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.

okay. good morning everybody. happy bike to workday. [applause.] >> good morning. i am the executive director of the san francisco bicycle coalition. this is a beautiful day to ride a bicycle in san francisco. thanks everyone for coming out. you know, the sense of joy and freedom of people riding bikes is palpable on the streets everywhere we have ridden this morning. on bike to workday thousands across the city are going to be

commuting and experiencing the joy of biking for the first time, getting the first taste of what it is like to commute by bicycle. the joy of bikes is one of the reasons why we ride. we bike for the future of our planet and for the sustainability of our community. we bike because it is affordable and easy way to get around the city. we want the city, san francisco, to be a place where people can afford to live and work and affordable transportation is part of that. we bike for the feeling of wind in our face and health of our severals and families. it is unmistakable on bike to workday san francisco is a better place when we share the joy of biking together. [applause.] you know, there is one thing standing in the way of more people experiencing that joy and of more of us biking to work together.

that is safety. not everyone feels safe riding a bicycle in san francisco, and the san francisco bicycle coalition with the wonderful people here the city leaders are working harder to push for quick improvements to our street. we hear every year on bike to workday the most effective way to welcome more people bikes is to deliver on physically protected bike lanes and separated bike lanes. yes. i am happy to be up here with leadership from may or breed, the members of the board of supervisors and the city officials we have here today. we have demonstrated we can get the improvements delivered quickly. there is no excuse why san francisco can't do it better and faster. in 2018 over five miles of

protected bike lanes were built. that was a record breaking year. what if 2019 can break that record and more and the year after that? how about we keep breaking records until every street is safe for people who bike? today is our opportunity to dream big and to reimagine how we get around our city. san francisco can continue to lead the way showing other cities around the country and the world how to provide the best infrastructure for people who bike. let's meet the demand we so clearly see today on bike to workday and keep bringing the joy of bicycling to everyone. now, it is my sincere pleasure to introduce the person who i got to ride in to work today with, the mayor of the city and county of san francisco, london breed. (applause).

>> mayor breed: good morni ng, everyone. you know, this was really fun. it was the first time i did bike to workday where i didn't ride in my district, district five. i got a chance to ride on the newly completed dedicated bike lanes on valencia. first of all, i was going faster than anybody else thanks to a motorized bike from new while. thank you so much for the amazing bike. make sure to visit their location. they have the best team of folks to set you up on a bike to get up the hills. i don't know how you do it. i used to walk my bike up the hill. now, i can ride it up the hill. thank you so much. as our city continues to grow. we know how important it is to make sure that we are moving

people around by different modes of transportation safely. bicycles is not just an alternative mode of transportation. it is a great mode of transportation along with muni and other things that we could use to move so many people throughout san francisco. as our city grows we know that safety is one of the most important things that we need to focus on. that is why we pushed to move forward and get howard street done and get valencia street done in a more timely manner than before. as bryan said we -- bryan said we have broken records in the past. we are going to break another record. i am today because i like to give directives as mayor and tell people what to do. thathat is the job, right? i want the m.t.a. to begin the process of developing a plan

within a month's time to make sure that within the next two years we build 20 miles of protected bike lines throughout san francisco. [applause.] we can do it. we just need the effort. we need the dedication into it. as i said, it is about saving lives. everyone moving around in the city should feel safe. we have had too many people who lost their lives. 12 people this year on the streets. that is unacceptable. that is 12 too many. we have to do better now. that means changes in behavior and part of the changes in behavior as much as i hate to do it means morsitations and more of the citations for people breaking the law especially those driving.

when we know that ultimately when we have challenges on the streets, a vehicle is the winner in that situation every single time. we have to deal with those folks who are making right turns when they shouldn't, those who are not stopping completely at a stop sign, and i am asking the san francisco police department to up did number of citations that it is giving for the purposes of keeping people safe. [applause.] and we will be focusing on those areas where we know there are serious challenges with the number of injuries that continue to occur. the way we make san francisco better and safer, of course, it involves all of as making sure we are following the rules of the road, that we are respecting one another on the road, looking out for bicycles and pedestrians and our vehicles are doing a

better job then have before. as much as i don't want to prove in that direction, it is necessary to keep people safe on the streets. i am committed to doing just that. i want to thank you all for being here today. we know there is work to do to make san francisco a bike friendly, walk friendly and move around friendly as we improve public transportation and do a better job for residents. the goal is safety. i want the kids that i see out there biking to school to feel safe and parents with babies. i can't believe you have babies in carriers. i want parents taking the most precious cargo to school or daycare to feel safe. i want san francisco to have the same kind of people who bike to have the same kind of experience that i had when i went be to uc davis.

it was a place that anyone can bike anywhere throughout san francisco. it was a bicycle town. the more people biking the better, more environmentally friendly our city will be. thank you for coming out to bike to workday. have a wonderful day. [applause.] >> thank you so much, mayor breed. what about the promises. it was a great day with much to celebrate on bike to workday. in addition to the leadership of mayor breed we have wonderful champions on the board of supervisors. i want to invite the supervisor from district one, supervisor sandra lee fewer. >> my apologies. i broke my arm last year. i will get over it. i want to say thank you to my d1 contingent who got up early this morning, including my husband

riding to city hall and thank you for the great event and for advocating to keep our bikers safe. in my district i am looking to add bike lanes on streets we have and to make biking some separate entrances that they don't have to share with vehicles. today i want to give a big shout out for everyone who biked today and especially to my colleagues. i am the only one that probably did not bike today. thank you for stepping up for the board and thanks to all of you and especially d1 contingent and my wonderful husband. thank you. >> thank you so much. next supervisor catherine stephanie district two. >> it is great to be here. i got off my bike and joined the bicycle coalition.

i am excited about that. i want to thank raffa and the district two who road with me and jeff -- who rode with me. and gene for letting me borrow your incredible bike. this is the first time i have ever ridden an e-bike. i thought it was hard because when i ride a bike it is to train for something. riding a bike is to be hard and you are to go hard and you know. today i was on an e assist bike and it was easy. that is what you can learn. every bike to workday i learn something new. you can ride a bike esly. i am very excited about that. i am looking for a new mother's day present a new e bike. if you want to let my husband and kids know.

i was excited to have a different experience. it teaching me a lot, and i want to echo what mayor breed and supervisor fewer said. it is tragic what is happening. if there is an education component we need to stress. we have to keep on keeping on here. thank you. this is a great morning. [applause.] >> thank you, supervisor stephanie. next we have supervisor gordon. >> good morning, everyone. thanks everyone for being at city hall and throughout the city this morning. to really promote the importance of pedaling for our health, for the joy it brings and the community it builds. it is awesome to see my colleagues and city leaders here

who participated. i must say with all due respect some of us had to ride farther than others to get here. i am looking at supervisor haney. there are a dozen of us that had a blast biking together starting at 20 persons. we went through golden gate park and the 20th avenue neighbor wood and golden gate park. along the wiggle and the protected market street. i want to thank those who helped us make it up the hill this morning. it is the first time i have biked beyond 19th avenue. like a lot of west side residents, my family has been doing bicycling as an occasional

recreational activity in the neighborhood to places like golden gate place. it is a recreation activity for my family. it is more for the people in our city. the most effective way to welcome more people to bikes is to create more protected bike lanes. our city has shown we can get protected bike lanes and other vision zero improvements on the ground quickly. i support more lanes so we can have a connected network of bike lanes in san francisco to keep people safe. thank you to the bike coalition and the dedicated advocates for biking and safe streets. for all of your work not only to help more people enjoy biking but also to expand biking as a

sustainable mode of transit in our city. thank you. >> i love your t-shirt. next we will hear from supervisor brown from district five. >> thank you for d5. where are you? usually when i ride a bike to work i get an extra 15 minutes snooze because it is all downhill. i don't have to think or do anything. today they made me ride and go up the webster hill on page. unlike my colleagues and the mayor i ride a bike. i ride a heavy ass bike. it woke me up. i want to thank the bike coalition. every year and i got there right on time and kristen was right on time.

it is such a great way to go to work and do anything else. actually getting a little exercise and fresh air making your day better and sets the pays for the day -- sets the pace for the day. we have to push forward and demand the protected bike lanes. today we were riding down page and we had a lyft driver cut around the line and go down the wrong side of page street and stay parked in the bike lane as we were all coming down. i was yelling and swearing. i think they all knew i was a little bit mad, but this is the thing. not only do we need to ticket

people for not stopping at signs. we need to ticket people in the bike lane. we need to ticket people in the bike lanes. it is unacceptable. we could have had ahead on collision. it is unacceptable. for the 20 coming i will take as many as i can get. thank you very much. enjoy your day. >> thank you so much, supervisor brown. now matt haney. >> who road as rhodes -- who roe their bike through district 6 today? i am so proud that district 6 is the heart where we have seen the growth of our protected bike network.

today we rode from the tenderloin. we went around through the district. what we saw is a lot of need still out there for a further investment in our protected bike network. i want to thank mayor breed for her commitment and directive. on fifth street it is clear we need a protected bike lane on fifth street now. we were very happy to see the improvements with the new protected bike lane on howard. we need the rest of howard, right? we went across market where we still need improvements. if we are going to have a fully protected bike lane we have a ways to go. we went down church street with a protected bike lane that has helped see the largest increase in cyclists in any street.

300% increase in folks riding their bike in the tenderloin. it is good for the city, good for people, for the entire community. it is important for people to ride their bikes to work without fearing for their lives. this is a simple thing. you should be able to get on your bike and go to work and not worry about your sift and getting hit -- about your safety. we had somebody hit by a card. we can create a network of bike lanes to make sure everyone can ride safely to work. thank you to the bike coalition. i signed up today and i hope everybody else did, too. thank you. >> next up we have from district

8 supervisor mandelman. >> good morning. i want to congratulate my colleague stephanie on the finest fitness brag. normally she is competing for a triathlon. if you are getting around the city, bikes is an important part of keeping us healthy, reducing congestion on the streets and of saving our environment. i want to thank the folks who biked with me today. i want to say how proud i am it accounts for 1600 members of the bicycle coalition. i have been a member for more than a decade. the bike share station at 24th is the most pop particular in the city. i am proud of that. 20% of regulation residents comy

bike. d8 is leading the way on bicycling. we need help from city hall. we need to finish valencia street and get it to market and we need 2000 new bike racks in the city this year. it is wonderful more people are cycling and great that we are getting our scooters and bike shares off the sidewalks and tied down. that means demand is greater for the bike racks. i want to thank the bike coalition for the tremendous leadership you have been providing. i was saying before we started, you know, i think about generations of people. this is a multi-decade long project making the city staff and bike friendly. i think about the early pioneers

who get out on their bike. there was no bike lane and nothing on the street to indicate anybody should be sharing. they went out and we improved conditions for cyclists. now, i am so excited about the 20 miles of protected bike lanes. i am also excited my colleague fewer pushed to enforce the traffic laws and protect cyclists and pedestrians. thank you for being here. it is a great day. >> thank you so much. now somebody else with a long commute. supervisor walton district 10. >> good morning, bikers. i am a little out of breath. i rode all the way from bayview. i want to say thank you to the bicycle coalition and thank andy

for leading us on the jump me this morning. as you heard from the colleagues and the mayor, we are dedicated to make sure we have more protected bike lanes in the city. i know how dangerous it is to drive in san francisco, i know how dangerous it is to riled in san francisco. we are working hard to make sure that everyone is protected on the a long journeys to work and throughout san francisco. as i look around to see more people biking with their children with young people. it also reiterates how important it is to protect everyone who are cyclists and of course our folks who are pedestrians on the streets. with that said i am looking forward to today when we can say ride your bike to work through protected bike lanes day. >> i am looking forward to that

day. from district 11. i will welcome supervisor saw s. >> i want to shout out to district 11. thank you for lending me a bike, for riding us, sf m.t.a. staff for riding with us. parents with children for riding with us. are you pumped? that is what i am talking about. we should do this once a month. we have the right energy. we get in there to get stuff done and stop fighting with one another, right? i am dedicated to safety, to the bike lanes. we got to add more and put safety first, pedestrians and cyclists. we have to make sure this is a safe city for everyone. thank you for everything you do and have a wonderful day

everyone. >> thank you. i am down for a once a month ride. some supervisors couldn't join us. this is district nine, sou. >> i am sorry supervisor ronan could not be here. i am her assistant. i ride every day. i understand the conditions and i want you to know supervisor ronan is ready to push for the remainder of the street to be protected. we are grateful for support of the bicycle coalition here. i see our delegate to the advisory commission. we are glad to know community organizing is part of this effort. i want to say on the ride this

morning it wasn't a collision but there was a small accident and 911 was awesome. they came right out. the person he who went down was not seriously injured. she was attended to immediately. they carried her bike away. thanks so much for bicycling today. keep at it. i will see you on the road. >> in a dual capacity i want to welcome somebody speaking on behalf of supervisor peskin, the chair of the transportation authority and executive director of the transportation authority kelly chang. >> good morning on behalf of district three happy bike to workday. there is d3 contingent? we had a great ride this

morning. there is more coming. they were going to do embarcadero. we have a lot of work underwear with partners at public works, m.t.a. thank you, mayor for your leadership. we are ready to partner with the city to get that done. i am grateful to collaborate on the text on the ballot this fall. the while point is safer streets and better transit and to decongest our city. i am pumped that my board is pumped. awesome. good-bye. >> you are absolutely right. projected bike lanes don't build themselves. we need funding. the san francisco bike coalition is ready to work to make sure we have the much needed funds for

the infrastructure that you need. >> i want to start with the person who is probably with the most hand in the actual construction and planning in his dent. that is our director of transportation, ed reskin. >> happy bike toward day. the reason we do bike to workday is a reminder for those who ride bikes and invitation for those who don't. riding to work and home is a great way to get around the city. it is good for your physician cat health and hental health. >> i clear my work on the way to work. it is good for our city. it is a way to get around. it causes no congestion and

pollution and goal of 80% of the strips sustainable with 2030. it is in line the crime at crisis the board has adopted. it is one of the most attainable ways to get around the city. san francisco is a great place to ride. last year bicycling magazine declared it is the second best city for bicycling in the country. last year san francisco was named one of the 10 best cities for bicycling in the world. that is not by accident. you heard the political support we had in san francisco to enable us to make investments in making this a better and safer place to l to buy south carolina. thanks to the mta staff with partners with the ta but

particularly the is if had ta. -- i want to recognize the board of supervisors and the mayor. last year 11 miles of improvements, including 5.5-miles of bike lanes. it was millions of rides, hundreds of new bike racks. this is making the city better for cycling. as you have heard from everybody here. we need to do more, better, fatter. if we achieve our goals of eliminating traffic fa fatalitis in san francisco. we are grateful for the challenge of mayor breed to double. you heard this morning it will provide the wind to get that

done. it is not just money. we are thankful to the voters for supporting investments in bicycling. it is to get the work done. happy bike to workday everybody. >> thank you, director reskin. i think this is probably you're eighth bike to workday. thank you to all you have done to improve biking in the city. >> at partner for better market street the director of public works. [applause.] >> happy bike to workday everyone. i want to say and assure you all of the agencies, m.t.a., public works, fire, planning departments are hard at work to get more bike lanes. 20 miles is doable.

we will make sure. protected bike lanes yes. second street is almost done. we continue to be hard at work to make bicycling fun, enjoyable and great mode of transportation in our city. happy bike to workday. >> thank you. finally i want to welcome from the san francisco police department. the commander. >> good morning, everyone. happy bike to workday. on behalf of the san francisco police department and chief scott, we are so pleased to be part of this event every year. thank you, bryan for his leadership and everything he does. mayor breed we have to do more in terms of using all of the tools necessary to make sure pedestrians and bicyclists are safe. i rode in today. as amy from supervisor row nan's

office mentioned i saw the person trapped on the tracks on market street. she was bleeding. it is a reminder we have to work to be safe and stay in the bike lanes. i want to thank the fire department for the response and director nuru. everyone have a great day. thank you. >> thank you so much. i want to acknowledge a few other folks. chief nicholson from the fire department. thank you. director debbie from the department of environment. you are great partners in this work. i want to recognize somebody who is extra special this year. it is our bike commuter of the year, ricky ramos. he is leading the way to show folks it is possible to commute by bike.

that is it. final thanks to supervisor haney today. to everyone else. happy bike to workday. go out there and ride a bike and enjoy >> i'm rebecca and i'm a violinist and violin teacher. i was born here in san francisco to a family of cellists, professional cellists, so i grew up surrounded by a bunch of musical rehearsals an lessons. all types of activities happened in my house. i began playing

piano when i was 4. i really enjoyed musical activities in general. so when i was 10, i began studying violin in san francisco. and from there, i pretty much never stopped and went on to study in college as well. that's the only thing i've ever known is to have music playing all the time, whether it is someone actually playing next to you or someone listening to a recording. i think that i actually originally wanted to play flute and we didn't have a flute. it's always been a way of life. i didn't know that it could be any other way. >> could you give me an e over here. great. when you teach and you're seeing a student who has a problem, you have to think on your feet to solve that problem. and that same kind of of thinking that you do to fix it applies to your own practice as

well. so if i'm teaching a student and they are having a hard time getting a certain note, they can't find the right note. and i have to think of a digestible way to explain it to them. ee, d, d, e. >> yes. then, when i go on to do my own practice for a performance, those words are echoing back in my head. okay. why am i missing this? i just told somebody that they needed to do this. maybe i should try the same thing. i feel a lot of pressure when i'm teaching young kids. you might think that there is less pressure if they are going on to study music or in college that it is more relaxing. i actually find that the opposite is true. if i know i'm sending a high school student to some great music program, they're going to get so much more instruction.

what i have told them is only the beginning. if i am teaching a student who i know is going to completely change gears when they go to college and they never will pick up a violin again there is so much that i need to tell them. in plain violin, it is so difficult. there is so much more information to give. every day i think, oh, my gosh. i haven't gotten to this technique or we haven't studies they meese and they have so much more to do. we only have 45 minutes a week. i have taught a few students in some capacity who has gone on to study music. that feels anaysing. >> it is incredible to watch how they grow. somebody can make amazing project from you know, age 15 to 17 if they put their mind to it. >> i think i have 18 students

now. these more than i've had in the past. i'm hoping to build up more of a studio. there will be a pee ono, lots of bookshelves and lots of great music. the students will come to my house and take their lessons there. my schedule changes a lot on a day-to-day basis and that kind of keeps it exciting. think that music is just my favorite thing that there is, whether it's listening to it or playing it or teaching it. all that really matters to me is that i'm surrounded by the sounds, so i'm going top keep doing what i'm doing to keep my life in that direction.