and more in tune with the project budget that we've identified for the project. with that said, we obviously stretched the time out a little bit here because once that negotiation process takes place, i'll have to come back to you for the standard process of a contract approval process. so my goal is to enter isn't a negotiation scenario, get a price that is reasonable and appropriate for the project, and then come

back to you, hopefully next month, with a proposal to award a construction contract. what that may mean is the construction duration may shift a little at our first project, we were anticipating starting that on june 1st, and completing in october. but because of this sequence of events, we'll probably have to push that construction process to july and negotiate a shorter construction window for that particular project. coleman will follow that, and start construction in december and finish in april-ish. i'm happy to answer any questions. >> commissioner harrison. >> today we're voting on to allow you to go into the negotiations process? >> yes. the administration code allows us to negotiate with either the bidding contractor who submitted the bid, see if we can get to an appropriate place, or go to another

contractor who meets the qualifications of the original bid process. >> and then you'll come back to us? >> and then we'll come back to you with a name and number and a contract request award. >> secondly, as i mentioned at the capital committee the other day, i want to thank you and congratulate for you due diligence and finding a new in-fill on this turf. it has been kind of a touchy subject for a while. thank you for your work. >> i have a question, but let's do public comment first? >> chairwoman: is there any public comment on this item? >> richard? [laughter] >> good morning. i had a little chat with mr. amar earlier, and i concluded that it is good for the commission to approve of the right to negotiate. that is not the main gift of whagistof what i want to talk

about. it is the use of the legal ballpark -- i was hoping that they would be able to find a way varying the size of the ball field. i want to introduce women's softball, so that's recreation and a larger field than the little leaguers. so of such planning, is there a way you can make adjustments, where it is used by both the little guys and little gals and women's softball? i think it is just adding on different pieces of synthetic turf and moving the bags around,and then there will be a higher degree of recreational usage of such area. other than that, i like the idea they're going to have good stuff in there. it is not that black rubber thing that i didn't like.

it was -- that's about it. i hope they can get that softball-sized, and maybe some of the gals here might want to swing a bat. i think you'll get better park usage because there be league guys on most of the weekends. >> thank you. >> chairwoman: is there anyone else who would like to make public comment? being none, public comment is closed. >> thank you. >> i just wanted to say i'm glad that we did this demonstration, that our experiment worked, and that we have some options to the traditional sympathetic field. and so the question i wanted to ask is that going forward, i know it has been pretty standard procedure that we replace our fields,lik, like every 10 years? that will continued to be the case for both fields?

>> the lifecycle for these fields is approximately eight to 10 years. i think we have some experience with the fields lasting a little longer than that, but, yeah, we do expect to have the same lifecycle with this alternate in-fill. commissioner, it has been a long road on this program. as you'll recall, what we said when conversations about the original in-fill material caused concern, we said, (a) we stood by the date tan the belief thadata and the beliefthat the . we knew this technology was going to evolve over time, and alternate in-fills were just beginning, but we didn't want to just jump in. we didn't want to be the ones to go out and purchase them not knowing how -- you know, how resilient they were going to be. and now we have enough

experience, and a lot of the manufacturers are also using alternate in-fills, and this is the way of the future. you have to remember, these fields don't require any water, don't require any herbicides, much lower maintenance costs. and more importantly, in a dense city like hours, they afford more opportunities for play. it's that simple. >> having lots of family members that play soccer, i personally want to express my appreciation and thanks for this special effort. >> thank you. >> dan, the cost, or the bid, seems so much higher than the budget. [laughter] >> with that experience that we're getting of getting better products, we don't seem to be getting better prices. what's happening there? >> um...i'm still scratching my head a little bit on this one. not to get into the weeds on this, there are a few

contractors out there that have the experience on putting synthetic turf fields in. it requires kind of a unique skill set and some experience doing it. some of our standard contractors in the city that do terrific work in our park system, don't have the experience to do the section of synthetic turf that is required. it is not just the green stuff. the more important element is the base below that. and getting that correct and the drainage and the material correct is the backbone of the system. with that, as part of the outreach process, i talked to and did some outreach to four or five different contractors we worked in the past, a lot of them in the bay area, and lot of them are not city contractors. little interest from some, and little response from others. i think folks are two busy. so we only ended up with one bid on this. since receiving the bid, we sat down with the architect and the contractor and tried to

line crawl through where the deviation was. we found some items -- and i'll use this at one example. we had some minimal painting work out there on some concrete walls, painting from our standard khaki green to a more bright and joyful color. the contractor wanted half a million dollars to do painting. and that's after the contractor reaching out to 15 different painting subcontractors, and only receiving one bid from them. so that is an example of why their bid was higher than anticipated. it's just a difficult climate right now with subcontractor it'ss, and the local hiring goals, which increased some of the bid prices. i'm hoping looking at different subcontractors and doing a little more outreach, we can hone in on a price we can afford and get this project

moving. >> good luck. i don't see any other questions. entertain a motion. >> motion to approve. >> seconded. >> all those in favor, so moved. thank you. >> chairwoman: as mentioned at the beginning of the meeting, item nine is off calendar. item 10, is there anyone here who wishes to make general public comment that did not comment on item four. come on up. >> thank you commissioners. thank you, general manager. this is my first public comment. i'm a resident of pratr pratrao hill. my family lives across from jackson park, on arkansas street. my child goes to live oak school, and i have an office on 17th street, next to the parkside. so i spent 24 hours a day

around jackson park, to be honest. i'm also a coach in the sfydl, and my child plays there as well, and i'm a coach in the junior warriors, and we play soccer as well, but not through the city directly. we love jackson park. we love everything about it. we love hearing the softball players come at the end of the day. today we'll have our windows open, it is a beautiful day, and we'll hear the sounds of the game coming in. but it needs some love and care. it is a park that is a little closed off to the residents of the neighborhood, there are big fences that surround it. we can't quite use it as a park. it is a baseball field, a softball field. i love hearing about the plans to renovate it, to put some t.l.c. into the park. we're hoping you support that. there has been a lot of development in our neighborhood over the past five years, there are some, i think, 30,000 units opening within a

two-mile radius of the park, and we don't have really any unprogrammed space to hang out in that is not devoted to sports, which, again, i love, i'm also a softball player. what i'm hoping is that the commissioner will support the full funding for the park that is going forward. and that's that. >> thank you for coming to see us. >> thank you for having me. have a good day. >> chairwoman: is there anyone else who would like to make jen publi general public comment? seeing none, this item is closed. item 11, commissioners, any public comment? >> defense attorney: public comment is closed. item 12, new business agenda setting? public comment? being none, it is closed. item 13, communications? any public comment. being none, public comment is closed.

item 14 is a adjournment. >> moved and seconded. >> seconded. >> thank you very much. >> chairwoman: thank you, commissioners. all right. 2, 1 you innovation on or was on over 200 years they went through extensive innovations to the existing green new metal gates were installed our the perimeter

9 project is funded inform there are no 9 community opportunity and our capital improvement plan to the 2008 clean and safe neighborhood it allows the residents and park advocates like san franciscans to make the matching of the few minutes through the philanthropic dungeons and finished and finally able to pull on play on the number one green a celebration on october 7, 1901, a skoovlt for the st. anthony's formed a club and john then the superintendent the golden gate park laid out the bowling green are here sharing meditates a permanent green now and then was opened in 1902 during the course the 1906 san francisco earthquake that citywide much

the city the greens were left that with an ellen surface and not readers necessarily 1911 it had the blowing e bowling that was formed in 1912 the parks commission paid laying down down green number 2 the san francisco lawn club was the first opened in the united states and the oldest on the west their registered as san francisco lark one 101 and ti it is not all fierce competition food and good ole friend of mine drive it members les lecturely challenge the stories some may be true some not memories of past winners is reversed presbyterian on the wall of champions. >> make sure you see the one

in to the corner that's me and. >> no? not bingo or scrabble but the pare of today's competition two doreen and christen and beginninger against robert and others easing our opponents for the stair down is a pregame strategy even in lawn bowling. >> play ball. >> yes. >> almost. >> (clapping). >> the size of tennis ball the

object of the game our control to so when the players on both sides are bold at any rate the complete ends you do do scoring it is you'll get within point lead for this bonus first of all, a jack can be moved and a or picked up to some other point or move the jack with i have a goal behind the just a second a lot of elements to the game. >> we're about a yard long. >> aim a were not player i'll play any weighed see on the inside in the goal is a minimum the latter side will make that arc in i'm right-hand side i play my for hand and to my left if i wanted to acre my respect i extend so it is arced to the

right have to be able to pray both hands. >> (clapping.) who one. >> nice try and hi, i'm been play lawn bowling affair 10 years after he retired i needed something to do so i picked up this paper and in this paper i see in there play lawn bowling in san francisco golden gate park ever since then i've been trying to bowl i enjoy bowling a very good support and good experience most of you have of of all love the people's and have a lot of have a lot of few minutes in mr. mayor the san francisco play lawn bowling is in golden gate park we're sharing meadow for more information about the club

>> shop and dine in the 49 promotes local businesses and challenges residents to do their business in the 49 square files of san francisco. we help san francisco remain unique, successful and right vi. so where will you shop and dine in the 49? >> i'm one of three owners here in san francisco and we provide mostly live music entertainment and we have food, the type of food that we have a mexican food and it's not a big menu, but we did it with love. like ribeye tacos and quesadillas and fries. for latinos, it brings families together and if we can bring

that family to your business, you're gold. tonight we have russelling for e community. >> we have a ten-person limb elimination match. we have a full-size ring with barside food and drink. we ended up getting wrestling here with puoillo del mar. we're hope og get families to join us. we've done a drag queen bingo and we're trying to be a diverse kind of club, trying different things. this is a great part of town and there's a bunch of shops, a variety of stores and ethnic restaurants. there's a popular little shop that all of the kids like to hanhang out at. we have a great breakfast spot

call brick fast at tiffanies. some of the older businesses are refurbished and newer businesses are coming in and it's exciting. >> we even have our own brewery for fdr, ferment, drink repeat. it's in the san francisco garden district and four beautiful muellermixer ura alsomurals. >> it's important to shop local because it's kind of like a circle of life, if you will. we hire local people. local people spend their money at our businesses and those local mean that wor people willr money as well. i hope people shop locally. [ ♪ ]

>> the health service board will now come to order. please stand for the pledge of allegiance. i pledge allegiance to the flagt ates of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. . >> madam secretary, roll call, please. (roll call). we have a quorum. >> item number 4 please. >> item number 4.

approval with possible modifications of the minutes of the meeting set forth below. regular meeting minutes from march 14, 2019. >> are there any corrections to the minutes? no corrections. i could entertain a motion. >> i move the regular meeting from march 14, 2019 be approved. >> second. >> any public comment? all in favor. opposed. it is unanimous in favor. >> all right. moving right along here on to number 5. general public comment on matters within the board's jurisdiction. >> is there any public comment within the board's jurisdiction? seeing none, we move to item 6.

>> item 6 is presidents report. >> i want to thank mitchell gregs who has gone above and beyond duty for customer service. i have had a couple casings okayses this month that were okayses this month were complicated. he exemplifs aphis e execs emfi. item number 7, please. >> the director's report. this is given by the executive director of the health service system abbie yant. >> good afternoon. the highlights from the director's report. we have completed our election.

we had five candidates, three dropped out, two remained. that allows us to seat those two candidates, one of which is our president and the other is mr. chris canning, who is a lieu department in the active duty police department. he will be able to sit with the board at the june meeting. we also have news that we -- the mayor's office appointed their member, marry howe -- mary howe. many understand her work in human resources. she is employed in in marincou. she is a resident in san francisco. we are not sure if she will be here for the may meeting but defendant for june. we will have a complete board in

june, which is great. i did want to just highlight we have been following some of the taxes at the federal and state level. at the federal level, the ex ice tax. there -- exise tax it will be applied for the 2020 year. the managed care tax in california is also in play, and that may very well apply next year. we weren't sure -- the state wasn't sure how to read the feds on this one, but apparently in michigan they have a similar tax and got approved very recently by the federal government. it is likely that california will apply again.

those two taxes are going to be -- we will give you the breakdown on the cost as we move forward. i want to highlight that we did have the well-being at work celebration in march, and it was great to not only see all of the participation from many different departments. we had a commander from the police department, assistant hospital administrator and the wellness manager from m.t.a. all spoke in great detail with a lot of commitment and passion about the well-being programs and how they were implemented in the various facilities, which in this case all three are 24/7 departments. it is an awesome responsibility. it was impressive to see how much thought they have given to those programs. we did respond to questions in the director's report that have

come up. marina was able to pull together the migration analysis that you requested that we look at and pay attention to. folks moving in and out. we will continue to monitor that. we expect to see more out-migration. time will tell what actually happens. the other on the data from the screening that we had some questions in the data marina presented. she is working through the data questions with kaiser data people so it will be able to better answer the screening question itself once we are certain of the data. i have come to the conclusion we have an ongoing longer list of items that we are looking at

each of the plans and how they perform opioids, fertility benefits and co-pays. we met this week to develop a more robust process for how we do some better analysis and presentation back to the board about those questions because they are getting more and more complicated. we want to take the time to give a well researched response to the board. that is under kay. on the personnel side i see vanessa price cooper is here for the contracts unit. welcome. some of you may know lisa campo. she has been with the well-being for some time and has been promoted to coordinator.

malica is assuming some of the 1209 benefits technician. there is movement there. there are fewer positions under recruitment activities. there are six there, and we are getting excellent service from the human resource department and hope to have those positions felled at that point. we have got fun projects going on that we engaged the services of the controller's audit unit online services which is an excellent way to due process improvement. mitchell has been working with them to look at call volume in member services. what are the calls? what can we do to reduce the need for the calls.

we have had leadership and staff training. we did a pilot project. engaged in a project we are under taking. we will get to a certain point to stop and suspend open enrollment. it is a great partnership with the controller's office and we are looking forward to a disciplined approach within the department. i think that concludes my highlights for today. >> any public comment on this item? any questions from the board? no public comment. item number 8, please. 8. financial report as of february 28, 2019. presentation by pamela levin,

chief financial officer. >> pamela levin chief financial officer health services system. to clarify the cadillac tax, it is 2022 when it might possibly come up. the report presented to you summarizes the revenues and expenses of the budget through february 28, 2019 as well as the projection for the year ending june 30, 2019. in terms of the trust, the balance on june 30, 2018 was $77.4 million. based on the activity through the endhe of february, it is projected to be $83.9 million

which is an increase of $6.5 million. we are seeing unfavorable claims experienced for the uhcppo and blue shield access plus plan. for blue shield trio and delta dental self funded the claims experience is favorable. we received $300,000 in pharmacy rebates and the year-to-date amount is $2.1 million. the projected year end as of june 30, 24019ne is $6.9 millio. the healthcare sustainability is projected to have a year end balance of $1.3 million. a total of $500,000 in performance guarantee payment have been received as of february 28th. as of today $105,000 has been

paid out this year for the adoption andsure gas see plan. we t updated it today. the totald expended since first offered is $178,000. the amount of forfeitures for unused flexible spending will not be known until june 2019. we continue with the graph. the goal of setting the rates is for the actual cumulative expenses to be equal to the total revenues including stabilization reserve up or down but the buyout was down over the course much the year. in summarizing where w we are te cumulative expenses are high or

for the health plan. it is lower for blue shield access and trio and delta dent dental. in termsnthe of general fund administration budget. through february 28th we were projecting year end balance around $300,000. that is due to salary savings associated with delays in hiring. that is the conclusionentation. are there any questions? any comments or questions? >> any public comment on this item? seeing none, we will move onto our rates benefit section now. first item is number nine please. >> item nine rates and benefits

for the plan year 2020 presented by the executive director. >> i have the calendars in your packet. once again, we are at the point where things are moving along very smoothly and we can make the decision to not have the april 25th meeting. we held that in a that in abaya. >> any public comment on this item? >> item number 10, please. review delta dental active employee ppo, experience and approve rate stabilization reserve recommendation presented by mike clark am. >> good afternoon. i am here today to talk through

the delta dental active ppo plan experience and suggest our recommendation for the rate stabilization handling into 2020 rates. if you look at page one, just bottom line on top we will recommend today that one half of the available reserve be applied. i will walk you through the rationale for that recommendation. as you see in the first paragraph there has been a continued pattern of lower actual claims and fees relative to premiums that is a consistent theme within pamela's financial report. thus we are recommending a higher level of rate stabilization reserve buy down be applied than what would be typical as the per policy through allocation. we view this as fiscally responsible approach to reduce

what you will see as a rate stabilization balance on this plan that is built-up substantially over the last five years. you will see our recommendation to apply one-half of that available stabilization reserve or $7.16 million which will preserve the other half with rounding 7 million and 15,000 for use in 2021 beyond rating. for comparison if you are curious. it will be at the bottom of page one. page 2 provides general background on stabilization policy itself. noting that it is important to recognize that we talk about the dental plan, we talk about active employee ppo only because every other dental plan offered

by us to active employees and all retirees are fully insured. this is the only self funded plan out there so that is why we talk about the claims for this plan rate stabilization reserve because every other dental plan including all retiree plans are fully insured. so page 3. you will see the experience for this plan over the last six years in the table at the bottom of the page. for this particular year, the claim and fee costs were 5% lower than the actual premium in the plan. as you will see in my call out boxes to the right, the actual experiences represented by the grey bars and it is averaged pretty close to $120 per employee per month for each of the last six years.

we have not seen cost inflation in this plan. it has been pretty consistent in terms of the actual cost of the plan and i will talk through reasons for that in just a bit. we also focus on loss ratio. in actureterm. that is taking the total claim and fee dollars divided by the premiums so anytime you have a loss ratio that is less than 100% that means you have lower claims and fees than the premiums in the plan, and as you can see with the bars representing the actual claims and fees, the line presenting the premiums, you can see why we have loss ratios below 100% each of the six years. so on page 4, i list three key reasons why we had ongoing

favorable experience in this active dental ppo plan. one is the experience. it has been constant claims and fees on employee per month basis. we have an underlying issue on the plan which is under utilization of preventative care. we would like to see more members tap the coverage and use preventative care benefits. out of every person employee or dependent enrolled in this plan and keep in mind every employee in this plan is paying some contribution to be in the plan, one out of three aren't seeking preventative services. that is a concern of ours and something we continue to brainstorm ideas with delta dental to encourage members to seek preventative cleanings and preventative services within the framework of the dental plan. third, from a premium

calculation standpoint, we have been using a higher annual claim increase factor in the past years. you may not recall last year we suggested using a lower trend factor in the 2019 rating. we will start to see that play out in the 2019 experience versus premium calculation difference, but that doesn't reflect in this data because this takes us through the end of 2018. as i note in the paragraph below the three items, we do expect claims and fees close to premiums as a result of some of the changes for 2019. >> excuse me. if you are encouraging preventative cleanings and so forth, would that, is there some sense if that were to spike and people acted on what you are

recommending, would that have impact here? >> yes, terrific question. i expect if we start to see a significant increase in the preventative care utilization, i could see a short term increase in claims. presumably some of those individuals shoe have not been seeking periling ventive services could be diagnosed with cavities and gum disease, as an example, so that does have potential to create what i might see a short term spike in claims, although still again preventing much more serious procedures that might have to occur just by nature of being in so much pain you finally are compelled to see a dentist. >> thank you. >> just an observation here. an employee pays $5 per month. >> for single coverage, that's

correct. >> employee plus one pays about $9 per month. i can see where it isn't significant. they think i am paying a lot for is this. i didn't know it until i looked how much the premium was the delta dental. you know, definitely it is kind of surprising only one of three have cleaning. that is not a good thing at all. if the premiums are consistently more than the cost, then why don't you reduce premiums? are you doing that? >> the overall cost of the plan is much more than just the employee contributions. you are correct. single employee pays $5 and employee plus 1:15 the total --

15 the total rates are much more than those figures. >> i know that. >> can i follow up on commissioner scott's question. when you look back. you have analyzed for 2018. we have been sort of under utilizing it for several years, and is that the case? do we have preventative screening ratings back to 2013? >> i have seen the data going back a couple years. i personally have not seen it back to 2013. we could work with delta dental to gather that experience over the last six years. the average of one out of three not using the plan is consistent. >> i think i assume we all believe in preventative dental care, number one, the reason is that the one doesn't when you start to have symptoms and need care, you will not only be in

pain but also reach -- this plan as a cap, does it not? >> there is a $2,500 annual maximum for each person in this plan. >> do we have any idea what the trend is in that in terms of are we seeing more and more of the lag? this can happen not much on an annual basis but over years we might see the few people reaching the cap. i am curious to know if we can demonstrate the consequences of this under utilization of prevention. >> we are happy to pull together a summary of six years of information on utilization to have available for you. i will do that as a take away to work with delta dental to affirm that. >> your challenge to the health service system is appropriate. we have responsibility to make

sure these kinds of services are being utilized. in addition to healthy diet and exercise and get out of the chair 30 minutes. we need to focus on this. it looks good because we save money. it is not good. >> i want to say especially here. you the ppo dentist get the preventative services, paid by the plan, and every member represented here is paying something out of their paycheck in the contribution to be in this plan. >> aside would the well-being program or any of that cover dental or recommend people get dental when you discuss it? >> it is very much part of the discussions we have been having with delta dental. i understand it is not a typical to have a third of the population that doesn't go to

the dentist for a variety of reasons. i think we need to find out why our population is choosing not to go to the dentist and really go out on it for the obvious reasons. oral health is a huge indicator. we put in place the smile away benefit to help those can chronic disease. we do need to step it up to find a way to help the membership make use of dental services so we work with them to create a better campaign, work with well-being, but it is a struggle to get people to go to the dentist that choose not to go. >> flyers come out in the mail. >> yeah, yeah, there is a lot of information out there. i know in general in health information education doesn't change behavior.

we have to figure out and we we will look at partners to find best practices to change behavior. i don't think it is that people don't know to go to the dentist. there are other things. i have a spouse who won't go to a dentist that won't anesthetize him. he has to pay extra. his wife makes sure he goes. i am sure there are many stories that occur. we will have to dig into the issue to understand what will change behavior. >> thank you. page 5. now, i want to talk specifically about the rate stabilization reserve and provide background on our ultimate recommendation for today. the delta dental rate stabilization reserve started in 2014, and over the course of time because of the favorable

experience you have seen in the prior exhibit we have seen significant surpluses build-up to the point where we have about $14 million as of december 31, 2018. noted at the bottom of the page you can see how much the rating benefited through the buy down year-over-year and how that has grown from 2.8% in 2016 up to 8.4% for 2019. we made some changes in our forecasting and our rating method but we also are looking for, you know, ways to spend that $14 million greater than policy. page 6. very detailed page. bottom line shows approximately $5.6 million was the adjustment to stabilization carried forward. the amount by which the plan

kind of exceeded or was better than forecast from an actual cost perspective versus expectation. that leads to the chart on page 7. when we do the math of starting point, stabilization balances at the end of 2017. look at the offset in 2019 rating. add back increase based on 2018 experience, you can see the $14 million calculation. we are recommending that we use half. you may ask why do i suggest half? the policy is one heard. i want to make sure that there is adequate reserve present for future years so let's say if we do encourage and a lot of people start using the plan beyond today and we start to see upticks in experience. there is a contingency reserve

on this plan. we don't talk about it here. the rate stabilization is a third line every serve after the i.b.m. p and contingency reserve. i feel that still having $7 million available for use in 2021 and beyond is adequate but also feel the fiscally responsible action to take is to apply for than one-third per policy. that gets to my recommendation on slide 8. what i would ask you to consider today two approval actions. number one, suspend self underred stabilization reserve on one time bases for del deltal and approve $7 million to be applied towards the buy down across the