getting a shot. >> no, this is simply expanding the accessibility but does not change any current approach for someone obtaining a vaccine. i will share that specific table of the specific vaccine shortly. page 3, just to remind that, these rate cards in the presentation are shown for two common strategies, but there are multiple employer contribution strategies for active employees across the entire system. so please note that the total rates apply in all situations and we are simply showing two of the most common employer contribution strategies for the city and county of san francisco >> paul brown, blue shield. good question. i don't know the answer 100%. i don't believe that a vaccine

filled at a pharmacy would be integrated into the emr. it is a function of convenience, somebody going to fill a prescription, obviously the prescription emanating from the emr would be upgraded, but if they got to the pharmacy and elected to have a vaccine, that would not backfill into the e.i.r. unfortunately. >> this is a comment for all of our health plan partners. as we look at contracts and services and benefits, i think we should be looking to preventive services. we're looking at that for others if there is some gap, i would hope all the health plans would work to try to maximize the honesty and accuracy of the data that we will be asking for as a health services system. >> yes.

we as the health system would have the record, it just would not be backfilled. thank you. >> okay. , a couple of clarifying notes on page 5 that i'll go through quickly. i talked about our recommended increases on the status quo basis. these do include all components of the rate cards including the previously approved rate stabilization amortization of $1,896,000. the two elements of rate cards no longer apply. the california organization tax that was built in is required cost for blue shield and is set to expire june 30th, 2019. so that fee today is give or take about $2.70 per employee per month that would go away, and based on the prior approval,

best doctors is no longer included in the rate cards, and for trio, just noting that the maximum exposure is capped at a lower level than access plus for blue shield. responsibility claims is there is more than 115% of projected claims versus 125%, and this provides avid risk protection and we also have a map to increase of eight-point 5% for 2020. thankfully we don't need to consider that with a much lower calculated increase. the rate increase renewal, overall, we thought you would like to see on the last bullet on page 7 that we still see much lower dependent per employee and early retiree ratios and trios a

versus access plus. it tends to have more dependence per employer or retiree covered. from a. fee perspective, the fixed costs that roll into the renewal for blue shield, the good news is total fixed fee increase, 1.3%. and you can see the elements of those three items on page 8. so the expanding vaccination access a retail pharmacies, pag. the select flu vaccine presently available to benefit of zero% preventive cost share. this is to expand that accessibility of certain vaccines. no prescription would be required for coverage of the vaccines. i'm about to walk you through, and they are covered in accordance with guidelines.

so the list, page 10, shows all of the different elements of the vaccinations that would be covered at retail pharmacies, including influenza, which is currently available, along with the applicable age limits for those particular vaccines. >> can i ask one question that just occurred to me. since there's no prescription available, and hpv, for example, is for nine years or older, how do pharmacies handle a 10 -year-old coming into the pharmacy, saying, i've heard about hpv, my mother doesn't want me to get that because she is opposed to vaccines, but i wanted. do the pharmacies have informed

consent for minors? how do they handle this? >> especially access plus, you have lots of dependence. some who i am assuming are under the age of 21. >> we will research that and report back next month. >> again, since there is no co-pay, and it won't appear on the minor's record, that i can see where a young woman or a young man, since this is licensed for both, might choose that option to go to a pharmacy and say, i don't want it in my record, so this is what i want. >> do they have their own i.d. since they are minors, or would they be -- >> i think we can only speculate at this point.

>> and then the second change, we have outlined here, the recommendation to expand the counciling availability. we expect only a modest, perhaps negligible financial impact. the cost of services, but also some living potential. >> i'm sorry to keep asking these stupid questions. since some of these vaccines are one time or two shot things, some of us, including myself, can't remember when i got, and exactly what i got. if i walk into walgreens as a blue shield member and say, i think i need a vaccine for shingles, how does the pharmacy screen to know that i actually am due for it, or can get it, were not excluded, or i didn't already have it? is there feedback?

maybe you should research that, too. >> i can tell you anecdotally that there is a questionnaire that you fill out similar to what you do when you are getting a flu shot. there is screening criteria. >> is one of the shortcomings of questionnaires. >> exactly. >> on page 13, we introduced the rate cards with the two plan design change recommendations built in, although admittedly both on a very negligible basis on impact, and so i obviously won't read through all of the details of the rate cards, but to acclimate to you, pages 14 and 15 are the change in total cost of the employer and the

member contributions here over a year. the member of the top of page 14 , the employer contribution change in the middle of page 14, and the monthly total cost rate. they wanted to get a view of bottom line of how things are changing, and then page 14 is for the early retirees and the 9393 group. page 15 are early retirees which are the same, and the 19683 group, the actual rate cards follow on 16 and 17, and then you have the same sequence of four pages for trio from pages 18 to 21. recognizing there are a lot of numbers on those eight pages. are there any questions about anything contained on pages 14 through 21?

>> no questions? >> no. >> with that, i bring you to slide 23. i will read the entirety of this for our recommendation. first that the blue shield of california plan renewal proposal for combined rate increase of 1.9% which flips for access plus , 0.9% for trio. we asked for that approval. we asked for the approval of the resulting rate cards and that includes our twaddle recommended plan design enhancements expanding availability of the vaccinations listed earlier in the document a retail pharmacies

>> all right. i need a motion. >> i move we approve the contributions for plan year 2020 , including two additional enhancements as recommended. >> a second. >> great, public comment on this item? come forward. >> hi there. my name is erica. i am a city employee and blue shield is my provider. last month i spoke about concerns that i had with --, i don't know how to turn this on. sorry, last month i spoke about the terms i have with drug coverage. how many other drugs fall into

the category you're paying 100% out of pocket, 40% less than using insurance. one, 50, people citing cancer having to deal with this, is it only fertility drugs, so disproportionately impacts women i don't know the answer, i'm hoping that this body asked those questions and received answers -- receives answers before you take any vote. the second issue i want to speak about is arguably more concerning. it has come to my attention that my ability to access insurance seems to be dependent on my partnership status. i will give you an example. if you're a heterosexual couple and go to the dr. and you are 35 years or older and you tell them you want to start a family, you have been trying for six months, you are covered. no other questions asked. you are not asked if you are trying to conceive when a woman is all relating, you are covered if you are a lesbian couple, single by choice or uncoupled and you want to start a family,

you will receive denial letters such as this one. the only other way that you can get covered is if you have a demonstrated condition recognized as the cause for him to -- infertility. let me tell you what doesn't count. age, i am not a doctor. i am 41. it doesn't take an md to know it is harder for me to get different. low ovarian reserve. despite the fact that i am comfortable of stimulating drugs , i will produce very little, one, maybe two if i am lucky. family history of early onset and onset of menopause. how many other conditions fall into this category? i have had four failed iui treatments and i am on round three of ivf, yeah, i have to

fight for the insurance. i'm not here today to talk about me. this discriminatory practice of insurance providers is not unique to san francisco, but what is unique is this is san francisco. a place that prides itself, that defines itself on equality. what is unique is that this isn't a small company. you are determining that health benefits of 30,000 people and my guess, at a cost of a few hundred million dollars. what is unique is that you are spending taxpayer money, that there is a commission whose sworn responsibility is to ensure that fair and equal access to all its members. you can demands that all employees have equal access to benefits and not approve the contract. do you feel comfortable voting on a plan who has a policy that is questionable and arguably discriminatory and that the

department has yet to provide clear evidence this is not the case. thank you. >> i will call your attention that prior to when i was reviewing the director's report, first of all, thank you for coming forward once again and bringing your experience to light for others. i much appreciate it. we have begun an in-depth review of our facility benefit. this is noted on page 2 of my report, of which the question, this benefit was put into place just several years ago, and we are working with the plans now to get a better understanding of who is accessing the benefit and what the experience is. erica's situation, i cannot respond to in particular, as you

are well aware, but we have worked in partnership with blue shield and the medical group to address the concerns and the specialty drug issue that was raised at the last board meeting that is now on the list as well. we recognize the increased complexity in navigating the system, including the infertility and assisted projection technology of which there is a grey line. we will address -- we are trying to stay on top of changes in the market. we have reached out to -- mike, remind me, the a.m. consultant helped us with the development of the fertility benefit several years ago, and she has commented that this is an area, this grey area between assisted reproduction and technology and infertility and it has surfaced

many places, and there are ways that we can address that, and so in order to do that, we are searching -- researching all these implications that would come with removing the requirement of a diagnostic and assisted infertility, including tax implications. these are the taste of things that are considered when the surrogate and adoption benefit were considered. and the data analysis that we are looking at is on the way to discern the utilization and mitigate any abuse and ensure equal access and address perceived barriers of all kinds of families, regardless of sexual orientation or partners. we remain committed to inclusivity as a guiding principle ingrained in our strategic plan, and we will take the steps to do so. i don't know if i mentioned it

here, but when i attended the conference board in march, myself and our account manager from blue shield found ourselves sitting next to each other at a presentation done by salesforce, which actually helps orchestrate the benefits for their members, because there are so many -- there's so many decision points in the process that a member could be better supported perhaps if we had a service like that. i appreciate erica bringing this forward. i have commented to her and our team that we are near ready for presentation, and maybe able to bring it forward next month, a more in-depth policy analysis of where we are at.

we are working diligently to ensure that our members are getting the care they require. >> can i add that i think, you know, in support of the concerns , that we are aware there is now and an enhanced alliance between ucsf and catholic healthcare west, which includes st. mary's hospital, and when we reviewed the trio plan, i read the bishop's statement on morality for all the healthcare providers, staff, employees, physicians, et cetera , and these enhanced alliances raises more questions again about this issue of we were assured that there was not an issue in san francisco, or these issues between providers

in trio, but i think that -- i don't know quite what it is or what it means, but my only -- it may exacerbate problems that are already existing. is changing the marketplace. we'd to keep on top of this and ahead of this, and not wait until members have, you know, a complaint, frankly. i appreciate bringing this complaint and concern to us because we need to know what is happening in the real world. >> i guess i have a basic factual question about whether blue shield is, in fact, treating heterosexual couples and infertility treatment different than single women or lesbian women her seeking fertility treatment. >> blue shield, this will be added to the list of follow-up questions. i do not know the answer, but i

made a bunch of notes following your comments. the one that i underlined a couple of times is equal access. i can assure you that there should be no benefit in our benefit plan, the way we administer it that should discriminate, in any form or fashion based on sexual orientation, gender or otherwise , so i'm very interested to more about this. i wasn't at last month's meeting , and i will take it upon myself to follow up, and again, i can assure you, there should not be anything, in any part of our benefit administration that restricts access based on gender or the like. we will definitely look into that. >> it is good to hear you say that. this is concerning to me and to

the board of supervisors. if it is happening in san francisco, it is not good. >> definitely not good. i would be surprised if we did, but i don't challenge your words , but i definitely need to learn more about this. >> definitely. >> i will say that i would not be surprised if there are issues around fair access, and i think this is only enhanced by another recent pronouncement of federal administration that allows religious beliefs to override provider responsibilities in individual settings. so it tries to allow people's religion to take precedence over medical care. i appreciate your looking into this, and understanding how this

could be dealt with, or is dealt with, and if there are examples. >> i should briefly comment on the article about the alliance between dignity. i read that as well. we are not part of that, obviously it is just between the providers. everything i have read is mostly about access. ucsf is at in overcapacity, and my interpretation was it is a means to increase access to facility care more so than anything else, but that's what i got from the article. >> you can understand our concern, because there are civility -- facility dictums about certain kinds of care. we were assured there would be unobstructed, or unimpeded access to that care. for example, a woman who was delivering her second or third child and wanted a tubal

ligation, now i don't think they would be admitted to st. mary's because they don't have ups dr. services, we can understand there maybe other procedures. so if it is about access to institutional care and the receiving institution has prohibitions, it is a little hard for me to be comfortable with these kinds of agreements. >> i -- i agree with you. >> thank you. is this an issue with kaiser, also? >> no, not that i have been made aware. i do want to caution the board members about adjudicating a particular case in this instance , and so we haven't been made aware of other cases. we have asked all plans, and i would reiterate that publicly, to provide us with the data and that utilization of the fertility benefit through their plans. we have not yet received that back from any of our plans.

we are really looking forward to that because we would like to then consider what inappropriate and sensitive way would be to actually talk with our members who have had those experiences, and to understand firsthand what those experiences have been. i don't imagine that we have large numbers, but -- and i'm basing that solely on the fact that i know that our live birth delivery rate is less than 200 year for the whole system. i don't imagine that we have an unmanageable number of people using the fertility benefit that we could actually talk to and understand what their experience is. i know they would appreciate to get that kind of feedback as well. regarding the question, i did seek from dignity, i have received there notice letter to the regions that i will forward to the board.

it does adjust some of the issues that you have raised. >> is there any other comments by the board board or any public comment? all right. there is a motion on the board to approve the recommendation of the actuary. all those in favour? opposed? it is unanimous. okay. we are on to item number 14, please. >> item 14, review and approve the united healthcare preferred provider organization city plan, nonmedicare rates and premier contributions for the presentation by the clark. >> if you look at the content pages, the format will follow similarly to what we just reviewed for blue shield, and again, noting the appendix information to the extent that that aids you in reviewing the

recommendations. today on page 2, our staff recommendation is that the health service board approve the renewal proposal as we presented here, any associated rate cards, and one recommended plan design enhancement, and again this came out of conversation that was had at the march board meeting. we are recommending the reduction of the family, and a pocket maximum to two times individual limit overview. we will review that in detail in a bit. as i mentioned earlier, the overall resulting planning increase for 2020 is 7%, and page 3, like in the entire presentation, these rate cards or for two of the more common strategies for employer contributions by the city and county of san francisco. on page 5, these recommended

rate increases for t.p.o. are based on 2018 claim experience that we trend to 2020 using a national trend factor. it was previously approved administrative fees from the march meeting that, are contained in the appendix to this document, and the previously approved changes in rate stabilization amortization that were also approved in the march meeting. and there is a small impact to the design change that i have concluded -- included as well. in particular, just a refresh on the rate safely you will see that in my third bullet points. we have $1,661,000 of fly down impact embedded into the 2019 rates. now we have 117,000 embedded into the 2020 rates. and rounded numbers, a at $1.8 million increase impact of the total cost on top of just normal underwriting.

and then expert opinion fees no longer apply in the rate cards. on page 6, very important to stress that the plan is running as we would have expected, approximately a 5% increase on a per employee, per retiree per month basis in the claim experience in 2017 and 2018, which is pretty consistent with the national trends, active employees ran a little bit more favourable, early retirees, less favourable, and on the whole, approximately 5%. then we used factors in our forecasting a five-point eight% for medical, six-point 4% per prescription -- prescription drugs. i talked earlier about the rate stabilization difference. they will talk about only a zero-point 1% impact to the rate increase, so fairly small. we will talk about on page 10,

and so that all adds up to approximately 10% increase when incorporating all of these elements. and then i spoke about it earlier, but i want to emphasize the last bullet on page 7. last year, in may, the health service board approved a three year migration of the family rate ratios to aid and help lower the member contributions required for retirees in the plan, taking retiree plus one or retiree plus two or more coverage, and so 2020 will be year two of that three year application of that change. so when we look at rate cards in a bit, you will see favourable changes in the member contributions for early retirees in those family levels.

page 8, just a refresher on city planning choices not available. if you recall, it is where members are in a zip code, they live in a zip code were either city plan is the only plan choice, city plan and kaiser permanente are available, but not blue shield, or city plan and blue shield are available, but not kaiser. and almost all circumstances, it is the first dash, city plan is the only plan they have. and the way we determine the rate to produce the favourability and member contributions for active employees. we link the premium rates to the blue shield access plus plan. for early retirees, we link the premium rates to the city plan. you will see that that produces the same number of contributions for the single tier or early

retirees as for access plus. that is wait -- the way the city charter employer contribution formulas work. it provides contribution relief for active employees in those areas, and early retirees live outside of the bay area and certain other outside of california geographies. page 10 specifics on lowering the family and network out of tax maximum recommendation. currently that is $12,700 compared to a single tier in the out-of-pocket maximum of this plan of 3750. it is a large, large increase in out-of-pocket maximum one somebody asks dependents to the plan. and so we are proposing lowering that 12,700 figure 27,500. the other plans for the out-of-pocket maximums have

singled and we believe this plan should too. we estimate it is a fairly nominal additional cost impact to implement this change. so then on slide 12 we moved to presenting the rate cards. again, two sets. the active employee 9383 employer contribution and 19683. there is a step for the city plan and a set for city plan choice not available. they presume adoption. the extra 0.1% attributable to the family and network out-of-pocket maximum change. on page 13 you will see for the city plan, the rate and contribution change illustration from 2019 to 2020, that results from the calculations that go

behind the rate cards. so on the active employees, you do see increases in the monthly employee contributions of about $90 a month for single tier coverage, up to $256 for family coverage under the 939383 strategy. again, keep in mind that the employer contributions for this plan, for active employees, are based on the exact same amounts of employer contributions or access plus, based on the anchor of the employer contribution for this plan that is anchored to the same employer contribution for the second highest cost plan offered by us, which happens to be blue shield, access plus.

and so if you recall, access plus had a 2.3% increase in total rate. this plan including the rate stabilization adjustment. there is a 10% increase in total rate, therefore that creates leverage and the resulting increase in the employer contribution for city plan. for the early retiree, it also creates some impact on the retiree only tear, but i spoke about the second year of the three-year transition of the cost ratio that we are using to produce the family tier rates, and you can see that results in reductions in retiree contributions for city plan for both the retiree plus one and the retiree plus two or more.

so page 13 shows those changes. page 14, for the hundred 9683 active employees strategy, same exact numbers as we looked on page 14 for early retirees. and then that leads to the return -- the rate card on 15 and 16. and then starting on page 17 are the city plan choice not available rating illustrations. again, for the active employees, the total cost rates follow access plus, and so that's where you see the 2.3% increase on the total cost rates. the employer contributions are the same as city plan, so that also results in an increase for

active employees. early retirees, again, you see reductions in the retiree contributions across the board for city plan choice not available. rate cards for city plan choice not available follow on slides 19 and 20. are there any questions before i bring you to our recommendation page? >> what is it can -- how does a contingency reserve fit into all of this. we have stabilization, if we use contingency reserves and a lot of other situations. >> so we don't suggest using contingency reserves and rating because those exist to christian impacts of a wildly different actual experience in the plan

relative to what we would forecast. in each of the last two years, what has generated the member contribution increases to be as high as they are is claim experience. we have actually seen apps that are slightly below trained -- trend for the last two years. it is almost the final unwinding of the very large rate stabilization balances that have built up the last five to six years. for instance, next year i would expect that if we have another year where plan experience meets expectations, we will not have that sort of rate stabilization adjustment in the rating that we have had each of the past several years. >> does that mean you lose contingency reserve? >> we would only use the contingency reserve if there were very, very significant

fluctuations in actual experience relative to the forecast. >> oh. that's what happens when all the medicare retirees are removed from the plan. all right. >> the contingency would be to take claim. it wouldn't be applied to rates for two years. we have a plan where all the year as all of a sudden we just have a huge influx of bills. >> correct. it would be used to pay claims. and we would do an associated offset of that. we do account for change in the reserve when we do the underwriting for the plan, but we aren't necessarily using additional reserves, we are merely accounting for the change in the contingency reserve.

>> okay. any other questions. >> with that, i will take you to slide 22 where we recommend that the health service for the approve the following. number 1, the city plan t.p.o. and city plan choice not available renewal as presented in this material, with a 10% increase to city plan rates. the resulting 2020 monthly rate cards presented in this material that i just walked through, along with the one recommended design enhancements to reduce the family and network out of pocket maximum to two times individual limit. >> do i have a motion? >> i moved to accept the recommendations regarding one, two, and three as outlined on the slide. >> i second the motion. >> public comment on this item? seeing no public comment, all those in favour? >> aye. >> opposed?

it is unanimous. all right, item number 15. >> item 15, review and approve kaiser permanente nonmedicare rates and presentations. >> mike clark, this is my final presentation today at. [laughter] >> let's hear the cheers in the room. [laughter]. >> i will present the kaiser permanente california region renewal summary rate cards and recommendation today for active employees and early retirees, and like other presentations, we do include some information on rate card notes, and the 2019 rate cards, and for those interested, the buildup of the underwriting generated by kaiser permanente to create the renewal that we present today. on page 2, we are going to recommend that the health service board approve a

five-point 9% insured plan premium increase to 2019 to 2020 for the active employees of early retirees in california who are enrolled in kaiser permanente, noting that this is a combination of four-point nine cent for the actual plan renewal , and one point -- and 1% of the unfortunate return of the federal accountable care act health insurance tax in 2020 that was suspended by the federal government in 2019. i will note that our executive director does have a legislative update in her director's report, and there is commentary on this particular health insurance tax. we certainly hope that it attaches to legislation eventually and is ultimately suspended for 2020, but at this point, it remains the law. >> i have a question before you

go. let's assume that something does happen miraculously, and it is suspended. would we be able to adjust the rate, do we have a timeframe where we could adjust the rate for 2020, or is it fixed? >> my impression would be it would depend on when such an adjustment could occur, and conversations we would have with kaiser permanente at that time. i don't know if a representative from kaiser permanente would have further comment. >> good afternoon. i'm from kaiser permanente. i will just reinforce what mike describes. depending on when the law changed, we would be more than happy to adjust the rates as long it was before the contract went into effect.

even if we didn't have an opportunity to correct in the plan here, we would reconcile in the future. thank you. >> okay. page 3 contains the same reminders about the two most common strategies. page 4, just to refresh with the board, last year we had, from 2018 until 2019, the year we are presently in, there was a 0.3% rate decrease, and so we are certainly looking in conversations with kaiser to strive for more consistent renewal and insured premium change actions from year-to-year , but again, i will note that the 5.9%, which is really from the plan cost stan point, four-point nine% is

consistent with national trends. and the increased as result from two key elements. first, there was an almost eight % increase in actual per member claim experience 2017 to 2018, or early 2018 claims that serve as the basis for 2020 rate development. this is higher than prior year-over-year comparisons, and was especially higher for early retirees, and then we have talked about the tax coming back and the under rating detail is in the appendix. so we include the fully termed drug premiums from kaiser. the vision plan, the sustainability, the charge of $3 and then again, i mentioned earlier to reinforce there required change to fertility member cost share for 2020. currently it is $20 co-pay that

will move to 50% of service cost for 2020. >> that seems like a huge difference. was there some mandate that kaiser do this, or is it something that kaiser decided to do from their own actuarial experience? that could be a huge hit for members who want to access this, if i'm reading this correctly. >> i will ask a representative of kaiser to speak. >> hi, kaiser permanente. the change in the benefits, it is my understanding that it is for the actual infertility diagnosis and treatment, not -- it was already at 50%. so we have a policy within our organization that we have those benefits in alignment, and so we

, two years ago, addressed that we wanted to face it in, and we gave the two years. we paid for the enriched benefits this past year ourselves with the understanding that it would be changed this year. it is to make the benefit in complete alignment, which is the policy within our organization. >> alignment with what? >> i'm sorry, these more expensive procedures are already at 50%. this is for any other diagnostic services. it was out of alignment in our system. it was the 20-dollar co-pay. we are bringing this in alignment with the rest of the benefit. >> is there some sense about -- i don't know how much these extra diagnostic procedures might cost a member. i assume that they are invasive and all that, is there some sense about what we're talking about in terms of cost to bring this in alignment.

>> really good question. i can get back to you on that. i frankly don't know the cost. i think it is probably a wide range of things. some would be more invasive, some would be regular, but i will need to check on that. >> is this part of what you're looking for? >> it is my understanding that this decision was made a couple of years ago for all the plans to be at the same level. and i think they didn't put it into the contract, so that is my understanding, that the other plans have the same cost structure, correct? >> it is my understanding that all the plans are 50%, and that is one of the things that we want to be into alignment. >> we will verify that. >> thank you. >> okay. >> okay. i will take you then to the rate exhibits themselves, page 7 and

8 documents the changes in the monthly rates for employees and retirees, and then employer contributions, and the total rate. we have talked about 5.9%, recognizing that the $3 sustainability fund charge are in the same vision, that's why you see percentages that are slightly under 5.9% on this exhibit, but that is what everything is going up by. and then on page 8, the 196 contribution strategy for actives, as well as the early retirees. i will note that the city charter employer contribution formula creates an environment where early retirees paid no contributions for kaiser permanente. and then the resulting rate

cards themselves are exhibited on slides nine and ten of the presentation. with that, i take slide 11 where i ask the board approve the rates and contributions for active employees of retirees as included in this presentation. adopting the 5.9% premium increase from the 2019 plan year to 2020, for active employees in early retirees, and then also approve the rate cards that result from kaiser's rating action for the interim. >> thank you very much. i see a motion again. >> i moved to approve the kaiser permanente premium contributions were playing your 2020 as presented in slide 11. >> second. >> second. >> all right.

is there any public comment on this item. no public comment. all those in favour? >> aye. >> opposed? it is unanimous in favour. that concludes our benefits. thank you. we now are going into regular board matters. that will be item number 16. >> item 16, reports and updates from contract health representatives. >> does anybody have anything to say from the health plan representatives? nothing. okay, public comment on this item? come forward. >> excuse me if this is not relevant or bit into my agenda me is meeting, i expressed my concern about charges for laboratory tests under the unitedhealth dpo, like when these tests oh, curve, there is

a charge of $25 for that, and i'm thinking that,. >> wait a minute, we're still under item number 16, which is the contracted health plan representative comment. >> okay. >> that we will be on the item in a second. >> excuse me. >> there was no public comment on item 16. we will moved item number 17. >> item 17, opportunity for the public to comment on matters within the board's jurisdiction. >> as i was saying inappropriately, yeah, there are several -- a person who is seriously ill may have to have extensive lab tests, and let's say, suppose at a rate of $25, say there is ten lab tests in succession, that comes to $250,

and especially if you are low income, this could work as a disadvantage, so i'm thinking that this would have bearing on the rates and benefits for the coming year. >> i would just like to call attention to the fact that we wrote a paper on the co-pay issue, and it was included in last month's materials. >> i'm speaking for a protector of benefits. we are still inquiring about how this is a medicare issue for kaiser, and we look forward to the answer next month with regard to the rights to medical treatment that was part of medicare's benefit, and is in the u.h.c. package for medicare advantage. we are waiting to hear

officially about whether or not kaiser will also give those rights. we have heard unofficially that they asked me to direct the question to the board. thank you. >> any further public comment? no further public comment. item number 18. >> opportunity to place items within the board's jurisdiction on future agendas. >> does anybody have anything they would like on a future agenda? seeing then. any public comment on this item? public comment is closed. all right. and we are finished with this meeting. if this -- if there is no objection, this matter is adjourned.

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